NODAL DISEASE IN PURELY GLOTTIC CARCINOMA - IS ELECTIVE NECK TREATMENT WORTHWHILE

Objective: Although there is a generalized understanding of the relati vely low overall incidence of nodal disease from purely glottic carcin oma, the exact role for elective neck treatment in the management of t his disease remains controversial. The purpose of this study was to id entify the incidence of occult nodal disease (including paratracheal) in patients who have glottic carcinoma without significant extra-glott ic extension and to identify which patients are at risk for this. A re trospective chart review of 92 such patients who had either undergone neck dissection or been observed for a minimum of 2 years was performe d. Results: For the 92 patients, neck treatment consisted of observati on in 68 patients, paratracheal node dissection in four, unilateral ne ck dissection in four, unilateral neck dissection and excision of para tracheal nodes in 14, and bilateral neck dissection with paratracheal node excision in two. Of the 24 nodal dissections performed, four were positive for occult metastatic disease. No patient in the observation group developed nodal disease. Conclusion: The incidence of occult no dal disease in NO glottic carcinoma is low, 0% in early stage disease (T1-T2) and 19% in late stage disease (T3-T4). Nodes at highest risk i ncluded only the paratracheal, level II, and level III. Elective neck treatment should only be undertaken for advanced (T3-T4) disease and e ven then is of questionable benefit. If undertaken, it should have a l ow potential morbidity, such as selective neck dissection or radiation . Computed tomography was not useful in staging the neck for this subs et of patients.