AUDIT IN THE MANAGEMENT OF T3 FIXED-CORD LARYNGEAL-CANCER

Purpose: To determine results of various treatments for T3 fixed-cord lesions and the subset T3 glottic cancer in Auckland from 1979 to 1995 . Patients and Methods: Data were collected retrospectively from a dep artmental database, and the notes were reviewed. Because of the diffic ulty in determining the subsite of some fixed-cord lesions, the entire group of T3 fixed-cord lesions was examined, and those tumors that we re considered to be definitely arising from the glottis were then anal yzed as a specific subset. Results: Fixed-cord lesions were diagnosed in 75 patients (21 supraglottic, 54 glottic). Primary surgery (total l aryngectomy) was performed on 46 patients, primary radical dose radiot herapy was undertaken on 25 patients, and four patients were treated p alliatively. For T3 fixed-cord lesions, disease-specific survival for radiotherapy and surgery was 36% and 66%, respectively, and 32% and 67 %, respectively, for T3 glottic lesions. For both T3 fixed-cord and T3 glottic lesions, surgery produced significantly better survival than did radiotherapy (<60 Gy; P=.0157). With radiotherapy greater than 60 Gy, cancer of the larynx has been controlled in seven of 13 patients, although only five patients are alive, with a median follow-up of 24 m onths (range, 12-49 months). Conclusion: Radiotherapy less than 60 Gy produced markedly inferior results to surgery for T3 fixed-cord lesion s and T3 glottis in Auckland. Radiotherapy at more than 60 Gy shows pr omise, but an ongoing audit is essential to ensure that survival is si milar to surgery and to that reported by those promoting organ-preserv ation protocols. Copyright (C) 1998 by W.B. Saunders Company.