Surgery or radiotherapy for early stages carcinomas of the glottic larynx

Aims and background: The choice of treatment in limited squamous cell carci noma of the glottic larynx often depends on Individual and tumor factors. D ata of the literature clearly show that surgery and radiotherapy tend to gi ve identical results in terms of survival. We examined 196 cases of T1-T2/N 0 cancers of the glottic larynx. We review the literature and discuss the i ndications and the efficacy of the various available treatments. Methods and study design: 196 consecutive cases of T1-T2/N0 cancers of the glottic larynx were examined. In 54.5% the tumor was confined to the vocal cord; in 38.2% it extended to the anterior commissure, in 4.6% to the aryte noid cartilage and in 2.5% to the floor of the ventricle. We performed part ial laryngeal surgery in 41.3% (81 cases). Radiotherapy alone was employed in 58.6% (115 cases). Results: In Tla and T1b cases there was no statistically significant differ ence in 5-year disease-free survival. In T2 cases the NED survival of patie nts who underwent partial laryngectomies (90% of cases) was significantly b etter (P <0.05) than among patients given radiotherapy (73%). NED survival st 5 years in patients with the primary tumor on a vocal cord, ventricle or anterior commissure was 78%, 80% and 81%, respectively, with no statistica lly significant difference among the various sites. It is possible that inv olvement of the anterior commissure exposes patients to greater risk of rec urrence when radiotherapy alone is used (5 out of 23 cases, 21.7%, compared to 3 out of 52 cases, 5.7%, among our surgically treated patients). Conclusions: When the tumor is confined to the vocal cord and mobility is n ot impaired (Tla), surgery and radiotherapy give comparable results, and th e latter yields a better functional out come. When the anterior commissure Is involved, recurrences appear to be less likely after surgery. In T2 glot tic carcinoma, surgery gives better results than radiotherapy alone. in any event, the choice of treatment should be patient-specific and based on a c areful analysis of the factors involved in each case.