Clinically staged T3N0M0 laryngeal cancer: how is it best treated? Definitive radiotherapy with salvage surgery v/s combined surgery and radiotherapy

Controversy surrounds the optimum treatment of T3N0 cancer larynx. Curative radiotherapy with salvage surgery in reserve is an accepted methodology as is also a combined protocol of surgery and radiotherapy. A retrospective a nalysis of the survival results of 119 cases of clinically stayed T3N0 canc er larynx treated over a 14-year period at a single centre with either of t he above two modalities has been undertaken The selection of the treatment modality for an individual patient was decided jointly by the patient and t he clinicians at a combined cancer clinic. The combined surgery plus radiot herapy treatment group was comprised of a relatively greater number of tran sglottic tumours while the curative radiotherapy group had a higher proport ion of glottic tumours. Actuarial four-year disease-free survival rates wer e significantly better with combined treatment (79.3 per cent) than with ra dical radiotherapy and surgical salvage (65.3 per cent) - p value = 0.024. In the radical radiotherapy group, failure was almost always at the primary site and the probability of surviving with an intact larynx was approximat ely half of the total survival. As per this study, a policy of radical radiotherapy (with salvage surgery f or failure) for unselected clinically staged T3N0 cancer larynx, does not p rovide for comparable cure rates or for satisfactory laryngeal preservation .