Organ preservation with radiotherapy for T1-T2 carcinoma of the pyriform sinus

Purpose. To report long-term results using radiotherapy with or without a p lanned neck dissection for T1-T2 carcinoma of the pyriform sinus. Methods. An analysis of 101 patients treated at the University of Florida w ith RT with or without a planned neck dissection for organ preservation. Results. The 5-year local control rates after RT were 90% for T1 cancers an d 80% for T2 lesions. The only parameter that significantly influenced loca l control in univariate analyses was apex involvement for T1 tumors. Multiv ariate analysis revealed no parameter that significantly affected local con trol. Cause-specific survival rates at 5 years were as follows: stage I-II, 96%; stage III, 62%; stage IVA, 49%; and stage IVB, 33%. The absolute surv ival rates were as follows: stage I, 57%; stage II, 61%; stage III, 41%; st age IVA, 29%; and stage IVB, 25%. Moderate to severe long-term complication s developed in 12% of patients. Conclusions. RT alone or combined with a planned neck dissection resulted i n local control with larynx preservation in a high proportion of patients. The chance of cure is comparable to that observed after conservation surger y, and the risk of major complications is lower. The addition of adjuvant c hemotherapy is unlikely to improve the probability of organ preservation, b ut might improve locoregional control for patients with advanced nodal dise ase. (C) 2001 John Wiley & Sons, Inc.