Combined radiation therapy and surgery for carcinoma of the supraglottis and pyriform sinus

Following a review of the most recently accepted TNM system for glottic carcinoma and for supraglottic carcinoma as recently reported out by the American Joint Committee for Cancer Staging, a review of our work with glottic carcinoma and with supraglottic carcinoma is now presented. It was felt that T-3 and T-4 glottic carcinoma simulated T-3 and T-4 supraglottic carcinoma, although the latter is more likely to have cervical metastasis. Conclusions of our work using 5,500 rads pre-operatively for supraglottic carcinoma resulted in a 90 percent three-year cure rate for T-1 lesions, 79 percent cure rate for T-2 lesions, 63 percent cure rate for T-3 lesions and a 33 percent cure rate for T-4 lesions. On the basis of our pathological studies and a follow-up on the patients the conclusion was reached that T-1, N-0 or T-2, N-0 supraglottic carcinoma should be treated with radical radiation therapy with curative objective. For the T-3 lesions with border line radiocurability a trial course of radiotherapy should be attempted. If the tumor shows satisfactory regression to a dose level of 4,500 rads of radiation therapy it should be continued to a curative dose level, and surgery should be reserved for radiation failures. On the other hand, if the tumor response to radiation is poor and if the tumor is large and extensive or deeply ulcerated as in T-3 and T-4 lesions which are often associated with lymph node metastasis, a planned combined approach of radiation and surgery is advised.     

Prognostic value of vocal cord fixation with respect to treatment in cancers of the supraglottis and pyriform sinus

Vocal cord fixation in supraglottic and pyriform sinus cancers has, in the past, precluded management by radiotherapy alone. Ninety-eight patients were reviewed to determine the prognostic effect of vocal cord fixation. The predictive value of cord mobility status after 50 Gy was evaluated with respect to treatment modality. For patients treated with radiotherapy alone, cord mobility status was predictive of recurrence, yielding 3 year recurrence rates of 33.3% (mobile) versus 80% (fixed) [p = 0.04]. Mobile cords after 50 Gy had similar recurrence rates (33.3% vs. 40.0%, p = 0.60) whether treated by radiotherapy or radiotherapy/surgery. Radiotherapy alone may be used in cases when fixed cords become mobile after 50 Gy without compromising cure rates or laryngeal function. Combined modality provides the best results when cords remain fixed.     

Five hundred cancers of the larynx and pyriform sinus: Results of treatment by radiation and surgery

Three hundred eighty cancers of the larynx and 120 of the pyriform sinus were treated in the 15 years from 1958-1973 at Yale-New Haven Hospital. They were studied for response to treatment by surgery, radiation or a combination of the two. Overall control rates in the entire group of 500 were 51% for radiotherapy, 51% for surgery. Further analysis showed significant differences in the results obtained by stage and by location for surgery and radiotherapy. The total number of cases treated by combined therapy was relatively small, except for pyriform sinus. Radiotherapy success showed a steep gradient from 82% in Tl lesions to 5% in T4. The gradient for surgery was less steep with 64% success for Tl and 40% for T4. Both radiotherapy and surgery were most successful in glottic cancer and least successful in the pyriform sinus. However, the success range varied more with radiation than with surgery (83% success in glottic cancer, 5% in pyriform sinus cancer for radiotherapy; 81% in glottic cancer and 24% in pyriform sinus for surgery). Late primary recurrences (3 years or more after radiation therapy) developed only in the glottic group. Recurrent cancer at the primary site in non-glottic lesions appeared within 2 years after radiotherapy in 65 of the 66 local recurrences. Similarly, 77 of the 82 local recurrences of non-glottic cancer after surgery appeared within 2 years. With only 1 exception in 34 cases, surgical salvage of radiation failures succeeded only in glottic cancer. Of the 136 T1 glottic lesions there were no discernible regional metas-tases. In the remaining 73 glottic T2 and T3 lesions, cervical node me-tastases developed in 8 lesions. Supraglottic cancer was the most likely to produce cervical node metastasis from an early primary lesion (5 Tl lesions among 10 supraglottic lesions with unrecognized positive nodes). Eight of the 65 patients with fixed cervical node metastasis were controlled with no evidence of disease after 3 years. Among the treatment failures, most of those in the radiotherapy group were due to uncontrolled primary disease (72%). The failures among the surgical group were due mainly to metastasis (72%). Final controls obtained by surgery, radiotherapy, combined treatment and secondary salvage of radiation or surgical failures were as follows: glottic 82%; supraglottic 58%; transglottic 58%; subglottic 60%; pyriform sinus 17%.     

喉功能保留的梨状窝癌外科治疗

目的　评价喉功能保留梨状窝癌的手术治疗效果。方法　回顾性分析了 1974～ 1994年 6月我院初治的 44例经保留喉功能手术治疗的梨状窝癌病例。其中T110例 ,T2 14例 ,T3 18例 ,T42例。 2例术后放射治疗 ,42例术前放射治疗。原发灶术式包括 :36例梨状窝切除术 ;8例喉及下咽部分切除术。结果　 44例 5年生存率为 5 0 % ,I期为 80 % ,II期为 71 43% ,III期为 5 2 9% ,IV期为2 6 7%。总的局部控制率为 81 8%。T3 加T4 的 5年生存率为 45 %。T3 加T4 的 5年局部控制率为75 % (15 /2 0 )。结论　综合治疗过程中选择适宜患者 ,行保留喉功能的梨状窝癌手术 ,可取得满意的治疗效果。术前放射治疗有助于梨状窝癌尤其是T3 梨状窝癌患者喉功能的保留。     

保留喉功能的梨状窝癌切除术的临床研究

目的探讨梨状窝癌保留喉功能手术的外科切除与修复的治疗效果.方法分析保留喉功能的梨状窝癌切除26例的手术方法、并发症、生存率等.结果术后拔管率为53.8%(14/26),3、5年生存率分别为65.4%(17/26)和50%(13/26),并发症发生率为34.6%(9/26).结论保留喉功能梨状窝癌手术适应于T1、T2及经过仔细选择的T3期肿瘤患者,此术式不影响患者的生存率,并能提高患者的生存质量.     

喉功能保留的梨状窝癌外科治疗

目的 评价喉功能保留梨状窝癌的手术治疗效果。方法 回顾性分析了１９７４～１９９４年６月我院初治的４４例经保留喉功能手术治疗的梨状窝癌病例,其中Ｔ１１０例Ｔ２１８例,Ｔ４２例。２例术后放射治疗,４２例术前放射治疗,原发灶术式包括：３６例梨状窝切除术;８例喉及下咽部分切除术。结果 ４４例５年生存率为５０％,Ｉ期为８０％,Ⅱ期为７１．４３％,Ⅲ期为５２．９％,Ⅳ期为２６．７％,总的局部控制率为８１．８％     

梨状窝内侧壁癌切除与喉功能保留

目的探讨梨状窝内侧壁癌切除喉功能保留术的技术方法和临床疗效.方法回顾性分析手术治疗的梨状窝内侧壁癌71例.其中49例行喉功能保留术;22例未保存喉功能.喉功能保留手术方法①切除范围声带活动正常者行患侧水平上半喉+梨状窝内侧壁切除;声带活动受限者行同侧水平半喉+声门旁间隙+梨状窝内侧壁切除;声带固定者行患侧垂直半喉+梨状窝内侧壁和部分梨状窝外侧壁切除,梨状窝尖受累者切除范围扩大到环状软骨环和颈段食管;②修复喉修复对利用会厌、甲状软骨膜、带状肌肌筋膜、颈前皮瓣修复喉缺损;梨状窝修复对缺损范围小者用下咽粘膜瓣或残缘粘膜分离后直接对合,缺损范围大者用胸大肌肌皮瓣转移及胸三角皮瓣修复;③颈淋巴结处理71例中65例(91.5%)行颈清扫术,其中同侧颈清扫术39例,双侧颈清扫术26例;④术后全部病例予以辅助性放射治疗,剂量60～75Gy.结果寿命表法统计3年、5年生存率喉功能保留组分别为63.4%和49.6%;喉功能不保留组分别为52.4%和42.4%.喉功能保留组喉功能全部恢复者占71.4%(35/49),部分恢复者占28.6%(14/49).结论梨状窝内侧壁癌易侵入喉部,但多数病例在彻底切除肿瘤病灶的前提下保留喉功能是可行的.     

梨状窝内侧壁癌切除与喉功能保留

目的 探讨梨状窝内侧壁癌切除喉功能保留犬的技术方法和临床疗效。方法 回顾分析手术治疗的梨状窝内侧壁癌71例。其中49例行喉功能保留术;22例未保存喉功能。喉功能保留手术方法：①切除范围：声带活动正常者行患侧水平上半喉＋梨状窝内侧壁切除;声带活动受限者行同侧水平半喉＋声门旁间隙＋梨状窝内侧壁切除;声带固定者行患侧垂直半喉＋梨状窝内侧壁和部分梨状窝外侧壁切除,梨状窝尖受累者切除范围扩大到环状软骨环和颈段食管;②修复:喉修复对利用会厌、甲状软骨膜、带状肌肌筋膜、颈前皮瓣修复喉缺损;梨状窝修复对缺损范围小者用下咽粘膜瓣或残缘粘膜后直接讨合,对缺损范围大者用胸大肌肌皮瓣转移及胸三角皮瓣修复;③颈淋巴结处理：71例中65例（91．5％）行颈清扫术,其中同侧颈清扫术39例,双侧颈清扫术26例;④术后全部病例予以辅助放射性治疗,剂量60－75Gy。结果 寿命表法统计3年、5年生存率：喉功能保留组分别为63．4％和49．6％;喉功能不保留组分别为52．4％和42．4％。喉功能保留组喉功能全部恢复者占71．4％（35／49）,部分恢复者占28．6％（14／49）。结论 梨状窝内侧壁癌易侵入喉部,但多数病例在彻底切除肿瘤病灶的前提下保留喉功能是可行的。     

Radical irradiation for carcinoma of the pyriform sinus

Radiation therapy is sometimes prescribed as an alternative to partial or total laryngo-pharyngectomy in the initial management of carcinoma of the pyriform sinus. Forty-two patients were irradiated for cure and have a follow-up period of 2-14 years. Local control by irradiation alone was 11 of 14 for T1, 6 of 10 for T2, 3 of 6 for T3, and 1 of 7 T4. Three T2 failures were salvaged by laryngopharyngectomy for an ultimate control of 9 of 10 for T2. Management of the neck is critical since 79% of the patients presented with clinically positive necks, and many had substantial neck disease. Complete or partial neck dissection was added after irradiation on an individualized basis. In spite of the extensive degree of neck disease, only three patients died of uncontrolled neck disease with the primary controlled. The two-year absolute survival for Stages I and II was 83%, Stage III 62% and Stage IV 52%. The five-year absolute survival for Stages I and II was 66%, Stage III 38%, and Stage IV 10%. Complications of irradiation, neck dissection, and surgical salvage procedures are reviewed.     

梨状窝癌侵犯梨状窝尖的病理组织学观察及其临床意义

目的 探讨梨状窝癌侵犯状窝尖的临床意义。方法 对４３例梨状窝癌全喉下咽切除标本的次连续切片进行病理组织学观察。结果 梨状窝尖是梨状窝下１／３部分,梨状窝癌侵犯梨状窝尖易侵犯邻近组织和器官,结果 梨状窝尖受侵是癌组织向下咽下方侵犯的初始部位和重要标本,因此,外科治疗应以全喉及病侧下咽切除为宜。     

保留喉功能的梨状窝癌手术14例

目的 探讨保留喉功能的梨状窝癌手术方法和适应证。方法 梨状窝癌患者14例, Ⅰ期3例, Ⅱ期5例, Ⅲ期4例, Ⅳ期2例。行保留喉功能的手术治疗, 术后放疗40～55 Gy。结果 随访5年, 14例均恢复发音功能, 12例拔管。3年生存率为64.29%, 5年生存率为42.86%。结论 经严格术前评估, 大部分梨状窝癌患者可通过精细手术保留喉正常组织, 并通过多种修复方法恢复喉的全部或部分功能。     

Squamous cell carcinoma of the pyriform sinus

This is a review of 418 patients with cancer of the pyriform sinus who had complete treatment at University of Texas M. D. Anderson Hospital, treated over a 28-year time span. Treatment modalities used included radiation therapy, surgery, and planned combined treatment, primarily in the form of surgery and postoperative radiation therapy. Superficial lesions, with no impairment of laryngeal motility, are suitable for irradiation therapy planned for cure. (The policies of treatment have changed throughout the years). Analysis is made comparing the results of the larger groups of patients treated by surgery only, or surgery followed by postoperative radiation therapy. There is a significant lower incidence of failure above the clavicle in the combined treatment group, and a better 5-year survival. Rate of recurrences and the specific sites of failure above the clavicles are discussed, as well as the means of preventing such. The causes of death between 2 and 5 years are presented.     

梨状窝内侧壁癌的手术治疗

目的：探讨切除梨状窝内侧壁癌并保留喉功能手术的可行性及疗效。方法: 1990～2001年共手术治疗122例梨状窝内侧壁癌,其中87例行保留喉功能的梨状窝内侧壁癌切除术, T1、T2期患者行梨状窝切除术,将声门旁间隙组织一并切除,T3、T4期患者行梨状窝切除＋部分喉切除术,并根据肿瘤范围切除其他受累组织,以局部残留黏膜、胸大肌肌皮瓣、结肠上徙进行修复。35例未保留喉功能。术后均给予放射治疗。结果: 全部患者的3、5年生存率分别为67.2％（82/122）、45.1％（55/122）,其中喉功能保留组3、5年生存率分别为71.3％（62/87）、48.3％（42/87）,喉功能不保留组分别为57.1％（20/35）、37.1％（13/35）。喉功能保留组全部恢复呼吸、发音及吞咽保护者占71.3%（62/87）,部分恢复发音及吞咽保护占28.7%(25/87)。结论:在彻底切除肿瘤的前提下,对梨状窝内侧壁癌患者行喉功能保留手术是可行的。