SAN FRANCISCOSurgery appears to offer better results than radiation as primary therapy for many laryngeal cancers. Results of a five-year study in Germany suggest that tumor excision and subsequent reconstruction offer better clinical outcomes, better preservation of voice function, and lower cost than radiation therapy.
We highly recommend the surgical alternative, said University of Giessen researcher Hiltrud Glanz, MD, speaking at the 101st Annual Meeting of the American Academy of Otolaryngology-Head and Neck Surgery. Given the appropriate resection technique, she added, we can preserve the vocal cords or reconstruct them to maintain vocal function.
Dr. Glanz group followed 180 of 284 patients with laryngeal or glottic cancer (Tis, T1-T3) who were treated between 1990 and 1996. All of the 180 patients followed received primary microsurgery, with technique adapted to each tumor, depending on site, size, spread, and differentiation.
After total excision of the tumor, Dr. Glanz said, the surgical defects were reconstructed with special attention to voice production. The patients were followed for at least 1.5 years postsurgery. No direct comparison with the patients treated by radiation was presented.
The clinical results of surgical treatment were excellent, Dr. Glanz reported. Of the 180 patients followed, 175 (97%) returned to their normal work and family lives without any evidence of recurrent disease during the follow-up period.
Morbidity among at least half of the patients was so minor as to be nearly irrelevant, she said. The extremely low incidence of postoperative morbidity, Dr. Glanz added, helped keep the total treatment costs relatively low.
One of the five patients who had recurrent disease is now free of disease following total laryngectomy. Two are still living with distant metastases. The other two patients eventually died of cancer despite radical salvage treatment.
All of the disease-free patients retained their larynx, Dr. Glanz reported. In a patient survey, 80% reported their voice strength and quality as either excellent or good.
Partial laryngeal surgery provides a wide range of individual adaptation to tumor size and growth as well as the best possible field for reconstruction, Dr. Glanz concluded. This method enables the patient to continue his or her life almost normally and in good voice without fear of long-term side effects. We consider primary surgery a reasonable recommendation in patients with Tis, T1, and T2 laryngeal cancer, and in very select patients with T3 glottic cancer.