Strategies in the treatment of T2/T3 laryngeal cancer from the viewpoint of larynx-preservation surgery

The strategies in the treatment of T2/T3 laryngeal cancer were investigated retrospectively from the viewpoint of larynx-preservation surgery. A total of 229 patients with T2/T3 laryngeal cancer were treated between 1996 and 2005, in which period all strategies in the treatment of head and neck cancers were decided at a weekly conference consisting of head and neck surgeons and therapeutic radiologists. The distribution of T-stage was as follows: 79, 38 in T2, T3 glottic carcinoma, and 50, 67 in T2, T3 supraglottic carcinoma, respectively. The rate of larynx preservation in T2 glottic carcinoma was 84% (66/79), although the local control rate of radiation therapy in this group was 68% (49/72). Similarly the larynx-preservation rate in T2 supraglottic carcinoma was 80% (40/50), although the local control rate of the therapy was 67% (28/42). More than half of these patients with recurrent primary lesion after radiation therapy were treated by larynx-preservation surgery as salvage, which improved the rate of larynx preservation. On the other hand, the local control rates of larynx-preservation surgery, which included T3 carcinomas, were 95% (20/21) in glottic carcinoma and 94% (15/16) in supraglottic carcinoma, respectively. When considering the larynx-preservation strategies in the treatment of T2/T3 laryngeal cancer, it is worth noting the following point: chemoradiation therapy is surer than larynx-preservation surgery in respect of the anticipated functional outcome after treatment, but larynx-preservation surgery is more certain than radiation therapy as regards the local control rate. Case for surgery should be selected accordingly.