[Management of T3 supraglottic carcinoma: a retrospective study].

Objective: To discuss the strategy of therapeutic management of T3 supraglottic carcinoma. Methods: A retrospective analysis of 459 patients with T3 supraglottic carcinoma treated in our hospital was performed. We evaluated the results of different managements, including surgery alone, preoperative radiotherapy, postoperative radiotherapy and radiotherapy alone. The extent of the lesion was also put into analysis. Statistical analysis of the overall survival (OS), cause-specific survival (CSS), local control (LC), regional control(RC), function-conservation (FC) were performed with the statistical package from SPSS. Results: In all patients, the rates of 5-year OS, CSS, LC, RC and FC were 64.2%, 71.2%, 87.8%, 78.8% and 64.5% respectively. The OS, LC and FC of the patients treated by surgery alone, preoperative radiotherapy and postoperative radiotherapy had no significant difference, and were remarkably better than that of patients treated by radiotherapy alone (P<0.001). In 412 patients treated by surgery, 300 patients received function-conservation laryngectomy. 209 patients (50.7%, 209/412) survived and maintained well-function of larynx for 5 years, which was significantly better than those in the radiotherapy alone group (27.7%, 13/47). The patients with the lesion invading the pre-epiglottic space but limited in supraglottic area had better OS (70.2%), LC (93.5%) and FC (85.1%). The rate of 5-year neck lymphatic metastasis was 56.2%(258/459), and the 5-year OS of patients with N0, N1, N2 and N3 stage were 76.0%, 66.2%, 50.5% and 13.0% respectively. Conclusions: Surgical treatment was the best therapeutic approach for T3 supraglottic laryngeal carcinoma. Most patients with T3 lesions are suitable for function-conservation laryngectomy. Surgical procedure was determined by tumor invaded location and extension. The combined therapy of surgery and radiotherapy had no significant advantage.

Upper neck (level II) dissection for N0 neck supraglottic carcinoma.

OBJECTIVES: Elective neck dissection for the N0 neck in head and neck surgery is still controversial. This prospective nonrandomized study of N0 supraglottic carcinoma was designed to find an appropriate method of neck management. STUDY DESIGN: Anatomical studies show that the first echelon of lymphatic drainage from the supraglottic larynx is toward the upper jugular nodes (level II). An upper neck dissection (UND) was applied and all the lymph nodes were sent for frozen section. If the subclinical metastasis was found, a modified neck dissection was performed. If the nodes harbored no foci of cancer, the patients were observed after surgery on the supraglottic lesions. METHODS: Patient records of 142 patients with supraglottic laryngeal cancer (T1-4N0M0) were reviewed, with special attention paid to neck recurrences and survival rates. The cases were treated between 1976 and 1990 and all were observed for at least 5 years after the operation or until the time of death. RESULTS: The UND specimens of 142 patients were negative for metastasis. The 5-year survival rate for this group after surgery was 80.8%, according to the life table analysis. Fifteen of the 142 patients (10.6%) had neck recurrences during the period of observation within 5 years. The recurrence rate of this series with limited dissection on the neck was comparable with those reported in the literature after neck dissection, either radical or modified. CONCLUSIONS: There is no need for a comprehensive neck dissection for N0 supraglottic laryngeal cancer. A selective neck dissection such as UND (level II) or a supraomohyoid neck dissection (sparing the submandibular region) of level II and III will serve the purpose of radical neck treatment for the supraglottic cancer.

Horizontovertical laryngectomy for supraglottic carcinoma.

Recent decades have seen the expansion of indications for partial laryngectomy. This study focused on the application of horizontovertical laryngectomy for T2 and selected T3 and T4 supraglottic carcinomas. An osteomuscular flap was designed to reconstruct the laryngeal defect to preserve all the essential laryngeal functions. Seventy-six patients treated between November 1979 and October 1990 were reviewed retrospectively. All but two were followed up for at least 5 years. There were 11 cases of T2, 57 cases of T3, and 8 cases of T4 tumors. The survival rates of 7 cases of stage II, 56 cases of stage III, and 13 cases of stage IV carcinoma were 100%, 84.3%, and 74.3%, respectively. The functional recovery was satisfactory; 78.4% of 74 patients underwent decannulation, and all but one patient resumed a normal diet. This study showed that conservation surgery is reliable for selected supraglottic cancers, even for those lesions that extend beyond the confines of the supraglottis.

Cerebellar medulloblastomas: a comparison between adults and children.

A retrospective analysis of 19 medulloblastomas in patients aged 2 to 24 years was conducted employing 14 children (<15 years old) and 5 adults. All patients received gross total excision of the tumour with postoperative craniospinal irradiation. The patients were then followed up for more than 5 years. To determine which factors influenced the prognosis of these two age groups, we analysed the differences of the proliferating cell nuclear antigen (PCNA), the degree of tumour invasion and the outcome between adult and childhood medulloblastomas. In summary, medulloblastomas in adults and children had similar cell proliferative activity and long term survival rates but the tumours with brain stem invasion, which commonly occurred in children, had an early recurrence rate and a poor prognosis. The prognosis of medulloblastoma may depend upon the degree of tumour invasion of the brain stem.

Evaluation of 1987 UICC TNM classification for laryngeal cancer.

According to the outcome of 296 cases of laryngeal cancer of the supraglottic type treated at the Cancer Hospital, CAMS, China, the 1978 UICC TNM classification was preferred to the 1987 version. The mobility of metastatic node, together with the dimension of the node, should be considered as definite criteria for assessing the nodal status.

[Proposal on T staging of maxillary sinus cancer].

The TNM staging of maxillary sinus cancer was stipulated by the UICC in 1987 using Ohngren line of demarcation. This report is to discuss the applicability of this staging based on 232 cases of maxillary sinus cancer treated in this hospital. Of 232 cases, the 3-year survival rate for those who received surgery alone was 4/6, for those after radical irradiation, 15.6% (20/128) and for those by combined irradiation and surgery, 43.9% (43/98). The 3-year survival rate for the whole series was 28.9%. To analyze the survival rates of different types of lesion separately, we found that those with involvement of the posterior wall, hence invading the pterygopalatine fossa had poor prognosis with a three year survival rate of 19.5%. And invasion of soft and/or hard palate also gave poor survival. Contrary to the common consensus, invasion of ethmoidal sinuses did not pose a serious prognosis. The feasibility of the Ohngren line in TNM staging was thus questioned. On the basis of our data, a modification of the TNM staging of JJC for maxillary sinus cancer is suggested.

Salvage surgery for nasopharyngeal carcinoma.

Nasopharyngeal carcinoma is not a disease to be treated primarily by surgery. Radiation is the first choice of treatment. But, once it recurs, a second course of radiation controls only a small portion of the patients, with a high risk of accumulated radiation injury. We discuss the outcome of salvage surgery in nine cases of nasopharyngeal recurrence and 69 cases of neck metastasis that was uncontrolled or had recurred after irradiation was evaluated. A five-year survival rate of 44% for the primary lesions and 49% for the neck node metastases justifies the rationale of surgery on selected cases of radiation failure.

Immediate reconstruction using visceral transfer after pharyngolaryngoesophagectomy for advanced hypopharyngeal cancer.

The management of 32 stage IV cases of cancer of the hypopharynx was reviewed retrospectively with a view of selecting a pertinent treatment modality to ensure low morbidity and high survival and evaluating the applicability of abdominal viscera as a reconstructive measure after total pharyngolaryngoesophagectomy. Three methods of visceral reconstruction have been used at this hospital, viz., reversed gastric tube, colon interposition, and stomach transposition. In our experience, the gastric pull-up is more reliable. The success rate of oral alimentation of 20 gastric pull-ups was 95% and the mortality rate was 5%. The overall 3-, 5-, and 10-year survival rate was 37.5% (12/32), 38% (8/21), and 30% (3/10), respectively. Preoperative irradiation gave a 3-year survival rate of 40% (8/20) for T4 N0-3 cases.

Comparison of pre- and postoperative radiation in the combined treatment of carcinoma of maxillary sinus.

A series of 50 patients with cancer of the maxillary sinus treated by either preoperative or postoperative radiation from February, 1958 to June, 1974 is presented. In the postoperative group the patients were either free from recurrence, of if there was recurrence, the tumor was less than 0.5 cm in diameter. In the preoperative group, 23 of 36 patients survived for more than five years (64%). In the postoperative group, 4 of 14 patients survived for more than five years (26%). There is an obvious superiority in the preoperative radiation group. The surgical complication rate in the preoperative group was 29% as compared to 14% in the postoperative group. Although the incidence of complications in the preoperative group is higher, we believe it is worth attempting in clinical practice because of the more favourable survival rates.