Prognostic factors in supraglottic carcinoma patients treated by surgery or radiotherapy.

The decision regarding treatment of supraglottic carcinoma remains controversial, despite recent advances in radiotherapy and surgical procedures. The need to evaluate the prognostic importance of demographic, clinical, pathologic, and treatment-related variables prompted this study. The patient population was of 164 consecutive cases of supraglottic carcinoma. Clinical charts were reviewed and cases were restaged according to the 1987 version of the UICC-AJC classification based on the initial clinical description: 18 T1, 30 T2, 58 T3, 58 T4, 61 NO, 24 N1, and 79 N2a-N3. Management policy for these patients varied during the study, reflecting different opinions of the responsible physicians and technical advances. Seventy-seven patients (47%) underwent surgery, patients who underwent surgery and radiotherapy, respectively, remained alive with no evidence of disease. The 5-year actuarial survival rates were 58.5% for patients initially treated by surgery, and 16.3% for patients in the radiotherapy group. Although several demographic, clinical, and pathologic variables were studied, only initial treatment (p <.0001), N stage (p = .0003), and T stage (p = .0017) were deemed to have independent prognostic value by multivariate regression techniques based on Cox's proportional hazards model. This study has shown that survival of supraglottic carcinoma patients depends on the treatment modality, T stage, and N stage. Our results are disappointing with regard to radiotherapy as a treatment for supraglottic carcinoma in patients with tumors at clinical stages III and IV.

Major glossectomy: end results of 106 cases.

Advanced cancers of the oral cavity continue to be a therapeutic challenge. Despite significant improvements in radiotherapeutic techniques and adjuvant chemotherapy, patients usually die after a short period. Recent progress in reconstructive techniques has made major glossectomy (subtotal, near total, total or extended total) a reasonable palliative and potentially curative approach. It is the purpose of this study to report a series of 106 patients treated from 1985 to 1994 regarding surgical complications and prognosis. All but 1 patient undergoing major glossectomy had squamous cell carcinoma. Primary tumour sites were oral tongue (50 cases), base of the tongue (18 cases), floor of the mouth (28 cases) and other parts of the mouth (10 cases). Tumour stages were: 25 T3, 57 T4, 24 Tx, 34 N0, 20 N1, 32 N2a-N3, 20 Nx. The types of glossectomy were as follows: 24 subtotal, 31 near total and 51 total. A total laryngectomy was performed in only 6 cases. A neck dissection was performed in all but 3 patients: 12 unilateral radical neck dissection (RND), 1 unilateral supra, omohyoid (SOH), 39 simultaneous bilateral RND, 8 simultaneous bilateral SOH, and 43 RND associated to contralateral SOH. A pectoralis major myocutaneous flap was used to repair the operative defect in 96 cases. Complications were seen in 52 cases (49%). The most common complications were wound infection (17 cases), flap necrosis (15 cases) and fistula (15 cases). Significant transient aspiration was seen in 8 patients. At the study closing date, 30 patients were alive without disease, 5 had recurrent disease, 47 died of cancer, 14 died of causes not related to cancer or treatment and 10 were lost to follow-up. The 5-year actuarial survival rates were, respectively, 45%, 18% and 18% for T3, T4 and Tx. Other significant variables were pN stage (P = 0.0672) and year of admission (0.0318). In conclusion a major glossectomy without laryngectomy whenever possible is a safe procedure for a selected group of patients with advanced tongue and floor of the mouth cancer. The actuarial survival rates presented suggests that, in a very select group of patients, major glossectomy is a surgical procedure to be considered.

Major glossectomy: end results of 106 cases / Glossectomia maior: resultados concluidos de 106 casos

Advanced cancers of the oral cavity continue to be a therapeutic challenge. Despite significant improvements in radiotherapeutic techniques and adjuvant chemotherapy, patients usually die after a short period. Recent progress in reconstructive techniques has made major glossectomy (subtotal, near total, total or extended total) a reasonable palliative and potentially curative approach. It is the purpose of this study to report a series of 106 patients treated from 1985 to 1994 regarding surgical complications and prognosis. All but 1 patient undergoing major glossectomy had squamous cell carcinoma. Primary tumour sites were oral tongue (50 cases), base of the tongue (18 cases), floor of the mouth (28 cases) and other parts of the mouth (10 cases). Tumour stages were: 25 T3, 57 T4, 24 Tx, 34 N0, 20 N1, 32 N2a-N3, 20 Nx. The types of glossectomy were as follows: 24 subtotal, 31 near total and 51 total. A total laryngectomy was performed in only 6 cases. A neck dissection was per-formed in all but 3 patients: 12 unilateral radical neck dissection (RND), 1 unilateral supra, omo-hyoid (SOH), 39 simultaneous bilateral RND, 8 simultaneous bilateral SOH, and 43 RND associated to contralateral SOH. A pectoralis major myocutaneous flap was used to repair the operative defect in 96 cases. Complications were seen in 52 cases (49 per cent). The most common complications were wound infection (17 cases), flap necrosis (15 cases) and fistula (15 cases). Significant transient aspiration was seen in 8 patients. At the study closing date, 30 patients were alive without disease, 5 had recurrent disease, 47 died of cancer, 14 died of causes not related to cancer or treatment and 10 were lost to follow-up. The 5-year actuarial survival rates were, respectively, 45 per cent, 18 per cent and 18 per cent for T3, T4 and Tx. Other significant variables were pN stage (P=0.0672) and year of admission (0.0318). In conclusion a major glossectomy without laryngectomy whenever possible is a safe procedure for a selected group of patients with advanced tongue and floor of the mouth cancer. The actuarial survival rates presented suggests that, in a very select group of patients, major glossectomy is a surgical procedure to be considered