Treatment of laryngeal carcinoma with conservative surgery and postoperative radiation therapy.

Thirteen patients with carcinoma of the supragiottic larynx (N = 10), vocal cord (N = 2), and pyriform sinus (N = 1) were treated with conservative surgery followed by radiation therapy. This plan was chosen because clinically or histologically proven lymph node metastases were present and because the primary cancer had one or more of the following factors that were adverse to patient survival: (1) the tumor extended beyond the limits of safe, conservative laryngeal surgery; (2) it infiltrated surrounding soft tissues, ie, preepiglottic space; (3) it was close to the resected margin; and (4) perineural invasion was present. Laryngeal function has been adequate in all but two patients: one has persistent aspiration one year after treatment, and one has a narrow airway after an extended supraglottic laryngectomy that included the anterior third of both cords and a portion of the subglottis at the anterior commissure with adjacent thyroid cartilage. One patient died in the immediate postoperative period, and this case cannot be evaluted. Twelve patients who completed treatment have been followed up for a median of 30 months (1 1/2 through 3 1/2 years), and all have remained free of recurrent disease.