Supraglottic larynx cancer, T1-4 N0, treated by radical radiation therapy. Problem of neck relapse.

The records of 203 patients with T1-4 N0 epidermoid carcinoma of the supraglottic larynx treated at the Dr. Daniel den Hoed Cancer Center/Rotterdam Radiotherapeutic Institute (RRTI), in 1965-1979 were reviewed. This report is confined to the 165 patients treated by radiation therapy (RT) only and focuses on the problem of relapse in the neck. A comparison is made between patients treated for the primary tumor with RT portals less than or equal to 30 cm2 and patients treated with larger field sizes. Sixty patients suffered a local recurrence, which was followed by a relapse in the neck in 13 patients. Nineteen patients experienced a relapse in the neck without a previous local failure. Five of these patients experienced a local failure at a later time. A multivariate analysis showed that the risk of a regional failure was significantly higher after a local failure and also for patients treated with small radiation portals (less than or equal to 30 cm2). Patients with an advanced tumor stage did not have a higher risk of a regional failure. A recurrence in the neck carried a poor survival; nearly two thirds of these patients died of their disease. As a recurrence in the neck seems to be correlated to the control of the primary tumor as well as to the (elective) treatment of the neck, best strategies to further increase the local/regional control are discussed.