Preservation of the Larynx in the Treatment of Supraglottic Laryngeal Carcinoma

We assessed the possibility and limitations of preserving the larynx in the treatment of Supraglottic laryngeal carcinoma. Over the period from 1988 to 1997, we treated forty-one cases which included four T1, twenty T2, five T3 and twelve T4 patients. The three year preservation rates of the larynx and three year survival rates of the patients were 75% and 100% in T1 patients, 45% and 95% in T2, and 0% and 52.9% in T3 and T4 cases. Ordinary once-a-day radiotherapy was effective in T1N0 cases, but preservation of the larynx was possible in only 37.5% of T2N0 cases. Using hyperfractionated radiotherapy, the preservation rate was improved to 75%. Supraglottic hemilaryngectomy was available to three T2 cases, whose tumors were larger than 2 cm in diameter, but had not advanced downward over the aryepiglottic fold and had no lymph node metastasis. Five advanced cases of T2 with invasion to the glottis or lymph node metastasis needed total laryngectomy. As for T3, T4 cases, although total laryngectomy and bilateral neck dissection were performed in operable cases, the three year survival rate was poor. These observations suggest that it may be difficult to preserve the larynx in T3, T4 cases.