The records of all patients with supraglottic laryngeal cancer seen and definitively treated from 1961 to 1970 at the University Hospital were reviewed. The total number of carcinomas felt to arise primarily from the supraglottic area was 118. Of these, 89 had what we considered sufficient follow-up to be used in tabulating the results of treatment.
Tumors irradiated primarily received 6,500 R Cobalt therapy. There were 50 of the 89 patients who received primary irradiation therapy. Thirty-one of the patients received primary surgical therapy. Of these, three had laryngectomies only, seven partial laryngectomies and neck dissections, and the remaining patients had total laryngectomies and neck dissection. Only eight of the 89 patients received initial combined therapy, or surgery and irradiation within three months of each other.
In our experience, supraglottic cancers without nodal metastasis, regardless of size, will have about 73 percent absolute three-year survival, whether treated with irradiation or surgery primarily.
The absolute three-year survival for supraglottic carcinomas with nodal metastasis and primary irradiation therapy was 6 percent. On the average, these were larger lesions with nodal metastasis. The absolute three-year survival for supraglottic carcinomas with nodes receiving primary surgery was 23 percent. These were significantly smaller lesions than those irradiated primarily.
Of the patients without lymph node metastasis, 24 percent of the supraglottic lesions irradiated primarily developed laryngeal recurrences requiring secondary therapy. None of the patients with similar lesions receiving primary surgery developed laryngeal recurrences. Of the supraglottic carcinomas with nodal metastasis and receiving primary irradiation, 75 percent developed local recurrences and 83 percent had persistent or recurrent neck metastasis in the same neck. Of the patients with similar lesions receiving primary surgery, 20 percent developed local recurrences and 33 percent developed recurrent neck metastasis in the same neck.
The alternatives of treatment for primary therapy of a supraglottic carcinoma without nodal metastasis are either full dose irradiation or a partial laryngectomy, if possible, and a neck dissection. Supraglottic carcinomas with evidence of nodal metastasis are probably best treated surgically, in some cases in combination with irradiation therapy.