The management of glottic and supraglottic cancers of the larynx in relation to neck metastasis

Year 2003, Volume: 11 Issue: 5, 129 - 133, 13.10.2003

Ali Vefa Yücetürk Onur Çelik Görkem Eskiizmir

Abstract

Objectives: We evaluated the management of glottic and supraglottic laryngeal cancers in relation to neck metastasis.Patients and Methods: Fifty-two patients 51 males, 1 female; mean age 59.2 years; range 27 to 82 years under- went surgery for primary laryngeal cancers. Preoperative and postoperative TNM classification and staging were made according to the AJCC 1997 criteria. The mean follow- up period was 39.4 months range 6 to 74 months .Results: The tumors were glottic in 31 patients and supra­ glottic in 21 patients. Laryngectomies were partial in 34 patients and total in 18 patients. Ali the patients with supra­ glottic tumors and those with glottic T2.4 tumors unden/vent neckdissection, aswell. Radiotherapyvvasadministeredto 22 patients with established N2 or N3 tumors. Clinical assess- ment was in agreement with the pathological result in 63.5%; 13.5% and 23.1% of cases were underdiagnosed and over- diagnosed, respectively. The rates of neck metastasis were 0% in T-ı, 25% in T2 , 75% in T3, and 66.7% in T4 supraglottic tumors. The corresponding rates for glottic cancers were 0%, 16.7%, 28.6%, and 60%, respectively. The overall rate of N+ tumors was 28.9%. Four patients 7.7% developed local, two patients 3.9% developed regional recurrences. Mortality occurred in eight patients 15.4% due to follovving causes: laryngeal recurrence T4 N2, T4 N2, TgN^, regional recurrence T4N2 , asecond primary malignancy in one patient, and other causes in three patients. Five- and two-year disease-specific survival rates Kaplan-Meier analysis were 90.7%, and over­ all survival rates were 73.7% and 87.3%, respectively.Conclusion: Neck metastasis and advanced stage of the tumor were the most effective prognostic factors.

Keywords

Carcinoma, squamous cell/surgery, laryngeal neoplasms/diagnosis/surgery, lymph nodes/pathology, lymphatic metas­tasis, neck, neckdissection, neoplasm staging, survival rate

Glottik ve supraglottik larenks kanserlerinde tedavinin boyun metastazı açısından değerlendirilmesi

Abstract

Amaç: Glottik ve supraglottik larenks kanserlerinde tedavinin boyun metastazı ile ilgili boyutları değerlendirildi.Hastalar ve Yöntemler: Çalıflmaya primer larenks kanseri nedeniyle cerrahi tedavi uygulanan 52 hasta alındı. Ameliyat öncesi ve sonrası TNM sınıflandırması ve evreleme AJCC1997 ölçütlerine göre yapıldı. Ortalama izlem süresi 39.4ay dağılım 6-74 ay idi.Bulgu l a r : Otuz bir hastada glottik, 21 hastada supraglottik kanser saptandı. Otuz dört hastada parsiyel, 18 hastada total larenjektomi uygulandı. Supraglottik ve T2 - 4glottik kanserlerin hepsine aynı seansta boyun diseksiyonu da uygulandı. Patolojik incelemede N2veya pN3b u l unan 22 hastaya ameliyat sonrasında radyoterapi uygulandı. Klinik değerlendirmenin patolojik sonuçla uyumu%63.5 bulundu; olguların %13.5’inde ve %23.1’inde değerlendirme eksik veya fazla yapılmıfltı. Boyun metastazı oranı supraglottik kanserlerde T1’de %0, T2’de %25,T3’te %75, T4’te %66.7 bulundu. Glottik kanserlerde buoranlar sırasıyla %0, %16.7, %28.6 ve T4’te %60 olarakbelirlendi. N+tümörlerin genel oranı %28.9 idi. Dört hastada %7.7 lokal, iki hastada %3.9 rejyonel nüks görüldü. İzlem süresi içinde sekiz hasta flu nedenlerle yaflamını yitirdi: Larenjeal nüks T4N2, T4N2, T3N1 , rejyonelnüks T4N2 , ikinci primer tümör 1 hasta , kanser dıflınedenler 3 hasta . Befl ve iki yıllık hastalığa özgü sağkalım oranı %90.7; toplam sağkalım sırasıyla %73.7 ve%87.3 bulundu Kaplan-Meier analizi .Sonuç: Boyun metastazı ve ileri tümör evresi larenks kanserinde en etkin prognostik faktörlerdir

Keywords

Karsinom, yassı epitel hücreli/cerrahi, larenjeal neoplaziler/tanı/cerrahi, lenf nodu/patoloji, lenfatik metastaz, boyun, boyun diseksiyonu, neoplazi evrelemesi, sağkalım oranı

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