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A Multifactorial Study of 221 Cases Treated by Surgery or Radiotherapy

Luiz P. Kowalski, MD, PhD; Marcos B. P. Batista, MD; Carlos R. Santos, MD; Adilson Scopel, MD; Joao V. Salvajolli, MD; Humberto Torloni, MD

Arch Otolaryngol Head Neck Surg. 1996;122(1):77-82.

Abstract
Objective
To evaluate prognostic factors in patients with T3,N0-1 glottic and transglottic carcinoma treated in a single institution.

Design
Retrospective, nonrandomized case series.

Setting
Tertiary case referral centers, ambulatory or hospitalized care.

Patients
Two hundred twenty-one consecutive cases of stage III glottic or transglottic squamous cell carcinoma. Tumor stage was T3,N0,M0 in 167 cases and T3,N1,M0 in 54 cases.

Interventions
Surgery in 176 cases and radiotherapy in 45 cases.

Main Outcome Measures
Recurrences and survival (multivariate).

Results
Almost 7% of the patients who underwent surgery and 39.6% who had radiotherapy had local recurrences. Recurrences in the neck were seen in 16.4% of the patients who underwent surgery and in 10.5% of those who had radiotherapy. Distant metastases were diagnosed only in patients who underwent surgery (4.6%). The 5-year actuarial overall survival rates were 56.3% in the surgical group and 35.2% in the radiotherapy group (P=.007). Age involvement of pyriform sinus, N stage, and history of tracheostomy were independent prognostic factors for risk of death.

Conclusions
The presence of metastatic lymph nodes, age, and involvement of the pyriform sinus were the important prognostic factors in patients who underwent surgery. A small group of patients with T3,N0,M0 tumors could benefit from radiotherapy, with surgery reserved for recurrence.

(Arch Otolaryngol Head Neck Surg. 1996;122:77-82)

Author Affiliations
From the Departments of Head and Neck Surgery (Drs Kowalski, Batista, Santos, and Scopel) and Radiotherapy (Dr Salvajolli), Hospital A C Camargo, and the Epidemiology and Biostatistics Unit, Ludwig Institute for Cancer Research (Dr Torloni), São Paulo, Brazil.

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