Glanz H, Kimmich T, Eichhorn T, Kleinsasser O
Hals-Nasen-Ohrenklinik der Philipps-Universität, Marburg.
HNO. 1989 Jan;37(1):1-10.
The results in the management of 460 vocal cord carcinomas and 124 supraglottic carcinomas are reported. Of the vocal cord carcinomas, 63.3% were diagnosed in the early Tis and T1 stage. Seventy-six tumors were resected endoscopically, 128 by laryngofissure and chordectomy. Not one of these patients has lost his life, larynx or voice. In bilateral tumors of the T1b category, 2 patients developed local recurrences and lost their larynx. Sixty-two carcinomas of the Tis, T1a and T1b categories were irradiated primarily. Two of these patients died and 14 underwent laryngectomy for local recurrence. In T2 carcinomas a 5-year cure rate of 87.5% was achieved by vertical partial resection. The 5-year cure rate after laryngectomy or laryngectomy with neck dissection for T2N0 and T2N+ carcinoma was 86.2% and 75.0% respectively. Most treatment failures were due to late metastases which could not be controlled. In T3 carcinomas with a 5-year cure rate of 71.4% (N0) and 70.0% (N+) respectively, treatment failures were also mainly seen in patients with N0 necks where we did not carry out a prophylactic neck dissection. Five-year survival rates for primary surgery in supraglottic T1-T4 carcinomas were 100%, 82.4%, 84% and 58.3%. The widely hel opinion that laryngeal carcinoma should only be subjected to surgery for irradiation failure can no longer be sustained. More patients lose their larynx or their life after irradiation of small carcinomas than after primary surgery. Furthermore, too many patients have to undergo two major cancer treatments (irradiation and salvage surgery). In larger carcinomas radiotherapy produces a lower survival rate and too many patients require two stressful cancer therapies. The number of retained larynges is not substantially higher than with primary surgery. Primary irradiation for selected cases should be part of every therapy concept that aims at an adequate and individual treatment of every patient.
报告了460例声带癌和124例声门上癌的治疗结果。在声带癌中，63.3%在Tis和T1早期阶段被诊断出来。76例肿瘤通过内镜切除，128例通过喉裂开术和弦切除术切除。这些患者中没有一人失去生命、喉部或嗓音。在T1b类双侧肿瘤中，2例患者出现局部复发并失去了喉部。62例Tis、T1a和T1b类癌主要接受了放疗。这些患者中有2例死亡，14例因局部复发接受了喉切除术。在T2癌中，垂直部分切除术的5年治愈率为87.5%。T2N0和T2N+癌行喉切除或喉切除加颈部清扫术后的5年治愈率分别为86.2%和75.0%。大多数治疗失败是由于无法控制的晚期转移。在T3癌中，5年治愈率分别为71.4%（N0）和70.0%（N+），治疗失败也主要见于未进行预防性颈部清扫的N0颈部患者。声门上T1 - T4癌一期手术的5年生存率分别为100%、82.4%、84%和58.3%。认为喉癌仅应在放疗失败后才进行手术的广泛观点已不再成立。小癌放疗后失去喉部或生命的患者比一期手术后更多。此外，太多患者不得不接受两种主要的癌症治疗（放疗和挽救性手术）。在较大的癌症中，放疗产生的生存率较低，太多患者需要接受两种压力较大的癌症治疗。保留喉部的数量并不比一期手术显著更高。对于选定病例的一期放疗应成为旨在对每位患者进行充分个体化治疗的每个治疗方案的一部分。
