Radiation therapy treatment of larynx cancers.

Cancers in the mouth and throat area comprise only 5% of all cancers seen in the US. Because of their critical location and the various consequences of treatment, they produce a devastating impact on the quality of life. Of the many anatomic sites in the upper air and food passages, the oral cavity and larynx are involved with cancer in two thirds of the patients. In the oral cavity, less than 50% of the cancers are diagnosed when the disease is still localized, leading to a generally poor overall result. In the larynx, two thirds of the primaries arise in the glottis where hoarseness stimulates early diagnosis, leading to an excellent prognosis. Treatment strategies must be directed toward the observed patterns of failure. For mouth and throat cancers, even when modestly advanced, distant failure is observed in fewer than one third of the patients. Control of the disease in the primary site and regional node stations generally employs aggressive use of surgery, radiation therapy, or a combination of the two. More recently, the use of chemotherapy programs combined with either surgery or radiation therapy has been of benefit to patients with advanced lesions. The choice of a specific management program depends upon (1) the cancer control to be expected, (2) the effectiveness of a possible salvage treatment program, and (3) the quality of life experienced by the successfully treated patient. Radiation therapy is increasingly becoming the treatment of choice for early carcinomas of the larynx. Recently published results from four major institutions embracing over 4000 patients suggest radiation therapy cure rates for T1 lesions of 90% and T2 lesions of 70%, with the successful salvage by surgery of more than 50% of the radiation therapy failures, bringing the ultimate cure rate to over 95% for T1 lesions and over 85% for T2 lesions. The excellent results coupled with the good quality of life mandates this approach. Surgical alternatives are more frequently suggested for T3 lesions or for supraglottic lesions. Primary radiotherapy for T3 glottic lesions currently cures more than 50% of such patients with surgical salvage, bringing the total cure rate to 75%. Also two thirds of the cured patients retain their functioning larynx, increasing consideration must be given to primary radiation therapy and surgical salvage for these more advanced glottic lesions.(ABSTRACT TRUNCATED AT 400 WORDS)