Combined treatment of stage III laryngeal cancer with different schedules of radiotherapy and surgery. Evaluation of preventive methods of the treatment of regional areas (cooperative randomized study)

: In 1980-1987, a cooperative randomized study of 363 patients with stage III laryngeal cancer (T1-3N0-1M0) was carried out. In 249 patients tumor was located in the vestibular space and in 114 in the vocal cord area; 78.5% of the patients had no regional metastases (N0) and 21.5% had metastases (N1). Combined therapy was applied to 251 patients, 135 of which were first exposed to radiotherapy and then to surgery and 116 were first exposed to surgery and then radiotherapy. In 71 patients, regional zones underwent preventive treatment (in 24 patients elective radiotherapy and in 47 preventive removal of the cervical fat were used). In 112 patients, the therapeutic protocol was modified due to different reasons (69 patients underwent only surgery and 43 radical radiotherapy). The therapeutic results were assessed in terms of three parameters: incidence of relapses and regional metastases, relapse-free time, and survival. This approach revealed no significant differences in the efficacy of the different protocols of the combined treatment. The 5-year survival rate of the patients with vestibular and cord space tumor was 77.9% and 80.7% respectively, when treated according to the radiotherapy + surgery protocol, and 82.8% and 89.2%, respectively, when treated according to the surgery + radiotherapy protocol. Comparison of preventive approaches showed that the 5-year survival rate increased by 92% as a result of removal of the subcutaneous fat from the neck area.