Clinical Evaluation and Analysis of Treatments for Advanced Laryngeal Carcinoma (Stage III, Stage IV).

we reported aggressive treatment for patients with Stage III and IV laryngeal carcinomas based on our study of the records of 89 consecutive patients (previously untreated) who presented stage III and IV carcinomas of the larynx in the period 1975-89.Of these, 53 were stage III patients and 36 were stage IV, and the histological diagnosis in every case was squamous cell carcinoma. The average age of the patients was 66.2 years, and the male-female ratio was 9 to 1.In the advanced laryngeal carcinoma, the incidence in the cases of supraglottic carcinoma (47/89, 52.8%) was higher than in the cases of glottic carcinoma (37/89, 41.6%). Thirty-one of the 47 cases of supraglottic carcinoma (66.0%) had metastasis to the jugular lymph nodes.The 5-year cumulative survival rate, viewed by stages, was 63.8% for stage III glottic carcinoma, 74.4% for stage IV glottic carcinoma, 60.9% for stage III supraglottic carcinoma and 40.0% for stage IV supraglottic carcinoma.Initial examinations revealed metastasis to the jugular lymph nodes in 41 cases. Prognosis was poor, with the 5-year cumulative survival rate for these cases (47.5%) lower than that for the 48 cases without metastasis (66.3%).Twenty of the 89 cases of advanced laryngeal carcinoma were classified as poorly differentiated squamous cell carcinoma, and the 5-year cumulative survival rate for these (33.1%) was definitely lower than for that the well differentiated types (69.4%; P<0.05).We conclude that wide resection with complete neck dissection, including irradiation and chemotherapy, is indicated for stage III and IV laryngeal carcinomas-particularly in patients who have supraglottic stage IV tumors with poorly differentiated squamous cell carcinoma. Adjuvant and neo-adjuvant chemotherapy should be administered to prevent lung metastasis, which is the most recurrent form of cancer.