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Interjugular neck dissection and post-operative irradiation for neck control in advanced glottic cancers – are we justified?

  • Ashok M. Shenoy (a1), A. Nanjundappa (a1), Pradeep Kumar (a1), Rekha V. Kumar (a2), B. K. M. Reddy (a3), V. Kannan (a3) and N. Anantha (a3)...

Abstract

At the Kidwai Memorial Institute of Oncology, advanced laryngeal cancers are subjected routinely to primary surgery and/or post-operative radiotherapy (RT). The surgery consists of wide field laryngectomy which entails total laryngectomy, ipsilateral/bilateral thyroid lobectomy, bilateral paratracheal clearance, and bilateral clearance of levels 2, 3 and 4 lymphatics. Post-operative RT is indicated in event of the following histopathological (HPE) situations to consolidate local-regional control: (1) T4 primary; (2) significant subglottic extension; and (3) jugular/paratracheal metastatic deposits. This prospective study highlights the therapeutic efficacy of this protocol at our centre in 45 consecutive T4/T3 glottic cancers and specifically evaluates the role of interjugular dissection and/or post-operative RT in prevention of regional recurrence. Fifty-two per cent of primary lesions needed a post-surgical upstaging as against 14 per cent of the neck lesions. Accordingly 91 per cent of the cases (41/45) qualified for post-operative RT and 82 per cent (37/41) complied with the prescribedschedule. Recurrent disease in the lateral neck was noted in 2/37 who received the prescribed schedule and 1/4 non-compliant cases; while a recurrent central neck disease was noted in 1/37 and 1/4 of these cases respectively. All cases were followed-up for a period of two years and 66 per cent of the evaluable cases for a period of five years. This study confirms conclusively that our treatment schedule yields extremely gratifying two-year local-regional control rates of 89 per cent which translates into a two and five-year actuarial survival rate of 92 and 70 per cent respectively.

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Corresponding author

Dr Ashok M. Shenoy, Department of Head and Neck Surgery, Kidwai Memorial Institute of Oncology, Hosur Road, Bangalore, India-5600029.

References

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Interjugular neck dissection and post-operative irradiation for neck control in advanced glottic cancers – are we justified?

  • Ashok M. Shenoy (a1), A. Nanjundappa (a1), Pradeep Kumar (a1), Rekha V. Kumar (a2), B. K. M. Reddy (a3), V. Kannan (a3) and N. Anantha (a3)...

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