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

Published online by Cambridge University Press:  29 June 2007

Ashok M. Shenoy*
Affiliation:
Departments of Head and Neck Surgery, The Kidwai Memorial Institute of Oncology, Hosur Road, Banagalore, India.
A. Nanjundappa
Affiliation:
Departments of Head and Neck Surgery, The Kidwai Memorial Institute of Oncology, Hosur Road, Banagalore, India.
Pradeep Kumar
Affiliation:
Departments of Head and Neck Surgery, The Kidwai Memorial Institute of Oncology, Hosur Road, Banagalore, India.
Rekha V. Kumar
Affiliation:
Departments of Oncopathology, The Kidwai Memorial Institute of Oncology, Hosur Road, Banagalore, India.
B. K. M. Reddy
Affiliation:
Departments of Radiation Oncology, The Kidwai Memorial Institute of Oncology, Hosur Road, Banagalore, India
V. Kannan
Affiliation:
Departments of Radiation Oncology, The Kidwai Memorial Institute of Oncology, Hosur Road, Banagalore, India
N. Anantha
Affiliation:
Departments of Radiation Oncology, The Kidwai Memorial Institute of Oncology, Hosur Road, Banagalore, India
*
Dr Ashok M. Shenoy, Department of Head and Neck Surgery, Kidwai Memorial Institute of Oncology, Hosur Road, Bangalore, India-5600029.

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.

Type
Main Articles
Copyright
Copyright © JLO (1984) Limited 1994

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References

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