Abstract
ABSTRACT
Objective
To evaluate patients who received bilateral elective nodal irradiation (ENl) alone as a sole treatment to clinically negative neck.
Methods
We retrospectively reviewed clinical records of 55 T3N0 supraglottic squamous cell carcinoma (SCC) patients with cord fixation treated in Imam Hospital, Tabriz from January 2001 to January 2007. The primary site was treated with laryngectomy and radiotherapy (RT), and their NO necks were treated with RT alone. RT was delivered in standard fractionation and field arrangement with median dose of 5000 cGy.
Results
Out of fifty five patients, six were excluded because of the preoperative treatment with chemotherapy and/or radiation, or positive margins. Four had insufficient follow up, leaving 45 patients with N0 necks who completed radiation in both side. On median follow up of 24 months, the clinically negative neck was the first site of failure in 4.4% of patients (2/45). Median time to recurrence was 11 months.
Conclusion
Our data support the use of ENI as a prophylactic treatment for clinically negative neck in T3 supraglottic SCC. We suggest that routine neck dissection may not be necessary, and ENI may be a safer modality is an oncologically acceptable alternative in T3N0 supraglottie SCC patients. Prospective trials are necessary to further define role of RT in this patient population. (Rawal Med J 2010;35: ).
Keywords
Squamous cell carcinoma, radiotherapy, supraglottis.
INTRODUCTION
Management of the N0 neck in supraglottic laryngeal carcinoma (SGLC) remains controversial. There is a strong debate on when and how to treat the neck in patients with SGLC and N0 neck. Embryologic and clinical studies in the past have shown that the cancer of supraglottic larynx has a tendency to spread bilaterally to the cervical lymphatic.1 Cervical lymph node metastases represent the single most important prognostic factor influencing the outcome in patients with SCC of the head and neck.2 For SGLC, the incidence of occult metastases has been reported to vary from 21-41%, compared to the glottis.3 Modern imaging techniques such as ultrasonography, CT, MRI and PET, probably may never detect microscopic disease in neck nodes.4 Three treatment options are available for management of the clinically negative neck (cN0): elective neck dissection, elective neck irradiation or observation with therapeutic neck dissection performed if regional metastases become clinically apparent.4,5 Most of the current literature favors elective treatment for T3No neck in supraglotic carcinoma, because of improved survival6 and significantly decreased cervical recurrence.7 Albert et al suggested use of RT as a prophylactic treatment for the clinically negative neck.8 The purpose of this study was to evaluate the effectiveness of elective nodal irradiation for patients with T3N0 SG

Key words: Squamous cell carcinoma, radiotherapy, supraglottis.