• 대한두경부종양학회지
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• 제13권1호
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• pp.24-29
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• 1997

Background: Supraglottic and hypopharyngeal regions drain into the upper deep cervical lymph nodes. And bilateral neck node metastasis is frequently occured especially, in the early stage. It influences on the prognosis of above diseases. The prognosis for patients wih supraglottic and hypopharyngeal cancers, although usually poor, has improved by modern imaging technique, better application of treatment modalities, increasing assortment of reconstructive procedures and improved application of radiation therapy. Objectives: This study was designed to obtain objective data about the patterns of neck node metastasis and to identify the necessity of elective bilateral neck dissection. Material and Methods: Twenty four patients with supraglottic cancer and twenty six patients with hypopharyngeal cancer were investigated from the chart review. Results: In supraglottic cancer, the most frequent sites of neck metastasis is level II (52.9%) and level III (52.9%) in ipsilateral side, level II (29.4%) in contralateral side, in hypopharyngeal cancer, level II (73.7%) and III (52.6%) in ipsilateral side, level II (10.5%) in contralateral side. In elective neck dissection, the occult metastasis is about 50% in supraglottic cancer, but there is no occult metastasis in hypopharyngeal cancer. Conclusion: In supraglottic cancer, elective bilateral neck dissection is necessary because of early contralateral neck metastasis, but in hypopharyngeal cancer, elective contralateral neck dissection may not be always necessary because of rare occult metastasis and contralateral neck metastasis.

• 대한두경부종양학회지
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• 제14권2호
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• pp.164-168
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• 1998

레이저를 이용한 내시경하 상후두부분절제술은 술전에 정확한 병기판정으로 초기 국소병변의 선택을 신중하게 하고 경부 림프절전이의 치료를 효율적으로 시행하는 경우 기존의 수술법과 유사한 생존율을 얻을 수 있었다. 환자의 상태에 따라서 충분한 수술시야를 확보하는데 어려움이 있으며, 병변의 위치에 따라서 술중 절제연의 확인이 힘들다는 제한점을 고려해야 하며, 술 후 발생할 수 있는 출혈, 부종, 오연 등의 합병증에 대비하기 위하여 술 전 기관절개술이 유용할 것으로 생각된다.

• 대한두경부종양학회지
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• 제25권1호
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• pp.18-23
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• 2009

Objectives : In $CO_2$ laser surgery for supraglottic cancer, neck dissection is generally done in second stage. We investigated simultaneous neck dissection with primary resection could be available in laser supraglottic surgery. Material and Methods : We analyzed 13 patients with supraglottic cancer who were treated with transoral supraglottic laryngectomy and simultaneous neck dissection from 2001 to 2007. Tumor stage, extent of laser surgery, histological results, survival rate, local control rate, complications, and functional results were reviewed. Results : 5-year local control rate, survival rate and disease specific survival rate from the neck was 100%, 69.9%, 100% respectively. Tracheotomy was done in all 13 cases. One patient had a long tracheotomy indwelling (191 days). In the rest of 12 patients average decanulation time was 7.4 days(1-22 days). Nasogastric tube was inserted in 5 cases, and average oral intake was possible in 3.5 days(1-16 days). Average hospital days was 29.7 days. There was no serious complication associated with neck dissection. Conclusion : Simultaneous neck dissection with primary laser resection for supraglottic cancer is oncologic sound and can be performed without significant surgical morbidity.

• 대한두경부종양학회지
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• 제9권2호
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• pp.193-199
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• 1993

The prognosis of supraglottic cancer is worse than that of glottic cancer. Supraglottic cancers by subsites have different microenvironment of cancer cells, locoregional spread patterns. Therefore we presume that high therapeutic efficacy, while preserving the organ, can be obtained when supraglottic cancer is treated effectively according to its biological behaviors. For the purpose of determination of clinical characteristics and causes of treatment failures by subsites of supraglottis, the authors analyzed 24 cases(stage III 14 cases, stage IV 10 cases) of supraglottic cancer which were managed mainly by surgery in our institute. The results were as follows; 1) The suprahyoid group had worse pathologic grades, more frequent spread to hypopharynx, more freguent recurrence at primary site, and better three-year survival rate than the infrahyoid group. 2) The infrahyoid group had more frequent spread to glottis, understaging, recurrence at cervical nodes than the suprahyoid group. 3) There was no differences in nodal metastasis by sub sites. These results suggest that the suprahyoid group may have more aggressive spread pattern but better prognosis than the infrahyoid group.

• 대한두경부종양학회지
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• 제17권2호
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• pp.194-197
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• 2001

Background and Objectives: Supraglottic cancer have a great tendency to spread cervical lymph nodes and lymph node metastasis is a well known prognostic factor. However the treatment for N0 neck in supraglottic cancer is still controversial. Materials and Methods: We retrospectively analyzed our neck management of supraglottic cancer patients who present with cN0 contralateral neck from 1989 through 1997. 36 patients were eligible for analysis. The primary site was surgically removed and the neck was managed by elective neck irradiation (ENI), elective neck dissection (END), or therapeutic neck dissection (TND) with postoperative radiation therapy (PORT). Results: Our results revealed that 18 of 36 patients have clinically negative neck, another 18 patients have clinically positive neck (N1-3). In clinically negative group, 12 of 18 patients were received ENI and there was 1 failure in contralateral neck area. Remaining 6 patients were received END with PORT and there was no failure. In clinically positive neck group, 3 of 18 patients were received ipsilateral TND and an additional contralateral END with PORT. Remaining 15 patients who were received TND with PORT, developed 3 neck failure. Conclusion: ENI or ipsilateral or bilateral END can be done in the cN0 neck of supraglottic cancer however ipsilateral TND and contralateral END with PORT is reasonable for the cN(+) neck.

• 대한두경부종양학회지
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• 제20권1호
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• pp.19-23
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• 2004

Background and Objectives: Neck metastasis is one of the most important prognostic factor in head and neck squamous cell carcinoma. Recently, elective neck dissection has been widely accepted for accurate pathologic staging and elective treatment of neck. Occult metastasis rate of laryngeal cancer varies widely depending upon authors. To evaluate the rate and characteristics of occult metastasis and efficacy of the elective neck dissection in clinical N0 laryngeal cancer, we performed this study. Materials and Method: Seventy two patients (supraglottic cancer: 19 cases, glottic cancer: 53 cases) who underwent surgery for laryngeal cancer as an initial treatment from 1993 to 2002 were evaluated. All was underwent elective neck dissection at the time of surgery for the primary treatment. The record of patients and pathologic report were reviewed retrospectively. Results: Occult metastasis rate of supraglottic and glottic cancer were 42.1% (8/19) and 9.4% (5/53), respectively. According to T stage, the occult meastasis of supraglottic and glottic cancer was 20%, 0% in T1, 36.4%, 0% in T2, 100%, 40% in T2, 100%, 20% in T4, respectively. Occult metastasis was mostly confined within level II (69.2%), III (76.9%), IV (23.1%). Conclusion: Based on ours results, elective neck dissection might be needed in treating of clinically N0 all supraglottic cancer and advanced T3, T4 glottic cancer.

• Radiation Oncology Journal
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• 제12권3호
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• pp.323-329
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• 1994

Purpose: In supraglottic cancer, radiation therapy is used to preserve the laryngeal function but combined surgery and radiation therapy is required in advanced stage. The authors Present the results of radiation therapy alone and combined surgery Plus Postoperative radiation therapy for supraglottic cancer. Methods and Materials: A retrospective analysis was done for 43 patients with squamous cell carcinoma of the supraglottic larynx who were treated from Feburary 1982 to December 1991, in the Department of Radiation Oncology, Korea University Hospital. Patient distribution according to the AJCC staging system was as follows: I, 3($7.0\%$); II, 7($16.3\%$); III, 17($39.5\%$); IV, 16($37.2\%$). Patients' age ranged from 30 to 72 years(median 62). Follow up durations were from 21 to 137 months(median 27). Seventeen patients($39.5\%$) were treated by radiation therapy alone with radiation doses of 6840-7380 cGy and 26 patients($60.5\%$) were treated with surgery plus postoperative irradiation with doses of 5820-6660 cGy. Results: Overall five-year survival rate for all stage was $51.8\%$, with $100\%$ for Stage I and II, $47.3\%$ for Stage III, and $29.2\%$ for Stage III. The difference of the survival rate by stage was statistically significant(p=0.0152). Five-year survival rates were $100\%$ for locally confined tumor in the supraglottic larynx, $37.5\%$ for transglottic extension, $26.7\%$ for hypopharynx extension, and only two of 5 patients with both transglottic and hypopharynx extension were alive(p=0.0033). Five-year survival rates by neck node status were as follows: $55.0\%$ for NO, $64.3\%$ for N1, $50.0\%$ for N2, and all 2 of N3 were died of disease. Overall survival rate for radiation therapy alone group was $42.8\%$, and it was $56.7\%$ for surgery plus postoperative radiation therapy group with no statistically significant difference(p=0.5215). In Stage I and II, all Patients survived. In Stage III and IV, 5-year survival rate for radiation therapy alone group was $28.5\%$ and $43.4\%$ for surgery plus postoperative irradiation group(p=0.5103). Local control rate was $58.8\%$(10/17) for radiation therapy alone group and $73.1\%$ (19/26) for surgery plus postoperative irradiation group. Three patients from surgery plus postoperative radiation therapy group developed distant metastasis in lungs. Conclusion: Treatment results of radiation therapy alone was excellent in early stage supraglottic cancer. In advanced stage, even the difference was statistically not significant, the result of postoperative radiation therapy group was superior compared with radiation therapy alone group. Since 1992, concomitant chemoradiotherapy with hyperfractionated radiotherapy is being used to improve the result of the treatment and preserve the laryngeal function in advanced stage supraglottic cancer.

• 대한기관식도과학회지
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• 제4권1호
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• pp.91-95
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• 1998

Background： Laryngeal cancer, the most common malignancy of head and neck, is being detected and treated in earlier and more effectively due to introduction of endoscope, continuous development of radiographic technology, and advancement in new surgical techniques such as laser surgery and conservation laryngeal surgery Objectives To compare the different treatment results for early laryngeal cancer to determine which methos provides the good prognosis. Materials and Methods： Retrospective study was done for 135 patients with early laryngeal squamous cell carcinoma(Stage I or II) who were treated at our institute between 1989 to 1996. There were 105 patients with glottic cancer(Stage I: 68 patients, Stage II：37 Patients) and 30 patients with supraglottic cancer(Stage I: 12 patients, Stage II：18 patients) Initial treatment included radiation therapy for 54 patients, endoscopic laser surgery for 8 patients, laryngofissure and cordectomy for 8 patients, vertical partial laryngectomy for 37 patients, supraglottic laryngecomy for 14 patients and supracricoid laryngectomy for 5 patiens, and total laryngectomy for 9 patients. Results : Salvage treatments, such as total laryngectomy, conservation laryngeal surgery, radiation therapy and neck dissection were performed for initial treatment failure with 9 patients after radiation therapy, 8 patients after conservation laryngeal surgery, 2 patients after endoscopic laser and 3 patients after total laryngectomy. Overall 3-year survival rate for glottic 71 was 92.4%, glottic f 84.3%, supraglottic 7172.7%, and supraglottic f was 63.%%. However, survival rate of the same stage was variable according to the choice of initial treatment. Conclusion New classification of the early laryngeal cancer was necessary and helpful for the choice of the initial treatment.

• 대한기관식도과학회지
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• 제8권1호
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• pp.81-86
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• 2002

Background and objectives : There may be frequent lymphatic neck metastasis among supraglottic cancer patients after their primary surgery. The aim of this study was to evaluate the effectiveness of prophylactic neck dissections in supraglottic cancer patients to lower the neck metastasis. Material and method : The authors retrospectively reviewed medical records of 52 patients (7 females. 45 males) who had received the operations for the supraglottic cancer from 1995 to 2000. They were preoperatively examined with Computer Tomographic images, and also examined by the cervical neck palpations. Postoperative pathologic specimens were reviewed and the Pathologic stagings were confirmed by the pathologist. Results : Among 52 patients who received surgery for supraglottic carcinoma, 5 patients received ipsilateral neck dissection, 12 patients received ipsilateral neck dissection with postoperative radiation therapy, 10 Patients received bilateral neck dissection and 25 patients received bilateral neck dissection with postoperative radiation treatment. In comparison of the data of N0 to N+ conversion rate of neck, there were 11 ipsilateral T3 N0 patients and 2 patients(18%) were converted to N+ status, and there were 8 Patients with T4 N0 stages, and 3 patients(38%) were converted to N+ status. In comparing the data of contralateral neck dissection on N0 patient, there were 8 patients of T3 N0 patients, and there was 1 patient (13%) who showed recurrence. There were 5 patients of T4 N0 stages and there was 1(20%) patient with recurrences. When the ipsilateral N stages were N2a, and N2b, there 1 case of contraleral N+ conversions, respectively. In recurrences, there were 2 patients of N2b staged patients and 1 patient of N2c patient that showed recurrence during the follow up period. Conclusion : This data shows that at least an ipsilateral neck dissection is necessary in order to prevent the recurrences, and also suggests that bilateral neck dissection is necessary for the higher T stage. Since the higher N staged patients showed higher rate of recurrence, so that neck dissection is mandatory for the higher N staged patients.

• 대한두경부종양학회지
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• 제23권1호
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• pp.15-20
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• 2007

Background and Objectives：Supraglottic partial laryngectomy is oncologically sound surgical procedure for selected cases of laryngeal cancer which maintains physiologic speech and swallowing without permanent tracheostoma. The purpose of this study is to evaluate the oncologic and functional results of supraglottic partial laryngectomy and neck dissection for supraglottic cancer. Materials and Methods：Between 1991-2005, Twenty-three supraglottic cancer patients, underwent supraglottic partial laryngectomy, were studied retrospectively. There were 5 patients with cT1, 14 with cT2, 4 with cT3 and 11 patients with cN0, 1 with cN1, 10 with cN2, 1 with cN3. All patients underwent neck dissection and postoperative radiotherapy was added to twenty patients. They were reviewed with respect to primary subsites, extended subsites, treatment result, survival rate, factors affecting the prognosis, postoperative complication, time of decannulation and oral diet, and postoperative voice. Results：Among eleven patients with clinically negative node, six patients had pathologically positive nodes. So occult metastasis was 54.5%. Two patients recurred at cervical lymph node and one had distant metastasis to lung. Local and regional control were 100% and 91.3%. The overall 3-year and 5-year survival rate were 84%, 78%, respectively. Nineteen cases were squamous cell carcinomas and four were basaloid squamous cell carcinomas. Basaloid subtype was significantly affected to survival. Decannulation and oral feeding were possible in 100%. Conclusions：Supraglottic partial laryngectomy is oncologically safe and functionally good procedure in supraglottic cancers. Elective neck dissection is beneficial in management of occult cervical metastasis.