Comprehensive study on prognosis of malignant tumours of larynx – a prospective study.

More than 100 cases of laryngeal malignancy is being detected each year in upgraded institute of otorhinolaryngology Department, Madras Medical College Chennai. So the burden cases of carcinoma of larynx is ever increasing. Madras Metropolitan tumour registry, a population based cancer registry in chennai states that as of 2002, carcinoma larynx finds a place in top 10 cancers in men. Cumulative risk of getting ca larynx in their life time (0-74) is 1 in 208 and 1in 2000 in male and female respectively. ca larynx affects both sex with male preponderance which affects essential functions of larynx like speech and respiration and causes death. It is Mandatory to evaluate about the prognostic factors and treatment modalities is of prime importance. Predicting the favourable prognostic factors and choosing correct line of management is of paramount importance to increase the survival rate. In the era of organ preservation not all cases are subjected to surgery. So radiotherapy is the preferred treatment for most cases. But Radiotherapy carries the risk of residual or recurrent growth. This Dissertation analysis the prognostic factors and treatment modality adopted for 50 cases of our institute since 2004 and their survival rate after 2yrs. Since Organ Preservation is the main aim nearly 50% of the cases are subjected to Curative Radiotherapy when they present with T1, or T2 stage without metastases. In our study, out of 50 cases Curative radiotherapy is given for 22 cases who presented in early stage of the disease. Palliative radiotherapy with Chemotherapy given for 10 cases who presented with late stage of the disease. 13 patients underwent Total Laryngectomy, out of which 12 patients were in the stage III and one in Stage IV. Ideally, most cases are glottic cancers with T3 stage without nodal or distant metastases. Two cases underwent modified radical neck dissection along with Laryngectomy. Five cases absconded from treatment. There are eight cases of recurrence within the period of 2 years. Out of which one case was after Total Laryngectomy with modified radical neck dissection. That case was not subjected to post operative radiotherapy since that patient developed post operative Pharyngo cutaneous fistula and Subsequently he underwent myocutaneous flap transposition procedure. So we are unable to give Radiotherapy within about 4 months. Two cases of recurrence occured after primary Radiotherapy for Glottic cancer T1 No Mo and T3 No Mo. Those patients underwent total Laryngectomy who is disease free till now. Post radiation oedema of more than 6 months was considered as the criteria for surgery in first case. Residual lesion was considered as the criteria for surgery for second case. Remaining cases were given adjuvant Chemotherapy with Palliative procedures. All the recurrent cases were presented with nodal metastasaes initially. Histologically lymphoid depleted cases of 5 went in for recurrence. All the poorly differentiated cases responded well to Radiotherapy. Tumour Grade is not predicted as the important prognostic indicator as many literature studies shows Adequate resection of tumour, leaving tumour free margin resulted in disease free survival till 2 years – Literature also concurs with this