Preoperative radiotherapy reduces cervical metastasis of supraglottic carcinoma: A prospective randomized trial in 201 patients

Objective To evaluate the effectiveness of preoperative radiotherapy in the control of overall cervical lymph node metastasis from supraglottic carcinoma. Methods A prospective randomized study on 210 patients with supraglottic carcinoma was performed. Nine patients were lost from follow-up and therefore excluded. The analysis was based on the remained 201 patients including fifteen who did not complete the treatment protocol. Surgery alone (S) was carried out in 102 patients and radiotherapy (40Gy) followed by surgery (R+S) in 99 patients. All the patients were followed up for more than three years. Results No statistically significant difference in survival rates between S and R + S groups was found by using the Kaplan-Meier analysis. However, relative risk of overall cervical recurrence had a trend of reduction for patients in R + S group, versus patients in S group. There was a statistically significant reduction of lymph node metastasis in R + S group compared to S group in stage I - III (P = 0.0198) while in stage lV no such difference was observed. Patients with stage I - III disease who did not receive preoperative radiation were 1.766 times more likely to develop neck recurrence compared to patients who did. Among all the factors, only TNM stage and histological nodal status were found to be independent risk factors for regional control. Contralateral neck failure occurred more frequently in patients with advanced lesion (P = 0.020) and in patients without preoperative radiation (P = 0.018). Conclusion There may be a trend towards improved control of cervical lymph node metastasis with preoperative radiation of 40 Gy dose in patients with supraglottic cancer in stage I - III of the disease.