A total of 72 consecutive laryngeal carcinoma patients at stage T3 or T4 were studied. The laryngeal cancer patients were treated first with concurrent chemoradiotherapy (40 Gy) in our department. Patients with residual disease subsequently underwent curative surgery, and chemoradiotherapy was continued to 70 Gy for those without residual disease. The three-year disease-specific-free survival (DSS) rates in patients with supraglottic, glottic and subglottic tumors were 58%, 71% and 100%, respectively. In patients at stage T3/T4, the DSS rates were 75%/46%, and in those with/without lymph node metastasis (N+/N-) the rates were 56%/78%. The three-year laryngeal preservation (LP) rates in patients with supraglottic/glottic/subglottic tumors, T3/T4 and N+/N- tumors were 12%/26%/50%, 28%/4% and 13%/29%, respectively. The recurrence rate was 29%, of which 75% have died, primarily of distant metastasis. These DSS and LP rates were not significantly different among the three subregions and N stages, although those in patients at stage T4 were significantly low, compared with T3 patients (p=0.01). These results suggest that additional treatment may be required for patients with T4 disease. Chemotherapy after surgery is now considered for T4 patients.
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