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May 14, 1982

Treatment of Cancer of the Larynx

JAMA. 1982;247(18):2498. doi:10.1001/jama.1982.03320430022013

To the Editor.—  The article by A. Robert Kagan, MD, on radiologic evaluation and radiation therapy of "Cancer of the Endolarynx" (1981; 246:1124) was concise and informative. Certain points, however, demand discussion. The author stated that radiation therapy is the treatment of choice for all T1 and T2 lesions of the larynx. He cites minimal morbidity with cure rates of 60% to 70%.Dr Kagan dismissed the results of surgical treatment in operative series as being favorably biased. He failed to point out that patients undergoing salvage surgery for recurrence are not presented as failures in the radiation treatment statistics.In this regard, DeSanto1 presented the Mayo Clinic experience in treatment for in situ and early invasive carcinoma of the glottis. Actuarially determined survival rates were similar when transoral surgery, laryngofissure, and radiation therapy were compared. However, of the 147 patients treated with radiation therapy, 84 required salvage surgery,