Neck failure in T2N0 squamous cell carcinoma of the true vocal cords: the Fox Chase experience and review of the literature.

There is a need for additional data in the literature regarding elective nodal irradiation in the treatment of T2N0 squamous cell carcinoma of the glottic larynx. We examined the experience at the Fox Chase Cancer Center and performed a literature review in order to define a treatment policy. Sixteen patients with T2 squamous cell carcinoma of the glottic larynx were treated with radiation therapy. Ten patients were irradiated to the larynx alone and six to the larynx and regional nodes. None of the patients in our series experienced a nodal recurrence regardless of whether the neck was electively irradiated. A literature review of 413 patients revealed that 2.6% of patients who did not have their nodes electively irradiated and had their primary tumor controlled experienced a nodal failure compared to 3.7% if the primary and regional nodes were irradiated (P = 0.88). Similarly, there was no significant difference in the rate of nodal failure for patients who experienced a recurrence at the primary site regardless of whether they received elective nodal irradiation (P = 0.36). We recommend treatment to the larynx alone since our policy is to treat the regional nodes only when the incidence of occult lymphadenopathy in the neck exceeds 15%.