End results of a prospective trial on elective lateral neck
dissection vs type III modified radical neck dissection in the
management of supraglottic and transglottic carcinomas
Brazilian Head and Neck Cancer Study Group1 1Participants in the Brazilian Head and Neck
Cancer Study Group: Ricardo R. Brentani, Luiz P. Kowalski, José F. Soares, and Humberto
Torloni (Principal investigators, Ludwig Institute for Cancer Research and Hospital A. C.
Camargo, São Paulo, Brazil); Raimunda N. Pereira (Data processing, Hospital A. C. Camargo,
São Paulo, Brazil); Mauro K. Ikeda, Roberto P. Andrade, Jose Magrin, Roberto E. V. Miguel,
Carlos R. Santos, Leda M. B. Saba, Joao V. Salvajoli (Hospital A. C. Camargo, São Paulo,
Brazil); Maria P. Curado, José C. Oliveira, Paula O. Montandon, Márcio M. Machado, Giovana
F. Denofrio, Waldyr C. Quinta, Rene B. Alvarez, Rita C. G. Alencar (Hospital Araújo Jorge,
Goiânia, Brazil); Benedito V. Oliveira, Gil Ramos, Lysandro S. Antunes (Hospital Erasto
Gaertner, Curitiba, Brazil); Jozias Andrade Sobrinho, Abrão Rapoport, Marcos B. Carvalho,
Antonio S. Fava, José F. Gois Filho, José F. S. Chagas, Jossi L. Kanda, Flavio M. Gripp,
Marcelo H. Ribas, Ivan S. Castro (Hospital Heliópolis, São Paulo, Brazil); Joni M. S. Oliveira,
José A. M. Oliveira, Ricardo C. Carvalho, Laércio B. Araújo (Hospital Napoleão Laureano, João
Pessoa, Brazil); Paulo A. L. Pontes, Luiz C. Gregório, Márcio Abrahão, Onivaldo Cervantes,
Marcos B. Paiva, Werner S. Hebbel, Reginaldo R. Fujita, Pedro H. H. Motta, Roberto A. Segreto
(Hospital São Paulo-Escola Paulista de Medicina, São Paulo, Brazil); Roberto S. Camargo,
Marcos S. Menten, Eugênio A. B. Ferreira, Celson Chassot (Hospital Universitário da
Universidade de São Paulo, São Paulo, Brazil).
Head and Neck Surgery Department, Hospital A. C. Camargo, Rua Professor Antonio Prudente,
211, 01509-010 - São Paulo, Brazil.
Presented at the Fifth Research Workshop on the Biology, Prevention, and Treatment of Head
and Neck Cancer, McLean, Virginia, Aug 26-30, 1998.
Funded by:
Ludwig Institute for Cancer Research, São Paulo branch
Keywords
laryngeal cancer; surgery; neck dissections; clinical trial; survival analysis
Abstract
Background
Either modified type III radical neck dissection (MRND) or lateral neck dissections (LNDs) are
considered valid treatments for patients with laryngeal carcinoma with clinically negative neck
findings (N0). The object of this prospective study was to compare complications, neck
recurrences, and survival results of elective MRND and LND on the management of laryngeal
cancer patients.
Patients and Methods
This prospective randomized study began in 1990, and patient accrual was closed on December
1993. A total of 132 patients was included in the trial. All patients had previously untreated T2T4 N0 M0 supraglottic or transglottic squamous cell carcinoma. No significant imbalance was
found between groups with respect to demographic, clinical, pathologic, and other therapeutic
variables. Seventy-one patients were given MRNDs (13 bilateral) and 61 were given LNDs (18
bilateral).
Results
The false-negative rate was 26%, and most positive nodes were sited at levels II and III.
Complications and period of hospitalization were similar in both groups. There were 6 ipsilateral
neck recurrences (4 in the MRND group, and 2 in the LND group). The 5-year actuarial survival
calculated by Kaplan-Meier method was 72.3% in the MRND group and 62.4% in the LND
group (log-rank test p = .312).
Conclusions
The rate of false-negative nodes in supraglottic and transglottic carcinomas was 26%, and most
positive nodes were at levels II and III. The rates of 5-year overall survival, neck recurrences,
and complications were similar in both groups. These results confirm the efficacy of lateral neck
dissection in the elective treatment of the neck in patients with supraglottic and transglottic
carcinomas. © 1999 John Wiley & Sons, Inc. Head Neck 21: 694-702, 1999.
Accepted: 11 May 1999
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