THE LARYNX, BRONCHI AND OESOPHAGUS

custom to use stomach replacement and this operation is described in
Chapter 43.

Posterior Wall. In this site it is important to make sure of the histology of
the tumour. If it is a leiomyosarcoma or a carcinosarcoma a wide local
removal should be done and the patient followed closely for 5 years.

If it is a carcinoma radiotherapy should be the primary treatment unless a
gland is palpable when surgery should be used. Small tumours can be removed
via a lateral pharyngotomy with primary repair. If the tumour is larger the
defect is replaced by a deltopectoral skin flap. In most instances these patients
will be able to keep their larynx.

Combined Therapy. In recent years it has become common to make use of
combined therapy hi cases where neither surgery nor radiotherapy on their
own give good results. The principle of this treatment is that a small dose of
radiotherapy is 90 per cent cancerocidal. Going beyond this dose leads to
mucositis and scarring which cause healing problems if secondary surgery is
attempted. Furthermore, in large tumours, radiotherapy will not sterilize the
centre of a tumour mass where there is no oxygen tension. Surgery will clear
a tumour macroscopically, but it will not remove small extensions outside the
immediate area of the tumour.

In planned combined therapy the patient has about 3000 r and 3 weeks later
has the same surgery that he would have had, if surgery had been the prime
treatment. In this way it is hoped that the best of both worlds will be obtained.
Since the results of treatment of hypopharyngeal tumours are so poor many
centres are using combined therapy. To date, however, no controlled trial has
been published to show that this method of treatment is a significant advance.

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