Combined therapy for advanced cancer of the larynx and laryngopharynx consists of an integrated program in three phases: first, the administration of a preoperative, planned dose of supervoltage therapy; second, a postirradiation rest interval; finally, definitive, radical, extirpative surgery. The rest period may be as short as one day or as long as eight weeks. The extent of surgery does not depend upon the tumor response to radiotherapy, but is predetermined at the initial examination.
Shinz and Zuppinger21 originally suggested the sandwich method, with surgery interposed between preoperative or postoperative irradiation. Buschke and Gelante22 initially advocated a planned, unalterable method of preoperative irradiation of 4,100 to 6,500 roentgens and subsequent, definitive surgery one to three months after completion of therapy.
In 1951, MacComb and Fletcher23 reported favorable results in three instances of advanced cancer of the pyriform fossae treated by panlaryngectomy and radical neck dissection and followed