Treatment
Limited Stage (T1, T2)
➤ All patients with T1, T2 laryngeal cancer should be treated, at least initially,
with intent to preserve the larynx.
➤ T1, T2 laryngeal cancer can be treated with radiation or larynx-preservation
surgery with similar survival outcomes.
• Selection of treatment depends on patient factors, local expertise, and the availability of
appropriate support and rehabilitative services.
• Every effort should be made to avoid combining surgery with radiation therapy because
functional outcomes may be compromised by combined-modality therapy.
• Single-modality treatment is effective for limited-stage, invasive cancer of the larynx.
➤ The success of the larynx preservation approach may be higher with initial
larynx-preserving surgery compared to radiation based on retrospective
studies. However, this may be subjected to patient selection factors. In
experienced hands, endoscopic resections are preferred because of equal
or better outcomes compared to open partial laryngectomy unless there are
issues with tumor exposure or safety of the endoscopic approach. (Moderate
Recommendation; EB-I)
➤ Surgical excision of the primary tumor with intent to preserve the larynx
should be undertaken with the aim of achieving tumor-free margins. Surgery
that anticipates the need for postoperative radiation therapy to treat close
or involved tumor margins or widespread dysplasia is NOT an acceptable
treatment approach. (Strong Recommendation; EB-H)
➤ Local tumor recurrence after radiation therapy may be amenable to salvage
by organ-preservation surgery, but total laryngectomy will be necessary for a
substantial proportion of patients, especially those with index T2 tumors.
➤ Combined chemotherapy and radiation may be used for larynx preservation for
selected limited stage patients with:
1. unfavorable or deeply invasive T2
2. T2 N+ cancers
3. patients for whom total laryngectomy may be the only surgical option
4. when the functional outcome after larynx-preservation surgery is expected to be
unsatisfactory
5. when surgical expertise for such procedures is not available.
