➤ Limited-stage laryngeal cancer constitutes a wide spectrum of disease.
The clinician must exercise judgment when recommending treatment in this
category. (Moderate Recommendation; EB-I)
• For a given patient, factors that may influence the selection of treatment modality
include extent and volume of tumor; vocal cord mobility, involvement of the anterior
commissure; lymph node metastasis; the patient's age, occupation, pretreatment voice
and swallowing function, patient preference and compliance; and the availability of
expertise in radiation therapy or surgery.
• Optimal outcomes require specialized skill, judgment and expertise.
• Poorly performed open or endoscopic surgery or radiation therapy will raise the risk
for recurrence or the need to add additional modalities of therapy to achieve disease
control.
Advanced Stage (T3, T4)
➤ Organ-preservation surgery, combined chemotherapy and radiation, and
radiation therapy alone, all with further surgery reserved for salvage, offer
the potential for larynx preservation without compromising overall survival.
• Anticipated success rates for larynx preservation, associated toxicities, and suitability
for a given patient will vary among these approaches.
• Selection of a treatment option will depend on patient factors including age,
co-morbidities, preferences, socio-economic factors, local expertise, and the
availability of appropriate support and rehabilitation services.
➤ For selected patients with extensive T3 or large T4a lesions and/or poor
pretreatment laryngeal function, better survival rates and quality of life
may be achieved with total laryngectomy rather than organ preservation
approaches and may be the preferred approach. (Strong Recommendation;
EB-H)
➤ All patients should have multidisciplinary evaluation regarding their suitably
for a larynx-preservation approach, and they should be apprised of these
treatment options.
• No larynx preservation approach offers a survival advantage compared with total
laryngectomy and appropriate adjuvant treatment.
➤ A minority of patients with T3, T4 primary-site disease will be suitable for
specialized organ-preservation surgical procedures, such as a supracricoid
partial laryngectomy. (Moderate Recommendation; EB-I)
• The addition of postoperative radiation therapy will compromise functional
outcomes.
• Induction chemotherapy before organ-preservation surgery is NOT recommended
outside of a clinical trial.
