Treatment
➤ Concurrent chemoradiation therapy offers a significantly higher chance
of larynx preservation than does radiation therapy alone or induction
chemotherapy followed by radiation albeit at the cost of higher acute
in-field toxicities and without improvement in overall survival. (Strong
Recommendation; EB-H)
• The best available evidence supports the use of cisplatin as the drug of choice in this
setting.
➤ There is insufficient evidence to indicate that survival or larynx-preservation
outcomes are improved by the addition of induction chemotherapy before
concurrent treatment or the use of concurrent treatment with altered
fractionation radiation therapy in this setting. (Moderate Recommendation;
EB-I)
➤ For patients who desire larynx-preservation therapy but are not candidates for
organ-preservation surgery or chemoradiation, radiation therapy alone is an
appropriate treatment.
• With this last approach, survival is similar to that associated with chemoradiation
therapy when timely salvage surgery is incorporated, but the likelihood of larynx
preservation is lower.
Regional Cervical Nodes
➤ Most patients with T1, T2 lesions of the glottis and clinically negative cervical
nodes (N0) do not require routine elective treatment of the neck.
➤ Patients with advanced lesions of the glottis and all patients with supraglottic
lesions should have elective treatment of the neck, even if clinically N0.]
➤ Patients with clinically involved regional cervical nodes (N+) who are
treated with definitive radiation therapy or chemotherapy and radiation
therapy and who have a complete clinical, radiologic and metabolic imaging
(positron emission tomography–computed tomography [PET-CT] at 12
weeks or later after therapy) do not require elective neck dissection. (Strong
Recommendation; EB-H)
➤ Patients with equivocal fluorodeoxyglucose (
18
F-FDG) uptake should undergo
neck dissection. The risks and cost of expectant observation versus surgery
should be discussed with the patient. (Strong Recommendation; EB-H)
➤ Patients with clinically involved cervical nodes who are treated with surgery
for the primary lesion should have neck dissection. If there are poor-risk
features, adjuvant concurrent chemoradiation therapy is indicated.
