Patient Selection
➤ Selection of therapy for an individual patient requires assessment by the
multidisciplinary team, as well as consideration of voice, and swallowing
function, patient comorbidity, psychosocial situation and preferences, and local
therapeutic expertise. (Moderate Recommendation; EB-I)
• The multidisciplinary team should include surgical oncolog y, medical oncolog y,
radiation oncolog y, speech patholog y, radiolog y, patholog y, nursing, dietetics,
psycholog y, and a variety of rehabilitative services including dental/prosthodontics,
smoking cessation, or other ancillary services as required for such things as pain
management, and psychosocial support.
➤ There are no validated markers that consistently predict outcomes of
larynx-preservation therapy. (Moderate Recommendation; EB-I)
• However, patients with a non-functional larynx (e.g., extensive T3 or T4a) or tumor
penetration through cartilage into surrounding soft tissues are considered poor
candidates for a larynx preservation approach.
• Primary surgery, usually total laryngectomy, is commonly recommended in this setting.
➤ Continued cigarette smoking is associated with a worse outcome after therapy.
• Patients should be encouraged to abstain from smoking after the diagnosis and
monitored and recommended for smoking cessation programs as necessary throughout
and following treatment.
