Carcinoma of the supraglottic larynx: Treatment results with radiotherapy alone or with planned neck dissection

Abstract

On the basis of our data and the literature, early or moderately advanced supraglottic carcinomas may be treated successfully with either supraglottic laryngectomy or radiotherapy. Supraglottic laryngectomy probably produces a higher initial local control rate but, based on anatomic and coexisting medical constraints, is suitable for a smaller subset of patients and has a higher risk of complications compared with radiotherapy.

When is definitive radiotherapy the preferred treatment for head and neck squamous cell carcinoma?

“…Patients who have low-volume, favorable primary SCCs unsuitable for a partial laryngectomy are treated with definitive RT. After consistent consideration of the above-listed pro et contra argument, the 5-year locoregional control rates in the range well above 80 % can be expected for early-stage I-II tumors and C60 % for stage III-IVA tumors with acceptably low (\5 %) probability of severe late complications, comparing favorably with the surgical series [16,20].…”

“…Patients with supraglottic SCC may be stratified into relatively low-volume primary cancers suitable for a supraglottic laryngectomy or definitive RT and advanced SCCs that are best treated with a total laryngectomy and neck dissection usually followed by postoperative (chemo)RT [16,17]. Patients who are suitable for larynx preservation have small primary tumors (6 cm 3 or less as assessed on a contrast-enhanced CT), have a good airway and non-compromised swallowing.…”

Laryngeal Cancer

“…As local control and voice quality outcomes are similar many centers prefer RT as the initial management option. In a series of 274 T1-2 supraglottic larynx cancer patients treated with RT demonstrated excellent 5-year local control (T1 = 100 % vs. T2 = 86 %) and cause specifi c survival (T1 = 100 % vs. T2 = 93 %) rates [ 5 ].…”

When is radiation therapy in head and neck squamous cell carcinoma not indicated?

“…Patients with the following clinically staged HNSCCs are generally considered for treatment with surgery alone: T1-T2N0 oral cavity, T1-T2N0 oropharynx [5,6], T1N0 glottis limited to one vocal cord [7], and T1-T2N0 supraglottis [8]. Postoperative RT is added for the indications previously discussed but the intention in the treatment of these patients should be single modality treatment to avoid the morbidity of more than one treatment modality.…”