Laryngeal Cancer Treatment (PDQ®)–Health Professional Version

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Changes to This Summary (12/21/2016)

The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.

General Information About Laryngeal Cancer

An editorial change was made to this section.

Updated statistics with estimated new cases and deaths for 2016 (cited American Cancer Society as reference 1).

Stage Information for Laryngeal Cancer

Revised text to state that the assessment of the primary tumor is based on inspection and palpation when possible and by fiberoptic laryngoscopy; also added that panendoscopy under anesthesia ensures careful clinical examination to determine the clinical extent of local disease. An additional revision states that head and neck magnetic resonance imaging, computed tomography, or positron emission tomography/computed tomography should be done before therapy to supplement inspection and palpation.

Treatment Option Overview for Laryngeal Cancer

Added text to state that elective neck radiation should be considered for T3 or T4 glottic tumors or T1 to T4 supraglottic tumors.

Stage I Laryngeal Cancer Treatment

Added text to state that selection of treatment should include an evaluation of voice function and quality after treatment; added that endoscopic CO2 laser resections may also achieve similar results in terms of local control and function (cited Agrawal et al. as reference 1) compared with radiation therapy, although no randomized studies have been performed (cited Dey et al. as reference 2). Also added that a meta-analysis of 22 consecutive case series to examine oncologic control demonstrated no clear differences between transoral CO2 laser excision and external beam radiation therapy (EBRT) in terms of local control; there was a trend for improved posttreatment voice quality with radiation therapy. Transoral CO2 laser–excision surgery dominates radiotherapy from a cost-utility standpoint (added level of evidence 2C).

Added option to list of glottis standard treatments to include endoscopic CO2 laser excision (cited Higgins as reference 11).

Stage II Laryngeal Cancer Treatment

Added option to list of supraglottis standard treatments to include EBRT alone for the smaller lesions encompassing the primary disease and regional elective nodes.

Revised option in list of supraglottis standard treatments to state supraglottic laryngectomy with bilateral neck dissections, depending on location of the lesion, clinical status of the patient, and expertise of the treatment team.

Revised option in list of supraglottis standard treatments to state postoperative radiation therapy (PORT) is indicated for positive or close surgical margins or other adverse pathological risk factors.

Added PORT With or Without Chemotherapy as a new subsection.

Stage III Laryngeal Cancer Treatment

Added Forastiere et al. as reference 1.

Added Lefebvre et al. as reference 6 and level of evidence 1iiC.

Revised option in list of supraglottis standard treatments to state definitive radiation therapy alone with altered fractionation in patients who are not candidates for concomitant chemotherapy and surgery for salvage of radiation failures.

Added option to list of supraglottis standard treatments to include surgery with or without PORT (cited The Department of Veterans Affairs Laryngeal Cancer Study Group as reference 8).

Revised option in list of glottis standard treatments to state definitive radiation therapy alone with altered fractionation in patients who are not candidates for concomitant chemotherapy and surgery for salvage of radiation failures.

Added option to list of glottis standard treatments to include surgery with or without PORT.

Added option to list of subglottis standard treatments to include definitive radiation therapy alone with altered fractionation in patients who are not candidates for concomitant chemotherapy and surgery (total laryngectomy) for salvage of radiation failures.

Added option to list of subglottis standard treatments to include induction chemotherapy followed by concomitant chemotherapy and radiation. Also added that laryngectomy is reserved for patients with less than a 50% response to chemotherapy or who have persistent disease after radiation.

Added Concomitant Chemoradiation Therapy as a new subsection.

Added Induction Chemoradiation Therapy Followed by Concomitant Chemoradiation Therapy as a new subsection.

Added Altered Fractionation as a new subsection.

Added Surgery Followed by PORT or Chemoradiation Therapy as a new subsection.

Stage IV Laryngeal Cancer Treatment

Added Forastiere et al. as reference 1.

Added Lefebvre et al. as reference 6.

Revised option in list of supraglottis standard treatments to state for patients with bulky T4 disease, surgery with PORT with or without concomitant chemotherapy based on pathological risk factors for large volume T4 disease.

Revised option in list of glottis standard treatments to state for patients with bulky T4 disease, total laryngectomy with PORT with or without concomitant chemotherapy based on pathological risk factors for large volume T4 disease.

Added Concomitant Chemoradiation Therapy as a new subsection.

Added Induction Chemoradiation Therapy Followed by Concomitant Chemoradiation Therapy as a new subsection.

Added Surgery Followed by PORT or Chemoradiation Therapy as a new subsection.

This summary is written and maintained by the PDQ Adult Treatment Editorial Board, which is editorially independent of NCI. The summary reflects an independent review of the literature and does not represent a policy statement of NCI or NIH. More information about summary policies and the role of the PDQ Editorial Boards in maintaining the PDQ summaries can be found on the About This PDQ Summary and PDQ® - NCI's Comprehensive Cancer Database pages.

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