Cancer Health Center

Supraglottis

Standard treatment options:

1. External-beam radiation therapy alone for the smaller lesions.[1,2]
2. Supraglottic laryngectomy or total laryngectomy, depending on location of the lesion, clinical status of the patient, and expertise of the treatment team. Careful selection must be made to ensure adequate pulmonary and swallowing function postoperatively.
3. Postoperative radiation therapy is indicated for positive or close surgical margins.

Radiation should be preferred because of the good results, preservation of the voice, and the possibility of surgical salvage in patients whose disease recurs locally.[3]

Treatment options under clinical evaluation:

1. Hyperfractionated radiation therapy to improve tumor control rates and diminish late toxicity to normal tissue.[2,4]
2. Isotretinoin (i.e., 13-cis-retinoic acid) daily for 1 year to prevent development of second upper aerodigestive tract primary tumors.[5]

Glottis

Standard treatment options:

1. Radiation therapy.[1,2,6,7,8]
2. Partial or hemilaryngectomy or total laryngectomy, depending on anatomic considerations. Under certain circumstances, laser microsurgery may be appropriate.[9]

Treatment options under clinical evaluation:

1. Hyperfractionated radiation therapy to improve tumor control rates and diminish late toxicity to normal tissue.[2,4]
2. Isotretinoin daily for 1 year to prevent development of second upper aerodigestive tract primary tumors.[5]

Subglottis

Standard treatment options:

1. Lesions can be treated successfully by radiation therapy alone with preservation of normal voice.[1]
2. Surgery is reserved for failure of radiation therapy or for patients in whom follow-up is likely to be difficult.

Treatment options under clinical evaluation:

1. Hyperfractionated radiation therapy to improve tumor control rates and diminish late toxicity to normal tissue.[2,4]
2. Isotretinoin daily for 1 year to prevent development of second upper aerodigestive tract primary tumors.[5]

Current Clinical Trials

Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage II laryngeal cancer. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.

General information about clinical trials is also available from the NCI Web site.

References:

1. Mendenhall W, Werning J, Pfister D, et al.: Treatment of head and neck cancers. In: DeVita VT Jr, Hellman S, Rosenberg SA, eds.: Cancer: Principles and Practice of Oncology. Vols. 1 & 2. 8th ed. Philadelphia, Pa: Lippincott Williams & Wilkins, 2008, pp 809-77.
2. Wang CC, ed.: Radiation Therapy for Head and Neck Neoplasms. 3rd ed. New York: Wiley-Liss, 1997.
3. Ogura JH, Sessions DG, Spector GJ: Conservation surgery for epidermoid carcinoma of the supraglottic larynx. Laryngoscope 85 (11 pt 1): 1808-15, 1975.
4. Parsons JT, Mendenhall WM, Cassisi NJ, et al.: Hyperfractionation for head and neck cancer. Int J Radiat Oncol Biol Phys 14 (4): 649-58, 1988.
5. Hong WK, Lippman SM, Itri LM, et al.: Prevention of second primary tumors with isotretinoin in squamous-cell carcinoma of the head and neck. N Engl J Med 323 (12): 795-801, 1990.
6. Mittal B, Marks JE, Ogura JH: Transglottic carcinoma. Cancer 53 (1): 151-61, 1984.
7. Medini E, Medini I, Lee CK, et al.: Curative radiotherapy for stage II-III squamous cell carcinoma of the glottic larynx. Am J Clin Oncol 21 (3): 302-5, 1998.
8. Mendenhall WM, Amdur RJ, Morris CG, et al.: T1-T2N0 squamous cell carcinoma of the glottic larynx treated with radiation therapy. J Clin Oncol 19 (20): 4029-36, 2001.
9. Steiner W: Results of curative laser microsurgery of laryngeal carcinomas. Am J Otolaryngol 14 (2): 116-21, 1993 Mar-Apr.