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    Laryngeal Cancer Treatment (PDQ®): Treatment - Health Professional Information [NCI] - Stage III Laryngeal Cancer

    Supraglottis

    Standard treatment options:

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    1. Chemotherapy administered concomitantly with radiation therapy can be considered for patients who would require total laryngectomy for control of disease.[1]
    2. Induction chemotherapy followed by concomitant chemotherapy and radiation. Laryngectomy is reserved for patients with less than a 50% response to chemotherapy or who have persistent disease following radiation.[2,3,4,5,6,7]
    3. Definitive radiation therapy alone in patients who are not candidates for concomitant chemotherapy and surgery (total laryngectomy) for salvage of radiation failures.[8]
    4. Surgery with or without postoperative radiation therapy.[9]

    Treatment options under clinical evaluation:

    1. Hyperfractionated radiation therapy to improve tumor control rates and diminish late toxicity to normal tissue.[10,11]
    2. Clinical trials exploring chemotherapy, radiosensitizers, or particle-beam radiation therapy.[12,13,14,15,16]

      A meta-analysis of three trials of patients with locally advanced laryngeal carcinomas compared patients who received standard radical surgery plus radiation therapy with patients who received neoadjuvant cisplatin and fluorouracil (5-FU), followed by radiation therapy alone in responders or radical surgery plus radiation therapy in nonresponders.[17] The meta-analysis demonstrated a nonsignificant trend in favor of the control group who received standard radical surgery plus radiation therapy with an absolute negative effect in the chemotherapy arm that reduced survival at 5 years by 6%. The possibility of a slightly decreased survival must be balanced by the retention of the larynx in those patients whose disease was controlled.

    3. Isotretinoin (i.e., 13-cis-retinoic acid) daily for 1 year to prevent development of second upper aerodigestive tract primary tumors.[18]

    Glottis

    Standard treatment options:

    1. Chemotherapy administered concomitantly with radiation therapy can be considered for patients who would require total laryngectomy for control of disease.[1]
    2. Induction chemotherapy followed by concomitant chemotherapy and radiation. Laryngectomy is reserved for patients with less than a 50% response to chemotherapy or who have persistent disease following radiation.[2,3,4,5,6,7]
    3. Definitive radiation therapy alone in patients who are not candidates for concomitant chemotherapy and surgery (total laryngectomy) for salvage of radiation failures.[8]
    4. Surgery with or without postoperative radiation therapy.[9]
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