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

    Supraglottis

    Standard treatment options:

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    Overview

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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, including those with nonbulky T4a 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. For patients with bulky T4 disease, surgery with postoperative radiation therapy with or without concomitant chemotherapy based on pathological adverse features.[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, 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, including those with nonbulky T4a 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. For patients with bulky T4 disease, total laryngectomy with postoperative radiation therapy with or without concomitant chemotherapy based on pathological adverse features.[9]
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