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

    continued...

    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.[12,13,15,16]

      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 daily for 1 year to prevent development of second upper aerodigestive tract primary tumors.[18]

    Subglottis

    Standard treatment options:

    1. Laryngectomy plus total thyroidectomy and bilateral tracheoesophageal node dissection usually followed by postoperative radiation therapy.[10,19,20,21,22]
    2. Treatment by radiation therapy alone is indicated for patients who are not candidates for surgery.

    Treatment options under clinical evaluation:

    1. Hyperfractionated radiation therapy to improve tumor control rates and diminish late toxicity to normal tissue.[10,11]
    2. Simultaneous chemotherapy and hyperfractionated radiation therapy.[23]
    3. Clinical trials exploring chemotherapy, radiosensitizers, or particle-beam radiation therapy.[12,13,15,16]

      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.

    4. Isotretinoin daily for 1 year to prevent development of second upper aerodigestive tract primary tumors.[18]
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