Larynx Treatment Algorithm

Question 1

Treatment algorithm for stage 1-2?

Answer 1

Definitive XRT, laser cordectomy, partial laryngectomy

Question 2

Treatment algorithm for stage 3-4?

Answer 2

1. Total laryngectomy with thyroidectomy –> adjuvant XRT or CRT for + margin or + ENE
2. Definitive CRT alone
3. Definitive XRT with altered fractionation

Question 3

Do you offer definitive CRT or XRT to patients who have impaired larynx function?

Answer 3

No ( because the point is to preserve larynx function)

Question 4

What is the treatment option for glottic Tis?

Answer 4

endoscopic resection (preferred) or RT

Question 5

What stage groups are amenable to larynx preservation in glottic cancer?

Answer 5

T1-T2N0, select T3N0

Question 6

From what stage would your require a total laryngectomy?

Answer 6

T3N1

Question 7

For glottic cancer how are treatments for T4a vs T4b differenct?

Answer 7

T4a: total laryngectomy (preferred) or chemoRT

T4b: chemoRT (no surgery)

Question 8

For advanced laryngeal cancer, in which situation would you boost tracheal stoma to 60 - 66 Gy?

Answer 8

If emergent tracheostomy, subglottic extension, soft tissue invasion, ECE in level VI, scar crosses stoma, or close/positive margin