Laryngeal Cancer: Radiotherapy

Overview Standards of therapy for laryngeal carcinoma [see S3 guideline below].

Legend: * TLM: transoral laser microsurgery; * * TORS: “transoral robotic surgery.”

Radiotherapy

Radiation therapy should be delivered as intensity-modulated radiation therapy (EC: B; LoE: 1a).It allows precise adjustment of dose distribution to the target volume and organs to be spared, even for complex target volumes. In the lymph node levels to be electively irradiated, the dose should be between 50 Gy and 60 Gy with individual doses of 1.5 to 2.0 Gy, depending on the risk (EC: B; LoE: !b).

For primary therapy, the intensity-modulated radiation dose is around 70 Gy in the tumor area.

Therapy in detail

Supraglottic carcinoma

• T1 and T2 carcinomas: transoral laser surgical resection.
• T3 and esp. T3 carcinomas: vertical frontolateral partial resection (surgical partial removal) of the larynx according to Leroux-Robert or external classical partial resection according to Alonso
• T3 to T4a carcinomas for which partial resection is no longer possible: laryngectomy (safety margin 5 mm)Radiotherapy can be omitted if
  • Resection in the area of the mucosa and the tumor portions not surrounded by cartilage with > 5 mm tissue in sano and
  • Unilateral or bilateral neck dissection with evidence of > 10 noninvolved lymph nodes in each case.
• Postoperative radio- or radiochemotherapy (RCTX) for:
  • Advanced pT3 tumors or pT4a tumors.
  • Tumors with scarce or positive resection margins.
  • Perineural invasion and in cases of vascular invasion (lymphatic vessel invasion and/or venous invasion).
  • > 1 affected lymph node
  • 1 affected lymph node with extracapsular tumor growth.
• Hemilaryngectomy (surgical removal of one half of the larynx) for strictly unilateral findings.
• Horizontal supraglottic partial resection for involvement of the epiglottis/pouch ligament.
• Laryngectomy with neck dissection en bloc for extensive findings with metastases (daughter tumors); additional percutaneous postradiation (radiation therapy from outside the body).

Glottic carcinoma (vocal fold carcinoma).

• T1 and T2 carcinomas: transoral laser surgical resection (surgical removal) or primary radiotherapy (radiatio), i.e., radiotherapy alone.
• Stage pT3 pNx: vertical frontolateral partial resection of the larynx according to Leroux-Robert (in rare cases transoral) possibly also laryngectomy (laryngectomy) alternatively organ-preserving concept (radiochemotherapy, RCTX) in patients who refuse surgical therapyRadiation therapy can be omitted, if
  • Resection in the area of the mucosa (mucous membrane) and the tumor portions not surrounded by cartilage with > 5 mm of tissue in sano and
  • Unilateral or bilateral neck dissection (engl. “neck preparation”) with detection of > 10 unaffected lymph nodes in each case.
• Postoperative radio- or radiochemotherapy (RCTX) for:
  • Advanced pT3 tumors or pT4a tumors.
  • Tumors with scarce or positive resection margins.
  • Perineural invasion and in cases of vascular invasion (lymphatic vessel invasion and/or venous invasion).
  • > 1 affected lymph node
  • 1 affected lymph node with extracapsular tumor growth.

Subglottic carcinomas

• T1 and T2 carcinomas: partial hypopharyngeal resection.
• Laryngectomy (laryngectomy) with hypopharyngeal partial resection with radiotherapy (radiotherapy, radiatio) for advanced tumors.
• For inoperable tumors: tumor reduction by laser and radiotherapy (radiotherapy, radiatio) or radio-chemotherapy possible.