Treatment

The main treatment modalities are radiotherapy and surgery with the aim to provide optimal cure with the best functional results. Induction chemotherapy may select patients with advanced carcinoma suitable for full-course radiotherapy to save the larynx. Patient factors such as general condition, lifestyle, previous treatment, and personal views are all important in the treatment decision.

Limited glottic carcinomas are treated with equal results by radiotherapy and surgery with external techniques or endoscopically using the CO2 laser, which is increasingly employed. The voice may be better spared by radiotherapy, the cure rate being 70-90%.

Advanced glottic carcinomas (T3-T4) are treated by primary radiotherapy at many centres and surgery or induction chemotherapy are reserved for salvage of failures. Near total laryngectomy is an operation that saves the voice, but the patient is given a stoma for breathing In advanced carcinomas the neck nodes are included in the treatment planning; the survival rate is 50-60%. Partial voice conservation laryngectomy techniques are employed in some centres as primary treatment for early supraglottic carcinomas. Endoscopic laser surgery is reported to give the same cure rate and less functional morbidity, at least in experienced hands. As 30-40% of the patients have nodal metastases, neck dissection is usually performed when surgery is the sole treatment. Primary radiotherapy gives nearly the same cure rate, but any recurrence means that a total laryngectomy is most often necessary. Local control rates with primary surgery and radiotherapy are 80-90%. Subglottic primary carcinomas are rare and the high risk of paratracheal and upper mediastinal nodal metastases must be taken into account.

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