Treatment of advanced laryngeal cancer (T3-4)

Various treatment options for advanced laryngeal cancer are discussed. Although no results of prospective studies are available, combined treatment of total laryngectomy and radiotherapy seems to offer the best locoregional control rates and maybe survival rates. This, however, results in the loss of natural voice. Radiotherapy alone (RA) will result, in unselected cases, in a local failure rate of approximately 50%. However, when the radiation schedule will be tailored to radiobiological parameters like potential doubling time of clonogenic cells local control may be enhanced. The choice of treatment may be related to known prognostic factors like severe airway obstruction, sex, tumorextension and involvement of neck nodes. Since in females and in patients with tumors confined to the glottic region only local control with RA is high, primary radiotherapy is advocated. For patients with severe airway obstruction or N2-3 neck nodes, locoregional control rates with RA are poor, so surgery combined with postoperative radiotherapy is advisable. For the remaining group of patients RA may be tested against combined treatment in a prospective trial.