Deciding on optimal management of supraglottic carcinoma

The management of supraglottic carcinoma is controversial. Laryngectomy with or without a radical neck dissection as the sole therapy is usually inappropriate. After supraglottic partial laryngectomy plus neck dissection, many patients are troubled with aspiration and often do poorly if postoperative radiation therapy is administered. Likewise, advocating radiation therapy alone for all lesions is inappropriate, although conventional once-daily radiation therapy is highly effective in eradicating early supraglottic carcinomas. However, for large T3 and T4 lesions, local control is poor with conventional radiation therapy. Thus these advanced lesions have been managed by total laryngectomy plus radiation therapy. To avoid loss of voice, a program of accelerated split fractionated radiation therapy was initiated at Massachusetts General Hospital in 1979. The results have shown marked improvement in local control of most moderately advanced supraglottic carcinomas.