[Laryngeal cancer treatment concept in metastases]

The prognosis of laryngeal carcinoma worsens dramatically with the discovery of primary or secondary lymph node metastases. Thus consistent prophylaxis and therapy of metastases is indispensable. The standard therapy of manifest cervical lymph node metastases is surgery, if possible using the approach of conservative neck dissection. In cases of a lymph node stage N3, i.e. fixated metastases with a diameter greater than 6 cm, individually adapted therapy in necessary because of the extremely poor prognosis. Elective treatment of the N0 neck is surgical, too; however, the site of the primary tumour, possibly infiltrated compartments and, accordingly, invasion of deep lymphatic vessels have to be considered. Special care is necessary if the so-called primitive glottis is invaded (arytenoid region, aryepiglottidian fold, epiglottis). In the case of distant metastases a temporary remission can be obtained with chemotherapy in most cases, but this chemotherapy should not be forced, because there exists no real chance of cure. The trend is towards less aggressive, outpatient schedules of chemotherapy.