Use of Larynx-Preservation Strategies in the Treatment of Laryngeal Cancer

Published online ahead of print November 27, 2017, doi: 10.1200/JCO.2017.75.7385

Arlene A. Forastiere, Nofisat Ismaila, Jan S. Lewin, Cherie Ann Nathan, David J. Adelstein, Avraham Eisbruch, Gail Fass, Susan G. Fisher, Scott A. Laurie, Quynh-Thu Le, Bernard O’Malley, William M. Mendenhall, Snehal Patel, David G. Pfister, Anthony F. Provenzano, Randy Weber, Gregory S. Weinstein, and Gregory T. Wolf

Purpose

To update the guideline recommendations on the use of larynx-preservation strategies in the treatment of laryngeal cancer.

Methods

An Expert Panel updated the systematic review of the literature for the period from January 2005 to May 2017.

Results

The panel confirmed that the use of a larynx-preservation approach for appropriately selected patients does not compromise survival. No larynx-preservation approach offered a survival advantage compared with total laryngectomy and adjuvant therapy as indicated. Changes were supported for the use of endoscopic surgical resection in patients with limited disease (T1, T2) and for initial total laryngectomy in patients with T4a disease or with severe pretreatment laryngeal dysfunction. New recommendations for positron emission tomography imaging for the evaluation of regional nodes after treatment and best measures for evaluating voice and swallowing function were added.

Recommendations

Patients with T1, T2 laryngeal cancer should be treated initially with intent to preserve the larynx by using endoscopic resection or radiation therapy, with either leading to similar outcomes. For patients with locally advanced (T3, T4) disease, organ-preservation surgery, combined chemotherapy and radiation, or radiation alone offer the potential for larynx preservation without compromising overall survival. For selected patients with extensive T3 or large T4a lesions and/or poor pretreatment laryngeal function, better survival rates and quality of life may be achieved with total laryngectomy. Patients with clinically involved regional cervical nodes (N+) who have a complete clinical and radiologic imaging response after chemoradiation do not require elective neck dissection. All patients should undergo a pretreatment baseline assessment of voice and swallowing function and receive counseling with regard to the potential impact of treatment options on voice, swallowing, and quality of life.

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