Surgery and/or Radiation Therapy

Surgery and radiation therapy have been the standard treatments for laryngeal cancer. However, outcome data from randomized trials are limited. Studies have attempted to evaluate the use of surgery or radiation but have been underpowered.[1] Selection of primary surgery versus radiation therapy–based treatment should be made in a multidisciplinary setting with consideration of disease stage, comorbidities, and functional status, including voice and swallowing outcomes and lung capacity.

Small superficial cancers without laryngeal fixation or lymph node involvement are successfully treated by radiation therapy or surgery alone, including laser excision surgery. Radiation therapy may be selected to preserve the voice and to reserve surgery for salvaging failures. The radiation field and dose are determined by the location and size of the primary tumor. A variety of curative surgical procedures are also recommended for laryngeal cancers, some of which preserve vocal function. An appropriate surgical procedure must be considered for each patient, given the anatomical problem, performance status, and clinical expertise of the treatment team. Advanced laryngeal cancers are often treated by combining radiation with concurrent chemotherapy for larynx preservation and total laryngectomy for bulky T4 disease or salvage.[2-4]

Evaluation of treatment outcome can be reported in various ways: locoregional control, disease-free survival, determinate survival, and overall survival (OS) at 2 to 5 years. Preservation of voice is an important parameter to evaluate. Outcome should be reported after initial surgery, initial radiation, planned combined treatment, or surgical salvage of radiation failures. Primary source material should be consulted to review these differences.

A review of published clinical results of definitive radiation therapy for head and neck cancer suggests a significant loss of local control when radiation therapy was prolonged. Extending standard treatment schedules should be avoided whenever possible.[5,6]

Radiation therapy has not been directly compared with endolaryngeal surgery (with or without laser) for the treatment of patients with early-stage laryngeal cancer. The evidence is insufficient to show a clear difference in local control or OS for these two treatment options. Retrospective data suggest that, compared with surgery, radiation therapy might cause less perturbation of voice quality without a significant difference in patient perception.[7]