Subglottis

Lesions can be treated successfully by radiation therapy alone with preservation of normal voice.

Surgery is reserved for failure of radiation therapy or for patients who cannot be easily assessed for radiation therapy.

A meta-analysis examined oncologic control in 22 consecutive case series.

A meta-analysis examined oncologic control in 22 consecutive case series.

No clear differences were demonstrated between transoral CO2 laser excision and EBRT in terms of local control (odds ratio [OR], 0.81; 95% confidence interval [CI], 0.51–1.3) and laryngectomy-free survival (OR, 0.84; 95% CI, 0.42–1.66).

A meta-analysis examined oncologic control in 22 consecutive case series.

There was a trend for improved posttreatment voice quality with radiation therapy. Transoral CO2 laser–excision surgery dominates radiation therapy from a cost-utility standpoint.[5][Level of evidence B4]

In a randomized study of patients with early-stage larynx cancer, patients were assigned to standard fractionation in 2 Gy daily fractions or a hypofractionated regimen of 2.25 Gy daily; 82 patients were allocated to a conventional fractionation (CONV) arm (66 Gy/33 fractions for T1 and 70 Gy/35 fractions for T2), with 74 patients to the hypofractionation (HYPO) arm (63 Gy/28 fractions for T1 and 67.5 Gy/30 fractions for T2).[10] The study was underpowered and closed early because of a lack of accrual, although no statistically significant differences were seen between treatment arms in terms of local progression-free survival (PFS).Earlier single-institution reports support hypofractionated regimens using 2.25 Gy per fraction for early T1 and T2 larynx cancer with high local control rates.[11][Level of evidence C3]

In a randomized study of patients with early-stage larynx cancer, patients were assigned to standard fractionation in 2 Gy daily fractions or a hypofractionated regimen of 2.25 Gy daily; 82 patients were allocated to a conventional fractionation (CONV) arm (66 Gy/33 fractions for T1 and 70 Gy/35 fractions for T2), with 74 patients to the hypofractionation (HYPO) arm (63 Gy/28 fractions for T1 and 67.5 Gy/30 fractions for T2).[10] The study was underpowered and closed early because of a lack of accrual, although no statistically significant differences were seen between treatment arms in terms of local progression-free survival (PFS).Earlier single-institution reports support hypofractionated regimens using 2.25 Gy per fraction for early T1 and T2 larynx cancer with high local control rates.[11][Level of evidence C3]

With a median follow-up of 67 months (range, 2–122 months), the 5-year local PFS rate was 77.8% for the CONV arm and 88.5% for the HYPO arm (hazard ratio [HR], 1.55; P = .213).

In a randomized study of patients with early-stage larynx cancer, patients were assigned to standard fractionation in 2 Gy daily fractions or a hypofractionated regimen of 2.25 Gy daily; 82 patients were allocated to a conventional fractionation (CONV) arm (66 Gy/33 fractions for T1 and 70 Gy/35 fractions for T2), with 74 patients to the hypofractionation (HYPO) arm (63 Gy/28 fractions for T1 and 67.5 Gy/30 fractions for T2).[10] The study was underpowered and closed early because of a lack of accrual, although no statistically significant differences were seen between treatment arms in terms of local progression-free survival (PFS).Earlier single-institution reports support hypofractionated regimens using 2.25 Gy per fraction for early T1 and T2 larynx cancer with high local control rates.[11][Level of evidence C3]

No significant difference was observed in the toxicity profile between the two arms.

In a randomized study of patients with early-stage larynx cancer, patients were assigned to standard fractionation in 2 Gy daily fractions or a hypofractionated regimen of 2.25 Gy daily; 82 patients were allocated to a conventional fractionation (CONV) arm (66 Gy/33 fractions for T1 and 70 Gy/35 fractions for T2), with 74 patients to the hypofractionation (HYPO) arm (63 Gy/28 fractions for T1 and 67.5 Gy/30 fractions for T2).[10] The study was underpowered and closed early because of a lack of accrual, although no statistically significant differences were seen between treatment arms in terms of local progression-free survival (PFS).Earlier single-institution reports support hypofractionated regimens using 2.25 Gy per fraction for early T1 and T2 larynx cancer with high local control rates.[11][Level of evidence C3]

In a subgroup exploratory analysis for T1a disease, the 5-year local PFS rate trended positively in the HYPO arm (76.7% vs. 93.0%; HR, 3.65; P = .056).[10][Level of evidence B1]