Abstract
Laryngeal squamous cell carcinoma is the second most common head and neck cancer. Its pathogenesis is strongly associated with smoking. The management of this disease is challenging and mandates multidisciplinary care. Currently, accepted treatment modalities include surgery, radiation therapy, and chemotherapy—all focused on improving survival while preserving organ function. Despite changes in smoking patterns resulting in a declining incidence of laryngeal cancer, the overall outcomes for this disease have not improved in the recent past, likely due to changes in treatment patterns and treatment-related toxicities. Here, we review emerging concepts and novel strategies in the use of radiation therapy in the management of laryngeal squamous cell carcinoma that could improve the relationship between tumor control and normal tissue damage (therapeutic ratio).
Highlights
Laryngeal cancer is the second most common head and neck cancer, and it represents about a fifth of the total head and neck cancer diagnoses [1]
Tumors limited to one vocal cord (T1a) or involving both (T1b) cords can be successfully treated with single modality therapy, either surgery or radiation therapy (RT) alone, resulting in excellent oncologic outcomes with 5year local control (LC) rates at around 90–95%
The current clinical trial NCT03622164 is evaluating the role of unilateral neck RT in patients with squamous cell carcinomas of the head and neck undergoing primary surgical resection and bilateral, modified radical, or selective neck dissections, with ≥10 pathologically negative lymph nodes removed on the contralateral neck that will require adjuvant
Summary
Laryngeal cancer is the second most common head and neck cancer, and it represents about a fifth of the total head and neck cancer diagnoses [1]. Accepted treatment modalities in the management of laryngeal cancer include surgery, radiation therapy (RT), and chemotherapy. Tumors limited to one vocal cord (T1a) or involving both (T1b) cords can be successfully treated with single modality therapy, either surgery (endoscopic techniques) or RT alone, resulting in excellent oncologic outcomes with 5year local control (LC) rates at around 90–95%. The optimal radiation dose, fraction size, and overall treatment time for local control in early stage glottic cancers with conventional radiation was evaluated in a Japanese prospective randomized trial [21]. The use of a slightly hypofractionated radiation regimen (2.25 Gy per fraction) applied over a shorter overall treatment time was superior to conventional fractionation (2 Gy per fraction), with respect to local control and without increasing toxicity. There is a growing interest in the use of modern RT modalities like intensity-modulated radiation therapy (IMRT), stereotactic ablative radiation therapy (SABR), and charged particle therapy, with the attempt to decrease treatment-related toxicities while maintaining, if not improving, outcomes
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