The management of early laryngeal cancer: options for patients and therapists

Abstract

To evaluate the optimal treatment of early laryngeal cancer and to highlight new developments. The use of hyperfractionation and acceleration of radiotherapy may result in improved outcomes for patients with respect to cancer cure and preservation of the larynx. Options for surgical treatment include endoscopic resection and open partial laryngectomy. The use of endoscopic vertical partial laryngectomy may overcome the difficulties encountered in exposure with transoral laser resection of anterior commissure tumors. The microdebrider may be a useful alternative to CO(2) laser in endoscopic resection in selected cases. A further treatment option that shows promising results is photodynamic therapy, which has some important advantages over the other treatment modalities. Further larger studies are needed to assess the efficacy of these treatment modalities to ascertain the treatment modality of choice. Different treatment modalities are available for early laryngeal cancer. The treatment choice should take into account the likely post-treatment morbidity, quality of life, patient preference, and voice quality. The cost of treatment, not only to the treating institution but also to the patient and those involved in the patient's care at home, is also an important issue. Well-designed randomized multicenter controlled trials are now necessary to influence patients' and clinicians' decision in the choice of the most effective and predictable treatment plan.