Current options in the treatment of laryngeal carcinoma

ABSTRACT

The incidence rate of carcinoma of larynx varies globally. This malignancy is significant as it has a high rate of cure. Beside other factors topography and the clinical stage of the disease is important to decide the modality of treatment. Supraglottic carcinoma is amenable to treatment either by surgery, radiotherapy or by combining both. Radiotherapy is effective in supragloltic carcinoma in superficial growths only. T1 glottic carcinoma can be treated by radiotherapy, excision, laser evaporation with equivocal results. T2 lesions may be treated by either radiotherapy or hemilaryngectomy with similar outcome. T3 glottic lesion is treatable with radiotherapy and salvage surgery for recurrence. Conservation surgery is also possible for T3 lesions in the recent years. In selected cases partial laryngectomy and radiotherapy may permit preservation of laryngeal function. Total laryngectomy is the mainstay of treatment for T4 lesions along with resection of adnexal areas. Subglotlic cancers are only treatable by total laryngectomy. For transglottic growths partial laryngectomy is only feasible when cartilages are spared. Radiorecurrent growths are now considered amenable to conservation surgery. Induction chemotherapy is useful for tumour regression only in advanced cases. For the nodal disease prophylactic neck dissection has no value now in No status. Radical neck dissection is mandatary once the node figures out. For the relief of airway in advanced disease emergency laryngectomy should be avoided for the danger of stomal recurrence. Among the voice restoration procedures oesophageal speech is the most cost affective