Guidelines in the Management of Advanced Carcinoma of the Larynx

  • Sudhir Bahadur


The term advanced laryngeal cancer generally designates stage T3 or T4 disease according to UICC/AJCC staging. These may attain advanced stage by virtue of advanced T classification (T3 or T4), N classification (N1–N3) or M classification (M1). However, it also allows early T classification (T1, T2) to be included in advanced lesions if they are associated with nodal metastasis.


  1. 1.
    Dinshaw KA, Sharma V. Radiation therapy in early glottic carcinoma. Significance of prognostic factors and dose fractionation. Indian J Cancer. 1990;27:143–53.PubMedGoogle Scholar
  2. 2.
    Bahadur S, Iyer S. The results of surgery in advanced carcinoma of the larynx. Indian J Otolaryngol Head Neck Surg. 1985;37:131–4.Google Scholar
  3. 3.
    Bahadur S, Amatya RC, Kacker SK. Primary surgery versus radiation failed salvage surgery in advanced carcinoma of the larynx and hypopharynx. Indian J Cancer. 1986;23:89–93.PubMedGoogle Scholar
  4. 4.
    Chen AY, Sehrag H, Hao Y, et al. Changes in treatment of advanced laryngeal cancer 1985–2003. Otolaryngeal Head Neck Surg. 2006;35:831–7.CrossRefGoogle Scholar
  5. 5.
    Bahadur S, Amatya RC, Iyer S, et al. Study of distribution of lymph node metastasis from squamous cell carcinoma of head and neck. Indian J Cancer. 1983;20:143–6.Google Scholar
  6. 6.
    Myers EN, Swen JY, Myers JN. Cancer of the head and neck. 4th ed. Philadelphia: Saounders; 2003.Google Scholar
  7. 7.
    Piccinilo JF. Importance of co-morbidity in head and neck cancer. Laryngoscope. 2000;110:593–602.CrossRefGoogle Scholar
  8. 8.
    Hong WK, Lippman SM, Itri LM, et al. Prevention of second primary tumors isotretinoin in squamous cell carcinoma of the head and neck. N Engl J Med. 1990;323:795–801.CrossRefGoogle Scholar
  9. 9.
    Breithart W, Holland J. Psychosocial aspects of head and neck cancers. Semin Oncol. 1988;15:61–9.Google Scholar
  10. 10.
    Dropkin MJ. Body image and quality of life after head and neck surgery. Cancer Pract. 1999;7:309–13.CrossRefGoogle Scholar
  11. 11.
    Steiner W. Results of curative laser micro surgery of laryngeal carcinoma. Am J Otolaryngology. 1993;14:116–21.CrossRefGoogle Scholar
  12. 12.
    The Department of Veterans Affairs Laryngeal Cancer Study Group. Induction chemotherapy plus radiation compared with surgery plus radiation in patients with advanced laryngeal cancer. N Engl J Med. 1991;324:1685–90.CrossRefGoogle Scholar
  13. 13.
    Forastiere AA, Geopfert H, Maor M, et al. Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer. N Engl J Med. 2003;349:2091–8.CrossRefGoogle Scholar
  14. 14.
    Ferlito A, Rianaldo A, Silver CF, et al. Neck dissection for laryngeal cancer. J AM Coll Surg. 2008;207:587–97.CrossRefGoogle Scholar
  15. 15.
    Leyland MK, Sessions DG, Lenox J. The influence of lymph node metastasis in treatment of squamous cell carcinoma of oral cavity, oropharynx, larynx and hypopharynx. Larynscope. 2005;115:629–39.CrossRefGoogle Scholar
  16. 16.
    Weber PC, Johnson JT, Myers E. The impact of bilateral neck dissection on pattern of recurrence and survival in supraglottic carcinoma. Arch Otolaryngol Head Neck Surg. 1994;120:703–6.CrossRefGoogle Scholar
  17. 17.
    Brazilian Head and Neck Cancer study group. End results of a prospective trial on elective lateral neck dissection vs type III modified radical neck dissection in management of supraglottic and transglottic carcinomas. Head Neck. 1999;21:694–702.CrossRefGoogle Scholar
  18. 18.
    Lefebvre JL. What is the role of primary surgery in the treatment of laryngeal and hypopharyngeal cancer – Hays-Martin lecture. Arch Otolaryngol Head Neck Surg. 2000;126:285–8.CrossRefGoogle Scholar
  19. 19.
    Zhang SY, Lu ZM, Luo XN. Retrospective analysis of prognostic factors in 205 patients with laryngeal carcinoma who underwent surgical treatment. PLoS One. 2013;4:e60157. CrossRefGoogle Scholar
  20. 20.
    Bahadur S, Kumar S, Tandon DA, et al. Combined therapy in advanced head and neck cancer. J Laryngol Otol. 1992;106:243–9.CrossRefGoogle Scholar
  21. 21.
    Berniere J, Domenge C, Ozsahin M, et al. Post operative irradiation with or without concurrent chemotherapy for locally advanced head and neck cancer. N Engl J Med. 2004;350:1945–52.CrossRefGoogle Scholar
  22. 22.
    Tupchang L, Phil D, Scott CB, et al. Randomized study of pre-operative versus post – operative radiation therapy in advanced head and neck carcinoma long term follow up of RTOG study 73-03. Int J Radiat Oncol Biol Phy. 1991;20:21–8.CrossRefGoogle Scholar
  23. 23.
    Krstevska V, Stojkovski J, Lazarevska E, Crrenkova S. Radical surgery and post operative radiotherapy in patients with advanced squamous cell carcinoma of the larynx. Arch Otolaryngol. 2011;19:1–2.Google Scholar
  24. 24.
    Spector GJ. Distant metastasis from laryngeal and hypopharyngeal cancer. ORL. 2001;63:224–8.CrossRefGoogle Scholar
  25. 25.
    Yimaz T, Hosal S, Ozyar E, Akyol F, Gursal B. Post operative radiotherapy in advanced laryngeal cancer: effect on local regional recurrence, distant metastasis and second primaries J. Laryngol Otol. 2005;119:784–90.Google Scholar
  26. 26.
    Nguyen Tan PF, Le QT, Quivery M, et al. Treatment results and prognostic factors of advanced T3-T4 laryngeal carcinoma: the University of California San Francisco (UCSF) and Stanford university hospital (SUH) experience. Int J Radiat Oncol Bio Phys. 2001;50:1172–80.CrossRefGoogle Scholar
  27. 27.
    Gounn CG, Conger BT, Shails WC, et al. The effect of treatment on survival in patients with advanced laryngeal carcinoma. Laryngoscope. 2009;119:1312–7.CrossRefGoogle Scholar
  28. 28.
    Karatzanis AD, Psychogios G, Waldfaher F, et al. Management of locally advanced laryngeal cancer. J Otolaryngol Head Neck Surg. 2014;43:4–7.CrossRefGoogle Scholar
  29. 29.
    Megwaln UC, Sikora AW. Survival outcomes in advanced laryngeal cancer. JAMA Otolaryngeal Head Neck Surg. 2014;140:855–60.CrossRefGoogle Scholar
  30. 30.
    Cooper IS, Pajak TE, Forastiere A, et al. Precisely defining high risk operable head and neck tumors based on RTOG 85-03 and 88-24: targets for post operative radiotherapy. Head Neck. 1998;20:588–94.CrossRefGoogle Scholar
  31. 31.
    Pearson BW, Salassa JR. Transoral laser microresection for cancer of the larynx involving the anterior commissure. Laryngoscope. 2003;113:1104–12.CrossRefGoogle Scholar
  32. 32.
    Hinni ML, Salassa JR, Grant DG, et al. Transoral laser microsurgery for advanced laryngeal cancer. Arch Otolaryngeal Head Neck Surg. 2007;133:1198–204.CrossRefGoogle Scholar
  33. 33.
    Strong MS, Jako GJ. Laser surgery in the larynx early: clinical experience with continuous CO2 laser. Ann Otol Rhinol Laryngol. 1972;81:791–8.CrossRefGoogle Scholar
  34. 34.
    Rudert HH, Warner JA, Hoft S. Transoral carbon dioxide laser resection of supraglottic carcinoma. Ann Otol Rhinol Laryngol. 1999;108:819–27.CrossRefGoogle Scholar
  35. 35.
    Steiner W, Ambrosh P. Endoscopic laser surgery of the upper aerodigestive tract with special emphasis on cancer surgery. Stuttgart: Thieme; 2000.Google Scholar
  36. 36.
    Canis M, Martin A, et al. Organ preservation in T4 a laryngeal cancer: is transoral laser microsurgery an option? Eur Arch Otolaryngol. 2013;270:2719–27.CrossRefGoogle Scholar
  37. 37.
    Pignon JP, Le Maltre E, Bourhis J, Match NC. Collaborative group. An update on 93 randomized trials and 17346 patients. Radiother Oncol. 2009;92:4–14.CrossRefGoogle Scholar
  38. 38.
    Richard JM, Sancho Garniere H, Passey JJ, et al. Randomized trial of induction chemotherapy in larynx carcinoma. Oral Oncol. 1998;34:224–32.CrossRefGoogle Scholar
  39. 39.
    Forastiere AA, Zhang Q, Weber RS, et al. Long term results of RTOG 91-11, a comparison of three non surgical treatment strategies to preserve the larynx in patients with advanced larynx cancer. J Clin Oncol. 2013;31:845–52.CrossRefGoogle Scholar
  40. 40.
    Machtay M, Monghan J, Trotti A, et al. Factors associated with severe late toxicity after concurrent chemo-radiotherapy for locally advanced head and neck cancer: an RTOG analysis. J Clin Oncol. 2008;26:3582–9.CrossRefGoogle Scholar
  41. 41.
    Wang JJ, Goldsmith TA, Holman AS, et al. Pharyngo-oesophageal stricture after treatment of head and neck cancer. Head Neck. 2012;34:967–73.CrossRefGoogle Scholar
  42. 42.
    Pfister DG, Ridge JA. Induction chemotherapy for larynx preservation: patient selection or therapeutic effect? J Clin Oncol. 2006;26:540–2.CrossRefGoogle Scholar
  43. 43.
    Vokes E. Competing roads to larynx preservation. J Clin Oncol. 2013;31:833–5.CrossRefGoogle Scholar
  44. 44.
    Lefebvre JL, Pointreau V, Rolland F, et al. Induction chemotherapy followed by either chemo-radiotherapy or bio radiotherapy for larynx preservation: the tremplin randomized phase II study. J Clin Oncol. 2013;31:853–9.CrossRefGoogle Scholar
  45. 45.
    Posner MR, Norris CM, Wirth LJ, et al. Sequential therapy for locally advanced larynx and hypopharynx cancer sub group in Tax 324; survival surgery and organ preservation. Ann Oncol. 2009;20:921–7.CrossRefGoogle Scholar
  46. 46.
    Brochstein B, Haraf DJ, Rademaket AV, et al. Patterns of failure prognostic factors and survival in loco-regionally advanced head and neck cancer treated with concurrent chemo radiotherapy a 9 year 337 patients multi institution of experience. Ann Oncol. 2004;15:1179–86.CrossRefGoogle Scholar
  47. 47.
    Silver CE, Beither JJ, Shaha AR, et al. Current trends in initial management of laryngeal cancer; the declining use of open surgery. Eur Arch Otolaryngol. 2009;266:1332–52.CrossRefGoogle Scholar
  48. 48.
    Cmelak AJ, Li S, Meredith SL, et al. Phase III trial of chemo-radiation for organ preservation in resectable stage III or IV squamous cell carcinoma of the larynx or oropharynx. Results of Eastern Co-operative Oncology Group study E2399. J Clin Oncol. 2007;25:3971–7.CrossRefGoogle Scholar
  49. 49.
    Chen AV, Halpern M. Factors predictive of survivals in advanced laryngeal cancer. Arch Otolaryngol Head Neck. 2009;31:429–41.Google Scholar
  50. 50.
    Hoffman HT, Porter K, Karnell LH, et al. Laryngeal cancer in United States: changes in demographics patterns of care and survival. Larynscope. 2006;116:1–13.CrossRefGoogle Scholar
  51. 51.
    Thakar A, Bahadur S, Mohanti BK, Nivsarkar S. Clinically staged T3NoMo laryngeal cancer: how is it best treated? Definitive radiotherapy with salvage surgery versus combined surgery and radiotherapy. J Laryngol Otol. 2000;114:108–12.CrossRefGoogle Scholar
  52. 52.
    Thakar A, Bahadur S, Tandon DA, Ranganathan A, Rath GK. Laryngeal preservation by treatment with induction chemotherapy and radiotherapy protocol for stage III and IV carcinoma of larynx. J Laryngol Otol. 1999;113:433–8.PubMedGoogle Scholar
  53. 53.
    Mohanti BK, Umapathy U, Thakar A, Pathy S. Short course palliative radiotherapy of 20 Gyin 5 factions for advanced and incurable head and neck cancer. Radiother Oncol. 2004;71:275–80.CrossRefGoogle Scholar

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© The Author(s) 2019

Authors and Affiliations

  • Sudhir Bahadur
    • 1
  1. 1.Department of Otolaryngology and Head-Neck SurgeryFormerly at All India Institute of Medical SciencesNew DelhiIndia

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