Laryngeal cancer: United Kingdom National Multidisciplinary guidelines

Abstract

This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. Significantly new data have been published on laryngeal cancer management since the last edition of the guidelines. This paper discusses the evidence base pertaining to the management of laryngeal cancer and provides updated recommendations on management for this group of patients receiving cancer care.Recommendations• Radiotherapy (RT) and transoral laser microsurgery (TLM) are accepted treatment options for T1a–T2a glottic carcinoma. (R)• Open partial surgery may have a role in the management of selected tumours. (R)• Radiotherapy, TLM and transoral robotic surgery are reasonable treatment options for T1–T2 supraglottic carcinoma. (R)• Supraglottic laryngectomy may have a role in the management of selected tumours. (R)• Most patients with T2b–T3 glottic cancers are suitable for non-surgical larynx preservation therapies. (R)• Concurrent chemoradiotherapy should be regarded as the standard of care for non-surgical management. (R)• Subject to the availability of appropriate surgical expertise and multi-disciplinary rehabilitation services, TLM or open partial surgical procedures ± post-operative RT, may be also be appropriate in selected cases. (R)• In the absence of clinical or radiological evidence of nodal disease, elective treatment (RT or surgery ± post-operative RT) is recommended to at least lymph node levels II, III and IV bilaterally. In node positive disease, it is recommended that lymph node levels II–V should be treated on the involved side. If level II nodes are involved, then elective irradiation of ipsilateral level Ib nodes may be considered. (R)• Most patients with T3 supraglottic cancers are suitable for non-surgical larynx preservation therapies. (R)• Concurrent chemoradiotherapy should be regarded as the standard of care for non-surgical management. (R)• Subject to the availability of appropriate surgical expertise and multi-disciplinary rehabilitation services, TLM or open partial surgical procedures ± post-operative RT, may also be appropriate in selected cases. (R)• In the absence of clinical or radiological evidence of nodal disease, elective treatment (RT or surgery ± post-operative RT) is recommended to at least lymph node levels II, III and IV bilaterally. In node positive disease, lymph node levels II–V should be treated on the involved side. (R)• As per the PET-Neck clinical trial, patients with N2 or N3 neck disease who undergo treatment with chemoradiotherapy to their laryngeal primary and experience a complete response with a subsequent negative post-treatment positron emission tomography combined with computed tomography (PET–CT) scan do not require an elective neck dissection. In contrast, patients who have a partial response to treatment or have increased uptake on a post-treatment PET–CT scan should have a neck dissection. (R)• Larynx preservation with concurrent chemoradiotherapy should be considered for T4 tumours, unless there is tumour invas...

Oncologic outcomes with transoral robotic surgery for supraglottic squamous cell carcinoma: Results of the French Robotic Surgery Group of GETTEC

“…Although no study ever directly compared oncologic outcomes of these 3 procedures, the outcomes seem to be similar, 15,16 with surgery possibly having a slight advantage in terms of initial local control, albeit with a higher initial postoperative morbidity and cost relative to radiotherapy. Although no study ever directly compared oncologic outcomes of these 3 procedures, the outcomes seem to be similar, 15,16 with surgery possibly having a slight advantage in terms of initial local control, albeit with a higher initial postoperative morbidity and cost relative to radiotherapy.…”

Elective neck dissection in patients with radio‐recurrent and radio‐residual squamous cell carcinoma of the larynx undergoing salvage total laryngectomy: Systematic review and meta‐analysis

“…The supraglottis has a rich lymphatic supply, resulting in a higher risk of nodal disease. In view of this, the UK national multidisciplinary guidelines for laryngeal cancer recommends elective treatment of bilateral lymph nodes in early (T1‐T2) primary supraglottic cancers with either RT or ND . To date, the patterns of cervical nodal metastases has been well described in the primary setting of laryngeal SCC .…”

Radioresistant laryngeal cancers upregulate type 1 IGF receptor and exhibit increased cellular dependence on IGF and EGF signalling

“…According to NICE guidelines, patients with glottic LSCC should be offered trans‐oral laser microsurgery (TLM) for T1a glottic disease, and TLM or radiotherapy for T1b‐T2 glottic or T1‐T2 supraglottic LSCC (NICE guidelines [NG36]. https://www.nice.org.uk/guidance/ng36), with salvage laryngectomy or radiotherapy for recurrence . Rates of local control and 5‐year survival in early‐stage tumours are similar following radiotherapy or TLM (~80%), and meta‐analyses in early glottic cancers suggest improved survival following TLM, with uncertainty regarding vocal quality outcomes .…”

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The overall 5-year survival from laryngeal squamous cell carcinoma (LSCC) is ~65%, with only modest improvement over 20 years. 1,2 According to NICE guidelines, patients with glottic LSCC should be offered trans-oral laser microsurgery (TLM) for T1a glottic disease, and TLM or radiotherapy for T1b-T2 glottic or T1-T2 supraglottic LSCC (NICE guidelines [NG36]. https ://www.nice.org.uk/guida nce/ng36),

AbstractObjectives: Patients failing radiotherapy for laryngeal squamous cell carcinoma (LSCC) often require salvage total laryngectomy which has major functional consequences, highlighting a need for biomarkers of radiotherapy resistance.

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