An elderly male presents with T3N0 laryngeal carcinoma. What would be the management?(AIIMS Nov 2014, May 2014)
Ans. b. Concurrent chemoradiotherapy (Ref: Harrison 19/e p504-505, 18/e p 734-735; com/ article/ 2047862-overview style="font-size: 1.04761904761905em; font-family: Times New Roman, Times, serif">)An elderly male presents with T3N0 laryngeal carcinoma. Treatment is concurrent chemoradiotherapy.'Advanced laryngeal cancers are often treated by combining radiation with concurrent chemotherapy for larynx preservation and total laryngectomy for bulky T4 disease or salvage.''Concurrent radiation therapy plus Cisplatin resulted in a statistically higher percentage of patients with an intact larynx at 10 years.''Concomitant Cisplatin with radiation therapy resulted in a 41% reduction in risk of locoregional failure compared with radiation therapy alone.' Cancer Larynx* It is 10 times more common in malesQ than females.* Disease is mostly seen in the age group of 40-70 yearsQ.* Both tobaccoQ and alcoholQ are well established risk factor in laryngeal cancer.* Cigarette smoke contains benzopyrene and other hydrocarbons which are carcinogenic in man.* About 90-95% of laryngeal malignancies are squamous cell carcinomaQ with various grades of differentiation.* Cordal lesions are often well-differentiatedQ while supraglottic ones are Anaplastic.1. Supraglottic Cancer:- Supraglottic cancer is Jess frequent than glottic cancerQ.- Nodal metastases occur earlyQ, upper and middle jugular nodes are often involved.- Bilateral metastases may be seen in cases of epiglottic cancer.- Pain on swallowing is the most frequent initial symptomQ.- Mass in the neck may be the first sign.- Hoarseness is a late symptom.- Pain may be referred to ear by way of vagus nerve and auricular nerve of ArnoldQ.2. Glottic Cancer:- It is MC site of CA LarynxQ- Mostly originates from free edge and upper surface of anterior 1/3rd of true vocal cordQ followed by middle third 1 /3rd. Spread locally to anterior commissure than to opposite cord (conus elasticus initially acts as barrier for subglottic spreadQ).- Fixation of vocal cord indicates spread of disease to thyroaretenoid muscle and is a bad prognostic signQ.- As vocal cord is free of lymphatics, nodal metastases is never seen in cordal cancer, unless the disease spread beyond membranous cord.- Hoarseness is MC and the earliest symptomQ because of this glottic cancer is detected early.3. Subglottic Cancer:- Least common siteQ.- Subglottic region extends from glottic area to lower border of cricoid cartilage.- Spreads locally around anterior wall to opposite side or down wrards to trachea, upwrard spread to vocal cord is late and hoarseness is not an early symptomQ- Lymphatic metastases to prelaryngeal, pretracheal (Delphian nodeQ) and lower jugular nodes.- Earliest and most prominent symptom is stridorQ, but it appears only in advanced stage. Hoarseness is late feature.
Neoadjuvant chemotherapy followed by radiotherapy
Concurrent chemoradiotherapy
Radical radiotherapy followed by chemotherapy
Radical radiotherapy without chemotherapy
Tumors