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 invasion through cartilage into the soft tissues of the neck, in which case total
laryngectomy yields better outcomes. (R) • In the absence of clinical or radiological evidence of nodal disease, elective treatment (RT or surgery ± post-operative RT) is recommended to bilateral lymph node levels II, III, IV, V and VI. (R).