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Treatment of early (stage I and II) head and neck cancer: The larynx

Wayne M Koch, MD, FACS
Mitchell Machtay, MD
Simon Best, MD
Section Editors
Bruce E Brockstein, MD
David M Brizel, MD
Marshall R Posner, MD
Marvin P Fried, MD, FACS
Deputy Editor
Michael E Ross, MD


The management of early laryngeal cancer is presented here. The treatment of locoregionally advanced laryngeal cancer is discussed separately, as is the management of metastatic disease.

(See "Treatment of locoregionally advanced (stage III and IV) head and neck cancer: The larynx and hypopharynx".)

(See "Treatment of metastatic and recurrent head and neck cancer".)


Worldwide, there are an estimated 238,000 cases of laryngeal cancer and 106,000 deaths annually [1]. In the United States, there are approximately 13,400 cases and 3700 deaths due to laryngeal cancer annually [2].

Laryngeal cancer is diagnosed predominantly in men, which at least in part, reflects in the effects of tobacco and alcohol use. There is also an increased risk in former smokers.

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Literature review current through: Nov 2017. | This topic last updated: Apr 18, 2016.
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  1. Global Burden of Disease Cancer Collaboration, Fitzmaurice C, Allen C, et al. Global, Regional, and National Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life-years for 32 Cancer Groups, 1990 to 2015: A Systematic Analysis for the Global Burden of Disease Study. JAMA Oncol 2017; 3:524.
  2. Siegel RL, Miller KD, Jemal A. Cancer Statistics, 2017. CA Cancer J Clin 2017; 67:7.
  3. Patel SG, Lydiatt WM, Glastonbury CM, et al. Larynx. In: AJCC Cancer Staging Manual, 8th, Amin MB (Ed), Springer, New York 2017. p.149.
  4. Hoffman HT, Porter K, Karnell LH, et al. Laryngeal cancer in the United States: changes in demographics, patterns of care, and survival. Laryngoscope 2006; 116:1.
  5. American Society of Clinical Oncology, Pfister DG, Laurie SA, et al. American Society of Clinical Oncology clinical practice guideline for the use of larynx-preservation strategies in the treatment of laryngeal cancer. J Clin Oncol 2006; 24:3693.
  6. NCCN guidelines http://www.nccn.org/professionals/physician_gls/f_guidelines.asp#site.
  7. Tamura Y, Tanaka S, Asato R, et al. Therapeutic outcomes of laryngeal cancer at Kyoto University Hospital for 10 years. Acta Otolaryngol Suppl 2007; :62.
  8. Aaltonen LM, Rautiainen N, Sellman J, et al. Voice quality after treatment of early vocal cord cancer: a randomized trial comparing laser surgery with radiation therapy. Int J Radiat Oncol Biol Phys 2014; 90:255.
  9. Trotti A 3rd, Zhang Q, Bentzen SM, et al. Randomized trial of hyperfractionation versus conventional fractionation in T2 squamous cell carcinoma of the vocal cord (RTOG 9512). Int J Radiat Oncol Biol Phys 2014; 89:958.
  10. Breitbart W, Holland J. Psychosocial aspects of head and neck cancer. Semin Oncol 1988; 15:61.
  11. de Boer MF, Pruyn JF, van den Borne B, et al. Rehabilitation outcomes of long-term survivors treated for head and neck cancer. Head Neck 1995; 17:503.
  12. Chera BS, Amdur RJ, Morris CG, et al. T1N0 to T2N0 squamous cell carcinoma of the glottic larynx treated with definitive radiotherapy. Int J Radiat Oncol Biol Phys 2010; 78:461.
  13. Carl J, Andersen LJ, Pedersen M, Greisen O. Prognostic factors of local control after radiotherapy in T1 glottic and supraglottic carcinoma of the larynx. Radiother Oncol 1996; 39:229.
  14. Smee RI, Williams JR, Broadley K, Bridger GP. Early glottic carcinoma treated by radiotherapy: defining a population for surgical salvage. Laryngoscope 2013; 123:171.
  15. Sakata K, Oouchi A, Nagakura H, et al. Accelerated radiotherapy for T1, 2 glottic carcinoma: analysis of results with KI-67 index. Int J Radiat Oncol Biol Phys 2000; 47:81.
  16. Hinerman RW, Mendenhall WM, Amdur RJ, et al. Carcinoma of the supraglottic larynx: treatment results with radiotherapy alone or with planned neck dissection. Head Neck 2002; 24:456.
  17. Mendenhall WM, Amdur RJ, Morris CG, Hinerman RW. T1-T2N0 squamous cell carcinoma of the glottic larynx treated with radiation therapy. J Clin Oncol 2001; 19:4029.
  18. Zumsteg ZS, Riaz N, Jaffery S, et al. Carotid sparing intensity-modulated radiation therapy achieves comparable locoregional control to conventional radiotherapy in T1-2N0 laryngeal carcinoma. Oral Oncol 2015; 51:716.
  19. Al-Mamgani A, Kwa SL, Tans L, et al. Single Vocal Cord Irradiation: Image Guided Intensity Modulated Hypofractionated Radiation Therapy for T1a Glottic Cancer: Early Clinical Results. Int J Radiat Oncol Biol Phys 2015; 93:337.
  20. Zeitels SM, Burns JA. Oncologic efficacy of angiolytic KTP laser treatment of early glottic cancer. Ann Otol Rhinol Laryngol 2014; 123:840.
  21. Silver CE, Beitler JJ, Shaha AR, et al. Current trends in initial management of laryngeal cancer: the declining use of open surgery. Eur Arch Otorhinolaryngol 2009; 266:1333.
  22. Steiner W. Results of curative laser microsurgery of laryngeal carcinomas. Am J Otolaryngol 1993; 14:116.
  23. Ambrosch P. The role of laser microsurgery in the treatment of laryngeal cancer. Curr Opin Otolaryngol Head Neck Surg 2007; 15:82.
  24. Kayhan FT, Kaya KH, Sayin I. Transoral robotic cordectomy for early glottic carcinoma. Ann Otol Rhinol Laryngol 2012; 121:497.
  25. Lallemant B, Chambon G, Garrel R, et al. Transoral robotic surgery for the treatment of T1-T2 carcinoma of the larynx: preliminary study. Laryngoscope 2013; 123:2485.
  26. Mendelsohn AH, Remacle M, Van Der Vorst S, et al. Outcomes following transoral robotic surgery: supraglottic laryngectomy. Laryngoscope 2013; 123:208.
  27. Ganly I, Patel SG, Matsuo J, et al. Analysis of postoperative complications of open partial laryngectomy. Head Neck 2009; 31:338.
  28. Raitiola H, Pukander J, Laippala P. Glottic and supraglottic laryngeal carcinoma: differences in epidemiology, clinical characteristics and prognosis. Acta Otolaryngol 1999; 119:847.
  29. Mendenhall WM, Werning JW, Hinerman RW, et al. Management of T1-T2 glottic carcinomas. Cancer 2004; 100:1786.
  30. Groome PA, O'Sullivan B, Mackillop WJ, et al. Compromised local control due to treatment interruptions and late treatment breaks in early glottic cancer: Population-based outcomes study supporting need for intensified treatment schedules. Int J Radiat Oncol Biol Phys 2006; 64:1002.
  31. McCoul ED, Har-El G. Meta-analysis of impaired vocal cord mobility as a prognostic factor in T2 glottic carcinoma. Arch Otolaryngol Head Neck Surg 2009; 135:479.
  32. Marshak G, Brenner B, Shvero J, et al. Prognostic factors for local control of early glottic cancer: the Rabin Medical Center retrospective study on 207 patients. Int J Radiat Oncol Biol Phys 1999; 43:1009.
  33. Reddy SP, Mohideen N, Marra S, Marks JE. Effect of tumor bulk on local control and survival of patients with T1 glottic cancer. Radiother Oncol 1998; 47:161.
  34. Nonoshita T, Shioyama Y, Kunitake N, et al. Retrospective analysis: concurrent chemoradiotherapy and adjuvant chemotherapy for T2N0 glottic squamous cell carcinoma. Fukuoka Igaku Zasshi 2009; 100:26.
  35. Sachse F, Stoll W, Rudack C. Evaluation of treatment results with regard to initial anterior commissure involvement in early glottic carcinoma treated by external partial surgery or transoral laser microresection. Head Neck 2009; 31:531.
  36. Dey P, Arnold D, Wight R, et al. Radiotherapy versus open surgery versus endolaryngeal surgery (with or without laser) for early laryngeal squamous cell cancer. Cochrane Database Syst Rev 2002; :CD002027.
  37. Cellai E, Frata P, Magrini SM, et al. Radical radiotherapy for early glottic cancer: Results in a series of 1087 patients from two Italian radiation oncology centers. I. The case of T1N0 disease. Int J Radiat Oncol Biol Phys 2005; 63:1378.
  38. Schrijvers ML, van Riel EL, Langendijk JA, et al. Higher laryngeal preservation rate after CO2 laser surgery compared with radiotherapy in T1a glottic laryngeal carcinoma. Head Neck 2009; 31:759.
  39. Remacle M, Eckel HE, Antonelli A, et al. Endoscopic cordectomy. A proposal for a classification by the Working Committee, European Laryngological Society. Eur Arch Otorhinolaryngol 2000; 257:227.
  40. Remacle M, Van Haverbeke C, Eckel H, et al. Proposal for revision of the European Laryngological Society classification of endoscopic cordectomies. Eur Arch Otorhinolaryngol 2007; 264:499.
  41. Gallo A, de Vincentiis M, Manciocco V, et al. CO2 laser cordectomy for early-stage glottic carcinoma: a long-term follow-up of 156 cases. Laryngoscope 2002; 112:370.
  42. Delsupehe KG, Zink I, Lejaegere M, Bastian RW. Voice quality after narrow-margin laser cordectomy compared with laryngeal irradiation. Otolaryngol Head Neck Surg 1999; 121:528.
  43. Vilaseca I, Huerta P, Blanch JL, et al. Voice quality after CO2 laser cordectomy--what can we really expect? Head Neck 2008; 30:43.
  44. Rutkowski T, Wygoda A, Składowski K, et al. Predictors of radiotherapy outcome in patients with T2 supraglottic carcinoma. Eur Arch Otorhinolaryngol 2012; 269:923.
  45. Groome PA, O'Sullivan B, Irish JC, et al. Management and outcome differences in supraglottic cancer between Ontario, Canada, and the Surveillance, Epidemiology, and End Results areas of the United States. J Clin Oncol 2003; 21:496.
  46. Cabanillas R, Rodrigo JP, Llorente JL, Suárez C. Oncologic outcomes of transoral laser surgery of supraglottic carcinoma compared with a transcervical approach. Head Neck 2008; 30:750.
  47. Peretti G, Piazza C, Cattaneo A, et al. Comparison of functional outcomes after endoscopic versus open-neck supraglottic laryngectomies. Ann Otol Rhinol Laryngol 2006; 115:827.
  48. Agrawal A, Moon J, Davis RK, et al. Transoral carbon dioxide laser supraglottic laryngectomy and irradiation in stage I, II, and III squamous cell carcinoma of the supraglottic larynx: report of Southwest Oncology Group Phase 2 Trial S9709. Arch Otolaryngol Head Neck Surg 2007; 133:1044.
  49. Weinstein GS, O'Malley BW Jr, Snyder W, Hockstein NG. Transoral robotic surgery: supraglottic partial laryngectomy. Ann Otol Rhinol Laryngol 2007; 116:19.
  50. Desai SC, Sung CK, Jang DW, Genden EM. Transoral robotic surgery using a carbon dioxide flexible laser for tumors of the upper aerodigestive tract. Laryngoscope 2008; 118:2187.
  51. Sessions DG, Lenox J, Spector GJ. Supraglottic laryngeal cancer: analysis of treatment results. Laryngoscope 2005; 115:1402.
  52. Levendag P, Vikram B. The problem of neck relapse in early stage supraglottic cancer--results of different treatment modalities for the clinically negative neck. Int J Radiat Oncol Biol Phys 1987; 13:1621.
  53. Lutz CK, Johnson JT, Wagner RL, Myers EN. Supraglottic carcinoma: patterns of recurrence. Ann Otol Rhinol Laryngol 1990; 99:12.
  54. Hicks WL Jr, Kollmorgen DR, Kuriakose MA, et al. Patterns of nodal metastasis and surgical management of the neck in supraglottic laryngeal carcinoma. Otolaryngol Head Neck Surg 1999; 121:57.
  55. Chiu RJ, Myers EN, Johnson JT. Efficacy of routine bilateral neck dissection in the management of supraglottic cancer. Otolaryngol Head Neck Surg 2004; 131:485.
  56. Dahm JD, Sessions DG, Paniello RC, Harvey J. Primary subglottic cancer. Laryngoscope 1998; 108:741.
  57. Strome SE, Robey TC, Devaney KO, et al. Subglottic carcinoma: review of a series and characterization of its patterns of spread. Ear Nose Throat J 1999; 78:622.
  58. Garas J, McGuirt WF Sr. Squamous cell carcinoma of the subglottis. Am J Otolaryngol 2006; 27:1.
  59. Paisley S, Warde PR, O'Sullivan B, et al. Results of radiotherapy for primary subglottic squamous cell carcinoma. Int J Radiat Oncol Biol Phys 2002; 52:1245.