After determining a diagnosis and completing a full pre-treatment evaluation, doctors will recommend a course of treatment for their patients. In general, there are three different options for the treatment of subglottic laryngeal cancers that can be used alone or in combination.
Surgery
Surgery may be an option for the treatment of laryngeal cancers, depending on the type, grade, and stage of the cancer. Subglottic cancers may be treated by a laryngectomy, and often a neck dissection.
In some cases of small, early stage tumors, minimally invasive transoral surgery can be performed using direct laryngoscopy and a laser or other laryngeal instruments. For more advanced tumors, surgery may involve the removal of a portion of or the entire larynx (voicebox).
Radiation
For the treatment of laryngeal cancers, there are two types of radiation based on when this treatment is given and for what intent. Radiation therapy can be used as a form of primary treatment, in which an external beam of radiation is directed at the tumor in order to destroy the rapidly dividing cancer cells. Radiation can also be given following surgical resection, termed adjuvant radiation, with the goal of decreasing the chances that the cancer will come back.
Chemotherapy
Chemotherapy is sometimes used in combination with radiation therapy as a primary treatment. It is also sometimes given prior to beginning either primary surgical or nonsurgical treatment, called induction chemotherapy.
General Treatment Options for Subglottic Laryngeal Cancer
These options depend on T, N, and M stages.
Cancer Within the Subglottis
- For small cancers that have not invaded very deeply, surgical removal is generally preferred. Surgery can usually be done through the mouth using an endoscope (laryngoscopy).
- Primary radiation therapy is also a treatment option.
Tumors That Do Not Require a Total Laryngectomy (T1-2, selected T3)
- Surgery is usually performed through an open approach and a portion of the larynx is resected. Unilateral or bilateral neck dissections will also be performed depending on the tumor size and location.
- Depending on the findings during surgery, no additional treatment may be necessary, or adjuvant radiation may be recommended.
- Primary radiation therapy is also a treatment option.
T3 Tumors That Require a Total Laryngectomy (N0-1)
For tumors that require removal of the entire larynx (voice box), there are a few treatment options:
- Surgical removal of the voice box (total laryngectomy) with unilateral or bilateral neck dissection.
- If there are no adverse features found, no additional treatment may be necessary.
- If adverse features are found, surgery may be followed by adjuvant radiation.
- Chemotherapy and radiation, followed by surgery if there is any remaining or recurrent cancer.
- If a patient cannot tolerate chemotherapy, radiation alone is an option, followed by surgery if there is any remaining or recurrent cancer.
- Induction chemotherapy is also an option. Depending on the response to the initial chemotherapy, treatment may be followed by some combination of radiation, chemotherapy, and surgery.
- Patients may also be enrolled in a clinical trial.
T3 Tumors That Require a Total Laryngectomy (N2-3)
For tumors that require removal of the entire larynx (voice box), there are a few treatment options:
- Surgical removal of the voice box (total laryngectomy) with unilateral or bilateral neck dissection.
- If there are no adverse features, no additional treatment is necessary.
- If adverse features are found, additional treatment may include radiation alone, chemotherapy plus radiation, or further surgery.
- Chemotherapy and radiation, followed by surgery if there is any remaining or recurrent cancer.
- Induction chemotherapy is also an option. Depending on the response to the initial chemotherapy, treatment may be followed by some combination of radiation, chemotherapy, and surgery.
- Patients may also be enrolled in a clinical trial.
T4a, Any N
- The recommended treatment for these tumors is surgical removal of the voice box (total laryngectomy) with unilateral or bilateral neck dissection.
- Surgery will usually be followed by radiation with or without chemotherapy.
- If a patient chooses not to have surgery, treatment options include chemotherapy and radiation, induction chemotherapy followed by additional therapy depending on the response to therapy, or enrollment in a clinical trial.
T4b, any N; Unresectable Neck Disease; or Patients Unfit for Surgery
In cases that are very advanced, or in patients who are extremely sick, patients should have an extensive discussion with their doctor in order to consider the possibility of palliative therapy or hospice care.
