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Advances in Organ Preservation for Laryngeal Cancer

  • Head and Neck Cancer (PL Swiecicki, Section Editor)
  • Published:
Current Treatment Options in Oncology Aims and scope Submit manuscript

Opinion statement

At the University of Wisconsin, all treatment of head and neck cancer patients begins with discussion at our multi-disciplinary tumor board. Most patients with T4 disease, with existing laryngeal dysfunction, considered unlikely to complete definitive CRT or who have a high risk of persistent aspiration after non-operative management undergo total laryngectomy. A laryngeal sparing approach is attempted on most other patients. Radiotherapy is delivered over 6.5 weeks, preferably with concurrent weekly cisplatin. If the patient is hesitant of chemotherapy or has contraindications to cisplatin, concurrent cetuximab may be offered. Patients treated with RT alone are often treated to the same dose, but via an accelerated schedule by adding a 6th fraction per week. The 6th fraction is given by delivering two treatments at least 6 h apart on a weekday of the patient’s choosing. We consider the following to be major risk factors for clinically significant weight loss during treatment: a 10% or greater loss of weight in the 6 months prior to starting treatment, delivery of concurrent cisplatin, and treatment of the bilateral neck with radiation. Patients who have 2–3 of these characteristics are often given gastrostomy tubes prophylactically. Patients are seen 2 weeks after completion of therapy, and then every 3 months after completion for 2 years. A CT neck and PET-CT are performed at the first 3-month visit. They are seen twice in year three, and then yearly until years 5–7. At each of these visits, we have a low threshold to present the patient at our multidisciplinary tumor board for consideration of salvage laryngectomy if there are signs of progression.

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Funding

This work was supported in part by the UW Carbone Cancer Center Support Grant (P30 CA014520) and the Wisconsin Head and Neck Cancer SPORE (P50 DE026787).

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Authors and Affiliations

  1. Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA

    Graham Campbell MD & Randall J Kimple MD, PhD

  2. Department of Surgery – Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, USA

    Tiffany A Glazer MD

  3. Department of Medicine – Medical Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53705, USA

    Justine Yang Bruce MD

  4. University of Wisconsin Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, USA

    Randall J Kimple MD, PhD & Justine Yang Bruce MD

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  1. Graham Campbell MD
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  2. Tiffany A Glazer MD
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  3. Randall J Kimple MD, PhD
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Correspondence to Justine Yang Bruce MD.

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Conflict of Interest

Dr. Campbell has no financial disclosures. Dr. Glazer has a leadership role in the AAO-HSN Head and Neck Education Committee. Dr. Kimple has a grant from the National Institute of Health and received personal fees from Guidepoint Global, Mele Associates, and Galera Therapeutics. Dr. Bruce is an advisory board member to Phoenix Solutions, Ideaya Biosciences, Istari Oncology, Lilly, Merck, OncLive, and Sanofi Genzyme. She is a member of the safety monitoring committee for Kura Oncology.

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Campbell, G., Glazer, T.A., Kimple, R.J. et al. Advances in Organ Preservation for Laryngeal Cancer. Curr. Treat. Options in Oncol. 23, 594–608 (2022). https://doi.org/10.1007/s11864-022-00945-5

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