A 55-year-old man presents with T4aN0M0 squamous cell carcinoma of the supraglottic larynx with thyroid cartilage invasion on CT. He has adequate pulmonary function. According to NCCN guidelines and standard practice, what is the recommended definitive treatment?
- A Definitive radiotherapy alone
- B Total laryngectomy with adjuvant radiotherapy ✓
- C Concurrent chemoradiotherapy with cisplatin
- D Induction chemotherapy followed by radiotherapy
Explanation
T4a laryngeal cancer with cartilage invasion is generally not amenable to organ preservation. Total laryngectomy with adjuvant radiotherapy (based on pathological risk factors) is the standard of care. The VA Laryngeal Cancer Study Group established organ preservation with induction chemotherapy plus radiotherapy, but this was for T3 tumors without cartilage invasion. T4a with cartilage erosion has poor outcomes with chemoradiotherapy alone and requires surgery. Concurrent chemoradiotherapy is an option for select T4a patients who refuse surgery, but total laryngectomy remains the gold standard.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.