A patient with carcinoma of the larynx has T2N0M0 disease involving the supraglottis with normal cord mobility. According to current TNM staging (AJCC 8th edition) and oncologic principles, the preferred management is:

• A Total laryngectomy with bilateral neck dissection as primary treatment
• B Supraglottic laryngectomy only, without radiation, as the disease is resectable
• C Induction chemotherapy followed by assessment, with no role for radiotherapy in T2 disease
• D Organ-preserving concurrent chemoradiotherapy (cisplatin-based) with close surveillance; total laryngectomy reserved for salvage ✓

Explanation

For T2N0M0 supraglottic carcinoma with preserved vocal cord mobility, current guidelines (NCCN, AJCC) favor organ-preservation protocols — either concurrent chemoradiotherapy or radiation alone — as first-line treatment to preserve laryngeal function. The VA larynx trial established that induction chemo + radiotherapy offered laryngeal preservation in ~64% without compromising survival. Total laryngectomy is reserved for organ-preservation failure (salvage). Supraglottic laryngectomy requires adequate pulmonary reserve and has a risk of aspiration; it is a valid surgical option but organ preservation RT/CRT is currently preferred.

Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.