A 58-year-old smoker is found to have T1a carcinoma of the left vocal cord on laryngoscopy. The lesion is confined to one vocal cord with normal mobility and no regional or distant metastasis. According to current NCCAP/NCCN guidelines, what is the preferred primary treatment offering the best voice outcome?

• A Open partial laryngectomy (frontolateral)
• B Transoral laser microsurgery (TLM) or radiotherapy with comparable local control, TLM preferred for voice preservation ✓
• C Concurrent chemoradiation (CCRT) as per organ preservation protocol
• D Total laryngectomy with voice prosthesis rehabilitation

Explanation

T1a glottic carcinoma (single vocal cord, normal mobility) has excellent local control (>90%) with either transoral laser microsurgery (CO2 laser cordectomy) or radical radiotherapy. Current guidelines favour TLM as it provides comparable oncological outcomes with faster treatment, lower cost, and often superior voice quality compared with radiotherapy, which can cause chronic mucosal changes. Open partial laryngectomy and total laryngectomy are not indicated for T1a disease. CCRT is reserved for advanced or unresectable disease.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.