A 55-year-old smoker has a T1a squamous cell carcinoma of the left true vocal cord confined to the mobile cord without anterior commissure involvement. The preferred treatment modality that preserves voice quality with the highest local control rate is:
- A Total laryngectomy with voice prosthesis
- B Transoral laser microsurgery (TLM) — endoscopic cordectomy (Type II or III Remacle classification) ✓
- C Induction chemotherapy followed by concurrent chemoradiation
- D Open partial laryngectomy — vertical hemilaryngectomy
Explanation
T1a glottic carcinoma (confined to one mobile vocal cord, no anterior commissure involvement) has equivalent 5-year local control rates (>90%) with both radiotherapy and transoral laser microsurgery (TLM). However, TLM is increasingly preferred as it is a single outpatient procedure, preserves surrounding tissue, allows precise endoscopic resection (Type II subepithelial or Type III transmuscular cordectomy per Remacle classification), and avoids the prolonged treatment course of radiotherapy. Voice outcomes are comparable. Total laryngectomy is not indicated for T1 disease; induction chemotherapy is reserved for organ-preservation protocols in advanced (T3–T4) 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.