A 50-year-old with T1N0M0 glottic carcinoma (limited to one true vocal cord, normal mobility) is being evaluated for treatment. Which treatment offers equivalent 5-year local control with maximum laryngeal preservation?
- A Total laryngectomy — gold standard for T1 glottic carcinoma
- B Radiation therapy alone (63–66 Gy) or transoral laser microsurgery (TLM) — both have >90% local control ✓
- C Concurrent chemoradiation with cisplatin
- D Supracricoid laryngectomy with CHEP reconstruction
Correct answer: B. Radiation therapy alone (63–66 Gy) or transoral laser microsurgery (TLM) — both have >90% local control
Explanation
T1 glottic carcinoma has the best prognosis of all laryngeal cancers because the glottis is relatively avascular with a paucity of lymphatics, so nodal spread is rare. Both radiation therapy (63–66 Gy over 6.5 weeks) and transoral laser microsurgery (TLM — CO2 laser cordectomy) offer equivalent local control rates exceeding 90–95%, with excellent voice outcomes. These are the preferred treatment modalities. Total laryngectomy is reserved for salvage after failure of organ-preservation treatment. Chemoradiation is reserved for T3/T4 or node-positive disease.
Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.
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Written and medically reviewed by the StethoPrep medical team.