Table of Contents Purpose of This PDQ Summary General Information Cellular Classification Stage Information
Treatment Option Overview Stage I Laryngeal Cancer Stage II Laryngeal Cancer Stage III Laryngeal Cancer Stage IV Laryngeal Cancer Recurrent Laryngeal Cancer Get More Information From NCI Changes to This Summary (10/31/2008) More Information
Purpose of This PDQ Summary
This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about the treatment of laryngeal cancer. This summary is reviewed regularly and updated as necessary by the PDQ Adult Treatment Editorial Board 1.
Information about the following is included in this summary:
- Prognostic factors.
- Cellular classification.
- Staging.
- Treatment options by cancer stage and type.
This summary is intended as a resource to inform and assist clinicians who care for cancer patients. It does not provide formal guidelines or recommendations for making health care decisions.
Some of the reference citations in the summary are accompanied by a level-of-evidence designation. These designations are intended to help readers assess the strength of the evidence supporting the use of specific interventions or approaches. The PDQ Adult Treatment Editorial Board uses a formal evidence ranking system 2 in developing its level-of-evidence designations. Based on the strength of the available evidence, treatment options are described as either “standard” or “under clinical evaluation.” These classifications should not be used as a basis for reimbursement determinations.
This summary is available in a patient version 3, written in less technical language, and in Spanish 4. General Information
Note: Estimated new cases and deaths from laryngeal cancer in the United States in 2008:[1]
- New cases: 12,250.
- Deaths: 3,670.
The larynx is divided into three anatomical regions. The supraglottic larynx
includes the epiglottis, false vocal cords, ventricles, aryepiglottic folds,
and arytenoids. The glottis includes the true vocal cords and the anterior and
posterior commissures. The subglottic region begins about 1 cm below
the true vocal cords and extends to the lower border of the cricoid cartilage
or the first tracheal ring.
The supraglottic area is rich in lymphatic drainage. After penetrating the
pre-epiglottic space and thyrohyoid membrane, lymphatic drainage is initially
to the jugulodigastric and midjugular nodes. About 25% to 50% of patients
present with involved lymph nodes. The precise figure depends on the T stage. The
true vocal cords are devoid of lymphatics. As a result, vocal cord cancer
confined to the true cords rarely, if ever, presents with involved lymph nodes.
Extension above or below the cords may, however, lead to lymph node
involvement. Primary subglottic cancers, which are quite rare, drain through
the cricothyroid and cricotracheal membranes to the pretracheal, paratracheal,
and inferior jugular nodes, and occasionally to mediastinal nodes.[2]
A clear association has been made between smoking, excess alcohol ingestion,
and the development of squamous cell cancers of the upper aerodigestive
tract.[3] For smokers, the risk of the development of laryngeal cancer decreases after the cessation of smoking but remains elevated even years later when compared to that of nonsmokers.[4] If a patient who has had a single cancer continues to smoke and drink
alcoholic beverages, the likelihood of a cure for the initial cancer, by any
modality, is diminished, and the risk of second tumor is enhanced. (Refer to the PDQ summary on Smoking Cessation and Continued Risk in Cancer Patients 5 for more information.) Second
primary tumors, often in the aerodigestive tract, have been reported in as many as
25% of patients whose initial lesion is controlled. A study has shown that
daily treatment of these patients with moderate doses of isotretinoin
(i.e., 13-cis-retinoic acid) for 1 year can significantly reduce the incidence of
second tumors.[5] No survival advantage has yet been demonstrated, however, in
part because of recurrence and death from the primary malignancy.
Supraglottic cancers typically present with sore throat, painful swallowing,
referred ear pain, change in voice quality, or enlarged neck nodes. Early
vocal cord cancers are usually detected because of hoarseness. By the time
they are detected, cancers arising in the subglottic area commonly involve the
vocal cords; thus, symptoms usually relate to contiguous spread.
The most important adverse prognostic factors for laryngeal cancers include
increasing T stage and N stage. Other prognostic factors may include sex, age,
performance status, and a variety of pathologic features of the tumor,
including grade and depth of invasion.[6]
Prognosis for small laryngeal cancers that have not spread to lymph nodes is
very good, with cure rates of 75% to 95% depending on the site, tumor bulk,[7]
and degree of infiltration. Although most early lesions can be cured by either
radiation therapy or surgery, radiation therapy may be reasonable to preserve
the voice, leaving surgery for salvage. Patients with a preradiation
hemoglobin level higher than 13 g/dL have higher local control
and survival rates than patients who are anemic.[8] This observation is being
evaluated in a randomized clinical trial.
Locally advanced lesions, especially those with large clinically involved lymph
nodes, are poorly controlled with surgery, radiation therapy, or combined
modality treatment. Distant metastases are also common, even if the primary
tumor is controlled.
Intermediate lesions have intermediate prognoses, depending on site, T stage,
N stage, and performance status. Therapy recommendations for patients with
these lesions are based on a variety of complex anatomic, clinical, and social
factors, which should be individualized and discussed in multidisciplinary
consultation (surgery, radiation therapy, and dental and oral surgery) prior to
prescribing therapy.
Patients treated for laryngeal cancers are at the highest risk of recurrence in the
first 2 to 3 years. Recurrences after 5 years are rare and usually represent
new primary malignancies. Close, regular follow-up is crucial to maximize the
chance for salvage. Careful clinical examination and repetition of any
abnormal staging study are included in follow-up, along with attention to any
treatment-related toxic effect or complication.
References
-
American Cancer Society.: Cancer Facts and Figures 2008. Atlanta, Ga: American Cancer Society, 2008. Also available online. 6 Last accessed October 1, 2008.
-
Spaulding CA, Hahn SS, Constable WC: The effectiveness of treatment of lymph nodes in cancers of the pyriform sinus and supraglottis. Int J Radiat Oncol Biol Phys 13 (7): 963-8, 1987.
[PUBMED Abstract]
-
Spitz MR: Epidemiology and risk factors for head and neck cancer. Semin Oncol 21 (3): 281-8, 1994.
[PUBMED Abstract]
-
Bosetti C, Garavello W, Gallus S, et al.: Effects of smoking cessation on the risk of laryngeal cancer: an overview of published studies. Oral Oncol 42 (9): 866-72, 2006.
[PUBMED Abstract]
-
Hong WK, Lippman SM, Itri LM, et al.: Prevention of second primary tumors with isotretinoin in squamous-cell carcinoma of the head and neck. N Engl J Med 323 (12): 795-801, 1990.
[PUBMED Abstract]
-
Yilmaz T, Hoşal S, Gedikoglu G, et al.: Prognostic significance of depth of invasion in cancer of the larynx. Laryngoscope 108 (5): 764-8, 1998.
[PUBMED Abstract]
-
Reddy SP, Mohideen N, Marra S, et al.: Effect of tumor bulk on local control and survival of patients with T1 glottic cancer. Radiother Oncol 47 (2): 161-6, 1998.
[PUBMED Abstract]
-
Fein DA, Lee WR, Hanlon AL, et al.: Pretreatment hemoglobin level influences local control and survival of T1-T2 squamous cell carcinomas of the glottic larynx. J Clin Oncol 13 (8): 2077-83, 1995.
[PUBMED Abstract]
Cellular Classification
The vast majority of laryngeal cancers are of squamous cell histology.
Squamous cell subtypes include keratinizing and nonkeratinizing and well-differentiated to poorly differentiated grade. A variety of nonsquamous cell
laryngeal cancers also occur.[1] These are not staged using the American Joint
Cancer Committee staging system, and their management, which is not discussed here, can
differ from that of squamous cell laryngeal cancers. In situ squamous cell
carcinoma of the larynx is usually managed by a conservative surgical procedure
such as mucosal stripping or superficial laser excision. Radiation therapy may
also be appropriate treatment of selected patients with in situ carcinoma of
the glottic larynx.[2]
References
-
Mendenhall WM, Riggs CE Jr, Cassisi NJ: Treatment of head and neck cancers. In: DeVita VT Jr, Hellman S, Rosenberg SA, eds.: Cancer: Principles and Practice of Oncology. 7th ed. Philadelphia, Pa: Lippincott Williams & Wilkins, 2005, pp 662-732.
-
Wang CC, ed.: Radiation Therapy for Head and Neck Neoplasms. 3rd ed. New York: Wiley-Liss, 1997.
Stage Information
The staging system is clinical and based on the best possible estimate of the
extent of disease before treatment. The assessment of the primary tumor is
based on inspection and palpation when possible and by both indirect mirror
examination and direct endoscopy when necessary. The tumor must be confirmed
histologically, and any other pathological data obtained on biopsy may be
included. Head and neck magnetic resonance imaging or computed tomography
should be done prior to therapy to supplement inspection and palpation.[1]
Additional radiographic studies may be included. The appropriate nodal
drainage areas in the neck are examined by careful palpation.
The American Joint Committee on Cancer (AJCC) has designated staging by TNM
classification.[2]
TNM Definitions
Primary tumor (T)
- TX: Primary tumor cannot be assessed
- T0: No evidence of primary tumor
- Tis: Carcinoma in situ
Supraglottis
[Note: Supraglottis involves many individual subsites. Relapse-free survival may
differ by subsite and by T and N groupings within stage.]
Glottis
- T1: Tumor limited to the vocal cord(s), which may involve anterior or posterior
commissure, with normal mobility
- T1a: Tumor limited to one vocal cord
- T1b: Tumor involves both vocal cords
- T2: Tumor extends to supraglottis and/or subglottis and/or with impaired
vocal cord mobility
- T3: Tumor limited to the larynx with vocal cord fixation and/or invades paraglottic space, and/or minor thyroid cartilage erosion (e.g., inner cortex)
- T4a: Tumor invades through the thyroid cartilage and/or invades tissues
beyond the larynx (e.g., trachea, soft tissues of neck, including
deep extrinsic muscle of the tongue, strap muscles, thyroid, or esophagus)
- T4b: Tumor invades prevertebral space, encases carotid artery, or invades mediastinal structures
[Note: Glottic presentation may vary by volume of tumor, anatomic region involved, and
the presence or absence of normal cord mobility. Relapse-free survival may
differ by these and other factors in addition to T and N subgroupings within
the stage.]
Subglottis
- T1: Tumor limited to the subglottis
- T2: Tumor extends to vocal cord(s) with normal or impaired mobility
- T3: Tumor limited to larynx with vocal cord fixation
- T4a: Tumor invades cricoid or thyroid cartilage and/or invades tissues beyond the larynx (e.g., trachea, soft tissues of neck,
including deep extrinsic muscles of the tongue, strap muscles, thyroid, or esophagus)
- T4b: Tumor invades prevertebral space, encases carotid artery, or invades mediastinal structures
Regional lymph nodes (N)
- NX: Regional lymph nodes cannot be assessed
- N0: No regional lymph node metastasis
- N1: Metastasis in a single ipsilateral lymph node 3 cm or smaller in greatest
dimension
- N2: Metastasis in a single ipsilateral lymph node larger than 3 cm but 6 cm or smaller in greatest dimension, or in multiple ipsilateral lymph
nodes 6 cm or smaller in greatest dimension, or in bilateral or
contralateral lymph nodes 6 cm or smaller in greatest dimension
- N2a: Metastasis in a single ipsilateral lymph node larger than 3 cm
but 6 cm or smaller in greatest dimension
- N2b: Metastasis in multiple ipsilateral lymph nodes 6 cm or smaller in greatest dimension
- N2c: Metastasis in bilateral or contralateral lymph nodes 6 cm or smaller in greatest dimension
- N3: Metastasis in a lymph node larger than 6 cm in greatest dimension
In clinical evaluation, the actual size of the nodal mass should be measured,
and allowance should be made for intervening soft tissues. Most masses larger than 3 cm in diameter are not single nodes but confluent nodes or
tumors in soft tissues of the neck. There are three stages of clinically positive
nodes: N1, N2, and N3. The use of subgroups a, b, and c is not required but
recommended. Midline nodes are considered homolateral nodes.
Distant metastasis (M)
- MX: Distant metastasis cannot be assessed
- M0: No distant metastasis
- M1: Distant metastasis
AJCC Stage Groupings
Stage 0
Stage I
Stage II
Stage III
- T3, N0, M0
- T1, N1, M0
- T2, N1, M0
- T3, N1, M0
Stage IVA
- T4a, N0, M0
- T4a, N1, M0
- T1, N2, M0
- T2, N2, M0
- T3, N2, M0
- T4a, N2, M0
Stage IVB
- T4b, any N, M0
- Any T, N3, M0
Stage IVC
Evaluation of treatment outcome can be reported in various ways: locoregional
control, disease-free survival, determinate survival, and overall survival at 2
to 5 years. Preservation of voice is an important parameter to evaluate.
Outcome should be reported after initial surgery, initial radiation, planned
combined treatment, or surgical salvage of radiation failures. Primary source
material should be consulted to review these differences.
Because of clinical problems related to smoking and alcohol use in this
population, many patients succumb to intercurrent illness rather than to the
primary cancer.
Direct comparison of results of radiation versus surgery is complicated.
Surgical studies can report outcome based on pathologic staging, whereas
radiation studies must report on clinical staging, with the obvious problem of
understaging in patients treated with radiation, particularly in the neck. In
addition, radiation alone is often recommended for patients with poor
performance status, which leads to less favorable results.
References
-
Thabet HM, Sessions DG, Gado MH, et al.: Comparison of clinical evaluation and computed tomographic diagnostic accuracy for tumors of the larynx and hypopharynx. Laryngoscope 106 (5 Pt 1): 589-94, 1996.
[PUBMED Abstract]
-
Larynx. In: American Joint Committee on Cancer.: AJCC Cancer Staging Manual. 6th ed. New York, NY: Springer, 2002, pp 47-57.
Treatment Option Overview
Note: Some citations in the text of this section are followed by a level of
evidence. The PDQ editorial boards use a formal ranking system to help the
reader judge the strength of evidence linked to the reported results of a
therapeutic strategy. (Refer to the PDQ summary on Levels of Evidence 2 for more
information.)
Small superficial cancers without laryngeal fixation or lymph node involvement
are successfully treated by radiation therapy or surgery alone, including laser
excision surgery. Radiation therapy may be selected to preserve the voice
and to reserve surgery for salvaging failures. The radiation field and dose are
determined by the location and size of the primary tumor. A variety of
curative surgical procedures are also recommended for laryngeal cancers, some
of which preserve vocal function. An appropriate surgical procedure must be
considered for each patient, given the anatomic problem, performance status,
and clinical expertise of the treatment team. Advanced laryngeal cancers are
often treated by combining radiation and surgery.[1-4] A review of published clinical
results of radical radiation therapy for head and neck cancer suggests a
significant loss of local control when the administration of radiation therapy
was prolonged; therefore, lengthening of standard treatment schedules should be
avoided whenever possible.[5,6] Because the cure rate
for advanced lesions is low, clinical trials exploring chemotherapy,
hyperfractionated radiation therapy,[7] radiation sensitizers, or particle-beam
radiation therapy should be considered.[8,9] Although cure rates are not changed with chemoradiation administered in a neoadjuvant setting, organ preservation is increased.[10]
A multi-institutional trial randomized patients to induction cisplatin plus fluorouracil (5-FU) followed by radiation therapy, radiation therapy administered concurrently with cisplatin, or radiation therapy alone.[10] Concurrent radiation therapy plus cisplatin resulted in a statistically significantly higher percentage of patients with an intact larynx at 2 years (i.e., 88% vs. 75% and 70% for concurrent chemotherapy, induction chemotherapy, and radiation alone, respectively) and higher locoregional control (i.e., 78% vs. 61% and 56%, respectively) than the other two regimens. Both chemotherapy regimens had a lower incidence of distant metastases and better relapse-free survivals than radiation therapy alone, but they also had a higher rate of high-grade toxic effects. Overall survival rates were not significantly different between the different groups.[10][Level of evidence: 1iiC]
The risk of lymph node metastases in patients with stage I glottic cancer
ranges from 0% to 2%, and for more advanced disease, such as stage II and stage
III glottic, the incidence is only 10% and 15%, respectively. Thus, there is
no need to treat glottic cancer cervical lymph nodes electively in patients
with stage I tumors and small stage II tumors. Consideration should be given
to using elective neck radiation for larger or supraglottic tumors.[11]
For patients with cancer of the subglottis, combined modality therapy is
generally preferred though for the uncommon small lesions (i.e., stage I or stage
II), radiation therapy alone may be used.
Patients who smoke during radiation therapy appear to have lower response rates
and shorter survival durations than those who do not;[12] therefore, patients
should be counseled to stop smoking before beginning radiation therapy.
Accumulating evidence has demonstrated a high incidence (i.e., >30%–40%) of
hypothyroidism in patients who have received external-beam radiation to the
entire thyroid gland or to the pituitary gland. Thyroid-junction testing of
patients should be considered prior to therapy and as part of posttreatment
follow-up.[13,14]
References
-
Silver CE, Ferlito A: Surgery for Cancer of the Larynx and Related Structures. 2nd ed. Philadelphia, Pa: Saunders, 1996.
-
Wang CC, ed.: Radiation Therapy for Head and Neck Neoplasms. 3rd ed. New York: Wiley-Liss, 1997.
-
Thawley SE, Panje WR, Batsakis JG, et al., eds.: Comprehensive Management of Head and Neck Tumors. 2nd ed. Philadelphia, Pa: WB Saunders, 1999.
-
Mendenhall WM, Riggs CE Jr, Cassisi NJ: Treatment of head and neck cancers. In: DeVita VT Jr, Hellman S, Rosenberg SA, eds.: Cancer: Principles and Practice of Oncology. 7th ed. Philadelphia, Pa: Lippincott Williams & Wilkins, 2005, pp 662-732.
-
Fowler JF, Lindstrom MJ: Loss of local control with prolongation in radiotherapy. Int J Radiat Oncol Biol Phys 23 (2): 457-67, 1992.
[PUBMED Abstract]
-
Hansen O, Overgaard J, Hansen HS, et al.: Importance of overall treatment time for the outcome of radiotherapy of advanced head and neck carcinoma: dependency on tumor differentiation. Radiother Oncol 43 (1): 47-51, 1997.
[PUBMED Abstract]
-
Bourhis J, Wibault P, Lusinchi A, et al.: Status of accelerated fractionation radiotherapy in head and neck squamous cell carcinomas. Curr Opin Oncol 9 (3): 262-6, 1997.
[PUBMED Abstract]
-
Taylor SG 4th: Integration of chemotherapy into the combined modality therapy of head and neck squamous cancer. Int J Radiat Oncol Biol Phys 13 (5): 779-83, 1987.
[PUBMED Abstract]
-
Stupp R, Weichselbaum RR, Vokes EE: Combined modality therapy of head and neck cancer. Semin Oncol 21 (3): 349-58, 1994.
[PUBMED Abstract]
-
Forastiere AA, Goepfert H, Maor M, et al.: Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer. N Engl J Med 349 (22): 2091-8, 2003.
[PUBMED Abstract]
-
Spaulding CA, Hahn SS, Constable WC: The effectiveness of treatment of lymph nodes in cancers of the pyriform sinus and supraglottis. Int J Radiat Oncol Biol Phys 13 (7): 963-8, 1987.
[PUBMED Abstract]
-
Browman GP, Wong G, Hodson I, et al.: Influence of cigarette smoking on the efficacy of radiation therapy in head and neck cancer. N Engl J Med 328 (3): 159-63, 1993.
[PUBMED Abstract]
-
Turner SL, Tiver KW, Boyages SC: Thyroid dysfunction following radiotherapy for head and neck cancer. Int J Radiat Oncol Biol Phys 31 (2): 279-83, 1995.
[PUBMED Abstract]
-
Constine LS: What else don't we know about the late effects of radiation in patients treated for head and neck cancer? Int J Radiat Oncol Biol Phys 31 (2): 427-9, 1995.
[PUBMED Abstract]
Stage I Laryngeal Cancer
Supraglottis
Standard treatment options:
- External-beam radiation therapy alone.
- Supraglottic laryngectomy. Total laryngectomy may be reserved for patients
unable to tolerate potential respiratory complications of surgery or the
supraglottic laryngectomy. Radiation, however, should be preferred because of
the good results, preservation of the voice, and the possibility of surgical salvage in
patients whose disease recurs locally.[1]
Glottis
Standard treatment options:
- Radiation therapy.[2-5]
- Cordectomy for very carefully selected patients with limited and superficial
T1 lesions.[6,7]
- Partial or hemilaryngectomy or total laryngectomy, depending on anatomic
considerations.
- Laser excision.[6]
Subglottis
Standard treatment options:
- Lesions can be treated successfully by radiation therapy alone with
preservation of normal voice. Surgery is reserved for failure of radiation
therapy or for patients who cannot be easily assessed for radiation therapy.
Current Clinical Trials
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage I laryngeal cancer 7. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site 8.
References
-
Ogura JH, Sessions DG, Spector GJ: Conservation surgery for epidermoid carcinoma of the supraglottic larynx. Laryngoscope 85 (11 pt 1): 1808-15, 1975.
[PUBMED Abstract]
-
Mittal B, Rao DV, Marks JE, et al.: Role of radiation in the management of early vocal cord carcinoma. Int J Radiat Oncol Biol Phys 9 (7): 997-1002, 1983.
[PUBMED Abstract]
-
Wang CC: Factors influencing the success of radiation therapy for T2 and T3 glottic carcinomas. Importance of cord mobility and sex. Am J Clin Oncol 9 (6): 517-20, 1986.
[PUBMED Abstract]
-
Mendenhall WM, Amdur RJ, Morris CG, et al.: T1-T2N0 squamous cell carcinoma of the glottic larynx treated with radiation therapy. J Clin Oncol 19 (20): 4029-36, 2001.
[PUBMED Abstract]
-
Foote RL, Olsen KD, Kunselman SJ, et al.: Early-stage squamous cell carcinoma of the glottic larynx managed with radiation therapy. Mayo Clin Proc 67 (7): 629-36, 1992.
[PUBMED Abstract]
-
Steiner W: Results of curative laser microsurgery of laryngeal carcinomas. Am J Otolaryngol 14 (2): 116-21, 1993 Mar-Apr.
[PUBMED Abstract]
-
Olsen KD, Thomas JV, DeSanto LW, et al.: Indications and results of cordectomy for early glottic carcinoma. Otolaryngol Head Neck Surg 108 (3): 277-82, 1993.
[PUBMED Abstract]
Stage II Laryngeal Cancer
Supraglottis
Standard treatment options:
- External-beam radiation therapy alone for the smaller lesions.[1,2]
- Supraglottic laryngectomy or total laryngectomy, depending on location of
the lesion, clinical status of the patient, and expertise of the treatment
team. Careful selection must be made to ensure adequate pulmonary and
swallowing function postoperatively. Radiation should be preferred because
of the good results, preservation of the voice, and the possibility of surgical salvage in
patients whose disease recurs locally.[3]
- Postoperative radiation therapy is indicated for positive or close
surgical margins.
Treatment options under clinical evaluation:
- Hyperfractionated radiation therapy to improve tumor control rates and
diminish late toxicity to normal tissue.[2,4]
- Isotretinoin (i.e., 13-cis-retinoic acid) daily for 1 year to prevent development
of second upper aerodigestive tract primary tumors.[5]
Glottis
Standard treatment options:
- Radiation therapy.[1,2,6-8]
- Partial or hemilaryngectomy or total laryngectomy, depending on anatomic
considerations. Under certain circumstances, laser microsurgery may be
appropriate.[9]
Treatment options under clinical evaluation:
- Hyperfractionated radiation therapy to improve tumor control rates and
diminish late toxicity to normal tissue.[2,4]
- Isotretinoin daily for 1 year to prevent development of second upper
aerodigestive tract primary tumors.[5]
Subglottis
Standard treatment options:
- Lesions can be treated successfully by radiation therapy alone with
preservation of normal voice.[1,2] Surgery is reserved for failure of
radiation therapy or for patients in whom follow-up is likely to be difficult.
Treatment options under clinical evaluation:
- Hyperfractionated radiation therapy to improve tumor control rates and
diminish late toxicity to normal tissue.[2,4]
- Isotretinoin daily for 1 year to prevent development of second upper
aerodigestive tract primary tumors.[5]
Current Clinical Trials
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage II laryngeal cancer 9. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site 8.
References
-
Mendenhall WM, Riggs CE Jr, Cassisi NJ: Treatment of head and neck cancers. In: DeVita VT Jr, Hellman S, Rosenberg SA, eds.: Cancer: Principles and Practice of Oncology. 7th ed. Philadelphia, Pa: Lippincott Williams & Wilkins, 2005, pp 662-732.
-
Wang CC, ed.: Radiation Therapy for Head and Neck Neoplasms. 3rd ed. New York: Wiley-Liss, 1997.
-
Ogura JH, Sessions DG, Spector GJ: Conservation surgery for epidermoid carcinoma of the supraglottic larynx. Laryngoscope 85 (11 pt 1): 1808-15, 1975.
[PUBMED Abstract]
-
Parsons JT, Mendenhall WM, Cassisi NJ, et al.: Hyperfractionation for head and neck cancer. Int J Radiat Oncol Biol Phys 14 (4): 649-58, 1988.
[PUBMED Abstract]
-
Hong WK, Lippman SM, Itri LM, et al.: Prevention of second primary tumors with isotretinoin in squamous-cell carcinoma of the head and neck. N Engl J Med 323 (12): 795-801, 1990.
[PUBMED Abstract]
-
Mittal B, Marks JE, Ogura JH: Transglottic carcinoma. Cancer 53 (1): 151-61, 1984.
[PUBMED Abstract]
-
Medini E, Medini I, Lee CK, et al.: Curative radiotherapy for stage II-III squamous cell carcinoma of the glottic larynx. Am J Clin Oncol 21 (3): 302-5, 1998.
[PUBMED Abstract]
-
Mendenhall WM, Amdur RJ, Morris CG, et al.: T1-T2N0 squamous cell carcinoma of the glottic larynx treated with radiation therapy. J Clin Oncol 19 (20): 4029-36, 2001.
[PUBMED Abstract]
-
Steiner W: Results of curative laser microsurgery of laryngeal carcinomas. Am J Otolaryngol 14 (2): 116-21, 1993 Mar-Apr.
[PUBMED Abstract]
Stage III Laryngeal Cancer
Supraglottis
Standard treatment options:
- Surgery with or without postoperative radiation therapy, as evidenced in RTOG-7303 10, for example.[1-6]
- Definitive radiation therapy with surgery for salvage of radiation
failures.[7]
- Chemotherapy administered concomitantly with radiation therapy can
be considered for patients who would require total laryngectomy for control of disease. Laryngectomy would be reserved for patients with less than a 50%
response to chemotherapy or who have persistent disease following
radiation.[8-13]
Treatment options under clinical evaluation:
- Hyperfractionated radiation therapy to improve tumor control rates and
diminish late toxicity to normal tissue.[14,15]
- Clinical trials exploring chemotherapy, radiosensitizers, or particle-beam
radiation therapy.[16-20]
A meta-analysis of three trials of patients with locally advanced laryngeal
carcinomas compared patients who received standard radical surgery plus
radiation therapy with patients who received neoadjuvant cisplatin and
fluorouracil (5-FU), followed by radiation therapy alone in responders or radical
surgery plus radiation therapy in nonresponders.[21] The meta-analysis
demonstrated a nonsignificant trend in favor of the control group who received
standard radical surgery plus radiation therapy with an absolute negative
effect in the chemotherapy arm that reduced survival at 5 years by 6%. The
possibility of a slightly decreased survival must be balanced by the retention
of the larynx in those patients whose disease was controlled.
- Isotretinoin (i.e., 13-cis-retinoic acid) daily for 1 year to prevent development
of second upper aerodigestive tract primary tumors.[22]
Glottis
Standard treatment options:
- Surgery with or without postoperative radiation therapy, as evidenced in RTOG-7303 10, for example.[1-6,23]
- Definitive radiation therapy with surgery for salvage of radiation
failures.[7,24]
- Chemotherapy administered concomitantly with radiation therapy can
be considered for patients who would require total laryngectomy for control of disease. Laryngectomy would be reserved for patients with less than a 50%
response to chemotherapy or who have persistent disease following
radiation.[8-13]
Treatment options under clinical evaluation:
- Hyperfractionated radiation therapy to improve tumor control rates and
diminish late toxicity to normal tissue.[14,15]
- Clinical trials exploring chemotherapy, radiosensitizers, or particle beam
radiation therapy.[16,17,19,20]
A meta-analysis of three trials of patients with locally advanced laryngeal
carcinomas compared patients who received standard radical surgery plus
radiation therapy with patients who received neoadjuvant cisplatin and
fluorouracil, followed by radiation therapy alone in responders or radical
surgery plus radiation therapy in nonresponders.[21] The meta-analysis
demonstrated a nonsignificant trend in favor of the control group who received
standard radical surgery plus radiation therapy with an absolute negative
effect in the chemotherapy arm that reduced survival at 5 years by 6%. The
possibility of a slightly decreased survival must be balanced by the retention
of the larynx in those patients whose disease was controlled.
- Isotretinoin daily for 1 year to prevent development of second upper
aerodigestive tract primary tumors.[22]
Subglottis
Standard treatment options:
- Laryngectomy plus isolated thyroidectomy and tracheoesophageal node
dissection usually followed by postoperative radiation therapy.[1-3]
- Treatment by radiation therapy alone is indicated for patients who are not
candidates for surgery. Patients should be closely followed, and surgical
salvage should be planned for recurrences that are local or in the neck.
Treatment options under clinical evaluation:
- Hyperfractionated radiation therapy to improve tumor control rates and
diminish late toxicity to normal tissue.[14,15]
- Clinical trials exploring chemotherapy, radiosensitizers, or particle-beam
radiation therapy.[16,17,19,20]
A meta-analysis of three trials of patients with locally advanced laryngeal
carcinomas compared patients who received standard radical surgery plus
radiation therapy with patients who received neoadjuvant cisplatin and
fluorouracil, followed by radiation therapy alone in responders or radical
surgery plus radiation therapy in nonresponders.[21] The meta-analysis
demonstrated a nonsignificant trend in favor of the control group who received
standard radical surgery plus radiation therapy with an absolute negative
effect in the chemotherapy arm that reduced survival at 5 years by 6%. The
possibility of a slightly decreased survival must be balanced by the retention
of the larynx in those patients whose disease was controlled.
- Isotretinoin daily for 1 year to prevent development of second upper
aerodigestive tract primary tumors.[22]
Current Clinical Trials
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage III laryngeal cancer 11. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site 8.
References
-
Thawley SE, Panje WR, Batsakis JG, et al., eds.: Comprehensive Management of Head and Neck Tumors. 2nd ed. Philadelphia, Pa: WB Saunders, 1999.
-
Mendenhall WM, Riggs CE Jr, Cassisi NJ: Treatment of head and neck cancers. In: DeVita VT Jr, Hellman S, Rosenberg SA, eds.: Cancer: Principles and Practice of Oncology. 7th ed. Philadelphia, Pa: Lippincott Williams & Wilkins, 2005, pp 662-732.
-
Arriagada R, Eschwege F, Cachin Y, et al.: The value of combining radiotherapy with surgery in the treatment of hypopharyngeal and laryngeal cancers. Cancer 51 (10): 1819-25, 1983.
[PUBMED Abstract]
-
Spaulding CA, Krochak RJ, Hahn SS, et al.: Radiotherapeutic management of cancer of the supraglottis. Cancer 57 (7): 1292-8, 1986.
[PUBMED Abstract]
-
Ogura JH, Sessions DG, Spector GJ: Conservation surgery for epidermoid carcinoma of the supraglottic larynx. Laryngoscope 85 (11 pt 1): 1808-15, 1975.
[PUBMED Abstract]
-
Tupchong L, Scott CB, Blitzer PH, et al.: Randomized study of preoperative versus postoperative radiation therapy in advanced head and neck carcinoma: long-term follow-up of RTOG study 73-03. Int J Radiat Oncol Biol Phys 20 (1): 21-8, 1991.
[PUBMED Abstract]
-
MacKenzie RG, Franssen E, Balogh JM, et al.: Comparing treatment outcomes of radiotherapy and surgery in locally advanced carcinoma of the larynx: a comparison limited to patients eligible for surgery. Int J Radiat Oncol Biol Phys 47 (1): 65-71, 2000.
[PUBMED Abstract]
-
Spaulding MB, Fischer SG, Wolf GT: Tumor response, toxicity, and survival after neoadjuvant organ-preserving chemotherapy for advanced laryngeal carcinoma. The Department of Veterans Affairs Cooperative Laryngeal Cancer Study Group. J Clin Oncol 12 (8): 1592-9, 1994.
[PUBMED Abstract]
-
Merlano M, Benasso M, Corvò R, et al.: Five-year update of a randomized trial of alternating radiotherapy and chemotherapy compared with radiotherapy alone in treatment of unresectable squamous cell carcinoma of the head and neck. J Natl Cancer Inst 88 (9): 583-9, 1996.
[PUBMED Abstract]
-
Adelstein DJ, Saxton JP, Lavertu P, et al.: A phase III randomized trial comparing concurrent chemotherapy and radiotherapy with radiotherapy alone in resectable stage III and IV squamous cell head and neck cancer: preliminary results. Head Neck 19 (7): 567-75, 1997.
[PUBMED Abstract]
-
Jeremic B, Shibamoto Y, Milicic B, et al.: Hyperfractionated radiation therapy with or without concurrent low-dose daily cisplatin in locally advanced squamous cell carcinoma of the head and neck: a prospective randomized trial. J Clin Oncol 18 (7): 1458-64, 2000.
[PUBMED Abstract]
-
Forastiere AA, Goepfert H, Maor M, et al.: Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer. N Engl J Med 349 (22): 2091-8, 2003.
[PUBMED Abstract]
-
Bernier J, Domenge C, Ozsahin M, et al.: Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer. N Engl J Med 350 (19): 1945-52, 2004.
[PUBMED Abstract]
-
Wang CC, ed.: Radiation Therapy for Head and Neck Neoplasms. 3rd ed. New York: Wiley-Liss, 1997.
-
Parsons JT, Mendenhall WM, Cassisi NJ, et al.: Hyperfractionation for head and neck cancer. Int J Radiat Oncol Biol Phys 14 (4): 649-58, 1988.
[PUBMED Abstract]
-
Bachaud JM, David JM, Boussin G, et al.: Combined postoperative radiotherapy and weekly cisplatin infusion for locally advanced squamous cell carcinoma of the head and neck: preliminary report of a randomized trial. Int J Radiat Oncol Biol Phys 20 (2): 243-6, 1991.
[PUBMED Abstract]
-
Merlano M, Corvo R, Margarino G, et al.: Combined chemotherapy and radiation therapy in advanced inoperable squamous cell carcinoma of the head and neck. The final report of a randomized trial. Cancer 67 (4): 915-21, 1991.
[PUBMED Abstract]
-
Wang CC, Suit HD, Blitzer PH: Twice-a-day radiation therapy for supraglottic carcinoma. Int J Radiat Oncol Biol Phys 12 (1): 3-7, 1986.
[PUBMED Abstract]
-
Browman GP, Cripps C, Hodson DI, et al.: Placebo-controlled randomized trial of infusional fluorouracil during standard radiotherapy in locally advanced head and neck cancer. J Clin Oncol 12 (12): 2648-53, 1994.
[PUBMED Abstract]
-
Adelstein DJ, Lavertu P, Saxton JP, et al.: Mature results of a phase III randomized trial comparing concurrent chemoradiotherapy with radiation therapy alone in patients with stage III and IV squamous cell carcinoma of the head and neck. Cancer 88 (4): 876-83, 2000.
[PUBMED Abstract]
-
Pignon JP, Bourhis J, Domenge C, et al.: Chemotherapy added to locoregional treatment for head and neck squamous-cell carcinoma: three meta-analyses of updated individual data. MACH-NC Collaborative Group. Meta-Analysis of Chemotherapy on Head and Neck Cancer. Lancet 355 (9208): 949-55, 2000.
[PUBMED Abstract]
-
Hong WK, Lippman SM, Itri LM, et al.: Prevention of second primary tumors with isotretinoin in squamous-cell carcinoma of the head and neck. N Engl J Med 323 (12): 795-801, 1990.
[PUBMED Abstract]
-
Mittal B, Marks JE, Ogura JH: Transglottic carcinoma. Cancer 53 (1): 151-61, 1984.
[PUBMED Abstract]
-
Medini E, Medini I, Lee CK, et al.: Curative radiotherapy for stage II-III squamous cell carcinoma of the glottic larynx. Am J Clin Oncol 21 (3): 302-5, 1998.
[PUBMED Abstract]
Stage IV Laryngeal Cancer
Supraglottis
Standard treatment options:
- Total laryngectomy with postoperative radiation therapy, as evidenced in RTOG-7303 10, for example.[1-7]
- Definitive radiation therapy with surgery for salvage of radiation
failures.[8]
- Chemotherapy administered concomitantly with radiation therapy can
be considered for patients who would require total laryngectomy for control of disease. Laryngectomy would be reserved for patients with less than a 50%
response to chemotherapy or who have persistent disease following
radiation.[9-14]
Treatment options under clinical evaluation:
- Hyperfractionated radiation therapy to improve tumor control rates and
diminish late toxicity to normal tissue.[2,15]
- Clinical trials exploring chemotherapy, radiosensitizers, or particle-beam
radiation therapy.[16-20]
A meta-analysis of three trials of patients with locally advanced laryngeal
carcinomas compared patients who received standard radical surgery plus
radiation therapy with patients who received neoadjuvant cisplatin and
fluorouracil, followed by radiation therapy alone in responders or radical
surgery plus radiation therapy in nonresponders.[21] The meta-analysis
demonstrated a nonsignificant trend in favor of the control group who received
standard radical surgery plus radiation therapy with an absolute negative
effect in the chemotherapy arm that reduced survival at 5 years by 6%. The
possibility of a slightly decreased survival must be balanced by the retention
of the larynx in those patients whose disease was controlled.
- Isotretinoin (i.e., 13-cis-retinoic acid) daily for 1 year to prevent development
of second upper aerodigestive tract primary tumors.[22]
Glottis
Standard treatment options:
- Total laryngectomy with postoperative radiation therapy.[1-4,23]
- Definitive radiation therapy with surgery for salvage of radiation
failures.[8]
- Chemotherapy administered concomitantly with radiation therapy can
be considered for patients who would require total laryngectomy for control of disease. Laryngectomy would be reserved for patients with less than a 50%
response to chemotherapy or who have persistent disease following
radiation.[9-14]
Treatment options under clinical evaluation:
- Hyperfractionated radiation therapy to improve tumor control rates and
diminish late toxicity to normal tissue.[2,15]
- Clinical trials exploring chemotherapy, radiosensitizers, or particle-beam
radiation therapy.[16,17,19,20]
A meta-analysis of three trials of patients with locally advanced laryngeal
carcinomas compared patients who received standard radical surgery plus
radiation therapy with patients who received neoadjuvant cisplatin and
fluorouracil, followed by radiation therapy alone in responders or radical
surgery plus radiation therapy in nonresponders.[21] The meta-analysis
demonstrated a nonsignificant trend in favor of the control group who received
standard radical surgery plus radiation therapy with an absolute negative
effect in the chemotherapy arm that reduced survival at 5 years by 6%. The
possibility of a slightly decreased survival must be balanced by the retention
of the larynx in those patients whose disease was controlled.
- Isotretinoin daily for 1 year to prevent development of second upper
aerodigestive tract primary tumors.[22]
Subglottis
Standard treatment options:
- Laryngectomy plus total thyroidectomy and bilateral tracheoesophageal node
dissection usually followed by postoperative radiation therapy.[1-4]
- Treatment by radiation therapy alone is indicated for patients who are not
candidates for surgery.
Treatment options under clinical evaluation:
- Hyperfractionated radiation therapy to improve tumor control rates and
diminish late toxicity to normal tissue.[2,15]
- Simultaneous chemotherapy and hyperfractionated radiation therapy.[24]
- Clinical trials exploring chemotherapy, radiosensitizers, or particle-beam
radiation therapy.[16,17,19,20]
A meta-analysis of three trials of patients with locally advanced laryngeal
carcinomas compared patients who received standard radical surgery plus
radiation therapy with patients who received neoadjuvant cisplatin and
fluorouracil, followed by radiation therapy alone in responders or radical
surgery plus radiation therapy in nonresponders.[21] The meta-analysis
demonstrated a nonsignificant trend in favor of the control group who received
standard radical surgery plus radiation therapy with an absolute negative
effect in the chemotherapy arm that reduced survival at 5 years by 6%. The
possibility of a slightly decreased survival must be balanced by the retention
of the larynx in those patients whose disease was controlled.
- Isotretinoin daily for 1 year to prevent development of second upper
aerodigestive tract primary tumors.[22]
Current Clinical Trials
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage IV laryngeal cancer 12. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site 8.
References
-
Mendenhall WM, Riggs CE Jr, Cassisi NJ: Treatment of head and neck cancers. In: DeVita VT Jr, Hellman S, Rosenberg SA, eds.: Cancer: Principles and Practice of Oncology. 7th ed. Philadelphia, Pa: Lippincott Williams & Wilkins, 2005, pp 662-732.
-
Wang CC, ed.: Radiation Therapy for Head and Neck Neoplasms. 3rd ed. New York: Wiley-Liss, 1997.
-
Thawley SE, Panje WR, Batsakis JG, et al., eds.: Comprehensive Management of Head and Neck Tumors. 2nd ed. Philadelphia, Pa: WB Saunders, 1999.
-
Arriagada R, Eschwege F, Cachin Y, et al.: The value of combining radiotherapy with surgery in the treatment of hypopharyngeal and laryngeal cancers. Cancer 51 (10): 1819-25, 1983.
[PUBMED Abstract]
-
Spaulding CA, Krochak RJ, Hahn SS, et al.: Radiotherapeutic management of cancer of the supraglottis. Cancer 57 (7): 1292-8, 1986.
[PUBMED Abstract]
-
Ogura JH, Sessions DG, Spector GJ: Conservation surgery for epidermoid carcinoma of the supraglottic larynx. Laryngoscope 85 (11 pt 1): 1808-15, 1975.
[PUBMED Abstract]
-
Tupchong L, Scott CB, Blitzer PH, et al.: Randomized study of preoperative versus postoperative radiation therapy in advanced head and neck carcinoma: long-term follow-up of RTOG study 73-03. Int J Radiat Oncol Biol Phys 20 (1): 21-8, 1991.
[PUBMED Abstract]
-
MacKenzie RG, Franssen E, Balogh JM, et al.: Comparing treatment outcomes of radiotherapy and surgery in locally advanced carcinoma of the larynx: a comparison limited to patients eligible for surgery. Int J Radiat Oncol Biol Phys 47 (1): 65-71, 2000.
[PUBMED Abstract]
-
Spaulding MB, Fischer SG, Wolf GT: Tumor response, toxicity, and survival after neoadjuvant organ-preserving chemotherapy for advanced laryngeal carcinoma. The Department of Veterans Affairs Cooperative Laryngeal Cancer Study Group. J Clin Oncol 12 (8): 1592-9, 1994.
[PUBMED Abstract]
-
Merlano M, Benasso M, Corvò R, et al.: Five-year update of a randomized trial of alternating radiotherapy and chemotherapy compared with radiotherapy alone in treatment of unresectable squamous cell carcinoma of the head and neck. J Natl Cancer Inst 88 (9): 583-9, 1996.
[PUBMED Abstract]
-
Adelstein DJ, Saxton JP, Lavertu P, et al.: A phase III randomized trial comparing concurrent chemotherapy and radiotherapy with radiotherapy alone in resectable stage III and IV squamous cell head and neck cancer: preliminary results. Head Neck 19 (7): 567-75, 1997.
[PUBMED Abstract]
-
Jeremic B, Shibamoto Y, Milicic B, et al.: Hyperfractionated radiation therapy with or without concurrent low-dose daily cisplatin in locally advanced squamous cell carcinoma of the head and neck: a prospective randomized trial. J Clin Oncol 18 (7): 1458-64, 2000.
[PUBMED Abstract]
-
Forastiere AA, Goepfert H, Maor M, et al.: Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer. N Engl J Med 349 (22): 2091-8, 2003.
[PUBMED Abstract]
-
Bernier J, Domenge C, Ozsahin M, et al.: Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer. N Engl J Med 350 (19): 1945-52, 2004.
[PUBMED Abstract]
-
Parsons JT, Mendenhall WM, Cassisi NJ, et al.: Hyperfractionation for head and neck cancer. Int J Radiat Oncol Biol Phys 14 (4): 649-58, 1988.
[PUBMED Abstract]
-
Bachaud JM, David JM, Boussin G, et al.: Combined postoperative radiotherapy and weekly cisplatin infusion for locally advanced squamous cell carcinoma of the head and neck: preliminary report of a randomized trial. Int J Radiat Oncol Biol Phys 20 (2): 243-6, 1991.
[PUBMED Abstract]
-
Merlano M, Corvo R, Margarino G, et al.: Combined chemotherapy and radiation therapy in advanced inoperable squamous cell carcinoma of the head and neck. The final report of a randomized trial. Cancer 67 (4): 915-21, 1991.
[PUBMED Abstract]
-
Wang CC, Suit HD, Blitzer PH: Twice-a-day radiation therapy for supraglottic carcinoma. Int J Radiat Oncol Biol Phys 12 (1): 3-7, 1986.
[PUBMED Abstract]
-
Browman GP, Cripps C, Hodson DI, et al.: Placebo-controlled randomized trial of infusional fluorouracil during standard radiotherapy in locally advanced head and neck cancer. J Clin Oncol 12 (12): 2648-53, 1994.
[PUBMED Abstract]
-
Adelstein DJ, Lavertu P, Saxton JP, et al.: Mature results of a phase III randomized trial comparing concurrent chemoradiotherapy with radiation therapy alone in patients with stage III and IV squamous cell carcinoma of the head and neck. Cancer 88 (4): 876-83, 2000.
[PUBMED Abstract]
-
Pignon JP, Bourhis J, Domenge C, et al.: Chemotherapy added to locoregional treatment for head and neck squamous-cell carcinoma: three meta-analyses of updated individual data. MACH-NC Collaborative Group. Meta-Analysis of Chemotherapy on Head and Neck Cancer. Lancet 355 (9208): 949-55, 2000.
[PUBMED Abstract]
-
Hong WK, Lippman SM, Itri LM, et al.: Prevention of second primary tumors with isotretinoin in squamous-cell carcinoma of the head and neck. N Engl J Med 323 (12): 795-801, 1990.
[PUBMED Abstract]
-
Mittal B, Marks JE, Ogura JH: Transglottic carcinoma. Cancer 53 (1): 151-61, 1984.
[PUBMED Abstract]
-
Weissler MC, Melin S, Sailer SL, et al.: Simultaneous chemoradiation in the treatment of advanced head and neck cancer. Arch Otolaryngol Head Neck Surg 118 (8): 806-10, 1992.
[PUBMED Abstract]
Recurrent Laryngeal Cancer
Treatment of recurrent supraglottic, glottic, and subglottic cancer includes
further surgery or clinical trials.[1-4]
Standard treatment options:
Treatment options under clinical evaluation:
- Patients whose disease does not respond to combined radiation therapy and
surgery probably are best treated by palliative chemotherapy in clinical
trials.
Current Clinical Trials
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with recurrent laryngeal cancer 13. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site 8.
References
-
Million RR, Cassisi NJ, eds.: Management of Head and Neck Cancer: A Multidisciplinary Approach. Philadelphia, Pa: Lippincott, 1994.
-
Wang CC, ed.: Radiation Therapy for Head and Neck Neoplasms. 3rd ed. New York: Wiley-Liss, 1997.
-
Vikram B, Strong EW, Shah JP, et al.: Intraoperative radiotherapy in patients with recurrent head and neck cancer. Am J Surg 150 (4): 485-7, 1985.
[PUBMED Abstract]
-
Jacobs C, Lyman G, Velez-García E, et al.: A phase III randomized study comparing cisplatin and fluorouracil as single agents and in combination for advanced squamous cell carcinoma of the head and neck. J Clin Oncol 10 (2): 257-63, 1992.
[PUBMED Abstract]
-
Wong LY, Wei WI, Lam LK, et al.: Salvage of recurrent head and neck squamous cell carcinoma after primary curative surgery. Head Neck 25 (11): 953-9, 2003.
[PUBMED Abstract]
-
Lavey RS, Calcaterra TC: Partial laryngectomy for glottic cancer after high-dose radiotherapy. Am J Surg 162 (4): 341-4, 1991.
[PUBMED Abstract]
-
Wang CC, McIntyre J: Re-irradiation of laryngeal carcinoma--techniques and results. Int J Radiat Oncol Biol Phys 26 (5): 783-5, 1993.
[PUBMED Abstract]
-
Al-Sarraf M: Head and neck cancer: chemotherapy concepts. Semin Oncol 15 (1): 70-85, 1988.
[PUBMED Abstract]
Get More Information From NCI
Call 1-800-4-CANCER
For more information, U.S. residents may call the National Cancer Institute's (NCI's) Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237) Monday through Friday from 9:00 a.m. to 4:30 p.m. Deaf and hard-of-hearing callers with TTY equipment may call 1-800-332-8615. The call is free and a trained Cancer Information Specialist is available to answer your questions.
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The NCI Web site 15 provides online access to information on cancer, clinical trials, and other Web sites and organizations that offer support and resources for cancer patients and their families. For a quick search, use our “Best Bets” search box in the upper right hand corner of each Web page. The results that are most closely related to your search term will be listed as Best Bets at the top of the list of search results.
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Find Publications
The NCI has booklets and other materials for patients, health professionals, and the public. These publications discuss types of cancer, methods of cancer treatment, coping with cancer, and clinical trials. Some publications provide information on tests for cancer, cancer causes and prevention, cancer statistics, and NCI research activities. NCI materials on these and other topics may be ordered online or printed directly from the NCI Publications Locator 16. These materials can also be ordered by telephone from the Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237), TTY at 1-800-332-8615. Changes to This Summary (10/31/2008)
The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.
Editorial changes were made to this summary. More Information
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Important:
This information is intended mainly for use by doctors and other health care professionals. If you have questions about this topic, you can ask your doctor, or call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237). |