Larynx

Question 1

How is T1 staged in larengeal cancer?

Answer 1

• T1a = one cord (glottis)
• T1b = 2 cords (glottis)
• T1 - one subsite (suprglottis)
• Limited to subglottis

Question 2

How is T2 staged in larengeal cancer?

Answer 2

• Extends to supra/sub or impaired mobility (glottis)
• One subsite/extends to glottis/ mobile (Supraglottis)
• Extends to cords/mobile (subglottis)

Question 3

How is T3 staged in larengeal cancer?

Answer 3

• Cord fixation

Question 4

How is T4 staged in larengeal cancer?

Answer 4

• extends beyond the larynx

Question 5

How is early disease managed?

Answer 5

• Choice
• Transoral laser microsurgery (T1a)
• OR Radiotherapy (T1b-T2)

Question 6

How is advanced disease managed?

Answer 6

• RT with concomittant chemoor surgery with adj RT

- T4a - consider surgery and adjuvant RT =/- concurrent chemo

Question 7

How are early larengeal cancers treated?

Answer 7

• T1-T2a
• Low tumour volume
• RT with surgery in reserve or TLM
• Survival between two is similar, but no trials to compare
• 2.25Gy / #
• No concurrent chemo, no prophylactic neck RT
• larger tumours with further infiltration, RT may be easier

Question 8

How are T2b-T3 tumours treated (glottis)?

Answer 8

• Surgery in selected cases
• Mostly RT with larrynx preservation
• Concurrent chemo is gold standard
• Elective treatment to nodal areas II, III and IV

Question 9

How are early supraglottic tumours treated?

Answer 9

• RT or conservation surgery
• No concurrent chemo unless the patient is node +ve
• prophylactic bilateral neck node XRT, levels II and III

Question 10

How is locally advanced larangeal cancer managed?

Answer 10

• Total laryngectomy +/- RT
• Organ preservation where possible
• Concurrent chemoRT is standard
• Node neg = prophylactic nodal treatment to II-IV
• node pos = chemoRT or RT modified to include
• Could follow RT with neck disection for nodal removal

Question 11

What is the NIMRAD trial?

Answer 11

• Nimorazole with RT vs RT alone
• Nimorazole potential to sensitise hypoxic cells to cytotoxic effects of ionising RT
• See how well it is tolerated
• Is it an alternative to chemo?

Question 12

What are the palliative treatment options?

Answer 12

• Tracheostomy
• May be followed by more radical treatment
• chemoRT does provide control for T4 tumours but must be careful with patient selection

Question 13

How is cetuxamab used?

Answer 13

• where chemo is contraindicated
• can be used in ChemoRT (recurrent)
• weekly 7 weeks
• Monoclonal antibody
• Cost effectiveness, NICE

Question 14

What are RT fractrionations for N0 glottic carcinoma?

Answer 14

• 63Gy / 28# / 5.5 weeks (Grade B)
• 50Gy / 16# / 3 weeks (T1 disease only) (Grade C)
• 55Gy / 20# / 4 weeks (Grade C)

Question 15

What are RT fractions for non-glottic larynx cancer (stage I/II)?

Answer 15

• 70Gy / 35# / 7 weeks (Grade C)
• 65-66Gy / 30# / 6 weeks (Grade C)
• 66Gy / 33# OR 70Gy / 35#, 6 fractions per week over 6 weeks (Grade B)