ASCO Updates Guidelines for Treating Laryngeal Cancer

11/30/17

The American Society of Clinical Oncology (ASCO) has released new guideline recommendations for the use of larynx-preservation strategies in the treatment of laryngeal cancer, published in the Journal of Clinical Oncology (online November 27, 2017; doi:10.1200/JCO.2017.75.7385).

An expert panel led by Nofisat Ismaila, MD, MSc, clinical guideline specialist, ASCO, convened to conduct a systematic review of available literature on larynx-preservation strategies for laryngeal cancer from 2005 to 2017.

After concluding the literature review, the panel confirmed that the use of a larynx-preservation approach for patients does not compromise survival. Furthermore, there was no larynx-preservation strategy found that offered a survival advantage compared with total laryngectomy and adjuvant therapy.

Changes to the previous recommendations involved the use of endoscopic surgical resection in patients with T1 and T2 disease, initial total laryngectomy in patients with T4a disease, and PET imaging for evaluating regional nodes.

According to the new recommendations, patients with T1 or T2 laryngeal cancer should begin treatment with intent to preserve the larynx by using endoscopic resection or radiation therapy. As for patients with T2 or T4 disease, organ-preserving surgery in combination with chemotherapy and radiation (or radiation alone) may preserve the larynx without compromising overall survival. Selected patients with extensive T3 or large T4a lesions or poor laryngeal function prior to treatment are recommended total laryngectomy to achieve better survival rates and quality of life.  

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Additionally, the updated guidelines recommend that patients with clinically involved regional cervical nodes who have a complete clinical and radiologic imaging response after chemoradiation should not receive elective neck dissection.

Furthermore, the guidelines make suggestions for evaluating voice and swallowing function. “All patients should undergo a pretreatment baseline assessment of voice and swallowing function and receive counseling with regard to the potential impact of treatment options on voice, swallowing, and quality of life,” the guidelines read.—Zachary Bessette