ASCO Clinical Practice Guideline Update: Use of Larynx-Preservation Strategies in the Treatment of Laryngeal Cancer

As reported in the Journal of Clinical Oncology by Arlene A. Forastiere, MD, of The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, and colleagues, ASCO has issued a clinical practice guideline update on the use of larynx-preservation strategies in the treatment of laryngeal cancer. The prior guideline was issued in 2006. The guideline update was informed by an expert panel systematic review of the literature from January 2005 to May 2017. The expert panel was co-chaired by Dr. Forastiere and Gregory T. Wolf, MD, of the University of Michigan.

The key elements of the updated guideline follow:

  • The panel confirmed that the use of a larynx-preservation approach for appropriately selected patients does not compromise survival. No larynx-preservation approach offered a survival advantage compared with total laryngectomy and adjuvant therapy as indicated.
  • Guideline changes support the use of endoscopic surgical resection in patients with limited disease (T1, T2) and the use of initial total laryngectomy in patients with T4a disease or with severe pretreatment laryngeal dysfunction.
  • New recommendations have been added for positron-emission tomography imaging for the evaluation of regional nodes after treatment and best measures for evaluating voice and swallowing function.

The key recommendations follow:

  • Patients with T1, T2 laryngeal cancer should be treated initially with an intent to preserve the larynx by using endoscopic resection or radiation therapy, with either leading to similar outcomes.
  • For patients with locally advanced (T3, T4) disease, organ-preservation surgery, combined chemotherapy and radiation, or radiation alone offer the potential for larynx preservation without compromising overall survival.
  • For selected patients with extensive T3 or large T4a lesions and/or poor pretreatment laryngeal function, better survival rates and quality of life may be achieved with total laryngectomy.
  • Patients with clinically involved regional cervical nodes (N+) who have a complete clinical and radiologic imaging response after chemoradiation do not require elective neck dissection.
  • 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.

Additional information is available at www.asco.org/head-neck-cancer-guidelines and www.asco.org/guidelineswiki.

 

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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