What are the staging criteria and treatment options for T1, T2, and T3 laryngeal squamous cell carcinoma?

Laryngeal Squamous Cell Carcinoma Staging and Treatment Options for T1, T2, and T3

Laryngeal squamous cell carcinoma (LSCC) staging is based on tumor extent, with treatment options varying by stage to optimize survival while preserving laryngeal function when possible.

T1 Laryngeal Cancer

Staging Criteria:

• T1 Glottic: Tumor limited to vocal cord(s) with normal mobility
• T1 Supraglottic: Tumor limited to one subsite with normal vocal cord mobility

Treatment Options:

• Standard treatment: Single-modality approach with either:

  • Radiation therapy (RT): 66-70 Gy with standard fractionation 1
  • Transoral laser microsurgery (TLM) for appropriate cases 1

• Key considerations:

  • For superficial tumors on free edge of vocal cord: Endoscopic laser resection may be preferred 1
  • For indistinct lesions or those with abnormal-appearing mucosa: RT preferred 1
  • T1 glottic cancer does not require neck dissection or neck RT 1

T2 Laryngeal Cancer

Staging Criteria:

• T2 Glottic: Tumor extends to supraglottis and/or subglottis, and/or with impaired vocal cord mobility
• T2 Supraglottic: Tumor invades mucosa of more than one adjacent subsite of supraglottis or glottis or region outside the supraglottis without fixation of the larynx

Treatment Options:

• Standard treatment:

  • RT with more intense delivery: either hyperfractionation (80.5 Gy in 70 fractions of 1.15 Gy twice daily) or moderately accelerated RT (66-70 Gy in 33-35 fractions over 5.5-6 weeks) 1
  • Transoral surgery followed by RT or chemoradiotherapy (CRT) if indicated 1

• Key considerations:

  • For T2N0-N1: Altered fractionation RT is a valid option 1
  • For T2 with single positive lymph node <3 cm: Consider more intense RT regimens 1
  • Prophylactic nodal RT required (except for T2 glottic tumors) up to 50 Gy 1

T3 Laryngeal Cancer

Staging Criteria:

• T3: Tumor limited to larynx with vocal cord fixation and/or invades paraglottic space and/or minor thyroid cartilage erosion

Treatment Options:

• For T3 not requiring total laryngectomy:

  • Larynx preservation protocol with concurrent chemoradiotherapy 1
  • Induction chemotherapy followed by RT in selected cases 1

• For T3 requiring total laryngectomy:

  • Surgery (total laryngectomy) with neck dissection followed by RT or CRT 1
  • Concurrent chemoradiotherapy with cisplatin preferred for organ preservation 1

• Key considerations:

  • T3 patients have lower locoregional control with larynx preservation protocols compared to surgery (HR 14.1) 2
  • 5-year larynx preservation rate for T3 tumors is approximately 36% 2
  • T3 oral cavity and T3 laryngeal cancers with cartilage invasion may benefit more from primary surgical approach 1

Important Treatment Considerations Across All Stages

1. Neck management:

   • Prophylactic nodal RT required for all except T1-2 glottic tumors 1
   • For single positive lymph node <3 cm: RT dose increased to 70 Gy 1
   • Selective neck dissection or sentinel node biopsy recommended for cT1-2 tumors treated with primary surgery 1

2. Functional outcomes:

   • Voice function tends to be better with non-surgical approaches 3
   • Swallowing function can be comparable between surgical and non-surgical approaches 3

3. Prognostic factors:

   • Age >60 years and positive nodal status are significant predictors of worse overall survival 2
   • Advanced T stage correlates with decreased larynx preservation rates 2

4. Imaging considerations:

   • Cross-sectional imaging essential for accurate T-staging to assess submucosal extent, cartilage invasion, and extralaryngeal spread 4
   • Endoscopic evaluation best for assessing mucosal extent and vocal cord mobility 4

Treatment Algorithm by Stage

1. T1 Disease:

   • First-line: RT (66-70 Gy standard fractionation) or TLM for appropriate cases
   • No neck treatment for T1 glottic cancer
   • Consider patient factors and tumor location when choosing modality

2. T2 Disease:

   • First-line: Intensified RT (hyperfractionated or accelerated) or transoral surgery
   • Include prophylactic nodal RT except for T2 glottic tumors
   • Consider adjuvant therapy based on pathologic findings if surgery chosen

3. T3 Disease:

   • For larynx preservation candidates: Concurrent chemoradiotherapy (cisplatin preferred)
   • For cases requiring total laryngectomy: Surgery with neck dissection followed by adjuvant therapy
   • Consider induction chemotherapy in selected cases to identify responders for organ preservation

By following these stage-specific approaches, optimal oncologic outcomes can be achieved while maximizing the potential for laryngeal preservation when appropriate.