From the Guidelines
The management of T3N1M0 glottic squamous cell carcinoma typically involves a multimodality approach with concurrent chemoradiation as the standard of care. The recommended treatment consists of definitive radiation therapy (70 Gy in 35 fractions over 7 weeks) with concurrent cisplatin chemotherapy (100 mg/m² on days 1,22, and 43 of radiation) 1. For patients who cannot tolerate cisplatin, weekly carboplatin (AUC 1.5-2) or cetuximab (400 mg/m² loading dose followed by 250 mg/m² weekly) can be considered as radiosensitizing alternatives. Prior to treatment, a complete head and neck examination, laryngoscopy, imaging (CT/MRI of neck and chest CT), and nutritional assessment should be performed. A prophylactic gastrostomy tube may be necessary to maintain nutrition during treatment. Following completion of chemoradiation, patients require close surveillance with clinical examinations every 1-3 months for the first year, every 2-4 months in the second year, every 4-6 months in years 3-5, and annually thereafter. Post-treatment imaging is typically performed at 3 months after completion to assess response. Salvage surgery remains an option for persistent or recurrent disease. This approach is recommended because the T3N1 classification indicates locally advanced disease with regional lymph node involvement, and concurrent chemoradiation offers the best chance of locoregional control while preserving laryngeal function when possible. Some key points to consider in the management of T3N1M0 glottic squamous cell carcinoma include:
- The importance of a multidisciplinary treatment approach, as emphasized in the guidelines from the National Comprehensive Cancer Network (NCCN) 1
- The role of concurrent chemoradiation in improving locoregional control and preserving laryngeal function, as demonstrated in studies such as the Intergroup trial R91-11 1
- The need for careful patient selection and consideration of individual factors, such as performance status and comorbidities, in determining the optimal treatment approach. It is also worth noting that, according to the american society of clinical oncology clinical practice guideline for the use of larynx-preservation strategies in the treatment of laryngeal cancer, concurrent chemoradiation therapy is the recommended treatment for T3-T4 cancers of the glottis or supraglottis 1. However, the most recent and highest quality study, which is the NCCN guidelines from 2014, should be prioritized when making a definitive recommendation 1.
From the Research
Management of T3N1M0 Glottic Squamous Cell Carcinoma
The management of T3N1M0 glottic squamous cell carcinoma is complex and involves various treatment modalities.
- Treatment options include total laryngectomy, conservation surgery, radiation therapy, and chemoradiation.
- According to 2, the overall 5-year observed survival rate for T3N0M0 glottic carcinoma was 54%, and the 5-year disease-specific survival rate was 67%.
- However, the provided studies do not directly address the management of T3N1M0 glottic squamous cell carcinoma.
- A study by 3 evaluated the survival outcomes for patients with T3N0M0 squamous cell carcinoma of the glottis treated with definitive radiation alone versus chemoradiation, and found that overall survival was higher in patients treated with chemoradiation.
- Another study by 4 reported the outcomes of superselective intra-arterial chemotherapy for squamous cell carcinoma of the glottic larynx, and found that the overall 5- and 10-year survival rates were 70.4% and 62.9%, respectively.
- A review by 5 discussed the role of radiotherapy in the treatment of glottic squamous cell carcinoma, and stated that radiotherapy cure rates are 65% to 70% for low-volume T3-T4a SCCs, and that concomitant cisplatin is given for T3-T4a SCCs.
- A study by 6 reported the outcomes after radiation therapy for T2N0/stage II glottic squamous cell carcinoma, and found that the 5-year overall survival was 78% for 3D-CRT vs 81% for IMRT.
Treatment Modalities
- Total laryngectomy: may be considered for patients with advanced disease 2
- Conservation surgery: may be considered for patients with early-stage disease 2
- Radiation therapy: may be used as a definitive treatment for patients with T3N0M0 glottic carcinoma 3, 5
- Chemoradiation: may be used to improve overall survival in patients with T3N0M0 glottic carcinoma 3