Can a nonbulky, T1-2 supraglottic larynx cancer near the vocal cords be treated like a glottic tumor?

The supraglottic larynx and the pharynx, unlike the glottic larynx, share similar embryological origins and therefore exhibit analogous lymphatic drainage patterns to levels II and III. Therefore, occult dissemination to regional lymph nodes has to be considered regardless of the characteristics of a cT1-T2N0 SGL tumor (e.g. bulky, non-bulky, exophytic, or endophytic). Treating a cT1-2N0 with a typical 5x5 or 6x6 glottic field places the patient at risk for regional failure. In this context, we treat cT1-T2N0 SGL tumors to 70 Gy with prophylactic coverage of bilateral levels II-IV to 54-56 Gy. To note, in a N0 neck, target volumes should be limited to reduce the associated side effects of their treatment as the majority of the toxicity orig...

I would treat both necks Lv. II-IV as well

If the patient's tumor was T1N0 of false cord and had a negative PET/CT and had a history of carotid artery problems, I would consider a more limited carotid artery sparing technique. The lymphatic supply to the false cords is sparser than to other supraglottic sites.

With the caveats noted above, the risk to the patient may outweigh the benefit of treating the nodes and weigh in favor of more limited volumes that allow sparing of the carotids. Including the nodes and carotids in the treatment fields subject the patient to a much higher risk of stroke in the treatment of a tumor that has an excellent chance of long term local control.