In what cases of T3N0 glottic SCC, would you omit chemotherapy and offer radiation alone?

The question seems to stem from a presentation of a patient that would have historically been stage 2, but more recent editions of AJCC and more refined imaging have upstaged the patient to stage 3 by calling minimal paraglottic extension on an MRI. This is similar to a previous question where a pat...

I would not, if I do not have to:

• Medical Contraindications to Chemotherapy

  • Poor performance status (ECOG ≥2).

  • Significant comorbidities: severe cardiac disease, uncontrolled renal/hepatic dysfunction, severe neuropathy/hearing loss, prior platinum intolerance.

  • Advanced age with frailty wher...

It would be unusual to omit chemotherapy because salvage therapy is often more morbid than concurrent low-dose systemic therapy.

Paraglottic space alone is insignificant upstaging per Dagan 2007 especially if only seen on MRI. I am comfortable with the RT-alone approach in this situation.

Dagan et al....

If adjuvant was thought to be too risky or the patient declined.

We do not have the luxury of obtaining required diagnostic studies. Often we order a study that is approved by the health insurance.

Will order an MRI to evaluate the extension of carcinoma of the larynx.

Gainesville has published excellent outcomes using hyperfractionation for low-volume T3 glottic primaries with local control of nearly 90%. These volumes were prospectively collected and confirmed by radiology at the tumor board. Certainly more tolerable than concurrent chemo xrt.