Is it necessary to treat the entire larynx with intermediate or elective dose in a T1/T2 squamous cell carcinoma of the supraglottic or subglottic larynx?

It would be hard to miss it without missing your target. Additionally, you have level 6 nodes with the subglottis and levels 2-4 with the supraglottis. Not a great idea.

To clarify, don’t try to spare the glottis.

A resounding yes - I am currently palliating a patient with a roaring recurrent laryngeal cancer after chemoradiation for a supraglottic tumor where the entire larynx was not covered in the initial field. At the very least, the entire larynx should be covered in the intermediate dose in supraglottic...

No. Your flexible laryngoscopy and CT/MR/PET should guide coverage. Can also follow the 5+5 guidelines.

Excellent question, given the varied answers.

I do not intentionally contour the entire larynx in small supraglottic primaries. I follow the 5+5 approach. The excellent local control rates of partial laryngectomy for small supraglottic primaries is a definitive answer to me that we do not need to in...