Topics:
Head and Neck Cancers • Radiation Oncology
Why is pT3 not a PORT indication for glottic larynx in the NCCN guidelines?
NCCN list T3 as an indication for PORT for all head/neck subsites including supraglottic larynx with the sole exception of glottic larynx. (Some other sources include pT3 as indication)
Understanding that staging and LN involvement risk are different for pT3 larynx vs. other sites, and larynx preservation is preferred for T3 disease, what is the specific data/rationale for pT3 glottic larynx not needing adjuvant RT after surgery?
Answer from: Radiation Oncologist at Academic Institution
pT3 glottic larynx is a somewhat unusual finding in typical clinical practice since modern imaging is quite good at detecting T3 lesions and most of these will be treated with definitive chemoradiotherapy. Downstaging from cT4 to pT3 would also be unusual because cT4 findings on imaging are fairly s...
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Answer from: Radiation Oncologist at Academic Institution
A fixed cord high volume T3 likely has at least 1 cm of subglottic extension and should receive postop RT because of the risk of level 6 nodal mets. A low volume T3 fixed cord or mobile cord with para glottic space invasion (stage migration) should not have undergone total laryngectomy. However, if ...
Answer from: Radiation Oncologist at Community Practice
Laryngectomy is an en bloc resection outside fascial planes. Widely negative margins are much more believable and represent a much lower risk of recurrence than in other subsites of the head and neck. In other areas, resection is often not even attempted for T3 lesions because lesions are usually T3...