Requirements for Effective Delivery of Primary Chemoradiation for Glottic Cancer

  • Primary CRT is an option mainly for selected T3 glottic cancers
    • Not excessively bulky
    • No cartilage destruction
  • Patient factors
    • Functional larynx: airway, swallowing, aspiration
    • Likely to complete CRT treatment
      • Fitness, age
      • Social support / financial means
    • Ability to cope with possible sequelae of CRT
      • Aspiration
      • Dysphagia
      • Renal failure
      • Hearing loss/ peripheral neuropathy
      • Tracheostomy
      • Hypothyroidism
  • Total laryngectomy often a better option in low resource environments because CRT
    • Complex, sophisticated, toxic treatment
    • Requires complex supportive care, both during and following treatment
  • Required package of care for favourable outcomes
    • CT/MRI/PET imaging for planning and surveillance
    • Modern radiation techniques
    • Medical and social support during treatment
    • Speech and swallowing therapy
    • Access to PEG feeding (Short and/or long-term)
    • Cancer surveillance (MRI / PET)
    • Thyroid replacement therapy
    • Complex salvage surgery including pedicled and free flaps

Index: Clinical Practice Guidelines for Glottic Cancer

Resource Appropriate Glottic Cancer Guideline Scenarios