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