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Management of Supraglottic cancer based on TNM staging 2018 guidelines
- 1. MANAGEMENT
- 3. TX Primary tumor cannot be assessed. Tis Carcinoma in situ. T1 Tumor limited to 1 subsite of supraglottis. Normal vocal cord mobility. T2 Tumor invades mucosa of >1 adjacent subsite of supraglottis/ glottis/ beyond supraglottis (mucosa of tongue base, vallecula, medial wall of pyriform sinus). Normal vocal cord mobility. T3 Tumor limited to larynx and/or invades: postcricoid area, preglottic space, inner cortex of thyroid cartilage. Vocal cords fixed. T4 T4a: Moderately Advanced local disease. T4b: Very advanced local disease. T4a Tumor involving outer cortex of thyroid cartilage and/or tissues beyond larynx (trachea, soft tissues of neck, deep extrinsic muscle of tongue, strap muscles, thyroid, esophagus). T4b Tumor invading prevertebral space, encasing carotid artery/ mediastinal structures.
- 5. stage T N M 0 Tis N0 M0 I T1 N0 M0 II T2 N0 M0 III T3 N0 M0 T1, T2, T3 N0, N1 M0 IVA T4a N0, N1 M0 T1, T2, T3, T4a N2 M0 IVB T4b Any N M0 Any T N3 M0 IVC Any T Any N M1
- 6. Stage I & II (T1-2, N0) Stage III External beam radiotherapy Transoral laser microsurgery Neck evaluation for occult metastasis
- 7. Stage I & II (T1-2, N0) Stage III (a) T1-2, N1 (b) T3, N0-1 Non surgical Surgical Normal creatinine Compromised creatinine Concurrent RT & CT Concurrent targeted therapy(cetuximab/ nimotuzumab) With radiotherapy Accelerated RT
- 8. Transoral laser microsurgery with ipsilateral Neck dissection with adjuvant therapy Adjuvant therapy Supraglottic laryngectomy with bilateral neck dissection Stage I & II (T1-2, N0) Stage III (a) T1-2, N1 Non surgical Surgical (b) T3, N0-1
- 9. Stage I & II (T1-2, N0) Stage III (b) T3 N0-1(a) T1-2, N1 Laryngeal function intact Normal creatinine clearance Laryngeal function compromised Laryngeal function intact Compromised creatinine clearance Concurrent RT & CT Near total/ Total laryngectomy with bilateral neck dissection Concurrent targeted therapy & RT Accelerate d RT Supraglottic laryngectomy with bilateral neck dissection with adjuvant therapy
- 10. Stage IV T3 N2a-3T1-2 N2a-3 Non surgical surgical Normal creatinine compromised creatinine CT/ RT Targeted therapy & RT Accelerated RT
- 11. Stage IV T3 N2a-3T1-2 N2a-3 Non surgical surgical Transoral laser microsurgery & bilateral neck dissection & adjuvant therapy Split therapy & neck dissection & adjuvant therapy Supraglottic laryngectomy & bilateral neck dissection & adjuvant therapy
- 12. Stage IV T3 N2a-3T1-2 N2a-3 Laryngeal function intact Normal creatinine clearance RT & CT Laryngeal function intact Compromised creatinine clearance Targeted therapy & RT Laryngeal function compromised Near total/ Total laryngectomy with bilateral neck dissection Accelerated RT Supraglottic laryngectomy with bilateral neck dissection with adjuvant therapy
- 13. Stage IV (T4 any N) Intact laryngeal function & framework (no cartilage destruction) Normal creatinine clearance RT & CT Near total/ Total laryngectomy with bilateral neck dissection Compromised creatinine clearance Targeted therapy & RT Accelerated RT Near total/ Total laryngectomy with bilateral neck dissection Laryngeal function & framework compromised (cartilage destruction)
- 14. Stage IV (T4 any N) Intact laryngeal function & framework (no cartilage destruction) Near total/ Total laryngectomy with bilateral neck dissection with adjuvant therapy Laryngeal function & framework compromised (cartilage destruction)