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Cancer of The Supraglottic Larynx
Surgery, radiation, or radiochemotherapy are options (see NCCN guidelines and review)
Surgery is commonly used for this site often with postoperative radiation (see typical postOp port.)
Radiation alone is useful for early cases (T1 or T2) see typical lateral and ap ports, NCCN dose
control rates, more control rates here and here , survival rates, more survival results
| Supraglottic Larynx (see pic) The lymphatic drainage is separated into two components, a superficial mucosal component that drains into a deep system of collecting ducts. The deep system unites with the lymphatic drainage of the inferior pharynx The draining vessels of the unified deep system exit the larynx through the natural defect in the thyrohyoid membrane that permits passage of the superior laryngeal neurovascular bundle. At this point, one component of the lymphatic drainage extends superiorly and terminates in the ipsilateral Level II nodes while a second component extends lateral and drains into nodes located at the junction of Levels II and III. There is occasionally a third component that drains into the nodes located in Level III nodes Tumors involving the supraglottic larynx are at risk for crossed lymphatic drainage. However, the drainage mechanism is unclear. There appears to be cross-drainage of the superficial mucosal lymphatics, however, no consistent direct cross-drainage of the deep collecting duct has been described. B & C. Schematic illustrations demonstrate the ipsilateral (B) and contralateral (C) nodal groups most likely at risk for developing nodal metastases from a lateralized supraglottic carcinoma. On the ipsilateral side, Groups II and III are at greatest risk for developing nodal metastases. The group at highest risk for metastases on the contralateral side is Group II. (see pic B and C) |
| Stage | Control with Radiation |
| T1 | 71 - 100% |
| T2 | 50 - 83% |
| T3 | 37 - 70% |
| T4 | 23 - 48% |
| there is evidence that treating twice a day (hyperfractionation) may improve control rates, for T2 from 80% up to 90% and for T3/T4 from 33% up to 64% |
