Radiotherapy in Ca Larynx

1. RT techniques in Ca Larynx
Dr Chandana Sanjee
DNB Resident- Radiation Oncology

2. ANATOMY OF LARYNX

5. Indirect Laryngoscopy

6. Subsites in Larynx
1. Ca Supraglottis
Epiglottis, False vocal cord, Ventricles
Aryepiglottic fold, Arytenoids
2. Ca Glottis
True VC , Ant. and post. Commissure
3. Ca Subglottis

7. Lymphatics
• Supraglottic larynx -superior deep cervical
nodes
• Glottis-No lymphatics
• Subglottis-Inferior deep cervical nodes, pre- or
para-tracheal nodes (level VI)

8. Supraglottic Larynx

9. Vocal Cord and Lymph node
T1 : 0
T2: <2%
T3 and T4 :20-30%
If Supraglottic invasion –Level 3, 2
If Subglottic invasion –Level 6
DOI: 10.1200/JCO.2001.19.20.4029 Journal of Clinical Oncology 19, no. 20 (October 2001) 4029-
4036. T1-T2N0 Squamous Cell Carcinoma of the Glottic Larynx Treated With Radiation Therapy
William M. Mendenhall, Robert J. Amdur, Christopher G. Morris, Russell W. Hinerman

10. Goal of Treatment
• Best functional result with least risk of serious
complication
1. Loco regional Control
2. Larynx preservation

11. Management of CIS
• Stripping of the cord
• Excision using CO2 laser
• RT
LC and Larynx preservation-91%

12. Early Vocal Cord Carcinoma
• Radiotherapy
• Supracricoid
Laryngectomy
• Hemilaryngectomy
• Cordectomy
• Verrucous Ca- Partial
Larngectomy>RT>Total
Laryngectomy
Recurrent lesions after
treatment are always
agressive

13. Moderately Advanced Vocal Cord
Carcinoma
Favourable
• Extensive bilateral or
compromised airway-
Mangement as per
advanced group
Unfavourable
• Radiotherapy

14. Advanced Vocal Cord Cancer
T3,T4 N0
• Total laryngectomy+ RT
• Total Laryngectomy+Lateral
neck dissection+RT
T3,T4 N1
• Total Laryngectomy+Lateral
neck dissection+RT
• MC sites of
recurrence post
surgery
1. Tracheal stoma
2. Base of tongue
3. Neck nodes
4. Soft tissues of neck

15. Indication of Post op RT
1. Positive margin
2. Significant suglottic
extension
3. Cartilage invasion
4. PNI
5. Extension of primary to
soft tissues f neck
6. Multiple positive neck
nodes
7. ECE
8. Dose 60-70Gy/30-35# with
5 fractions per week over
6-7 weeks depending on
margins.
Indication of Pre op RT
1. Fixed nodes
2. Energency tracheostomy
through tumour
3. Extension of tumour
involving skin

16. Early and Moderately Advanced
Supraglottic Lesions
1. Radiotherapy
2. Supraglottic Laryngectomy+
RT
Advanced Supraglottic Lesions
1. Total Laryngectgomy
2. Concomitant
Chemoradiotherapy

17. Advanced Supraglottic Lesions

18. Immobilisation and Simulation
• Head and Neck
Thermoplastic mask
• AP and Lateral films

19. Ca Larynx Early Glottic Cancer(T1–2 )
• Superior: Sup border thyroid
cartilage
• Inferior: Inferior border of
cricoid cartilage
• Anterior: 0.5–1 cm fall-off to
skin
• Posterior: in front of vertebral
bodies
• 4x4- 6x6 fields
• Dose-66-70Gy/33-35# with 5
fractions per week over 6-7
weeks

20. • Field borders for
Supraglottic Carcinoma
N0

21. • Target volume and SC
are localised onto a
transverse outline
Single lateral field for T1 glottic tumour of
right vocal cord

22. • Anterior field to treat
lower neck and SCF

23. • Two anterior oblique
fields for treatment of
early glottic carcinoma

33. Ca Larynx Early Glottic Cancer(T1–2 )
2 opposed lateral wedged
fields for T1 glottic tumor
2 anterior oblique fields for
early glottic cancer

34. T3–4 Glottic and Supraglottic
Laryngeal Cancer
• Superior: superior to mandibular angle
• Inferior: bottom of cricoid cartilage •Subglottic
extension (+), shoulders should be pulled down
as much as possible.
• If patient is operated, 1.5 cm superior to stoma
(stoma is treated in supraclavicular field)
Anterior: 0.5–1 cm skin fall-off to neck and one-
third of mandible Posterior: usually spinous
processes

35. Follow up
• 1st year – 4-6 weeks
• 2nd year – 6-8weeks
• 3rd year- Every 3 months
• 4th and 5th -Every 6
months
• Thereafter annually
• LN examination,IDL ,TFT
• Challenges
1. Distinguish between
edema and recurrence
• Progressive edema
• Persistent throat pain
• Fixation of previous
mobile vocal cord

36. Thank You