Abstract

According to the Union for International Cancer Control (UICC) / American Joint Committee on Cancer (AJCC)
staging system the advanced laryngeal cancer generally denotes stage III or IV , Stage III being represented by T3 or N1
tumors and the non-metastatic stage IV including N2-N3 or T4 tumors.
The main therapeutic goals are local control and survival, but also the functional organ preservation (speech,
swallowing and airway patency ), if possible. To achieve these objectives, the management should be established by a
multidisciplinary tumor board, based on the analysis of patient-specific factors (age, performance status, comorbidity,
psychosocial support), cancer topography and staging, but also the physician expertise and the availability of
rehabilitation services. Regarding the larynx preservation there are two major therapeutic strategies, total laryngectomy
(associated with adjuvant radio and chemotherapy) and larynx preservation strategy, that includes neoadjuvant
chemotherapy followed by exclusive radiotherapy or concurrent radio-chemotherapy or radio-biotherapy.
Total laryngectomy can be performed by open surgery or, in order to avoid a wide surgical field and reduce the local
morbidity , by transoral techniques. After laryngectomy the recurrence can be local, to the resection site, nodal, to cervical
lymph nodes, or distal, the lung being the most common site of recurrence as a distant metastasis. To improve
locoregional control and survival adjuvant treatment are proposed, including radiotherapy, chemo and biotherapy.