Radiation therapy for squamous cell carcinoma of the subglottic larynx

This study aims to summarize our institution’s experience in treating patients with primary subglottic squamous cell carcinoma (SCC) with radiotherapy (RT) and to define the optimal treatment plan for these patients.

We retrospectively reviewed the medical records of 18 patients with subglottic SCC curatively treated with RT between 1977 and 2009. T₁ and T₂ cancers were considered early disease; T₃ and T₄ lesions were considered advanced disease. Patients were stratified according to whether they received RT alone or RT and surgery. Patients treated surgically tended to have more advanced disease and required a total laryngectomy. Patients were excluded if they had distant metastasis at diagnosis or if their tumor was glottic in origin and extended inferiorly into the subglottis.

Twelve patients (67 %) had advanced disease, and six patients (33 %) had early disease. Local control was achieved in 100 % of the patients with early disease, regardless of treatment group. Of the patients with advanced disease, local control was achieved in five of the seven patients (71 %) treated with RT alone and in four of the five (80 %) treated with surgery and RT. Ultimate local control was achieved in six of the seven patients (86 %) with advanced disease treated with RT alone. Overall local control was 83 % at 5 years, with a 5-year cause-specific survival of 66 % and a 5-year overall survival of 44 %. Local-regional control mirrored that of local control, with an overall local-regional control rate of 83 %. No patient suffered a severe acute or late complication or acute toxicity during the treatment process.

Patients with SCC of the subglottic larynx have a high likelihood of local-regional control after undergoing RT along or combined with surgery. Those with T₁–T₂ and low volume T₃–T₄ cancers have high probability of local control with voice preservation after definitive RT.