Larynx & Hypopharynx

Larynx and hypopharynx cancers are often treated with radiotherapy to preserve the voice box. Advanced disease gets a full head and neck plan with both sides of the neck; early glottic cancer gets one of the smallest fields in the head and neck, often with fewer, larger fractions.

Setup, dose levels and organ limits follow Head & Neck Planning Essentials. The larynx covers two quite different plans:

• Locally advanced larynx and hypopharynx — a full head and neck plan, much like the oropharynx.
• Early glottic cancer (Tis–T2 N0) — a small field around the larynx only, with no neck, often in fewer, larger fractions. See below.

After a total laryngectomy, treatment follows the post-operative page.

• The goal is organ preservation — curing the cancer while keeping voice and swallowing.
• Schedule. Commonly 70 Gy in 35 fractions with an SIB (63 and 56 Gy levels). For radiotherapy alone, the same doses may be accelerated to five or six fractions a week, finishing in six weeks.
• Concurrent chemotherapy may be considered for node-positive disease, bulky unfavorable T2 supraglottic tumors and all T2 hypopharynx tumors. Selected T1–T2 N0 tumors are treated with radiotherapy alone. Induction chemotherapy is not given routinely.
• Both sides of the neck are treated, from level II to IV.

• Radiotherapy alone, to the larynx only. The neck is not treated.
• Schedules are moderately hypofractionated. For Tis–T1: 63 Gy in 28 fractions (2.25 Gy) or 60 Gy in 25 fractions (2.4 Gy); higher doses should be considered for bulky T1 tumors. For T2: 66–70 Gy in 33–35 fractions (may be accelerated), 65.25 Gy in 29 fractions (2.25 Gy) or 64.8 Gy in 27 fractions (2.4 Gy). Unfavorable T2 tumors — impaired cord movement, subglottic extension, bulk or anterior commissure involvement — are treated as advanced disease.
• Swallowing moves the larynx. Motion from swallowing can blur the planning CT and move the target during treatment; the PTV needs to cover the mobile larynx, and some departments coach patients not to swallow.
• The carotid arteries sit just beside the target. With no neck treated, their dose is kept as low as reasonably achievable.
• Bolus is not routinely needed. It is considered only when the target reaches the skin or very superficial tissue, as with some anterior commissure tumors.

Uses the shared head and neck constraint table. What changes here:

• Larynx — part of the target, so its limit does not apply.
• Cervical esophagus — higher doses are expected than with upper-neck cancers.
• Pharyngeal constrictors — the inferior constrictor lies next to the larynx and hypopharynx.
• Brachial plexus — close to the lower-neck nodal levels.
• Carotid arteries (early glottic) — kept as low as reasonably achievable when the neck is not treated.