Management of T4a Laryngeal Cancer

Purpose of the Review The aim of this study is to compare the results of surgical and non-surgical approach for T4a laryngeal cancer in term of curative effects, complications, and functional results by means of a systematic review of the most recent literature. Recent Findings Despite the recommendations contained in the guidelines, a general rise in non-surgical treatments and declining use of total laryngectomy has occurred during the last decades. This has paralleled some evidence of declining survival for advanced laryngeal cancer in many countries. Summary Recent data clearly demonstrate the superiority of total laryngectomy and post-operative radiotherapy, which produce a substantial long-term control and survival rates for patients with T4 laryngeal cancer. The most negative prognostic factor is represented by the N status. Open partial laryngectomy, in light of its good and encouraging oncological/functional results, could represent an alternative to total laryngectomy for selected patients affected by laryngeal cancer in certain T4a subcategories, i.e., those with limited anterior extension. Considering the worse oncologic results, principally in patients with poor general conditions and T4a cancer, non-surgical larynx preservation should only be addressed to carefully selected patients who refused total laryngectomy, characterized by more limited T4a disease, minimal involvement through the cartilage, and without pre-treatment impairment of laryngeal functions.