Introduction | 21 1 in more severe cases, breathing difficulties. The supraglottic area tend to show fewer early symptoms, leading to a higher likelihood of diagnosis at an advanced stage and is particularly prone to lymphatic spread due to the rich lymphatic network, contrasting with glottic cancers, which are often discovered earlier due to voice changes. Subglottic tumor are quite seldom and often precipitates symptoms of dyspnea and coughing, particularly in cases where the tumor attains considerable size, thereby impeding airflow within the respiratory tract. Treatment options are diverse, with larynx preserving strategies on the one hand, and total laryngectomy (TL) on the other hand. TL, the surgical removal of the entire larynx, is often recommended for extensive tumors, especially T4 or with impaired function at diagnosis or as salvage when other treatments have failed29,30. This procedure can effectively control the cancer but results in the loss of natural voice and necessitates a permanent stoma for breathing31–33. Respiration is then carried out through a tracheal stoma, created by bringing the trachea to the skin in the lower, front part of the neck. This procedure effectively separates the upper portion of the airway from the lower, leading to permanent loss of voice and smell. Organ-preserving strategies like chemoradiation (CRT, a combination of cisplatin based chemotherapy and radiation therapy) and radiation therapy alone are preferred when feasible, as they aim to maintain laryngeal function34. CRT is particularly used for tumors that are locally or regionally advanced, offering a potential for cure while preserving the larynx35. The impact of treatments on patients with advanced laryngeal carcinoma varies significantly. TL, while potentially curative, profoundly affects speech, swallowing, and breathing, necessitating significant lifestyle adjustments and rehabilitation31. In most cases, postoperative radiotherapy is still needed. In the Netherlands almost all patient receive a voice prosthesis (VP) during surgery, also called a primary puncture36. After rehabilitation most patients are able to use the VP and speak. Conversely, organ-preserving approaches may lessen these functional impacts but come with their own set of challenges, including acute side effects like mucositis, dysphagia, and altered taste, as well as long-term risks such as radiation-induced fibrosis, swallowing issues and poor laryngeal functioning as well as potentially decreased efficacy in controlling the cancer compared to surgical options26,37,38. So, how do you make the right treatment decision?
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