A fit patient has biopsy-proven isolated recurrent T3 glottic carcinoma two years after definitive radiotherapy, with a functional but threatened larynx and no metastases. What offers the best chance of cure?
For resectable substantial recurrence after full-dose radiotherapy, salvage laryngectomy is the principal curative option; vascularised tissue may reduce fistula risk and rehabilitation must be planned.
A. Repeat full-dose radiotherapy routinely: Re-irradiation can be considered selectively but is not the default curative option for resectable bulky intralaryngeal recurrence.
B. Salvage total laryngectomy with reconstruction planned for the irradiated field: For resectable substantial recurrence after full-dose radiotherapy, salvage laryngectomy is the principal curative option; vascularised tissue may reduce fistula risk and rehabilitation must be planned.
C. Endoscopic biopsy alone: Biopsy establishes diagnosis but does not treat T3 recurrent disease.
D. Chemotherapy alone with curative expectation: Systemic therapy alone is generally non-curative for an isolated resectable recurrence.
E. Observation until airway obstruction: Delay risks loss of resectability, aspiration and emergency airway compromise.
If disease encased the carotid with distant metastases and no realistic curative route, symptom-directed systemic and palliative care planning would take precedence.
Independent Clinora educational material; not official JCIE content, an accredited programme, clinical advice, or a substitute for local policy and specialist judgement.
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