Is Primary Radiotherapy an Acceptable Treatment Modality for Verrucous Carcinoma of the Larynx?

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Background

Verrucous carcinoma is a well-differentiated variant of squamous cell carcinoma. The oral cavity is the most common site of occurrence, followed by the larynx. Treatment of laryngeal verrucous carcinoma (LVC) is controversial. LVC is often approached with a different mindset compared to that for conventional laryngeal squamous cell carcinoma. Radiotherapy, commonly used in all stages of conventional laryngeal squamous cell carcinoma, is often avoided in LVC because early reports described a potential for anaplastic transformation with this treatment modality (Laryngoscope. 1993;103:253–257). Early studies also suggested inferior locoregional control compared to surgery. As such, surgery has traditionally been the preferred treatment modality for LVC. However, more contemporary reports have questioned this preference and challenged the early concerns of anaplastic transformation and inferior prognosis with radiotherapy.

Best Practice

The existing literature still suggests that the highest locoregional control and survival rates are achieved with surgery; however, a direct comparison between surgery and radiotherapy is challenging due to a lack of well-designed, randomized studies. Despite initial concerns of early studies, radiotherapy is an acceptable contemporary treatment modality for LVC, with reasonable locoregional control and survival outcomes. Currently, radiotherapy methods carry a negligible risk of anaplastic transformation and expectedly good functional results, as seen in treatment for non-verrucous histologies. However, surgery remains the gold standard for LVC when organ preservation is possible. In patients who are poor surgical candidates or in settings in which acceptable functional results cannot be achieved with surgery, radiotherapy can be considered as an alternative treatment option.