Radiation therapy in diseases of the larynx

Laryngeal cancer is one of the most rewarding tumours for the radiotherapist to treat, particularly when it arises on the vocal cord. The diagnosis is usually made when the disease is at an early stage, so that many patients are suitable for radical treatment and a high percentage are now cured and recover their normal voice. During the past 30 years there has been a steady improvement in the results (Baclesse, 1967; Holsti and Taskinen, 1967). These have been achieved by the use of better equipment and especially by the greater skill of the radiotherapist and the closer collaboration with his colleagues in laryngology. Coutard (1934) considered that the treatment of laryngeal tumours was one of the most profitable for the radiotherapist to study because reactions on a variety of normal tissues, tumour regression and the effect of changes in fractionation and dose could be readily observed. Malignant laryngeal tumours are epidermoid in character and generally poorly differentiated, except those which arise from the vocal cord which are highly differentiated and may produce keratin. The glottic tumour usually arises from the anterior half of the cord. It spreads forward to the anterior commissure and to a lesser extent posteriorly towards the arytenoid, involvement of which may cause restriction of the cord's movement. Deep extension towards the thyroid cartilage is not an early phenomenon in the proliferative growth but tends to occur in ulcerative tumours and may also cause limitation in the movement of the cord.