Radiotherapy for laryngeal cancers: 2025 update

Abstract

We present the updated recommendations of the Société française de radiothérapie oncologique (SFRO; the French society of radiation oncology) regarding the radiotherapy management of laryngeal cancers. Clinical examination in a seated position and nasofibroscopy are essential for accurately assessing laryngeal mobility, a crucial parameter in the therapeutic decision-making process for glottic cancer. In early-stage cancers, treatment selection depends on multiple factors and requires thorough consideration and multidisciplinary discussion. Between surgery and radiotherapy, the decision can be personalized to achieve an optimal balance between tumour control and the preservation of laryngeal function. In advanced-stage laryngeal tumours, the therapeutic approach is mainly based on two strategies: concomitant chemoradiotherapy or induction chemotherapy followed by chemoradiotherapy. However, in some cases where these approaches are not feasible, the treatment relies on upfront total laryngectomy, often followed by adjuvant therapy. With the exception of early-stage glottic tumours, where hypofractionation has proven its efficacy, there is no formal indication to modify the standard fractionation regimen. Due to the movements induced by respiration and swallowing, laryngeal mobility must be taken into account. Three-dimensional volumetric imaging is the gold standard for ensuring accurate daily patient positioning and monitoring weight loss. The follow-up of laryngeal cancers is crucial for the early detection of potential recurrences and for adjusting oncological management when necessary. It also plays a key role in patient rehabilitation, ensuring the best possible preservation of vocal and respiratory functions to optimize quality of life.