1. Home
  2. Radiation oncology
  3. Head and neck

Head and neck glottic larynx squamous cell carcinoma definitive EBRT

Head and neck cancer treatment is complex and combined modality therapy is common. The involvement of an experienced multidisciplinary team (MDT) in the initial development and ongoing evaluation of the treatment plan, and the management of the sequelae associated with treatment is recommended. Consider treatment at or liaison with high volume centres.rrr Patients should have appropriate access and care-pathways to supportive care services including inpatient, medical oncology and allied health care where appropriate.

On this page
Expand all Collapse all Back to top
  • Squamous cell carcinoma (SCC) of the glottic larynx.
  • Stage I-II (T1N0M0/T2N0M0).r

Cautions

  • Pregnancy.
  • Non-rheumatoid collagen vascular disorders.

Exclusions

  • Previous high dose radiation therapy to the same site.

Indications notes

  • Tis can be considered in some circumstances depending on individual patient and tumour related factors.
  • Consider using panendoscopy ± biopsy ± examination under anaesthesia (EUA) to identify primary disease.
  • CT scan of the head and neck ± chest should be performed.
  • MRI of the head and neck ± skull base neurography sequences should be considered if suspicion of perineural invasion or base of skull involvement.
  • Staging PET/CT scan should be performed.
  • Anxiety and depression are common in patients with cancer. A referral to a psychosocial practitioner should be considered.
  • Verify the patient does not have claustrophobia or anxiety prior to simulation as pre-medication or other supplementary support may be needed.
  • Patients should be strongly encouraged to cease smoking and reduce alcohol consumption as continuation of these habits decreases the efficacy of treatment.r
Simulation Options Notes
Position
  • Supine.
  
Arm/leg/head/neck/shoulder position
  • Head neutral.
  • Shoulders should be down as far as possible.
Immobilisation and supports
  • Immobilisation mask.
  • Neck support/vacuum bag.
  • Knee supports.
  
Organ pre-requisites
  • N/A
  
Contrast
  • N/A

 
Radiopaque markers
  • N/A

 
Bolus
  • Consider bolus.
  • Consider bolus for primary target volumes (PTVs) close to the skin.
Other imaging
  • PET/CT.
  • MRI.
  • Diagnostic CT.
  • Consider fusion/co-registration of diagnostic imaging to planning scan to aid in tumour delineation.
CT acquisition
  • 3D CT.
  • CT slice thickness ≤3 mm.
  • Scan from vertex to 1.0 cm below carina.
  • Consider metal artefact reduction technique for cases with dental filling or other high-density objects.
Medications
  • Consider pre-medication for mask anxiety.
  

Tis - T1N0

VMAT
Phase Target area Dose prescription Prescription volume Beam type Beam Energy Dose/# Fractions Scheduling
#/day #/fortnight
1 Larynx 63 Gy ICRU 83 Photons 6 MV 2.25 Gy 28 1 10
OR
1 Larynx 60 Gy ICRU 83 Photons 6 MV 2.4 Gy 25 1 10

Current staging systems do not take into consideration bulk of disease. Tumour bulk is a prognostic factor and higher doses should be considered for bulky T1 disease.r

T2N0

VMAT
Phase Target area Dose prescription Prescription volume Beam type Beam Energy Dose/# Fractions Scheduling
#/day #/fortnight
1 Larynx 66-70 Gy ICRU 83 Photons 6 MV 2 Gy 33-35 1 6#/week (overall time 5-6 weeks)
OR
1 Larynx 65.25 Gy ICRU 83 Photons 6 MV 2.25 Gy 29 1 10

Prescription notes

  • Increasing overall treatment time can compromise both locoregional control and overall survival.r r
  • Patients should be compensated (e.g. bi-daily, treatment acceleration and/or hypofractionation) for non-treatment days i.e. public holidays or service days or for unavoidable treatment delays.
  • Other schedules  may be considered including:
    • 64-68 Gy in 32-34 fractionsr
    • 55 Gy in 20 fractionsr
    • 66 Gy in 30 fractions (2.2 Gy/fraction) to 70 Gy in 35 fractions (2.0 Gy/fraction) (5 fractions per week in 6-7 weeks).r
  • It may be reasonable to use a lower integrated dose for clinically uninvolved larynx beyond the gross target volume (GTV).
Volumes Description
GTV
  • Gross disease.                                                                                                    
CTV
  • Entire larynx at level of GTV and 0.5-1.0 cm superiorly and inferiorly.           
PTV
  • CTV + 0.5-1 cm margin as per department protocol.

Margin ranges have been agreed by the Radiation Oncology reference committee and reflect safe clinical practice.

Target volume notes

  • Adequate consideration of volumes must be given for subclinical spread above and below the glottis particularly in the T2 setting which may have reduced local control with narrow margins.r
Organ at risk (OAR) True structure constraint (ideal) Planning OAR volume (PRV) constraint Additional information (aim to keep doses as low as possible)
Brachial plexus
  • Max dose ≤66 Gy
  
  • Target volumes should take priority.
Brainstem
  • Max dose ≤54 Gyrr
  • Max dose ≤60 Gy
  • Higher doses may be appropriate depending on the clinical situation.
Carotid
  • ALARA.
  
  • Minimise dose where possible when no elective nodal irradiation e.g. Stage I-II SCC of the glottic larynx.
Cervical oesophagus
  • Mean dose ≤35 Gy
  

 
Cochlea
  • Mean dose ≤45 Gyrr
  
  • V55 Gy <5% 
  • To prevent sensorineural hearing loss the dose of the cochlea should be kept as low as possible.r
Globe
  • Mean dose ≤35 Gy
  • Max dose ≤50 Gyr
  
  • Consider tighter constraints on anterior globe to minimise risk of conjunctivitis.
Glottic/supraglottic larynx
  • Mean dose ≤35 Gy
    
Lacrimal gland
  • Mean dose ≤30 Gy
    
Lens
  • D0.03 cc ≤6 Gyr
  
  • Acceptable:
    • D0.03 cc ≤15 Gyr
Lips
  • Mean dose ≤30 Gy
  
  • The lips may be contoured separately to the oral cavity as the goal is to keep the lip dose much lower than the oral cavity dose.
Mandible 
  • Avoid hotspots falling within the mandible.
  
  • Limiting volumes of intermediate dose may reduce risk of osteoradionecrosis e.g.
    • V60 Gy <14%r
    • V42 Gy <30% (without pre-treatment dental extractions)r
    • V50 Gy <30% (with dental extractions)r
    • V56 Gy <30% (without dental extractions).r
Temporal mandibular joints (TMJ)
  • Maximum dose ≤65 Gyr
  • 1cc ≤60 Gyr
  
  • Contour each side separately starting at the superior articular surface near the zygoma bone and ending at the notch at the superior part of the ramus of the mandible.
Optic chiasm and optic nerves
  • Max dose ≤54 Gyr
  • Max dose ≤60 Gy
  • Additional goals may include:
    • Maximum dose 55-60 Gy, to keep risk of radiation induced optic neuropathy (RION) to <3-7%.
    • The risk of RION increases to 7-20% for doses >60 Gy in 1.8-2 Gy fractions.r
Oral cavity
  • Non-oral cavity cancers:
    • Mean dose ≤30 Gyr
  • Oral cavity cancers:
    • Mean dose ≤50 Gyr
  
  • Efforts should be made to avoid hot spots >60 Gy within the oral cavity, particularly for non-oral cavity cancers.
  • For non-oral cavity cancers, the oral cavity will be defined as a composite structure consisting of the anterior half to 2/3 of the oral tongue/floor of mouth, buccal mucosa and palate.r
  • For oral cavity cancers, the oral cavity will be defined as the subset of this composite structure that does not overlap with PTV.r
Parotid glands
  • Mean dose of at least one parotid gland ≤26 Gyrrr
  
  • ​Reduce mean doses to both parotids as much as possible.r
Pituitary
  • For nasopharyngeal carcinoma (NPC):
    • D0.03 cc ≤60 Gyr
  
  • For NPCs:
    • Acceptable:
      • D0.03 cc ≤65 Gyr
Pharyngeal constrictors
  • Mean dose ≤50 Gyr
  

  • Mean dose of 50 Gy predicted 20% probability of late dysphagia.r

  • Chance of dysphagia increases by 19% with each additional 10 Gy.r
Superior pharyngeal constrictors
  • Mean dose ≤55 Gy for each structure.r
    
Middle pharyngeal constrictors
Inferior pharyngeal constrictors
Retina
  • Max dose ≤50 Gyr
    
Spinal cord
  • Max dose ≤45 Gyr
  • Max dose ≤50 Gyr
  • Max dose ≤50 Gy (to keep risk of myelopathy <1%).rr
Submandibular gland
  • Mean dose ≤39 Gyr
    
Temporal lobe/brain
  • Max dose ≤60 Gyr

  • For NPC or tumours where PTV is close to the temporal lobes due to perineural invasion consider higher doses, for example:

    • D0.03cc ≤65 Gy for T1-T2 tumours.r

    • D0.03cc ≤70 Gy for T3-T4 tumours.r

  
  • V40 Gy <5 ccr

OAR notes

  • OAR doses listed in the table are based on conventional fractionation.
  • These constraints have been reviewed by and are the consensus of the reference committee. In certain sub-sites meeting the constraints of particular OARs will be prioritised over others and should not compromise target coverage.
  • In some circumstances these constraints may be exceeded at the clinician's discretion.
  • Where no referenced dose constraints are available, the listed constraints are the consensus of the reference committee.
  • PRV includes a margin that is added around the OAR to compensate for that organ's geometric uncertainties.

Suggested OAR contouring atlases and guidelines

Modality Frequency Match point
  • kV or
  • Cone beam CT (CBCT) 
  • Daily
  • Check laryngeal cartilage, soft tissue alignment and body contour.

Target verification recommendations reflect the minimum imaging required for the safe delivery of this protocol.

Target verification notes

  • Departments should have a system in place to monitor change in patient contour due to weight loss or tumour shrinkage. For example, regular CBCT or repeat planning CT may be performed to check dose distribution. Repeat simulation and planning may be required if changes are not within departmental tolerances.

The side effects listed below are not a complete list of all possible side effects for this treatment and should only be used as a guide.

Acute: Short term side effects during or within a few weeks post radiation therapy (usually temporary)
Skin reaction/dermatitis

Including itch, erythema, dry or moist desquamation.

Read more about skin reactions.
Mucositis

Read more about mucositis. 
Fatigue

Read more about fatigue.
Odynophagia
Dysphagia
Dysphonia
Cough
Stridor

An abnormal wheezing or high-pitched sound caused by an obstructed airway.

Late: Long term side effects - months to years post radiation therapy (may be permanent)
Skin changes

Including telangiectasia, atrophy and changes to skin pigmentation.
Fatigue

Read more about fatigue.
Dysphonia
Dysphagia

Including long-term feeding tube.
Carotid atherosclerosis
Hypothyroidism
Laryngeal necrosis and dysfunction
Soft tissue fibrosis and necrosis
Second malignancy
Source Study & year published

Supports use

Yes/No/NA

 Is the radiation dose and fractionation consistent with  the protocol? Comments
Phase III trials

Yamazaki et al. 2006r

 Yes Yes

Prospective randomised study - T1 squamous cell carcinoma (SCC) of the true vocal cords.
Radiation therapy (RT) Dose: Conventional fractionation (CFX):

60–66 Gy in 30–33 fractions (fx)] vs hypofractionated (HFX) (56.25 Gy in 25fx) or HFX (63 Gy in 28fx).

Overgaard et al. 2003 (DAHANCA 6 and 7)r

 Yes Yes

 Multicentre, controlled, randomised trial.
5 vs 6 fx per week
Total dose: 66-68 Gy in 33-34fx

Aaltonen et al. 2014r

 Yes Yes

Randomised control trial (RCT), n= 60 patients.

Laser surgery (n= 32)  vs external beam radiation therapy (n=28) .

  RT delivered: 66 Gy in 2 Gy daily fractions over 6.5 weeks.
Overall voice quality similar in both arms.

Moon et al. 2014 (KROG 0201)r

 Yes Yes

CFX vs HFX - T1-2 (n = 156)
Closed early due to poor accrual
T1: CFX (66 Gy in 33fx) vs HFX (63 Gy in 28fx)
T2: CFX (70 Gy in 35fx)  vs HFX (67.5 Gy in 30fx)
HFX at least not inferior to CFX.
Guidelines Date published/revised

Supports use

Yes/No/NA

 Is the radiation dose and fractionation consistent with  the protocol? Comments
Cancer Care Ontario V.2.2019r Yes N/A  
Royal College of Radiologists 3rd edition 2019r Yes Yes

T1/T2N0: 63 Gy/28fx
NCCN V.1.2023r Yes Yes

T1N0: 63 Gy/28fx or 66 Gy/33fx
T2N0: 65.25 Gy/29fx or 70 Gy/35fx

Efficacy

Radiation therapy alone versus surgery

For early-stage glottic laryngeal carcinomas surgery or radiation therapy (RT) have similar effectiveness. A number of systematic reviews of non-randomised clinical trials have shown endolaryngeal surgery (with or without laser) can provide similar voice and laryngeal function preservation and survival rates when compared to RT alone.rrrrrr

Hypofractionation versus standard fractionation

The ultimate goal in treating early glottic carcinoma is cure of the tumour, while preserving organ function, allowing the best voice quality possible, and without serious side effects. Dose per fraction and overall treatment time have been identified as factors that contribute to locoregional control.rr  Numerous studies have shown a locoregional control advantage for hypofractionated radiation therapy schedules when treating early stage glottic carcinoma, as compared to standard 2 Gy per fraction daily treatments without an increase in serious complications.rrrrr Therefore the use of hypofractionated protocols over conventional schedules is considered standard of care.

The Japanese RCT reported significantly improved local control with hypofractionated radiation therapy (56.25-63 Gy in 2.25 Gy fractions) compared with 60-66 Gy in 2 Gy fractions.r In this trial, 180 patients with T1 glottic cancer, treated from 1993 to 2001, were randomised to either conventional or hypofractionated schedules. The dose prescribed for each schedule was dependent on the size of the tumour (in the hypofractionated arm 56.25 Gy was prescribed if the tumour was ≤ 2/3 rds in length of the ipsilateral or bilateral vocal cords, versus 63 Gy if the tumour occupied > 2/3 rds of the vocal cord). The 5 year local control was 77% vs 92% in the conventional and hypofractionated arms, respectively (p<0.004).

The DAHANCA group also reported improvement on 5 year locoregional control (LRC) with an accelerated fractionated schedule.r 1476 patients were randomised to either 5 or 6 fractions of radiation therapy per week with the same total dose. The total dose delivered was 66-68 Gy in 33-34 fractions, except for well-differentiated T1 glottic tumours which were treated with 62 Gy. Of these patients 47% had laryngeal cancer, and 29% of patients overall had Stage I disease. Individual figures for LRC for early stage glottic cancer were not reported, but overall LRC improved from 60 to 70% (p=0.0005) in favour of the 6 fraction per week arm. There was no significant difference in overall survival. Disease-specific survival was 73% vs 66% for six and five fractions, respectively (p=0.01).

Toxicity

  • Several studies comparing conventional and hypofractionated dose schedules have reported similar outcomes for late normal tissue morbidity.rrr
  • In a large series reported by Chera et al. (n=585) there was a low rate (1.7%) of severe acute or late complications.r
  • The Japanese RCT by Yamazaki et al in 2006 demonstrated no statistically significant difference in acute skin/mucosal reactions or late toxicity between the conventional and hypofractionated dose schedules.r With a median follow-up of 64 months, no severe late complications were observed.

Flinders Filters has partnered with eviQ to build reliable, robust search filters to retrieve core high level evidence on topics of significance to eviQ. The project goal is the provision of a sustainable model for evidence retrieval to ensure ongoing currency of content.

These search filters have been developed to retrieve the most up to date evidence from PubMed, in real time, using specifically designed search filters built to meet our needs.

Searches can be used when a protocol is scheduled for review or at any time you choose. Please click on the Specific, Balanced and Sensitive tabs below to access the Pubmed searches.

Specific Balanced Sensitive
restricted to retrieving randomised control trials and systematic reviews.

is the middle ground between sensitive and specific searches.

retrieves all clinically relevant evidence - generally a broader search on a given topic.

Access Flinders Filters, a division of the Flinders Digital Health Research Centre at Flinders University to read more about research solutions to searching problems.

Troubleshooting

Occasionally the searches may not display correctly or take too long to load (and will eventually timeout). This may be caused by Internet Explorer being unable to handle long URL's. You can rectify this by using Firefox, Safari or Google chrome. It is always a good idea to clear the cache regularly to ensure you are getting the most up to date search.

Feedback

If you identify any new articles that you believe should be included in the content, please use the feedback button below to inform us of the name of the article(s). 

[%id%]
[%title%]
[%abstract%]

Version 4

Date Summary of changes
06/11/2023
  • Reviewed and approved at the head and neck reference committee meeting 8th June 2023. 

Summary of changes:​

  • Evidence:
    • ​Evidence table:
      • ​Guidelines:
        • Remove Dutch National Guidelines 2002.      
        • Update CCO 2009 to v.2 2019.
        • Update RCR to 2019 3rd ed.
        • Update NCCN to version 1. 2023.
  • Efficacy:
    • Update 'Radiation alone versus surgery' subsection with additional supporting references:

      • Huang, G. J., M. S. Luo and H. B. Liu. 2022. "A comparison of the survival between laser surgery and radiation in T(1a)N(0)M(0) glottic cancer: a population-based analysis and meta-analysis." 

      • Mo, H. L., J. Li, X. Yang, et al. 2017. "Transoral laser microsurgery versus radiotherapy for T1 glottic carcinoma: a systematic review and meta-analysis."

      • Warner, L., K. Lee and J. J. Homer. 2017. "Transoral laser microsurgery versus radiotherapy for T2 glottic squamous cell carcinoma: a systematic review of local control outcomes." 

  • Indications and patient population:
    • Update AJCC from 7th to 8th edition.
    • Moved  'Prior radiation therapy to the head and neck' from cautions to exclusions subsection and changed to more generic 'Previous high dose radiation therapy to same site'.
    • Remove subheading 'Links to other regimens'.
  • Clinical information:
    • Changed ‘could’ to ‘should’ perform CT scan of head and neck +/- chest.
    • Include MRI and PET scan for staging.
    • Referrals to allied health specialities amalgamated into single statement.
    • Include impact of timely diagnosis on head and neck cancers, and link to ‘Head & Neck Cancer, Australia's - Optimal Care Pathway’.
    • Include flag to check the patient does not have claustrophobia or anxiety prior to simulation.
    • Include word 'strongly' i.e "Patients should be strongly encouraged to cease smoking...".
  • Simulation:
    • Head position changed to ‘Head neutral’.
    • Immobilisation and supports - remove ‘ankle supports’.
    • Radiopaque markers - include ‘Consider wire’ option with notes- ‘Consider use of wire to delineate surgical scars or skin involvement’.
    • Bolus - notes to read ‘Consider bolus for primary target volumes (PTV) close to the skin.
    • Other imaging – note updated to include fusion and registration for tumour delineation.
    • CT acquisition – notes updated to include consider metal artefact reduction and to scan from vertex to 1.0 cm below carina.
    • Medications – option included to ‘Consider pre-medication for mask anxiety’.
  • Dose prescription:
    • Dose prescription tables:
    • Tis - T1N0 and T2N0
      • Remove 3DCRT and IMRT from table heading.
      • Remove ICRU 50 and change prescription point to prescription volume.
      • Change Beam energy to 6MV.
      • Remove references from table.
      • Include statement between the tables regarding current staging systems and bulky disease, include reference: Reddy, S. P., R. L. Hong, S. Nagda, et al. 2007.
    • Prescription notes -
      • Include statement: 'Increasing overall treatment time can compromise both locoregional control and overall survival'. References to include: Hendry, J. H., S. M. Bentzen, R. G. Dale, et al. 1996 and Hua, Y. J., Y. F. Ou-Yang, X. Zou, et al. 2021. 
      • Update 'Patients should be compensated for non-treatment days' to include methods of compensation e.g. bi-daily, treatment acceleration and/or hypofractionation.
      • Consensus to include new statement 'It may be reasonable to use a lower integrated dose for clinically uninvolved larynx beyond the gross target volume'.
  • Target volumes:
    • Target volume table:
      • Update column headings to ‘Volumes’ and ‘Description’.
      • Remove: ACI ID 3221 '2D traditional field borders and lateral larynx DRR'.
    • Target volume notes –
      • Remove previous statement regrading reduced PTV margins for 3DCRT/IMRT/VMAT.
      • Include point denoting subclinical spread in T2 setting, include reference: Kim, J. W., H. K. Byeon, H. S. Choi, et al. 2017.
  • Organs at risk (OAR)
    • Remove base of tongue as an OAR.
    • Brachial plexus – remove dose references in ‘additional information’ and replace with statement about target volumes taking priority.
    • Brainstem – remove – ‘Small volumes (1-10cc) max dose <59Gy for fraction doses <2Gy’ in additional information column and replace with statement : ‘Higher doses may be appropriate depending on clinical situation’.
    • Carotid – include as new OAR structure , ALARA as ideal constraint, and minimise dose when no elective nodal irradiation involved.
    • Cervical oesophagus - remove dose constraints from ‘additional information’.
    • Globe - Include statement in ‘additional information’ re tighter constraints for anterior chamber.
    • Glottis /supraglottic larynx – true structure constraint (ideal) = Mean ≤35 Gy. Remove ‘additional information’ comment about patients who have had total laryngectomy.
    • Lacrimal gland – change from max dose to mean dose (i.e. mean dose ≤30 Gy).
    • Lens - Ideal constraint to read D0.03cc ≤6 Gy (reduced from <10 Gy). In ‘additional information’ include option acceptable D0.03cc ≤15 Gy.
    • Lips – Ideal constraint update mean to ≤30 Gy remove max dose <40 Gy. In ‘additional information’ remove alternative dose constraints.
    • Split mandible and temporal mandibular joints (TMJ) into 2 distinct OAR.
      • Mandible – remove actual maximum dose and replace with ‘Avoid hotspots falling in mandible’. Remove ‘additional information’ re: hot spots and include ‘Limiting volumes of intermediate doses may reduce risk of osteoradionecrosis’:
        • V60 Gy < 14%
        • V42 Gy < 30% (without pre-treat dental extractions)
        • V50 Gy < 30% (with dental extractions)
        • V56 Gy < 30% (without dental extractions).
      • TMJ – Ideal constraint include max dose ≤65 Gy and 1cc ≤60 Gy. ‘Additional information’ – include contouring information for TMJ.
    • Parotid glands – ‘Additional information’ – remove points referring to sparing one parotid and 20cc combined dose.
    • Pharyngeal constrictors - Additional information – remove ‘up to 60Gy’ and include predicted risks of dysphagia.
    • Include superior, middle and inferior pharyngeal constrictors as individual OAR. Ideal constraint is mean dose  ≤55 Gy.
    • Temporal lobe/brain- ‘Ideal’- include nasopharyngeal or PNI options –
      • D 0.03 cc ≤65 Gy for T1-T2 tumours.
      • D0.03 cc ≤70 Gy for T3-T4 tumours. Additional information delete content ‘Max < 70 Gy may be considered’.
    • Remove thyroid as an OAR 
    • Pituitary – include as new OAR. Ideal for nasopharyngeal cancers D0.03cc ≤60Gy Additional information include – ‘Acceptable’ D0.03cc ≤65Gy.
    • OAR notes –
      • Include new subheading 'Suggested OAR contouring atlases'.
  • ​Target verification:
    • Modality – remove MV.
    • Match point include note to check 'laryngeal cartilage, soft tissue alignment and body contour'.
    • Target verification notes:
      • Consensus to remove following statement: 'Consideration should be given to dose delivered from verification imaging and whether this needs to be accounted for in treatment planning, particularly with respect to critical OARs'.  
  • ​Side Effects 
    • Include “Fatigue” as Late: Long-term side effect.
  • Related Patient information protocol changes:
    • Update content with current requisite eviQ shared content “What is aim of treatment? and  “Radiation therapy is given to destroy cancer cells and shrink the tumour”.
    • Update “How long will this treatment take? section” with current requisite eviQ shared content sections
      • When is treatment delivered and how long does each treatment take? and
      • How long is a treatment course?

    • Important information - agreed to update content with current requisite eviQ shared content. It includes more detailed information on fertility specifically in the “How does treatment affect fertility?” section.Other information about your treatment: agreed to modify content to only include mask information ( i.e. your mask and what if I feel nervous or claustrophobic). All other content previously in this section moved to 'General advice for people with cancer' section which supersedes FAQs section to bring into line with current requisite eviQ shared content.

  • Review in 2 years.

Version 3

Date Summary of changes
08/08/2013

Discussed at RCM Nov 2012. Evidence reviewed at RCM in June 2013 and approved for publishing on eviQ.

This protocol supersedes protocol ID: 414 - Early Glottic, SCC, Definitive, Conventional Fractionation. See protocol for explanation.
Review Group - 1
31/05/2017 Transferred to new eviQ website.
02/05/2018 Protocol reviewed at 16th Novemeber 2017 RCM and updated.
Protocol version number increased to V.3.
Changed to review group 3: 5 yearly review.

The information contained in this protocol is based on the highest level of available evidence and consensus of the eviQ reference committee regarding their views of currently accepted approaches to treatment. Any clinician (medical oncologist, haematologist, radiation oncologist, medical physicist, radiation therapist, pharmacist or nurse) seeking to apply or consult this protocol is expected to use independent clinical judgement in the context of individual clinical circumstances to determine any patient's care or treatment. While eviQ endeavours to link to reliable sources that provide accurate information, eviQ and the Cancer Institute NSW do not endorse or accept responsibility for the accuracy, currency, reliability or correctness of the content of linked external information sources. Use is subject to eviQ’s disclaimer available at www.eviQ.org.au

Send feedback for this page

First approved:
Last reviewed:
Review due:

The currency of this information is guaranteed only up until the date of printing, for any updates please check:

https://www.eviq.org.au/p/584

06 Oct 2024