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10. Principles of Selecting Treatment

  • Page ID
    18393
    • Should require a lot of thought
      • Need to individualise treatment
      • Cannot simply base on TNM staging
    • Need to balance cure with preservation of function
      • Swallowing
      • Voice
      • Aspiration
      • Airway
    • Consider patient’s values, beliefs, financial status, socioeconomic support
    • Consider available resources
    • Tumour factors
      • Site
        • Lateral may not require laryngectomy
        • Small AE fold / medial may be amenable to transoral excision
      • Stage
      • Mobility
        • Cartilage invasion
        • Prevertebral fascia invasion
      • Distal extent: May need flap reconstruction, oesophagectomy
    • Prior radiation therapy
    • Patient factors
      • Age, fitness, nutritional status
      • Pulmonary status (tolerate aspiration)
      • Cognitive status
      • Values and beliefs
      • Socioeconomic status and social support
      • Access to thyroid replacement therapy
      • Reliability for follow-up
    • Institutional support
      • Surgical expertise
      • Availability of CO2 laser transoral microsurgery
      • Radiotherapy package of care
      • Speech and swallowing support
      • Tracheoesophageal speaking valves/ electrolarynx