Figure 2. Illustrating the effectiveness of intensity-modulated and image-guided radiotherapy to achieve local control in T4 laryngeal cancer.

The tumor invaded the thyroid cartilage and soft tissue of the neck and produced acute airway obstruction requiring emergency tracheostomy. A repeat CT scan at 40 Gy demonstrated significant shrinkage of the tumor allowing removal of the tracheostomy tube after treatment. The patient is disease-free 45 months after treatment and conserve a normal voice allowing him to work part-time after retirement.