PET/CT is useful in case of isolated chronic cervical lymph node significant swelling & FNA revealed metastatic carcinoma & primary lesion is not detected by clinicoendoscopic examinatin. Then PET/CT can discover the site of the primary lesion to help the plan of treatment of such case. Regarding your question, i do not think so because the classic methods of staging by clinical ex, panendoscopy with biopsy & contrasted CT +/- MRI are much helpful. In this situation, adding PET/CT depends on availability & total care cost of such cases. It may be more useful to apply PET/CT post complete surgicochemiorad of cancer larynx to be sure that there is no residual disease or far micrometastasis.

Hazem, I acknowledge for your answer, can you give me any literature  of supports your this opinion? and we use PET/CT for staging of larynx cancer ,especially squamous cell carsinoma, but in literature I can not find to explain our praxis.What do you think about our praxis?

It is customary in our interdisciplinary H&N oncology group to suggest PET/CT scan for laryngeal cancers of stages III or IV, whether supraglottic, subglottic or glottic. Using PET/CT in stages III and IV provides the best predictive results and happens to be a rational choice in terms of cost. The literature support for this choice are the NCCN guidelines for H&N malignancies, which are available upon free registration on the american national comprehensive cancer network site.

Thanks for your answer ,I read guidelines for H&N malignancies, and It supports your comments.

I agree with Alberto but my opinion pointed to in case of nonavailability of  PET/CT.  

I didn't review the literature, but one should better perform a pet-ct scan or if not available a ct scan of head / neck / thorax / abdomen. 

A total laryngectomy has a deep impact not the qol of your patient. So you should better rule out any metastasis oder second cancers, or any other life threatening disease (we had a patient with an aortic aneurysm) as far as possible. 

It's also a very helpful tool in post therapeutic follow up after radio-chemotherapy since a normal ct scan will only show some mass. And the pet will show you the metabolism.

But nevertheless it's quite expensive

Of course, although expensive, PET-CT is a good imaging modality in terms of tumor staging (N status, M status). In laryngeal cancer, however, its role is limited in my opinion.

Firstly, PET-CT is quite inaccurate in terms of anatomic classification of laryngeal cancer for surgery. Also, very small lesions and even residual tumor can be hard to assess due to the common unspecific inflammatory enhancement characteristic of the larynx. Secondly, distant metastasis in laryngeal cancer is rare especially in the case of N0 neck and even in patients with N+ neck. In glottic cancer, even neck metastases are relatively rare. Regional and distant metastasis as well as second primary lung cancer are effectively assessed with neck CT/MRI and CT of the thorax.

In my opinion, local control in laryngeal cancer is crucial due to the gruesome sequelae of local progression. When total laryngectomy is under consideration the larynx is mostly non-functional anyway so there would not be much to spare in terms of function. In our practice, PET-CT probably would not make too much of a difference regarding the decision of performing TL, which also acts as an excellent palliative procedure with a relatively short recovery time (there are problems with this associated with TL after oncological treatment). The QoL inferiority of TL patients compared to those who receive only palliative treatment is highly questionable. In the literature, curatively aimed chemoradiotherapy and TL have produced fairly similar QoL outcomes. Of course, in the case of deteriorated general condition due to comorbidity and expected short life expectancy it is always good to quiestion the role of any aggressive surgical/oncological treatment. Co-morbidities shold be assessed with care.

I would opt for staged imaging. If thorax CT is normal, no PET-CT would be necessary. In the rare cases of pulmonary metastasis, PET-CT could give some additional information not obtained from whole body CT-scans.

Thanks for your comments.

Yes. Total laryngectomy is an invasive treatment for the  quality of life of the patient. So, in agreement with Steffen Nolte, you should better rule out any metastasis or second cancers.