Radiotherapy Dose Escalation in Locally Advanced Squamous Cell Carcinoma of the Larynx or Hypopharynx

Inclusion Criteria:

* At least 18 years of age (no upper age limit)
* Biopsy proven squamous cell carcinoma of the glottis or supraglottic larynx or hypopharynx with the following T,N and M stages:
* Glottic Larynx:

T3-4: Any primary tumor volume

* Supraglottic Larynx:

T2: Primary tumor volume \> 4.0cc T3-4: Any primary tumor volume

* Hypopharynx:

T2: Primary tumor volume \> 4.0cc T3-4: Any primary tumor volume

* N-Stages (the same for all primary sites): All N-stages
* M-Stages (the same for all primary sites): M0 or M1suitable for curative attempt with Stereotactic Body Radiation Therapy.
* Radiologic evaluation of the chest within 12 weeks prior to treatment; at a minimum, chest x-ray is required. CT imaging of the chest or PET/CT is acceptable.
* ECOG Performance Status 0-2
* CBC/differential obtained within 8 weeks prior to treatment, with adequate bone marrow function defined as follows:
* Platelets ≥ 100,000 cells/mm3
* Hemoglobin ≥ 8.0 g/dl (Note: The use of transfusion or other intervention to achieve Hgb ≥ 8.0 g/dl is acceptable.)
* Adequate renal and hepatic function within 4 weeks prior to treatment, defined as follows:
* Serum creatinine \< 2.0 mg/dl
* Total bilirubin \< 2 x the institutional ULN
* AST or ALT \< 3 x the institutional ULN.

  \*Note that physician attestation of patient having no known history of liver disease can take the place of bilirubin and AST/ALT labs.
* Negative pregnancy test within 2 weeks prior to treatment for women of childbearing potential
* Women of childbearing potential and male participants who are sexually active must practice adequate contraception during treatment and for 6 weeks following treatment.
* Patients must be deemed able to comply with the treatment plan and follow-up schedule.
* Patients must provide study specific informed consent prior to study entry

Exclusion Criteria:

* Prior history of radiation therapy to the head and neck that would likely increase the risk of serious complications from the RT delivered on this protocol
* Prior history of head and neck cancer with the exception of nonmelanoma skin cancer.
* Currently taking Disease Modifying Rheumatoid Drugs (DMRDs)
* Severe, active co-morbidity, defined as follows:
* Unstable angina and/or congestive heart failure requiring hospitalization within the last 6 months
* Transmural myocardial infarction within the last 6 months
* Acute bacterial or fungal infection requiring intravenous antibiotics at the time of registration
* Chronic Obstructive Pulmonary Disease exacerbation or other respiratory illness requiring hospitalization or precluding study therapy at the time of registration
* Hepatic insufficiency resulting in clinical jaundice and/or coagulation defects; Note, however, coagulation parameters are not required for entry into this protocol.
* Pre-existing ≥ grade 2 neuropathy
* Prior organ transplant
* Systemic lupus
* Psoriatic arthritis.
* Known HIV positive. HIV positive patients are known to have worse clinical outcomes especially for local, regional, and distant cancer control. This poorer prognosis is thought to be secondary to a compromised immune system.