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A Journal on Otorhinolaryngology, Head and Neck Surgery,
Plastic Reconstructive Surgery, Otoneurosurgery

Indexed/Abstracted in: EMBASE, Scopus




Otorinolaringologia 2014 June;64(2):45-56


language: English

Organ preservation for the management of locally advanced laryngeal cancer: a review of chemoradiation approaches

Sacco A. G. 1, Vainshtein J. M. 2, Eisbruch A. 2, Wolf G. T. 3, Worden F. P. 1

1 Hematology-Oncology, Internal Medicine, University of Michigan Health System, Ann Arbor, USA; 2 Radiation Oncology, University of Michigan Health System, Ann Arbor, USA; 3 Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, USA


At present, the standard of care for the management of locally advanced laryngeal cancer includes upfront total laryngectomy with adjuvant radiation (RT), or alternatively, definitive chemoradiation (CRT) in appropriately selected patients. Larynx preservation strategies employed over the last few decades have been continuously refined with randomized trials evaluating different treatment options. First-generation larynx preservation trials established the role of induction chemotherapy (IC) followed by RT as an acceptable non-surgical treatment alternative, whereas second-generation trials demonstrated the superiority of concurrent CRT for larynx preservation compared to earlier induction approaches, although overall survival rates were not changed. Subsequent trials evaluating the role of alternating CRT, intensification of the induction regimen, use of definitive chemotherapy alone, or incorporation of molecular targeted therapies have not provided sufficient evidence to suggest a survival or larynx preservation advantage over concurrent CRT. Finally, the strategy of chemoselection, which utilizes the tumor response to one cycle of IC to select which patients are most likely to be cured by CRT versus those who should immediately proceed to total laryngectomy, represents an attractive approach meriting further consideration. This review will discuss the rationale and evidence-based data for the use of CRT in a larynx preservation treatment paradigm.

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