American Society of Clinical Oncology clinical practice guideline for the use of larynx-preservation strategies in the treatment of laryngeal cancer.
OBJECTIVE
To develop a clinical practice guideline for treatment of laryngeal cancer with the intent of preserving the larynx (either the organ itself or its function). This guideline is intended for use by oncologists in the care of patients outside of clinical trials.


METHODS
A multidisciplinary Expert Panel determined the clinical management questions to be addressed and reviewed the literature available through November 2005, with emphasis given to randomized controlled trials of site-specific disease. Survival, rate of larynx preservation, and toxicities were the principal outcomes assessed. The guideline underwent internal review and approval by the Panel, as well as external review by additional experts, members of the American Society of Clinical Oncology (ASCO) Health Services Committee, and the ASCO Board of Directors.


RESULTS
Evidence supports the use of larynx-preservation approaches for appropriately selected patients without a compromise in survival; however, no larynx-preservation approach offers a survival advantage compared with total laryngectomy and adjuvant therapy with rehabilitation as indicated.


CONCLUSIONS
All patients with T1 or T2 laryngeal cancer, with rare exception, should be treated initially with intent to preserve the larynx. For most patients with T3 or T4 disease without tumor invasion through cartilage into soft tissues, a larynx-preservation approach is an appropriate, standard treatment option, and concurrent chemoradiotherapy therapy is the most widely applicable approach. To ensure an optimum outcome, special expertise and a multidisciplinary team are necessary, and the team should fully discuss with the patient the advantages and disadvantages of larynx-preservation options compared with treatments that include total laryngectomy.
American Society of Clinical Oncology, Alexandria, VA, VA 22314, USA.
Pfister
David G
DG
Laurie
Scott A
SA
Weinstein
Gregory S
GS
Mendenhall
William M
WM
Adelstein
David J
DJ
Ang
K Kian
KK
Clayman
Gary L
GL
Fisher
Susan G
SG
Forastiere
Arlene A
AA
Harrison
Louis B
LB
Lefebvre
Jean-Louis
JL
Leupold
Nancy
N
List
Marcy A
MA
O'Malley
Bernard O
BO
Patel
Snehal
S
Posner
Marshall R
MR
Schwartz
Michael A
MA
Wolf
Gregory T
GT
D017326:Clinical Trials, Phase III as Topic; D003680:Deglutition Disorders / Q000209:etiology; D019317:Evidence-Based Medicine; D006801:Humans; D007822:Laryngeal Neoplasms / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D007825:Laryngectomy / Q000009:adverse effects* / Q000379:methods*; D007830:Larynx / Q000503:physiopathology / Q000601:surgery*; D008207:Lymphatic Metastasis; D009367:Neoplasm Staging; D010358:Patient Participation; D018579:Patient Selection; D011446:Prospective Studies; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D012955:Societies, Medical; D016019:Survival Analysis; D014139:Tracheostomy; D016896:Treatment Outcome