Organ Preservation for Advanced Larynx Cancer: Issues and Outcomes.
OBJECTIVE
To provide a review of the clinical data, controversies, and limitations that underpin current recommendations for approaches to larynx preservation for locally advanced larynx cancer requiring total laryngectomy.


METHODS
The key findings from pivotal randomized controlled trials are discussed, including quality of life, late effects, and function assessments. Trials investigating taxane inclusion in induction chemotherapy and trials of epidermal growth factor receptor inhibition for radiosensitization are put into perspective for larynx cancer. Controversies in the management of T4 primaries and the opportunities for conservation laryngeal surgery are reviewed.


RESULTS
There are data from clinical trials to support induction chemotherapy, followed by radiotherapy (preferred approach in Europe) and concomitant cisplatin plus radiotherapy (preferred in North America) for nonsurgical preservation of the larynx. Treatment intensification by a sequential approach of induction, followed by concomitant treatment, is investigational. Transoral laryngeal microsurgery and transoral robotic partial laryngectomy have application in selected patients.


CONCLUSIONS
The management of locally advanced larynx cancer is challenging and requires an experienced multidisciplinary team for initial evaluation, response assessment, and support during and after treatment to achieve optimal function, quality of life, and overall survival. Patient expectations, in addition to tumor extent, pretreatment laryngeal function, and coexisting chronic disease, are critical factors in selecting surgical or nonsurgical primary treatment.
Arlene A. Forastiere, Johns Hopkins University and Sydney Kimmel Comprehensive Cancer Center, Baltimore, MD; Randal S. Weber, The University of Texas MD Anderson Cancer Center, Houston, TX; and Andy Trotti, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL. af@jhmi.edu.
Arlene A
AA
Forastiere
Arlene A. Forastiere, Johns Hopkins University and Sydney Kimmel Comprehensive Cancer Center, Baltimore, MD; Randal S. Weber, The University of Texas MD Anderson Cancer Center, Houston, TX; and Andy Trotti, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.
Randal S
RS
Weber
Arlene A. Forastiere, Johns Hopkins University and Sydney Kimmel Comprehensive Cancer Center, Baltimore, MD; Randal S. Weber, The University of Texas MD Anderson Cancer Center, Houston, TX; and Andy Trotti, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.
Andy
A
Trotti
D000970:Antineoplastic Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D006801:Humans; D007822:Laryngeal Neoplasms / Q000473:pathology / Q000628:therapy*; D007825:Laryngectomy; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D011788:Quality of Life; D011838:Radiation-Sensitizing Agents / Q000627:therapeutic use; D011879:Radiotherapy Dosage; D016032:Randomized Controlled Trials as Topic; D020127:Recovery of Function; D013065:Speech Intelligibility; D043823:Taxoids / Q000627:therapeutic use; D014833:Voice Quality
D000970:Antineoplastic Agents; D011838:Radiation-Sensitizing Agents; D043823:Taxoids