Radiotherapeutic Approaches of Functional Organ Preservation for Laryngeal Cancer

Radiation therapy（RT）has been established as curative treatment for early and locally advanced laryngeal cancer, and excellent local control rate and functional outcomes have been reported especially in patients with T1 or T2 glottic cancer. In contrast, clinical outcomes for locally advanced laryngeal cancer is not sufficient, although RT combined with chemotherapy（CRT）is advocated as a treatment choice in NCCN guideline for T3 disease. There have been no studies directly comparing organ-preservation surgery with nonsurgical or-gan-preservation protocols including chemoradiation therapy for locally advanced-stage laryngeal tumors in a prospective manner with comparable patient groups. In the only prospective randomized study comparing total laryngectomy and nonsurgical organ preservation, the results of Veterans Affairs（VA）Laryngeal Cancer Study demonstrated that disease-specific survival was the same in the 2 groups. The results of the RTOG 9111, comparing 3 arms including CRT, induction chemotherapy, and RT（the VA protocol）and RT alone exhibited that organ preservation was significantly better for the CRT arm, although OS did not differ among the 3 groups. However, it has been suggested that long-term outcomes after CRT might affect clinical outcomes including functional laryngeal preservation and salvage surgery. In this symposium, we will discuss the possibility whether newer strategies such as induction chemotherapy followed by CRT or RT combined with novel biological agents improve clinical outcomes of the landmark intergroup studies.