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Invited Commentary
September 2016

The Challenges of Laryngeal Preservation—Is It the Systemic Agent or the Proper Sequence of Therapy?

Author Affiliations
  • 1Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia
JAMA Otolaryngol Head Neck Surg. 2016;142(9):849-850. doi:10.1001/jamaoto.2016.1229

During the last 20 years, laryngeal preservation (LP) has been the cornerstone of advances in larynx cancer therapy. Since the early Veterans Affairs laryngeal study,1 neoadjuvant therapy has been believed to achieve organ preservation without compromising survival in most patients (66%) with locally advanced laryngeal cancer. This finding was further supported by the European Organization for Research and Treatment of Cancer larynx preservation study.2 Thereafter, the Radiation Therapy Oncology Group (RTOG) 91-11 trial found a higher rate of LP after concurrent platinum-based chemoradiotherapy (hazard ratio, 0.46; 95% CI, 0.30-0.71), resulting in the adoption of this approach as the modality of choice for LP, at least in the United States.3 With longer follow-up, the end point of laryngeal-free survival was improved for the concomitant and sequential approaches, whereas radiotherapy alone was clearly inferior.

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