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Clinical Challenges
September 2005

Concurrent Chemoradiotherapy as the Most Appropriate Treatment for Most T3 Laryngeal Carcinomas

Author Affiliations



RONALD B.KUPPERSMITHMDAuthor Affiliations: Departments of Otolaryngology–Head and Neck Surgery, UC Davis Medical Center, Sacramento, Calif, and Northern California VA Medical Center, Mather Field, Calif.

Arch Otolaryngol Head Neck Surg. 2005;131(9):815-818. doi:10.1001/archotol.131.9.815

Hypothesis: Concurrent platinum-based chemoradiotherapy (CRT) is the most appropriate first-line treatment for most T3 laryngeal carcinomas.

Prior to the Department of Veterans Affairs (VA) Laryngeal Cancer Study Group’s prospective randomized organ preservation trial,1 the standard of care for most T3 laryngeal carcinomas was total laryngectomy (TL) and postoperative adjuvant radiotherapy. Along with the introduction of nonoperative organ-preserving treatment strategies came an extensive and ongoing debate on the most appropriate treatment for advanced laryngeal carcinoma. Both the VA laryngeal study1 and subsequent European Organization for Research and Treatment of Cancer (EORTC) trial2 for hypopharyngeal carcinoma demonstrated that neoadjuvant CRT, compared with TL and postoperative radiotherapy, allowed preservation of the larynx in 50% to 64% of patients without compromising survival. Neither of these studies included a radiotherapy-only arm, bringing into question the true role of neoadjuvant chemotherapy. This led to the Radiation Therapy Oncology Group (RTOG) 91-11 trial3 that compared radiation only to both neoadjuvant and concurrent platinum-based chemotherapy. The results showed that concurrent CRT increased organ preservation rates but failed to show a survival advantage.