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

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.