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Original Article
March 2000

What Is the Role of Primary Surgery in the Treatment of Laryngeal and Hypopharyngeal Cancer?Hayes Martin Lecture

Author Affiliations

From the Head and Neck Department, Centre Oscar Lambret (Northern France Comprehensive Cancer Center), Lille, France.

Arch Otolaryngol Head Neck Surg. 2000;126(3):285-288. doi:10.1001/archotol.126.3.285

Larynx and hypopharynx cancer management has, over the past decade and after a rather long period of status quo, notably changed. For a long time, if in some countries or institutions radiotherapy (XRT) was considered the standard, surgery was in general the preferred approach. No randomized trial has yet compared both approaches for patients treated with curative intent.

The improvement of XRT techniques and imaging reliability, surgical advances (classical partial procedures and radical surgery), and the appearance of active chemotherapeutic regimens have shifted many paradigms. In particular, a tendency to avoid removing the entire larynx led many teams to assess preservation strategies using chemotherapy as first-line therapy to select candidates for either subsequent XRT or subsequent surgery. Encouraging results have been published. This does not, however, signify that the new standard is to initiate the treatment of any larynx or hypopharynx squamous cell carcinoma (SCC) with chemotherapy and/or XRT and to consider surgery only as a salvage treatment in nonresponders to chemotherapy or for persistent or recurrent diseases after XRT.