Current status of larynx preservation trials.

Over the past 15 years, larynx preservation has been extensively assessed but only in the light of induction chemotherapy. From these evaluations, it appeared that the use of induction chemotherapy was safe and adequate for patient selection: irradiation with or without salvage surgery for induction chemotherapy responders and surgery with or without postoperative irradiation for induction chemotherapy nonresponders. Neither the ultimate local control nor survival worsened, and at least, half the patients retained their larynxes. Such results should not lead researchers to forget other larynx-preserving possibilities. Irradiation alone and, moreover, irradiation with modified fractionation or chemotherapy permits cure and preservation of function in many larynx and hypopharynx cases. Conversely, subtotal surgery may, in very selected cases, reach a similar goal. Finally, the new advances in imaging and biology could lead to fine tuning of patient selection. These advances could have the additional advantage of permitting use, thereafter, of chemotherapy as a real treatment and not as simply a selection parameter.