Programs of organ and function preservation

Abstract

An intensive clinical research has been carried out over the past three decades aiming to avoid performing a total laryngectomy. Large partial open procedures or endoscopic laser CO2 surgery may be an alternative to total laryngectomy in very highly selected cases. Altered fractionated radiotherapy has proved to be more efficient than conventional radiotherapy. However, most of the research has been done by combining chemotherapy and radiotherapy. The first programs used induction chemotherapy (cisplatin and 5-fluorouracil with or without docetaxel) followed by radiotherapy in good responders. Toxicity was acceptable, neither disease control nor survivals were compromised, and larynx could be preserved in at least two-thirds of the cases. The second programs used concomitant chemoradiotherapy. Concurrent chemoradiotherapy provided higher larynx preservation rates but at the price of a substantial acute and late toxicity potentially compromising the larynx function. Alternating chemoradiotherapy did not increase toxicity, but larynx preservation was similar to induction chemotherapy. Whether concurrent or alternating, there was no improvement of survival. A recent randomized phase II has assessed induction chemotherapy followed by radiotherapy with either concurrent chemotherapy or concurrent biotherapy without difference between both arms. One ongoing phase III trial assesses induction chemotherapy with or without biotherapy followed by chemoirradiation with or without this biotherapy.