Related Experiment Video
Updated: Jun 26, 2026
05:25
Identification and Protection of the Recurrent Laryngeal Nerve during Transoral Robotic Thyroidectomy
Published on: October 24, 2025
Phase 3 randomized trial on larynx preservation comparing sequential vs alternating chemotherapy and radiotherapy
J L Lefebvre1, F Rolland, M Tesselaar
1Department of Head and Neck Cancer, Centre Oscar Lambret, 3 rue Frederic Combemale-BP 307, FR 59020 Lille Cedex, France. jl-lefebvre@o-lambret.fr
Journal of the National Cancer Institute
|January 30, 2009
Summary
This study compared sequential versus alternating chemotherapy and radiotherapy for advanced larynx or hypopharynx cancer. Both treatment strategies demonstrated similar survival outcomes and toxicity profiles, supporting larynx preservation.
Area of Science:
- Oncology
- Radiation Oncology
- Medical Oncology
Background:
- Advanced larynx and hypopharynx cancers are often treated with induction chemotherapy followed by irradiation or concurrent chemoradiotherapy as alternatives to laryngectomy.
- The European Organization for Research and Treatment of Cancer (EORTC) conducted a randomized phase 3 trial (24954) to compare these approaches.
Purpose of the Study:
- To compare the efficacy and toxicity of sequential versus alternating chemotherapy and radiotherapy in patients with advanced larynx or hypopharynx cancer.
- To evaluate larynx preservation rates, overall survival, and progression-free survival between the two treatment arms.
Main Methods:
- A randomized phase 3 trial involving 450 patients with resectable advanced squamous cell carcinoma of the larynx or hypopharynx.
- Patients were assigned to either a sequential arm (induction chemotherapy followed by radiotherapy) or an alternating arm (alternating chemotherapy and radiotherapy).
- Treatment response was assessed, and nonresponders underwent salvage surgery. Survival data were analyzed using the Kaplan-Meier method.
Main Results:
- Survival with a functional larynx was similar between the sequential and alternating arms (hazard ratio = 0.85).
- Median overall survival was 4.4 years for sequential and 5.1 years for alternating treatment. Median progression-free intervals were 3.0 and 3.1 years, respectively.
- Grade 3 or 4 mucositis was more frequent in the sequential arm (32%) compared to the alternating arm (21%). Late severe edema/fibrosis was also slightly higher in the sequential arm (16% vs. 11%).
Conclusions:
- Larynx preservation, progression-free interval, and overall survival were comparable between the sequential and alternating treatment strategies.
- Both acute and late toxic effects were similar across both treatment arms, suggesting comparable safety profiles.
