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Current status of larynx preservation trials
1Head and Neck Department, Centre Oscar Lambret, Lille, France.
Current Opinion in Oncology
|May 1, 1996
Summary
Larynx preservation is achievable through induction chemotherapy, allowing organ sparing in over half of patients. Further research into imaging and biology may refine patient selection for larynx-preserving treatments.
Area of Science:
- Oncology
- Otorhinolaryngology
- Radiation Oncology
Background:
- Larynx preservation has been evaluated primarily using induction chemotherapy over the last 15 years.
- Induction chemotherapy has proven safe and effective for selecting patients for larynx-preserving treatment strategies.
- Established protocols involve irradiation for responders and surgery for non-responders, with comparable outcomes to non-organ-sparing approaches.
Purpose of the Study:
- To review the efficacy of larynx preservation strategies.
- To explore alternative larynx-preserving treatment options beyond induction chemotherapy.
- To highlight the potential of novel imaging and biological markers for optimizing patient selection.
Main Methods:
- Review of studies on induction chemotherapy for larynx preservation.
- Analysis of treatment outcomes including local control, survival, and larynx preservation rates.
- Discussion of alternative larynx-preserving modalities like irradiation alone or with modified fractionation/chemotherapy, and subtotal surgery.
- Consideration of emerging advances in imaging and biology for patient selection.
Main Results:
- Induction chemotherapy is a safe and effective method for patient selection in larynx preservation.
- Approximately half of the patients treated with induction chemotherapy preserved their larynx.
- Neither local control nor survival rates were compromised by these larynx-preserving strategies.
- Irradiation alone, modified fractionation, or chemotherapy can achieve cure and function preservation in many larynx and hypopharynx cases.
- Subtotal surgery offers a larynx-preserving option in highly selected cases.
Conclusions:
- Induction chemotherapy is a validated strategy for larynx preservation, offering organ sparing in over 50% of patients without compromising oncologic outcomes.
- Alternative larynx-preserving approaches, including radiation-based therapies and selective surgery, should be considered.
- Advances in imaging and molecular biology hold promise for refining patient selection and potentially utilizing chemotherapy as a primary treatment modality rather than solely a selection tool.