Multidisciplinary management controversies in laryngeal cancer

While the primary goal of laryngeal cancer management is to save life, the preservation of structure and function also holds a very prominent position in the decision making for this disease. Although the therapeutic options to achieve these goals exist for most patients presenting with laryngeal carcinoma, they are not applied to a significant number of patients. In this paper we will summarise some of the disagreements which exist about optimal management and demonstrate that the opinions of experts trained to treat this disease have been shaped by non-evidence based approaches. In large part the specialty of practice and the geographic location of specialists have the greatest influence on the type of treatment recommended to an individual patient with a given stage of disease; medical knowledge, or more correctly the lack of it when comparing treatment options, seems to have a lesser influence on the decision process. We will consider the principal opportunities available to attempt to resolve controversies in laryngeal cancer. The discussion will include attention to randomised clinical trials, patient preferences, economic issues, and techniques to avoid the problems of selection bias when comparing outcomes for different treatments.