Re: Randomized Trial of Induction Chemotherapy With Cisplatin and 5-Fluorouracil With or Without Docetaxel for Larynx Preservation

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Pointreau et al. ( 1 ) clearly showed that docetaxel, cisplatin, and 5-fluorouracil (TPF) is better than PF for larynx preservation in their important phase III study. Unfortunately, we are only given results for larynx preservation as an indicator of a successful laryngeal outcome. It is important to address the issue of laryngectomy-free survival, too, because that endpoint has broader implications. Laryngectomy-free survival accounts for those patients who survived with an intact and functional larynx instead of only focusing on those with a preserved larynx. Two endpoints that are considered by many to be important in larynx preservation trials are not presented in the study. These are prolonged tracheotomy and permanent percutaneous endoscopic gastrostomy dependency ( 2 , 3 ). Interpretation and implication of the results of the trial will be strengthened by these data. It is also not clear why a total laryngectomy was chosen as the operation of choice for these patients instead of a partial laryngectomy in which a portion of the larynx was preserved. Finally, five patients underwent a total laryngectomy with no tumor found in the specimen, and no explanation is given for this finding.