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Larynx Preservation Trial of Sequential vs Alternating Therapy

Induction chemotherapy followed by radiation therapy, and concomitant chemotherapy and radiation therapy both appear to be valuable alternatives to total laryngectomy in patients with advanced cancers of the larynx or hypotharynx. Lefebvre et al (p. 142 ) report the results of a phase III randomized trial in which these regimens were compared in patients with advanced larynx or hypotharynx cancer.

They found that larynx preservation, the progression-free interval, overall survival, and acute and late toxic effects were all similar in the two groups, including late severe edema and/or fibrosis among patients in both arms and grade 3 or 4 mucositis among patients in the sequential arm who received radiotherapy and among patients in the alternating arm. The authors conclude that the optimal approach for larynx preservation has still not been identified and therefore that other treatment options warrant evaluation in clinical trials.