World J Oncol

World Journal of Oncology, ISSN 1920-4531 print, 1920-454X online, Open Access

Article copyright, the authors; Journal compilation copyright, World J Oncol and Elmer Press Inc

Journal website http://www.wjon.org

Review

Volume 9, Number 2, April 2018, pages 39-45

Current Status of Organ Preservation in Carcinoma Larynx

**Table 1.** Radiotherapy Versus TLS in Stage I Glottic Cancer
Author	Year	No. of patients	Local control	Larynx preservation	Voice quality
Aaltonen et al [5]	2014	RT 28; TLS 32	At 2 years, 88% in RT vs. 90% TLS	Not available	Overall voice quality similar in both arms. Voice more breathy in TLS; less hoarseness-related inconvenience in RT.
Remmelts et al [7]	2013	RT 159; TLS 89	At 5 years, 86% in RT vs. 75% in TLS (P = 0.07)	5-year 83% in RT vs. 93% in TLS (P < 0.05)	VHI 12.4 ± 8.9 in TLS vs. 8.3 ± 7.7 in RT (P < 0.05) suggestive of poor outcome of TLS
Milovanovic et al [8]	2013	RT 74; TLS 72	Equal in both arms	Equal in both arms	Shimmer score mean 3.75 in TLS; 4.07 in RT
van Gogh et al [9]	2012	RT 39: TLS 67	At 2 years, 95% in RT vs. 97% in TLS	At 2 years, 95% in RT vs. 100% in TLS	Shimmer score mean 5.06 in TLS vs. 5.39 in RT; voice outcome recovery earlier in TLS.
Dinapoli et al [6]	2010	RT 70; TLS 73	Equal oncological outcome		Median VHI 18 in TLS vs. 4 in RT (P < 0.0001)

Table 1. Radiotherapy Versus TLS in Stage I Glottic Cancer

Author

Year

No. of patients

Local control

Larynx preservation

Voice quality

Aaltonen et al [5]

2014

RT 28; TLS 32

At 2 years, 88% in RT vs. 90% TLS

Not available

Overall voice quality similar in both arms. Voice more breathy in TLS; less hoarseness-related inconvenience in RT.

Remmelts et al [7]

2013

RT 159; TLS 89

At 5 years, 86% in RT vs. 75% in TLS (P = 0.07)

5-year 83% in RT vs. 93% in TLS (P < 0.05)

VHI 12.4 ± 8.9 in TLS vs. 8.3 ± 7.7 in RT (P < 0.05) suggestive of poor outcome of TLS

Milovanovic et al [8]

2013

RT 74; TLS 72

Equal in both arms

Shimmer score mean 3.75 in TLS; 4.07 in RT

van Gogh et al [9]

2012

RT 39: TLS 67

At 2 years, 95% in RT vs. 97% in TLS

At 2 years, 95% in RT vs. 100% in TLS

Shimmer score mean 5.06 in TLS vs. 5.39 in RT; voice outcome recovery earlier in TLS.

Dinapoli et al [6]

2010

RT 70; TLS 73

Equal oncological outcome

Median VHI 18 in TLS vs. 4 in RT (P < 0.0001)

**Table 2.** Results of Organ Preserving Approaches in Advanced Laryngeal Cancer
Study	Year	Arms	Outcome	Laryngeal preservation
VA trial [19]	1991	Induction chemo followed by RT vs. surgery + RT	After two cycles of chemo clinical CR 31%, PR 54%, 2-year survival 68% in both the groups. 36% of the patients of chemotherapy group required total laryngectomy.	Overall larynx preservation was 64% in the nonsurgical arm.
GORTEC trial [23]	2000 - 2001	Induction chemo with TPF vs. PF followed by radiotherapy or surgery according to the response	Overall response rate after induction chemotherapy was higher with TPF (80% versus 59% (P = 0.002). There was no significant difference between the treatment arms in the 3-year rate of overall (60% in each arm) or disease-free (58% with TPF versus 44% with PF) survival	The 3-year larynx preservation rate was significantly higher in the TPF arm than in the PF arm (70% versus 58%; P = 0.03).
RTOG 91-11 [20]	2003	RT vs. induction chemo followed by RT vs. CTRT	At a median follow-up of 3.8 years local control significantly better in CTRT arm (78%) vs. induction chemo followed by RT (61%) vs. RT alone (56%). Overall survival similar in all three groups	Larynx preservation was significantly higher in the CTRT arm (88%) as compared to induction chemo followed by RT(75%; P = 0.005)) or RT alone (70%; P ≤ 0.001).
RTOG 91-11 update [21]	2013	RT vs. induction chemo followed by RT vs. CTRT	Median follow-up for surviving patients is 10.8 years. Both chemotherapy regimens significantly improved LFS compared with RT alone (induction chemotherapy vs. RT alone: hazard ratio (HR), 0.75; 95% CI, 0.59 to 0.95; P = 0.02; concomitant chemotherapy v RT alone: HR, 0.78; 95% CI, 0.78 to 0.98; P = 0.03). Overall survival did not differ significantly, although there was a possibility of worse outcome with concomitant relative to induction chemotherapy (HR, 1.25; 95% CI, 0.98 to 1.61; P = 0.08)	Concomitant cisplatin/RT significantly improved the larynx preservation rate over induction PF followed by RT (HR, 0.58; 95% CI, 0.37 to 0.89; P = 0.0050) and over RT alone (P < 0.001), whereas induction PF followed by RT was not better than treatment with RT alone (HR, 1.26; 95% CI, 0.88 to 1.82; P = 0.35).

Table 2. Results of Organ Preserving Approaches in Advanced Laryngeal Cancer

Study

Year

Arms

Outcome

Laryngeal preservation

VA trial [19]

1991

Induction chemo followed by RT vs. surgery + RT

After two cycles of chemo clinical CR 31%, PR 54%, 2-year survival 68% in both the groups. 36% of the patients of chemotherapy group required total laryngectomy.

Overall larynx preservation was 64% in the nonsurgical arm.

GORTEC trial [23]

2000 - 2001

Induction chemo with TPF vs. PF followed by radiotherapy or surgery according to the response

Overall response rate after induction chemotherapy was higher with TPF (80% versus 59% (P = 0.002). There was no significant difference between the treatment arms in the 3-year rate of overall (60% in each arm) or disease-free (58% with TPF versus 44% with PF) survival

The 3-year larynx preservation rate was significantly higher in the TPF arm than in the PF arm (70% versus 58%; P = 0.03).

RTOG 91-11 [20]

2003

RT vs. induction chemo followed by RT vs. CTRT

At a median follow-up of 3.8 years local control significantly better in CTRT arm (78%) vs. induction chemo followed by RT (61%) vs. RT alone (56%). Overall survival similar in all three groups

Larynx preservation was significantly higher in the CTRT arm (88%) as compared to induction chemo followed by RT(75%; P = 0.005)) or RT alone (70%; P ≤ 0.001).

RTOG 91-11 update [21]

2013

RT vs. induction chemo followed by RT vs. CTRT

Median follow-up for surviving patients is 10.8 years. Both chemotherapy regimens significantly improved LFS compared with RT alone (induction chemotherapy vs. RT alone: hazard ratio (HR), 0.75; 95% CI, 0.59 to 0.95; P = 0.02; concomitant chemotherapy v RT alone: HR, 0.78; 95% CI, 0.78 to 0.98; P = 0.03). Overall survival did not differ significantly, although there was a possibility of worse outcome with concomitant relative to induction chemotherapy (HR, 1.25; 95% CI, 0.98 to 1.61; P = 0.08)

Concomitant cisplatin/RT significantly improved the larynx preservation rate over induction PF followed by RT (HR, 0.58; 95% CI, 0.37 to 0.89; P = 0.0050) and over RT alone (P < 0.001), whereas induction PF followed by RT was not better than treatment with RT alone (HR, 1.26; 95% CI, 0.88 to 1.82; P = 0.35).