Outcome of Salvage Total Laryngectomy Following Organ Preservation Therapy

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Abstract
PRIOR TO 1990, most patients with advanced laryngeal cancer underwent total laryngectomy (TL) for management of their tumor. In the early 1990s, Wolf et al1 reported the outcome of the Veterans Affairs (VA) Cooperative Study, a randomized prospective organ preservation trial, for patients with advanced laryngeal cancer. Total laryngectomy was compared with induction chemotherapy and radiation therapy (RT). The patients in the experimental arm received 2 cycles of cisplatin and fluorouracil. Major responders received a third cycle of chemotherapy and then definitive RT. Nonresponders underwent TL. Approximately two thirds of the patients in the organ preservation group retained their larynges, and their survival was equivalent to patients treated by initial TL. However, the local failure rate was higher in the experimental group compared with those receiving standard therapy (TL), and the distant failure rate was higher for those not receiving chemotherapy.

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