LARYNX PRESERVATION - THE DISCUSSION IS NOT CLOSED

Advanced but resectable larynx and hypopharynx squamous cell carcinoma s are, in the vast majority of cases, treated by radical surgery and p ostoperative irradiation, resulting in the total ablation of the voice box. Some institutions prefer to use irradiation and reserve radical surgery for salvage. There is no randomized comparison of results obta ined with these two strategies. Induction chemotherapy with the use of platinum and 5-fluorouracil provides notable response rates and allow s the prediction of radiosensitivity in those patients who show a resp onse to chemotherapy. This has been the basis of the most frequent lar ynx preservation approach: induction chemotherapy followed by irradiat ion in good responders or by radical surgery in poor responders, This strategy did not jeopardize survival and allowed larynx preservation i n 50% to 66% of survivors. These results are of importance but it shou ld nonetheless be remembered that irradiation is an efficient treatmen t of these tumors and may have an improved activity(with modified frac tionation or concurrent administration of chemotherapy and irradiation ) and that selected cases are amenable to subtotal laryngectomy. On th e other hand, new prospects for treatment are emerging (biologic tools , place of imaging), as well as new parameters for the success of trea tment (quality of life, quality of preserved function, cost effectiven ess), in summary, larynx preservation is undoubtedly feasible but rema ins investigational.