ORIGINAL ARTICLE ORGAN PRESERVATION FOR ADVANCED LARYNGEAL CARCINOMA Robert L. Foote, MD, 1 R. Tyler Foote, 1 Paul D. Brown, MD, 1 Yolanda I. Garces, MD, 1 Scott H. Okuno, MD, 2 Scott E. Strome, MD 3 1 Department of Radiation Oncology, Mayo Clinic College of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905. E-mail: foote.robert@mayo.edu 2 Division of Medical Oncology, Mayo Clinic College of Medicine, Rochester, Minnesota 3 Department of Otorhinolaryngology, University of Maryland, Baltimore, Maryland Accepted 24 October 2005 Published online 17 April 2006 in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/hed.20387 Abstract: Background. Inclusion of patients with mobile vocal cords on larynx preservation trials may lead to overstate- ment of larynx preservation (LPR) and survival (OS) rates. Methods. This is a retrospective review of patients at our institution who would have been eligible for the Department of Veterans Affairs Laryngeal Cancer Study Group (VA) and Radiation Therapy Oncology Group/Head and Neck Intergroup (RTOG 91-11) clinical trials. No laryngeal conservation proce- dure could be performed in patients with mobile vocal cords. Results. One hundred one patients at our institution would have been eligible for the VA trial. The 2-year OS was 76% for total laryngectomy and 90% for radiotherapy patients (p ¼ .28) compared with 68% reported for the VA trial. Seventy-three patients at our institution would have been eligible for the RTOG 91-11 trial. The 5-year OS was 52% for total laryngectomy and 63% for radiotherapy patients (p ¼ .18) compared with 55% reported for the RTOG 91-11 trial. Radiotherapy patients had an LPR of 80% (VA trial) and 86% (RTOG 91-11 trial). Conclusion. It is unlikely that inclusion of patients with mobile vocal cords had a significant impact on OS or LPR for the VA and RTOG 91-11 larynx preservation trials. V V C 2006 Wiley Periodicals, Inc. Head Neck 28: 689–696, 2006 Keywords: laryngeal carcinoma; organ preservation; total lar- yngectomy; chemoradiotherapy The management of advanced supraglottic and glottic larynx cancer that would require a total laryngectomy has been undergoing an evolution in the United States over the past 20 years. Patients are undergoing total laryngectomy less frequently, and the use of chemoradiotherapy is becoming more common. The Department of Veterans Affairs Laryngeal Cancer Study Group (VA) completed a clinical trial that confirmed that there is no difference in overall survival in pa- tients randomly assigned to total laryngectomy and postoperative radiotherapy or induction che- motherapy followed by radiotherapy in patients who responded to the induction chemotherapy. 1 However, significant differences included preser- vation of the larynx in 64% of the patients treated with induction chemotherapy and radiotherapy and improved function and quality of life in patients with laryngeal preservation compared with patients undergoing a total laryngectomy. 2,3 Subsequently, the Radiation Therapy Oncology Group and the Head and Neck Intergroup con- ducted a randomized clinical trial (RTOG 91-11) that revealed that concomitant cisplatin chemora- diotherapy resulted in a better larynx preserva- Correspondence to: R. L. Foote V V C 2006 Wiley Periodicals, Inc. Organ Preservation for Laryngeal Cancer HEAD & NECK—DOI 10.1002/hed August 2006 689