Key words: concomitant chemora- diotherapy, conservative surgery, func- tional organ preservation, laryngeal cancer. Acknowledgments: We thank Verlie A Jones for revision of the English. Correspondence to: Daniela Alterio, MD, European Institute of Oncology, Division of Radiotherapy, Via Ripa- monti 435, 20141 Milan, Italy. Tel +39-02-57489037; fax +39-02-94379227; email daniela.alterio@ieo.it Received January 5, 2013; accepted March 15, 2013. What is the price of functional surgical organ preservation in local-regionally advanced supraglottic cancer? Long-term outcome for partial laryngectomy followed by radiotherapy in 32 patients Daniela Alterio 1 , Mohssen Ansarin 2 , Barbara A Jereczek-Fossa 1,3 , Stefano Zorzi 2 , Luigi Santoro 4 , Dario Zerini 1 , Mariangela Massaro 2 , Elena Rondi 5 , Silvia Ferrario 1,3 , Gaia Piperno 1 , Maria Cossu Rocca 6 , Mara Griseri 1,3 , Lorenzo Preda 7 , Fausto Chiesa 2 , and Roberto Orecchia 1,3,8 1 Division of Radiotherapy, and 2 Department of Head and Neck Surgery, European Institute of Oncology, Milan; 3 University of Milan, Milan; 4 Department of Experimental Oncology, 5 Department of Medical Physics, 6 Division of Medical Oncology, and 7 Division of Radiology, European Institute of Oncology, Milan; 8 National Center for Oncological Hadrontherapy, Pavia, Italy ABSTRACT Aims and background. To achieve the goal of organ preservation, both a chemora- diotherapy and a conservative surgical approach can be proposed. The aim of the study was to review all patients treated in our Institute with conservative surgery and postoperative radiotherapy for locally advanced supraglottic tumor. Methods and study design. A retrospective analysis of 32 patients treated between 2000 and 2010 was performed. Overall survival, disease-free survival and late laryn- geal toxicity were evaluated. The impact of surgical procedures, radiotherapy charac- teristics and addition of chemotherapy on late laryngeal toxicity was studied. Results. The median follow-up was 38 months. Overall survival and disease-free sur- vival at 5 years were 73% and 66%, respectively. Three (9%) patients experienced local recurrence (after 22, 25 and 40 months, respectively) and were treated with total la- ryngectomy. The larynx preservation rate was 93%. Severe treatment-related late la- ryngeal toxicity (grade 3 and 4 laryngeal edema, laryngeal stenosis, presence of tra- cheotomy at last follow-up because of treatment-related toxicity, and the need for en- teral nutrition) was experienced by 34% of patients. The functional larynx preserva- tion rate was 81%. The statistically significant risk factors for severe late toxicity were: female gender, extension of the surgical procedure, removal of one arytenoid and as- sociation with concomitant chemotherapy. Conclusions. We confirmed literature data on the feasibility and efficacy of a surgical organ preservation strategy. However, the high incidence of severe late toxicity re- quires further studies to improve patient selection and to reduce side effects. Introduction The treatment of laryngeal cancer has changed over the last decades. Prior to the 90s, the standard approach to locally advanced stages was total laryngectomy. Subse- quently, the concept of “organ preservation” using radiotherapy and chemotherapy instead of radical surgery was introduced for patients with both hypopharyngeal and laryngeal cancers 1,2 . The best combination was found to be the concomitant chemoradiotherapy regimen, which has been the preferred strategy and is the most widely applicable treatment 3-6 . In addition, thanks to the refinement of surgical pro- cedures and the development of the surgeon’s ability to preserve the physiological Tumori, 99: 667-675, 2013