This article presents the 10-year results of a single institution’s treatment of advanced laryngeal cancer. The institution established a protocol based on the Dutch Head and Neck Society consensus document on laryngeal cancer diagnostics and treatment published in 1991. This protocol consisted of organ-preserving radiotherapy for T3 disease, supplemented with chemotherapy for extensive neck disease, with total laryngectomy and adjuvant radiotherapy for T4 disease. The primary endpoint was overall survival (OS); there was no measurement of voice, swallowing or quality of life outcomes. One hundred-and-eighty-two patients were studied, 60 of which had total laryngectomy. The five-year OS showed no statistical difference between T3 and T4 cancers: 52% for T3 cancers and 48% for T4 cancers (p = 0.528). As the majority of T3 cancers were treated non-surgically and the majority of T4 cancers were treated with total laryngectomy and radiotherapy, the question should be asked if organ-preserving strategies for the treatment of T3 disease are adversely affecting patient survival. This question has been raised by other groups, who have noted decreased survival for patients with advanced laryngeal cancer in the United States at the same time as increasing use of organ-preserving treatment modalities over surgery.
