The current study was designed to test the hypothesis that different combinations of current treatments might increase the probability of preservation of the larynx and increase quality of life for patients.

Eligible patients had been newly diagnosed with stage III or stage IV squamous carcinoma of the glottic and supraglottic regions. Patients with a T1 or a high-volume T4 tumor were excluded from the study. A total of 547 patients were randomly assigned to three treatment arms: cisplatin and fluorouracil followed by radiation if the patient responded to chemotherapy; cisplatin concurrent with radiation therapy; or radiation only. After the completion of therapy, data from 517 patients (173 in the first arm, 172 in the second arm, and 172 in the third arm) were analyzed.

At two years of follow-up, the laryngeal preservation rate for the patients treated with concomitant chemotherapy and radiotherapy was significantly better than for patients treated with sequential chemotherapy and radiation therapy or with radiation therapy alone. Far fewer patients in concurrent treatment group required a laryngectomy. Local and regional control was also better for the concurrent group. There were no significant differences between the group that received chemotherapy followed by radiation and the group that received just radiation.

"Our findings demonstrate that concurrent chemotherapy and radiation treatment is superior to chemotherapy followed by radiation and radiation alone when attempting to preserve a patient's larynx," said Moshe H. Maor, M.D., of the M.D. Anderson Cancer Center and lead author of the study. "We can now offer patients an excellent therapy that can spare them the lifelong effects of a total laryngectomy."