Induction Chemotherapy Followed by Chemoradiation in Patients of Locally Advanced Laryngeal and Hypopharyngeal Cancers with Intent of Organ Preservation

Abstract

Laryngeal and hypopharyngeal cancers are among the most common malignancies of the head and neck region. Traditionally, these cancers have been managed with surgery, but the advent of organ-preserving treatments has revolutionized their management. Induction chemotherapy followed by chemoradiation is an emerging approach for patients with locally advanced laryngeal and hypopharyngeal cancers, with the primary intent of organ preservation while ensuring optimal oncological outcomes.
Induction chemotherapy, typically consisting of platinum-based agents such as cisplatin and taxanes, is utilized to reduce tumor size and assess tumor response. This initial treatment phase offers a chance for organ preservation, with the aim to downstage tumors and make them amenable to subsequent chemoradiation. The subsequent chemoradiation phase involves combining chemotherapy with radiation therapy, which intensifies tumor control while allowing for the preservation of the larynx and hypopharynx. This approach aims to avoid total laryngectomy, which can have significant functional and psychological impacts on patients. Studies have demonstrated that induction chemotherapy followed by chemoradiation can offer comparable survival outcomes to surgery, with the added benefit of preserving critical organ function, particularly speech
and swallowing. However, careful patient selection and monitoring of treatment toxicity are crucial to optimize the benefits of this regimen. Long-term outcomes, including survival, recurrence, and quality of life, are pivotal in evaluating the success of this organ-preserving strategy. The integration of induction chemotherapy with chemoradiation represents a promising alternative to surgery in the management of locally advanced laryngeal and hypopharyngeal cancers. Further prospective studies are needed to refine patient selection criteria and determine the long-term efficacy and safety of this approach in preserving both organ function and survival.