[Update on Larynx Organ Preservation in locally advanced Laryngeal and Hypopharyngeal Carcinoma].

Abstract

The management of locally advanced laryngeal and hypopharyngeal squamous cell carcinomas remains challenging for ENT specialists due to the larynx's complex multidimensional function and the high rates of local and locoregional recurrence or distant metastatis. Surgical (including total laryngectomy, LE, followed by adjuvant radio(chemo)therapy) and nonsurgical approaches aiming on larynx organ preservation (including definitive concomitant chemoradiation or sequential induction chemotherapy (IC) followed by radiotherapy) are available. These treatment modalities will be critically discussed in this review.In line with the national German S3 guidelines for laryngeal and oro-/hypopharyngeal cancer, patients must receive comprehensive counseling on both surgical and non surgical concepts. To date, early response to IC constitutes the most robust surrogate marker for organ preservation candidacy, guiding the early redirection of non responders to upfront LE. Late salvage LE after definitive radiochemotherapy is associated with high perioperative morbidity, often rendered unfeasible due to radiation-induced fibrosis and impaired vascularity; thus, it should not be considered as a standard treatment option.IC and response evaluation after just one cycle of IC, as applied in the DeLOS-II study, allow for early identification of non-responders, for whom LE (associated with significantly lower complication rates than salvage surgery) should be recommended prior to radiotherapy. The neoadjuvant use of immunotherapy in combination with IC likely represents the next frontier in the context of laryngeal organ preservation. The ongoing ELOS study is currently investigating the efficacy of an IC regimen comprising docetaxel and cisplatin in combination with pembrolizumab.