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Ten-year follow-up confirmed that concurrent chemoradiation gives the best larynx preservation and local control in advanced laryngeal cancer, but also revealed more late deaths unrelated to cancer in that arm, raising questions about long-term toxicity.
Ten-year update of the RTOG 91-11 trial comparing induction chemotherapy then radiotherapy, concurrent cisplatin chemoradiation, and radiotherapy alone in 547 patients with advanced laryngeal cancer.
Laryngectomy-free survival was similar between the two chemotherapy arms and better than radiotherapy alone; locoregional control and laryngeal preservation remained best with concurrent treatment (ten-year preservation 81.7 percent versus 67.5 percent with induction), but overall survival showed a non-significant trend against the concurrent arm because of more non-cancer deaths.
Concurrent chemoradiation remains standard, but the excess of late non-cancer deaths is a reminder that swallowing dysfunction and aspiration after chemoradiation carry long-term risk.