Advanced larynx cancer.

Despite advances in diagnosis and treatment, the prognosis for patients with stage III-IV laryngeal cancer is not significantly different than it was four decades ago [1]. This failure to improve survival is multifactorial and is likely linked to controversy surrounding optimal treatment regimens for a heterogeneous patient and tumor population. At the root of this controversy is a lack of randomized controlled trials that compare different therapeutic options, personal and institutional treatment philosophies, and a paucity of standardized functional and quality-of-life outcome measures for specific treatment modalities. Therapeutic decision making is further complicated by the potential use of organ preservation approaches in some patients [2**, 3*, 4**]. Clearly, quality-of-life considerations are an integral part of treatment planning and a well-informed patient is necessary to achieve an optimal result. Philosophically, it is the physician's responsibility to recommend the best treatment option and to explain the other viable treatment strategies. It is our opinion that conservation laryngeal surgery represents the mainstay of treatment for patients with advanced laryngeal carcinomas, whose tumors have characteristics amenable to these approaches and who functionally can tolerate such procedures. For those patients who would likely require a total laryngectomy or who are not suitable for surgical conservation, organ preservation should be used as a primary option in a controlled setting.