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An account of the results of treatment of cancer of the larynx is given employing the clinical staging presented by a committee member of the International Union Against Cancer. This system of staging may be valuable and may permit a better comparison of results and selection of treatment methods. It is only by constant comparison and review of the various modes of treatment that we can hope to achieve better results. Surgery and radiotherapy are complementary. External radiotherapy is the recommended choice of primary therapy in the early (T1T2N0M0) lesions. In patients with moderately advanced tumors (T3N0M0), 3 different plans of therapy may be offered: a. planned preoperative radiation therapy followed by total laryngectomy and radical neck dissection; b. initial radiotherapy followed by total laryngectomy and elective neck dissection in selective cases only, i.e., in patients where there is evidence of residual tumor in the larynx; c. initial total laryngectomy and elective radical neck dissection with or without postoperative radiation therapy. Some authors claim good results with plan a; others prefer plan b because a greater number of surviving patients retain their voice. Plan c is losing in popularity but is still recommended by some authors in supraglottic cancer. As the tumor extends to other regions with fixation or outside the larynx (T4N0M0), or metastasizes to cervical nodes (N1‐3), total laryngectomy or laryngopharyngectomy with radical neck dissection may give the best chance for long time survival. Radiotherapy is an important adjuvant and is probably most effective when given preoperatively.

A review of the rationale for application of combined radiation and chemotherapy in the treatment of certain malignant tumors has been presented. The mechanisms of action of ionizing radiations and many of the commonly employed chemotherapeutic agents are intimately related to the nucleic acid metabolism of proliferating cells. Modification of the DNA‐molecule by certain chemotherapeutic agents results in sensitization of the cell to subsequent irradiation. Reduction in the total number of malignant cells by preirradiation chemotherapy facilitates subsequent radiotherapy of advanced tumors. Certain chemotherapeutic antitumor agents exert a beneficial effect by restraining the growth of distant metastases which often escape clinical detection.

We compared two groups of patients with squamous cell carcinoma of the larynx. Group 1 consisted of 483 patients treated from 1958 through 1978. Primary surgery was selected in 41% pre- or postoperative radiation therapy in 16% and primary radiation therapy in 43%. Group 2 consisted of 247 patients treated from 1978 through 1983. Primary surgery was selected in only 1.6%, pre- or postoperative radiation therapy in 23%, and primary radiation therapy, with surgery in reserve for residual or recurrent carcinoma, in 76%. Although the results were comparable for patients with early stage tumors in the two groups, significantly higher local-regional tumor control rates and corrected survival rates were recorded for patients with advanced tumors in group 2. More patients survived with a cancer-free functional larynx, the surgical salvage rates were higher, the complication rates and the death rates lower in group 2 compared to group 1.