In addition to the prolongation of survival, preservation of the laryngeal function is one of the most important goals in the treatment of locally advanced head and neck cancer, and is an issue that must be resolved. The impact of total laryngectomy on patients is significant and may lead to various problems other than cancer itself, such as lifestyle restrictions, changes in appearance, loss of communication opportunities, loss of employment in the working-age population, and cognitive decline in the elderly.
When function-sparing surgery is not possible, radiotherapy is the treatment of choice; however, it is expected to preserve not only the morphology of the larynx but also its function. In the past few decades, radiotherapy, chemoradiotherapy, and induction chemotherapy have been used as curative treatments with unsatisfactory results. Although we are now using our accumulated knowledge and experience to tailor treatment to individual conditions and backgrounds, there is still room for debate on whether optimal treatment is being selected.
The present article reviews past efforts to preserve the laryngeal function and discusses future prospects through clinical trials using novel agents and immune checkpoint inhibitors to augment the therapeutic effect of radiotherapy.
