Evolution and Perspectives of Functional Larynx Preservation Strategies in Advanced Laryngeal Cancer

The management of advanced laryngeal cancer has evolved from surgical strategies centered around total laryngectomy to larynx preservation approaches aimed at maintaining both the anatomical structure and function, along with survival rates. Induction chemotherapy has played a pivotal role in this evolution, beginning with the landmark 1991 VA Laryngeal Cancer Study, which demonstrated that PF (cisplatin, fluorouracil)-based induction chemotherapy could achieve laryngeal preservation without compromising overall survival. The concept of chemo-selection later emerged, allowing treatment to be tailored based on individual responses to induction chemotherapy, further enhancing laryngeal preservation outcomes. While docetaxel, cisplatin, and fluorouracil (TPF) therapy has shown high efficacy, its severe toxicities have presented challenges, leading to the development of alternative regimens such as paclitaxel, carboplatin, and cetuximab (PCE). In addition to anatomical preservation, functional outcomes such as swallowing and voice are increasingly emphasized and supported by patient-reported measures, including MDADI. Advances in imaging biomarkers, such as metabolic tumor volume through FDG-PET/CT and molecular biomarkers, such as circulating tumor DNA for detecting minimal residual disease (MRD) and tumor immune microenvironmental profiles, have shown potential in guiding patient selection and tailoring treatments. Future innovations integrating these biomarkers with immunotherapeutic strategies are anticipated to enhance survival outcomes and quality of life in patients receiving larynx preservation therapy.