Systemic therapy in the curative treatment of laryngeal cancer

The aim of this narrative review is to provide a comprehensive overview of systemic approaches in the context of curative treatments for laryngeal squamous cell carcinoma, evaluating oncologic outcomes, survival, and the preservation of voice and swallowing functions. It summarises current evidence from landmark clinical trials, international guidelines, and recent developments in multidisciplinary management, including systemic therapies and advanced radiation techniques. Early-stage laryngeal SCC shows high rates of cure with either surgery or radiotherapy. For locally advanced disease, concurrent chemoradiation remains the nonsurgical standard for organ preservation, though it offers no significant survival advantage over primary surgery. Patient selection is critical; individuals with T4 disease or severe baseline dysfunction often achieve better outcomes with total laryngectomy. While induction chemotherapy and immunotherapy have shown mixed results in definitive settings, neoadjuvant immunotherapy is emerging as a promising approach. Additionally, proton therapy offers potential for reducing late toxicities, such as dysphagia, by better sparing surrounding organs. In conclusion, optimal management of laryngeal cancer requires meticulous multidisciplinary evaluation and personalised treatment. Balancing oncologic control with functional preservation remains the primary challenge, necessitating a shift toward integrated, patient-centred care.