Reexamining the treatment of advanced laryngeal cancer.

Determining the standard of care for a cancer with a diverse set of treatment variables is difficult. Advanced laryngeal cancer is one such case. The treatment for advanced laryngeal cancer is now at a point where the current standard of care—concurrent chemotherapy and radiotherapy with surgical salvage (ie, laryngectomy)—must be reexamined. Why? Because published studies—identified as evidence-based medicine—have set a standard of care that has resulted in major unintended consequences. The survival of patients with laryngeal cancer should not be decreasing. Unfortunately, this is happening today. The focal points of this commentary are (1) how these unintended consequences leading to decreased survival have occurred, (2) what can be done to avoid similar outcomes in the future, and (3) how the current standard of care for laryngeal cancer should be changed. STUDIES LEADING TO THE CURRENT STANDARD OF CARE