INTRODUCTION
Laryngeal squamous cell carcinoma (LSCC) is diagnosed in 1800 patients in England and Wales annually, half of whom have locally advanced disease ((American Joint Committee on Cancer (AJCC 8) stages III and IV) at presentation [1]. Prior to 1991, laryngectomy was considered a treatment of choice offering the highest chance of cure. However, the treatment paradigm shifted towards non-surgical laryngeal preservation strategies following the results of the Veterans Affairs (VA) Laryngeal Cancer Study, which demonstrated equitable survival and favourable laryngeal preservation rates (64%) in patients undergoing induction chemotherapy and definitive radiotherapy versus total laryngectomy and postoperative radiotherapy[2]. The role of concurrent chemoradiotherapy (CRT) was established by the Radiation Therapy Oncology Group 91-11 trial which showed improved locoregional control and even higher laryngeal preservation rates of 81% with concomitant CRT when compared with 67% in the induction chemotherapy/radiation arm and 63% in definitive radiotherapy arm [3].
Whilst primary CRT has become the standard of care for T3 and low-volume T4 disease in most United States and UK centres since the publication of these two seminal trials, a number of questions regarding the role of larynx preserving strategies remain [4]. In particular, the vexed issue of what constitutes meaningful laryngeal preservation when accounting for function and quality of life. (C)RT is associated with significant side-effects with a third of patients experiencing grade 3-5 toxicities, most notably airway and swallowing ramifications[3]. It is, therefore, of significant clinical relevance to attempt to inform patient selection for these treatment strategies.