Treatment of Locally Advanced Layngohypopharyngeal Cancers: A Network Meta-Analysis
In brief
Concurrent chemoradiotherapy cuts larynx loss by two thirds compared with surgery
A network meta-analysis of 15 trials (4,395 patients) found that all non-surgical approaches preserved the larynx far better than surgery plus postoperative radiotherapy, with concurrent cisplatin-based chemoradiotherapy showing the greatest benefit (about a two-third reduction in loss). Induction chemotherapy followed by radiotherapy may modestly improve survival, but choice should depend on patient health and expertise.
- Journal
- The Laryngoscope (Q1)
- Published
- 29 July 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Vincenzo Capriotti, Elisa Dal Cin, Agostina De Stefani, Massimiliano Nardone, Alessandro Abramo, Vinidh Paleri, et al.
- PMID
- 42528018
- DOI
- 10.1002/lary.70780
Why clinicians should know about it
- Picked for Immunology and Allergy (top studies of the week, 2 August 2026).
- Picked for Internal Medicine (top studies of the week, 2 August 2026): Head‑and‑neck cancer, excluded specialty
- Picked for Otorhinolaryngology (top studies of the week, 2 August 2026): Organ‑preservation strategies for advanced laryngeal/hypopharyngeal cancer
Abstract
OBJECTIVE: To compare the efficacy of non-surgical organ-preservation strategies for locally advanced or resectable laryngeal and hypopharyngeal squamous cell carcinoma (SCC). DATA SOURCES: Randomized controlled trials (RCTs) published through June 30, 2025, identified via systematic database and trial-registry searches and reference screening. REVIEW METHODS: We performed a systematic review and Bayesian random-effects network meta-analysis of RCTs enrolling adults with locally advanced/resectable laryngeal/hypopharyngeal SCC. Treatments included surgery plus postoperative radiotherapy (RT), RT alone, concurrent cisplatin-based chemoradiotherapy (CTRT), induction chemotherapy followed by RT/CTRT, altered-fractionation RT, dose-modified CTRT, and RT ± cetuximab. Effect estimates were synthesized as hazard ratios (HRs) and odds ratios (ORs). Treatments were ranked using surface under the cumulative ranking curve (SUCRA). RESULTS: Fifteen RCTs (n = 4395; 13 strategies) were included. For laryngeal preservation, cisplatin-based CTRT ranked highest (SUCRA 0.73), followed by induction TPF → RT (0.72) and RT + cetuximab (0.61). All non-surgical strategies outperformed surgery plus postoperative RT for laryngeal preservation (HR 0.34; 95% CI, 0.20-0.58). For overall survival, induction PF → RT showed the highest probability of benefit (SUCRA 0.68), with overlapping credible intervals across leading regimens. For locoregional control, induction TPF → RT ranked best (SUCRA 0.94). Sensitivity analyses supported robustness. CONCLUSION: Concurrent cisplatin-based CTRT remains the most consistent organ-preservation strategy. Induction PF → RT may offer modest overall survival benefit, whereas sequential TPF → RT appears superior for locoregional control. Treatment should be individualized by comorbidity, functional goals, and institutional expertise; head-to-head trials and incorporation of immunotherapy/targeted agents are needed. LEVEL OF EVIDENCE: N/A.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.