Laryngeal cancer is the second common Head & Neck cancer in the United States, despite all the measures to curb, we in India also have high incidence because of habit of consumption of tobacco and Alcohol. The ultimate goal of every clinician treating laryngeal cancer is to remove the disease with the preservation of voice and swallowing. Early glottic and supraglottic cancers are treated by surgery or radiation therapy without affecting the phonatory function but this is difficult to achieve in larger transglottic lesions because the preferred surgical treatment for advanced laryngeal tumors remains total laryngectomy (TL), a surgical technique in which laryngeal speech is sacrificed. This is the reason majority of our Indian patients refuse treatment.
The other alternative is Radiation and chemotherapy, part of the so-called organ-sparing protocols, have also resulted in effective outcomes but 30 -40% may require salvage surgery for recurrent disease and post radiotherapy conservative procedures cannot be performed because of poor healing resulting in high fistula rate and assessment of oncological safe margins is not adequate. So these patients land in Total Laryngectomy with high postoperative complications, so primary surgery with voice conservation is preferred modality of treatment. There is a report by Hoffmann et all that for supraglottic cancers survival is poorer with Concurrent chemo radiotherapy as compared to primary surgery followed by radiotherapy.