Glowing larynx symbolizing personalized cancer treatment

Beating Larynx Cancer: Can 'Chemoselection' Save Your Voice?

Theo Raines in Health & Wellness November 2025 • 4 min read.

"A groundbreaking approach using chemotherapy to target and preserve the larynx could change how we treat voice box cancer."

For individuals facing advanced laryngeal squamous cell carcinoma (LSCC)—a type of cancer affecting the voice box—treatment decisions can be daunting. Fortunately, organ preservation protocols, pioneered by the landmark Veterans Affairs (VA) Larynx trial, have transformed the landscape.

These protocols hinge on a critical concept: using chemotherapy as a 'biologic selection agent.' This means that only patients who respond favorably to initial chemotherapy then proceed to radiation or chemoradiation, with the goal of preserving the larynx (voice box). The underlying philosophy acknowledges that not all larynx cancers respond uniformly to treatment, and tailoring the approach can lead to better outcomes.

This article explores the role of induction chemotherapy as a selection tool for advanced LSCC, diving into the evidence supporting its use, how it's evolving, and what the future holds for this personalized treatment strategy. We will dissect the science in an accessible way.

The VA Larynx Trial: A Turning Point

Glowing larynx symbolizing personalized cancer treatment

The VA Larynx study was revolutionary, challenging the traditional approach of surgery followed by radiation for advanced, surgically resectable LSCC. Researchers hypothesized that selectively directing patients to the most appropriate treatment—either larynx-removing surgery or larynx-preserving radiation—would improve overall survival and quality of life.

The study compared standard total laryngectomy (removal of the voice box) followed by radiation therapy to an induction chemotherapy regimen consisting of three cycles of cisplatin and 5-fluorouracil (5-FU). The key was response: patients who showed a partial or complete response (at least a 50% reduction in tumor size) after two chemotherapy cycles completed the third cycle and proceeded to radiation.

Larynx Preservation: 64% of patients in the induction chemotherapy arm were able to preserve their larynx after two years.
Overall Survival: Survival rates were equivalent between the surgery and induction chemotherapy arms.
Recurrence Patterns: The surgery arm saw more distant disease failures, while the induction chemotherapy arm had more local failures.

This trial established organ preservation as a feasible option for advanced LSCC and paved the way for further refinement of induction chemotherapy strategies.

The Future of Chemoselection: Personalized and Precise

Building upon the foundation of trials using chemotherapy for advanced LSCC, significant prospects exist for further development and optimization in the current clinical and research environment.

The future of chemoselection lies in personalized medicine. Identifying biomarkers—genetic, epigenetic, or cellular indicators—before treatment begins could allow doctors to predict which patients will respond to chemotherapy. This would spare non-responders from unnecessary toxicity and ensure they receive the most effective treatment from the outset.

By incorporating new agents and refining patient selection through biomarkers, induction chemoselection has the potential to significantly improve larynx preservation rates, survival, and quality of life for individuals facing this challenging cancer.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1016/j.oraloncology.2018.09.026, Alternate LINK

Title: From Va Larynx To The Future Of Chemoselection: Defining The Role Of Induction Chemotherapy In Larynx Cancer

Subject: Cancer Research

Journal: Oral Oncology

Publisher: Elsevier BV

Authors: Matthew E. Spector, Andrew J. Rosko, Paul L. Swiecicki, J. Chad Brenner, Andrew C. Birkeland

Published: 2018-11-01

Everything You Need To Know

What is 'chemoselection' and how does it aim to improve outcomes for larynx cancer patients?

In the context of larynx cancer, 'chemoselection' refers to using chemotherapy as a 'biologic selection agent.' It involves administering chemotherapy to patients with advanced laryngeal squamous cell carcinoma (LSCC) and then assessing their response. Only those who respond favorably proceed to radiation or chemoradiation. The primary goal of 'chemoselection' is to selectively preserve the larynx (voice box) in patients who are most likely to benefit from this approach.

What was the significance of the VA Larynx Trial in the treatment of advanced laryngeal squamous cell carcinoma (LSCC)?

The VA Larynx Trial was a landmark study that compared total laryngectomy (removal of the voice box) followed by radiation therapy to an approach using induction chemotherapy consisting of cisplatin and 5-fluorouracil (5-FU). Patients who responded well to chemotherapy then received radiation. The trial demonstrated that organ preservation was a feasible option, as 64% of patients in the chemotherapy arm preserved their larynx after two years, with equivalent overall survival rates compared to surgery. The study's results highlighted the possibility of tailoring treatment based on individual responses to chemotherapy.

What were the differences in recurrence patterns observed between the surgery and induction chemotherapy arms in the VA Larynx Trial, and what are the implications?

The VA Larynx Trial revealed that while overall survival rates were similar between surgery and induction chemotherapy arms, recurrence patterns differed. The surgery arm experienced more distant disease failures, suggesting that the cancer spread to other parts of the body. Conversely, the induction chemotherapy arm saw more local failures, indicating that the cancer recurred in the original site (the larynx). This implies that choosing between surgery and 'chemoselection' involves weighing the risks of different types of recurrence.

What specific chemotherapy drugs and treatment schedule were used in the induction chemotherapy arm of the VA Larynx Trial, and how was response to chemotherapy determined?

The induction chemotherapy regimen used in the VA Larynx Trial consisted of three cycles of cisplatin and 5-fluorouracil (5-FU). Patients received two cycles initially, and their response was evaluated. If they showed a partial or complete response (at least a 50% reduction in tumor size), they completed the third cycle and proceeded to radiation. This approach allowed clinicians to assess the effectiveness of the chemotherapy and select patients who were more likely to benefit from larynx-preserving radiation.

How might 'chemoselection' evolve to further personalize and improve the treatment of advanced laryngeal squamous cell carcinoma (LSCC) in the future?

The future of 'chemoselection' involves further development and optimization of personalized treatment strategies for advanced LSCC. By building on the foundation of trials like the VA Larynx study, researchers aim to refine the selection process and identify biomarkers or other factors that can predict treatment response. This could lead to more precise and effective organ preservation protocols, potentially improving both survival rates and quality of life for patients with larynx cancer. Future studies might explore new chemotherapy regimens, radiation techniques, or combinations of therapies to further enhance outcomes.