# RTOG 91-11: concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer

Source: https://onco.cc/key-papers/paper-rtog-91-11-forastiere-nejm-2003/  
OnCo record `paper-rtog-91-11-forastiere-nejm-2003` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Giving cisplatin at the same time as radiotherapy preserved the larynx in more patients with advanced laryngeal cancer than either induction chemotherapy followed by radiotherapy or radiotherapy alone, defining the standard larynx-preserving treatment.

## Summary

Phase 3 trial of 547 patients with stage III to IV laryngeal cancer randomised to induction cisplatin-fluorouracil followed by radiotherapy, concurrent cisplatin with radiotherapy, or radiotherapy alone.

Laryngectomy-free survival was similar between the chemotherapy arms, but laryngeal preservation at two years was 88 percent with concurrent chemoradiation against 75 percent with induction and 70 percent with radiotherapy alone, and locoregional control was best with concurrent treatment; overall survival was similar in all arms.

## Fields

- Kind: Key paper
- Last checked: 2026-09-17
- Journal: New England Journal of Medicine
- Year: 2003
- DOI: 10.1056/NEJMoa031317
- Authors: Forastiere AA, Goepfert H, Maor M, et al.
- Findings: Two-year laryngeal preservation 88 percent (concurrent) vs 75 percent (induction) vs 70 percent (radiotherapy alone).; Overall survival similar across arms.
- What it means: Concurrent cisplatin chemoradiation is the standard larynx-preserving treatment for advanced laryngeal cancer where the larynx is still functioning; laryngectomy is reserved for extensive disease or salvage.
- Caveats: Long-term follow-up showed more non-cancer deaths in the concurrent arm.; T4 tumours with cartilage invasion were excluded.

## Sources

- N Engl J Med 2003: https://doi.org/10.1056/NEJMoa031317
- PubMed: https://pubmed.ncbi.nlm.nih.gov/14645636/

## Connected records

- cancers: [Laryngeal and hypopharyngeal cancer](https://onco.cc/cancers/laryngeal-cancer/)
- trials: [RTOG 91-11](https://onco.cc/trials/rtog-91-11/)
- journals: [New England Journal of Medicine](https://onco.cc/journals/nejm/)

---
JSON: https://onco.cc/api/v1/entities/paper-rtog-91-11-forastiere-nejm-2003.json