We analyzed the clinical outcomes of 849 laryngeal cancer patients treated in the past 40 years (1971–2012), a time period that saw global treatment shift from surgery to chemoradiotherapy, at a single Japanese tertiary referral center and university teaching hospital.

To compare the chronological treatment trends, patients were divided into four decades (1972–1982, 1983–1992, 1993–2002, and 2003–2012), and larynx preservation and overall survival rates were compared. The total dose of radiotherapy (RT)-based treatments was fixed at 60Gy, and has not been increased over the past 40 years. In 1997, we conducted the first supracricoid laryngectomy (SCL) in Japan, and since then, we have become the primary institute for promoting SCL.

There were 104, 173, 253, and 319 patients registered in 1972–1982, 1983–1992, 1993–2002, and 2003–2012, respectively. Five-year overall survival rates (all stages) were 74, 76,5, 75,6, and 82,2 % in 1972–1982, 1983–1992, 1993–2002, and 2003–2012, respectively. Five-year larynx preservation rates (all stages) were 65,5, 75,7, 75,4, and 80,9 % in 1972–1982, 1983–1992, 1993–2002, and 2003–2012, respectively. In non-surgical options, S1 (an oral fluoropyrimidine derivative) +RT showed superiority over RT alone in larynx preservation and overall survival. Among surgical options, SCL significantly contributed to larynx preservation in intermediate and advanced stages and radiation-failed cancers. SCL was associated with overall survival not poorer than total laryngectomy.

The number of laryngeal cancer patients treated at our institute has increased and overall survival and larynx preservation rates have exhibited favorable improvements over the past four decades. In non-surgical approaches, proper case selection is the key to success and may be much more important than pursuing RT dose escalation. Treatment selection should not merely be decided based on guidelines; each patient's individual status must be taken into consideration. Moreover, the patient's benefit should be considered before clinical interests. We must make extra efforts in pursuing an ideal balance between non-surgical and surgical larynx preservation options in treating laryngeal cancers.