Main topics

Rationale
Larynx Preservation represents an important option for patients affected by Locally Advanced (LA) Laryngo-Hypopharyngeal Squamous Cell Carcinoma (LHSCC), given the chance to provide a curative treatment without affecting the ability to speak. However, to date the indications for the available strategies of Larynx Preservation – i.e., surgical preservation, induction chemotherapy, and concomitant chemoradiation treatment – are still debated. International Guidelines do not provide meticulous indications, instead recommending a case-by-case discussion also keeping into consideration the expertise of each Multidisciplinary Tumour Board.

The purpose of this Consensus Project is to dissect the topics with scanty literature, summarise the current evidence, point out the most debated questions, enlighten the fields needing further research and provide expert opinions on topics with inadequate clinical evidence.

Methods and Topics
The Scientific Committee and the Scientific Young Secretariat of this Project has elected a Core Group and an Expert Group:
● The Core Group is composed of a small number internationally recognised experts (15), representing ENT Surgeons, Radiation Oncologists, Medical Oncologists, Radiologists, Pathologists, Speech and Language Pathologists, and Dieticians, selected in Europe and North America;
● The Expert Group is composed of a larger number of internationally recognised experts (about 50) coming from all over the world and representing all the specialisations previously listed. Also, Patients’ Representatives are included in the Expert Group.

For each topic the following rules have been applied:
● Define absolute contraindications and contraindications specific to each treatment approach;
● Discuss radiological indications;
● Discuss available clinical/biochemical predictor of organ preservation success;
● Define the expected functional outcome;
● Discuss differences between hypopharynx and larynx.
Level of evidence and literature references have been reported for each statement.

The final statements list have been voted according to a two-round Delphi consensus method by the members of the Core Group and the Expert Group. Votes have been expressed according to the Likert scale (1-5), and comments have been collected. Statements have been approved if a consensus of ≥ 80% is reached within the first round, otherwhile they have been reviewed by the members of the Core Group taking into consideration also eventful comments, and then a second round with the same cut-off for approval took place.