If a stage I laryngeal cancer completely responds to FU-based chemotherapy (given for another malignancy) would you consider observation?

We expect a 60-80% response rate with induction chemo data, with 20% having a complete response. That doesn’t preclude local treatment but predicts for better outcome.

Holding RT and following early stage laryngeal cancer seems like a risky proposition. You have a high likelihood of a favorable outcome with microscopic residual disease treated with small field definitive radiotherapy. The late toxicities are low with RT for early glottic cancer and it’s a relatively short treatment with 28 fractions. If you follow that patient and the tumor grows back within 3 mo or if the patient misses a follow up and you see them back in 6-9 mo, then the tumor could progress to a stage that requires chemoradiation or a laryngectomy.

2025-12-04 Addendum: Additional long term data from MDAH on CTX alone in Stage II-IVa laryngeal SqCCa. Ref. below.

Trinconi Cunha, M et al. Chemotherapy Alone for Stage II-IVa laryngeal squamous cell carcinoma: A 20-year follow up. Cancer 2025;131(23)

2019-03-03 Addendum: 10 yr update of Univ. Paris results using CTX alone for N0M0 larynx and pharynx SqCCa. Please see new reference below.

Laccourreye, O et al. Ten-year outcome of curative "exclusive" chemotherapy in N0M0 SqCCa of the larynx and pharynx with complete clinical response. Head and Neck (Early View) published online 01 Feb 2019.

Depends on the patient and what the other malignancy is... Some pts. have been cured of HN malignancies w CTX alone. See references below:

Laccourreye, O (Univ. Paris) CTX alone w curative intent in T1-4 N0 M0 SqCCa of the pharyngolarynx. Cancer 2001;9(6):1504-1511.

Holsinger, F (MDAH) Durable Long-Term Remission With Chemotherapy Alone for Stage II to IV Laryngeal Cancer. JCO 2009;27(12):1976-1982.

No. I would irradiate. Jim Parsons (UF alumni) used to say a "CR is only halfway to a C-U-R-E."