I. Laryngeal Function Preservation in Early Laryngeal Cancer Treatment The available treatment methods in early laryngeal cancer treatment include radiation therapy, laser tumor resection via oral route and partial laryngectomy. In addition to the radical treatment of tumor, there is also the preservation of laryngeal function (phonation) to improve the quality of life of patients after treatment. The 5-year survival rate of laryngeal cancer with simple radiotherapy is 93%-96% in T1 (local early stage) stage laryngeal cancer, and 81% in T2 (local early-middle stage) stage laryngeal cancer. In the case of local residual or recurrence of radiotherapy, there is still a chance to save the patient by surgery, and there is a possibility to narrow down the scope of surgical resection in order to preserve part of laryngeal function. The treatment of early laryngeal cancer varies in different countries. Since radiation therapy can preserve laryngeal function, most of the reports are based on the choice of radiation therapy. In the United States, radiation therapy is recommended as the first choice in the treatment of early laryngeal cancer, and in recent years, more and more institutions have begun to choose radiation therapy as the first choice for T1N0 (localized early laryngeal cancer without cervical lymph node metastasis) laryngeal cancer for the sake of preserving laryngeal function. For in situ cancer of the vocal folds, endoscopic resection can be chosen to achieve good curative effect, but in the case of more extensive lesions or the limitation of surgical techniques, radiation therapy is more often chosen. For early stage laryngeal cancer, radiation therapy has a relatively small field, and the acute and chronic injuries caused by irradiation are also small, so it is a treatment method easily accepted by patients.The efficacy of radiation therapy for T1N0 vocal fold cancer is generally recognized, and the toxicity of the treatment is limited. Acute mucositis is a common side effect of radiotherapy, but it is mostly tolerable and does not affect the treatment after symptomatic treatment; laryngeal edema may occur after radiotherapy in about 1% of cases, and increasing irradiation field will increase the possibility of laryngeal edema. It has been proved that the local control rate of <2gy< font="">per dose is worse than that of ≥2Gy per dose, so it is recommended that in the course of radiotherapy, the best dose should not be less than 2Gy per dose, and it is not desirable to divide the dose by more than 300cGy per dose, even though the total amount of irradiation is not very high (6,000cGy), in more than half of the patients, it can cause a high morbidity of hissing, laryngeal edema, and chronic laryngoedema in 10 percent of the patients. In 10% of patients, chronic laryngeal edema can be caused, leading to complications such as laryngeal obstruction and, in those who require further surgical intervention, serious postoperative complications. T1N0 laryngeal cancer patients can retain better vocal quality after radiation therapy. 89% of patients have improved vocalization after radiation therapy, and a considerable number of patients even regain normal vocalization. The role of chemotherapy in preserving laryngeal function In the treatment of advanced laryngeal cancer, simple radiation therapy and partial laryngectomy have high failure rate, and total laryngectomy is often chosen for this part of patients. For patients who wish to preserve part of the laryngeal function, radiotherapy + partial laryngectomy is often chosen, and this comprehensive treatment method is still used in many parts of the world. In the past 20 years, the role of chemotherapy in the treatment of laryngeal cancer for the preservation of laryngeal function has received increasing attention. Chemotherapy combined with radiation therapy has achieved survival rates comparable to those of surgical treatment alone. The results of this clinical study were further confirmed in the EORTC (European organization for Research and Treatment of Cancer) study on the preservation of laryngeal structures in the treatment of laryngeal cancer. Chemotherapy + radiotherapy + surgical salvage therapy when necessary is emerging as a treatment modality for advanced laryngeal cancer. The modality of combining chemotherapy and radiotherapy is a subject that is being extensively studied. Studies have shown that concurrent chemotherapy helps to preserve laryngeal structures in T2 vocal type carcinoma with a large mass. In the treatment of advanced head and neck tumors, more centers are conducting randomized studies comparing the efficacy of induction chemotherapy + concurrent radiotherapy with concurrent radiotherapy. However, in the treatment of advanced laryngeal cancer, the American RTOG (Radiation Therapy Oncology Group) Trial No. 91-11 and the Head and Neck Tumor Group jointly published the results of the trial in 2003, which took concurrent radiochemotherapy as the first regimen for the preservation of the laryngeal structure in advanced laryngeal cancer, and the results of this study suggested that cisplatin given concurrently with radiotherapy at a follow-up period of 3.8 years achieved a rate of This study showed that cisplatin administered concurrently with radiotherapy at 3.8 years achieved a laryngeal preservation rate of 84%, compared to 67% with radiotherapy alone and 72% with the PF regimen of induction chemotherapy + radiotherapy. However, the 5-year overall survival rate was 55%, leaving much room for improvement in outcome. Although the therapeutic goal of partial laryngectomy is also to preserve the function of the larynx, organ preservation therapy in the usual sense refers to non-surgical routes. The challenge for any treatment modality intended to preserve laryngeal structures is to balance tumor control with the goals of preserving the patient’s vocal cords, assuring post-treatment quality of life, including good quality of phonation, swallowing function, and avoiding a permanent tracheostomy. Clinicians are faced with multiple considerations. When conservative treatment is successful in preserving the organ, everything is fine, however, when conservative treatment fails and further surgical intervention is required, even if it affects survival, the cost of treatment will rise significantly, and in such cases, it may be that direct total laryngectomy is a superior option in the first place. Therefore, it is a challenging problem for head and neck oncologists to screen out such patients from a large number of cases while avoiding unnecessary total laryngectomy. Experience has shown that when laryngeal tumors invade the laryngeal cartilage, or soft tissues outside the larynx, treatment that preserves the laryngeal structures is less likely to be successful, and total laryngectomy is a more appropriate option. Whether concurrent radiochemotherapy and induction chemotherapy can improve survival and laryngeal preservation is a topic currently under investigation. Experience has shown that the degree of tumor response to induction chemotherapy, i.e., the time of tumor regression after induction chemotherapy, is an important prognostic sign for the success of laryngeal structure preservation, and the earlier the tumor regresses after chemotherapy, the higher the chances of laryngeal preservation success. However, in some cases, the extent of tumor response to chemotherapy is often not apparent until after the second cycle of chemotherapy, and the RTOG91-11 clinical trial showed a tumor response rate of 85% after 2 cycles of induction chemotherapy. It is important to note that the lack of tumor response to induction chemotherapy is not a perfect indicator for total laryngectomy, as the RTOG91-11 trial showed that radiation therapy was still effective in patients who did not respond well to induction chemotherapy. In conclusion, the treatment of laryngeal cancer should be based on the radical treatment and the protection of patients’ phonatory function as much as possible, and the appropriate treatment plan should be formulated according to the site of the tumor, clinical staging, lesion extent, pathological type, as well as the patient’s age and physical condition. Due to the use of modern CT, MR and laryngoscope in clinic, the scope and staging of laryngeal cancer are more accurate, which is helpful for choosing treatment methods, together with the use of digital positioning technology, three-dimensional planning system and digital gas pedal, and the improvement of the method of fixation of the patient’s head, which greatly improves the accuracy of radiotherapy as well as the homogeneity of the distribution of the radiotherapy dose, and results in a new increase in the cure rate of the patients.