The role of chemotherapy as part of a larynx sparing treatment strategy for advanced laryngeal cancer has evolved considerably over the last 20 years. During the 1980s, no sort of chemotherapy—induction/neoadjuvant, concurrent, adjuvant, or any combination of these approaches— could be considered part of standard treatment. Partial laryngectomy and primary radiation were the recommended therapeutic options for patients hoping to avoid total laryngectomy. These approaches are still used in selected patients today. However, standard therapy for an advanced primary cancer of the larynx commonly entailed surgical removal of the voice box. The landmark Veterans Affairs’ (VA) laryngeal cancer study, 1 initially published in 1991, provided the best initial evidence to support cisplatin-based, induction chemotherapy as part of a larynx preserving treatment approach. The VA investigators randomized patients with stage III or IV laryngeal cancer to primary surgery and postoperative radiation versus three cycles of induction chemotherapy followed by radiation. Laryngectomy was reserved for patients with a less than major response after two cycles of chemotherapy, suspected disease persistence after radiation, or relapse. The chemotherapy/radiation arm yielded survival rates comparable to those achieved with primary surgical management. Two thirds of surviving patients retained their larynx. The similarly designed European Organisation for Research and Treatment of Cancer (EORTC) larynx preservation study, which focused on patients with advanced cancer of the hypopharynx, further supported the principles of the VA trial. 2 Induction chemotherapy followed by radiation with surgery reserved for salvage came to be considered a new standard treatment for patients with locally advanced cancer of the larynx. Subsequent studies, most prominently the Radiation Therapy