Feature precluding larynx-preservation chemoradiation (RTOG 91-11 concurrent cisplatin +...

Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.

ID	`RF-LARYNGEAL-POOR-PRESERVATION-CANDIDACY`
Type	Red flag
Status	reviewed 2026-07-11 \| pending_clinical_signoff
Diseases	`DIS-LARYNGEAL`
Sources	`SRC-NCCN-HNSCC-2025` `SRC-RTOG-9111-FORASTIERE-2003`

Red Flag Origin

Definition	Feature precluding larynx-preservation chemoradiation (RTOG 91-11 concurrent cisplatin + RT) as the preferred locally advanced treatment pathway, favoring primary total laryngectomy instead: radiographic cartilage invasion / destruction, tumor extension through cartilage into extralaryngeal soft tissue, substantial (≥1 cm) invasion of the tongue base, or pretreatment laryngeal dysfunction (severe aspiration, or feeding-tube / tracheostomy dependence) indicating a non-functional larynx that organ- preservation therapy would not salvage.
Clinical direction	intensify
Category	fitness-eligibility
Shifts algorithm	ALGO-LARYNGEAL-1L

Trigger Logic

{
  "any_of": [
    {
      "finding": "laryngeal_cartilage_invasion",
      "value": true
    },
    {
      "finding": "extralaryngeal_soft_tissue_extension",
      "value": true
    },
    {
      "comparator": ">=",
      "finding": "tongue_base_invasion_cm",
      "threshold": 1
    },
    {
      "finding": "pretreatment_laryngeal_dysfunction",
      "value": true
    }
  ],
  "type": "composite_clinical"
}

Notes

STUB pending Clinical Co-Lead sign-off (CHARTER §6.1). Larynx- preservation-candidacy gate for locally advanced laryngeal SCC — routes ALGO-LARYNGEAL-1L step 5 to primary total laryngectomy instead of RTOG 91-11 concurrent chemoradiation. Grounded in the Disease-level narrative's "patient preference/fitness drives choice" framing plus well-established organ-preservation-candidacy criteria (RTOG 91-11 itself excluded T4 disease with cartilage destruction / >1 cm tongue-base invasion from its organ-preservation comparison). Distinct from RF-HNSCC-ORGAN-DYSFUNCTION (reused unchanged at ALGO-LARYNGEAL-1L step 6), which gates cisplatin FITNESS rather than larynx-preservation CANDIDACY. clinical_direction set to `intensify` (not `investigate`) per independent safety-review fix: this RF escalates from organ-preservation CRT to primary radical surgery when it fires, and every other algorithm-shifting RedFlag in this KB uses intensify/de-escalate/hold, never investigate (confirmed by grepping redflags/ sibling files) — the loader's _check_redflag_contracts flags investigate+non-empty shifts_algorithm as a re-classification warning.

Used By

Algorithms

ALGO-LARYNGEAL-1L - ALGO-LARYNGEAL-1L

Diseases

DIS-LARYNGEAL - Laryngeal squamous cell carcinoma

Indications

IND-LARYNGEAL-LA-1L-CRT - IND-LARYNGEAL-LA-1L-CRT
IND-LARYNGEAL-LA-1L-TOTAL-LARYNGECTOMY - IND-LARYNGEAL-LA-1L-TOTAL-LARYNGECTOMY

Procedures

SUR-LARYNGEAL-TOTAL-LARYNGECTOMY - Total laryngectomy