Current trends in initial management of hypopharyngeal cancer: The declining use of open surgery

Robert P. Takes, Primoz Strojan, Carl E. Silver, Patrick J. Bradley, Missak Haigentz, Gregory T. Wolf, Ashok R. Shaha, Dana M. Hartl, Jan Olofsson, Johannes A. Langendijk, Alessandra Rinaldo, Alfio Ferlito*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

157 Citations (Scopus)

Abstract

Squamous cell carcinoma of the hypopharynx represents a distinct clinical entity. Most patients present with significant comorbidities and advanced-stage disease. The overall survival is relatively poor because of high rates of regional and distant metastasis at presentation or early in the course of the disease. A multidisciplinary approach is crucial in the overall management of these patients to achieve the best results and maintain or improve functional results. Traditionally, operable hypopharyngeal cancer has been treated by total (occasionally partial) laryngectomy and partial or circumferential pharyngectomy, followed by reconstruction and postoperative radiotherapy in most cases.

Efforts to preserve speech and swallowing function in the surgical treatment of hypopharyngeal ( and laryngeal) cancer have resulted in a declining use of total laryngopharyngectomy and improved reconstructive efforts, including microvascular free tissue transfer. There are many surgical, as well as nonsurgical, options available for organ and function preservation, which report equally effective tumor control and survival. The selection of appropriate treatment is of crucial importance in the achievement of optimal results for these patients. In this article, several aspects of surgical and nonsurgical approaches in the treatment of hypopharyngeal cancer are discussed. Future studies must be carefully designed within clearly defined populations and use uniform terminology and standardized functional assessment and declare appropriate patient or disease endpoints. These studies should focus on improvement of resultsx, without increasing patient morbidity. In this respect, technical improvements in radiotherapy such as intensity-modulated radiotherapy, advances in supportive care, and incorporation of newer systemic agents such as targeted therapy, are relevant developments. (C) 2010 Wiley Periodicals, Inc. Head Neck 34: 270-281, 2012

Original languageEnglish
Pages (from-to)270-281
Number of pages12
JournalHead and Neck: Journal of the Sciences and Specialties of the Head and Neck
Volume34
Issue number2
DOIs
Publication statusPublished - Feb-2012

Keywords

  • hypopharynx
  • squamous cell carcinoma
  • treatment
  • laryngopharyngectomy
  • chemoradiotherapy
  • SQUAMOUS-CELL CARCINOMA
  • ADVANCED LARYNGEAL-CANCER
  • LOCALLY ADVANCED HEAD
  • QUALITY-OF-LIFE
  • INTENSITY-MODULATED RADIOTHERAPY
  • TRANSORAL LASER MICROSURGERY
  • UPPER AERODIGESTIVE TRACT
  • PYRIFORM SINUS CARCINOMA
  • PHASE-III TRIAL
  • NECK-CANCER

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