Guidelines in Management of Carcinoma of the Hypopharynx

  • Sudhir Bahadur


Carcinoma of the hypopharynx is a difficult disease to treat. Most patients on presentation have a few symptoms but have advanced stage of disease, often with cervical lymphadenopathy resulting in poor prognosis. Besides, airway and nutritional status are other important issues. Nearly 60–80% of patients are diagnosed to have stage III or IV disease at presentation [1–3]. Besides the high incidence of lymph node metastasis, another factor which contributes to poor prognosis is the significant rates of distant metastasis [4]. Nearly 60–80% patients of hypopharyngeal cancer present with clinically palpable nodal metastasis and often in contralateral neck. The distant metastasis may be seen in up to 40% and 60% cases [5]. Predominant sites for distant metastasis are the lung, mediastinal lymph nodes, liver and bone (Fig. 10.1a, b).


  1. 1.
    Hall SF, Groome PA, Irish J, O’Sullivan B. The natural history of patients with squamous cell carcinoma of hypopharynx. Larygngcope. 2008;118:1362–72.CrossRefGoogle Scholar
  2. 2.
    Bahadur S, Amalya RC, Iyer S, et al. Study of distribution of cervical lymph node metastasis in squamous cell carcinoma of head and neck. Indian J Cancer. 1983;20:142–6.PubMedGoogle Scholar
  3. 3.
    Bahadur S, Kacker SK. Surgical treatment of pyriform fossa cancer. Indian J Otolaryngol. 1985;37:83–5.Google Scholar
  4. 4.
    Gourin CG, Terris DJ. Carcinoma of the hypopharynx. Surg Oncol Clin N Am. 2004;13:81–98.PubMedCrossRefGoogle Scholar
  5. 5.
    Kotwalk C, Sako K, Razack MS, et al. Metastasis Patterns in squamous cell carcinoma of head and neck. Am J Surg. 1987;154:439–224.CrossRefGoogle Scholar
  6. 6.
    Takas RP, Strigan P, Silver CE, Bradley PK, et al. Current trends in initial management of hypopharyngeal cancer: the declining use of open surgery. Head Neck. 2012;2:270–81.CrossRefGoogle Scholar
  7. 7.
    Steiner W, Ambrosch P, Hess CF, Kron M. Organ preservation by trans oral laser microsurgery in pyriform sinus carcinoma. Otolaryngol Head Neck Surg. 2001;124:58–67.PubMedCrossRefGoogle Scholar
  8. 8.
    Lefebvre IL, Chevtiar D, Luboinski B, et al. Larynx preservation in pyriform sinus cancer: preliminary results of a European organization for research and treatment of cancer phase III trial. J Natl Cancer Inst. 1996;88:890–8.PubMedCrossRefGoogle Scholar
  9. 9.
    Buckley JG, MacLennan K. Cervical lymph node metastasis in laryngeal and hypopharyngeal cancer a prospective analysis of prevalence and distribution. Head Neck. 2000;22:380–5.PubMedCrossRefGoogle Scholar
  10. 10.
    Wei WI. The dilemma of treating hypopharyngeal carcinoma: more or less. Arch Otolaryngeal Head Neck Surg. 2002;128:229–32.CrossRefGoogle Scholar
  11. 11.
    Richman ID, Samji HA, Deschler DG. National laryngopharyngectomy and reconstructive surgery survival. Laryngoscope. 2009;119:1472–8.CrossRefGoogle Scholar
  12. 12.
    Cusumano R, Silver C, Brauer R, Strauch B. Pectoralis myocutaneous flap for replacement of cervical oesophagus. Head Neck. 1989;11:450–6.PubMedCrossRefGoogle Scholar
  13. 13.
    Lam K, Wei V, Lan V. Avoiding stenosis in tubed greater pectoral flap in pharyngeal repair. Arch Otolaryngol Head Neck Surg. 1996;83:1279–83.Google Scholar
  14. 14.
    Jones, AS, Roland NJ, Husband D, Hamilton JW, Gati I. Free revascularized jejunal loop repair following total pharyngolaryngectomy for carcinoma of the hypopharynx: Report of 90 patients. Br J Surg. 1996;83:1279–1283.PubMedCrossRefGoogle Scholar
  15. 15.
    Rob GL, Larin J, Deschler DG, et al. Speech and swallowing outcomes in reconstruction of the pharynx and cervical esophagus. Head Neck. 2003;25:232–44.CrossRefGoogle Scholar
  16. 16.
    Clark JR, Gilbert R, Irish J, et al. Morbidity after flap reconstruction of hypopharyngeal defects. Laryngoscope. 2006;116:173–81.PubMedCrossRefGoogle Scholar
  17. 17.
    Bahadur S, Chatterjee TK. Repair of pharyngeal defect following pharyngolaryngectomy with special reference to gastric transposition. Indian J Otolaryngol. 1988;40:100–2.Google Scholar
  18. 18.
    Ogura JH, Marks JE, Freeman RB. Results of conservation surgery for supraglottic and pyriform sinus cancer. Laryngoscope. 1980;90:591–600.PubMedCrossRefGoogle Scholar
  19. 19.
    Laccourreye O, Merite Drancy A, Brasnu D, et al. Supracricoid hemilaryngopharyngectomy in select pyriform sinus carcinoma staged T2. Laryngoscope. 1993;103:1373–9.PubMedCrossRefGoogle Scholar
  20. 20.
    Laccourreye O, Ishoo E, de Mones E, et al. Supracricoid hemilaryngectomy pharyngectomy in patients with squamous cell carcinoma of the pyriform sinus. Ann Otol Rhinol Laryngol. 2005;114:25–34.PubMedCrossRefGoogle Scholar
  21. 21.
    Ferlito A, Silver CE, Doward DJ, et al. Role of partial laryngeal cancer. Acta Otolaryngol. 2000;120:456–65.PubMedCrossRefGoogle Scholar
  22. 22.
    Chevalier D, Watelet JB, Darras JA, Piquet JJ. Supraglottic hemilaryngectomy plus radiation for treatment of early lateral margin and pyriform sinus carcinoma. Head Neck. 1997;19:1–5.PubMedCrossRefGoogle Scholar
  23. 23.
    Zeital SM, Koufman JA, Davis RK, et al. Endoscopic treatment of supraglottic and hypopharynx cancer. Laryngoscope. 1994;104:71–8.Google Scholar
  24. 24.
    Steiner W, Ambrosch P, Hess CF, Kron M. Organ preservation by trans oral laser microsurgery in pyriform sinus cancer. Otolaryngol Head Neck Surgery. 2001;124:58–67.CrossRefGoogle Scholar
  25. 25.
    Martin A, Jacket MC, Christiansen H, et al. Organ preservation with transoral laser microsurgery for cancer of hypopharynx. Laryngoscope. 2008;118:398–402.PubMedCrossRefGoogle Scholar
  26. 26.
    Tandon DA, Bahadur S, Chatterjee TK, Rath GK. Carcinoma of the hypopharynx. Result of combined therapy. Indian J Cancer. 1991;28:131–8.PubMedGoogle Scholar
  27. 27.
    Jones AS. Surgery for hypopharyngeal cancer. In: Gleason M, editor. Scott-Brown otorhinolaryngology head and neck surgery, vol. 2. London: Hodder Arnold; 2008. p. 2633–62.CrossRefGoogle Scholar
  28. 28.
    Vargees BT, Sebastian P, Mathew A. Treatment outcome in patients undergoing surgery for carcinoma of larynx and hypopharynx. Acta Otolaryngol. 2009;129:1480–5.CrossRefGoogle Scholar
  29. 29.
    Johnson LV, Gran C, Overgeard J. Hypopharyngeal Squamous cell carcinoma treatment results in 138 consumptive advised patients. Acta Otolaryngol. 2000;39:529–36.Google Scholar
  30. 30.
    Spector JG, Sessions DG, Haughey BH, et al. Delayed regional metastasis distant metastasis and second primary malignancies in carcinoma of larynx and hypopharynx. Laryngoscope. 2001;111:1079–87.PubMedCrossRefGoogle Scholar
  31. 31.
    Hoffman HT, Karnell LH, Shah JP, et al. Hypopharyngeal cancer. Patient care evaluation. Laryngoscope. 1997;107:1005–17.PubMedCrossRefGoogle Scholar
  32. 32.
    Combe M, Jones AS. Radiotherapy complications following laryngectomy. J Laryngol Otol. 1993;107:130–2.CrossRefGoogle Scholar
  33. 33.
    Bahadur S, Thakar A, Mohanti BK, Lal P. Results of radiotherapy with or without salvage surgery versus combined surgery and radiotherapy in advanced carcinoma of hypopharynx. J Laryngol Otol. 2002;116:29–32.PubMedCrossRefGoogle Scholar
  34. 34.
    Kim S, Wu HG, Heo D, et al. Advanced hypopharynx carcinoma treatment results according to treatment modalities. Head Neck. 2001;23:713–7.PubMedCrossRefGoogle Scholar
  35. 35.
    Pingree TF, Davis RK, Richman O, Derrick L. Treatment of hypopharyngeal carcinoma: a 10 year review of 1362 cases. Laryngoscope. 1987;97:901–4.PubMedCrossRefGoogle Scholar
  36. 36.
    Kraus DH, Relefsky MJ, Brock HA, Huo J, Harrison LB, Shah JP. Combined surgery and radiotherapy for squamous carcinoma of the hypopharynx. Otolaryngol Head Neck Surg. 1997;116:637–41.PubMedCrossRefGoogle Scholar
  37. 37.
    Wallberg PC, Anderson KE, Biorklund AT. Carcinoma of the hypopharynx: analysis of incidence and survival in Sweden over a 30 year period. Head Neck. 1998;20:714–9.CrossRefGoogle Scholar
  38. 38.
    Forastiere AA, Geopfert H, Maor M, et al. Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer. N Engl J Med. 2003;349:2091–8.CrossRefGoogle Scholar
  39. 39.
    Gupta T, Chopra S, Agarwal JP, et al. Squamous cell carcinoma of the hypopharynx single institution outcome analysis of large cohort of patients treated with primary non-surgical approaches. Acta Oncol. 2009;48:541–8.CrossRefGoogle Scholar
  40. 40.
    Eckel HE, Starr S, Volling P, Suttal C, et al. Surgical treatment for hypopharynx carcinoma: feasibility, mortality and results. Otolaryngol Head Neck Surg. 2001;124:561–9.PubMedCrossRefGoogle Scholar
  41. 41.
    Lefebvre JL. What is the role of primary surgery in treatment of laryngeal and hypopharyngeal cancer- Harrys- Martin Lecture. Arch Otolaryngol Head Neck Surg. 2000;126:285–588.CrossRefGoogle Scholar
  42. 42.
    The Department of veterans affairs Laryngeal cancer study group. Induction chemotherapy plus radiation compared with surgery plus radiation in patients with advanced laryngeal cancer. N Engl J Med. 1991;324:1685–90.CrossRefGoogle Scholar
  43. 43.
    Lefebvre JL, Rolland F, Tessalar M, et al. Phase 3 randomized trial on larynx preservation comparing sequential vs alternating chemotherapy and radiotherapy. J Natl Cancer Inst. 2009;101:142–52.PubMedPubMedCentralCrossRefGoogle Scholar
  44. 44.
    Pignon JP, Le Maitre A, Maillard E, Bourhis J, MACH-NC collaborative Group. Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): an update on 93 randomized trials and 17346 patients. Radiother Oncol. 2009;92:4–14.CrossRefGoogle Scholar
  45. 45.
    Posner MR, Norris CM, Wirth LJ, et al. Sequential therapy for locally advanced larynx and hypopharynx cancer subgroup in Tax 324, survival, surgery and organ preservation. Ann Oncol. 2009;20:921–7.CrossRefGoogle Scholar
  46. 46.
    Rades D, Fehlaur F, Sheikh Sharaf M, et al. Toxicity of two cisplatin-based radio-chemotherapy regimens for treatment of patients with stage III/IV head and neck cancer. Head Neck. 2008;30:235–41.PubMedCrossRefGoogle Scholar
  47. 47.
    Zuur CL, Simmis YJ, Lahadaal PE, et al. Risk factors of ototoxicity after cisplatin based chemo-radiation in locally advanced head and neck cancer; a multivariate analysis. Int J Radiat Oncol Biol Phys. 2007;68:1320–5.PubMedCrossRefGoogle Scholar
  48. 48.
    Sharma A, Mohanti BK, Thakar A, Bahadur S, Bhaskar S. Concomitant chemoradiation versus radical radiotherapy in advanced squamous cell carcinoma of oropharynx and nasopharynx using weekly cisplatin: a phase II randomized trial. Ann Oncol. 2010;21(11):2272–7.PubMedCrossRefGoogle Scholar
  49. 49.
    Lee WT, Akst LM, Adelstein DJ, et al. Risk factors for hypopharyngeal/upper esophageal stricture formation after concurrent chemo-radiotherapy. Head Neck. 2006;28:808–12.PubMedCrossRefGoogle Scholar
  50. 50.
    Vergeer MR, Doornaert PA, Reitveld DH, et al. Intensity induced morbidity and improves health related quality of life: results of a non-randomized prospective study. Int J Radiat Oncol Biol Phys. 2009;74:1–8.PubMedCrossRefGoogle Scholar
  51. 51.
    Clark JR, de Almeida J, Gilbert R, et al. Primary and salvage hypopharyngectomy: analysis and outcome. Head Neck. 2006;28:671–7.PubMedCrossRefGoogle Scholar
  52. 52.
    Relic A, Sleveict M, Stapf J, et al. Salvage surgery after induction chemotherapy with paclitaxel cisplatin and primary radiotherapy for advanced laryngeal and hypopharyngeal carcinoma. Ear Arch Otolaryngeal. 2009;206:1799–805.CrossRefGoogle Scholar
  53. 53.
    Davidsom J, Briant D, Gullane P, et al. The role of surgery following radiotherapy failure for advanced laryngopharyngeal cancer. Arch Otolaryngol Head Neck Surg. 1994;120:269–76.CrossRefGoogle Scholar
  54. 54.
    Wang RJ, Shah JP. The role of the head and neck surgeon in contemporary multidisciplinary treatment programme for advanced head and neck cancer. Curr Opin Otolaryngol Head Neck Surg. 2010;18:79–82.CrossRefGoogle Scholar
  55. 55.
    Pradhan SA, D’Cruz AK, Pai PS, et al. Near total laryngectomy in advanced laryngeal and piriform cancers. Laryngoscope. 2002;112:375–80.PubMedCrossRefGoogle Scholar
  56. 56.
    Shenoy AM, Pinkert PK, Nunjundappa N, et al. Functional utility and oncologic safety of near total laryngectomy with trachea-pharyngeal speech shunt in a Third World Oncologic Centre. Eur Arch Otolaryngol. 1997;254:128–32.CrossRefGoogle Scholar
  57. 57.
    Thakar A, Bahadur S, Toran KC, et al. Oncologic and functional failures in near total laryngectomy. Otolaryngol Head Neck Surg. 2007;137:223.CrossRefGoogle Scholar
  58. 58.
    Shah J. Hypopharynx and cervical oesophagus. In: Shah JP, Patel SG, editors. Head and neck surgery and oncology. 3rd ed. Philadelphia: Mosby; 2004. p. 235–66.Google Scholar

Copyright information

© The Author(s) 2019

Authors and Affiliations

  • Sudhir Bahadur
    • 1
  1. 1.Department of Otolaryngology and Head-Neck SurgeryFormerly at All India Institute of Medical SciencesNew DelhiIndia

Personalised recommendations