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Larynx Preservation in Hypopharyngeal Carcinomas

  • Shelley Hukku
  • Shikha Halder
  • Bidhu K. Mohanti
Chapter

Abstract

The hypopharynx consists of three parts, pyriform sinus, posterior pharyngeal wall, and post-cricoid region covered by mucosal lining, which gives rise to carcinoma mainly of squamous cell type. Hypopharyngeal cancers (HPC), more so in advanced stages, are characterized by aggressive disease and dismal treatment outcomes. The main goal of treatment in carcinoma hypopharynx is not only to achieve cure but also to ensure adequate preservation of voice and eating capacity. In order to achieve the goal, there is a paradigm shift in the treatment approaches. The advancements and refinements in nonsurgical therapies have been brought in a lesser reliance on surgical management of hypopharyngeal cancers. In the past two decades, guidelines on larynx preservation have been published for advanced laryngopharyngeal cancers. However, given the entirely different natural history and poor prognosis for hypopharyngeal cancers as compared to laryngeal cancer, the issue of larynx preservation needs to be separately addressed for these rare and aggressive tumors. In the present chapter, we discuss pertinent aspects of larynx preservation by nonsurgical approaches for the locally advanced hypopharyngeal cancers. It is imperative that organ preservation outcomes should be correlated with morbidity and potential factors that can reduce chemoradiotherapy-related late morbidity and aid better organ functions.

References

  1. 1.
    Gupta T, Chopra S, Agarwal JP, Laskar SG, D’cruz AK, Shrivastava SK, Dinshaw KA. Squamous cell carcinoma of the hypopharynx: single-institution outcome analysis of a large cohort of patients treated with primary non-surgical approaches. Acta Oncol. 2009;48:541–8.CrossRefGoogle Scholar
  2. 2.
    Petersen JF, Timmermans AJ, van Dijk BAC, et al. Trends in treatment, incidence and survival of hypopharynx cancer: a 20-year population-based study in the Netherlands. Eur Arch Otorhinolaryngol. 2018;275:181–9.CrossRefGoogle Scholar
  3. 3.
    Krstevska V. Hypopharyngeal Cancer. In: Agulnik M, editor. Head and Neck Cancer. London: InTech; 2012. ISBN: 978-953-51-0236-6. Available from: http://www.intechopen.com/books/head-and-neckcancer/hypopharyngeal-cancer.Google Scholar
  4. 4.
    Pracy P, Loughran S, Good J, Parmar S, Goranova R. Hypopharyngeal cancer: United Kingdom National multidisciplinary guidelines. J Laryngol Otol. 2016;130(S2):S104–10.CrossRefGoogle Scholar
  5. 5.
    Hall SF, Groome PA, Irish J, O’Sullivan B. Radiotherapy or surgery for head and neck squamous cell cancer: establishing the baseline for hypopharyngeal carcinoma? Cancer. 2009;115:5711–22.CrossRefGoogle Scholar
  6. 6.
    Takes RP, Strojan P, Silver CE, Bradley PJ, Haigentz M Jr, Wolf GT, Shaha AR, Hartl DM, Olofsson J, Langendijk JA, Rinaldo A, Ferlito A. International Head and Neck Scientific Group. Current trends in initial management of hypopharyngeal cancer: the declining use of open surgery. Head Neck. 2012;34:270–81.CrossRefGoogle Scholar
  7. 7.
    Lefebvre JL, Chevalier D, Luboinski B, Kirkpatrick A, Collette L, Sahmoud T. Larynx preservation in pyriform sinus cancer: preliminary results of a European Organization for Research and Treatment of Cancer phase III trial. EORTC Head and Neck Cancer Cooperative Group. J Natl Cancer Inst. 1996;88:890–9.CrossRefGoogle Scholar
  8. 8.
    Zelefsky MJ, Kraus DH, Pfister DG, Raben A, Shah JP, Strong EW, Spiro RH, Bosl GJ, Harrison LB. Combined chemotherapy and radiotherapy versus surgery and postoperative radiotherapy for advanced hypopharyngeal cancer. Head Neck. 1996;18:405–11.CrossRefGoogle Scholar
  9. 9.
    Department of Veterans Affairs Laryngeal Cancer Study Group, Wolf GT, Fisher SG, Hong WK, Hillman R, Spaulding M, Laramore GE, Endicott JW, McClatchey K, Henderson WG. 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
  10. 10.
    Lefebvre JL, Andry G, Chevalier D, et al. Laryngeal preservation with induction chemotherapy for hypopharyngeal squamous cell carcinoma: 10-year results of EORTC trial 24891. Ann Oncol. 2012;23:2708–14.CrossRefGoogle Scholar
  11. 11.
    Pignon JP, Bourhis J, Domenge C, Designé L. Chemotherapy added to locoregional treatment for head and neck squamous-cell carcinoma: three meta-analyses of updated individual data. MACH-NC Collaborative Group. Meta-Analysis of Chemotherapy on Head and Neck Cancer. Lancet. 2000;355(9208):949–55.CrossRefGoogle Scholar
  12. 12.
    Adelstein DJ, Li Y, Adams GL, Wagner H Jr, Kish JA, Ensley JF, Schuller DE, Forastiere AA. An intergroup phase III comparison of standard radiation therapy and two schedules of concurrent chemoradiotherapy in patients with unresectable squamous cell head and neck cancer. J Clin Oncol. 2003;21:92–8.CrossRefGoogle Scholar
  13. 13.
    Pignon JP, LeMaitre A, Maillard E, et al. Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): an update on 93 randomized trials and 17,346 patients. Radiother Oncol. 2009;92:4–14.CrossRefGoogle Scholar
  14. 14.
    Corvò R. Evidence-based radiation oncology in head and neck squamous cell carcinoma. Radiother Oncol. 2007;85:156–70.CrossRefGoogle Scholar
  15. 15.
    Hitt R, López-Pousa A, Martínez-Trufero J, et al. Phase III study comparing cisplatin plus fluorouracil to paclitaxel, cisplatin, and fluorouracil induction chemotherapy followed by chemo-radiotherapy in locally advanced head and neck cancer. J Clin Oncol. 2005;23:8636–45.CrossRefGoogle Scholar
  16. 16.
    Janoray G, Pointreau Y, Garaud P, Chapet S, Alfonsi M, Sire C, Jadaud E, Calais G. Long-term results of a multicenter randomized phase III trial of induction chemotherapy with cisplatin, 5-fluorouracil, ± docetaxel for larynx preservation. J Natl Cancer Inst. 2015;108(4):djv368.  https://doi.org/10.1093/jnci/djv368. 1 April 2016.CrossRefPubMedGoogle Scholar
  17. 17.
    Lorch JH, Goloubeva O, Haddad RI, Cullen K, Sarlis N, Tishler R, Tan M, Fasciano J, Sammartino DE, Posner MR, TAX 324 Study Group. Induction chemotherapy with cisplatin and fluorouracil alone or in combination with docetaxel in locally advanced squamous-cell cancer of the head and neck: long-term results of the TAX 324 randomised phase 3 trial. Lancet Oncol. 2011;12:153–9.  https://doi.org/10.1016/S1470-2045(10)70279-5.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Cohen EE, Karrison TG, Kocherginsky M, Mueller J, et al. Phase III randomized trial of induction chemotherapy in patients with N2 or N3 locally advanced head and neck cancer. J Clin Oncol. 2014;32:2735–43.CrossRefGoogle Scholar
  19. 19.
    Bozec A, Benezery K, Ettaiche M, Chamorey E, Vandersteen C, et al. Induction chemotherapy-based larynx preservation program for locally advanced hypopharyngeal cancer: oncologic and functional outcomes and prognostic factors. Eur Arch Otorhinolaryngol. 2016;273:3299–306.CrossRefGoogle Scholar
  20. 20.
    Bonner JA, Harari PM, Giralt J, Azarnia N, et al. Radiotherapy plus cetuximab for squamous-cell carcinoma of the head and neck. N Engl J Med. 2006;354:567–78.CrossRefGoogle Scholar
  21. 21.
    Lefebvre JL, Pointreau Y, Rolland F, Alfonsi M, Baudoux A, et al. Induction chemotherapy followed by either chemoradiotherapy or bioradiotherapy for larynx preservation: the TREMPLIN randomized phase II study. J Clin Oncol. 2013;31:853–9.CrossRefGoogle Scholar
  22. 22.
    Owen RD. The problem of hypopharyngeal carcinoma. Proc R Soc Med. 1950;43:157–70.PubMedPubMedCentralGoogle Scholar
  23. 23.
    Bataini P, Brugere J, Bernier J, Jaulerry CH, Picot C, Ghossein NA. Results of radical radiotherapeutic treatment of carcinoma of the pyriform sinus: experience of the Institut Curie. Int J Radiat Oncol Biol Phys. 1982;8:1277–86.CrossRefGoogle Scholar
  24. 24.
    Ahmad K, Fayos JV. Role of radiation therapy in carcinoma of the hypopharynx. Acta Radiol Oncol. 1984;23:21–6.CrossRefGoogle Scholar
  25. 25.
    Huang WY, Jen YM, Chen CM, Su YF, Lin CS, Lin YS, Chang YN, Chao HL, Lin KT, Chang LP. Intensity modulated radiotherapy with concurrent chemotherapy for larynx preservation of advanced resectable hypopharyngeal cancer. Radiat Oncol. 2010;15(5):37.CrossRefGoogle Scholar
  26. 26.
    Teoh M, Clark CH, Wood K, Whitaker S, Nisbet A. Volumetric modulated arc therapy: a review of current literature and clinical use in practice. Br J Radiol. 2011;84:967–96.CrossRefGoogle Scholar
  27. 27.
    Moncharmont C, Vallard A, Guy JB, Prades JM, Rancoule C, Magné N. Real-life efficacy of volumetric modulated arc therapy in head and neck squamous cell carcinoma. Eur Ann Otorhinolaryngol Head Neck Dis. 2017;134:165–9.CrossRefGoogle Scholar
  28. 28.
    Lacas B, Bourhis J, Overgaard J, Zhang Q, Grégoire V, Nankivell M, MARCH Collaborative Group, et al. Role of radiotherapy fractionation in head and neck cancers (MARCH): an updated meta-analysis. Lancet Oncol. 2017;18:1221–37.CrossRefGoogle Scholar
  29. 29.
    Overgaard J, Mohanti BK, Begum N, Ali R, Agarwal JP, Kuddu M, Bhasker S, Tatsuzaki H, Grau C. Five versus six fractions of radiotherapy per week for squamous-cell carcinoma of the head and neck (IAEA-ACC study): a randomised, multicentre trial. Lancet Oncol. 2010;11:553–60.CrossRefGoogle Scholar
  30. 30.
    Lefebvre JL. Candidates for larynx preservation: the next step? Oncologist. 2010;15(Suppl. 3):30–2.CrossRefGoogle Scholar
  31. 31.
    Lagha A, Chraiet N, Labidi S, Rifi H, Ayadi M, et al. Larynx preservation: what is the best non-surgical strategy? Crit Rev Oncol Hematol. 2013;88:447–58.CrossRefGoogle Scholar
  32. 32.
    Ang KK. Larynx preservation clinical trial design: summary of key recommendations of a consensus panel. Oncologist. 2010;15(Suppl. 3):25–9.CrossRefGoogle Scholar
  33. 33.
    Caudell JJ, Carroll WR, Spencer SA, Bonner JA. Examination of laryngoesophageal dysfunction-free survival as an endpoint in nonsurgical treatment of squamous cell carcinomas of the larynx and hypopharynx. Cancer. 2011;117:4447–51.CrossRefGoogle Scholar
  34. 34.
    Sherman EJ, Fisher SG, Kraus DH, Zelefsky MJ, et al. TALK score: development and validation of a prognostic model for predicting larynx preservation outcome. Laryngoscope. 2012;122:1043–50.CrossRefGoogle Scholar
  35. 35.
    Rosenthal DI, Mohamed AS, Weber RS, Garden AS, et al. Long-term outcomes after surgical or nonsurgical initial therapy for patients with T4 squamous cell carcinoma of the larynx: a 3-decade survey. Cancer. 2015;121:1608–19.CrossRefGoogle Scholar
  36. 36.
    Chen LY, Huang CC, Tsou YA, Bau DT, Tsai MH. Prognostic factor of severe complications in patients with hypopharyngeal cancer with primary concurrent chemoradiotherapy. Anticancer Res. 2015;35:1735–41.PubMedGoogle Scholar
  37. 37.
    Bradley PT, Bradley PJ. Treatment of hypopharyngeal carcinoma with primary chemoradiotherapy: functional morbidity. Curr Opin Otolaryngol Head Neck Surg. 2012;20:89–96.CrossRefGoogle Scholar
  38. 38.
    Al-Mamgani A, Mehilal R, van Rooij PH, Tans L, Sewnaik A, Levendag PC. Toxicity, quality of life, and functional outcomes of 176 hypopharyngeal cancer patients treated by (chemo)radiation: the impact of treatment modality and radiation technique. Laryngoscope. 2012;122:1789–95.CrossRefGoogle Scholar
  39. 39.
    Bossola M. Nutritional interventions in head and neck cancer patients undergoing chemoradiotherapy: a narrative review. Nutrients. 2015;7:265–76.CrossRefGoogle Scholar
  40. 40.
    Eisbruch A, Schwartz M, Rasch C, Vineberg K, et al. Dysphagia and aspiration after chemoradiotherapy for head-and-neck cancer: which anatomic structures are affected and can they be spared by IMRT? Int J Radiat Oncol Biol Phys. 2004;60:1425–39.CrossRefGoogle Scholar
  41. 41.
    Newman JR, Connolly TM, Illing EA, Kilgore ML, Locher JL, Carroll WR. Survival trends in hypopharyngeal cancer: a population-based review. Laryngoscope. 2015;125:624–9.CrossRefGoogle Scholar

Copyright information

© The Author(s) 2019

Authors and Affiliations

  • Shelley Hukku
    • 1
  • Shikha Halder
    • 1
  • Bidhu K. Mohanti
    • 2
  1. 1.Department of Radiation OncologyBLK Super Specialty HospitalNew DelhiIndia
  2. 2.Department of Radiation OncologyManipal HospitalNew DelhiIndia

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