Current Treatment Options in Oncology

, Volume 3, Issue 1, pp 41–49 | Cite as

Hypopharyngeal carcinoma

  • Russell W. Hinerman
  • Robert J. Amdur
  • William M. Mendenhall
  • Douglas B. Villaret
  • K. Thomas Robbins

Opinion statement

For more than 20 years, the policy at the University of Florida has been to treat patients with favorable stage T1-T2 pyriform sinus carcinoma by using radiation therapy alone, or with a planned neck dissection if advanced nodal disease is present. This approach usually leaves the patient with nearly normal swallowing and speech, and provides bilateral coverage of the regional neck and retropharyngeal lymphatics. More advanced lesions often are not controlled with radiation alone and are usually considered for partial or total laryngopharyngectomy if the patient is medically operable [1]. Radiation is usually administered postoperatively in this setting, unless the neck disease is thought to be unresectable, in which case preoperative radiation is given. Recent data have shown that adjuvant chemotherapy administered concomitantly with radiotherapy results in improved cure rates for patients with advanced disease compared with irradiation alone. Time-honored established guidelines are still used, although the edges have become blurred. Therefore, patients with larger primary tumors now may be considered for organ preservation treatment with irradiation and chemotherapy, reserving surgery for salvage situations. The subset of patients with advanced T4 pyriform sinus cancers (in whom cure with chemoradiation would likely result in tracheostomy and/or gastrostomy dependence) may be better served with elective surgery and postoperative irradiation. The definition of this subset of patients is unclear but probably includes patients with significant cartilage destruction and those who require pretreatment tracheostomy. The policy at the University of Florida is to treat essentially all pharyngeal wall cancers with external-beam irradiation alone.


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References and Recommended Reading

  1. 1.
    Mendenhall WM, Parsons JT, Devine JW, et al.: Squamous cell carcinoma of the pyriform sinus treated with surgery and/or radiotherapy. Head Neck Surg 1987, 10:88–92.PubMedCrossRefGoogle Scholar
  2. 2.
    Hoffman HT, Karnell LH, Shah JP, et al.: Hypopharyngeal cancer patient care evaluation. Laryngoscope 1997, 107:1005–1017.PubMedCrossRefGoogle Scholar
  3. 3.
    Czaja JM, Gluckman JL: Surgical management of early-stage hypopharyngeal carcinoma. Ann Otol Rhinol Laryngol 1997, 106:909–913.PubMedGoogle Scholar
  4. 4.
    Amdur RJ, Mendenhall WM, Stringer SP, et al.: Organ preservation with radiotherapy for T1-T2 carcinoma of the pyriform sinus. Head Neck 2001, 23:353–362. University of Florida experience treating early-stage pyriform sinus carcinomas with radiation therapy alone or with planned neck dissection.PubMedCrossRefGoogle Scholar
  5. 5.
    Pameijer FA, Mancuso AA, Mendenhall WM, et al.: Evaluation of pretreatment computed tomography as a predictor of local control in T1/T2 pyriform sinus carcinoma treated with definitive radiotherapy. Head Neck 1998, 20:159–168. Recently published Phase III randomized trial of 100 patients with resectable AJCC stage III and stage IV head and neck cancer treated with conventionally fractionated radiation therapy alone or with concomittant cisplatin and fluorouracil. Improvements were seen in disease clearance, recurrence-free interval, and primary site preservation but not in overall survival with use of combined modality treatment.PubMedCrossRefGoogle Scholar
  6. 6.
    Barzan L, Comoretto R: Hemipharyngectomy and hemilaryngectomy for pyriform sinus cancer: reconstruction with remaining larynx and hypopharynx and with tracheostomy. Laryngoscope 1993, 103:83–86.CrossRefGoogle Scholar
  7. 7.
    Steiner W: Results of curative laser microsurgery of laryngeal carcinomas. Am J Otolaryngol 1993, 14:116–121.PubMedCrossRefGoogle Scholar
  8. 8.
    Zeitels SM, Koufman JA, Davis RK, Vaughan CW: Endoscopic treatment of supraglottic and hypopharynx cancer. Laryngoscope 1994, 104:71–78.PubMedCrossRefGoogle Scholar
  9. 9.
    Davis RK, Kelly SM, Hayes J: Endoscopic CO2 laser excisional biopsy of early supraglottic cancer. Laryngoscope 1991, 101:680–683.PubMedGoogle Scholar
  10. 10.
    Wynder EL: The epidemiology of cancers of the upper alimentary and upper respiratory tracts. Laryngoscope 1978, 88:50–51.PubMedGoogle Scholar
  11. 11.
    Vincent RG, Marchetta F: The relationship of the use of tobacco and alcohol to cancer of the oral cavity, pharynx or larynx. Am J Surg 1963, 106:501–505.PubMedCrossRefGoogle Scholar
  12. 12.
    Spitz MR, Fueger JJ, Goepfert H, et al.: Squamous cell carcinoma of the upper aerodigestive tract. A case comparison analysis. Cancer 1988, 61:203–208.PubMedCrossRefGoogle Scholar
  13. 13.
    Wolf GT, Forastiere A, Ang K, et al.: Workshop report: organ preservation strategies in advanced head and neck cancer-current status and future directions. Head Neck 1999, 21:689–693.PubMedCrossRefGoogle Scholar
  14. 14.
    Zelefsky MJ, Kraus DH, Pfister DG, et al.: Combined chemotherapy and radiotherapy versus surgery and postoperative radiotherapy for advanced hypopharyngeal cancer. Head Neck 1996, 18:405–411.PubMedCrossRefGoogle Scholar
  15. 15.
    Brizel DM, Albers ME, Fisher SR, et al.: Hyperfractionated irradiation with or without concurrent chemotherapy for locally advanced head and neck cancer. N Engl J Med 1998, 338:1798–1804.PubMedCrossRefGoogle Scholar
  16. 16.
    Jeremic B, Shibamoto Y, Milicic B, et al.: Hyperfractionated radiation therapy with or without concurrent low-dose daily cisplatin in locally advanced squamous cell carcinoma of the head and neck: a prospective randomized trial. J Clin Oncol 2000, 18:1458–1464.PubMedGoogle Scholar
  17. 17.
    Adelstein DJ, Lavertu P, Saxton JP, et al.: Mature results of a Phase III randomized trial comparing concurrent chemoradiotherapy with radiation therapy alone in patients with stage III and IV squamous cell carcinoma of the head and neck. Cancer 2000, 88:876–883.PubMedCrossRefGoogle Scholar
  18. 18.
    Mendenhall WM, Parsons JT, Stringer SP, et al.: Squamous cell carcinoma of the head and neck treated with irradiation: management of the neck. Semin Radiat Oncol 1992, 2:163–170.PubMedCrossRefGoogle Scholar
  19. 19.
    Parsons JT, Palta JR, Mendenhall WM, et al.: Head and neck cancer. In Levitt and Tapley’s Technological Basis of Radiation Therapy: Clinical Applications, edn. 3. Edited by Levitt SH, Khan FM, Potish RA, Perez CA. Baltimore: Lippincott Williams & Wilkins; 1999:269–299.Google Scholar
  20. 20.
    Mendenhall WM, Parsons JT, Cassisi NJ, Million RR: Squamous cell carcinoma of the pyriform sinus treated with radical radiation therapy. Radiother Oncol 1987, 9:201–208.PubMedCrossRefGoogle Scholar
  21. 21.
    Million RR, Cassisi NJ, Mancuso AA: Hypopharynx: pharyngeal walls, pyriform sinus, postcricoid pharynx. In Management of Head and Neck Cancer: A Multidisciplinary Approach, edn. 2. Edited by Million RR, Cassisi NJ. Philadelphia: JB Lippincott; 1994:505–532.Google Scholar
  22. 22.
    Eisbruch A, Kim HM, Terrell JE, et al.: Xerostomia and its predictors following parotid-sparing irradiation of head-and-neck cancer. Int J Radiat Oncol Biol Phys 2001, 50:695–704. Reports early results for salivary gland sparing techniques using IMRT in the treatment of head and neck cancers at the University of Michigan.PubMedCrossRefGoogle Scholar
  23. 23.
    Chao KS, Deasy JO, Markman J, et al.: A prospective study of salivary function sparing in patients with head-and-neck cancers receiving intensity-modulated or three-dimensional radiation therapy: initial results. Int J Radiat Oncol Biol Phys 2001, 49:907–916.PubMedCrossRefGoogle Scholar
  24. 24.
    Gregoire V, Coche E, Cosnard G, et al.: Selection and delineation of lymph node target volumes in head and neck conformal radiotherapy. Proposal for standardizing terminology and procedure based on the surgical experience. Radiother Oncol 2000, 56:135–150.PubMedCrossRefGoogle Scholar
  25. 25.
    Dawson LA, Anzai Y, Marsh L, et al.: Patterns of local-regional recurrence following parotid-sparing conformal and segmental intensity-modulated radiotherapy for head and neck cancer. Int J Radiat Oncol Biol Phys 2000, 46:1117–1126.PubMedCrossRefGoogle Scholar
  26. 26.
    Eisbruch A, Marsh LH, Martel MK, et al. Comprehensive irradiation of head and neck cancer using conformal multisegmental fields: assessment of target coverage and noninvolved tissue sparing. Int J Radiat Oncol Biol Phys 1998, 41:559–568. Describes initial experience at the University of Michigan using IMRT to treat cancers of the head and neck. Offers a dosimetric analysis of IMRT compared with conventional treatment schemes.PubMedCrossRefGoogle Scholar
  27. 27.
    Nowak PJ, Wijers OB, Lagerwaard FJ, Levendag PC: A three-dimensional CT-based target definition for elective irradiation of the neck. Int J Radiat Oncol Biol Phys 1999, 45:33–39.PubMedCrossRefGoogle Scholar
  28. 28.
    Butler EB, Teh BS, Grant WH 3rd, et al.: SMART (simultaneous modulated accelerated radiation therapy) boost: a new accelerated fractionation schedule for the treatment of head and neck cancer with intensity modulated radiotherapy. Int J Radiat Oncol Biol Phys 1999, 45:21–32.PubMedCrossRefGoogle Scholar
  29. 29.
    vanDieren EB, Nowak PJ, Wijers OB, et al.: Beam intensity modulation using tissue compensators or dynamic multileaf collimation in three-dimensional conformal radiotherapy of primary cancers of the oropharynx and larynx, including the elective neck. Int J Radiat Oncol Biol Phys 2000, 47:1299–1309.PubMedCrossRefGoogle Scholar
  30. 30.
    Mendenhall WM, Parsons JT, Mancuso AA, et al.: Squamous cell carcinoma of the pharyngeal wall treated with irradiation. Radiother Oncol 1988, 11:205–212.PubMedCrossRefGoogle Scholar
  31. 31.
    Hermans R, Pameijer FA, Mancuso AA, et al.: Laryngeal or hypopharyngeal squamous cell carcinoma: can follow-up CT after definitive radiation therapy be used to detect local failure earlier than clinical examination alone? Radiology 2000, 214:683–687.PubMedGoogle Scholar
  32. 32.
    Pameijer FA, Hermans R, Mancuso AA, et al.: Pre- and post-radiotherapy computed tomography in laryngeal cancer: imaging-based prediction of local failure. Int J Radiat Oncol Biol Phys 1999, 45:359–366.PubMedCrossRefGoogle Scholar
  33. 33.
    Fein DA, Mendenhall WM, Parsons JT, et al.: Pharyngeal wall carcinoma treated with radiotherapy: impact of treatment technique and fractionation. Int J Radiat Oncol Biol Phys 1993, 26:751–757.PubMedGoogle Scholar
  34. 34.
    Sessions DG, Ogura JH: Classification of laryngeal cancer. Can J Otolaryngol 1974, 3:489–495.PubMedGoogle Scholar
  35. 35.
    American Joint Committee on Cancer: Manual for Staging of Cancer, edn 2. Philadelphia: JB Lippincott; 1983:37–42.Google Scholar
  36. 36.
    American Joint Committee on Cancer: AJCC Cancer Staging Handbook, edn 5. Edited by Fleming ID, Cooper JS, Henson DE, et al. Philadelphia: Lippincott-Raven; 1998:25–64.Google Scholar
  37. 37.
    Mendenhall WM, Parsons JT, Stringer SP, et al.: Carcinoma of the supraglottic larynx: a basis for comparing the results of radiotherapy and surgery. Head Neck 1990, 12:204–209.PubMedCrossRefGoogle Scholar

Copyright information

© Current Science Inc 2002

Authors and Affiliations

  • Russell W. Hinerman
    • 1
  • Robert J. Amdur
    • 1
  • William M. Mendenhall
    • 1
  • Douglas B. Villaret
    • 1
  • K. Thomas Robbins
    • 1
  1. 1.Department of Radiation OncologyUniversity of Florida College of MedicineGainesvilleUSA

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