Treatment of locoregionally advanced (stage III and IV) head and neck cancer: The larynx and hypopharynx
- Bruce E Brockstein, MD
Bruce E Brockstein, MD
- Section Editor — Cancer of the Head and Neck
- Clinical Professor of Medicine
- University of Chicago Pritzker School of Medicine
- Kerstin M Stenson, MD, FACS
Kerstin M Stenson, MD, FACS
- Professor of Otolaryngology
- Chief, Head and Neck Cancer Program, Rush University Medical Center
- Department of Otolaryngology/Head and Neck Surgery
- David J Sher, MD, MPH
David J Sher, MD, MPH
- Associate Professor of Radiation Oncology
- UT Southwestern Medical Center
- Section Editors
- David M Brizel, MD
David M Brizel, MD
- Section Editor — Radiation Therapy
- Leonard R Prosnitz Professor of Radiation Oncology
- Professor of Otolaryngology Head & Neck Surgery
- Duke University Cancer Institute
- Marshall R Posner, MD
Marshall R Posner, MD
- Section Editor — Cancer of the Head and Neck
- Professor of Gene and Cell Medicine
- The Tisch Cancer Institute
- Icahn School of Medicine at Mount Sinai
- Marvin P Fried, MD, FACS
Marvin P Fried, MD, FACS
- Section Editor — Head and Neck Surgery
- Professor and University Chairman, Department of Otorhinolaryngology - Head and Neck Surgery
- Montefiore Medical Center, Albert Einstein College of Medicine
Worldwide, there are approximately 238,000 new laryngeal cancer cases and 106,000 deaths annually . In the United States, there are approximately 13,000 cases and 3660 deaths due to laryngeal cancer annually . Glottic, supraglottic, and subglottic cancers represent approximately two-thirds, one-third, and 2 percent of laryngeal cancers, respectively. Hypopharyngeal cancer is less common than laryngeal cancer, with approximately one-fourth as many cases.
Tumors of the glottic larynx commonly present with hoarseness and are most often diagnosed at an early stage. However, patients with supraglottic and subglottic laryngeal cancers, as well as hypopharyngeal cancers, usually present with advanced disease due to a paucity of symptoms, propensity for local extension (subglottis), and rich lymphatics resulting in a high incidence of lymph node metastases (supraglottis).
The management of locoregionally advanced laryngeal and hypopharyngeal cancer is presented here. The treatment of early stage laryngeal and hypopharyngeal cancers is discussed separately.
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- ANATOMY AND STAGING
- OVERVIEW OF MANAGEMENT
- COMBINED MODALITY THERAPY
- Functional organ preservation (chemoradiotherapy) versus surgery
- Concurrent chemoradiotherapy
- Induction chemotherapy
- Sequential chemoradiotherapy
- Comparison of combined chemotherapy and radiation therapy approaches
- Larynx preservation surgery
- - Preoperative evaluation
- Conservation surgery
- - Postoperative radiation therapy
- Total laryngectomy
- MANAGEMENT OF THE NECK
- Patients treated with chemoradiotherapy
- Patients managed with primary surgery
- OLDER AND POOR PERFORMANCE STATUS PATIENTS
- COMPLICATIONS OF TREATMENT
- POSTTREATMENT EVALUATION AND SURVEILLANCE
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS