Current trends in initial management of hypopharyngeal cancer

The declining use of open surgery

Robert P. Takes, Primož 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

Research output: Contribution to journalReview article

121 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.

Original languageEnglish (US)
Pages (from-to)270-281
Number of pages12
JournalHead and Neck
Volume34
Issue number2
DOIs
StatePublished - Feb 1 2012

Fingerprint

Hypopharyngeal Neoplasms
Pharyngectomy
Radiotherapy
Organ Preservation
Intensity-Modulated Radiotherapy
Hypopharynx
Laryngectomy
Laryngeal Neoplasms
Survival
Therapeutics
Deglutition
Terminology
Comorbidity
Squamous Cell Carcinoma
Neoplasm Metastasis
Morbidity
Population
Neoplasms

All Science Journal Classification (ASJC) codes

  • Otorhinolaryngology

Cite this

Takes, R. P., Strojan, P., Silver, C. E., Bradley, P. J., Haigentz, M., Wolf, G. T., ... Ferlito, A. (2012). Current trends in initial management of hypopharyngeal cancer: The declining use of open surgery. Head and Neck, 34(2), 270-281. https://doi.org/10.1002/hed.21613
Takes, Robert P. ; Strojan, Primož ; Silver, Carl E. ; Bradley, Patrick J. ; Haigentz, Missak ; Wolf, Gregory T. ; Shaha, Ashok R. ; Hartl, Dana M. ; Olofsson, Jan ; Langendijk, Johannes A. ; Rinaldo, Alessandra ; Ferlito, Alfio. / Current trends in initial management of hypopharyngeal cancer : The declining use of open surgery. In: Head and Neck. 2012 ; Vol. 34, No. 2. pp. 270-281.
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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.",
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Takes, RP, Strojan, P, Silver, CE, Bradley, PJ, Haigentz, M, Wolf, GT, Shaha, AR, Hartl, DM, Olofsson, J, Langendijk, JA, Rinaldo, A & Ferlito, A 2012, 'Current trends in initial management of hypopharyngeal cancer: The declining use of open surgery', Head and Neck, vol. 34, no. 2, pp. 270-281. https://doi.org/10.1002/hed.21613

Current trends in initial management of hypopharyngeal cancer : The declining use of open surgery. / Takes, Robert P.; Strojan, Primož; Silver, Carl E.; Bradley, Patrick J.; Haigentz, Missak; Wolf, Gregory T.; Shaha, Ashok R.; Hartl, Dana M.; Olofsson, Jan; Langendijk, Johannes A.; Rinaldo, Alessandra; Ferlito, Alfio.

In: Head and Neck, Vol. 34, No. 2, 01.02.2012, p. 270-281.

Research output: Contribution to journalReview article

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T1 - Current trends in initial management of hypopharyngeal cancer

T2 - The declining use of open surgery

AU - Takes, Robert P.

AU - Strojan, Primož

AU - Silver, Carl E.

AU - Bradley, Patrick J.

AU - Haigentz, Missak

AU - Wolf, Gregory T.

AU - Shaha, Ashok R.

AU - Hartl, Dana M.

AU - Olofsson, Jan

AU - Langendijk, Johannes A.

AU - Rinaldo, Alessandra

AU - Ferlito, Alfio

PY - 2012/2/1

Y1 - 2012/2/1

N2 - 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.

AB - 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.

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