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Adjuvant Treatment Guidelines for Advanced Larynx and Hypopharynx Lesions

Understand the role of surgery, radiation, and chemotherapy for Stage IVa laryngeal and hypopharyngeal cancers. Learn about postoperative radiation therapy, chemotherapy as a radiation sensitizer, and palliative care options. Adverse effects and dosage details included.

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Adjuvant Treatment Guidelines for Advanced Larynx and Hypopharynx Lesions

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  1. What adjuvant treatment is required? • Stage Iva • combined modality • Surgery + radiation • Chemotx+ radiation for advanced larynx or hypopharynxlesions

  2. Radiotherapy For Stage 3 & 4 • Radiation pre or postop • Indicators for postoperative adjuvant radiation therapy: • Presence of negative prognostic factors such as extracapsular spread of tumor, perineural invasion, vascular invasion, fixation to surrounding structures, and multiple positive nodes • Preoperative radiation or chemoradiation therapy • Given when patients have advanced neck disease that involves the carotid artery or the deep neck musculature, in the hope that the tumor reduces in size and becomes resectable. • 50 to 70 Gy over 5 to 7 weeks • Adverse Effect: • Acute: mucositis, skin erythema • Late: fibrosis, xerostomia, altered taste, risk of osteoradionecrosis

  3. Chemotherapy • No survival advantage for HNSCC compared to surgery and/ or radiation • Role of chemotherapy: • as a radiation sensitizer • Palliation (symptom control) of recurrent or unresectable disease, combined with radiation • Cisplatin, carboplatin, 5-FU

  4. References: • Townsend et.al, “Sabiston Textbook of Surgery”, 18th ed.

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