Chemotherapy (chemo) uses anti-cancer drugs that are injected into a vein or given by mouth. These drugs enter the bloodstream and reach all areas of the body, making this treatment useful for cancers that have spread beyond where they started.
Chemo may be used in different situations for laryngeal and hypopharyngeal cancers.
- It is often given along with radiation as the main treatment for more advanced cancers of the larynx. This treatment, called chemoradiation, can allow some patients to avoid laryngectomy and retain the ability to speak.
- It may be used (as part of chemoradiation) after a cancer is removed with surgery, to try to kill any small areas of cancer that may remain and lower the chance the cancer will come back. This is called adjuvant treatment.
- It is sometimes used to help relieve symptoms from cancers that are too large or have spread too far to be completely removed with surgery.
Standard chemo drugs work by attacking cells that are dividing quickly, including cancer cells. The chemo drugs used most often for cancers of the larynx and hypopharynx include:
- 5-fluorouracil (5-FU)
- Docetaxel (Taxotere®)
- Paclitaxel (Taxol®)
Treatment may involve the use of a single drug or 2 or more in combination. Common combinations include cisplatin with 5-FU and cisplatin, docetaxel, and 5-FU. Sometimes chemo is combined with the targeted drug cetuximab.
Doctors give chemo in cycles, with each period of treatment followed by a rest period to give the body time to recover. Each cycle typically lasts for a few weeks.
Chemoradiation (also called chemoradiotherapy) is chemotherapy given at the same time as radiation. This has been shown to shrink laryngeal and hypopharyngeal tumors more than either treatment alone. It can be used in different situations.
- It may be an option as the main treatment instead of surgery to treat some laryngeal and hypopharyngeal cancers. If the tumor goes away completely with chemoradiation, no other treatment may be needed. But if some cancer remains, surgery may then be recommended.
- It may be used after surgery to try to lower the risk that the cancer will come back. This may be recommended if cancer is found at the edges (margins) of the removed surgery specimen, or if the cancer has other features that make it more likely to come back after surgery.
A common regimen is to give a dose of cisplatin every 3 weeks (for a total of 3 doses) during radiation. In patients who cannot tolerate chemoradiation, the targeted drug cetuximab is often used with radiation instead.
Possible side effects of chemotherapy
Chemo drugs attack cells that are dividing quickly, which is why they work against cancer cells. But other cells in the body, such as those in the bone marrow (where new blood cells are made), the lining of the mouth and intestines, and the hair follicles, also divide quickly. These cells can also be affected by chemo, which can lead to side effects. Side effects depend on the specific drugs used, their dose, and the length of treatment. Common side effects of chemo include:
- Nausea and vomiting
- Loss of appetite
- Mouth sores
- Hair loss
- An increased chance of infection (from a shortage of white blood cells)
- Problems with bleeding or bruising (from a shortage of blood platelets)
- Fatigue or shortness of breath (from low red blood cell counts)
Along with the risks above, some chemo drugs can cause other side effects. For example, cisplatin, docetaxel, and paclitaxel can cause nerve damage (called neuropathy), which can lead to numbness, tingling, or even pain in the hands and feet. The nerve damage caused by cisplatin can also cause hearing loss. This often improves once treatment is stopped, but it can last a long time in some people.
Although most side effects improve once treatment is stopped, some can last a long time or even be permanent. If your doctor plans treatment with chemo, be sure to discuss the drugs that will be used and the possible side effects. Once chemo is started, let your health care team know if you have side effects, so they can be treated. There are ways to prevent or treat many of the side effects of chemotherapy. For example, many drugs can help prevent or treat nausea and vomiting.
For more information on chemotherapy, see the “Chemotherapy” section of our website.
Last Revised: 02/17/2016