Chemotherapy for Laryngeal and Hypopharyngeal Cancers

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.

Chemo may be used in these ways for laryngeal and hypopharyngeal cancers:

  • 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 be able to speak. Chemoradiation is a common treatment for laryngeal and hypopharyngeal cancers. (See chemoradiation below.)
  • As part of chemoradiation after cancer has been removed with surgery. The goal is 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.
  • Before radiation or surgery to help shrink a large tumor so it's easier to treat or to ease problems it might be causing. This may be called neoadjuvant treatment or induction chemotherapy. It's also thought that tumor response to induction chemo may help in making plans for the next treatment. If there's good response (the tumor shrinks), chemoradiation and organ preservation may be best. (These are covered below in the chemoradiation section.) If there's little or no tumor response, surgery may be needed.
  • To help relieve symptoms from cancers that are too big or have spread too far to be completely removed with surgery. This may be called supportive or palliative care.

Chemo drugs

Chemo drugs work by attacking cells that are dividing quickly, this includes cancer cells. Some of the chemo drugs commonly used for cancers of the larynx and hypopharynx include:

  • Cisplatin
  • Carboplatin
  • 5-fluorouracil (5-FU)
  • Docetaxel (Taxotere®)
  • Paclitaxel (Taxol®)
  • Epirubicin

Treatment may involve the use of a single drug or 2 or more in combination. A common combination is cisplatin and 5-FU, but other combinations are also used.

Doctors give chemo in cycles, with each period of treatment followed by a rest period to give the body time to recover. In most cases, each cycle lasts for a few weeks.

Chemoradiation

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. Some call this organ preservation treatment because chemoradiation can be used instead of surgery so the structures in and near the larynx are not altered.

Chemoradiation can be used in different situations:

  • As the main treatment 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 be needed.
  • As the main treatment for people who are too sick for surgery or don't want to have surgery.
  • After surgery to try to lower the risk that the cancer will come back. This may be needed if cancer is found at the edges (margins) of the removed tumor, or if the cancer has other features that make it more likely to come back after surgery.
  • If the cancer has spread to nearby lymph nodes.

A common regimen is to give a dose of cisplatin every 3 weeks (for a total of 3 doses) during radiation. For people who cannot tolerate chemoradiation, the targeted drug cetuximab is often used with radiation instead.

Chemo side effects

Chemo drugs kill cells that are dividing quickly, which is why they work against cancer cells. But other cells, 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. This leads to side effects. Side effects depend on the specific drugs used, their dose, and the length of treatment. Side effects tend to be worse when chemo is given along with radiation. Common side effects of chemo include:

  • Nausea and vomiting
  • Loss of appetite
  • Mouth sores
  • Diarrhea
  • 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 instance, 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 last forever. 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 chemo. For instance, there are many drugs that can help prevent or treat nausea and vomiting.

More information about chemotherapy

To learn more about how chemotherapy is used to treat cancer, see Chemotherapy.

To learn about some of the side effects listed here and how to manage them, see Managing Cancer-related Side Effects.

The American Cancer Society medical and editorial content team
Our team is made up of doctors and master’s-prepared nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

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Last Medical Review: November 27, 2017 Last Revised: November 27, 2017

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