Treating Recurrent Laryngeal and Hypopharyngeal Cancers

Cancer is called recurrent when it come backs after treatment. Recurrence can be local (in or near the same place it started) or distant (spread to organs such as the lungs or bone). Treatment options for patients whose laryngeal or hypopharyngeal cancers come back after treatment depend mainly on what the initial treatment was and on where the cancer recurs.

Local recurrences in people who have already had limited surgery such as partial laryngectomy can often be treated with more extensive surgery (such as total laryngectomy) or with radiation therapy. If cancer comes back locally after radiation therapy, the usual treatment is total laryngectomy, but additional radiation therapy is sometimes used. Radiation in these cases is generally delivered by external beam. However, a special way of giving external beam radiation called stereotactic radiosurgery is also being studied. This approach gives high doses of radiation over just a few sessions (instead of weeks). Not all facilities have the expertise to be able to deliver stereotactic radiosurgery.

For distant recurrences and for local recurrences that have not responded to radiation therapy and surgery, the main treatment is chemotherapy and/or targeted therapy, sometimes along with radiation, if a person can tolerate it. If chemo is no longer working, a newer option might be treatment with an immunotherapy drug such as pembrolizumab (Keytruda) or nivolumab (Opdivo). These drugs can help the body’s own immune system attack the cancer. 

Because these cancers are often hard to treat, patients may want to consider taking part in clinical trials of newer treatments as well.