Hypopharyngeal

• Presentation:

  • globus sensation + neck mass
• Highest incidence: pyriform sinus
• True / False: women do better than males

  • True
• Anatomical location: C3 - C6
• Boundaries:

  • sup: hyoid bone
  • inf: upper esophageal sphincter
  • ant: larynx
  • post: retropharyngeal space
  • lateral: pyriform sinus
• True / False: hypo pharyngeal cancer has the best survival rate of all head and neck cancers

  • False: hypo pharyngeal has the worst survival rate
• Spread:

  • local: submucosal
  • lymphatic
  • hematogenous = lung
• Diagnosis:

  • contrast enhanced CT and MRI → see extent of disease
  • PET CT → post treatment
  • high specificity: can catch before 1 - 2 cm
• Prognostic indicators:

  • size
  • local spread
  • lymph node involvement
• Staging:

  • stage I: one part of hypopharynx, less than 2 cm
  • stage II: more than one part of hypo pharynx, 2 - 4 cm, has not affected vocal cords
  • stage III:
  • greater than 4 cm, affecting vocal cords, into esophagus
  • might or might not affect vocal cord, spread to 1 lymph node on same side (less than 3 cm)
  • stage IV:
  • A: thyroid or cricoid cartilage, hyoid bone, thyroid gland, muscle, fat, 1 lymph node on same side (3 - 6 cm),
  • B: in front of spine, carotid artery, between lungs, node larger than 6 cm
  • C: distant parts of body (mets)
• Treatment:

  • stage I:
  • surgery: laryngopharyngectomy + neck dissection
  • RT (retropharyngeal + lateral cervical lymph nodes)
  • stage II:
  • surgery + PORT
  • neoadjuvant chemo + RT (retropharyngeal + lateral cervical lymph nodes)
  • stage III:
  • surgery + PORT (3 - 4 weeks after resection)
  • surgery → gastric pull up, free flap transfer
  • neoadjuvant / adjuvant chemo = cisplatin / 5 FU
  • stage IV:
  • resectable:
  • laryngopharyngectomy + adjuvant RT +/- adjuvant chemo
  • unresectable: chemo RT (cisplatin / cetuximab = targeted)
• Recurrent Treatment:

  • surgical salvage
  • immunotherapy
  • chemotherapy
• RT:

  • technique: VMAT
  • energy: 6 MV
  • dose: 70 Gy / 33 fractions
  • high risk CTV = 70 Gy
  • intermediate risk CTV = 59.4 Gy
  • elective risk CTV = 50 - 54 Gy
  • 2 phase approach
  • 44 - 45 Gy → reduce field posteriorly
  • ant split → nodes below cricoid
  • junction at thyroid notch
  • setup:
  • 5 point mask
  • neutral head rest
  • field border:
  • sup: inferior aspect of mandible
  • inf: inferior to cricoid cartilage
  • ant: anterior to thyroid cartilage
  • post: posterior to spinous process
• Side Effects:

  • acute:
  • xerostomia: 10 - 20 Gy
  • mucositis: 20 - 30 Gy
  • chronic:
  • telangiectasia: 55 Gy
  • trismus: 60 Gy
  • xerstomia: 10 - 20 Gy