Treatment Options for Unresectable Stage IV Hypopharyngeal Cancer

Radiation therapy.

Chemotherapy has been combined with radiation therapy in patients who have locally advanced disease.[9-11] In a randomized trial, the 3-year projected OS rate was 37% (P = .14) for patients with stage III or stage IV inoperable disease receiving single daily fractionated radiation with concurrent cisplatin.[11][Level of evidence A1]

Radiation therapy clinical trials evaluating hyperfractionation schedules may be considered with chemotherapy (under clinical evaluation).[12-17] Concurrent chemotherapy is a standard treatment option for patients with locally advanced (stage III and stage IV) hypopharyngeal cancer. A meta-analysis of 93 randomized prospective head and neck cancer trials published between 1965 and 2000 showed a 4.5% absolute survival advantage in the subset of patients who received chemotherapy and radiation therapy.[18][Level of evidence B4] Patients who received concurrent chemotherapy had a greater survival benefit than those who received induction chemotherapy.