Chemotherapy for Laryngeal and Hypopharyngeal Cancers

Quit smoking before laryngeal and hypopharyngeal cancer treatment

If you smoke, you should quit. Smoking during chemotherapy treatment can cause more side effects and can cause the chemo drugs to not work as well. It can give you a higher chance of getting an infection and is linked to worse outcomes. Smoking after treatment can also increase the risk of the cancer coming back and of getting another new cancer. Quitting smoking (before treatment starts, if possible) is the best way to improve your chances of survival. It is never too late to quit. For help, see How to Quit Using Tobacco.

How is chemotherapy used to treat laryngeal or hypopharyngeal cancer?

Chemotherapy (chemo) is treatment with anti-cancer drugs that are injected into a vein or taken by mouth. These drugs enter the bloodstream and reach most parts of the body. Chemo may be used at different times during treatment for laryngeal and hypopharyngeal cancers:

• As the primary (main) treatment: For more advanced cancers of the larynx, chemo is given along with radiation. This treatment, called chemoradiation, is commonly used for laryngeal and hypopharyngeal cancers. It can allow some patients to avoid having a laryngectomy which means they won't have trouble speaking after treatment. It can also be used as the main treatment for people who are too sick for surgery or don't want to have surgery. 
• After surgery (adjuvant chemotherapy): Chemo along with radiation can be used after surgery to try to kill any cancer cells that might have been left behind but are too small to be seen on imaging tests. This can also lower the chance the cancer will come back,especially 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.
  
• Before surgery (neoadjuvant or induction chemo): Chemo can be given alone (induction chemo) or with radiation (neoadjuvant chemoradiation) before surgery to help shrink a large tumor so it's easier to treat or to ease problems it might be causing. How much the tumor shrinks with induction chemo may help in deciding the next treatment. If there is no sign of cancer left, radiation alone may be best. If the tumor shrinks a lot but can still be seen on imaging tests, chemoradiation or radiation alone may be options. (These are covered in the chemoradiation section.) If there's little or no tumor response, surgery may be needed.
• For locally advanced cancer: Chemo might be given 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.
• For metastatic cancer (cancer that has spread to distant organs): Chemo might be given for cancer that has spread to areas outside the head and neck area such as the lungs or bones.

Chemoradiation

Chemoradiation is chemotherapy given at the same time as radiation. This combination 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 "preserved" and not changed.

A common regimen is a dose of cisplatin every 3 weeks (for a total of 3 doses) during radiation. Sometimes, a smaller dose of cisplatin is given every week (for a total of 7 doses) along with radiation. For people who cannot tolerate chemo, the targeted drug cetuximab is often used with radiation instead.

How is chemotherapy given?

Chemo drugs for laryngeal or hypopharyngeal cancer that are given into a vein (IV), can be given either as an infusion over a certain period of time. This can be done in a doctor’s office, infusion center, or in a hospital setting.

Often, a slightly larger and sturdier IV has to be put in the vein system to give chemo. These are known as central venous catheters (CVCs) , central venous access devices (CVADs), or central lines. They are used to put medicines, blood products, nutrients, or fluids right into your blood. They can also be used to take blood for testing. There are many different kinds of CVCs. The most common types are the port and the PICC line.

Chemo is given in cycles, followed by a rest period to give you time to recover from the effects of the drugs. Cycles can be weekly or every 3 weeks long. The schedule varies depending on the drugs used. For example, with some drugs, the chemo is given only on the first day of the cycle. With others, it is given for a few days in a row, or once a week. Then, at the end of the cycle, the chemo schedule repeats to start the next cycle.

Adjuvant or neoadjuvant chemo can be given over weeks or months, depending on the drugs used. The length of treatment depends on how well it is working and what side effects you might have.

Chemotherapy drugs used to treat laryngeal and hypopharyngeal cancers

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)
• Methotrexate
• Capecitabine (Xeloda), a pill that is changed into 5-FU once it gets to the tumor.

You might be treated with a single drug or 2 or more together. Commonly used chemotherapy drugs include cisplatin or carboplatin alone, or in combination with 5-FU, but other combinations are also available.

Possible side effects of chemo for laryngeal and hypopharyngeal cancers

Chemo drugs kill cells that are dividing quickly, which is why they work against cancer cells. But other cells, such as those in the lining of the mouth and intestines, and the hair follicles, are also dividing quickly. Chemo can affect these cells too, which can lead to side effects.

The side effects of chemo depend on the type and dose of drugs used, their dose, and how long you take them. Side effects tend to be worse when chemo is given along with radiation. Common side effects of chemo can include:

• Nausea and vomiting
• Loss of appetite or weight loss
• Mouth sores
• Diarrhea
• Hair loss
• Nail changes
• Skin changes
• Ringing in the ears

Chemo can also affect the blood-forming cells in the bone marrow, which can lead to:

• An increased chance of infection (from low white blood cell counts)
• Easy bleeding or bruising (from a low blood platelet counts)
• Fatigue or shortness of breath (from low red blood cell counts)

Other side effects are specific to certain drugs. Ask your cancer care team about the possible side effects of the specific drugs you are getting. For example:

Neuropathy (nerve damage) is a common side effect of cisplatin, docetaxel, and paclitaxel, 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. If you might be treated with any of the drugs mentioned here, talk with your doctor about the side effects beforehand, and let them know right away if you start having numbness or tingling feelings or other side effects.

Hand-foot syndrome can happen during treatment with capecitabine or 5-FU (when given as an infusion). It can start out as redness in your hands and feet, and then might progress to pain and sensitivity your palms and soles. If it worsens, the skin may blister or peel, sometimes leading to painful sores. It’s important to tell your doctor right away about any early symptoms, such as redness or sensitivity, so that steps can be taken to keep things from getting worse.

Although most side effects get better once treatment is stopped, some can last a long time or even last forever. If your doctor is planning treatment with chemo, be sure to discuss the drugs that will be used and their 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. In some cases, the doses of the chemo drugs may need to be lowered or treatment may need to be delayed or stopped to help keep the problem from getting worse.