Salvage Treatment Options after Failed Primary Treatment of Hypopharyngeal Cancer.

Abstract

Recurrent hypopharyngeal cancer (rHPC) is a high-risk fatal disease associated with poor prognosis and high risk of complications in patients who are suitable to undergo salvage treatment. The treatment of such patients should be managed by a dedicated multidisciplinary team, most frequently a tertiary centre. and with the agreement of the patient. Close follow-up is crucial in achieving early detection and being able to treat the recurrence with curative intention. When persistent or recurrent disease is suspected, cross-sectional computed tomography imaging (CT) and positron emission tomography-CT scanning followed by panendoscopy with biopsies are the initial steps that need to be done in order to confirm diagnosis and accurate staging. The current treatment modality, which results in the best survival outcomes for rHCP is surgery. For most suitable patients, total pharyngolaryngectmy remains the best surgical modality, although open partial surgery OPS and transoral surgery are options for a small number of patients who have recurrences following treatment of an early stage disease. Free tissue transfer flaps or pedicled myocutaneous flaps will be necessary for most patients to reconstruct the excised pharynx. When making such a treatment plan it is most important to explain to each patient of the likely outcome both in terms of quantity and quality of life expectation. Many factors that are likely to increase the risk of treatment complications have been reported and are best anticipated and avoided. It is essential to perform a thorough preoperative assessment, follow a tried and trusted protocoled surgical plan and to have established enhanced recovery pathways for postoperative care that is available.