Table Of ContentCarcinoma
of the Larynx
and Hypopharynx
Sudhir Bahadur
Alok Thakar
Bidhu K. Mohanti
Editors
123
Carcinoma of the Larynx and Hypopharynx
Sudhir Bahadur • Alok Thakar
Bidhu K. Mohanti
Editors
Carcinoma of the Larynx
and Hypopharynx
Editors
Sudhir Bahadur Alok Thakar
All India Institute of Medical Sciences All India Institute of Medical Sciences
New Delhi New Delhi
India India
Bidhu K. Mohanti
Department of Radiation Oncology
Manipal Hospital
New Delhi
India
ISBN 978-981-13-3109-1 ISBN 978-981-13-3110-7 (eBook)
https://doi.org/10.1007/978-981-13-3110-7
Library of Congress Control Number: 2018963983
© The Editor(s) (if applicable) and The Author(s) 2019
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Preface
The incidence of cancer of the larynx and hypopharynx is high in India compris-
ing of significant tumor load, and it may be largely attributed to consumption of
tobacco and alcohol. Despite the availability of improved techniques for better
assessment of disease such as the use of rigid and flexible telescopes and much
improved imaging, less than 20% of patients are diagnosed in early stages.
Unfortunately, most patients still present with advanced disease and thus pose
considerable challenge in management. The tumor board consisting of multidis-
ciplinary team including a head and neck surgeon and radiation and medical
oncologists has become the standard practice to implement the treatment proto-
col after initial work-up and diagnosis. However, the decision-making is com-
plex and demanding.
The prognosis of early lesions is good, and results of treatment whether by radio-
therapy, by open partial laryngectomy, or by trans-oral laser surgery are generally
excellent. Though, open partial laryngectomy, once extremely popular, is now sel-
dom employed except in radiation-failed salvage setting. It has been mainly replaced
by TOLS (trans-oral laser surgery), but the question of technical expertise and avail-
ability of equipment still persists.
However, the surgeon faces a major dilemma while treating advanced tumors,
whether to sacrifice the larynx or make an effort to preserve the organ. Surgery with
postoperative radiotherapy is still considered by many as the gold standard treat-
ment. Though oncologic results in terms of survival are usually good, quality of life
is significantly impaired because of the loss of speech and the presence of perma-
nent tracheostomy. This has been partly overcome by the placement of tracheo-
esophageal prosthesis, though the cost of prosthesis and its frequent changes are
important issues. There has been serious research undertaken since the 1990s using
chemotherapy in combination with radiotherapy to improve the organ preservation
and survival. Concurrent chemotherapy and radiotherapy has shown to produce
excellent results, almost comparable to that of surgery while preserving the larynx
in more than half of cases and keeping the possibility of salvage surgery in the
remaining cases. However, some significant problems still remain.
v
vi Preface
1. Selection of patients
2. Toxicity reactions
3. Diagnosis of residual/recurrent disease, timing of salvage surgery, and its
morbidity
4. Cost involved and follow-up of patient
The editors and other authors have combined efforts to produce this textbook to
provide guidelines for the update management with appropriate radiology, pathol-
ogy, surgery, radiotherapy, chemoradiation, and rehabilitation. This textbook should
be of significant value to the residents as well as faculty staff of various specialities
including otolaryngology, head and neck surgery, general surgery, radiation oncol-
ogy, medical oncology, and radiology.
All the images of patients used in this textbook are original, and consent was
taken from them, as part of the treatment that these images may be used for educa-
tional purposes. No image reveals the identity of a patient.
This book on the larynx and hypopharynx is dedicated to our patients.
New Delhi, India Sudhir Bahadur
New Delhi, India Alok Thakar
New Delhi, India Bidhu K. Mohanti
Contents
1 Surgical Anatomy and Tumour Spread in the Larynx
and Hypopharynx . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Rajeev Kumar and Prem Sagar
2 Imaging in Carcinoma of the Larynx . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Abhinav Jain and S. S. Anand
3 Diagnosis, Assessment and Staging of Carcinoma of the Larynx . . . . 25
Sudhir Bahadur and Junaid Malik
4 Metastatic Neck Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Tapaswani Pradhan and Sudhir Bahadur
5 Guidelines in Management of Early Laryngeal Cancers
(T and T) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
1 2
Sudhir Bahadur and Alok Thakar
6 Guidelines in the Management of Advanced Carcinoma
of the Larynx . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
Sudhir Bahadur
7 Trans-oral Laser Microsurgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
Alok Thakar and Kapil Sikka
8 Radiation/Chemoradiation in Treatment of Carcinoma
of the Larynx . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
Bidhu K. Mohanti
9 Tumours of the Hypopharynx: Diagnosis, Assessment and Staging . . 125
Sudhir Bahadur and Arun Sharma
10 Guidelines in Management of Carcinoma of the Hypopharynx . . . . . 135
Sudhir Bahadur
11 Treatment of Early-Stage Hypopharyngeal
by Radiation Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155
Shelley Hukku, Shikha Halder, and Bidhu K. Mohanti
vii
viii Contents
12 Larynx Preservation in Hypopharyngeal Carcinomas . . . . . . . . . . . . 163
Shelley Hukku, Shikha Halder, and Bidhu K. Mohanti
13 Salvage Surgery in Post-radiotherapy/Chemoradiation
in Carcinoma of the Larynx and Hypopharynx . . . . . . . . . . . . . . . . . . 179
Sudhir Bahadur
14 Surgical Complications and Management . . . . . . . . . . . . . . . . . . . . . . 191
Sudhir Bahadur
15 Anaesthetic Complications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203
Anjali Kochhar
16 Vocal Rehabilitation Following Laryngectomy . . . . . . . . . . . . . . . . . . 209
Sudhir Bahadur
17 Quality of Life . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 219
Bidhu K. Mohanti
Editors and Contributors
About the Editors
Sudhir Bahadur, MS, FAMS, PhD is a highly
experienced cancer surgeon, trained in all types of
complex head and neck cancer surgeries. Dr. Bahadur
has worked at the All India Institute of Medical
Sciences, New Delhi, as a faculty member for nearly
30 years. His areas of interest are head and neck sur-
gery/oncology and surgery of the skull base. He is
the past president of the Foundation for Head and
Neck Oncology and Skull Base Surgery Society of
India and has published 200 research papers and
textbook chapters. Dr. Bahadur has received numer-
ous honors, including from the Foundation for Head
and Neck Oncology, Association of Otolaryngology
of India, and ICMR, New Delhi.
Alok Thakar, MS, FRCS is a professor of
Otolaryngology and Head and Neck Surgery at the
All India Institute of Medical Sciences, New Delhi.
His clinical and research interests have been directed
toward optimizing outcomes and minimizing the dis-
ability following treatment of head-neck and skull
base lesions. He has been instrumental in the devel-
opment of trans-oral laser surgery, as well as voice-
conserving oncosurgery, minimally invasive skull
base surgery, and techniques for rehabilitation of
facial nerve and lower cranial nerve lesions. He has
had a pioneering role in the introduction of trans-oral robotic surgery in the Indian
subcontinent.
Professor Thakar has served in several prominent advisory positions including
for the Task Force on Head-Neck Cancer Management, Indian Council of Medical
Research. He was a recipient of the Shakuntala Amir Chand National Award by the
ix
x Editors and Contributors
Indian Council of Medical Research and has served as honorable secretary of the
Foundation for Head and Neck Oncology. He has authored over 200 research pub-
lications and was recently appointed as honorary consultant to the Armed Forces
Medical Services.
Bidhu K. Mohanti is an MBBS graduate from
MKCG Medical College, Berhampur, and has an
MD in Radiotherapy from PGIMER, Chandigarh.
He is currently a consultant at Manipal Hospitals,
Delhi. Dr. Mohanti has over 30 years of experience
in oncology, covering academic, clinical, and
research responsibilities. He has worked as a radia-
tion oncologist and as faculty at Kidwai Memorial
Institute of Oncology, Bangalore, and the AIIMS,
New Delhi. He has also worked on an assignment for
the Ministry of Health, Oman, to establish the first
radiotherapy department and set up patient care at
the National Oncology Center, Royal Hospital,
Muscat. Dr. Mohanti has served as an expert for the
IAEA, Vienna, and European Commission. He has been a member of numerous
professional societies and has received several awards, including the Life Time
Achievement Award from the Foundation for Head and Neck Oncology. He has
published 165 peer-reviewed journal articles, international abstracts, book, and
chapters. He is the editor of Textbook of Radiation Oncology: Principles and
Practice (Elsevier) and has been invited to give many national and international
presentations.
Contributors
S. S. Anand Department of Radiodiagnosis, Hamdard Institute of Medical Sciences
and Research, Jamia Hamdard, New Delhi, India
Sudhir Bahadur Department of Otolaryngology and Head-Neck Surgery,
Formerly at All India Institute of Medical Sciences, New Delhi, India
Shikha Halder Department of Radiation Oncology, BLK Super Specialty Hospital,
New Delhi, India
Abhinav Jain Department of Radiodiagnosis, Hamdard Institute of Medical
Sciences and Research, Jamia Hamdard, New Delhi, India
Anjali Kochhar Department of Anaesthesiology, Hamdard Institute of Medical
Sciences and Research, Jamia Hamdard, New Delhi, India
