Laryngeal Cancer Timeline: Chemoradiation to Keep the Voice Box

Radiation given together with chemotherapy is the treatment most often used to keep the voice box in advanced laryngeal cancer, with surgery held in reserve if the cancer is not fully controlled.

This page is one of the treatment-track timelines for advanced laryngeal cancer. The steps before treatment, how a track is chosen and the long-term follow-up schedule are covered on the laryngeal cancer treatment timelines page.

Who follows this track

Chemoradiation to keep the larynx is most often used for advanced cancers that have not destroyed the cartilage or grown outside the larynx, in a person whose larynx still works reasonably well and whose health allows cisplatin. In large studies, it kept the larynx in place for about 8 in 10 people at 10 years, more often than the other larynx-keeping approaches, with overall survival similar to them. For cancers that have grown through the cartilage, or a larynx that already works poorly, surgery first is linked with better survival (see laryngectomy followed by radiation).

When cisplatin is not safe, radiation alone, or radiation with a different drug, follows a similar timeline. The other drugs work less well than cisplatin, so they are kept for people who cannot receive it.

Before treatment (weeks 0 to 4)

• Biopsy, CT and PET-CT scans and the pathology result.

• A dental check, with any needed dental work done before radiation starts.

• A swallow evaluation and swallowing exercises started before treatment.

• A dietitian visit and, for some, a feeding tube placed ahead of time.

• A hearing test before cisplatin.

• A custom mask is made to hold the head still during radiation.

Chemoradiation (about weeks 4 to 11)

• Radiation 5 days a week for about 7 weeks (35 treatments).

• Cisplatin chemotherapy given 3 times, 3 weeks apart, or once a week during radiation.

• Side effects build over the weeks and peak in the week or two after radiation ends. Throat soreness affects nearly everyone and often needs strong pain medicine. About half of people need a feeding tube for a while, many need IV fluids, and about a third need a hospital stay for supportive care. Other effects: throat soreness (mucositis), painful swallowing, hoarseness, dry mouth, taste changes, skin changes on the neck, tiredness, nausea and weight loss.

• Swelling of the larynx can narrow the airway; a tracheostomy is needed occasionally.

Recovery and checking the response (weeks 11 to 26)

• Soreness heals over several weeks after treatment ends. Swallowing is usually at its lowest about 3 months after treatment, then improves, with clear gains between 3 and 6 months. By 1 year, only about 1 in 25 people still depend on a feeding tube.

• A PET-CT scan no earlier than 12 weeks after treatment, together with a scope exam, shows whether any cancer remains. A clear scan at this point is very reassuring.

• If cancer remains or returns in the larynx, which happens for about 1 in 6 to 1 in 3 people, a total laryngectomy (salvage surgery) is the usual next step and can still offer a cure: about 42 to 48 in 100 people are alive 5 years later. Healing is slower after radiation, so a flap of healthy tissue is often used to strengthen the repair. The details of the operation and of speaking afterward are on the laryngectomy alone timeline.

• The voice is often rough for months and settles over the first year.

Quality of life on this track

In a study that surveyed people about 4 years after chemoradiation, average scores (0 to 100; higher is better) were 65 for overall quality of life, 73 for swallowing, 64 for speech and 76 for mood. These people were surveyed once rather than followed over time, so the timeline shows these scores as dashed outlines. In another study, mostly of larynx and lower throat cancers, swallowing scores dropped about 16 points by 3 months after chemoradiation and had not fully recovered by 1 year. Swallowing and speech are shown as 100 minus the score of the head and neck questionnaire, so that higher means better. The questionnaires are described on the quality-of-life questionnaires page.

Check-ups and long-term care

• Check-ups follow the usual schedule counted from the end of treatment, each with a scope exam of the larynx (fiberoptic laryngoscopy).

• Dental visits and possible fluoride treatments continue for life.

• A thyroid blood test (TSH) every 6 to 12 months for the first 3 years checks for an underactive thyroid.

• Swallowing is watched over the long term, because late stiffness can let food or liquid enter the airway. After chemoradiation for laryngeal cancer, about 1 in 4 people have pneumonia from this at some point, often without coughing. Swallowing exercises continue.

• Rarely, a larynx that has been kept no longer protects the airway or allows comfortable breathing years later, and removing it is considered.

• Lymphedema care, as needed.