Laryngeal Cancer Timeline: Chemotherapy First, Then Radiation or Surgery

For some advanced laryngeal cancers, a few cycles of chemotherapy are given first to see how the cancer responds. A good response leads to radiation to keep the voice box, and a poor response leads to surgery to remove it.

 

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.

Chemotherapy first, then radiation or surgery Chemotherapy first, then radiation or surgery The response to 2 to 3 cycles of chemotherapy decides the next step: radiation to keep the larynx, or laryngectomy Diagnosis and planning Treatment Side effects and healing Quality of life Overall Swallowing Speech Mood average scores; higher is better Check-ups and scans Long-term care Survival 5-year overall FIRST 6 MONTHS (BY WEEK) 6 TO 12 MONTHS YEARS 1 TO 5 AND BEYOND Wk 0 Wk 4 Wk 8 Wk 12 Wk 16 Wk 20 9 mo 1 yr 2 yr 3 yr 4 yr 5 yr + Check-ups count from the end of treatment: every 1 to 3 months in the first year, 2 to 6 months in the second, 4 to 8 months in years 3 to 5, then yearly. Scores 0-100; higher is better Week 0 is the biopsy that confirms the cancer. Times are typical ranges and vary from person to person. General education only. doctorlansford.com Biopsy Tumor board agrees on a recommendation; anxiety while waiting CT, PET/CT, pathology result Meet the team, dental check, voice and swallow test, dietitian, hearing test Chemotherapy: 3 cycles Poor response (about 1 in 7): laryngectomy, usually then radiation Response check: scope and scans Good response: radiation, often with chemotherapy, about 7 weeks Feeding tube for some during radiation (usually temporary) Tiredness, nausea, low blood counts Sore throat during radiation: peak, then heal Voice and swallowing improve over months Treatment ends: follow-up clock starts PET/CT and scope exam about 12 weeks after radiation Dental visits and possible fluoride treatments; dry mouth care; scope exams of the larynx Thyroid blood test (TSH) every 6 to 12 months for 3 years Swallowing exercises; lymphedema care; no tobacco 75 at diagnosis 45 at end 84 at 1 yr 75 at diagnosis 78-85 at end 91 at 1 yr 76 at diagnosis 92 during chemo 70 at 6 mo 84 at 2 yr 66 at diagnosis 83 during chemo 67 at 6 mo 76 at 2 yr Swallowing and speech: chemo-then-radiation trial Overall and mood: chemotherapy then chemoradiation study All treatments: about 54 in 100 alive at 5 years with stage III, 45 to 54 in 100 with stage IV (national cancer registries) About 58 in 100 alive at 5 years (randomized trial); with three drugs, larynx kept in about 74 in 100 at 5 years and 7 in 10 at 10 years

Teal words in the timeline are links. On a phone, swipe sideways to see the whole graphic.

Who follows this track

Chemotherapy first (induction chemotherapy) is another way to try to keep the larynx. It is used at some centers, especially for larger tumors or cancers with many involved lymph nodes, in people healthy enough for several strong drugs. Its advantage is that the response to chemotherapy helps sort out early who is likely to do well with radiation and who is better served by surgery. With the three-drug combination, about 7 in 10 people still had their larynx at 10 years in a large study. Compared with chemoradiation alone, it adds about 2 months to treatment.

Before treatment (weeks 0 to 3)

Chemotherapy (about weeks 3 to 12)

  • Usually 2 to 3 cycles of chemotherapy, commonly three drugs (docetaxel, cisplatin and fluorouracil), each cycle 3 weeks apart.

  • Side effects include tiredness, nausea, mouth soreness, low blood counts with a risk of infection, hair loss, and effects on hearing and the kidneys. Medicines to support blood counts are often given.

Checking the response (about weeks 9 to 12)

After 2 or 3 cycles, a scope exam and scans show how much the tumor has shrunk and whether the vocal cords move better.

  • Tumor gone or nearly gone: radiation follows to keep the larynx.

  • Tumor partly shrunk: radiation, often with chemotherapy, or surgery, depending on the details.

  • Little or no shrinkage: a total laryngectomy follows, usually with radiation afterward. This happens for about 1 in 7 people. The details of the operation are on the laryngectomy alone timeline.

Radiation (about weeks 15 to 22, after a good response)

  • Radiation 5 days a week for about 7 weeks, often with weekly chemotherapy.

  • Side effects are those of chemoradiation: throat soreness, painful swallowing, hoarseness, dry mouth, skin changes, tiredness and weight loss. A feeding tube is used by some people and is usually temporary.

Recovery (months 6 to 12)

  • A PET-CT scan about 12 weeks after radiation shows whether any cancer remains. If it does, a laryngectomy (salvage surgery) is the usual next step.

  • Swallowing and voice improve gradually over the following months.

Quality of life on this track

The first scores ("at diagnosis") were collected after the cancer was diagnosed and before treatment began, so they already reflect some of the burden of the cancer itself, not a person's quality of life before the cancer developed.

Average scores (0 to 100; higher is better):

  • Overall: 75 at diagnosis, about 45 at the end of chemoradiation, and 84 at 1 year.

  • Mood: 75 at diagnosis, about 78 to 85 at the end of chemoradiation, and 91 at 1 year.

  • Swallowing: 76 at diagnosis, 92 six weeks into chemotherapy (as the tumor shrinks), 70 at 6 months, 78 at 1 year and 84 at 2 years.

  • Speech: 66 at diagnosis, 83 six weeks into chemotherapy, 67 at 6 months, 69 at 1 year and 76 at 2 years.

Where the numbers come from: the overall and mood scores are from a study of chemotherapy first followed by chemoradiation, which reported swallowing only up to the end of chemoradiation (75 at diagnosis and about 40 to 57 at the end, depending on the cisplatin schedule). The swallowing and speech scores are from a randomized European trial in people with advanced cancer of the larynx or lower throat that compared chemotherapy first and then radiation (the numbers shown) with chemotherapy and radiation given in alternating blocks; the alternating schedule caused more swallowing and speech trouble at 6 weeks but no lasting difference. The 1-year swallowing and speech points are left off the graphic for space. Swallowing and speech are shown as 100 minus the score of the head and neck questionnaire, so that higher means better. Averages describe groups of people, not what any one person will feel. The questionnaires are described on the quality-of-life questionnaires page.

Check-ups and long-term care

Go to Laryngeal Cancer Treatment Timelines >>
Go to Chemoradiation Timeline >>
Go to Laryngectomy Followed by Radiation Timeline >>
Go to Chemotherapy and Immunotherapy >>
Go to Throat Cancer Treatments >>
 

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