Laryngeal Cancer Timeline: Laryngectomy Followed by Chemoradiation

When the pathology report after a total laryngectomy shows cancer at the edge of the removed tissue or growing outside a lymph node, chemotherapy is usually given together with radiation, which improves tumor control and survival.

 

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.

Laryngectomy followed by chemoradiation Laryngectomy followed by chemoradiation When the removed tissue shows cancer at the cut edge or growing outside a lymph node (extranodal extension) 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. Solid: first-year study; dashed: one-time surveys 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 Total laryngectomy and neck dissection, then about 5 weeks of healing Hospital about 2 to 3 weeks; eating by mouth after 1 to 2 weeks Radiation with cisplatin chemotherapy, 6 to 6.5 weeks Feeding tube after surgery, and for some during treatment (usually temporary) Sore throat, tiredness, nausea: peak, then heal Speech therapy with voice prosthesis; swallowing dips around treatment, then improves Treatment ends: follow-up clock starts PET/CT about 12 weeks after treatment Stoma care and voice prosthesis changes; dental visits and possible fluoride treatments Thyroid blood test (TSH) every 6 to 12 months for 3 years Swallowing exercises; lymphedema care; no tobacco 78 at diagnosis 38 at 1 mo 51 at 3 mo 60 at 6 mo 67 at 1 yr 92 at diagnosis 58 at 1 mo 80 at 3 mo 85 at 6 mo 88 at 1 yr 63 at diagnosis 7 at 1 mo 13 at 3 mo 18 at 6 mo 20 at 1 yr 73 at diagnosis 68 at 1 mo 85 at 3 mo 91 at 6 mo 94 at 1 yr 76 at ~3 yr 85 at ~3 yr 74 at ~3 yr 77 at ~3 yr 65 at 6 yr 80 at 6 yr 69 at 6 yr 78 at 6 yr All treatments: about 54 in 100 alive at 5 years with stage III, 45 to 54 in 100 with stage IV (national cancer registries) Adding cisplatin to radiation after surgery improves survival when the margin or a lymph node shows high-risk features

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

Who follows this track

Chemoradiation after surgery is used for two high-risk findings on the pathology report: cancer at the margin (the cut edge of the removed tissue), or cancer that has grown through the capsule of a lymph node (extranodal extension). It is sometimes considered for other combinations of risk features.

Before surgery and surgery (weeks 0 to 6)

The steps before surgery and the operation are the same as on the laryngectomy alone timeline. Because cisplatin may be used, a baseline hearing test is done.

Healing before treatment (weeks 4 to 10)

The surgical sites heal for about 5 to 6 weeks while the pathology report comes back and radiation is planned. Speech therapy with the voice prosthesis or electrolarynx begins.

Chemoradiation (about weeks 10 to 16)

  • Radiation 5 days a week for about 6 to 6.5 weeks, with cisplatin chemotherapy given either every 3 weeks or once a week during radiation. Other drugs are available when cisplatin is not a good fit.

  • Side effects are those of radiation (see the laryngectomy followed by radiation timeline), usually stronger, plus nausea, tiredness, and effects of cisplatin on hearing, the kidneys and blood counts, which are checked closely.

  • A feeding tube is used by some people during treatment and is usually temporary.

Recovery (months 4 to 12)

  • Swallowing and energy dip around the time of treatment and then improve over the following months.

  • Ringing in the ears or hearing loss from cisplatin can persist and is checked with hearing tests.

  • A PET-CT scan about 12 weeks after treatment sets a new baseline.

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.

No study has reported scores separately for laryngectomy followed by chemoradiation. The timeline repeats the scores from the laryngectomy followed by radiation timeline (0 to 100, higher is better): solid points from a study that followed 42 people through the first year after laryngectomy, nearly all with radiation afterward (overall 78 at diagnosis, 38 at 1 month, 51 at 3 months, 60 at 6 months and 67 at 1 year; swallowing 92, 58, 80, 85 and 88; speech 63, 7, 13, 18 and 20; mood 73, 68, 85, 91 and 94), and dashed points from people surveyed once about 3 years after laryngectomy and radiation (overall 76, swallowing 85, speech 74, mood 77) and once about 6 years after laryngectomy (overall 65, swallowing 80, speech 69, mood 78). Adding chemotherapy usually makes the months around treatment harder, but long-term scores are expected to be similar. 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

  • Check-ups follow the usual schedule counted from the end of treatment.

  • Stoma care, a stoma filter, voice prosthesis changes, dental visits and possible fluoride treatments continue for life. The dental care matters because of the jaw-healing risk after radiation (osteoradionecrosis).

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

  • Swallowing exercises, stretching of a narrowed throat when needed, and lymphedema care continue as needed.

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

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