Traditionally, total laryngectomy has been the standard treatment approach for advanced hypopharyngeal cancers. However, this method results in the loss of the larynx, leading to a deterioration in the quality of life for patients. Over the past two decades, a combination of chemotherapy and radiotherapy (CRT) has become more popular, but high severe late toxicities have been reported, including laryngeal and pharyngeal dysfunction.

Transoral laser microsurgery (TLM) has emerged as an alternative organ-preserving treatment method for several decades. Initially applied primarily to early-stage cancers, with the introduction of the concept of neoadjuvant chemotherapy (NACT), TLM is now being utilized for advanced-stage hypopharyngeal cancers. The main purpose of using NACT is to induce tumor shrinkage, followed by TLM to excise the tumor with margins adjusted according to the extent of the shrunken tumor. This approach may reduce the need for postoperative radiotherapy (RT) or decrease the RT dosage if necessary, potentially enhancing the quality of life after treatment.

Since 2016, two cycles of NACT with the docetaxel, cisplatin, and 5-fluorouracil (TPF) regimen has been administered for bulky laryngeal and pharyngeal tumors. The clinical response rate of primary tumors can achieve up to 89% (16/18), including a 33% complete response and a 56% partial response rate. However, patients receiving NACT with TPF regimens require hospitalization for at least 5 days. Furthermore, 66% of the patients experienced severe neutropenia (grade 3 and 4).

In recent years, the NACT regimen has shifted from the TPF regimen to the DCU regimen (docetaxel, cisplatin, and Ufur) for two cycles. The advantages of the DCU regimen include outpatient department (OPD) treatment, no need for port-A insertion, comparable tumor response (95%), and a lower rate of severe neutropenia (18%). Most of the tumors can be excised with en bloc resection under TLM after NACT.

This presentation will share our experiences with NACT followed by TLM for hypopharyngeal cancers.

Free flaps are frequently used in the reconstruction of tumors in the head and neck region. In our hospital, which is one of the centers where the most head and neck cancer surgery is performed in Türkiye, free flaps are performed by otolaryngologists, and information will be provided on the introduction of the operation videos, difficulties and how to cope with complications.