The dilemma of treating hypopharyngeal carcinoma: more or less: Hayes Martin Lecture.

The optimal therapy for hypopharyngeal carcinoma depends on its staging. For early-stage disease, radiotherapy and surgery achieve similar results. Radical surgery followed by radiotherapy is applicable in the management of patients with advanced-stage disease. Chemoradiation aiming to preserve the larynx can only be performed for selected patients and in well-equipped institutions. Thorough understanding of pathological behavior of hypopharyngeal carcinoma, its submucosal tumor extension, and its high propensity to metastasize to cervical lymph nodes allows head and neck surgeons to choose optimal surgical treatment. Lymph node status determines the type of neck dissection required while location and size of the primary tumor determine the extent of resection and choice of reconstruction procedure. Adequate tumor extirpation with less extensive and invasive procedures preserving unaffected normal tissue contribute to more tumor control and less morbidity.