Radiotherapy for hypopharynx cancers: 2025 update

Area of Science:

• Oncology
• Radiotherapy
• Head and Neck Cancer

Background:

• Hypopharynx cancer treatment requires updated recommendations.
• Intensity-modulated radiotherapy (IMRT) is the established standard.

Purpose of the Study:

• To present the updated French Society of Radiation Oncology guidelines for hypopharynx cancer radiotherapy.
• To outline treatment strategies based on tumor stage and characteristics.

Main Methods:

• Review and update of existing radiotherapy guidelines for hypopharynx cancer.
• Inclusion of recommendations for early-stage, locally advanced, and T4 tumors.
• Specification of fractionation schedules and dose prescriptions for curative and prophylactic radiotherapy.
• Consideration of postoperative radiotherapy based on pathological criteria.

Main Results:

• IMRT is the gold standard for hypopharynx cancers.
• Early T1/T2 tumors: exclusive radiation or surgery followed by radiation.
• Locally advanced T2/T3 tumors: chemoradiation or induction chemotherapy followed by radiation.
• T4 tumors: surgery is recommended.
• Specific curative and prophylactic radiation doses and fractionation schedules are detailed.
• Postoperative radiotherapy doses depend on pathological findings (e.g., R1 resection, extracapsular spread).

Conclusions:

• The guidelines provide a comprehensive framework for radiotherapy in hypopharynx cancer.
• Treatment decisions are stage-dependent, integrating surgery, radiation, and chemotherapy.
• Dose fractionation and prescription are critical for efficacy and toxicity, particularly regarding larynx toxicity.