**Abstract**

Hypopharyngeal carcinoma is relatively rare and has the worst prognosis of all head and neck cancers. Initially, surgery followed by postoperative radiation was the standard of care for locally advanced disease. In the recent years, various organ sparing approaches have evolved. There are mainly two schools of thought regarding larynx preservation in hypopharyngeal cancers which include either induction chemotherapy followed by response assessment for radical radiotherapy or concurrent chemoradiation. An ongoing trial is comparing the effectiveness between these two established approaches. The role of anti-EGFR therapy and immunotherapy is still being evaluated. Despite all the advancements in treatment, hypopharyngeal cancers are still associated with poor treatment outcomes.

**Keywords:** organ preservation, hypopharyngeal cancer, locally advanced, induction chemotherapy, concurrent chemoradiation

## **1. Introduction**

Hypopharyngeal carcinoma accounts for about 3% of all head and neck cancers [1]. Anatomically, the subsites include the piriform sinus, the posterior pharyngeal wall, and the post-cricoid region up to the esophageal inlet. Mostly squamous cell carcinoma of the hypopharynx presents as a locally advanced disease which is constituted by Stage III and IVa. Initially, surgery followed by postoperative radiotherapy was the most common treatment modality for these patients. The exploration of organ preservation approaches has opened a new area of research in hypopharyngeal and laryngeal tumors. The role of definitive radiotherapy (RT) was explored since the beginning of the twentieth century. Later, the role of chemotherapy either as induction or concurrent in addition to RT was also investigated. Despite all these available approaches, hypopharyngeal carcinomas still have the worst prognosis of all head and neck cancers with a reported 5-year overall survival rate of about 30–35% [2, 3]. About 50% of patients develop local recurrence within the first year itself and the majority develop distant metastasis too [3].
