Abstract
BackgroundSquamous cell cancers in the hypopharynx (HP) and cervical esophagus (CE) are different diseases with different staging systems and treatment approaches. Pharyngoesophageal junction (PEJ) tumor involves both the hypopharynx and the cervical esophagus simultaneously, but few reports focused on PEJ tumors. This study aimed to clarify clinical characteristics and the treatment approaches of PEJ tumors.Patients and MethodsA total of 222 patients with squamous cell carcinoma in the HP, PEJ, and CE were collected between January 2008 and June 2018 in Fudan University Shanghai Cancer Center. We compared different lymph node metastatic patterns of three diseases above and the survival of different tumor locations, different lymph node metastasis, and different radiotherapy approaches.ResultsFor HP, PEJ, and CE cancer, the upper and middle cervical lymph node metastatic rates were 85.7%, 47.1%, and 5.8%, respectively; the lower cervical lymph node metastatic rates were 36.7%, 42.9%, and 35.0%, respectively; and the mediastinal lymph node metastatic rates were 2.0%, 72.9%, and 80.6%, respectively. The 3-year overall survival rates were 69.5% in the HP group, 52.0% in the PEJ group, and 69.6% in the CE group (p = 0.024). No survival differences were found between the involved-field-irradiation and elective-node-irradiation subgroups among PEJ tumors (p = 0.717 for OS and p = 0.454 for PFS, respectively).ConclusionHP cancers had a high prevalence in all cervical lymph node metastases, while CE cancers had a lower prevalence in the cervical and mediastinal lymph node metastases. PEJ cancer had the combined metastatic patterns of both HP and CE cancers. Involved field irradiation was feasible in chemoradiotherapy for PEJ cancers.
Highlights
As is widely recognized, squamous cell cancers in the hypopharynx (HP) and cervical esophagus (CE) are different diseases with different staging systems and treatments, the hypopharynx and cervical esophagus are anatomically adjacent.HP cancers are staged according to the TNM classification system of head and neck tumors, in which the head and neck lymph nodes are considered to be regional lymph nodes
The TNM staging system of esophageal carcinoma is used for CE cancers and the regional lymph node area extends from the periesophageal cervical nodes in the neck to the celiac nodes [1]
A total of 222 patients were enrolled, of which 49 cases were diagnosed with HP cancer, 70 cases with Pharyngoesophageal junction (PEJ) cancer, and 103 cases with CE cancer
Summary
Squamous cell cancers in the hypopharynx (HP) and cervical esophagus (CE) are different diseases with different staging systems and treatments, the hypopharynx and cervical esophagus are anatomically adjacent. HP cancers are staged according to the TNM classification system of head and neck tumors, in which the head and neck lymph nodes are considered to be regional lymph nodes. The total dose should be 50.0–50.4 Gy at 1.8–2.0 Gy per fraction for the primary tumor, and involved regional lymph nodes with or without elective nodal regions (supraclavicular lymph nodes, etc.) and higher doses may be appropriate (60–66 Gy) according to the NCCN guideline. Squamous cell cancers in the hypopharynx (HP) and cervical esophagus (CE) are different diseases with different staging systems and treatment approaches. This study aimed to clarify clinical characteristics and the treatment approaches of PEJ tumors
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