Concurrent radiochemotherapy versus surgery followed by radiotherapy for hypopharyngeal carcinoma: A single-center study

Abstract

BackgroundHypopharyngeal cancer is a rare disease representing about 0.5% of all human malignancies and constituting only 3–5% of all head and neck cancer. Concurrent radiochemotherapy has been recommended as a standard of care in patients with locally advanced squamous cell head and neck carcinomas. There were very few reports about these tumors arising from North Africa. ObjecttiveThis work was a retrospective study at the Ain Shams University hospitals comparing induction chemotherapy and concomitant radiochemotherapy to surgery followed by radiotherapy as regards over all survival. MethodsThis study included 49 patients with hypopharyngeal carcinoma, twenty-three (46.93%) were treated surgically. Surgical excision of the tumor was by pharyngo-laryngo-esophagectomy, except for 2 patients treated by conservative surgery. Postoperative radiotherapy was given to all patients. Twenty sex patients (53.07%) were treated by induction chemotherapy and concomitant radiochemotherapy. ResultsThe mean age was 52.6years (range 25–82). In the present study, females (55.1%) dominated males (44.9%).The most commonly involved subsite, in this study, was the postcricoid area (31 patients=63.3%), followed by the pyriform sinus (16 patients=32.6%), while the posterior pharyngael wall was the site of origin in only two patients (4.1%). According to the AJCC-TNM staging system, 40 patients (81.6%) were advanced stages III and IV, while only 9 patients (18.4%) had an early presentation as stages I and II. Cox proportional-hazard regression was used to compare survival in the two study groups. There was no statistically significant difference in the failure function (death) between patients treated with concomitant radiochemotherapy or surgery followed by radiotherapy after adjusting for the age category, tumor grade, T stage and N stage (proportional hazard, 1.114; 95% CI, 0.574 to 2.163; P, 0.751).Of the variables included in the model, only N1 stage was an independent predictor for the hazard of death after adjusting for the treatment group, age category, tumor grade and T stage (proportional hazard, 2.321; 95% CI, 1.073–5.022; P, 0.033). The model had a −2 log likelihood (likelihood ratio statistic, LRS) of 277.316, which was not statistically significant (P, 0.0501) indicating adequate fit of the full model. ConclusionPostcricoid carcinoma comprises the majority of hypopharyngeal tumors in Egypt. Females are more commonly affected by these tumors, especially postcricoid carcinoma. There was no survival difference between the intended therapy for organ preservation and radical surgery groups. Patients who received concurrent radiochemotherapy had a better chance of survival with a preserved larynx compared with patients who underwent surgery.