Long-term survival of induction chemotherapy plus surgery and postoperative radiotherapy in patients with stage IV hypopharyngeal cancer

Abstract

This study was conducted to evaluate the safety, efficacy, and tolerability of induction chemotherapy plus surgery and postoperative radiotherapy in patients with stage IV hypopharyngeal cancer. The patients received two to three cycles of induction chemotherapy before surgery, with cisplatin (100 mg/m(2)) by rapid intravenous (i.v.) infusion over 15-20 min on day 1, bleomycin (10 mg/m(2)) on days 1 and 5, and 5-fluorouracil (800 mg/m(2)/day) by continuous i.v. infusion on days 1 through 5, repeated every 21 days. Adjuvant radiotherapy was begun 4-6 weeks after surgery. From July 1999 to December 2004, a total of 52 patients were enrolled. After completion of two to three courses of induction chemotherapy, 22 cases of CR (complete response) and 16 cases of PR (partial response) in the primary site were confirmed, giving an overall response rate (ORR) of 73.1% [95% confidence interval (CI), 61.1-85.2%]. There were 17 CRs and 19 PRs in neck lymph nodes, giving an ORR of 69.2%. The combined primary tumor site and lymph node response was 17 CRs and 16 PRs, giving an ORR of 63.5% (95% CI, 50.4-76.6%). The median time to progression and overall survival for all the patients were 32 months (95% CI, 7.6-56.4 months) and 36 months (95% CI, 22.3-49.7 months), respectively. The estimate of time to progression and overall survival at 5 years was 24.5% (95% CI, 12.5-36.5%) and 35.9% (95% CI, 23.2-48.6%), respectively. In conclusion, induction chemotherapy plus surgery and postoperative radiotherapy is a treatment modality that is tolerated with encouraging activity and survival outcome in patients with stage IV hypopharyngeal cancer.