Radical Surgery vs. Definitive Concurrent Chemoradiotherapy for Locally Advanced Hypopharyngeal Cancer

Abstract

Debates have always been around the superiority of radical surgery or definitive concurrent chemoradiotherapy (CCRT) for locally advanced hypopharyngeal cancer. The aim of this study is to retrospectively evaluate clinical outcomes and long-term adverse effects of patients treated in two methods and try to figure out this question.We retrospectively reviewed patients with locally advanced hypopharyngeal squamous cell carcinoma, as stage III-IV, between June 2013 and June 2019 in our hospital, who were treated with radical surgery plus adjuvant radiotherapy (SRT, n = 52) or definitive CCRT (n = 21). The overall survival (OS) and disease-free survival (DFS) were calculated and compared by the Kaplan-Meier method with SPSS 26.0 software, and the long-term adverse effects were compared with the chi-square test between two groups.We finally included 73 patients in this study, among whom 52 received SRT and 21 received CCRT. The 3-year OS rate and DFS rate for all patients (n = 73) were 69.1% and 76.9%, respectively. The 1-year OS rate of the CCRT group was better than the SRT group (95.2% v 84.6%, P = 0.049), while the 1-year DFS rates between two groups were similar. However, the 3-year OS rate of CCRT group was lower than SRT group (57.1% v 72.2%), even though it showed no statistical significance (P = 0.074). Besides, the feeding tube rate and tracheotomy rate after two years were both 23.8% of the CCRT group, which were significantly higher than the SRT (both were 5.8%) (P = 0.039).For patients with locally advanced hypopharyngeal cancer, definitive CCRT has a better OS than radical surgery in a short time, but the advantage shrank as time goes by. This may be related to the long-term adverse effects which are more prevalent during the latter follow-up period in the CCRT group. We need more prospective studies in the future to demonstrate it.