Radiotherapy alone or combined with neck dissection for T1− T2 carcinoma of the pyriform sinus: An alternative to conservation surgery

Abstract

Purpose : We present our experience with irradiation alone or combined with neck dissection for AJCC T 1− T 2 pyriform sinus carcinoma and compare our results to those obtained with conservation surgery. Methods and Materials : Seventy-three patients were treated between 1964 and 1990. All patients had a minimum of 2 years of follow-up; no patient was lost to follow-up. Results : The 5-year rates of local control and ultimate local control were, for Stage T 1 (17 patients), 88% and 94%; and for Stage T 2 (56 patients), 79% and 91%. Patients with T 2 lesions had a significantly higher rate of local control after twice-daily, compared with once-daily, irradiation ( p = .04). However, a multivariate analysis of various parameters revealed that none of the variables tested significantly influenced this end point: vocal cord mobility ( p = .15), once- vs. twice-daily fractionation ( p = .33), T 1 vs. T 2 ( p = .32), apex invasion ( p = .58), and pretreatment CT scan ( p = .67). Local control with laryngeal voice preservation was obtained in 88% of patients with T 1 cancers and 80% of those with T 2 cancers. Ultimate control above the clavicles at 5 years according to AJCC stage was as follows: I and II, 100%; III, 78%; IVA, 75%; and IVB, 60%. The probability of cause-specific survival at 5 years was as follows: I and II, 100%; III, 83%; and IVA and IVB, 51%. Overall, nine patients (12%) developed severe complications, one of which was fatal. Conclusion : Compared with available data from series using conservation surgery, radiotherapy alone or followed by neck dissection results in similar rates of local control and survival with a significantly lower risk of fatal complications.