Abstract
Laryngeal preservation strategies for resectable locally advanced hypopharyngeal carcinoma (LAHPC) have been explored. However, the optimal strategy remains unclear. To evaluate a response-adapted strategy based on an early response to radiotherapy (RT) in patients with resectable LAHPC. This cohort study was conducted from May 2009 to October 2019 with a median (IQR) follow-up period of 66.5 (44.7-97.0) months. The study was conducted at a tertiary academic medical center and included 423 patients pathologically confirmed stage III and IVB LAHPC. A total of 250 patients with previous cancer history, synchronous primary cancer, stage I or II, or with unresectable hypopharyngeal carcinoma were excluded. Patients who reached 80% or greater tumor regression when evaluated endoscopically and by imaging methods at 50 Gy received definitive RT or concurrent chemoradiotherapy, and those with less than 80% regression underwent surgery 4 to 6 weeks after RT. Five-year overall survival and survival with a functional larynx. Overall, 423 patients were included in the study (median [IQR] age, 55 [50-63] years; 408 [96.5%] men and 15 [3.5%] women). The response-adapted and primary surgery groups had significantly better survival than the primary RT group (52.7% and 54.4% vs 27.7%, respectively; P < .001). The response-adapted and primary surgery groups had similar 5-year overall survival of 52.7% vs 54.4%, respectively (hazard ratio [HR], 1.02; 95% CI, 0.75 to 1.39; P = .89). The response-adapted group had better 5-year survival with functional larynx than the primary surgery group (40.6% vs 33.9%; HR, 0.64; 95% CI, 0.49 to 0.84, P = .001). Surgery complications did not significantly differ between the 2 groups. Among patients in the response-adapted group who required total laryngectomy (n = 186) as indicated by pretreatment evaluation, the 5-year cumulative Kaplan-Meier survival with functional larynx was 39.8%. In this cohort study, the response-adapted strategy based on an early RT response facilitated better treatment tailoring, maximum tumor control, and higher laryngeal preservation compared with primary surgery and primary RT strategies. This approach could provide a feasible laryngeal preservation strategy in patients with LAHPC.
Highlights
Hypopharyngeal carcinoma (HPC) has one of the poorest prognoses of head and neck squamous cell carcinomas.[1,2] Considering its prognosis and the adjacent functional structures in affected patients, survival and organ preservation are both important in patients with HPC.[3,4] For early-stage HPC, surgery or radiotherapy (RT) can both result in a favorable prognosis
The response-adapted and primary surgery groups had similar 5-year overall survival of 52.7% vs 54.4%, respectively
Among patients in the response-adapted group who required total laryngectomy (n = 186) as indicated by pretreatment evaluation, the 5-year cumulative Kaplan-Meier survival with functional larynx was 39.8%. In this cohort study, the response-adapted strategy based on an early RT response facilitated better treatment tailoring, maximum tumor control, and higher laryngeal preservation compared with primary surgery and primary RT strategies
Summary
Hypopharyngeal carcinoma (HPC) has one of the poorest prognoses of head and neck squamous cell carcinomas.[1,2] Considering its prognosis and the adjacent functional structures in affected patients, survival and organ preservation are both important in patients with HPC.[3,4] For early-stage HPC, surgery or radiotherapy (RT) can both result in a favorable prognosis. The treatment of locally advanced hypopharyngeal carcinoma (LAHPC) remains challenging, with a reported 5-year overall survival (OS) rate of 30% to 40% and most patients requiring total laryngectomy.[5,6,7] Since the 1980s, many studies[7,8,9,10,11,12,13,14,15,16,17,18] have attempted to explore laryngeal-preservation strategies in patients with locally advanced laryngeal cancer and LAHPC. 2 laryngeal-preservation approaches have been established: (1) induction chemotherapy (IC) followed by RT or concurrent chemoradiotherapy (CCRT) and (2) CCRT
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