Treatment results for hypopharyngeal cancer by different treatment strategies and its secondary primary- an experience in Taiwan

Morgan Fu-Ti Chang,Kang-Hsing Fang,Eric Yen-Chao Chen,Joseph Tung-Chieh Chang,Shiang-Fu Huang,Chung-Jan Kang,Chien-Yu Lin,Chun-Ta Liao,I-How Chen,Hung-Ming Wang

doi:10.1186/1748-717x-5-91

Abstract

PurposeThe aim of this study was to evaluate treatment results in our hypopharyngeal cancer patients.Patients and MethodsA total of three hundred and ninety five hypopharyngeal cancer patients received radical treatment at our hospital; 96% were male. The majority were habitual smokers (88%), alcohol drinkers (73%) and/or betel quid chewers (51%). All patients received a CT scan or MRI for tumor staging before treatment. The stage distribution was stage I: 2 (0.5%); stage II: 22 (5.6%); stage III: 57 (14.4%) and stage IV: 314 (79.5%). Radical surgery was used first in 81 patients (20.5%), and the remaining patients (79.5%) received organ preservation-intended treatment (OPIT). In the OPIT group, 46 patients received radiotherapy alone, 156 patients received chemotherapy followed by radiotherapy (CT/RT) and 112 patients received concomitant chemo-radiotherapy (CCRT).ResultsThe five-year overall survival rates for stages I/II, III and IV were 49.5%, 47.4% and 18.6%, respectively. There was no significant difference in overall and disease-specific survival rates between patients who received radical surgery first and those who received OPIT. In the OPIT group, CCRT tended to preserve the larynx better (p = 0.088), with three-year larynx preservation rates of 44.8% for CCRT and 27.2% for CT/RT. Thirty-seven patients developed a second malignancy, with an annual incidence of 4.6%.ConclusionsThere was no survival difference between OPIT and radical surgery in hypopharyngeal cancer patients at our hospital. CCRT may offer better laryngeal preservation than RT alone or CT/RT. However, prospective studies are still needed to confirm this finding. Additionally, second primary cancers are another important issue for hypopharyngeal cancer management.

Highlights

Patients with carcinoma of the hypopharynx frequently have advanced disease at the time of presentation
There was no significant difference in overall and disease-specific survival rates between patients who received radical surgery first and those who received organ preservation-intended treatment (OPIT)
Growing evidence suggests that concomitant chemoradiotherapy (CCRT) may improve loco-regional tumor control in locally advanced head and neck cancers and, more importantly, improve survival rates compared with the sequential regimen or radiotherapy alone [14,15]

Summary

Introduction

Patients with carcinoma of the hypopharynx frequently have advanced disease at the time of presentation. Two phase III trials [11,12] of sequential chemotherapy and radiotherapy for resectable laryngeal or hypopharyngeal cancer revealed survival rates similar to those achieved with surgery and post-operative irradiation, but the larynx was preserved for many patients in the former group. A meta-analysis [13] of six trials comparing induction chemotherapy and radiotherapy with alternating or concomitant chemoradiotherapy (CCRT) revealed a hazard ratio of 0.91 (0.79-1.06) in favor of the latter. This analysis showed a five-year survival benefit of 32%- 40% when chemotherapy was added concomitantly to radiotherapy. Growing evidence suggests that CCRT may improve loco-regional tumor control in locally advanced head and neck cancers and, more importantly, improve survival rates compared with the sequential regimen or radiotherapy alone [14,15]

Objectives

Methods

Results

Conclusion