Cases Of Hypopharyngeal Cancer Research Articles

Efficacy and safety of boron neutron capture therapy for Hypopharyngeal/Laryngeal cancer patients with previous head and neck irradiation

Background and purposePatients with hypopharyngeal cancer (HPC)/laryngeal cancer (LCA) with a history of head and neck irradiation are often difficult to treat with conventional radiotherapy. This study aimed to clarify the efficacy and safety of boron neutron capture therapy (BNCT) for HPC/LCA. Materials and methodsIn this retrospective study, HPC/LCA with local lesions were analyzed, including both recurrent cases after treatment and second primary cases. The primary endpoints were tumor response and incidence of adverse events (AEs) after BNCT. The secondary endpoints were local control (LC), progression-free survival (PFS), and overall survival (OS). Evaluation of tumor response was terminated when any additional treatment was administered, and only survival data were collected. ResultsThe analysis included 25 and 11 cases of HPC and LCA, respectively. All had a history of head and neck irradiation, and median dose of prior radiotherapy was 70 Gy. The complete response (CR) rate was 72%, overall response rate was 84%, and the 1-year LC and PFS were 63.1% and 53.7%, respectively. The median survival time was 15.5 months, and the 2-year OS was 79.8%. Of the 27 patients with CR, 11 cases recurred at a median of 6.0 months. The acute G3 AEs were oral mucositis (6%), pharyngeal mucositis (3%), and soft tissue infection (3%). Acutely, there were no G4-5 AEs, except hyperamylasemia, and in the late phase, there were no G3 or higher AEs. ConclusionBNCT can be achieve good tumor response while preserving the larynx without severe AEs.

Extra-Capsular Spread of Lymph Node Metastasis in Oral, Oropharyngeal and Hypopharyngeal Cancer: A Comparative Subsite Analysis

Background: The extra-capsular spread (ECS) of lymph node metastasis (LNM) is a hallmark of aggressive primary tumor phenotype in head and neck cancer (HNC); however, the factors influencing ECS are poorly understood. Patients and Methods: This was a retrospective study, including 190 cases of oral tongue cancer (OTC), 148 cases of oropharyngeal cancer (OPC) (118 HPV-positive and 30 HPV-negative), and 100 cases of hypopharyngeal cancer (HPC). Tumor dimension, tumor biological variables (lymphovascular/perineural invasion and histologic grade), and LNM variables (LNM number and size) were analyzed according to the presence of ECS using multivariable logistic regression and receiver operating characteristic (ROC) curve analyses. Results: LNM variables were significant factors for ECS in all subsites of HNC (p < 0.05), except HPV-positive OPC. In OTC, tumor dimensional variables were significantly related to ECS (p < 0.01). Meanwhile, in OPC and HPC, neither the primary tumor dimension nor the T status were significant factors for ECS occurrence. The predictability of ECS by ROC curve using multiple variables was 0.819 [95% confidence interval: 0.759–0.878] in OTC, 0.687 [0.559–0.815] in HPV-positive OPC, 0.823 [0.642–1.000] in HPV-negative OPC, and 0.907 [0.841–0.973] in HPC. Conclusion: LNM variables were correlated with ECS occurrence for most HNC subsites, and site-dependent primary tumor characteristics might contribute differentially to the ECS development of LNM in HNC.

Bioengineering of a tumour-stroma 3D-tumouroid co-culture model of hypopharyngeal cancer.

Head and neck cancer (HNC) differs at anatomical sites and hypopharyngeal cancer (HPC) is a type of HNC. The non-surgical treatment option for advanced cases of HPC is radiotherapy (RT) with or without chemotherapy but survival is poor. Thus, new treatment approaches in combination with RT are essential. Yet, obtaining post-RT treated tumour specimens and lack of animal models with identical anatomical sites are the major translational research barriers. To overcome these barriers, for the first time, we have developed a tumour-stroma based in vitro three-dimensional (3D)-tumouroid co-culture model of HPC by growing FaDu and HS-5 cells together to mimic the complex tumour-microenvironment in a Petri dish. Before growing the cells together, imaging flow cytometry revealed distinct epithelial and non-epithelial characteristics of the cells. Growth rate of the 3D-tumouroid co-culture was significantly higher compared to the tumouroid monoculture of FaDu. Histology and morphometric analysis were done for the characterisation as well as the development of hypoxia was measured by CAIX immunostaining in this 3D-tumouroid co-culture. Taken together, this innovative in vitro 3D model of HPC resembles many features of the original tumour. The wider application of this pre-clinical research tool is in understanding newer combination (e.g. immunotherapy) treatment approaches with RT in HPC and beyond.

Mitoxantrone hydrochloride liposome injection in the treatment of recurrent/metastatic head and neck cancers: A multicenter, open-label, single-arm, phase Ⅰb study.

e18028 Background: Mitoxantrone is an anthraquinone antibiotic antitumor agent, and mitoxantrone hydrochloride liposomes have been approved for the treatment of relapsed or refractory peripheral T-cell lymphoma (PTCL) in China. The current study aimed to evaluate the safety and efficacy of mitoxantrone hydrochloride liposome in patients (pts) with recurrent/metastatic head and neck cancers. Methods: This study is a multicenter, open-label, single-arm, phase Ⅰb study. The pts with histologically confirmed diagnosis of head and neck squamous cell carcinoma (including nasopharyngeal carcinoma) were enrolled. Mitoxantrone hydrochloride liposome was administered at 20 mg/m2 by an intravenous infusion, every 21 days (q3w, 1 cycle) until disease progression, intolerable toxic reaction, death, or withdrawal by investigator or patient decision (a maximum of 8 cycles). The primary objective was to determine the safety of mitoxantrone hydrochloride liposome. Secondary objective was to assess the efficacy of mitoxantrone hydrochloride liposome in the treatment of recurrent/metastatic head and neck squamous cell carcinoma. Efficacy assessment was performed every 2 cycles after dosing as per RECIST v1.1. Results: From July 8, 2021 through November 5, 2021, 34 pts with median age of 48 years (range 20-69 years) were enrolled, including 23 with nasopharyngeal cancer and 11 with non-nasopharyngeal cancer (5 with tongue cancer, 2 with hypopharynx, 2 with tonsil cancer, and 1 each with larynx and gum cancer). The most common treatment-emergent adverse events (TEAEs) were white blood cell decreased (41.2%), anemia (41.2%) and lymphocyte count decreased (29.4%). TEAEs were generally Grade (G) 1-2; 13 pts reported G3 TEAE. The summary of all-grade TEAEs (≥ 10%) are shown in the table below. Nineteen pts had undergone at least 1 efficacy evaluation (including 18 pts with nasopharyngeal cancer and 1 with non-nasopharyngeal cancer). The overall objective response rate (ORR) was 42.1% (8/19) and disease control rate (DCR) was 78.9% (15/19). ORR for nasopharyngeal cancer was 38.9% (7/18) and DCR was 77.8% (14/18). One case of hypopharyngeal cancer was evaluated as partial remission (PR). Conclusions: The preliminary data of mitoxantrone hydrochloride liposome has showed manageable safety and evidence of efficacy in pts with recurrent/metastatic head and neck squamous cell carcinoma. An expanded sample size is still needed for further validation in the future study. Clinical trial information: NCT04902027. [Table: see text]

Transoral videolaryngoscopic surgery for laryngeal and hypopharyngeal cancer―Technical updates and long-term results

Abstract Objective Transoral videolaryngoscopic surgery (TOVS) was developed as a non-robotic procedure for en bloc laryngo-hypopharyngeal cancer resection. Straight devices had been used for this procedure, however, some cases had difficulty to reach the lesions especially in hypopharyngeal area. To overcome this problem, technical updates to facilitate transoral manipulation were developed and long term oncological and functional results were analyzed. Methods Surgical indications were Tis, T1, T2 and selected T3 cases. In advanced T3 or T4 lesions, neoadjuvant chemotherapy was performed before surgery. Radiation failure cases (rT1 and rT2) were also indicated for TOVS. Resectable nodal involvement can be managed by combination of neck dissection. Ninety hypopharyngeal and 25 supraglottic cancer cases were retrospectively reviewed for survival analyses. In fresh hypopharyngeal cancer, 51 Stage 0–II disease and 32 Stage III-IV disease were included. In supraglottic cancer, 11 Stage I–II disease and 9 Stage III-IV disease were included. Twelve radiation failure cases were analyzed separately. As new devices, malleable forceps and malleable suction coagulator were introduced to reach the whole laryngo-hypopharynx. New curved blades for the FKWO retractor were developed and these were applied for difficult hypopharyngeal exposure cases by conventional blades. Swallowing functional outcome and risk factors for postoperative dysphagia were evaluated by univariate analysis. Results The 5-year overall survival, disease-specific survival and larynx preservation rate of fresh hypopharyngeal cancer cases were 83.2%, 94.3% and 94.6%, respectively. Those of supraglottic cancer cases were 80%, 95% and 94.7%, respectively. Those of salvage cases were 87.5%, 87.5% and 82.5%, respectively. Those of T3 and T4 hypopharyngeal cancer treated by neoadjuvant chemotherapy with TOVS were 75.0%, 82.5% and 100% respectively. Surgical complication included bleeding (2.6%) and emergency tracheostomy (3.4%). Oral intake was maintained in 94.8% cases. By univariate analysis, patient’s age (especially 80 years of age or older), larger resected area, arytenoid resection and tracheostomy were regarded as risk factors for postoperative dysphagia. Among 31 recent cases, 5 cases had difficulty in exposing hypopharyngeal lesions by conventional blades. These exposure problems were solved by curved blades. Conclusion Using malleable devices and new curved blades for the FKWO retractor, exposure problems in the hypopharynx could be solved and TOVS could be applied in more cases. Although oncological outcomes and functional outcomes were good, patients with risk factors for dysphagia should be carefully indicated.

Tumor dimension-dependent microscopic extensions of hypopharyngeal cancer: Therapeutic implications for larynx-preserving hypopharyngectomy.

Hypopharyngeal cancer (HPC) is well characterized by the early submucosal spread of cancer cells into adjacent subsites of the hypopharynx and deep tissues, advocating a wide extent of treatment. However, the microscopic extensions (ME) from gross tumors, according to the primary tumor dimensions, has not been reported in detail. We included patients who underwent upfront curative surgery, and retrospectively reviewed pathology specimens from 45 HPC cases. The distance of the MEs, defined as tumor infiltration beyond the gross tumor border on the submucosal and deep sides, was measured. We analyzed potential correlations between MEs and various physical tumor factors. A rough linear correlation between the submucosal ME and the maximal diameter of tumors was found (p < .001, r2 = 0.225). Deep MEs did not correlate with tumor physical factors. However, the MEs differed significantly by the T status (p = .033 and .015 in submucosal and deep sides). In T1-2 tumors, the submucosal MEs were less than 0.5 cm, whereas those of T3-4 tumors were 1.5-2.0 cm. In HPC, local MEs beyond the gross tumor border correlated with primary tumor T status. Our findings support that the surgical safety margin for HPC can be adjusted according to tumor dimension.

A case of hypopharyngeal cancer with intractable tracheoesophageal fistula after the removal of Provox®

A case of hypopharyngeal cancer with intractable tracheoesophageal fistula after the removal of Provox^®

A Case of Hypopharyngeal Cancer with Suspected Carotid Sinus Syndrome

A Case of Hypopharyngeal Cancer with Suspected Carotid Sinus Syndrome

Results of pretreatment swallowing evaluation in patients with stage III/IV laryngeal and hypopharyngeal carcinoma.

Laryngeal and hypopharyngeal carcinoma are among the common head and neck cancers causing considerable swallowing dysfunction. The functional status of the organ (larynx) is an important point of contention while considering the patients for organ preservation protocol. The aim of this retrospective study was to assess the swallowing status in stage III/IV laryngeal and hypopharyngeal carcinoma and its influence on treatment decision. We evaluated all treatment naïve patients who were referred to the swallowing clinic in 2017 (Jan-Dec) for assessment of swallowing prior to treatment initiation. One hundred patients satisfied the eligibility criteria and were included in the study. The site and stage of laryngeal and hypopharyngeal cancer cases were almost equal in number. Their median age was 58years. Fiberoptic endoscopic evaluation of swallowing (FEES) was done in all patients. 30% of the patients only had swallowing difficulties. Only advanced T-stage (p = 0.04) had an influence on the pretreatment swallowing status. Thirty-seven patients required nasogastric tube (NGT) for feeding. By 2month post-treatment completion, most patients on NGT could resume oral feeding. Pretreatment swallowing assessment alone did not significantly seem to influence our decisions for organ preservation treatment. However, patients with aspiration could be identified and managed appropriately. Most patients on NGT could resume oral feeds post-treatment completion.

"Point line anterograde dissection" for the safe preparation of supraclavicular flap

Objective: To investigate the application in the preparation of supraclavicular island flap by "point line anterograde dissection (PLAD) ". Methods: A retrospective analysis was performed on 45 flaps of 43 patients treated with supraclavicular artery island flap from the Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital Affiliated to Capital Medical University from January 2013 to June 2019. The patients were all male, aged 35-72 years old. There were 26 cases of hypopharyngeal cancer, 4 cases of recurrent laryngeal cancer, 2 cases of cervical esophageal cancer, 1 case of tonsillar cancer, 1 case of parotid gland cancer, 3 cases of postoperative pharyngeal fistula after hypopharyngeal cancer, 2 cases of esophageal fistula after trauma, 2 cases of esophageal stricture after hypopharyngeal carcinoma operation, 1 case of autoimmune laryngeal stenosis, and 1 case of cheek defect after maxillary sinus cancer operation."Point" was the origin of the supraclavicular artery in the transverse carotid artery. "Line" was an extension line made along the starting point of the supraclavicular vessel for anterograde anatomy of 1-2 cm and the direction of the blood vessel. The extension line was used as the central axis of the designed island flap. Characteristics of flap blood supply, the time of flap preparation, flap survival, donor area recovery and clinical follow-up were recorded. Results: The arterial blood supply of the flap was constant, and the venous reflux was variable. The area of the prepared flap was (4-8) cm×(10-18) cm, and the preparation time was 30-60 min, with a median of 42 min. Skin flap survival rate was 100%. Partial necrosis of skin flap occurred in 1 patient and postoperative pharyngeal fistula occurred in 5 patients, all of whom were cured by dressing change. The donor site defects were closed and sutured directly. 3 patients had partial incision dehiscence and healed after dressing change. During the follow-up, 1 patient was lost, and the remaining 42 patients were followed up for 8 to 55 months.40 patients involved swallowing function, all of them returned to regular diet or soft fluid after operation.40 patients involved malignant tumors and local tumor recurrence in 3 patients among whom, there were 2 cases of lymph node recurrence, and 2 cases of distant metastasis, including 1 case of lung metastasis and 1 case of bone metastasis. Conclusion: PLAD is a simple, safe and efficient method for the preparation of supraclavicular island flap.

Transoral videolaryngoscopic surgery for laryngeal and hypopharyngeal cancer — Technical updates and long-term results

ObjectiveTransoral videolaryngoscopic surgery (TOVS) was developed as a non-robotic procedure for en bloc laryngo-hypopharyngeal cancer resection. Straight devices had been used for this procedure, however, some cases had difficulty to reach the lesions especially in hypopharyngeal area. To overcome this problem, technical updates to facilitate transoral manipulation were developed and long term oncological and functional results were analyzed. MethodsSurgical indications were Tis, T1, T2 and selected T3 cases. In advanced T3 or T4 lesions, neoadjuvant chemotherapy was performed before surgery. Radiation failure cases (rT1 and rT2) were also indicated for TOVS. Resectable nodal involvement can be managed by combination of neck dissection. Ninety hypopharyngeal and 25 supraglottic cancer cases were retrospectively reviewed for survival analyses. In fresh hypopharyngeal cancer, 51 Stage 0–II disease and 32 Stage III-IV disease were included. In supraglottic cancer, 11 Stage I–II disease and 9 Stage III-IV disease were included. Twelve radiation failure cases were analyzed separately. As new devices, malleable forceps and malleable suction coagulator were introduced to reach the whole laryngo-hypopharynx. New curved blades for the FKWO retractor were developed and these were applied for difficult hypopharyngeal exposure cases by conventional blades. Swallowing functional outcome and risk factors for postoperative dysphagia were evaluated by univariate analysis. ResultsThe 5-year overall survival, disease-specific survival and larynx preservation rate of fresh hypopharyngeal cancer cases were 83.2%, 94.3% and 94.6%, respectively. Those of supraglottic cancer cases were 80%, 95% and 94.7%, respectively. Those of salvage cases were 87.5%, 87.5% and 82.5%, respectively. Those of T3 and T4 hypopharyngeal cancer treated by neoadjuvant chemotherapy with TOVS were 75.0%, 82.5% and 100% respectively.Surgical complication included bleeding (2.6%) and emergency tracheostomy (3.4%). Oral intake was maintained in 94.8% cases. By univariate analysis, patient’s age (especially 80 years of age or older), larger resected area, arytenoid resection and tracheostomy were regarded as risk factors for postoperative dysphagia.Among 31 recent cases, 5 cases had difficulty in exposing hypopharyngeal lesions by conventional blades. These exposure problems were solved by curved blades. ConclusionUsing malleable devices and new curved blades for the FKWO retractor, exposure problems in the hypopharynx could be solved and TOVS could be applied in more cases. Although oncological outcomes and functional outcomes were good, patients with risk factors for dysphagia should be carefully indicated.

Alcohol consumption, tobacco smoking, betel quid chewing and oral health associations with hypopharyngeal cancer among men in Central South China: a case-control study.

BackgroundHypopharyngeal cancer has relatively high incidence rates in China, especially in high-risk areas. However, data on the role of major risk factors in these areas of China are still limited.MethodsWe have evaluated the roles of alcohol, tobacco and betel quid consumption, and oral health, based on 278 hypopharyngeal cancer cases and 693 controls from two centers in Central South China. The odds ratio (OR) and 95% confidence interval (CI) values were estimated using logistic regression.ResultsWe found that alcohol drinkers had a risk of hypopharyngeal cancer that was up to seven times higher than that for those who had never drunk. A very strong effect of traditional liquor as compared to other alcohol types was observed, with the OR reaching 11.26 (CI 6.53–19.41) for this cancer. Tobacco smokers were up to four times more likely to develop hypopharyngeal cancer than never smokers. The OR for betel quid chewing was 1.86 (CI 1.26–2.75) as compared to never users. Poor oral hygiene had a risk of hypopharyngeal cancer that was two times higher than that for normal oral hygiene.ConclusionIn this study, we have shown for what is believed to be the first time the association of increased hypopharyngeal cancer incidence with alcohol, tobacco, betel quid and oral hygiene in China. Alcohol may play a larger role for hypopharyngeal cancer in this population than in populations in other areas.

Clinical outcomes for 61 cases of hypopharyngeal cancer with synchronous esophageal cancer.

The aim of this research was to provide data from a single-center study of the treatment of synchronous hypopharyngeal cancer (HPC) and esophageal cancer (EC) with different treatment modalities. A total of 61 patients with synchronous HPC and EC were included in this study. Patients were treated with radiotherapy/chemoradiotherapy (28 cases), surgery (9 cases), palliative radiotherapy and/or chemotherapy (17 cases), or supportive care (7 cases). The median radiotherapy doses for EC and HPC in the radiotherapy/chemoradiotherapy group were 64.5 Gy (range, 0–70) and 70 Gy (range, 60–75.2), respectively. Seven patients in the surgery group received pharyngoesophagectomy with gastric pull-up reconstruction, and two received esophagectomy followed by radiotherapy at the hypopharynx. Cox proportional hazard analysis revealed that the outcome of active treatments, including surgery and radiotherapy/chemoradiotherapy, was better than that of conservative care. In survival analysis, patients in the surgery group tended to have a better 3-year overall survival rate than those in the radiotherapy/chemoradiotherapy group (55.6% vs 30.9%); however, this difference was not statistically different (P = 0.493). The two groups had similar 3-year progression-free survival rates (30.6% and 33.3%, P = 0.420). The current study suggested that radiotherapy/chemoradiotherapy should be considered as an important treatment modality in addition to surgery for synchronous HPC and EC.

Radiomics features analysis of PET images in oropharyngeal and hypopharyngeal cancer.

This study used radiomics image analysis to examine the differences of texture feature values extracted from oropharyngeal and hypopharyngeal cancer positron emission tomography (PET) images on various tumor segmentations, and finds the proper and stable feature groups. A total of 80 oropharyngeal and hypopharyngeal cancer cases were retrospectively recruited. Radiomics method was applied to the PET image for the 80 oropharyngeal and hypopharyngeal cancer cases to extract texture features from various defined metabolic volumes. Kruskal-Wallis one-way analysis of variance method was used to test whether feature value difference exists between groups, which were grouped by stage, response to treatment, and recurrence. If there was a significant difference, the corresponding feature cutoff value was applied to the Kaplan–Meier estimator to estimate the survival functions. For the various defined metabolic volumes, there were 16 features that had significant differences between early (T1, T2) and late tumor stages (T3, T4). Five images and 2 textural features were found to be able to predict the tumor response and recurrence, respectively, with the areas under the receiver operating characteristic curves reaching 0.7. The histogram entropy was found to be a good predictor of overall survival (OS) and primary relapse-free survival (PRFS) of oropharyngeal and hypopharyngeal cancer patients. Textural features from PET images provide predictive and prognostic information in tumor staging, tumor response, recurrence, and have the potential to be a prognosticator for OS and PRFS in oropharyngeal and hypopharyngeal cancer.

Treatment Results of 61 Cases of Hypopharyngeal Cancer with Second Primary Esophageal Cancer

Treatment Results of 61 Cases of Hypopharyngeal Cancer with Second Primary Esophageal Cancer

Occupational exposure to petroleum-based and oxygenated solvents and hypopharyngeal and laryngeal cancer in France: the ICARE study

BackgroundTo examine associations between occupational exposure to petroleum-based and oxygenated solvents and the risk of hypopharyngeal and laryngeal cancer.MethodsICARE is a large, frequency-matched population-based case-control study conducted in France. Lifetime occupational history, tobacco smoking and alcohol consumption were collected. Analyses were restricted to men and included 383 cases of hypopharyngeal cancer, 454 cases of laryngeal cancer, and 2780 controls. Job–exposure matrices were used to assess exposure to five petroleum-based solvents (benzene; gasoline; white spirits; diesel, fuels and kerosene; special petroleum products) and to five oxygenated solvents (alcohols; ketones and esters; ethylene glycol; diethyl ether; tetrahydrofuran). Odds ratios (ORs) adjusted for smoking, alcohol drinking and other potential confounders and 95% confidence intervals (CI) were estimated with unconditional logistic models.ResultsNo significant association was found between hypopharyngeal or laryngeal cancer risk and exposure to the solvents under study. Non-significantly elevated risks of hypopharyngeal cancer were found in men exposed to high cumulative levels of white spirits (OR = 1.46; 95% CI: 0.88–2.43) and tetrahydrofuran (OR = 2.63; 95CI%: 0.55–12.65), with some indication of a dose-response relationship (p for trend: 0.09 and 0.07 respectively).ConclusionThis study provides weak evidence for an association between hypopharyngeal cancer and exposure to white spirits and tetrahydrofuran, and overall does not suggest a substantial role of exposure to petroleum-based or oxygenated solvents in hypopharyngeal or laryngeal cancer risk.

The Role of a Gastroenterologist in Detection of a Hypopharyngeal Cancer: A Case Report

Introduction: Current guidelines do not recommend routine oropharyngeal evaluation on esophagogastroduodenoscopy (EGD). We present a case of hypopharyngeal cancer missed on two consecutive EGDs.Figure: Hypopharyngeal mass as seen during the EGD.Case: A 71-year-old male with history of prostate cancer status post radiation therapy presented with complaints of globus sensation, and gradually worsening dysphagia and odynophagia to solids and liquids for 2 months. He denied food regurgitation, heartburn, hematemesis, melena, allergies, weight loss, smoking or alcohol consumption. An EGD was performed which showed LA grade D esophagitis, small hiatal hernia and a duodenal bulb ulcer. He was started on high dose proton-pump inhibitors. Biopsies were negative for H. pylori. A repeat EGD after 2 months showed good resolution of esophagitis and well healed duodenal ulcers, as well as esophageal biopsies were negative for eosinophilic esophagitis. The patient's dysphagia persisted and further work up with an esophagram and a motility study were unrevealing. A third EGD was performed for attempted impedance evaluation to assess for association of reflux symptoms. Upon insertion of the endoscope in the hypopharynx, a 2cm friable, non-ulcerated hypopharyngeal mass was observed. Results of the biopsies revealed invasive poorly differentiated squamous cell carcinoma. A direct laryngoscopy confirmed the mass was originating from the post-cricoid mucosa, posterior to the arytenoids without arytenoidal mucosal involvement. A PET/CT scan was done and the tumor was classified as T1N0M0. Patient received radiation therapy with resolution of symptoms. Discussion: Hypopharyngeal cancers (HPC) are aggressive with majority diagnosed at advanced AJCC stages III or IV. Diagnosis of HPC at earlier stages might improve survival outcomes. In US, 7 million routine EGDs are performed per year. Oropharyngeal structures are also visible during EGDs. Therefore, EGDs could be a valuable tool in HPC screening, especially in high-risk patients. Currently, there are no guidelines regarding routine evaluation of the oropharyngeal anatomy during EGD. Since prior EGDs had missed the HPC lesion, this case raises several important questions. Should complete visualization of the oropharyngeal structures be part of a routine EGD? Does prolonged oropharyngeal evaluation during EGD raise the aspiration risk? Are there any specific sedation protocols better suited for oropharyngeal evaluation? Further studies are required to answer such questions.

Overview of surgery for laryngeal and hypopharyngeal cancer in Ontario, 2003-2010.

The primary purpose of this study was to describe variations in incidence rates, resections rates, and types of surgical resection for patients diagnosed with laryngeal and hypopharyngeal cancers in Ontario. All laryngeal and hypopharyngeal cancer cases in Ontario (2003-2010) were identified from the Ontario Cancer Registry (n = 3034). Variations in incidence rates, resection rates, and type of surgical resection were compared by sex, age group, neighborhood income, community population, health region, and physician specialty. Incidence rates per 100000 vary significantly by sex, age, neighborhood income, and community size. Women, the elderly (75+ years), those in the higher income quintiles, and those living in larger communities were significantly less likely to receive a laryngectomy procedure. Laryngeal and hypopharyngeal cancer incidence rates vary by sex, age, neighborhood income, community size, and health region. Resection rates vary by age, sex, and health region. These disparities warrant further evaluation to improve the quality of delivered care in Ontario.

Thyroid gland involvement in carcinoma of the hypopharynx

The thyroid gland is removed en bloc during laryngectomy. There are no objective criteria for deciding the extent of thyroid gland resection in primary hypopharyngeal cancer cases. The present study aimed to determine the incidence of thyroid gland involvement in hypopharyngeal cancer and identify the various predictors of this involvement. This paper reports a retrospective analysis of 358 patients with hypopharyngeal cancer, who underwent total laryngectomy with partial or total pharyngectomy at Tata Memorial Hospital, Mumbai between 2004 and 2010. The mean age of this population was 61 years. The pyriform sinus was the most common hypopharyngeal subsite involved (in 89 per cent of cases). Most patients underwent hemi-thyroidectomy as part of their surgery. The thyroid gland was involved in only 13 per cent of cases. Thyroid gland involvement is not common in hypopharyngeal cancer. Cases that involved the post-cricoid area, subglottic extension, extralaryngeal spread or prior tracheostomy were associated with a higher risk of thyroid gland involvement. Ipsilateral thyroidectomy is sufficient in most patients undergoing surgery (laryngectomy with partial or total pharyngectomy) for hypopharyngeal cancers.

Evaluating the significance of level IIb neck dissection for hypopharyngeal cancer

This study evaluated cervical lymph node metastases at level IIb in cases of hypopharyngeal cancer and analyzed the possibility of preservation of level IIb during neck dissection. In total, 34 patients (51 neck sides) with hypopharyngeal cancer that underwent neck dissection from April 2008 to April 2011 were retrospectively analyzed. We evaluated the distribution of metastatic lymph nodes at various levels (particularly level IIb) in cases treated with therapeutic neck dissection and elective neck dissection. The incidence of metastases in level IIb was 13.3% (4 of 30 patients) for therapeutic neck dissection and 0% (0 of 21 patients) for elective neck dissection. All the level IIb metastases were found on the ipsilateral side in the cases treated with therapeutic neck dissection. The results suggest that preservation of level IIb during neck dissection was possible in N0 cases of hypopharyngeal cancer.