Purpose/Objective(s)Since hypopharyngeal cancers have extensive submucosal spread and high risk of nodal involvement, elective nodal irradiation (ENI) including cervical lymph nodes is usually performed in definitive radiation therapy (RT). Therefore most patients complain severe xerostomia after conventional RT over a lifetime. The purpose of this study is to retrospectively assess the treatment outcome of intensity modulated radiation therapy (IMRT) to reduce the salivary function disorder for early hypopharyngeal cancer.Materials/MethodsPatients with clinical stage I/II squamous cell carcinoma of the hypopharynx treated with definitive IMRT between July 2007 and Jan 2014 in our institution were recruited from our database. The staging procedures included physical examination, laryngoscopy, chest X-ray, head and neck computed tomography scan, and/or magnetic resonance imaging. A total of 21 patients were analyzed. Patient characteristics were followings; median age: 64 years (range: 51-79 years), male/female: 21/0, stage I/II: 5/16, Piriform sinus/Postcricoid area/Posterior wall: 18/1/2. The prescribed dose (D95) to the primary and ENI was 66-70 Gy and 54 Gy in 33-35 fractions using simultaneous integrated boost technique. The regional lymph nodes for ENI included bilateral middle and lower cervical lymph nodes. The bilateral retropharyngeal lymph nodes were also included for posterior wall of primary subsite or extension to the posterior wall. The mean dose to the parotid glands was 26 Gy or lower to reduce damage to salivary functions. Chemotherapy was given concurrently with IMRT for 4 patients (cisplatin+5-FU: 2, cisplatin: 1, S-1: 1).ResultsAll patients achieved complete response (CR) after IMRT and CR rate was 100%. Two patients experienced a recurrence after CR. One patient with local and neck lymph node recurrence were treated successfully with salvage surgery. Another one patient with superficial local recurrence was treated with endoscopic mucosal resection. With a median follow-up duration of 42 months (range: 9-91 months), 3-year overall and cause-specific survival rates was 72.5% and 95.2%, respectively. These survival rates were comparable with those of previous reports of conventional radiation therapy. The 3-year local control rate was 89.6% and 3-year larynx-preservation survival rate was 72.5%. With regard to xerostomia (CTCAE v4.0), Grade 0 and Grade 1 were observed in 10 patients and 11 patients, respectively. There were no patients complained ≧Grade 2 xerostomia. Grade 3 pharyngeal ulceration was observed in 1 patient.ConclusionIMRT for early hypopharyngeal cancer achieved excellent salivary functions with favorable larynx preservation and acceptable toxicities. Purpose/Objective(s)Since hypopharyngeal cancers have extensive submucosal spread and high risk of nodal involvement, elective nodal irradiation (ENI) including cervical lymph nodes is usually performed in definitive radiation therapy (RT). Therefore most patients complain severe xerostomia after conventional RT over a lifetime. The purpose of this study is to retrospectively assess the treatment outcome of intensity modulated radiation therapy (IMRT) to reduce the salivary function disorder for early hypopharyngeal cancer. Since hypopharyngeal cancers have extensive submucosal spread and high risk of nodal involvement, elective nodal irradiation (ENI) including cervical lymph nodes is usually performed in definitive radiation therapy (RT). Therefore most patients complain severe xerostomia after conventional RT over a lifetime. The purpose of this study is to retrospectively assess the treatment outcome of intensity modulated radiation therapy (IMRT) to reduce the salivary function disorder for early hypopharyngeal cancer. Materials/MethodsPatients with clinical stage I/II squamous cell carcinoma of the hypopharynx treated with definitive IMRT between July 2007 and Jan 2014 in our institution were recruited from our database. The staging procedures included physical examination, laryngoscopy, chest X-ray, head and neck computed tomography scan, and/or magnetic resonance imaging. A total of 21 patients were analyzed. Patient characteristics were followings; median age: 64 years (range: 51-79 years), male/female: 21/0, stage I/II: 5/16, Piriform sinus/Postcricoid area/Posterior wall: 18/1/2. The prescribed dose (D95) to the primary and ENI was 66-70 Gy and 54 Gy in 33-35 fractions using simultaneous integrated boost technique. The regional lymph nodes for ENI included bilateral middle and lower cervical lymph nodes. The bilateral retropharyngeal lymph nodes were also included for posterior wall of primary subsite or extension to the posterior wall. The mean dose to the parotid glands was 26 Gy or lower to reduce damage to salivary functions. Chemotherapy was given concurrently with IMRT for 4 patients (cisplatin+5-FU: 2, cisplatin: 1, S-1: 1). Patients with clinical stage I/II squamous cell carcinoma of the hypopharynx treated with definitive IMRT between July 2007 and Jan 2014 in our institution were recruited from our database. The staging procedures included physical examination, laryngoscopy, chest X-ray, head and neck computed tomography scan, and/or magnetic resonance imaging. A total of 21 patients were analyzed. Patient characteristics were followings; median age: 64 years (range: 51-79 years), male/female: 21/0, stage I/II: 5/16, Piriform sinus/Postcricoid area/Posterior wall: 18/1/2. The prescribed dose (D95) to the primary and ENI was 66-70 Gy and 54 Gy in 33-35 fractions using simultaneous integrated boost technique. The regional lymph nodes for ENI included bilateral middle and lower cervical lymph nodes. The bilateral retropharyngeal lymph nodes were also included for posterior wall of primary subsite or extension to the posterior wall. The mean dose to the parotid glands was 26 Gy or lower to reduce damage to salivary functions. Chemotherapy was given concurrently with IMRT for 4 patients (cisplatin+5-FU: 2, cisplatin: 1, S-1: 1). ResultsAll patients achieved complete response (CR) after IMRT and CR rate was 100%. Two patients experienced a recurrence after CR. One patient with local and neck lymph node recurrence were treated successfully with salvage surgery. Another one patient with superficial local recurrence was treated with endoscopic mucosal resection. With a median follow-up duration of 42 months (range: 9-91 months), 3-year overall and cause-specific survival rates was 72.5% and 95.2%, respectively. These survival rates were comparable with those of previous reports of conventional radiation therapy. The 3-year local control rate was 89.6% and 3-year larynx-preservation survival rate was 72.5%. With regard to xerostomia (CTCAE v4.0), Grade 0 and Grade 1 were observed in 10 patients and 11 patients, respectively. There were no patients complained ≧Grade 2 xerostomia. Grade 3 pharyngeal ulceration was observed in 1 patient. All patients achieved complete response (CR) after IMRT and CR rate was 100%. Two patients experienced a recurrence after CR. One patient with local and neck lymph node recurrence were treated successfully with salvage surgery. Another one patient with superficial local recurrence was treated with endoscopic mucosal resection. With a median follow-up duration of 42 months (range: 9-91 months), 3-year overall and cause-specific survival rates was 72.5% and 95.2%, respectively. These survival rates were comparable with those of previous reports of conventional radiation therapy. The 3-year local control rate was 89.6% and 3-year larynx-preservation survival rate was 72.5%. With regard to xerostomia (CTCAE v4.0), Grade 0 and Grade 1 were observed in 10 patients and 11 patients, respectively. There were no patients complained ≧Grade 2 xerostomia. Grade 3 pharyngeal ulceration was observed in 1 patient. ConclusionIMRT for early hypopharyngeal cancer achieved excellent salivary functions with favorable larynx preservation and acceptable toxicities. IMRT for early hypopharyngeal cancer achieved excellent salivary functions with favorable larynx preservation and acceptable toxicities.