Cancer Res Treat.  2016 Jan;48(1):45-53. 10.4143/crt.2014.340.

Definitive Chemoradiotherapy Versus Surgery Followed by Adjuvant Radiotherapy in Resectable Stage III/IV Hypopharyngeal Cancer

• Kim JW
• Kim MS
• Kim SH
• Kim JH
• Lee CG
• Kim GE
• Keum KC

• KMID: 2152259
• DOI: http://doi.org/10.4143/crt.2014.340

Abstract

PURPOSE
The purpose of this study is to compare the treatment outcomes for locally advanced resectable hypopharyngeal cancer between organ-preserving chemoradiotherapy (CRT) and surgery followed by radiotherapy (SRT).
MATERIALS AND METHODS
We reviewed 91 patients with stage III/IV hypopharyngeal squamous cell carcinoma treated with radiotherapy (RT). In the CRT group (n=34), 18 patients were treated with concurrent CRT and 16 patients with induction chemotherapy plus concurrent CRT. In the SRT group (n=57), six patients were treated with total laryngopharyngectomy, 34 patients with total laryngectomy (TL) and partial pharyngectomy (PP), and 17 patients with PP, which were followed by adjuvant radiotherapy (n=41) or CRT (n=16). The median RT dose was 70 Gy for CRT and 59.4 Gy for SRT.
RESULTS
Five-year local control (84.1% vs. 90.9%), and disease-free survival (DFS, 51.0% vs. 52.7%) and overall survival (OS, 58.6% vs. 56.6%) showed no significant difference between the CRT and SRT groups. The functional larynx-preservation rate was higher in the CRT group (88.2% vs. 29.8%). Treatment-related toxicity, requiring surgical intervention, occurred more frequently in the SRT group (37% vs. 12%). In the SRT group, TL resulted in a significantly higher DFS than larynx-sparing surgery (63.9% vs. 26.5%, p=0.027). Treatment outcome of the SRT group improved when only patients with TL were considered (n=40); however, 5-year OS (67.1% vs. 58.6%, p=0.830) and DFS (63.9% vs. 51.0%, p=0.490) did not improve significantly when compared to the CRT group.
CONCLUSION
Organ preserving CRT provided a treatment outcome that is comparable to SRT for locally advanced hypopharyngeal cancer, while offering an opportunity for functional larynx-preservation and reduced treatment-related toxicity.

Keyword

Hypopharyngeal neoplasms; Chemoradiotherapy; Adjuvant radiotherapy; Treatment outcome; Organ preservation

MeSH Terms

Carcinoma, Squamous Cell
Chemoradiotherapy*
Disease-Free Survival
Humans
Hypopharyngeal Neoplasms*
Induction Chemotherapy
Laryngectomy
Organ Preservation
Pharyngectomy
Radiotherapy
Radiotherapy, Adjuvant*
Treatment Outcome

Figure

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  Fig. 1. Comparison of 5-year disease-free survival (A) and 5-year overall survival (B) between the surgery followed by radiotherapy (SRT) and chemoradiotherapy (CRT) groups; comparison of 5-year disease-free survival (C) and 5-year overall survival (D) between total laryngectomy and larynx-sparing surgery in the SRT group.

Reference

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