Primary Surgery vs Chemoradiation Treatment of Advanced-Stage Hypopharyngeal Squamous Cell Carcinoma.
Harris Brianna N,Biron Vincent L,Donald Paul,Farwell D Gregory,Luu Quang C,Bewley Arnaud F,Chen Allen M,Daly Megan E
JAMA otolaryngology-- head & neck surgery
IMPORTANCE:There is no consensus whether primary surgery followed by either adjuvant radiotherapy (RT) or adjuvant chemoradiation (CRT) or definitive CRT should be the standard treatment approach to advanced-stage hypopharyngeal squamous cell carcinoma (HP SCC). OBJECTIVES:To determine survival outcomes for patients with advanced-stage HP SCC treated at a single institution with either primary surgery plus RT or CRT or definitive CRT. EVIDENCE AND DATA ACQUISITION:We conducted a retrospective analysis of prospectively collected medical records in an institutional database for patients with HP SCC newly diagnosed between January 1999 and April 2013. Overall survival (OS) and recurrence-free survival (RFS) were calculated and compared between treatment groups using the Kaplan-Meier method, with multivariate Cox regression analysis used to control for demographic and clinicopathologic features. RESULTS:We identified 166 consecutively treated patients, 90 of whom did not meet study criteria. Of the 76 included patients, 48 (63%) had undergone definitive CRT, and 28 (37%) had undergone primary surgery with adjuvant RT or CRT. The groups were well balanced by age, smoking history, and alcohol use. Five-year OS and RFS for patients treated surgically were 66.3% and 53.6%, respectively; for patients treated with definitive CRT, OS and RFS were 41.3% and 34.5%, respectively. Multivariate Cox regression analysis showed that surgical management was associated with clinically improved OS (hazard ratio [HR], 4.78; 95% CI, 0.91-25.03; P = .06) and RFS (HR, 2.97; 95% CI, 0.76-11.53; P = .12), although the difference was not statistically significant. CONCLUSIONS AND RELEVANCE:Patients with advanced-stage HP SCC treated surgically with adjuvant RT or CRT showed a trend toward clinically improved OS and RFS compared with patients treated with definitive CRT. However, the difference was not statistically significant, and further investigation with larger controlled trials using modern approaches should be undertaken to optimize the initial management of advanced-stage HP SCC.
[Changing trend in prognosis of primary hypopharyngeal carcinoma and reason analysis: date comparison of 2003-2007 and 2010-2014 in a single centre].
Tao L,Zhou L,Zhang M,Wu H T,Li X M,Chen X L,Li C,Xie M,Cheng L,Heng Y
Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese journal of otorhinolaryngology head and neck surgery
To explore changing trend in prognosis of primary hypopharyngeal carcinoma and to analyze the reasons at the Eye, Ear, Nose and Throat Hospital of Fudan University. We retrospectively analyzed the clinical data of 461 patients with primary hypopharyngeal carcinoma treated at the Eye, Ear, Nose and Throat Hospital of Fudan University from 2003 to 2007 (Group 1) and 2010 to 2014 (Group 2) according to the inclusion criteria. 142 from Group 1, including 133 males and 9 females, rangedfrom 38 to 82 years old and 319 from Group 2, including 313 males and 6 females, ranged from 39 to 81 years old, were included in this work. The laryngeal function preservation rate, survival outcome, application and effect of pre-and post-operative adjuvant therapy were compared. SPSS 24.0 was used for statistical analyses. There were 62 patients with early disease (T1-2N0) including 18 in Group 1 and 44 in Group 2, in whom 3 (16.7%) underwent surgical procedures with laryngeal function preservation in Group 1, while, 30 (68.2%) underwent laryngeal function preservation surgery in Group 2. The laryngeal function preservation rate showed an obviously upward trend in recent years (χ(2)=13.617, 0.001), whereas, the recurrence-free survival rate (RFS) and overall survival rate (OS) showed no significant differences between two groups (0.469 and 0.808, respectively). Among the 399 patients with advanced disease, 124 were in Group 1 and 275 in Group 2. After propensity score matching (PSM) was used, the OS rate was significantly higher for Group 2 than Group 1 (0.017), while the application of laryngeal function preservation surgery was significantly higher in Group 2 (χ(2)=4.686, 0.030). The application rates of preoperative adjuvant therapy and postoperative adjuvant chemotherapy were significantly higher in group 2 than in group 1 (χ(2)=5.687, 0.017; χ(2)=19.407, 0.001). The application of laryngeal function preserving surgery significantly increases the retention rate of laryngeal functions in patients with early-stage hypopharyngeal carcinoma, with similar long-term survival outcomes. The application of comprehensive treatment including preoperative adjuvant therapy and postoperative adjuvant treatments, especially postoperative chemoradiotherapy, shows an obvious increase in the function preservation rate and long-term survival in patients with advanced hypopharyngeal carcinoma.
The impact of elevated C-reactive protein level on the prognosis for oro-hypopharynx cancer patients treated with radiotherapy.
Katano Atsuto,Takahashi Wataru,Yamashita Hideomi,Yamamoto Kentaro,Ando Mizuo,Yoshida Masafumi,Saito Yuki,Abe Osamu,Nakagawa Keiichi
The purpose of this study was to investigate an association between the prognosis for oro-hypopharynx squamous cell carcinoma treated with radiation therapy and the pre-therapeutic level of C-reactive protein (CRP). Patient with oro-hypopharyngeal squamous cell carcinoma who underwent definitive radiotherapy in our institution from January 2002 to August 2016 were enrolled. The patient were divided into elevated CRP (over 0.3 mg/dl) group and normal CRP groups, according to pre-treatment serum levels. There were 276 evaluable patients, and the median follow up was 41 months, ranging from 2 to 171 months. The 3-year OS and CSS for all enrolled patients were 67.0% and 72.8%, respectively. The OS and CSS rates were significantly worse in the elevated CRP group than in the normal CRP group, according to Kaplan-Meier survival curves analysed by a Log-rank test (p = 0.005 and p < 0.001, respectively). Multivariate analyses indicated that serum CRP levels remained independent predictors for both OS (HR: 1.588, p = 0.022) and CSS (HR: 1.989, p = 0.005). The pre-treatment CRP level is an independent predictor of treatment prognosis in patients with oro-hypopharyngeal cancer who underwent definitive radiotherapy. Especially, it is curious that an elevated CRP serum level is a significant predictor of loco-regional recurrence.
Salvage radiotherapy for recurrent hypopharyngeal and laryngeal squamous cell carcinoma (SCC) after first-line treatment with surgery alone: a 10-year single-centre experience.
Akbaba Sati,Held Thomas,Lang Kristin,Hoerner-Rieber Juliane,Zaoui Karim,Forster Tobias,Rieken Stefan,Plinkert Peter,Debus Juergen,Adeberg Sebastian
Radiation oncology (London, England)
PURPOSE:Salvage surgery of recurrent hypopharyngeal and laryngeal squamous cell carcinoma (SCC) results in limited local control and survival rates. As a result of recent technological progress, radiotherapy (RT) has become a valuable, potentially curative therapeutic option. Thus, we aimed to determine prognostic factors for survival outcome in order to optimize patient selection for salvage radiotherapy after failure of first-line treatment with surgery alone in this special patient cohort. METHODS:Seventy-five patients (85% male, median age of 64 years) underwent salvage RT in a secondary setting for recurrent hypopharyngeal or laryngeal SCC after prior surgery alone between 2007 and 2017. On average, patients were treated with one prior surgery (range 1-4 surgeries). Median time between surgery and salvage RT was 7 months (range 1-47 months) for initially advanced tumors (T3/4, N+, extracapsular spread) and 18 months (range 5-333 months) for initially early stage tumors. The majority of patients received concomitant chemotherapy (n = 48; 64%) or other kind of systemic treatment concurrent to radiotherapy (n = 10; 13%). RESULTS:Median follow-up was 41 months (range 3-120 months). Overall, fifteen patients were diagnosed with local failure (all were in-field) at last follow-up (20%). Median time to recurrence was 35 months (range 3-120 months) and 3-year local progression-free survival (LPFS) was 75%, respectively. Dose-escalated RT with 70.4 Gy applied in 2.1 Gy or 2.2 Gy fractions corresponding an EQD2 > 70 Gy (p = 0.032) and the use of concomitant cisplatin weekly chemotherapy (p = 0.006) had a significant positive impact on LPFS. 3-year OS and DPFS were 76 and 85%, respectively. No toxicity-related deaths occurred. Reported grade > 3 side effects were rare (n = 4/70, 6%). CONCLUSION:Salvage radiotherapy resulted in excellent local control rates while radiation dose and the use of cisplatin weekly chemotherapy were identified as prognostic factors for LPFS. Nevertheless, patient selection for curative salvage treatment remains challenging.
Survival differences between definitive radiotherapy and surgery followed by adjuvant radiotherapy in supraglottic and hypopharyngeal carcinoma.
Zhang Min,Gao Xian-Shu,Qin Yong,Sun Yue,Ma Ming-Wei
Chinese medical journal
BACKGROUND:Organ preservation has long been a consideration in the treatment of supraglottic and hypopharyngeal carcinoma to improve the quality of life (QOL). Definitive radiotherapy (DRT) with or without systematic treatment, such as chemotherapy, is always the first choice to achieve improved QOL. This retrospective study focused on the survival differences between DRT and surgery followed by adjuvant radiotherapy (S + RT) in supraglottic and hypopharyngeal carcinoma. METHODS:This study included adult patients with supraglottic or hypopharyngeal carcinoma undergoing single-modality treatment with either DRT or S + RT between January 2012 and August 2016. A total of 59 patients were identified, of whom 31 were treated with DRT, and 28 were treated with S + RT. In the 31 cases of DRT, 23 cases were treated with concurrent chemoradiotherapy (CRT), one case was treated with DRT plus cetuximab, and seven cases were treated with DRT alone. Of the other 28 cases of S + RT, 15 cases were treated with adjuvant concurrent CRT. Survival analysis was used to compare the overall survival (OS), local recurrence-free survival (LRFS) and distant metastasis-free survival (DMFS) between DRT and S + RT groups. RESULTS:The median follow-up was 20 months (range, 4-67 months). The patients of the two groups were similar with respect to mean age, original sites, and tumor stages. The 1-, 2-, and 5-year OS rates were 80.6%, 53.4%, and 24.7% for the DRT group and 85.7%, 67.1%, and 24.7% for the S + RT group, respectively. There was no significant difference between the two groups (χ = 3.183, P = 0.074). The 1-, 2-, and 5-year LRFS and DMFS were 90.4%, 61.7%, and 18.0% and 87.4%, 49.2%, and 9.9%, respectively, and no statistical difference was observed between the two groups (LRFS: χ = 0.028, P = 0.868; DMFS: χ = 3.347, P = 0.067). No significant difference was found between the two groups in acute radiotoxicity. CONCLUSION:Without loss of laryngeal function, the survival of DRT is comparable to that of S + RT in supraglottic and hypopharyngeal carcinoma.
Comparison of different treatment modalities in advanced laryngeal hypopharyngeal squamous cell carcinoma.
Ghaffar Shehzad,Akhtar Shabbir,Ikram Mubasher,Imam Sardar Zakariya,Sepah Yasir Jamal
Journal of the College of Physicians and Surgeons--Pakistan : JCPSP
OBJECTIVE:To compare outcome of patients with advanced laryngeal hypopharyngeal squamous cell carcinoma treated surgically or with chemotherapy and/or radiotherapy. STUDY DESIGN:Observational study. PLACE AND DURATION OF STUDY:The Aga Khan University Hospital, Karachi, from January 2000 to December 2005. METHODOLOGY:Medical records of already treated stage-III and IV squamous cell carcinoma of larynx/hypopharynx patients were reviewed. Group-A comprised of patients treated with surgery +/- adjuvant therapy whereas non-surgically managed patients were labeled as group-B. One hundred and nineteen out of 275 met the inclusion criteria. Kaplan Meier technique was used to estimate mean recurrence time with standard errors. Cox proportional hazard regression was used to estimate the hazard ratio with 95 percent confidence interval for gender, age and tumour location. RESULTS:Sixty two percent of group-A and 49% patients of group-B were stage-III. In group-A, 40% patients received postoperative adjuvant therapy while in group-B, 45% received concomitant chemoradiation. Mean follow-up duration was 18.3 months. Mean recurrence time was 1369+193 days. In group-A, mean recurrence time was 2097+277 days. It was 399+/-68 days for group-B patients (p < 0.001). The hazard ratio of recurrence in hypopharyngeal tumours was 1.5 times (95% CI 0.68, 3.30) as compared to tumours of larynx. The hazard ratio of recurrence was 1.98 times (95% CI 0.99, 3.95) when both larynx and hypopharynx were involved as compared to when tumour was localized to larynx only. No residual disease was noted at the completion of treatment in surgical group-A while 62% patients of the group-B had residual disease at the completion of treatment. Larynx was retained in only 25% patients in group-B. CONCLUSION:Statistically significant difference was noted in disease free outcome when stage-III and IV larynx hypopharynx cancer was managed surgically as compared to non-surgical management. Chances of retaining larynx are only 25% when managed non-surgically.
[Multi-disciplinary treatment increases the survival rate of late stage pharyngeal, laryngeal or cervical esophageal cancers treated by free jejunal flap reconstruction after cancer resection].
Zhu Y M,Zhang H,Ni S,Wang J,Li D Z,Liu S Y
Zhonghua zhong liu za zhi [Chinese journal of oncology]
OBJECTIVE:To investigate the survival status of patients with pharyngeal, laryngeal or cervical esophageal cancers, who received free jejunal flap (FJF) to repair the defects following tumor resection, and to analyze the effect of multi-disciplinary treatment on their survival. METHODS:Fifty-eight patients with pharyngeal, laryngeal or cervical esophageal cancer underwent free jejunal flap (FJF) reconstruction after cancer resection between 2010 and 2013. All their clinical records were reviewed and analyzed. RESULTS:The success rate of flap transplantation was 91.4% (53/58). The 2-year overall survival rates (OSR) of cervical esophageal cancer and hypopharyngeal cancer patients were 67.5% and 49.3%, respectively, both were significantly better than that of laryngeal cancer. The main causes of death were local recurrence and distant metastases. The group with no short-term complications had a better two-year OSR (59.0%) than the group with short-term complications (46.6%), however, the difference between them was not significant (P=0.103). The 2-year survival rate of the initial treatment group was 65.0%, better than that of the salvage treatment group (49.4%), but the difference was not significant (P=0.051). For the stage III and IV patients, the multi-disciplinary treatment group had a significantly better 2-year OSR (64.7%) than the single or sequential treatment group (37.0%, P=0.016). CONCLUSIONS:Free jejunal flap reconstruction is an ideal option for repairing the cervical digestive tract circumferential defects caused by tumor resection with a high success rate and a low mortality. Compared with the single or sequential treatment, multi-disciplinary treatment can significantly improve the survival rate of late-stage hypopharyngeal and cervical esophageal cancer patients.
The prognostic value of preoperative prognostic nutritional index in patients with hypopharyngeal squamous cell carcinoma: a retrospective study.
Ye Lu-Lu,Oei Ronald Wihal,Kong Fang-Fang,Du Cheng-Run,Zhai Rui-Ping,Ji Qing-Hai,Hu Chao-Su,Ying Hong-Mei
Journal of translational medicine
BACKGROUND:To analyze the prognostic value of preoperative prognostic nutritional index (PNI) in predicting the survival outcome of hypopharyngeal squamous cell carcinoma (HPSCC) patients receiving radical surgery. METHODS:From March 2006 to August 2016, 123 eligible HPSCC patients were reviewed. The preoperative PNI was calculated as serum albumin (g/dL) × 10 + total lymphocyte count (mm) × 0.005. These biomarkers were measured within 2 weeks prior to surgery. The impact of preoperative PNI on overall survival (OS), progression-free survival (PFS), locoregional recurrence-free survival (LRFS) and distant metastasis-free survival (DMFS) were analyzed using Kaplan-Meier method and Cox proportional hazards model. RESULTS:Median value of 52.0 for the PNI was selected as the cutoff point. PNI value was then classified into two groups: high PNI (> 52.0) versus low PNI (≤ 52.0). Multivariate analysis showed that high preoperative PNI was an independent prognostic factor for better OS (P = 0.000), PFS (P = 0.001), LRFS (P = 0.005) and DMFS (P = 0.016). CONCLUSIONS:High PNI predicts superior survival in HPSCC patients treated with radical surgery. As easily accessible biomarkers, preoperative PNI together with the conventional TNM staging system can be utilized to enhance the accuracy in predicting survival and determining therapy strategies in these patients.
Different clinical outcomes between locally advanced hypopharyngeal and oropharyngeal cancer treated with definitive concurrent chemoradiotherapy: implication for subgroup selection for induction chemotherapy.
Lim Sung Hee,Lee Su Jin,Ahn Myung-Ju,Park Keunchil,Sun Jong-Mu
Japanese journal of clinical oncology
OBJECTIVE:The purpose of this study is to compare the long-term clinical outcome of hypopharynx cancer and oropharynx cancer treated with concurrent chemoradiotherapy. METHODS:A total of 213 patients with locally advanced hypopharyngeal squamous cell carcinoma (n = 79) or oropharygeal squamous cell carcinoma (n = 134) were included. All patients were treated with upfront concurrent chemoradiotherapy between 1995 and 2012. RESULTS:The median overall survival and progression-free survival differed significantly between the two groups (P < 0.05). Overall survival and progression-free survival rates at 3 years were 52% and 42% for hypopharynx cancer, and 75% and 72% for oropharynx cancer, respectively. There was no significant difference in the overall incidence of distant metastases but more locoregional recurrences occurred in patients with hypopharynx cancer compared with those with oropharynx cancer with a statistical significance (P < 0.001). CONCLUSIONS:Patients diagnosed with locally advanced hypopharyngeal had relatively poor survival after upfront concurrent chemoradiotherapy. More intensive treatment such as induction chemotherapy before concurrent chemoradiotherapy might be needed to improve survival outcome in this subgroup of patients.
Galectin 7 (p53-induced gene 1): a new prognostic predictor of recurrence and survival in stage IV hypopharyngeal cancer.
Saussez Sven,Cucu Diana-Raluca,Decaestecker Christine,Chevalier Dominique,Kaltner Herbert,André Sabine,Wacreniez Agnes,Toubeau Gérard,Camby Isabelle,Gabius Hans-Joachim,Kiss Robert
Annals of surgical oncology
BACKGROUND:Eighty percent of hypopharyngeal squamous cell carcinoma patients have advanced stages (III and IV) of the disease, and biological markers are required to predict high-risk head and neck squamous cell carcinoma patients in need of highly aggressive treatments after surgery to improve the survival rate. We analyzed the potential prognostic value of galectin 7 in a series of 81 stage IV hypopharyngeal SCCs because galectin 7 is an emerging marker involved in the epidermal development of pluristratified epithelia and in epidermal cell migration. METHODS:The immunohistochemical expression of galectin 7 was determined on a series of 81 stage IV hypopharyngeal SCCs and was compared with that of galectins 1 and 3. RESULTS:High levels of galectin 7 expression were associated with rapid recurrence rates and dismal prognoses in these 81 stage IV hypopharyngeal SCCs, a feature not observed with galectin 3 and one observed weakly, if at all, with galectin 1. CONCLUSIONS:These data suggest that the immunohistochemical determination of galectin 7 expression in the case of high-risk hypopharyngeal cancers is a meaningful tool to identify patients who should benefit from aggressive postsurgical adjuvant therapy after surgery, including not only radiotherapy, but also chemotherapy.
Induction chemotherapy-based larynx preservation program for locally advanced hypopharyngeal cancer: oncologic and functional outcomes and prognostic factors.
Bozec Alexandre,Benezery Karen,Ettaiche Marc,Chamorey Emmanuel,Vandersteen Clair,Dassonville Olivier,Poissonnet Gilles,Riss Jean-Christophe,Hannoun-Lévi Jean-Michel,Chand Marie-Eve,Leysalle Axel,Saada Esma,Guigay Joël,Sudaka Anne,Demard François,Santini José,Peyrade Frédéric
European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery
To evaluate oncologic and functional outcomes and prognostic factors in patients with locally advanced hypopharyngeal cancer included in an induction chemotherapy (ICT)-based larynx preservation program in daily clinical practice. All patients with locally advanced (T3/4, N0-3, M0) hypopharyngeal squamous cell carcinoma, technically suitable for total pharyngo-laryngectomy, treated by docetaxel (75 mg/m(2), day 1), cisplatin (75 mg/m(2), day 1) and 5-fluorouracil (750 mg/m(2)/day, day 1-5) (TPF)-ICT (2-3 cycles) for larynx preservation at our institution between 2004 and 2013, were included in this retrospective study. Prognostic factors of oncologic (overall, cause-specific and recurrence-free survival: OS, SS and RFS) and functional (dysphagia outcome and severity scale, permanent enteral nutrition, larynx preservation) outcomes were assessed in univariate and multivariate analyses. A total of 53 patients (42 men and 11 women, mean age 58.6 ± 8.2 years) were included in this study. Grade 3-4 toxicities were experienced by 17 (32 %) patients during ICT. The rate of poor response (response <50 % without larynx remobilization) to ICT was 10 %. At 5 years, OS, SS and RFS rates were 56, 60 and 54 %, respectively. Four patients required definitive enteral nutrition (permanent enteral tube feeding). The rate of patients alive, disease-free and with a functional larynx at 2 years was 58 %. T4 tumor stage (p = 0.005) and response to ICT <50 % (p = 0.02) were independent prognostic factors of OS. Response to ICT was significantly associated with the risk of permanent enteral nutrition (p = 0.04) and larynx preservation (p = 0.01). In daily clinical practice, a TPF-ICT-based larynx preservation protocol can be used in patients with locally advanced hypopharyngeal cancer with satisfactory results in terms of tolerance, efficacy and oncologic and functional outcomes.
[The clinical characteristics and two different treatment outcomes of 321 patients with hypopharyngeal squamous cell carcinoma].
Lu T,Li Z D,Li S C,Li Y G,Liu H W,Jiang L,Huang D N,Wei H M,Liu Z
Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery
To investigate the clinical characteristics, two different treatment outcomes and prognostic factors of hypopharyngeal carcinoma. The life table method was used to calculate the overall survival rates, Log-rank test was used to compare the overall survival rates between the two groups．The Cox proportional hazard model was used to perform the multivariate analysis to confirm independent treatment modalities as prognostic factors. Among the 321 patients, 197 patients received surgery combine with radiotherapy or concurrent chemoradiotherapy treatment（S+R/CRT） and 124 patients received radiotherapy or concurrent chemoradiotherapy treatment(R/CRT). For 321 patients, the 1,3,5year overall survival rates were 75.87%,49.39%,41.38% and the median survival time was 37.65 months. The difference in throat retention ratio between the radiotherapy or concurrent chemoradiotherapy treatment(41.94%) and surgery combine with radiotherapy or concurrent chemoradiotherapy treatment（11.17%) was statistically significant (<0.01).Univariate analysis showed that clinical stage of tumor, T stage, N stage, M stage and two different treatment modalities have impact on survival prognosis. Cox regression multivariate analysis showed that T stage, N stage, two different treatment modalities were independent risk factors of prognosis. The overall prognosis of hypopharyngeal carcinoma was poor and dismal. Hypopharyngeal carcinoma is characterized by high degree of malignancy, difficult to be found early, prone to recurrence and metastasis after operation, large trauma and poor prognosis. Comprehensive examination should be conducted to define the stage of tumor and choose the rational treatment plan before treatment. Surgery combine with radiotherapy or chemotherapy treatment modality is still the main treatment strategy for advanced-stage hypopharyngeal carcinoma..
Outcomes in patients with early-stage hypopharyngeal cancer treated with radiotherapy.
Yoshimura Ryo-ichi,Kagami Yoshikazu,Ito Yoshinori,Asai Masao,Mayahara Hiroshi,Sumi Minako,Itami Jun
International journal of radiation oncology, biology, physics
PURPOSE:To analyze the outcome in patients with early-stage hypopharyngeal cancer (HPC) who were treated with radiotherapy (RT). METHODS AND MATERIALS:Between February 1988 and February 2007, 77 patients with Stage I or Stage II HPC underwent definitive RT in the Division of Radiation Oncology at the National Cancer Center Hospital. Eleven of the patients received local irradiation, and the other 66 patients received elective bilateral neck irradiation and booster irradiation to the primary lesion. The median follow-up period for all the patients was 33 months from the start of RT, ranging from 3 to 229 months. RESULTS:The rates of overall survival, HPC-specific survival, HPC recurrence-free survival, and local control with laryngeal voice preservation for the 77 patients at 5 years were 47%, 74%, 57%, and 70%, respectively. The survival rates were not affected by the patient characteristics or treatment factors, but the RT field was significantly correlated with local control in a multivariate analysis. Seven of the patients had Grade 3 or greater complications, but these complications occurred after salvage surgery in 6 of the patients. Of the 77 patients, 83% had synchronous or metachronous malignancies, but these malignancies did not influence the survival of the patients if the malignancies were detected at an early stage. CONCLUSION:RT is an appropriate treatment method for early-stage HPC. However, because synchronous or metachronous malignancies occur at a relatively high frequency, careful follow-up and the early detection of such malignancies are critical.
Epidemiological assessment and therapeutic response in hypopharyngeal cancer.
Amar Ali,Curioni Otávio Alberto,Paiva Diógenes Lopes de,Rapoport Abrão,Dedivitis Rogério Aparecido,Cernea Claudio Roberto,Brandão Lenine Garcia
Brazilian journal of otorhinolaryngology
UNLABELLED:Despite the low incidence, diagnostic and therapeutic advances, hypopharyngeal cancer still has high mortality. OBJECTIVE:To evaluate retrospectively the epidemiological profile and response to surgery and radiation/chemotherapy of patients with hypopharyngeal cancer. METHOD:We reviewed the medical records of 114 patients treated between 2002 and 2009 in a tertiary hospital with histopathological diagnosis of squamous cell carcinoma. RESULTS:The mean age of the patients was 57 years, 94.7% were males and 5.3% females, 98.2% were smokers and 92% consumed alcohol; 72% are illiterate or did not complete first grade schooling. The main complaints were: neck node (28%), pain and dysphagia (22%), odynophagia (12.2%), dysphonia (7.8%). The clinical staging was: I (1.7%), II (3.5%), III (18.4%), IV (76.3%). The treatment was carried out with radiotherapy and chemotherapy alone in 35%, with mean 2-year survival of 20% and 5-year survival of 18%; surgery followed by radiotherapy and chemotherapy in 22.8% with 2-year survival of 60.0% and 5 years of 55.0%; chemotherapy alone in 2.6%, and 39.4% without treatment. CONCLUSION:Most patients already had advanced clinical stages and independent of the treatment option, had a low survival rate, confirming the poor prognosis of this neoplasm.
Pattern of lymph node metastasis in hypopharyngeal squamous cell carcinoma and indications for level VI lymph node dissection.
Chung Eun-Jae,Kim Go-Woon,Cho Bum-Ki,Park Hae Sang,Rho Young-Soo
Head & neck
BACKGROUND:The purpose of this study was to determine the incidence, risk factors, and prognostic significance of level VI lymph node metastases from hypopharyngeal squamous cell carcinoma (SCC). METHODS:A retrospective review of 68 previously untreated patients with hypopharyngeal SCC who underwent level VI node dissection was performed. RESULTS:Level VI lymph node metastases occurred in 27.9% of patients. The occult metastasis rate of level VI node was 14.3%. Patients with level VI metastasis had significantly lower disease-specific (55.1% vs 26.3%) and overall survival rates (73.5% vs 31.6%). Level VI lymph node metastasis was significantly correlated with regional recurrence (83.7% vs 63.2%) and distant metastasis (67.3% vs 47.4%). Multivariate analysis revealed that pyriform sinus apex invasion (odds ratio [OR] = 5.106) was an independent factor for level VI nodal metastasis. CONCLUSION:Level VI lymph nodes should be removed in patients with pyriform sinus apex invasion, especially in those with advanced nodal disease. © 2016 Wiley Periodicals, Inc. Head Neck 38: E1969-E1973, 2016.
[Prognostic factors affecting results of comprehensive treatment of hypopharyngeal carcinoma].
Xu Wei,Lyu Zhenghua,Yang Zhe,Zou Jidong,Cao Hongyuan
Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese journal of otorhinolaryngology head and neck surgery
OBJECTIVE:To investigate the efficacy of surgery followed by adjuvant radiotherapy and the prognostic factors affecting the results of treatment in hypopharyngeal carcinoma. METHODS:A retrospective review of 149 patients with hypopharyngeal carcinoma that received surgical treatment from Jun 2003 to Jun 2010 was accomplished. In the 149 patients, the site of origin were pyriform sinus (n = 121), posterior pharyngeal wall (n = 21) and postcricoid (n = 7). According to UICC 2002 criteria, there were 3 in stage I, 15 in stage II, 29 in stage III and 102 in stage IV. Surgical methods for primary tumor were: pyriform sinus resection or posterior pharyngeal wall resection in 22 cases, partial pharyngectomy and partial laryngectomy in 29 cases, partial pharyngectomy and total laryngectomy in 67 cases, total pharyngectomy and total laryngectomy in 16 cases, total pharyngolaryngectomy and partial esophagus resection in 12 cases, and total esophagus resection in 3 cases. All the patients received elective and/or radical neck dissection. Unilateral or bilateral thyroid lobectomy was performed in 98 cases. Eighty-seven patients received intensity modulation radiated therapy (IMRT) postoperatively in the cancer center of Provincial Hospital Affiliated to Shandong University. Individualized adjustment of the radiation field was made according to the surgical condition. Forty-nine cases received radiotherapy in other hospitals (dose 50-70 Gy). Laryngeal function was restored in 51 patients (34.2%). The risk clinicopathological factors of survival and the causes of death were analyzed. RESULTS:The survival rate was calculated with Kaplan-Meier method. The overall 3- and 5- year survival rates were 47.7% and 38.7%, respectively. There were no significant differences in 3-year survival between T1-2 and T3-4 groups, N0 and N+ groups, stage I-II and III-IV groups, laryngeal function preserved and unpreserved groups. The overall 3 years survival rate of patients received surgery and adjuvant radiotherapy was higher than those just received surgery alone (χ² = 6.851, P < 0.05). The 3-year survival rate in patients treated in comprehensive treatment group has showed a good trend, although still no statistical significance (χ² = 0.176, P > 0.05). The cause of death in 86 patients, including regional lymph nodes recurrence in 25 cases (29.1%). Of them, one was stoma recurrence and 9 were retropharyngeal lymph nodes metastasis; distant metastasis in 19 cases (22.1%); local recurrence in 13 cases, local or regional recurrence with distant metastasis in 8 cases (9.3%), and second primary cancer in 6 cases (7.0%). CONCLUSIONS:The overall prognosis of hypopharyngeal carcinoma was poor and dismal. In accordance with specific conditions of surgery, active adjustment of the personalized protocol of IMRT was the key of improving the efficacy of hypopharyngeal carcinoma.
(125)I Seed Permanent Implantation as a Palliative Treatment for Stage III and IV Hypopharyngeal Carcinoma.
Li Lei,Yang Jie,Li Xiaojiang,Wang Xiaoli,Ren Yanxin,Fei Jimin,Xi Yan,Sun Ruimei,Ma Jing
Clinical and experimental otorhinolaryngology
OBJECTIVES:The aim of this study was to investigate the feasibility and safety of percutaneous (125)I seed permanent implantation for advanced hypopharyngeal carcinoma from toxicity, tumor response, and short-term outcome. METHODS:(125)I seeds implant procedures were performed under computed tomography for 34 patients with advanced hypopharyngeal carcinoma. We observed the local control rate, overall survival, and acute or late toxicity rate. RESULTS:In the 34 patients (stage III, n=6; stage IV, n=28), the sites of origin were pyriform sinus (n=29) and postcricoid area (n=5). All patients also received one to four cycles of chemotherapy after seed implantation. The post-plan showed that the actuarial D90 of (125)I seeds ranged from 90 to 158 Gy (median, 127 Gy). The mean follow-up was 12.3 months (range, 3.4 to 43.2 months). The local control was 2.1-31.0 months with a median of 17.7 months (95% confidence interval [CI], 13.4 to 22.0 months). The 1-, 2-, and 3-year local controls were 65.3%, 28.6%, and 9.5% respectively. Twelve patients (35%) died of local recurrence, fourteen patients (41%) died of distant metastases, and three patients (9%) died of recurrence and metastases at the same time. Five patients (15%) still survived to follow-up. At the time of analysis, the median survival time was 12.5 months (95% CI, 9.5 to 15.4 months). The 1-, 2-, and 3-year overall survival rates were 55.2%, 20.3%, and 10.9%, respectively. Five patients (15%) experienced grade 3 toxic events and nine patients (26%) have experienced grade 2 toxic events. CONCLUSION:This review shows relatively low toxicity for interstitial (125)I seed implantation in the patients with advanced stage hypopharyngeal cancer. The high local control results suggest that (125)I seed brachytherapy implant as a salvage or palliative treatment for advanced hypopharyngeal carcinoma merit further investigation.
Radiotherapy with fraction size of 2.25 Gy in T1-2 laryngeal and hypopharyngeal cancer.
Karasawa Kumiko,Kunogi Hiroaki,Hirai Takahisa,Hoji Hidehiro,Hirowatari Hisako,Izawa Hiromi,Ito Kana,Sasai Keisuke,Furuya Tomohisa,Ozawa Shuichi,Matsumoto Fumihiko,Ito Shin,Oba Shinichi
Journal of radiation research
This study was carried out to evaluate the influence of fraction size 2.25 Gy on local control of T1 and T2 laryngeal and hypopharyngeal cancers. Between August 2002 and December 2010, 80 patients with T1 and T2 laryngeal or hypopharyngeal cancers were treated with definitive radiotherapy with a fraction size of 2.25 Gy. Primary sites were the larynx in 69 and the hypopharynx in 11. Fifty-three patients were T1 and 27 were T2. All patients' pathology was squamous cell carcinoma except one carcinosarcoma. Radiotherapy was delivered 5 days/week with a 4-MV photon beam up to a total dose of 63.0 Gy. Median treatment time was 41 days. Statistical analysis of survival was calculated using the Kaplan-Meier method. No acute toxicity greater than grade 2 (CTCAE ver. 3.0.) including mucositis and dermatitis was observed. All but one patient had a complete response. The partial response patient received salvage surgery. The median follow-up period was 47 months (ranging from 4 to 108 months). No late toxicity greater than 1 was observed. Nine patients developed recurrence, seven local and two neck lymph nodes. Three patients died, one from laryngeal cancer and two from intercurrent diseases. The 5-year local control rates (LCRs) in the entire group, larynx T1, larynx T2 and hypopharynx T1 were 85.8%, 97.6%, 70.1% and 85.7%, respectively. The LCRs of T1 improved compared with our historical control, but not those of T2. The 2.25-Gy fraction size is safe and may have the potential to achieve good LCR in T1 lesions.
Salvage surgery for recurrence of laryngeal and hypopharyngeal squamous cell carcinoma: A retrospective study from 2005 to 2013.
Pujo K,Philouze P,Scalabre A,Céruse P,Poupart M,Buiret G
European annals of otorhinolaryngology, head and neck diseases
OBJECTIVES:Salvage surgery is the gold-standard treatment for locoregional recurrence of laryngeal and hypopharyngeal cancer following radiation therapy. Imperfect oncologic and functional results, however, require patient selection. The main objective of the present study was to determine preoperative factors for survival. Secondary objectives were to study 5-year overall and disease-free survival, general and locoregional complications, and functional results in terms of feeding and tracheotomy closure. PATIENTS AND METHOD:A retrospective multicenter study included 52 patients treated by salvage surgery for recurrence of laryngeal or hypopharyngeal squamous cell carcinoma after radiation therapy between 2005 and 2013. RESULTS:Factors associated with improved 3-year overall survival on univariate analysis comprised laryngeal primary (P=0.001), laryngeal recurrence (P=0.026), rT1, rT2 or rT3 rather than rT4 tumor (P=0.007), previous chemotherapy (P=0.036), and neck dissection during salvage surgery (P=0.005), the last of these being confirmed on multivariate analysis. Five-year overall survival was 36.0% (range, 27.6-44.4%), for a median 23.04 months (95% CI, 19.44-26.64). Five-year disease-free survival was 23.5% (range, 16.0-31.0%), for a median 8.04 months (95% CI, 2.04-14.04). CONCLUSION:Salvage surgery for laryngeal or hypopharyngeal cancer is difficult, and survival is not good. Laryngeal primary and recurrence location, moderate tumor volume and extension (<T4), prior chemotherapy and neck dissection during salvage surgery were associated with better overall and disease-free survival, which should enable better patient selection.
Definitive radiotherapy for T1-2 hypopharyngeal cancer: a single-institution experience.
Nakajima Aya,Nishiyama Kinji,Morimoto Masahiro,Nakamura Satoaki,Suzuki Osamu,Kawaguchi Yoshifumi,Miyagi Ken,Fujii Takashi,Yoshino Kunitoshi
International journal of radiation oncology, biology, physics
PURPOSE:To analyze the outcome in T1-2 hypopharyngeal cancer (HPC) patients treated with definitive radiotherapy (RT). PATIENTS AND METHODS:A total of 103 patients with T1-2 hypopharyngeal squamous cell carcinoma treated with radical RT between March 2000 and June 2008 at our institution were analyzed. Pre-RT neck dissection (ND) was performed in 26 patients with advanced neck disease. Chemotherapy was used concurrently with RT in 14 patients. Sixty patients were associated with synchronous or metachronous malignancies. The median follow-up for surviving patients was 41 months. RESULTS:The 3-year overall and cause-specific survival rates were 70% and 79%, respectively. The 3-year local control rates were 87% for T1 and 83% for T2 disease. The ultimate local control rate was 89%, including 7 patients in whom salvage was successful. The ultimate local control rate with laryngeal preservation was 82%. Tumors of the medial wall of the pyriform sinus tended to have lower control rates compared with tumors of the lateral or posterior pharyngeal wall. Among patients with N2b-3 disease, the 3-year regional control rates were 74% for patients with pre-RT ND and 40% for patients without ND. The 3-year locoregional control rates were as follows: Stage I, 100%; Stage II, 84%; Stage III, 67%; Stage IVA, 43%; Stage IVB, 67%. Forty-two patients developed disease recurrence, with 29 (70%) patients developing recurrence within the first year. Of the 103 patients, 6 developed late complications higher than or equal to Grade 3. CONCLUSIONS:Definitive RT accomplished a satisfactory local control rate and contributed to organ preservation.
An evaluation of the results of chemoradiotherapy and surgical treatment for hypopharyngeal cancer.
Demirci Uğur,Özmen Ömer Afşın,Demiröz Candan,Kasapoğlu Fikret,Coşkun Hamdi Hakan,Özkan Lütfi,Onart Selçuk
Kulak burun bogaz ihtisas dergisi : KBB = Journal of ear, nose, and throat
OBJECTIVES:This study aims to evaluate the efficacy chemoradiotherapy and surgical treatment in patients with hypopharyngeal cancer. PATIENTS AND METHODS:Between January 2003 and July 2009, 48 patients (31 males, 17 females; mean age 55.5±13.4 years; range 29 to 84 years) who were diagnosed with hypopharyngeal cancer were retrospectively evaluated. The patients were assigned into surgery (n=17) and chemoradiotherapy (n=31) groups. RESULTS:The overall survival of the patients with advanced disease in the surgery group was statistically higher than those in the chemoradiotherapy group. The recurrence rate of the patients was 35.3% in the surgery group, whereas it was 41.4% in the chemoradiotherapy group. CONCLUSION:Our study results indicated that the survival rates were higher in the surgery group. On the other hand, chemoradiotherapy had the advantage of laryngeal preservation.
Metastatic lymph node burden predictive of survival in patients undergoing primary surgery for laryngeal and hypopharyngeal cancer.
Choi Yeonjoo,Bin-Manie Manal,Roh Jong-Lyel,Cho Kyung-Ja,Lee Yoon Se,Choi Seung-Ho,Nam Soon Yuhl,Kim Sang Yoon
Journal of cancer research and clinical oncology
PURPOSE:Metastatic lymph node (LN) burden is one of the most important prognosticators in human solid cancers, but has rarely been examined in laryngeal and hypopharyngeal cancers (LHC). We evaluated the nodal factors predictive of recurrence and survival in patients with LHC. METHODS:This study included 141 consecutive patients who underwent primary surgery and neck dissection for previously untreated LHC at our tertiary referral centre. Nodal factors included the presence of pathological LN metastasis, number of positive LNs, LN ratio, and extra-nodal extension (ENE). Our proposed N classification was analysed by recursive partitioning analysis and compared with the AJCC and other N classifications using the c-index. Univariate and multivariate Cox proportional hazard regression analyses were used to define significant predictors of post-treatment disease-free survival (DFS) and overall survival (OS). RESULTS:Of the 141 patients, 66 (46.8%) had positive LNs, and 27 (19.1%) had ENE. In multivariate analyses, the number of positive LNs was strongly associated with DFS and OS outcomes (P < 0.01). Our new N classification was proposed with four categories, such as N0 (0 LN +), N1 (1 LN +), N2 (2-4 LN + or ENE) and N3 (≥ 5 LN +). The C-index of our new N classification improved the OS prediction (0.718) compared with the AJCC and the other N classifications (0.704-0.713). CONCLUSION:Metastatic LN burden is an important predictor of survival in patients with LHC. A proposed N classification using the number of positive LNs and ENE might improve the LHC survival prediction.
Impact of the early detection of esophageal neoplasms in hypopharyngeal cancer patients treated with concurrent chemoradiotherapy.
Watanabe Shigenobu,Ogino Ichiro,Inayama Yoshiaki,Sugiura Madoka,Sakuma Yasunori,Kokawa Atsushi,Kunisaki Chikara,Inoue Tomio
Asia-Pacific journal of clinical oncology
AIMS:We examined the risk factors and prognostic factors for synchronous esophageal neoplasia (SEN) by comparing the characteristics of hypopharyngeal cancer (HPC) patients with and without SEN. METHODS:We examined 183 patients who were treated with definitive radiotherapy for HPC. Lugol chromoendoscopy screening of the esophagus was performed in all patients before chemoradiotherapy. RESULTS:Thirty-six patients had SEN, 49 patients died of HPC and two died of esophageal cancer. The patients with SEN exhibited significantly higher alcohol consumption than those without SEN (P = 0.018). The 5-year overall survival (OS) rate of the 36 patients with SEN was lower than that of the other patients (36.2% vs 63.4%, P = 0.006). The SEN patients exhibited significantly shorter HPC cause-specific survival than the other patients (P = 0.039). Both the OS (P = 0.005) and the HPC cause-specific survival (P = 0.026) of the patients with SEN were significantly shorter than those of the patients without SEN in multivariate analysis. Category 4/T1 stage esophageal cancer was treated with concurrent chemoradiotherapy (CCRT), endoscopic treatment or chemotherapy. The 5-year survival rates for esophageal cancer recurrence for CCRT, endoscopic treatment and chemotherapy were 71.5, 43.7 and 0%, respectively. The median (range) survival time (months) of CCRT, endoscopic treatment and chemotherapy was 22.7 (7.5-90.6), 46.44 (17.3-136.7) and 7.98 (3.72-22.8), respectively. CONCLUSION:Advanced HPC patients with SEN might have a poorer prognosis than those without SEN even when the esophageal cancer is detected early and managed appropriately.
Rational choice of induction chemotherapy-based larynx preservation for hypopharyngeal cancer.
Liu Shuzhou,Fang Jugao,Ma Hongzhi,Meng Lingzhao,Bai Yunfei,Feng Ling,Lian Meng,Li Pingdong,Zhong Qi,Hou Lizhen
Backgroud: Induction chemotherapy, as a larynx preservation treatment, has been available for over 20 years. We conducted a retrospective study to evaluate the efficacy of this protocol with taxene, cisplatin and 5-fluorouracil in Chinese patients with hypopharyngeal cancer that chose preservation strategy. MATERIAL AND METHODS:170 patients with locally advanced hypopharyngeal cancer were assigned to receive induction chemotherapy. 107 patients (63%) with complete response or partial response received larynx preservation treatment and 63 non-responders (37%) received radical surgery. RESULTS:Median survival time was 30 months (range: 3-59 months). 63 patients (37%) had local-regional failure and 15 (9%) had distant metastasis. Three-year LFS was 27.8% (95% CI: 23.6-32.0%). The estimated three-year overall survival rate was 44.5% (95% CI: 39.5-49.5%). There was no significant difference in the three-year survival rate between responders (44.8%) and non-responders (43.9%) (p = .237), however patients with a partial response had a significant decrease in survival (32.2%) (p < .001). CONCLUSIONS:In patients with hypopharyngeal cancer, ICT with TPF regimen followed by RT, as a larynx preservation treatment, may be suitable for complete responders, but not partial responders.
Clinicopathological factors influencing the outcomes of surgical treatment in patients with T4a hypopharyngeal cancer.
Kim Sang-Yeon,Rho Young-Soo,Choi Eun-Chang,Kim Min-Sik,Woo Joo-Hyun,Lee Dong Hoon,Chung Eun Jae,Park Min Woo,Kim Da-Hee,Joo Young-Hoon
BACKGROUND:The purpose of this study was to determine prognostic factors influencing outcomes of surgical treatment in patients with T4a hypopharyngeal cancer. METHODS:The present study enrolled 93 patients diagnosed with T4a hypopharyngeal cancer who underwent primary surgery between January 2005 and December 2015 at six medical centers in Korea. Primary tumor sites included pyriform sinus in 71 patients, posterior pharyngeal wall in 14 patients, and postcricoid region in 8 patients. Seventy-two patients received postoperative radio(chemo)therapy. RESULTS:Five-year disease-free survival (DFS) and disease-specific survival (DSS) rates were 38% and 45%, respectively. In univariate analysis, 5-year DFS was found to have significant and positive correlations with margin involvement (p < 0.001) and extracapsular spread (p = 0.025). Multivariate analysis confirmed that margin involvement (hazard ratio (HR): 2.81; 95% confidence interval (CI): 1.49-5.30; p = 0.001) and extracapsular spread (HR: 2.08; 95% CI: 1.08-3.99; p = 0.028) were significant factors associated with 5-year DFS. In univariate analysis, cervical lymph node metastasis (p = 0.048), lymphovascular invasion (p = 0.041), extracapsular spread (p = 0.015), and esophageal invasion (p = 0.033) were significant factors associated with 5-year DSS. In multivariate analysis, extracapsular spread (HR: 2.98; 95% CI: 1.39-6.42; p = 0.005) and esophageal invasion (HR: 2.87; 95% CI: 1.38-5.98; p = 0.005) remained significant factors associated with 5-year DSS. CONCLUSION:Margin involvement and extracapsular spread are factors influencing recurrence while extracapsular spread and esophageal invasion are factors affecting survival in patients with T4a hypopharyngeal cancer treated by primary surgery.
Clinical Predictors of Laryngeal Preservation Rate in Stage III-IV Laryngeal Cancer and Hypopharyngeal Cancer Patients Treated with Organ Preservation.
Tangsriwong Kanograt,Jitreetat Tastsanachart
Asian Pacific journal of cancer prevention : APJCP
Purpose: To determine factors affecting laryngeal preservation rate in laryngeal and hypopharyngeal cancer patientstreated with organ preservation. Material and Methods: Retrospective study examining stage III to IV laryngeal andhypopharyngeal cancer patients who have been treated with organ preservation. Conventional radiation must be appliedin all patients with minimum dose of 45 Gray. Weekly or triweekly chemotherapy can be adding during radiation. Salvagesurgery should be considered in residual disease or local recurrence. Kaplan-Meier was used for survival analysis and,Log rank test and Cox proportional hazard test were used for uni and multivariate analysis. Results: From January2010 to October 2014, there were 69 patients treated with laryngeal preservation and 53 patients received radiationdose 61-70 Gray. After completing radiation, we found that 44 patients have no residual tumor within 6 months and33 patients can preserve their functional larynx later with complete response (median follow up 6 mo, range 0-46.3mo). The 1-year, 2-year and 3-year laryngeal preservation rate was 49%, 36 % and 32 % respectively. On univariateanalysis, lower nodal stage (p = 0.008), stage III disease (p = 0.046), tumor volume <10 ml (p = 0.005), no true vocalcord involvement (p = 0.016), dose 61-70 Gray (p < 0.001) and no interruption of treatment (p = 0.017) have betterlaryngeal preservation rates. ECOG performance status 2, higher nodal stage, stage IV, presence of true vocal cordinvolvement, upper airway obstruction before/during radiation and radiation dose below 61-70 Gray had an effect onworse overall survival when evaluated with univariate analysis statistical significance. Conclusion: For factors thataffected laryngeal preservation in our study were nodal stage, group stage, tumor volume, true vocal cord involvement,radiation dose and treatment break time more than one week with statistical significance.
[Meta-analysis of comparison for efficacies between surgical plus radio(chemo)therapy and non-surgery chemoradiotherapy treatment strategies for advanced hypopharyngeal cancer].
Fan J M,Wen S X,Wang B Q,Huangfu H,Zhai X S,Zhao X J
Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese journal of otorhinolaryngology head and neck surgery
Meta-analysis was used to compare the long-term efficacy and laryngeal function preservation rate of patients with advanced hypopharyngeal cancer treated with surgery plus radio(chemo)therapy (SRT) or non-surgery chemoradiotherapy (CRT). We searched publicly published articles on case-control studies of surgical and non-surgical comprehensive treatment of advanced hypopharyngeal cancer in PubMed, the Cochrane Library, Wanfang Database, Chinese Journal Full-text Database, and Chinese Science and Technology Periodical Database. The search language was limited to Chinese and English, and the period was from 1990 to 2018. These literatures were rigorously screened by inclusion and exclusion criteria. The data needed for this study were extracted and the Meta analysis was performed using RevMan 5.3 software. A total of 13 literatures were included, and the overall quality of the literature was relatively high, and no significant publication bias was suggested. A total of 1 994 subjects, including 720 in the SRT group and 1 274 in the CRT group. The average 3-year overall survival rates were 42.9% in SRT group and 44.8% in CRT group,with no significant difference (1.14, 95: 0.62-2.06, 0.68). The average 5-year overall survival rate (1.42, 95: 1.10-1.84, 0.01), 5-year local recurrence-free survival rate (1.68, 95: 1.11-2.55, 0.01) and 5-year local control rate (2.17, 95: 1.52-3.12, 0.01) of SRT group were 46.4%, 47.4% and 71.2%, respectively, which were higher than those of non-surgical group (37.9%, 32.0%, and 52.2% respectively). The average laryngeal function preservation rate was 19.8%,being significantly lower than 80.6% of the non-surgical group(0.03, 95: 0.01-0.07, 0.01). SRT has better long-term efficacy, while CRT has better preservation of laryngeal function.
Lymph Node Ratio Predicts Recurrence and Survival for Patients with Resectable Stage 4 Hypopharyngeal Cancer.
Lo Wu-Chia,Wu Chen-Tu,Wang Cheng-Ping,Yang Tsung-Lin,Lou Pei-Jen,Ko Jeng-Yuh,Chang Yih-Leong
Annals of surgical oncology
BACKGROUND:This study aimed to investigate the clinicopathologic prognostic predictors of stage 4 hypopharyngeal cancer and to extend the traditional tumor-node-metastasis classification system to advance its predictive ability. METHODS:The study enrolled 120 patients with pathologically stage 4 hypopharyngeal cancer treated with pharyngolaryngectomy and neck dissection between 2001 and 2007. RESULTS:The study showed a 5-year overall survival (OS) of 44.6%, a disease-specific survival (DSS) of 51.6%, and a disease-free survival (DFS) of 48% for all the patients. In the multivariate analysis, a lymph node (LN) ratio of 0.113 or higher was a significant poor prognostic factor for OS (hazard ratio [HR] 1.89; 95% confidence interval [CI] 1.17-3.05; p = 0.009), DSS (HR 2.17; 95% CI 1.29-3.64; p = 0.003), and DFS (HR, 2.24; 95% CI 1.12-4.52; p = 0.024) in stage 4 hypopharyngeal cancer. In addition, pretreatment neutrophil-lymphocyte ratio, lymphovascular invasion, and margin status also were predictors of survival outcomes. Furthermore, the study found that disease recurrence differed significantly between the patients with a LN ratio of 0.113 or higher (68.2%) and those with a LN ratio lower than 0.113 (39.5%) (p = 0.002). CONCLUSIONS:A LN ratio of 0.113 or higher is a strong predictor of disease recurrence and survival for patients with stage 4 hypopharyngeal cancer.
Prognostic value of the radiomics-based model in progression-free survival of hypopharyngeal cancer treated with chemoradiation.
Mo Xiaokai,Wu Xiangjun,Dong Di,Guo Baoliang,Liang Changhong,Luo Xiaoning,Zhang Bin,Zhang Lu,Dong Yuhao,Lian Zhouyang,Liu Jing,Pei Shufang,Huang Wenhui,Ouyang Fusheng,Tian Jie,Zhang Shuixing
PURPOSE:To develop a radiomics-based model to stratify the risk of early progression (local/regional recurrence or metastasis) among patients with hypopharyngeal cancer undergoing chemoradiotherapy and modify their pretreatment plans. MATERIALS AND METHODS:We randomly assigned 113 patients into two cohorts: training (n = 80) and validation (n = 33). The radiomic significant features were selected in the training cohort using least absolute shrinkage and selection operator and Akaike information criterion methods, and they were used to build the radiomic model. The concordance index (C-index) was applied to evaluate the model's prognostic performance. A Kaplan-Meier analysis and the log-rank test were used to assess risk stratification ability of models in predicting progression. A nomogram was plotted to predict individual risk of progression. RESULTS:Composed of four significant features, the radiomic model showed good performance in stratifying patients into high- and low-risk groups of progression in both the training and validation cohorts (log-rank test, p = 0.00016, p = 0.0063, respectively). Peripheral invasion and metastasis were selected as significant clinical variables. The combined radiomic-clinical model showed good discriminative performance, with C-indices 0.804 (95% confidence interval (CI), 0.688-0.920) and 0.756 (95% CI, 0.605-0.907) in the training and validation cohorts, respectively. The median progression-free survival (PFS) in the high-risk group was significantly shorter than that in the low-risk group in the training (median PFS, 9.5 m and 19.0 m, respectively; p [log-rank] < 0.0001) and validation (median PFS, 11.3 m and 22.5 m, respectively; p [log-rank] = 0.0063) cohorts. CONCLUSIONS:A radiomics-based model was established to predict the risk of progression in hypopharyngeal cancer with chemoradiotherapy. KEY POINTS:• Clinical information showed limited performance in stratifying the risk of progression among patients with hypopharyngeal cancer. • Imaging features extracted from CECT and NCCT images were independent predictors of PFS. • We combined significant features and valuable clinical variables to establish a nomogram to predict individual risk of progression.
[Treatment and prognosis of 264 patients with hypopharyngeal carcinoma].
Xu W,Lyu Z H,Sa N,Ma J K,Tian J J,Feng S H,Cui P,Cao H Y
Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese journal of otorhinolaryngology head and neck surgery
To investigate the key factors influencing the prognosis of hypopharyngeal carcinoma and the therapeutic methods improving the efficacy of treatments for hypopharyngeal carcinoma. Two hundred and sixty-four cases of hypopharyngeal squamous cell carcinoma treated from May 2010 to May 2015 were analyzed retrospectively. There were 211 cases of pyriform sinus carcinoma, 37 cases of posterior pharyngeal wall carcinoma, and 16 cases of postcricoid carcinoma. According to UICC 2002 criteria, 2 cases were for stage Ⅰ, 14 for stage Ⅱ, 32 for stage Ⅲ and 216 for stage Ⅳ. Postoperative circumferential defects existed in 112 (42.4%) cases, and 86 of them were reconstructed with free jejunum transplantation. Among all cases, 54 patients (20.5%) had the preservation of laryngeal functions after surgery and 210 patients (79.5%) with total laryngectomy; 238 cases (90.2%) underwent bilateral cervical lymph node dissection and 203 patients received posterior pharyngeal lymph node exploration and dissection, with positive metastases for posterior pharyngeal lymph nodes in 36 cases (17.7%). Eight cases with cervical lymph node metastasis extensively involving the soft tissue, prevertebral fascia or encases carotid artery received preoperative radiotherapy of 50 Gy. After surgery 13 patients received concurrent radiotherapy and chemotherapy, 337 underwent adjuvant radiotherapy with a dose of 50-60 Gy each, and 14 patients did not receive radiotherapy or did not completed their radiotherapy programs. SPSS 13.0 saftware was used to analyze the data. All patients were followed up for more than 2 years. With Kaplan-Meier method, the 2-, 3- and 5-years survival rates were 69.6%, 62.8% and 51.3%, respectively. There were significant differences in 3-year survival rates between T1-2 group (75.5%) and T3-4 group (59.2%) (χ(2)=4.282 =0.039), N0 group (81.6%) and N+ group (58.2%) (χ(2)=6.802 =0.009), laryngeal functions preserved (81.8%) and unpreserved group (58.9%) (χ(2)=5.314 =0.021). Multivariate Logistic regression analysis showed that cervical lymph node metastasis was an independent prognostic factor (=0.027). The success rate of free jejunum transplantation was 98.8%. Local recurrence, cervical lymph node recurrence, second primary cancer, and distant metastasis accounted respectively for 11.2%, 18.8%, 12.5% and 45.0% of death cases. The prognosis-associated factors for hypopharyngeal carcinoma should be taken into account, including the evaluation of the carcinogenesis of the mucosal area, early screening of premalignant lesion or second primary cancer in the esophagus and dissection of the posterior pharyngeal lymph nodes, which will help to improve the local control rate and recent survival rate in patients with hypopharyngeal cancer.
[Significance of retropharyngeal node dissection in treatment of hypopharyngeal carcinoma].
Lyu Z H,Xu W,Sa N,Ma J K,Tian J J,Feng S H,Cao H Y
Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese journal of otorhinolaryngology head and neck surgery
investigate the incidence of retropharyngeal lymph node (RPLN) metastasis and the risk factors for RPLN metastasis in hypopharyngeal cancer, and the relationship of planned dissection of the RPLN with the survival and tumor control rates in patients with hypopharyngeal cancer. A total of 203 patients with hypopharyngeal squamous cell carcinoma who underwent radical surgery as initial treatment from February 2011 to July 2015 were analyzed retrospectively. There were 167 cases of pyriform sinus carcinoma, 23 cases of posterior pharyngeal wall carcinoma, and 13 cases of postcricoid carcinoma. The incidence of RPLN metastasis in HPC was 17.7%, with a highest rate of 43.5% in pharyngeal wall carcinoma. The incidence of RPLN metastasis in T3-4 pyriform sinus carcinoma was 18.3%, which significantly higher than 2.8% in T1-2 cases(χ(2)=5.360, =0.020). The rate of RPLN metastasis was 23.8% in N2b-3 and 8.6% in N0-2a, with a statistically significant difference(χ(2)=7.637, =0.006). There was no statistically significant difference in overall survival rates between patients with and without RPLN metastasis(>0.05). Data were analyzed by SPSS 13.0 software. RPLN metastasis is not rare in hypopharyngeal carcinoma. Planned dissection of the RPLN should be performed with the initial surgery in patients with advanced hypopharyngeal cancer, especially posterior pharyngeal wall carcinoma, T3-4 pyriform sinus carcinoma and staged N2b-3 disease, which can reduce the regional recurrence rate and provided with a better prognosis.
Treatment Options for Hypopharyngeal Cancer.
Eckel Hans E,Bradley Patrick J
Advances in oto-rhino-laryngology
Patients with hypopharyngeal cancer are difficult to treat because they typically present with advanced disease, poor general health status and severe nutritional problems. Currently, treatment options for previously untreated and newly diagnosed hypopharyngeal cancer patients include surgery of the primary tumour and lymph nodes metastasis, radiotherapy, systemic medical treatment, including traditional chemotherapy and immunotherapy. Currently, a multimodal treatment approach is preferred using surgery, radiotherapy and systemic therapy with curative intent and best supportive care in patients considered unfit for curative treatment or patients presenting with distant metastatic spread. More detailed topics regarding the choice of treatment include biological and immunological host factors and their use for defining individualised cancer care, integration of novel therapies, integration of patient autonomy into clinical reasoning and dealing with patients' trade-offs between oncological outcome and individual quality of life, local availability of diagnostic therapeutic procedures and volume-outcome relationships for head and neck cancer surgery, radiotherapy and specialised supportive care. They also include considerations regarding potential delay between diagnosis and treatment, and between different treatment modalities within the frame of multimodal therapy. To date only one randomised trial comparing surgical versus non-surgical approaches has been published. Most randomised trials dealing with hypopharyngeal cancer compare different chemo- and radiotherapy regimen, but do not compare with a surgical approach. On the other hand, most studies on the results of surgery are best considered to be of low-quality case series. At the same time, many of the chemotherapy and radiation oncology studies in head and neck cancer include patients with different primary sites, where hypopharyngeal cancer patients when included usually account for a minority of the study population. Therefore, choosing the best treatment for an individual patient with hypopharyngeal cancer relies on personal experience and local expertise of the multidisciplinary team involved in the therapeutic process.
[A retrospective study on combined modality therapy with or without surgery for advanced hypopharyngeal squamous cell carcinoma: an analysis of 119 cases].
Zhang Y X,Peng H H,Zhang X X,Zhao J D,Wu W M,Wang J L,Huang D L,Zong L,Chen L W,Liu C Q,Liu M B
Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese journal of otorhinolaryngology head and neck surgery
To compare the treatment outcomes for locally advanced hypopharyngeal carcinoma between surgery plus radio(chemo) therapy(SRT) and non-surgery chemoradiotherapy(CRT). A total of 119 patients diagnosed with advanced hypopharyngeal carcinoma without distant metastases between 2010 and 2014 were identified in the Chinese People's Liberation Army General Hospital, and they were divided into 2 groups: 42 cases in SRT group and 77 cases in CRT group. Patients' clinical information was collected. Survival rates and prognostic factors were analyzed by the Kaplan-Meier method with SPSS 23.0 software. The survival rates, laryngeal preservation rates and complication rates were compared between the two groups using the chi-square test.Among the 119 patients, 112 were males and 7 were females. Age ranged from 27 to 78 years, with an average age of 57 years. There were no significant difference between the SRT and CRT group for five-year disease-free survival (DFS, 53.9% . 45.1%, χ(2)=1.251, =0.263) and overall survival (OS, 54.9% . 45.6%, χ(2)=1.749, =0.186). Compared to SRT group, CRT group did not showed the significant increase of treatment complications (χ(2)=0.858, =0.354), with a higher laryngeal preservation rate (50.0% vs. 71.4%, χ(2)=6.493, =0.011). Advanced hypopharyngeal carcinoma is of high malignancy and poor prognosis. Combined modality treatment is a main approach for advanced hypopharyngeal cancer. SRT offers disease-free survival and overall survival rates equivalent to CRT, but with a higher laryngeal preservation rate.