International Journal of Radiation Oncology*Biology*Physics
Clinical InvestigationDefinitive Radiotherapy for T1-T2 Squamous Cell Carcinoma of Pyriform Sinus
Introduction
Cancer of the pyriform sinus, because of its close anatomic association with the larynx, frequently requires removal of the entire larynx when tumors in this region are managed surgically. The options for treating pyriform sinus tumors include total laryngectomy with or without radiotherapy (RT), larynx preservation with partial laryngopharyngectomy with or without adjuvant RT, or definitive RT with or without concomitant chemotherapy 1, 2. Although total laryngectomy has a high probability of controlling the tumor, it is associated with a disruption of speech, and only 20–25% of patients are rehabilitated long term with a tracheoesophageal prosthesis (3). For Stage T1 and low-volume T2 cancer, the choice between partial laryngopharyngectomy and RT with larynx conservation is controversial, although the preferred treatment for larger, more advanced tumors is total laryngectomy, partial pharyngectomy, and neck dissection combined with pre- or postoperative RT 4, 5, 6, 7, 8, 9, 10.
At the University of Florida, patients with favorable Stage T1 and T2 pyriform sinus carcinoma have routinely been treated with RT alone or RT followed by neck dissection 1, 11. In recent years, we have added concomitant cisplatin chemotherapy for patients with Stage III or IV disease after the published data showed that this approach improves locoregional control and survival compared with RT alone 2, 12, 13. The purpose of this report was to update the University of Florida experience treating Stage T1-T2 pyriform sinus squamous cell carcinoma (SCC) with a larynx-conserving approach of definitive RT alone or combined with neck dissection and/or chemotherapy.
Section snippets
Patients and Methods
A total of 123 patients with previously untreated Stage T1-T2N0-N3M0 SCC of the pyriform sinus were treated with curative intent with definitive RT between November 1964 and June 2003. The patients were excluded if they had been treated with a planned split-course, postoperative, or palliative RT. The follow-up was 0.2–22.2 years (median, 3.2), and the follow-up of the living patients was 3.5–18.7 years (median, 10.7). No patient was lost to follow-up. The median age was 63 years (range,
Time to recurrence
Of the 123 patients, 46 (37%) developed local, regional, and/or distant recurrence. Of the recurrences, 95% and 97% were observed within 2 and 5 years of RT, respectively. One patient developed a recurrence at the primary site 5 years, 8 months after RT and was successfully salvaged with total laryngectomy.
Local control
The local control and ultimate local control rates, including those successfully salvaged after local recurrence, are given in Table 2. The 5-year local control rate after RT was 85% for
Discussion
The results of our study have shown that patients with Stage T1 and low-volume Stage T2 pyriform sinus cancer can be treated with either partial laryngectomy or RT with a relatively high likelihood of local control. Whether the larynx can be preserved in surgically treated patients depends on the training and experience of the surgeon and the medical condition of the patient. In particular, patients must have an adequate pulmonary reserve to withstand aspiration in the postoperative period.
Conclusions
Patients with Stage T1 and low-volume Stage T2 pyriform sinus carcinoma have a relatively high chance of local control with larynx preservation after either definitive RT or partial laryngopharyngectomy. Survival depends primarily on the extent of the nodal disease. The likelihood of complications might be greater after surgery, and because a substantial proportion require postoperative RT, the likelihood of complications is possibly greater after combined modality treatment compared with
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