Clinical Investigation
Outcomes in Patients With Early-Stage Hypopharyngeal Cancer Treated With Radiotherapy

https://doi.org/10.1016/j.ijrobp.2009.06.066Get rights and content

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.

Introduction

Patients with hypopharyngeal cancer (HPC) are often first diagnosed at an advanced stage. Because the diagnosis of early-stage HPC is relatively rare, few reports have analyzed the treatment results of early-stage HPC; thus, the optimal treatment for this condition remains uncertain (1).

Foote (2) reported that treatment options for early-stage HPC included endoscopic removal, open function-sparing partial laryngopharyngectomy, total laryngectomy with partial pharyngectomy, and radiotherapy (RT); factors in treatment selection were reported to be the extent and volume of the tumor (including anterior commissure involvement), patient preference (including occupational considerations), patient age, comorbid illnesses, patient compliance, voice quality, physician experience and skill, previous head-and-neck malignancy, risk of a second head-and-neck primary cancer, treatment cost, and physician and institutional biases.

At the National Cancer Center Hospital, patients with Stage I or II HPC are often treated with RT alone. In this study, we reviewed the data on patients who were treated with RT for early-stage HPC and analyzed the outcomes in these patients.

Section snippets

Patient characteristics

Between February 1988 and February 2007, 77 patients with Stage I (T1N0M0) or Stage II (T2N0M0) HPC underwent RT in the Division of Radiation Oncology at the National Cancer Center Hospital. These patients consisted of 6 women and 71 men, ranging in age from 42 to 80 years (median, 63 years) (Table 1). All the tumors were diagnosed as squamous cell carcinoma by histopathologic examination of the biopsy specimens, and each tumor was staged retrospectively according to the 2002 UICC TNM

Survival

The 5-year overall and HPC-specific survival rates for all 77 patients were 47% and 74%, respectively (Fig. 1). Thirty-nine patients died between 3.1 and 191 months (median, 15 months) after the start of RT; the causes of death were HPC in 13 patients who died 1150 months (median, 15 months) after the start of RT, other malignancies in 16 patients (esophageal cancer in 9, lung cancer in 2, laryngeal cancer in 1, oropharyngeal cancer in 1, oral cancer in 1, renal cancer in 1, and malignant

Discussion

Radiotherapy has long been recognized as effective for early-stage squamous cell carcinoma of the hypopharynx 1, 2. However, few reports have analyzed large numbers of patients undergoing RT for early-stage HPC without lymph node metastasis, and to our knowledge, no reports have statistically analyzed predictors of survival. Concurrent chemoradiotherapy and the computed tomography–based tumor volume have been reported to be strong predictors of local control in HPC patients, including patients

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