International Journal of Radiation Oncology*Biology*Physics
Clinical InvestigationOutcomes in Patients With Early-Stage Hypopharyngeal Cancer Treated With Radiotherapy
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.
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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 11–50 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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Conflict of interest: none.