Concurrent radiochemotherapy in advanced hypopharyngeal cancer

Abstract

BackgroundConcurrent platinum-based radiochemotherapy has been recommended as a standard of care in patients with locally advanced squamous cell head and neck carcinomas. Unfortunately, there is a lack of level one evidence on best treatment approach for advanced hypopharyngeal cancer. This report aims to summarize the results of our study on concurrent radiochemotherapy in patients with advanced hypopharyngeal cancer.MethodsA retrospective analysis of 41 patients with stage III-IV hypopharyngeal cancer was performed. All patients were treated with three dimensional conformal radiotherapy and received 70 Gy in 35 fractions (2 Gy per fraction, 5 fractions per week). In dependence of the period when radiotherapy was realized, two different treatment techniques were used. Concurrent chemotherapy consisted of cisplatin 30 mg/m2 given on a weekly basis.ResultsThe median age was 52 years (range 29-70). Stage IV disease was recognized in 73.2% of the patients. Complete response rates at the primary site and at the metastatic neck lymph nodes were 68.3% and 36.6%, respectively. A complete composite response was present in 27 patients (65.9%). Median follow-up was 13 months (range 7-36). Distant metastases as initial failure occurred in 7 patients (46.7%). The 2-year local relapse-free survival and regional relapse-free survival rates were 55.2% and 75.8%, respectively. The 2-year locoregional relapse-free survival rate was 51.3%. The 2-year disease-free survival and overall survival rates were 29.3% and 32.8%, respectively. Confluent mucositis was developed in 46.3% of patients. Leucopenia grade 1 was the most frequent hematological toxicity. The median weight loss at the end of treatment was 12% (range 5-21). The worst grade of late toxicity was most commonly pronounced in the skin and in the subcutaneous tissue.ConclusionsBased on unsatisfactory results in our study we suggest that the use of sequential radiochemotherapy or chemotherapy given concomitantly with altered fractionation radiotherapy with the implementation of intensity-modulated radiotherapy as radiotherapy technique could represent treatment approaches able to improve outcome in patients with advanced hypopharyngeal cancer.

Contemporary therapeutic management of locally advanced hypopharyngeal cancer: oncologic and functional outcomes – a report on 100 cases

“…The oncologic outcomes reported in the present study were comparable to those published in other studies on locally advanced hypopharyngeal cancer [12,13,15]. Five-year OS rates ranging from 25 to 50% are usually published depending on the clinical characteristics of the patients and treatment modalities.…”

“…Unsurprisingly, patients treated by induction CT had higher OS, SS, and LRC rates (Table II) RT ± CT or primary TPL. Beside induction CT, primary concurrent RT + CT is another modality of larynx preservation in patients with locally advanced larynx or hypopharynx cancer [12,13]. To date, there is not a high scientific rationale supporting the superiority of TPF induction CT followed by RT ± CT or of primary concurrent RT + CT in this setting [3].…”

Different clinical outcomes between locally advanced hypopharyngeal and oropharyngeal cancer treated with definitive concurrent chemoradiotherapy: implication for subgroup selection for induction chemotherapy

“…A retrospective analysis showed that the 2-year disease-free survival (DFS) and 2-year overall survival (OS) rates were only 29.3 and 32.8%, respectively, in patients with Stage III/IV hypopharyngeal cancer treated with CRT. The locoregional relapse-free survival rate at 2 years was 51.3% and distant metastasis-free survival rate at 2 years was 64.7% (11). A Phase II trial evaluating efficacy after treatment with induction chemotherapy followed by concomitant chemoradiotherapy in 59 patients with hypopharynx cancer or base of tongue cancer reported 3-year OS of 64% and PFS of 57% in all patients (4).…”

Untreated Cleft Palate a Unique Surgical Contraindication in Carcinoma of the Pyriform Fossa

“…13 In developing countries including India hypopharyngeal cancers are relatively more common constituting 20 to 35% of all the head and neck cancers.…”