Definitive Chemoradiation in Locally Advanced Squamous Cell Carcinoma of the Hypopharynx: Long-term Outcomes and Toxicity

Abstract

Abstract. Background/Aim: Definitive chemoradiation (CRT)is a common approach for locally advanced hypopharyngeal squamous cell carcinoma (SCC) Squamous cell carcinoma (SCC) of the hypopharynx is a rare malignancy accounting for approximately 3-5% of head and neck SCC cases (1) with a yearly incidence of 3,400 new cases in the United States (2). The management of hypopharyngeal SCC remains complex due to the close proximity of the hypopharynx to the larynx and esophagus and the natural history of the disease. Only 25% of patients with hypopharyngeal SCC present with early-stage disease (T1-T2N0) (3) and in these patients, both surgery and definitive radiation have been associated with similar outcomes in terms of local control and functional outcomes (1, 4). Due to the late presentation of symptoms and rich lymphatic drainage of the hypopharynx, most patients present with locoregionally advanced disease at the time of their diagnosis. Traditionally the standard-of-care for patients presenting with advanced disease has included extirpative surgery followed by adjuvant radiation (RT) (5, 6). The ability to preserve the larynx, and thus help maintain the crucial functions of speech and respiration has increasingly become recognized as an important goal of definitive treatment. Therefore, definitive chemoradiotherapy (CRT) has become a common treatment strategy. Treatment with CRT has indeed noted an annual 2% increase in hypopharynx patients since 1988, with over 70% of patients undergoing this treatment strategy in 2010 (7). Here, we present our long-term institutional experience of patients with locally advanced hypopharyngeal cancer treated with concurrent CRT over the past 30 years and examine the impact of this strategy on oncological outcomes and associated toxicity. Materials and MethodsWe queried the Cleveland Clinic's Institutional Review Board (IRB)-approved Head and Neck Cancers Registry for patients with hypopharyngeal carcinoma treated at our institution. Patients with histologically confirmed stage III-IVB SCC of the hypopharynx treated with definitive CRT from 1986 through 2013 were included. Patients with a history of prior major surgery of the neck or glottis, 3543

A Single Institution's Experience of Definitive Radiotherapy Using Volumetric-modulated Arc Therapy for Hypopharyngeal Cancers

“…According to previous studies, the 3-and 5-year OS rates after IMRT for patients with HPC were almost 50-80% and 35-44%, respectively (7, 12-15). In contrast, several studies mentioned treatment results after 3D-CRT for HPC, and the 3-and 5-year OS rates were almost 50-80% and 35-60%, respectively (7,10,11,(15)(16)(17). In the present study, the 3and 5-year OS rates were 77% and 60%, respectively.…”

“…These results were also similar to other IMRT studies. In contrast, in a 3D-CRT for HPC study reported by Juloori et al, grade 2 xerostomia was observed in almost 77% of patients, and grade 3 dysphagia in 36% (90% of the total cases received 3D-CRT, and others received IMRT) (17). In addition, in RTOG 91-11, grade 2 xerostomia was observed in almost 50% of patients, and grade 3 dysphagia in 15% (4).…”

Management of Advanced-stage Hypopharyngeal Carcinoma: 25-Year Experience from a Tertiary Care Medical Center

“…Our data is consistent with the literature, with hypopharyngeal cancer constituting 4% of all the patients in the head and neck cancer database of our institution. Patients with hypopharyngeal squamous cell carcinoma are mostly males with a known history of tobacco (90%) and heavy alcohol use (50%) [18].…”

“…Hypopharyngeal carcinoma is a rare malignancy that contributes to approximately 3 to 5% of head and neck carcinomas [1][2]. Approximately 3,400 new cases of hypopharyngeal cancer are diagnosed in the United States every year [3]. The majority of these patients (70% to 85%) present with advanced-stage disease (stage III & IV) [4][5][6].…”

“…Due to the presentation in the advanced stages, hypopharyngeal carcinoma patients tend to have the worst survival among cancers of the head and neck region, with five-year overall survival ranging from 25% to 41% [7][8][9][10][11]. Regarding the treatment options, definitive surgery or laryngeal preservation using chemoradiotherapy is considered the standard of care, but there is a continuing debate on the outcomes due to conflicting data [2,6,[10][11][12][13][14][15][16][17][18][19][20]. The purpose of this study is to evaluate the management and outcomes of advanced hypopharyngeal carcinoma in a tertiary care institution in the United States over the past 25 years.…”