Definitive radiotherapy alone or combined with a planned neck dissection for squamous cell carcinoma of the pharyngeal wall

Abstract

BACKGROUND. In the current study,the authors analyzed the results of definitive radiotherapy for squamous cell carcinoma of the pharyngeal wall. METHODS. Between 1964 and 2000, 148 patients were treated with definitive radiotherapy. All patients had a 2-year minimum follow-up. RESULTS. The following 5-year rates of local and ultimate local control were obtained: T1 disease, 93% and 93%; T2 disease, 82% and 87%; T3 disease, 59% and 61%; and T4 disease, 50% and 50%, respectively. Multivariate analysis revealed that twice-daily fractionation (P ϭ 0.0009), American Joint Committee on Cancer Stage I-II disease (P ϭ 0.0051), and oropharyngeal primary site (P ϭ 0.0193) were associated with improved locoregional control. The following 5-year absolute and cause-specific survival rates were obtained: Stage I, 56% and 89%; Stage II, 52% and 88%; Stage III, 24% and 44%; Stage IV, 22% and 34%; and overall, 30% and 49%, respectively. Eight patients (5%) died of complications.. CONCLUSIONS. Locoregional control and survival were found to be related to site, extent of disease, and fractionation schedule. Although outcomes have improved in recent years, the morbidity of treatment was significant in the current study and a substantial proportion of patients died secondary to the malignancy. Cancer

Treatment of squamous cell carcinoma of the posterior pharyngeal wall: Radiotherapy versus surgery

“…Despite advances in diagnosis and treatment techniques, the treatment outcome of this subsite of head and neck cancer remains relatively poor compared with cancers of other head and neck subsites . Most patients are initially diagnosed with advanced disease (70% of patients with T3–T4 disease in our study) because of the absence of symptoms at an early stage and the richness of submucosal lymphatics in the posterior pharyngeal wall.…”

“…Squamous cell carcinoma (SCC) of the posterior pharyngeal wall is a relatively rare location in pharyngeal SCC, accounting for 12% to 20% of this sublocation . Despite the lack of prospective comparison, radiotherapy (RT) — alone or associated with concomitant chemoradiotherapy (CRT) — and surgery have both been utilized to treat this type of cancer.…”

High Survival and Organ Function Rates After Primary Chemoradiotherapy for Intermediate-Stage Squamous Cell Carcinoma of the Head and Neck Treated in a Multicenter Phase II Trial

“…Comparable data regarding gastrostomy tube dependence rates are limited because the number of prospective trials in this patient population is few with many do not report this measure. 3,4,20 Nevertheless, from retrospective reviews, it appears that the long-term rate of feeding tube requirement is similar, 17,19 with the notable exception of the study by Fein et al, 14 who reported on 490 patients treated with radiotherapy alone for oropharyngeal primary tumors and noted permanent gastrostomy tubes in only two patients. In our cohort, similar to reports by other groups, [24][25][26] patients with hypopharyngeal and laryngeal primary tumors were at greatest risk for swallowing dysfunction after CRT.…”

“…However, even for T2-3 tumors, significant dysfunction can result, and although organ-preserving surgical techniques have been described, their application is limited by operator expertise and the need for appropriate patient selection. Furthermore, RT without primary surgery in resectable intermediate-stage patients has yielded local control rates comparable to those from surgery followed by RT, [14][15][16][17] especially if hyperfractionated RT is administered. 18 In fact, a retrospective review of North American trials suggested an advantage to RT as primary therapy followed by neck dissection with respect to treatment complications and functional outcome.…”

Surgery and Postoperative Radiotherapy for Squamous Cell Carcinoma of the Larynx and Pharynx

“…Definitive RT has been the preferred treatment of patients with oropharyngeal and pharyngeal wall carcinomas, so that most of the patients with pharyngeal tumors had lesions arising in the pyriform sinus. [11][12][13] All living patients had a minimum follow-up of 2 years. Four patients who were continuously disease-free were lost to follow-up and censored from further analysis at 2.2, 3.1, 8.3, and 13.7 years, respectively.…”