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

Abstract

Objective: The purpose of this study is to compare the long-term clinical outcome of hypopharynx cancer and oropharynx cancer treated with concurrent chemoradiotherapy. Methods: A total of 213 patients with locally advanced hypopharyngeal squamous cell carcinoma (n = 79) or oropharygeal squamous cell carcinoma (n = 134) were included. All patients were treated with upfront concurrent chemoradiotherapy between 1995 and 2012. Results: The median overall survival and progression-free survival differed significantly between the two groups (P < 0.05). Overall survival and progression-free survival rates at 3 years were 52% and 42% for hypopharynx cancer, and 75% and 72% for oropharynx cancer, respectively. There was no significant difference in the overall incidence of distant metastases but more locoregional recurrences occurred in patients with hypopharynx cancer compared with those with oropharynx cancer with a statistical significance (P < 0.001). Conclusions: Patients diagnosed with locally advanced hypopharyngeal had relatively poor survival after upfront concurrent chemoradiotherapy. More intensive treatment such as induction chemotherapy before concurrent chemoradiotherapy might be needed to improve survival outcome in this subgroup of patients.

Induction chemotherapy followed by concurrent chemoradiotherapy versus CCRT for locally advanced hypopharynx and base of tongue cancer

“…While the TAX (Cisplatin and Fluorouracil Alone or with Docetaxel in Head and Neck Cancer) 324 trial suggested that TPF IC was superior to a PF regimen with improved survival, we noticed that the 3-year OS rate in the TAX 324 trial, which included about 50% oropharyngeal cancer patients, was 62% in the TPF IC group [6], but only 49% in a subgroup analysis of hypopharynx cancer patients [10]. Such an inferior outcome for hypopharyngeal cancer was similar to our previous study [8] where the 3-year OS rate was 52% in the hypopharynx group compared to 75% in the oropharynx group (HR, 2.21; 95% CI, 1.38 to 3.56; p = 0.001) after treatment with upfront CRT. Hypopharynx and BOT cancers have been regarded as good candidates for organ preservation, and so multidisciplinary treatments including chemotherapy, and radiotherapy rather than surgery have been evaluated.…”

“…We hypothesized that some subgroup populations could benefit from integrating IC into CRT alone. Previously, we confirmed that long-term outcome was significantly worse in patients with hypopharyngeal cancer compared to those with oropharyngeal cancer (3-year overall survival [OS] rate 52% vs. 75%, p = 0.001; 3-year progression-free survival [PFS] rate 42% vs. 72%, p < 0.001), although the overall response rate (ORR) after CRT was fairly good in both groups [8]. And another phase III trial comparing concurrent CRT versus IC followed by CRT reported a more pronounced benefit of IC with a TPF regimen in patients with non-oropharyngeal cancer compared to overall LASCC patients [9].…”

Surgery is not the only determinant of an outcome in patients with hypopharyngeal carcinoma

“…Bozec noted that those patients who responded to induction chemotherapy were more likely to require permanent enteral nutrition . Lim recorded a 3‐year progression‐free survival of 42% with concurrent CRT, worse than, with comparable treatment, at other head and neck sites . This series had worse outcomes for those treated with chemotherapy; however, this was for a group who had many adverse features at presentation.…”

“…32 Lim recorded a 3-year progression-free survival of 42% with concurrent CRT, worse than, with comparable treatment, at other head and neck sites. 33 This series had worse outcomes for those treated with chemotherapy; however, this was for a group who had many adverse features at presentation. There are other determinants of achieving local control.…”

Thoracoscopic esophagectomy in total pharyngolaryngoesophagectomy for esophageal cancer; A case series

“…Carcinoma of the hypopharynx is associated with poor survival, largely because tumors in this region remain asymptomatic until the disease reaches an advanced stage [ 1 , 2 ]. Stage III or IV hypopharyngeal cancer often invades the cervical esophagus, which is a very aggressive cancer with a poor prognosis.…”