Hypopharyngeal Cancer: Looking Back, Moving Forward

Abstract

Population-based datasets can provide observational insights into cancer incidence, patterns of care, and trends in survival outcomes. They can be particularly valuable in rare cancers for which there can be a paucity of prospective evidence. In this issue of Current Oncology, Hall describes treatment and survival trends in 1333 patients with squamous cell carcinoma of the hypopharynx (hpc) treated between 1990 and 2010 in Ontario, based on data from the Ontario Cancer Registry, with linkages to three other administrative datasets 1 .As a rare malignancy, hpc accounts for fewer than 5% of head-and-neck cancers and portends a poor prognosis, driven by patient, anatomic, and disease factors 2 . Patients with hpc have high rates of tobacco-and alcohol-related comorbidities and second cancers and frequently come from lower socioeconomic backgrounds 3,4 . Late presentation is typical, with approximately 70%-90% of patients having stage iii or iv disease at the time of presentation, and is at least in part attributable to the anatomy and location of the hypopharynx 3-6 . The underlying disease-related biologic factors are less well understood, but compared with other head-and-neck sites, hpcs have high rates of multicentricity, submucosal spread, and regional and distant metastasis 7 . In retrospective series, approximately 60% of patients treated with curative intent experience disease relapse or residual disease, and up to 50% of recurrences involve distant failure 3,4 .Evidence-based practice in hpc is challenged by the low incidence of the disease and is largely based on extrapolations from clinical trials in laryngeal squamous cell carcinoma (scc) and subgroup analyses of multi-site head-and-neck scc trials. Despite the substantial heterogeneity in study methods and characteristics, randomized trials comparing concurrent chemoradiation with radiation alone or radiation after induction chemotherapy in locally advanced head-and-neck scc have generally demonstrated improved local outcomes, including larynx preservation, with inconsistent conclusions on survival benefit [8][9][10][11][12] . The Meta-Analysis of Chemotherapy in Head and Neck Cancer collaborative group, in a subgroup analysis of 2767 hpc patients, found a 5-year absolute survival improvement of 4% associated with concomitant chemotherapy (hazard ratio: 0.85; 95% confidence interval: 0.75 to 0.96) compared with radiotherapy alone 13 . Thus, based on those data and equipoise on optimal treatment, a shift from open surgery toward multimodality approaches for organ preservation has occurred in hpc despite the greater risk of acute and potentially chronic toxicities from concomitant chemotherapy 14,15 .Consistent with other population-based series, Hall observed an increase in the prevalence of concurrent chemoradiation in the post-2000 era and a decrease in the use of primary surgery or radiation alone, with no statistically significant difference in overall survival between the treatment groups 1,2 . Hall's main finding is the lack of a survival increment...

A novel prognostic model predicting the long-term cancer-specific survival for patients with hypopharyngeal squamous cell carcinoma

“…Total laryngectomy used to be the standard way of treatment for patients with HSCC. However, with the development of new therapeutic agents, there was a shift from surgery to the laryngeal preservation therapy after the introduction of chemoradiotherapy [24,25]. For selected patients, chemotherapy followed by radiation shared similar therapeutic outcomes and regional control to surgical treatment while allow more than half of the HSCC patients to retain the larynx [24].…”

PD-L1 Immunohistochemistry Assay Concordance in Urothelial Carcinoma of the Bladder and Hypopharyngeal Squamous Cell Carcinoma

“…A limitation of our study was the relatively small number of hypopharyngeal SCC cases which was due to the tumor’s relative rarity 33 and the fact that, like other malignancies of the aerodigestive tract, these lesions are typically treated with a multimodal approach 34 and may not be surgically resected depending on the extent of disease. Another potential limitation of the present study is that the evaluation of PD-L1 was performed on TMAs, as it is known that PD-L1 immunoexpression may be heterogeneous 35,36 .…”

FoxM1 overexpression promotes cell proliferation and migration and inhibits apoptosis in hypopharyngeal squamous cell carcinoma resulting in poor clinical prognosis

“…Head and neck squamous cell carcinoma (HNSCC) is the sixth most common group of malignancies worldwide, and is generally classified into four independent types of cancer ( 1 ). Hypopharyngeal squamous cell carcinoma (HSCC), which accounts for ~3–5% of all HNSCCs ( 2 ), has high rates of recurrence and poor survival rates, and is regarded as the most malignant form of HNSCC ( 3 , 4 ). At the time of diagnosis, ~80% of HSCC patients are at an advanced stage of disease.…”