From 1975From to 1985 patients with hypopharyngeal cancer were seen at King Faisal Specialist Hospital and Research Centre (KFSH&RC). The endoscopic investigation showed that 28.3% of these patients had postcricoid carcinoma; 19.85% had pyriform fossa carcinoma and 52.9% had involvement of both sites. The pathological diagnosis of all cases was squamous cell carcinoma type. The majority of the patients (62.98%) had T 4 lesions, which showed a late presentation to KFSH&RC. Information related to survival was available for a smaller number of patients due to many "lost-to-follow-up" cases. The overall median survival time was 8.5 months (1 -110 months). The survival rate for each site was calculated, as well as the staging of the disease and treatment modality used. It appeared that pyriform fossa (median 21 months) had the best survival rate. In addition, the earlier the lesion was detected and the more aggressive the treatment applied, the better the survival rate. Fifty percent of the patients receiving radiation therapy and surgery had a five-year survival rate. Factors other than smoking and/or drinking should be looked for in our community as predisposing to this disease in our population. When discussing hypopharyngeal tumors, we refer to the anatomic area extending from the level of the tip of the epiglottis to the lower border of the cricoid cartilage.1 It is divided into three anatomic regions: 2 1) pharyngoesophageal junction (postcricoid area); 2) pyriform fossa, and 3) the posterior pharyngeal wall.Until 1960, the main treatment for postcricoid and posterior pharyngeal wall cancers was radiation therapy, because of the lack of surgical procedures that would resect and reconstruct the alimentary tract in one stage and in a short time.3,4 Since the establishment of the gastric pull-up procedure, which was designed to resect hypopharyngeal tumors and to maintain gastrointestinal tract continuity in one stage, 5,6 the combined approach, i.e., surgery plus radiation therapy, is the preferred method of treatment for hypopharyngeal cancers whenever applicable.
7Cancer of the hypopharyngeal area has traditionally carried a bad prognosis, with a low five-year survival rate (16% to 25%), regardless of the type of treatment given. 1,3,4,[7][8][9][10][11][12] The stage at time of presentation, the patient's general condition (as these patients usually present with weight loss and malnutrition secondary to prolonged dysphagia), 12 any co-existing diseases and patient preferences, which indicated the treatment modality, are all taken into consideration when determining the prognosis.
Material and MethodsAt KFSH&RC, which is a tertiary care hospital, 202 cases of hypopharyngeal cancer were seen from 1975 to 1985. All were squamous cell cancer type. The majority of patients were from Saudi Arabia.
ManagementThe patients had the following workup: 1) direct laryngoscopy, esophagoscopy and biopsy to confirm the exact site and extension of the tumor and provide histological proof, 2) chest x-ray to show metastases up...