Purpose
The purpose of this study is to compare the treatment outcomes for locally advanced resectable hypopharyngeal cancer between organ-preserving chemoradiotherapy (CRT) and surgery followed by radiotherapy (SRT).
Materials and Methods
We reviewed 91 patients with stage III/IV hypopharyngeal squamous cell carcinoma treated with radiotherapy (RT). In the CRT group (n=34), 18 patients were treated with concurrent CRT and 16 patients with induction chemotherapy plus concurrent CRT. In the SRT group (n=57), six patients were treated with total laryngopharyngectomy, 34 patients with total laryngectomy (TL) and partial pharyngectomy (PP), and 17 patients with PP, which were followed by adjuvant radiotherapy (n=41) or CRT (n=16). The median RT dose was 70 Gy for CRT and 59.4 Gy for SRT.
Results
Five-year local control (84.1% vs. 90.9%), and disease-free survival (DFS, 51.0% vs. 52.7%) and overall survival (OS, 58.6% vs. 56.6%) showed no significant difference between the CRT and SRT groups. The functional larynx-preservation rate was higher in the CRT group (88.2% vs. 29.8%). Treatment-related toxicity, requiring surgical intervention, occurred more frequently in the SRT group (37% vs. 12%). In the SRT group, TL resulted in a significantly higher DFS than larynx-sparing surgery (63.9% vs. 26.5%, p=0.027). Treatment outcome of the SRT group improved when only patients with TL were considered (n=40); however, 5-year OS (67.1% vs. 58.6%, p=0.830) and DFS (63.9% vs. 51.0%, p=0.490) did not improve significantly when compared to the CRT group.
Conclusion
Organ preserving CRT provided a treatment outcome that is comparable to SRT for locally advanced hypopharyngeal cancer, while offering an opportunity for functional larynx-preservation and reduced treatment-related toxicity.
Citations
Citations to this article as recorded by
Prognostic Factors and Long-Term Outcome Prediction in Patients with Hypopharyngeal Carcinoma Treated with (Chemo)radiotherapy: Development of a Prognostic Model Miloslav Pala, Pavla Novakova, Adam Tesar, Lucie Vesela, Antonin Vrana, Jarmila Sukova, Zdenka Pechacova, Petra Holeckova, Tereza Drbohlavova, Tomas Podlesak, Petra Tesarova Biomedicines.2025; 13(2): 417. CrossRef
Patterns of recurrence in HNSCC patients treated definitively with upfront surgery, chemoradiation Pei Yuan Fong, Thomas Kwok Seng Loh, Liang Shen, Donovan Kum Chuen Eu, Chwee Ming Lim European Archives of Oto-Rhino-Laryngology.2024; 281(5): 2645. CrossRef
Distinct Failure Patterns in Hypopharyngeal Cancer Patients Receiving Surgery-Based Versus Radiation-Based Treatment Yu-Hsuan Lin, Jenn-Ren Hsiao, Yuan-Hua Wu, Jeffrey S. Chang, Chun-Yen Ou, Wei-Ting Lee, Cheng-Chih Huang, Chan-Chi Chang, Yu-Hsuan Lai, Sen-Tien Tsai, Wei-Ting Hsueh, Chia-Jui Yen, Chen-Lin Lin, Yu-Shan Chen, Shih-Sheng Jiang, Yu-Chu Su, Shang-Yin Wu Annals of Surgical Oncology.2023; 30(2): 1169. CrossRef
Survival analyses of different treatment modalities and clinical stage for hypopharyngeal carcinoma Tian-Yun Lin, Tsung-Lun Lee, Yen-Bin Hsu, Shyh-Kuan Tai, Ling-Wei Wang, Muh-Hwa Yang, Pen-Yuan Chu Frontiers in Oncology.2023;[Epub] CrossRef
Optimal treatment strategy and prognostic analysis for hypopharyngeal squamous-cell carcinoma patients with T3-T4 or node-positive: A population-based study Linhui Zheng, Sha Fang, Linfeng Ye, Wenqi Cai, Wenbin Xiang, Yan Qi, Huachao Wu, Chunqian Yang, Runze Zhang, Yifeng Liu, Yue Liu, Chaoyan Wu, Haijun Yu European Journal of Surgical Oncology.2023; 49(7): 1162. CrossRef
Study on the treatment outcomes of advanced laryngeal and hypopharyngeal cancer with induction chemotherapy Hideoki Uryu, Shingo Tamura, Rina Kitagawa, Ayaka Koide, Kaori Hara, Ryutaro Uchi, Torahiko Nakashima Toukeibu Gan.2023; 49(3): 249. CrossRef
Oncological and Functional Outcomes of Larynx-preserving Surgery for Hypopharyngeal Cancer: A Comparison with Definitive Radiation-based Treatment Donghyeok Kim, Nalee Kim, Sungmin Koh, Man Ki Chung, Young-Ik Son, Dongryul Oh, Han-Sin Jeong, Yong Chan Ahn Cancer Research and Treatment.2022; 54(1): 84. CrossRef
The impact of physician’s characteristics on decision-making in head and neck oncology: Results of a national survey Emilien Chabrillac, Sébastien Lamy, Pascale Grosclaude, Fanny Cros, Benjamin Vairel, Jérôme Sarini, Sébastien Vergez, Antoine Nebout, Pierre Bories, Agnès Dupret-Bories Oral Oncology.2022; 129: 105895. CrossRef
Posttreatment Non-Improved Vocal Cord Mobility Indicates the Need of Salvage Surgery for Hypopharyngeal Carcinomas Yu-qin He, Xi-wei Zhang, Yi-ming Zhu, Xiao-guang Ni, Ze-hao Huang, Chang-ming An, Jun-lin Yi, Shao-yan Liu Frontiers in Oncology.2021;[Epub] CrossRef
Tumor dimension‐dependent microscopic extensions of hypopharyngeal cancer: Therapeutic implications for larynx‐preserving hypopharyngectomy Joongbo Shin, Jiyeon Lee, Nayoung Hwang, Sung Yong Choi, Woori Park, Nayeon Choi, Young‐Ik Son, Junhun Cho, Han‐Sin Jeong Journal of Surgical Oncology.2021; 123(4): 872. CrossRef
Survival and complications with a surgical approach in advanced hypopharyngeal cancer Maria Paz Galeano Machuca, Deborah L. Ng, Shyuang‐Der Terng, Wen‐Ching Wu, Chih‐Tao Cheng Journal of Surgical Oncology.2021; 123(7): 1540. CrossRef
High Pretreatment LDH Predicts Poor Prognosis in Hypopharyngeal Cancer Jialing Wu, Kaiyun You, Changlong Chen, Huimin Zhong, Yanhui Jiang, Huaqian Mo, Juanjuan Song, Xingsheng Qiu, Yimin Liu Frontiers in Oncology.2021;[Epub] CrossRef
Matched-Pair Analysis of Survival in the Patients with Advanced Laryngeal and Hypopharyngeal Squamous Cell Carcinoma Treated with Induction Chemotherapy Plus Chemo-Radiation or Total Laryngectomy Patricia García-Cabo, Fernando López, Mario Sánchez-Canteli, Laura Fernández-Vañes, César Álvarez-Marcos, José Luis Llorente, Maria Ángeles de la Rúa, Pilar Blay, Juan P. Rodrigo Cancers.2021; 13(7): 1735. CrossRef
Physician practice variation in head and neck cancer therapy: Results of a national survey Fanny Cros, Sébastien Lamy, Pascale Grosclaude, Antoine Nebout, Emilien Chabrillac, Sébastien Vergez, Pierre Bories, Agnès Dupret-Bories Oral Oncology.2021; 117: 105293. CrossRef
Survival Benefits From Surgery for Stage IVa Head and Neck Squamous Cell Carcinoma: A Multi-Institutional Analysis of 1,033 Cases Jun-Ook Park, Young Min Park, Woo-Jin Jeong, Yoo Seob Shin, Yong Tae Hong, Ik Joon Choi, Ji Won Kim, Seung Hoon Woo, Yeon Soo Kim, Jae Won Chang, Min-Sik Kim, Kwang-Yoon Jung, Soon-Hyun Ahn, Chul-Ho Kim, Ki Hwan Hong, Phil-Sang Chung, Young-Mo Kim, Se-Heo Clinical and Experimental Otorhinolaryngology.2021; 14(2): 225. CrossRef
Prognostic significance of human papillomavirus status and treatment modality in hypopharyngeal cancer Nina Burbure, Elizabeth Handorf, John A. Ridge, Jessica Bauman, Jeffrey C. Liu, Anshu Giri, Thomas J. Galloway Head & Neck.2021; 43(10): 3042. CrossRef
Initial surgical versus non-surgical treatments for advanced hypopharyngeal cancer: A meta-analysis with trial sequential analysis Jie Cui, Liping Wang, Jinsong Piao, Haiyan Huang, Weiquan Chen, Zhen Chen, Hong Yang, Xiaojun Tan, Jiansheng Li, Genglong Liu International Journal of Surgery.2020; 82: 249. CrossRef
lncRNA HOXA11-AS Promotes Proliferation and Migration via Sponging miR-155 in Hypopharyngeal Squamous Cell Carcinoma Jianing Xu, Qiyu Bo, Xiang Zhang, Dapeng Lei, Jue Wang, Xinliang Pan Oncology Research Featuring Preclinical and Clinical Cancer Therapeutics.2020; 28(3): 311. CrossRef
Pacientes con carcinoma localmente avanzado de hipofaringe. Resultados a lo largo de un periodo de 30 años Xavier León, Montserrat López, Jacinto García, Carlota Rovira, María Casasayas, Miquel Quer Acta Otorrinolaringológica Española.2019; 70(6): 315. CrossRef
A Survival Analysis of Hypopharyngeal Cancer Patients: A Hospital-Cancer registry Based Study Manigreeva Krishnatreya, Amal Chandra Kataki, Jagannath Dev Sharma, Nizara Baishya, Tashnin Rahman, Mouchumee Bhattcharyya, Ashok Kumar Das, Manoj Kalita Indian Journal of Otolaryngology and Head & Neck Surgery.2019; 71(S1): 798. CrossRef
Long-term oncological and functional outcomes of induction chemotherapy followed by (chemo)radiotherapy vs definitive chemoradiotherapy vs surgery-based therapy in locally advanced stage III/IV hypopharyngeal cancer: Multicenter review of 266 cases Eun-Jae Chung, Woo-Jin Jeong, Young Ho Jung, Seong Keun Kwon, Tack-Kyun Kwon, Soon-Hyun Ahn, Myung-Whun Sung, Bhumsuk Keam, Dae-Seog Heo, Jin Ho Kim, Hong-Gyun Wu, Keun-Wook Lee, Keun-Yong Eom, Young-Soo Rho Oral Oncology.2019; 89: 84. CrossRef
Surgery is not the only determinant of an outcome in patients with hypopharyngeal carcinoma Robert Smee, Janet R. Williams, Damian P. Kotevski Head & Neck.2019; 41(5): 1165. CrossRef
Open-neck organ preservation surgery for hypopharyngeal cancer: indications, techniques, limits, and outcomes Patrick J. Bradley, Liangfa Liu Current Opinion in Otolaryngology & Head & Neck Surgery.2019; 27(2): 123. CrossRef
Oncologic and Functional Outcomes After Primary and Salvage Laryngopharyngoesophagectomy With Gastric Pull-Up Reconstruction for Locally Advanced Hypopharyngeal Squamous Cell Carcinoma Jeroen Meulemans, Floor Couvreur, Eline Beckers, Philippe Nafteux, Hans Van Veer, Vincent Vander Poorten, Pierre Delaere, Willy Coosemans Frontiers in Oncology.2019;[Epub] CrossRef
Patients With Locally Advanced Hypopharyngeal Carcinoma. Results Over a 30-year Period Xavier León, Montserrat López, Jacinto García, Carlota Rovira, María Casasayas, Miquel Quer Acta Otorrinolaringologica (English Edition).2019; 70(6): 315. CrossRef
Clinical value of ultrasonic imaging in diagnosis of hypopharyngeal cancer with cervical lymph node metastasis Guzi Wang, Xiaoguang Li, Li Li, Dayu Liu, Ruijie Sun, Qiu Zhang, Chenchen Geng, Haitong Gong, Xiaoqian Gao Oncology Letters.2019;[Epub] CrossRef
Management of advanced hypopharyngeal carcinoma: systematic review of survival following surgical and non-surgical treatments A Habib The Journal of Laryngology & Otology.2018; 132(5): 385. CrossRef
Surgery vs. radiotherapy for locally advanced hypopharyngeal cancer in the contemporary era: A population‐based study Yi‐Jun Kim, Rena Lee Cancer Medicine.2018; 7(12): 5889. CrossRef
The impact of surgical margin status on the outcomes of locally advanced hypopharyngeal squamous cell carcinoma treated by primary surgery Min Li, Ming Xie, Liang Zhou, Shuyi Wang Acta Oto-Laryngologica.2018; 138(12): 1136. CrossRef
The diagnostic role of diffusion-weighted magnetic resonance imaging in hypopharyngeal carcinoma Si‑Cong Zhang, Shui‑Hong Zhou, De‑Sheng Shang, Yang‑Yang Bao, Ling‑Xiang Ruan, Ting‑Ting Wu Oncology Letters.2018;[Epub] CrossRef
Matched-pair analysis of patients with advanced hypopharyngeal cancer: surgery versus concomitant chemoradiotherapy Shigemichi Iwae, Masato Fujii, Ryuichi Hayashi, Yasuhisa Hasegawa, Takashi Fujii, Kenji Okami, Akihiro Homma, Tetsuro Onitsuka, Takakuni Kato, Takenori Ogawa, Kyoichi Terao, Nobuya Monden, Naoki Otsuki, Hiroshi Nishino, Ichiro Ota, Yasushi Fujimoto, Kazut International Journal of Clinical Oncology.2017; 22(6): 1001. CrossRef
Survival benefit of surgical approach for advanced oropharyngeal and hypopharyngeal cancer: A retrospective analysis Chih-Tao Cheng, Ching-Yuan Lin, Skye Hung-Chun Cheng, Yi-Ping Lin, Lay-Chin Lim, Nicolas Pennarun, Zhen-Ying Liu, Shyuang-Der Terng Head & Neck.2017; 39(10): 2104. CrossRef
When is definitive radiotherapy the preferred treatment for head and neck squamous cell carcinoma? William M. Mendenhall, Primož Strojan, Avraham Eisbruch, Robert Smee, Alessandra Rinaldo, Alfio Ferlito European Archives of Oto-Rhino-Laryngology.2015; 272(10): 2583. CrossRef