Surgically-Treated Locoregionally Advanced Hypopharyngeal Cancer: Outcomes

Abstract

Introduction Hypopharyngeal tumors are head and neck malignancies associated with a great mortality rate, and the treatment of advanced lesions constitutes a challenging problem. Pharyngolaryngectomy continues to be the gold standard treatment modality for locally-advanced diseases, and it is currently used as the primary treatment or in cases of relapse after an organ preservation strategy. Objective This study aims to compare the survival rates of patients with advanced hypopharyngeal tumors treated with pharyngolaryngectomy as a primary or salvage option, and identify possible prognostic factors. Methods All patients with advanced hypopharyngeal squamous cell carcinomas who performed pharyngolaryngectomy between 2007 and 2014 were reviewed retrospectively. Results A total of 87 patients fulfilled the aforementioned criteria, and the sample had a mean age of 57.2 years and a male predominance of 43:1. The tumors were located in the pyriform sinus walls (81 tumors), in the posterior pharyngeal wall (4 tumors) and in the postcricoid region (2 tumors). A total of 60 patients underwent surgery as the primary treatment option, and 27 were submitted to salvage pharyngolaryngectomy after a previous treatment with chemoradiotherapy or radiotherapy. The 5-year overall survival was of 25.9%, the 5-year disease-free survival was of 24.2%, and the disease-specific survival was of 29.5%. Conclusion The patients treated with pharyngolaryngectomy as the primary option revealed a better 5-year-disease free survival than the patients who underwent the salvage surgery (35.8% versus 11.7% respectively; p < 0.05). The histopathological criteria of capsular rupture of the lymph nodes (30.1% versus 19.8% respectively for the primary and salvage groups; p < 0.05) and vascular invasion (30.5% versus 22.5% respectively; p < 0.05) reduced the 5-year disease-free survival. Pharyngolaryngectomy as the primary intent revealed a lower local recurrence rate than the salvage surgery (40.6% versus 83.3% respectively; p < 0.05).

Is Increased Time From Diagnosis to Treatment in Advanced Hypopharynx Cancer Associated With Poorer Outcomes: A Single-Centre Analysis

“…This is in accordance with other studies, which documented that not only the presence of regional disease but also the existence of nodal rupture are determinant factors in prognosis. 17 In the present study, the 5-year OS and DSS is similar to other series, supporting the idea that HSCC continues to have an unsatisfactory prognosis that has not changed appreciably over the past decades. 17 Our work is novel because it suggests that duration of adjuvant therapy may be more important than other timing metrics.…”

“…17 In the present study, the 5-year OS and DSS is similar to other series, supporting the idea that HSCC continues to have an unsatisfactory prognosis that has not changed appreciably over the past decades. 17 Our work is novel because it suggests that duration of adjuvant therapy may be more important than other timing metrics. Additional studies evaluating the reasons for RT or CRT breaks may be helpful in further understanding our practice patterns.…”

“…17 In the present study, the 5-year OS and DSS is similar to other series, supporting the idea that HSCC continues to have an unsatisfactory prognosis that has not changed appreciably over the past decades. 17…”

Survival and swallowing function outcome impact factors analysis of surgery-oriented comprehensive treatment for hypopharyngeal cancer in a series of 122 patients

“…Hypopharyngeal cancer (HPC) is reported as one of the most aggressive cancers of the head and neck region. [1][2][3][4] The primary tumor commonly causes intra-luminal obstruction of the upper aerodigestive tract, leading to progressive swallowing problems (dysphagia), hoarseness of voice (dysphonia), and airway compromise (dyspnea). 5 Most patients present with advancedstage disease at the initial diagnosis.…”

“…6 The prognosis of HPC is poor, with a 5 year overall survival (OS) rate of around 40%. 2,4,7 The treatment goals are to achieve local-regional tumor control with preservation of laryngopharyngeal functions: tracheostomy-free breathing, ability to maintain body mass (weight) by a daily oral diet, and ability to vocalize. 4 Transoral surgery, including transoral laser microsurgery (TLM) and transoral robotic surgery (TORS), has enabled oncologic surgeons to remove tumors without the need of breaching the neck skin.…”