A comparison of surgery and radiotherapy in the management of advanced pyriform fossa carcinoma

Abstract

This retrospective study analyses the outcome of treatment of 61 patients with advanced carcinoma of the pyriform fossa. Thirty-two patients (group 1) underwent surgery and postoperative radiotherapy and 29 patients (group 2) had induction chemotherapy followed by radiotherapy. The local recurrence-free survival at 5 years from the completion of therapy for group 1 was 54%, compared to 61% for group 2. The 5-year neck recurrence-free survival for groups 1 and 2 were 54% and 59%, respectively. The 5-year overall survival rates for groups 1 and 2 were 19% and 14%, respectively. Non-surgical therapy for advanced stage pyriform fossa cancer provides survival comparable with that achieved with the standard approach of surgery and postoperative radiotherapy. We advocate radical irradiation as the method of choice because it provides nodal coverage to the bilateral jugular chains and retropharyngeal nodes, all known to be at risk for metastases, and is associated with lower morbidity compared to surgery. But, however, despite the therapy, the outcome is poor.

Treatment results for hypopharyngeal cancer by different treatment strategies and its secondary primary- an experience in Taiwan

“…Among head and neck cancers, hypopharyngeal cancer has the worst prognosis. The five-year overall survival rate was 24.8% in our series, which is comparable to results from other studies where overall survival rates varied from 10 to 60% [1-3,6-10,12,17-23]. …”

“…Most retrospective studies of head and neck cancers included various subsites (Table 4). Some series revealed a significant rate of organ preservation with similar survival rates between surgery and chemo-radiotherapy in head and neck cancer patients [1,4,6-12,15,16,18,19,23-27], especially for laryngeal cancer. In this study, we separated the entire patient population into two main treatment groups: radical surgery or organ preservation.…”

“…These patients have some of the worst prognoses of all head and neck cancer patients, and combined-modality therapy is usually required to achieve a cure. The conventional treatment for advanced, but resectable, cases has been surgery followed by post-operative adjuvant therapy, and five-year survival rates vary from 10% to 60% [1-5]. Recently, the integration of chemotherapy and radiotherapy was investigated for organ preservation in patients with locally advanced hypopharyngeal cancers.…”

Concurrent radiochemotherapy in advanced hypopharyngeal cancer

“…Hypopharyngeal cancers are often at an advanced stage at diagnosis and are associated with a poor prognosis [4,6]. The reasons for the unfavourable prognosis of hypopharyngeal cancers are the strong tendency for extensive submucosal spread, the early occurrence of regional lymphatic involvement, and the relatively high rate of distant spread [7,8]. …”

“…This radical approach of treatment, lead to the loss of natural speech function and impairment of swallowing ability with a consequent negative impact on the quality of life, and low cure rates, reported 5-year survival between 20.0% and 50.0% [1,2,7,11,12]. …”