Did the Addition of Concomitant Chemotherapy to Radiotherapy Improve Outcomes in Hypopharyngeal Cancer? A Population-Based Study

Hall, Stephen F.; Griffiths, Rebecca

doi:10.3747/co.23.3085

Cited by 15 publications

(15 citation statements)

References 38 publications

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“…The comorbidity was established using the Elixhauser Index based on a 5‐year look back window of hospitalizations. Elixhauser created a summative scale over 31 domains and we used the cutoff points of 0, 1, 2, and >2 with greater comorbidity creating higher scores.…”

Section: Methodsmentioning

confidence: 99%

Evaluation of treatment outcomes in patients with supraglottic laryngeal cancer in Ontario, Canada: A population‐based study

Hall

Griffiths

2018

Head & Neck

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Section: Methodsmentioning

confidence: 99%

Evaluation of treatment outcomes in patients with supraglottic laryngeal cancer in Ontario, Canada: A population‐based study

Hall

Griffiths

2018

Head & Neck

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“…Organ preservation has seen radiotherapy (RT) being used over the years, coupled with chemotherapy, demonstrating in many series, comparable outcomes with at least preservation of an anatomical larynx . The benefit of the addition of chemotherapy however, has not been universally established . Demonstrated prognostic factors; including the extent of nodal disease, as well as how the local disease has spread with two or greater side walls of the hypopharynx being involved, are important in determining survival .…”

Section: Introductionmentioning

confidence: 99%

“…the addition of chemotherapy however, has not been universally established. 8,9 Demonstrated prognostic factors; including the extent of nodal disease, as well as how the local disease has spread with two or greater side walls of the hypopharynx being involved, are important in determining survival. 10 Evolving RT techniques may also have an impact.…”

Section: Introductionmentioning

confidence: 99%

Surgery is not the only determinant of an outcome in patients with hypopharyngeal carcinoma

Smee

Kotevski

2019

Head & Neck

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Background The aim of this study was to evaluate the outcomes in patients treated for hypopharyngeal carcinoma in a single‐center and the importance of considering how patient factors influence outcomes. Methods A retrospective review was conducted on patients who were seen at the Prince of Wales Hospital from 1968 to 2015. Kaplan‐Meier and Cox regression analyses were performed for each patient and treatment factor to investigate outcomes of local control, cancer‐specific survival (CSS), and ultimate local control. Results Three hundred thirty patients were analyzed. Significant multivariate predictors for improved local control and CSS were fitness for surgery, cancer operability, surgery with adjuvant radiotherapy, no treatment interruptions (P < .05). Five‐year local control (84%), CSS (50%), and ultimate local control (84%) rates were significantly higher in patients treated surgically with adjuvant radiotherapy, compared to single modality treatment (P < .05). Conclusion Patient factors influence the outcomes experienced by patients with hypopharyngeal carcinoma.

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“…Hall's main finding is the lack of a survival increment over the 20-year study period, leading to the conclusion that the addition of concomitant chemotherapy to definitive radiotherapy did not yield survival gains 1 .…”

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confidence: 99%

“…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 .…”

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confidence: 99%

Hypopharyngeal Cancer: Looking Back, Moving Forward

2016

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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...

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Did the Addition of Concomitant Chemotherapy to Radiotherapy Improve Outcomes in Hypopharyngeal Cancer? A Population-Based Study

Abstract: Background For oncologists and for patients, no site-specific clinical trial evidence has emerged for the use of

Cited by 15 publications

References 38 publications

Evaluation of treatment outcomes in patients with supraglottic laryngeal cancer in Ontario, Canada: A population‐based study

Evaluation of treatment outcomes in patients with supraglottic laryngeal cancer in Ontario, Canada: A population‐based study

Surgery is not the only determinant of an outcome in patients with hypopharyngeal carcinoma

Hypopharyngeal Cancer: Looking Back, Moving Forward

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