Combined chemotherapy and radiotherapy versus surgery and postoperative radiotherapy for advanced hypopharyngeal cancer

Background. Although the standard therapy for locally advanced hypopharyngeal cancer remains surgery and postoperative radiotherapy (RT), alternative treatment approaches include induction chemotherapy and RT. The purpose of this retrospective study was to compare the long-term outcome of these treatments performed in a single institution. Methods. Twenty-six patients with advanced, resectable, squamous cell carcinoma of the hypopharynx were treated with induction chemotherapy and definitive RT (group I), reserving laryngectomy for salvage. The induction phase of therapy consisted of 2-3 cycles of cisplatin-based chemotherapy followed by conventional fractionated RT to doses of 66-70 Gy. The outcomes of this group of patients were compared with the outcomes of 30 patients with hypopharyngeal cancer who were treated at our institution with surgery and postoperative RT (group II). The median follow-up times of the surviving patients in groups 1 and II were 5 and 9 years, respectively. Results. The local recurrence-free survival at 5 years from the completion of therapy for group I was 50%, compared with 69% for group II (p=.41). Among patients with T3-T4 Primary tumors, the 5-year local control rates were 58% and 59% for groups I and II, respectively (p=.78). The likelihood of larynx preservation, free of local disease at 5 years for group I, was 52%. The 5-year neck recurrence-free survival for groups I and II were 47% and 69%, respectively (p=.66). Among patients with N2-N3 stage disease, the 5-year incidence of neck failure for groups I and II were 73% and 68%, respectively (p=.74). The 5-year distant metastases-free survival for groups I and II were 67% and 57%, respectively (p=.19). The 5-year disease-free survival rates for groups I and II were 30% and 42%, respectively (p=.9). The 5-year overall survival rates for groups I and II were 15% and 22%, respectively (p=.65). Conclusions. Nonsurgical therapy for advanced-stage hypopharyngeal cancer provides survivorship comparable with that achieved with standard approaches of surgery and postoperative RT. However, despite the therapy, the outcome is poor. Future studies will need to explore new treatment strategies in an effort to improve upon the outcome for this group of patients. (C) 1996 John Wiley & Sons, Inc.