Neoadjuvant treatment combined with planned surgery in laryngeal function preservation for locally advanced pyriform sinus carcinoma.

OBJECTIVES: This study aimed to determine the efficacy and feasibility of preoperative radiotherapy with or without chemotherapy (XRT) followed by surgery of locally advanced pyriform sinus carcinoma. MATERIALS AND METHODS: We performed a retrospective study of 482 patients with T3 and T4 pyriform sinus carcinoma treated with curative intent between 1979 and 2008. The patients were divided into 4 groups according to different treatment patterns. RESULTS: The 5-year disease-special survival rate was 32%. Survival was best for the patients treated with surgery followed by XRT (41.1%) and with neoadjuvant XRT followed by surgery (39.4%), but it was worse with surgery only (27.1%) and XRT alone (23%). The disease-special survival was significantly different between the patients who accepted multidisciplinary therapy and those who accepted single therapy (P<0.001). The 5-year laryngeal function preservation survival rate of the patients with XRT followed by surgery was 13.6%, which was similar to those with XRT alone (16.2%), and superior to those who accepted surgery followed by XRT (3.8%) and surgery alone (0). Multivariate analysis results revealed that treatment pattern is an independent predictor of both overall and laryngeal function preservation survival rates (P < 0.001; hazard ratio, 0.56; 95% confidence interval, 0.44-0.71). Perioperative wound complications were not different among the patients in the 3 groups who accepted surgical treatment (P > 0.05). CONCLUSIONS: The results suggested that neoadjuvant XRT followed by planned surgery was feasible with satisfactory oncological and functional outcomes.

[Long-term results of different treatment modalities in 464 hypopharyngeal squamous-cell carcinoma patients].

OBJECTIVE: To present the treatment results and to identify the most effective therapeutic plan of different therapeutic modalities in patients with squamous-cell carcinoma of hypopharynnx. METHODS: A retrospective review of 464 patients with squamous-cell carcinoma of the hypopharynx treated between 1958 and 1998 was accomplished. The clinical characteristics, results of different treatments were analyzed by SPSS 10.0 statistic software. RESULTS: Of 464 patients, the age ranged from 20 to 88 years (mean 56.3 years) and the male to female ratio was 5.5:1. The primary lesion of 383 were originated from the pyriform sinus, 40 from posterior pharyngeal wall and 41 from the postcricoid area. According to the UICC 1997 TNM staging system, 75% had T3 or T4 lesion or 92.2% stage III or IV on presentation. 65% had neck metastases. 202 patients were treated with preoperative radiation plus surgery (R + S), 22 with surgery plus postoperative radiation (S + R), 26 surgery alone (S), 40 patients with salvage surgery after radiotherapy failure (RF) and 174 patients with radiotherapy alone. The overall 5-year survival rate was 34.2%. The overall 5-year survival rate of R + S group was 46.3%, S + R group was 49.2%, S alone group 22.8%, RF group was 40.8%, radiotherapy alone group 18.0% (P < 0.01). The overall 5-year survival rate of R + S group was higher than that of S alone group (P = 0.046). The rate of larynx preservation in R + S group was 39.6% in contrast to that of S + R and S alone group of 16.7% (P = 0.003). CONCLUSION: The survival rate of patients with squamous-cell carcinoma of the hypopharynx treated with combined therapy (R + S or S + R) is better than the other therapeutic modalities. R + S combined is able to offer an obviously higher rate of larynx preservation (39.6% vs 16.7%).

[Esophageal voice training and quality of life in laryngectomees].

OBJECTIVE: To evaluate the extensive and degree of physical rehabilitation improvement of the quality of life in laryngectomees. METHODS: Forty nine patients who underwent total laryngectomies were trained by esophageal voice rehabilitation successfully. The questionnaires of performance status scale for head and neck cancer patients (PSS-HN) and the functional assessment of head and neck cancer therapy (FACT-H&N) were answered by them before esophageal voice training and 3 months after successful vocal rehabilitation. RESULTS: Total laryngectomy deteriorated the quality of life in laryngectomees. The mean scores of PSS-HN scale and FACT-H&N questionnaire were lower than the criteria scores after patients underwent total laryngectomy, the mean score were 131. 4,90.6 respectively, the difference was significant statistically (t =53. 673, P <0.001) , (t = 67.44, P <0.001). After successful esophageal speech training, the mean scores of the laryngectomees were improved both in PSS-HN scale and FACT-H&N which were 240.4 and 103.7 respectively, the difference was significant statistically (t = 18.209, P < 0.001) , (t = 21.389, P<0.001). CONCLUSIONS: The quality of life in laryngectomees can be improved by physical rehabilitation and the esophageal voice training.