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).

Oncological results of surgical treatment versus organ-function preservation in larynx and hypopharynx câncer / Resultado oncológico de tratamento cirúrgico versus protocolo de preservação de órgão em câncer de laringe e hipofaringe

Summary Introduction: Since the beginning of the 1990s, non-surgical radiochemotherapy treatment has become popular with the prospect of maintaining oncological results and preserving the organ in patients with advanced squamous cell carcinoma of the larynx and hypopharynx. However, subsequent studies demonstrated increased recurrence and mortality after the non-surgical treatment became popular. Objective: To compare the oncological results of surgical and non-surgical treatments of patients with larynx and hypopharynx cancer and to evaluate the variables associated with disease recurrence. Method: This is a retrospective cohort study of 134 patients undergoing surgical (total or partial laryngectomy) or non-surgical (isolated radiotherapy, chemotherapy or induction chemotherapy followed by radiotherapy and chemotherapy) treatment, with 62 patients in the surgical group and 72 in the non-surgical group. Results: Disease-free survival rates were higher in the surgical group (81.7% vs. 62.2%; p=0.028), especially in III/IV stages (p=0.018), locally advanced tumors T3 and T4a (p=0.021) and N0/N1 cases (p=0.005). The presence of cervical lymph nodes, especially N2/N3, was considered a risk factor for disease recurrence in both groups (HR=11.82; 95CI 3.42-40.88; p<0.0001). Patients not undergoing surgical treatment were 3.8 times more likely to develop recurrence (HR=3.76; 95CI 1.27-11.14; p=0.039). Conclusion: Patients with larynx or hypopharynx cancer non-surgically treated had a poorer disease-free survival, especially in cases with locally advanced tumors (T3 and T4a) and in which the neck was only slightly affected (N0/N1).

Resumo Introdução: A partir de estudos do início dos anos 1990, popularizou-se o tratamento não cirúrgico com radioquimioterapia, com a perspectiva de manutenção do resultado oncológico e preservação do órgão em pacientes com carcinoma espinocelular avançado de laringe e hipofaringe. Entretanto, estudos posteriores demonstraram aumento da recorrência e da mortalidade com a difusão do tratamento não cirúrgico. Objetivo: Comparar o resultado oncológico dos tratamentos cirúrgico e não cirúrgico de pacientes com câncer de laringe e hipofaringe e avaliar as variáveis associadas à recidiva de doença. Método: Estudo de coorte retrospectiva de pacientes submetidos ao tratamento cirúrgico (laringectomia total ou parcial) e não cirúrgico (radioterapia isolada, radioterapia concomitante a quimioterapia ou quimioterapia de indução seguida de radioterapia e quimioterapia) de 134 pacientes, sendo 62 no grupo cirúrgico e 72 no não cirúrgico. Resultados: As taxas de sobrevivência livre de doença foram maiores no grupo cirúrgico (81,7% vs. 62,2%; p=0,028), principalmente em estádios III/IV (p=0,018), tumores localmente avançados T3 e T4a (p=0,021) e casos N0/N1 (p=0,005). A presença de linfonodos cervicais, principalmente N2/N3, foi considerada fator de risco para recidiva de doença nos dois grupos (HR=11,82; IC95% 3,42-40,88; p<0,0001). Pacientes não submetidos ao tratamento cirúrgico apresentaram 3,8 vezes mais chance de desenvolvimento de recidiva (HR=3,76; IC95% 1,27-11,14; p=0,017). Conclusão: Pacientes com câncer de laringe ou hipofaringe tratados de forma não cirúrgica tiveram menor sobrevivência livre de doença, especialmente nos tumores localmente avançados (T3 e T4a) e com pescoço pouco comprometido (N0/N1).

Avaliação epidemiológica e da resposta terapêutica no câncer da hipofaringe / Epidemiological assessment and therapeutic response in hypopharyngeal cancer

Apesar da baixa incidência, avanços diagnóstico e terapêutico, o câncer de hipofaringe ainda possui elevada mortalidade. OBJETIVO: Avaliar retrospectivamente o perfil epidemiológico e a resposta bà cirurgia e rádio/quimioterapia de pacientes portadores de câncer de hipofaringe. MÉTODO: Foram analisados prontuários de 114 pacientes atendidos entre 2002 e 2009 em um hospital terciário com o diagnóstico histopatológico de carcinoma epidermoide. RESULTADOS: A idade média dos pacientes foi 57 anos; 94,7% eram do sexo masculino e 5,3%, do feminino; 98,2% eram tabagistas e 92% etilistas; 72% analfabetos ou com 1º grau incompleto. As queixas principais foram: nódulo cervical (28%), dor e disfagia (22%), odinofagia (12,2%), disfonia (7,8%). O estádio clínico foi: I (1,7%), II (3,5%), III (18,4%), IV (76,3%). O tratamento foi realizado com rádio e quimioterapia exclusivas em 35%, com sobrevida média em 2 anos de 20% e 5 anos de 18%, cirurgia seguida de rádio e quimioterapia em 22,8% com sobrevida em 2 anos de 60,0% e 5 anos 55,0%, quimioterapia exclusiva em 2,6%, e 39,4% sem tratamento. CONCLUSÃO: A maioria dos pacientes já apresentava estádios clínicos avançados e, independentemente da opção terapêutica, apresentam baixa sobrevida, confirmando mau prognóstico desta neoplasia.

Despite the low incidence, diagnostic and therapeutic advances, hypopharyngeal cancer still has high mortality. OBJECTIVE: To evaluate retrospectively the epidemiological profile and response to surgery and radiation/chemotherapy of patients with hypopharyngeal cancer. METHOD: We reviewed the medical records of 114 patients treated between 2002 and 2009 in a tertiary hospital with histopathological diagnosis of squamous cell carcinoma. RESULTS: The mean age of the patients was 57 years, 94.7% were males and 5.3% females, 98.2% were smokers and 92% consumed alcohol; 72% are illiterate or did not complete first grade schooling. The main complaints were: neck node (28%), pain and dysphagia (22%), odynophagia (12.2%), dysphonia (7.8%). The clinical staging was: I (1.7%), II (3.5%), III (18.4%), IV (76.3%). The treatment was carried out with radiotherapy and chemotherapy alone in 35%, with mean 2-year survival of 20% and 5-year survival of 18%; surgery followed by radiotherapy and chemotherapy in 22.8% with 2-year survival of 60.0% and 5 years of 55.0%; chemotherapy alone in 2.6%, and 39.4% without treatment. CONCLUSION: Most patients already had advanced clinical stages and independent of the treatment option, had a low survival rate, confirming the poor prognosis of this neoplasm.

Neo-adjuvant chemotherapy in advanced hypopharyngeal carcinoma.

Objective: The aim of this retrospective study was to find out the role of neo-adjuvant chemotherapy (NACT) in changing the management and outcome of advanced hypopharyngeal cancer patients. Materials and Methods: This is a retrospective analysis of 59 treatment naïve, advanced hypopharyngeal cancer patients presenting to our tertiary care center from April 2010 to October 2011. NACT was given as two (platinum with taxane) or three drug with (platinum, taxane with 5-flurouracil [5 FU]) as 3 weekly regimen with cisplatin and docetaxel as 75 mg/m 2 each, 5-FU as 1000 mg/m 2 . NACT was either given with the intent of achieving: (1) surgical resection (extensive soft tissue disease, oropharyngeal involvement, extensive disease with cartilage erosion) or (2) organ preservation (Bulky disease with inner cartilage erosion, exolaryngeal disease without cartilage erosion, large N3 nodes). Results: The mean age of this population was 55 years. Most (83%) of the patients had pyriform sinus (PFS) involvement. 69% patients had Stage IVa disease, 21% Stage IVb and 10% Stage III. The overall response rate was 66%, including 06% complete responses and 60% partial responses. Following NACT, resectability was achieved in 30% (10/33) and organ preservation protocol was planned after NACT in 73% (19/26) patients. The main toxicities were neutropenia (grade 3, 4, 04%; febrile neutropenia, 4%), mucositis 5%, diarrhea 5%. The median progression free survival was 20 months. Conclusions: NACT can be useful in patients with oropharyngeal involvement to achieve surgical resection and larynx preservation in patients with bulky T3 disease.

The value of therapeutic planning and the degree of experience of the surgical team on the results of cancer treatment of the larynx and hypopharynx

OBJETIVO: avaliar a importância da experiência do cirurgiäo nos índices de complicaçäo pós-operatória e nas taxas de recidiva e de sobrevida. MATERIAL E METODOS: foram comparados os resultados obtidos pelos 8 cirurgiöes especialistas integrantes do quadro permanente do Serviço e que possuiam graus variados de experiência considerando o tempo de exercício da especialidade. RESULTADOS: os resultados observados näo apresentaram diferença significante entre os vários cirurgiöes e esta uniformidade é explicada pelo fato de que todo o planejamento terapêutico foi elaborado pelo consenso de todo o grupo e isto pode ter minimizado uma menor experiência do cirurgiäo responsável pela conduçäo do ato operatório. CONCLUSOES: os autores enfatizam a importância da avaliaçäo pré-operatória como uma condiçäo para que bons resultados sejam esperados e propöem que é na direçäo do completo domínio da propedêutica da regiäo que devem ser dirigidos os programas de formaçäo de novos especialistas.

Prognostic factors and relative risk in hypopharyngeal cancer--related parameters concerning stage, therapeutics and evolution

The prognostic value of 16 parameters was evaluated in a series of 126 squamous cell carcinoma of hypopharynx between 1978 and 1985 at the "Serviço de Cirurgia de Cabeça e Pescoço" of the "Hospital Heliópolis", São Paulo. The variables considered were: age, sex, ethnic background, interval between diagnosis and detection of first symptom, extension of primary lesion (T), N categories, histologic evaluation of primary lesion (pT) and neck node metastasis (pN), number of clinical positive nodes (NGPOS), radiation, chemotherapy and recurrence of the disease (local, regional and distant metastasis). After a multifactorial study using Cox life table model (3) and Dixon mathematic-statistical model (8), 5 of those 16 parameters were found to influence survival, independently. The five variables organized according to hypopharynx cancer prognostic significance were: age, odynophagia, number of clinical (NGPRE) and histological (NGPOS) metastatic lymph nodes and radiation therapy; odynophagia and radiotherapy were the variables that decreased the relative risk of recurrence in the survival of cancer of the hypopharynx.

Carcinoma of the hypopharynx: results of combined therapy.

Hypopharyngeal carcinoma is an aggressive cancer with a guarded prognosis. Results of 64 patients with-hypopharyngeal cancer, 59 of whom were in stage III or IV, undergoing curative therapy during a six-year period were analysed. A combined modality resulted in a 62% and 38.4% 2-year disease free survival incases with pyriform sinus and postcricoid tumours respectively. Results of radiotherapy failed salvage surgery were much poorer for either site.