RESUMEN
OBJECTIVE: The objective of this study was to evaluate the results of salvage surgery after definitive chemoradiation for hypopharyngeal squamous cell carcinoma. METHODS: This was a retrospective cohort study. Of the 79 patients with previously untreated hypopharyngeal squamous cell carcinoma who received definitive chemoradiation from January 2004 to January 2009, 24 who had recurrence and underwent salvage surgery at the National Cancer Center Hospital East, Chiba, Japan, were enrolled in this study. RESULTS: Of the 24 patients who underwent salvage surgery with curative intent, 13 had an isolated local failure, eight had an isolated neck failure and three had combined local and regional failure. Postoperative surgical complications were observed in eight (33.3%) patients. Of the 24 patients undergoing salvage surgery, 12 (50%) had recurrence. In 11 of these patients, death ensued from salvage failure, defined as the presence of any recurrence after salvage treatment. The causes of cancer-specific death ensuing from salvage failure were regional recurrence of the tumor (n = 6) (one of whom had concurrent distant metastases) and distant metastases alone (n = 5). No local recurrence after salvage surgery was observed in our group of patients. The disease-free and overall 24-month survival rates were 49.0 and 50.0%, respectively. Those patients who initially presented with unresectable disease had lower overall survival compared with those who initially presented with resectable disease (P = 0.0003). CONCLUSIONS: The oncologic outcomes were acceptable in those patients in whom salvage surgery was carried out. Those who initially presented with unresectable disease had a poor prognosis.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/terapia , Neoplasias Hipofaríngeas/diagnóstico , Neoplasias Hipofaríngeas/terapia , Recurrencia Local de Neoplasia/diagnóstico , Recurrencia Local de Neoplasia/terapia , Adulto , Anciano , Carcinoma de Células Escamosas/mortalidad , Quimioradioterapia Adyuvante , Cisplatino/administración & dosificación , Supervivencia sin Enfermedad , Docetaxel , Fraccionamiento de la Dosis de Radiación , Femenino , Fluorouracilo/administración & dosificación , Neoplasias de Cabeza y Cuello/terapia , Humanos , Neoplasias Hipofaríngeas/mortalidad , Quimioterapia de Inducción , Estimación de Kaplan-Meier , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/mortalidad , Estadificación de Neoplasias , Tomografía de Emisión de Positrones , Pronóstico , Estudios Retrospectivos , Terapia Recuperativa/métodos , Carcinoma de Células Escamosas de Cabeza y Cuello , Taxoides/administración & dosificación , Tomografía Computarizada por Rayos X , Insuficiencia del Tratamiento , Resultado del TratamientoRESUMEN
BACKGROUND: Altered fractionation radiotherapy (RT) improves locoregional control in head and neck cancer without aggravation of late adverse events. To improve successful larynx-preservation rates in patients with resectable, intermediate-volume hypopharyngeal cancer, a prospective trial of chemotherapy-enhanced accelerated RT was conducted. METHODS: Patients with T2 to T4 hypopharyngeal cancer received 40 Gray (Gy)/4 weeks to the entire neck followed by boost RT administering 30 Gy/2 weeks (1.5 Gy twice-daily fractionation). Cisplatin and 5-fluorouracil were administered concomitantly only during boost RT. RESULTS: Thirty-five patients were enrolled in this study. All patients completed this protocol as planned. After a median follow-up period for surviving patients of 59 months (24-90 months), overall survival and local control rates at 3 years were 91% (95% confidence interval, 81% to 100%), and 88% (79% to 99%), respectively. All surviving patients maintained normalcy of diets. CONCLUSION: This regimen was feasible with encouraging oncological and functional outcomes.