Definitive Chemoradiotherapy Versus Surgery Followed by Adjuvant Radiotherapy in Resectable Stage III/IV Hypopharyngeal Cancer
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Purpose The purpose of this study is to compare the treatment outcomes for locally advanced resectable hypopharyngeal cancer between organ-preserving chemoradiotherapy (CRT) and surgery followed by radiotherapy (SRT). Materials and Methods We reviewed 91 patients with stage III/IV hypopharyngeal squamous cell carcinoma treated with radiotherapy (RT). In the CRT group (n=34), 18 patients were treated with concurrent CRT and 16 patients with induction chemotherapy plus concurrent CRT. In the SRT group (n=57), six patients were treated with total laryngopharyngectomy, 34 patients with total laryngectomy (TL) and partial pharyngectomy (PP), and 17 patients with PP, which were followed by adjuvant radiotherapy (n=41) or CRT (n=16). The median RT dose was 70 Gy for CRT and 59.4 Gy for SRT. Results Five-year local control (84.1% vs. 90.9%), and disease-free survival (DFS, 51.0% vs. 52.7%) and overall survival (OS, 58.6% vs. 56.6%) showed no significant difference between the CRT and SRT groups. The functional larynx-preservation rate was higher in the CRT group (88.2% vs. 29.8%). Treatment-related toxicity, requiring surgical intervention, occurred more frequently in the SRT group (37% vs. 12%). In the SRT group, TL resulted in a significantly higher DFS than larynx-sparing surgery (63.9% vs. 26.5%, p=0.027). Treatment outcome of the SRT group improved when only patients with TL were considered (n=40); however, 5-year OS (67.1% vs. 58.6%, p=0.830) and DFS (63.9% vs. 51.0%, p=0.490) did not improve significantly when compared to the CRT group. Conclusion Organ preserving CRT provided a treatment outcome that is comparable to SRT for locally advanced hypopharyngeal cancer, while offering an opportunity for functional larynx-preser- vation and reduced treatment-related toxicity.
Abstract
Purpose The purpose of this study is to compare the treatment outcomes for locally advanced resectable hypopharyngeal cancer between organ-preserving chemoradiotherapy (CRT) and surgery followed by radiotherapy (SRT). Materials and Methods We reviewed 91 patients with stage III/IV hypopharyngeal squamous cell carcinoma treated with radiotherapy (RT). In the CRT group (n=34), 18 patients were treated with concurrent CRT and 16 patients with induction chemotherapy plus concurrent CRT. In the SRT group (n=57), six patients were treated with total laryngopharyngectomy, 34 patients with total laryngectomy (TL) and partial pharyngectomy (PP), and 17 patients with PP, which were followed by adjuvant radiotherapy (n=41) or CRT (n=16). The median RT dose was 70 Gy for CRT and 59.4 Gy for SRT. Results Five-year local control (84.1% vs. 90.9%), and disease-free survival (DFS, 51.0% vs. 52.7%) and overall survival (OS, 58.6% vs. 56.6%) showed no significant difference between the CRT and SRT groups. The functional larynx-preservation rate was higher in the CRT group (88.2% vs. 29.8%). Treatment-related toxicity, requiring surgical intervention, occurred more frequently in the SRT group (37% vs. 12%). In the SRT group, TL resulted in a significantly higher DFS than larynx-sparing surgery (63.9% vs. 26.5%, p=0.027). Treatment outcome of the SRT group improved when only patients with TL were considered (n=40); however, 5-year OS (67.1% vs. 58.6%, p=0.830) and DFS (63.9% vs. 51.0%, p=0.490) did not improve significantly when compared to the CRT group. Conclusion Organ preserving CRT provided a treatment outcome that is comparable to SRT for locally advanced hypopharyngeal cancer, while offering an opportunity for functional larynx-preser- vation and reduced treatment-related toxicity.
참고문헌 (25)
- Hall SF, "The natural history of patients with squamous cell carcinoma of the hypopharynx", Laryngoscope, 118, pp.1362~1371 (2008)
- Buckley JG, "Cervical node metastases in laryngeal and hypopharyngeal cancer : a prospective analysis of prevalence and distribution", Head Neck, 22, pp.380~385 (2000)
- Takes RP, "Current trends in initial management of hypopharyngeal cancer : the declining use of open surgery", Head Neck, 34, pp.270~281 (2012)
- Jones AS, "The management of early hypopharyngeal cancer : primary radiotherapy and salvage surgery", Clin Otolaryngol Allied Sci, 17, pp.545~549 (1992)
- Lefebvre JL, "Larynx preservation in pyriform sinus cancer:preliminary results of a European Organization for Research and Treatment of Cancer phase III trial. EORTC Head and Neck Cancer Cooperative Group", J Natl Cancer Inst, 88, pp.890~899 (1996)
- Chen SW, "Hypopharyngeal cancer treatment based on definitive radiotherapy : who is suitable for laryngeal preservation?", J Laryngol Otol, 122, pp.506~512 (2008)
- D'Cruz A, "Consensus recommendations for management of head and neck cancer in Asian countries : a review of international guidelines", Oral Oncol, 49, pp.872~877 (2013)
- Blanchard P, "Definitive radiotherapy for squamous cell carcinoma of the pyriform sinus", Radiother Oncol, 105, pp.232~237 (2012)
- Bernier J, "Defining risk levels in locally advanced head and neck cancers : a comparative analysis of concurrent postoperative radiation plus chemotherapy trials of the EORTC(#22931)and RTOG(# 9501)", Head Neck, 27, pp.843~850 (2005)
- Suzuki K, "The effectiveness of chemoradiation therapy and salvage surgery for hypopharyngeal squamous cell carcinoma", Jpn J Clin Oncol, 43, pp.1210~1217 (2013)
- Machtay M, "Hypopharyngeal dose is associated with severe late toxicity in locally advanced head-and-neck cancer : an RTOG analysis", Int J Radiat Oncol Biol Phys, 84, pp.983~989 (2012)
- Tulunay-Ugur OE, "Functional outcomes of chemoradiation in patients with head and neck cancer", Otolaryngol Head Neck Surg, 148, pp.64~68 (2013)
- Al-Mamgani A, "Toxicity, quality of life, and functional outcomes of 176 hypopharyngeal cancer patients treated by(chemo)radiation : the impact of treatment modality and radiation technique", Laryngoscope, 122, pp.1789~1795 (2012)
- Vergeer MR, "Intensity-modulated radiotherapy reduces radiation-induced morbidity and improves healthrelated quality of life : results of a nonrandomized prospective study using a standardized follow-up program", Int J Radiat Oncol Biol Phys, 74, pp.1~8 (2009)
- O'Sullivan B, "Deintensification candidate subgroups in human papillomavirus-related oropharyngeal cancer according to minimal risk of distant metastasis", J Clin Oncol, 31, pp.543~550 (2013)
- Joo YH, "Characteristics and prognostic implications of high-risk HPV-associated hypopharyngeal cancers", PLoS One, 8, pp.78718~ (2013)
- Shaughnessy JN, "HPV : a factor in organ preservation for locally advanced larynx and hypopharynx cancer?", Am J Otolaryngol, 35, pp.19~24 (2014)
- Kuo YL, "Partial laryngopharyngectomy in the treatment of squamous cell carcinoma of hypopharynx : analysis of the oncologic results and laryngeal preservation rate", Acta Otolaryngol, 132, pp.1342~1346 (2012)
- Ho CM, "Submucosal tumor extension in hypopharyngeal cancer", Arch Otolaryngol Head Neck Surg, 123, pp.959~965 (1997)
- Harrison DF, "Pathology of hypopharyngeal cancer in relation to surgical management", J Laryngol Otol, 84, pp.349~367 (1970)
- Davidge-Pitts KJ, "Pharyngolaryngectomy with extrathoracic esophagectomy", Head Neck Surg, 6, pp.571~574 (1983)
- Forastiere AA, "Long-term results of RTOG 91-11 : a comparison of three nonsurgical treatment strategies to preserve the larynx in patients with locally advanced larynx cancer", J Clin Oncol, 31, pp.845~852 (2013)
- Haddad R, "Induction chemotherapy followed by concurrent chemoradiotherapy(sequential chemoradiotherapy)versus concurrent chemoradiotherapy alone in locally advanced head and neck cancer(PARADIGM) : a randomised phase 3trial", Lancet Oncol, 14, pp.257~264 (2013)
- Spector JG, "Squamous cell carcinoma of the pyriform sinus : a nonrandomized comparison of therapeutic modalities and long-term results", Laryngoscope, 105(4 Pt 1), pp.397~406 (1995)
- Nutting CM, "Parotid-sparing intensity modulated versus conventional radiotherapy in head and neck cancer(PARSPORT) : a phase 3 multicentre randomised controlled trial", Lancet Oncol, 12, pp.127~136 (2011)