ABSTRACT
Objective: To analyze the effectiveness, safety and factors influencing the clinical prognosis of patients with hypopharyngeal carcinoma in T4b by nonsurgical treatments. Methods: The clinical data of 77 patients with T4b hypopharyngeal cancer treated in the College of Otolaryngology Head and Neck Surgery of the Chinese People's Liberation Army General Hospital from January 2010 to June 2021 were analyzed retrospectively. All were males, aged(57.0±8.0)years old. Patients were treated with induction chemotherapy plus concurrent chemoradiotherapy. Kaplan Meier survival analysis was used to compare the effects of different factors on prognosis. Adverse reactions during treatments and the causes of death were analyzed. Results: 98.7% of 77 patients with T4b hypopharyngeal cancer completed the chemotherapy plan and 94.8% completed the radiotherapy plan. The most common adverse reactions were grade 2 radiation oral mucositis (50/77, 64.9%) and grade 2 leukopenia (50/77, 64.9%). The incidence of grade 3 severe hoarseness was 7.8% (6/77), one patient (1.3%) underwent gastrostomy due to dysphagia, and pronunciation and swallowing function were effectively preserved in other patients. The overall survival rate was 71.9% at 1 year, 45.6% at 3 years and 29.7% at 5 years. The location of tumor, the presence of liquefaction necrosis in tumor, the use of molecular targeted drugs and the approach of radiotherapy were independent factors,each of which that affected the prognosis of T4b patients with advanced hypopharyngeal cancer [HR (95%CI) were 1.867(1.085-3.213), 3.018 (1.437-6.335), 0.372 (0.181-0.764) and 2.158 (1.015-4.588), respectively, P<0.05]. The two leading causes of death with high incidence were disease recurrence (12/32, 37.5%) and cervical large vessel rupture and hemorrhage (11/32, 34.4%). Conclusions: Non-surgical comprehensive treatment offers a high laryngeal preservation rate in patients with T4b hypopharyngeal cancer. The location of tumor, the liquefaction necrosis within tumor, the use of molecular targeted drugs, and the approach of radiotherapy are independent prognostic factors.
Subject(s)
Aged , Humans , Male , Middle Aged , Carcinoma, Squamous Cell , Chemoradiotherapy , Hypopharyngeal Neoplasms/drug therapy , Retrospective Studies , Treatment OutcomeABSTRACT
Hypopharyngeal cancers have worst prognosis among the all head and neck cancers. The aim of this study is to study the etiopathological factors, clinical presentation, treatment outcome and prognostic factors in relation to different treatment modalities of hypopharyngeal cancer. Over the period of two years 30 hypopharyngeal malignancy cases were taken for the study and their etiology, clinical presentation, treatment modality and prognostic factors were studied and discussed. It was found that smoking and poor oral hygiene is the important causative factors. Among the patients only carcinoma of pyriform fossae were found. It was commonly seen in between 5th to 7th decade of life. Histopathologically they are squamous cell type and were moderately to poorly differentiate. Most of the patients presented at stage IV and stage III.Management was done with a combination of radiotherapy and chemotherapy. The treatment outcome was more or less the same regardless of the treatment modality chosen.
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Hypopharyngeal Neoplasms/diagnosis , Hypopharyngeal Neoplasms/drug therapy , Hypopharyngeal Neoplasms/etiology , Hypopharyngeal Neoplasms/pathology , Hypopharyngeal Neoplasms/radiotherapy , Hypopharyngeal Neoplasms/therapy , Male , Middle AgedABSTRACT
OBJETIVO: Avaliar a deglutição orofaríngea de pacientes submetidos a protocolo de preservação de laringe no Hospital do Câncer AC Camargo. MÉTODOS: De 43 pacientes com carcinoma epidermóide de laringe e hipofaringe tratados com quimioterapia semanal (paclitaxel 30 mg/m² e cisplatina 20 mg/m²) concomitante à radioterapia externa fracionada (180 cGy/dia, dose total 7040 cGy), foram avaliados 31 pacientes. A avaliação consistiu de videofluoroscopia. Os resultados foram classificados de acordo com alterações de motilidade orofaríngea, estases, aspiração e severidade da disfagia. RESULTADOS: alterações de fase preparatória e oral: estase em cavidade oral (58 por cento) e aumento do tempo de trânsito oral (32,3 por cento); fase faríngea: estase em valécula (83,9 por cento), redução da elevação laríngea (74,2 por cento), atraso no início da deglutição faríngea (51,6 por cento) e estase em hipofaringe (45,2 por cento). A deglutição funcional foi observada em 35,5 por cento dos pacientes, 54,8 por cento tinham disfagias discretas ou moderadas e 9,6 por cento disfagias severas. CONCLUSÃO: A associação de quimioterapia e radioterapia para preservação laríngea resulta em alterações da deglutição, na maior parte discretas a moderadas. Alguns pacientes, entretanto, evoluem com disfagia severa, em que a alimentação por via oral não é possível.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Carcinoma, Squamous Cell/physiopathology , Deglutition Disorders/physiopathology , Hypopharyngeal Neoplasms/physiopathology , Laryngeal Neoplasms/physiopathology , Antineoplastic Agents/therapeutic use , Combined Modality Therapy , Carcinoma, Squamous Cell/drug therapy , Carcinoma, Squamous Cell/radiotherapy , Cisplatin/therapeutic use , Deglutition Disorders/etiology , Dyspepsia/etiology , Fluoroscopy , Hypopharyngeal Neoplasms/complications , Hypopharyngeal Neoplasms/drug therapy , Hypopharyngeal Neoplasms/radiotherapy , Laryngeal Neoplasms/drug therapy , Laryngeal Neoplasms/radiotherapy , Paclitaxel/analogs & derivatives , Paclitaxel/therapeutic use , Severity of Illness Index , Treatment Outcome , Video RecordingSubject(s)
Jaw Abnormalities/drug therapy , Jaw Abnormalities/radiotherapy , Head and Neck Neoplasms/surgery , Head and Neck Neoplasms/drug therapy , Head and Neck Neoplasms/radiotherapy , Therapeutic Approaches , Hypopharyngeal Neoplasms/drug therapy , Hypopharyngeal Neoplasms/radiotherapy , Laryngeal Neoplasms/drug therapy , Laryngeal Neoplasms/radiotherapy , Nasopharyngeal Neoplasms/drug therapy , Nasopharyngeal Neoplasms/radiotherapy , Oropharyngeal Neoplasms/drug therapy , Oropharyngeal Neoplasms/radiotherapy , Paranasal Sinus Neoplasms/drug therapy , Paranasal Sinus Neoplasms/radiotherapyABSTRACT
O autor revisa os avanços no tratamento do carcinoma ado recesso piriforme nos últimos 20 anos. No que diz respeito a cirurgia, dois pontos principais säo assinalados: 1) hemilaringofaringectomia supraglótica para tumores da parede medial da porçäo membranácea do seio piriforme com mobilidade preservada de cordas vocais; 2) várias opçöes de reconstruçäo do trânsito faringoesofágico, entre elas a transposiçäo gástrica e os enxertos microcirúrgicos. Devido a alta freqüência de metástases linfonodais (80-87%), além do grande número de casos com ruptura capsular de linfonodos (mais de 50%), o esvaziamento cervical é obrigatório no tratamento destes casos. Em referência aos tumores externos que ultrapassam a linha média, deve ser considerado o tratamento do lado oposto do pescoço (esvaziamento cervical radical ou funcional). A radioterapia exclusiva só é atualmente indicada para tumores inoperáveis, tendo em vista o insucesso desta modalidade terapêutica. Radioterapia pré-operatória aumenta a freqüencia de complicaçöes cirúrgicas. Radioterapia pós-operatória melhora as taxas de controle loco-regional da doença. A quimioterapia neoadjuvante, incluindo cisplatina e 5FU, com ou sem bleomicina, melhorou o controle local de casos submetidos a faringectomias parciais com radioterapia pós-operatória (33 para 63%). Conclusöes definitivas com respeito ao real papel da quimioterapia requerem estudos prospectivos randomizados