Résumé
Introduction: malignant tumors of head and neck [H and N] mostly squamous cell carcinoma [SCC] are common in Khorasan; the standard treatment consists of surgery with or without [pre or post operative] radiotherapy and occasionally only radical radiotherapy. According to many reports on high response rate of H and N metastatic tumorssometimes greater than 50% to the chemotherapeutic agents- it is accepted to use chemotherapy as a curative treatment modality in non-metastatic H and N tumors [1]. In our country there isn't any report about this treatment policy although there are many publications from European and American centers. In this paper we intend to present some parts of our experience on primary chemotherapy for nonrnetastatic SCC of laryngeal and hypopharyngeal carcinoma
Patients and methods: the study compiles 51 patients with primary SCC of larynx and hypopharynx who had been treated during 1375-1379 in Omid hospital. Twenty-four patients had been treated only by radiotherapy while 27 had been treated by chemoradiation. None of the patients in two groups had surgical treatment except for diagnostic biopsy. The reasons that surgery was not used in this groups of patients were as follow: medical contraindication, radical surgery impossibility due to advancement of primary tumor [unresectable] and refusing surgical treatment by patient. Patient's enrolments in two groups were only by physicians decision and practice and are being compared for age, sex, primary tumor site, Stage, histological grade and radiation dose [table 1]. Three endpoints are characterized: complete response [either clinical or pathologic], failure [either in local or lymphatic region] and suspicious cases, which negative biopsy but any of these: several local edema, obvious defect in barium swallow, vocal cord fixation, suspicious mucosal ulceration and progressive post treatment dysphagia. Radiotherapy was delivered by Cobalt 60 machine using classical conventional technique and dose fractionation. [For technical details see reference 2]. Chemotherapy regimen consists of commonly used combination of 5-flouracil [5FU] and cisplatin which doses are introduced in table 2. It was allowed accrual of every case whose chemotherapy was applied before [neeoadjuvant], during [concurrent] or sequential with radiotherapy and even one case after completing radiotherapy [adjuvant]. Statistical methods used are Z and T test and P value calculated which figures below 0.05 are considered significant and 0.05 up to 0.1 are considered borderline
Results: although there isn't any significant statistical difference between two groups related to age, sex, histological grade and anatomical site but as it is shown in table 1 there is a general trend toward enrolling some known and likely poorer prognostic factors in chemoradiation group. Pathologic grade 3 with 26% ratio in the chemoradiation group has higher amount than 16% in radiotherapy group and the mean age of patients in the former group is 2.5 years older. As well hypopharyngeal origin with 40% ratio has higher proportion in chemoradiation group. In distribution according to the stage of disease most of the patients in both groups are in the more advanced stages, however while no low stage cases were treated with chemoradiation in other group these are 25%. In addition clinical presentation as a large mass [more than 6 cm] is higher in patients treated with chemoradiation [37% versus 20%]