The role and clinical significance of microRNA-29a-3p in the development of hypopharyngeal carcinoma

Abstract Objective MicroRNA-29a-3p has been reported in a variety of cancers, but its role in hypopharyngeal cancer remains unclear. This study was to determine the role of microRNA-29a-3p in the occurrence and development of hypopharyngeal cancer. Methods 40 patients with hypopharyngeal cancer who underwent surgery in the Affiliated Hospital of Jining Medical University from April 2013 to November 2017 were selected for this study. The cancer tissue samples of the patients were collected, and the patients were followed up for three years. The expression of microRNA-29a-3p in tissue samples was detected by in situ hybridization with fluorescent probe, and the relationships among microRNA-29a-3p and clinicopathological factors, postoperative recurrent-metastasis, survival time were studied. Immunohistochemical was used to detect the expression of Ki67 and E-cadherin in tissue samples. Results Combined with HE staining results showed that microRNA-29a-3p expression was relatively high in non-cancer tissue cells (red blood cells and fibroblasts in tumor interstitial vessels), but was relatively low in cancer tissue and cells. According to the follow-up data of 40 patients with hypopharyngeal cancer, tumor size, T-stage, tumor differentiation, postoperative recurrent-metastasis of hypopharyngeal cancer patients were significantly negatively correlated with microRNA-29a-3p (p< 0.05). Immunohistochemica results further confirmed that microRNA-29a-3p was negatively correlated with the expression of Ki67 and E-cadherin. The survival time of patients positively related with microRNA-29a-3p expression (p< 0.05). Moreover, ROC curve analysis showed that the area under the curve of the combined detection of miRNA-29a-3p+Ki67+E-cadherin was larger than that of the single detection of the three indexes. Conclusions The expression of microRNA-29a-3p is closely related to the occurrence, development and prognosis of hypopharyngeal cancer, and it affects the proliferation and invasion. This indicates that microRNA-29a-3p serves as a therapeutic target for the occurrence and development of hypopharyngeal cancer. The evidence of study designs of this study is IV using "Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence".

Time between Diagnosis and Treatment of Hypopharynx and Larynx Cancer: Are Longer Delays Associated with Higher Discrepancy between Clinical and Pathological Staging?

Abstract Introduction At the time of diagnosis, treatment strategies for cancer are largely based upon clinical staging. However, discrepancy between clinical and pathological staging has been reported. Objective To assess the rate of staging discrepancy in Laryngeal and Hypopharyngeal Squamous Cell Carcinoma (LHSCC), the potential influence of higher interval of time from diagnosis to primary surgical treatment, and whether this has any impact on survival outcomes. Methods Retrospective study of patients with LHSCC proposed for primary surgical treatment. Results The study population included 125 Caucasian patients with LHSCC. The level of agreement between clinical and pathological tumor staging was moderate (Cohen's Kappa: 0.400; p < 0.001) and similar result was found for node staging (Cohen' Kappa: 0.520; p < 0.001). The mean time between diagnosis and surgical treatment was 26.66 days and no statistically significant influence was found with staging discrepancy. The sample presented a 5-year Overall Survival (OS) of 58.2% and a Disease-specific survival (DSS) of 72.6%. No statistically significant impact of staging discrepancy on survival was found. Conclusion For advanced LHSCC, based on the findings of physical examination, endoscopy and imaging, is possible to achieve a moderate accuracy between clinical and pathological staging which allows a reliable counselling and treatment planning. Interval of time under 3-4 weeks between diagnosis and surgical treatment does not influence the rate of discrepancy. However, almost 30% of staging discrepancy is expected due to false negatives of imaging and limitations of physical exams.

Hypopharyngeal cancer risk in Japanese: Genetic polymorphisms related to the metabolism of alcohol- and tobacco-associated carcinogens

Background: Several studies have investigated hypopharyngeal cancer (HC) risk in combination with xenobiotic metabolism-related genetic polymorphisms and the burden of alcohol consumption and smoking in European countries but not in East Asian countries. Patients and Methods: This hospital-based case–control study involved 61 male patients with HC and 71 male cancer-free controls. Information on age, body mass index, and alcohol and cigarette consumption was obtained from medical records, a self-completion questionnaire, and a thorough interview by an otolaryngologist. Alcohol dehydrogenase 1B (ADH1B), aldehyde dehydrogenase 2 (ALDH2), cytochrome P450 A1 (CYP1A1) MspI, CYP1A1 Ile462Val, glutathione S-transferase (GST) M1, GSTT1, and GSTP1 gene polymorphisms were determined by polymerase chain reaction-based methods. Univariate and multivariate analyses were performed by adjustment for age by the Mantel–Haenszel method. Results: The burden of alcohol and cigarette consumption significantly increased the risk of HC and showed a synergistic effect. ADH1B*1/*1 (odds ratio [OR] 7.34) and ALDH2 *1/*2 (OR 13.22) were significant risk factors for HC. Individuals with ADH1B*1/*1 or ALDH2 *1/*2 who consumed alcohol were more susceptible to HC. However, polymorphisms of CYP1A1 gene and GSTs were not significant cancer risk factors in patients with HC. Conclusions: ADH1B*1/*1 and ALDH2 *1/*2 were significant risk factors for HC, while polymorphism of CYP1A1 gene and GSTs was not a significant risk factor for HC. These polymorphisms determined the effects of alcohol and cigarette smoke in addition to burden of alcohol and cigarettes intake on the risk of HC

Down-regulated uncoupling protein 2 expression suppresses Fadu cell proliferation / 解剖学报

Objective The effect of uncoupling protein 2(UCP2) on the Fadu cells of the hypopharyngeal cancer was investigated in this study. The siRNA technology was used to study the effect of UCP2 on cell cycle and cell proliferation. iMeanwhile, cisplatin, a commonly chemotherapeutic drug, was researched on the effect of proliferation in Fadu cells after down-regulated UCP2 gene. Methods Flow cytometry/PI staining was used to observe the effect of UCP2 on Fadu cell cycle. Clone formation assay was used to detect the effect of down-regulated UCP2 on the proliferation of Fadu cells. MTT assay and Bnid assay were used to determine whether UCP2 enhanced the sensitivity of Fadu cells to cisplatin and to detect the effect of UCP2 on the proliferation of Fadu. Results The present result showed that down-regulated UCP2 expression inhibited Fadu cell cycle in G,/S phase and cell colony formation, but had no synergistic effect on inhibition of Fadu proliferation by cisplatin; The expression of UCP2 was significantly inhibited by genipin, and then inhibited cell proliferation in a time-concentration-dependent manner. Conclusion The proliferation of Fadu cells was weakened and the cell cycle was inhibited in G,/S phase after down-regulated UCP2, suggesting that UCP2 may play an important adjust role in the development in Fadu of hypopharyngeal cancer.

Tannic acid-induced apoptosis in FaDu hypopharyngeal squamous cell carcinoma

Tannic acid (TA) is a water-soluble polyphenol compound found in various herbal plants. We investigated the chemopreventive effects of TA on FaDu hypopharyngeal squamous carcinoma cells. In an 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay, TA showed dose-dependent cytotoxicity with a half maximal inhibitory concentration (IC50) of 50 µM. Cell cycle analysis and immunofluorescence imaging demonstrated that under low-dose (25 µM) treatment, FaDu cells were arrested in G2/M phase, and as the dose of TA was increased, apoptosis was induced with the increase of cell population at sub-G1 phase. The expressions of various cyclins, including cyclin D1 and cyclin-dependent kinases (CDK-1 and CDK-2), were down-regulated at low doses of TA, whereas apoptotic effectors such as cleaved caspase 3, cleaved caspase 7, and poly (ADP-ribose) polymerase (PARP) were expressed in a dose-dependent manner in Western blotting. In addition, TA-induced apoptosis of FaDu cells might be mediated by the extracellular signal-regulated kinase (ERK)/mitogen-activated protein kinase pathway, with the upregulation of p-AKT/p-PKB (phosphorylated protein kinase B) and p-ERK. Overall, our data support the hypothesis that TA is a potential candidate agent for the treatment of hypopharyngeal cancer.

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).

Pulmonary aspiration during intubation in a high-risk patient: A video clip and clinical implications

We report a case of pulmonary aspiration during induction of general anesthesia in a patient who was status post esophagectomy. Sudden, unexpected aspiration occurred even though the patient had fasted adequately (over 13 hours) and received rapid sequence anesthesia induction. Since during esophagectomy, the lower esophageal sphincter is excised, stomach vagal innervation is lost, and the stomach is flaccid, draining only by gravity, the patient becomes vulnerable to aspiration. As the incidence of perioperative pulmonary aspiration is relatively low, precautions to prevent aspiration tend to be overlooked. We present a video clip showing pulmonary aspiration and discuss the literature concerning the risk of aspiration and its preventive strategies.

Diagnostic value of enhanced CT/MRI for thyroid cartilage invasion by malignant tumor / 中华耳鼻咽喉头颈外科杂志

Objective@#To evaluate the values of enhanced CT and MRI for the diagnosis of thyroid cartilage invasion by laryngeal and hypopharyngeal cancer.@*Methods@#One hundred and ninety-seven patients with primary laryngeal or hypopharyngeal cancer treated with surgery between January 2013 and December 2014 were included in this study. All patients underwent enhanced CT and MRI before surgery. With MRI using the techniques of fast recovery fast spin echo (FRFSE), spin echo echo planar imaging (SE-EPI) and diffusion weighted imaging (DWI), thyroid cartilage invasion was evaluated and the results of postoperative histopathological examination was used as a gold standard for the determination of thyroid cartilage invasion. The sensitivity, specificity, positive predictive value and negative predictive value of enhanced CT or MRI in detecting thyroid cartilage invasion by laryngeal and hypopharyngeal cancer were evaluated. Data were analyzed with SPSS17.0 software.@*Results@#Among 197 patients, there were 35 cases with supraglottic laryngeal cancer, 92 cases with glottic laryngeal cancer, 9 cases with subglottic laryngeal cancer, and 61 cases with hypopharyngeal cancer. Postoperative pathologycal examinations showed that 63 (32.0%) of 197 patients had thyroid cartilage invasion by tumor. Based on TNM classification of AJCC (American Joint Commission for Cancer, 2010), there were 36 cases at T2 stage, 109 cases at T3 and 52 cases at T4; 117 cases with N0, 46 cases with N1 and 34 cases with N2. The sensitivity, specificity, positive predictive value and negative predictive value of CT for the detection of thyroid cartilage invasion were respectively 57%, 86%, 65% and 81%, and those of MRI were respectively 94%, 87%, 78% and 97%. Kappa values were 0.45 for CT and 0.77 for MRI in diagnosis of thyroid cartilage invasion, with statistically significant difference (χ2=6.78, P<0.05).@*Conclusion@#MRI (FRFSE and SE-EPI DWI) has more advantages than CT in the diagnosis of thyroid cartilage invasion by laryngeal or hypopharyngeal cancer.

Hypopharyngeal cancer masquerading as a thyroid mass

Hypopharyngeal cancer (HPC) is generally a rare head and neck malignancy. There are differing clinical presentations depending on the subsite location of primary tumour. Advanced HPC will have neck node metastasis particularly upper jugulodigastric nodes. We report a patient with postcricoid tumour who presented with anterior huge neck swelling mimic thyroid mass. The patient first presented to the General Surgical Unit for management of presumed thyroid lesion. She was diagnosed post-cricoid squamous cell carcinoma when further assessed by otorhinolaryngologist.

Screening of functional gene modules and the potential anti-cancer drugs in hypopharyngeal cancer / 局解手术学杂志

Objective Screening the functional gene modules that can play important roles in hypopharyngeal cancer and the potential anti-cancer drugs.Methods GEO database and MeV software were employed to screen the differentially expressed genes in hypopharyngeal cancer.Using STRING database,the protein-protein interaction network was identified.MCODE plugin of Cytoscape was used to identify the functional gene modules in the network.Based on DAVID database,the functions of modules were identified.DrugBank was used to screen the potential drugs that regulate the target genes of modules.Results 1 222 differentially expressed genes including 219 interaction pairs were i-dentified in whole genome profiling(P <0.05 ).Seven functional modules were identified in the network.The results of function analysis showed the module genes were enriched in cancer development related-function ‘regulation of angiogenesis’,‘cell adhesion’,‘DNA meta-bolic process’.A total of 50 potential drugs that regulating the 5 modules were screened.Conclusion Five functional modules that regulate the progress of hypopharyngeal cancer were identified,and maybe they can promote hypopharyngeal cancer through some functions such as regulation of angiogenesis 18 up-regulated protein kinases were identified.Their kinase inhibitors may potential have a role in anti-cancer, which provides a new target point for molecular therapy of nasopharyngeal cancer.

Predictors of Thyroid Gland Involvement in Hypopharyngeal Squamous Cell Carcinoma

PURPOSE: Decision to perform concurrent ipsilateral thyroidectomy on patients with hypopharyngeal cancer is important, and unnecessary thyroidectomy should be avoided if oncologically feasible. We hypothesized that concurrent ipsilateral thyroidectomy is not routinely required to prevent occult metastasis. This study aimed to determine the prevalence of histological thyroid invasion in patients with hypopharyngeal cancer, and to refine the indications for prophylactic ipsilateral thyroidectomy in patients with hypopharyngeal cancer. MATERIALS AND METHODS: A retrospective review of the medical records from the Department of Otolaryngology at Yonsei University College of Medicine was conducted from January 1994 to December 2009. A total of 49 patients underwent laryngopharyngectomy with thyroidectomy as a primary treatment of hypopharyngeal cancer. RESULTS: The incidence of thyroid gland involvement was 10.2%. The most common route of invasion was direct extension through the thyroid cartilage. Thyroid cartilage invasion (p=0.034) was the most significant factor associated with thyroid invasion. Disease-specific survival at 5 years was lower in patients with than without thyroid gland invasion (26.7% vs. 55.2%, respectively; p=0.032). Disease-free survival at 5 years was also lower in patients with than without thyroid gland invasion (20.0% vs. 52.1%, respectively; p=0.024). CONCLUSION: Ipsilateral thyroidectomy in combination with total laryngopharyngectomy is indicated when invasion of the thyroid cartilage is suspected in patients with hypopharyngeal cancer.

An Analysis of the Diversification of Cell Temperature of Photothermal Effects of Gold Nanorods Coated with mAb-EGFR on FADU Human Pharyngeal Squamous Cell Lines and Non-tumor Cells 293 T Cell Line / 听力学及言语疾病杂志

Objective To study the cell temperature on photothermal effects of gold nanorods coated with mAb-EGFR targeted on FADU human pharyngeal squamous cell lines and non- tumor cells(293T cell line) .Meth‐ods CTAB gold nanorods were synthesized to complete the functional modifications of EGFR monoclonal antibody , with a UV spectrophotometer and electron microscopy characterization .The cultured FADU hypopharyngeal cells and non-tumor cells 293 T cell lines were expressed by western blot EGFR statutory comparison of two cell lines , cells to swallow the gold nanorods were observed .Cell apoptosis was observed by Annexin-V -FLUOS and pro‐pidium iodide .Then we set different doses of gold nanoparticles concentration (15% ,25 % ,and 35% ) .After 6 minutes'near-infrared laser irradiation (λ=808 nm) ,the temperature was recorded once every minute ,and cell viability was detected by XTT assay .Results After six minutes'near -infrared laser irradiation ,the cell tempera‐ture was 41 ℃ ~43 ℃ ,with 15% ~25 % of gold nanorods .The cell killing effects on hypopharyngeal were signifi‐cant .The 293T cells did not show any damaging effects (P<0 .05) ,whereas the concentration of gold nanoparticles in 35% of hypopharyngeal FADU cells and 293T cells had significant cytotoxicity (P<0 .05) .Conclusion There were significant cell killing effects with 15% ~25% gold nanorods coated with mAb-EGFR in the near -infrared laser irradiation six minutes (Cell temperatures of both cell lines were 41 ℃ ~43 ℃)on hypopharyngeal FADU cell but not on non-tumor cells .

Comparative Study of Free Flap Reconstruction after Total Laryngopharyngectomy for Hypopharyngeal Cancer / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Recently, both jejunal and fasciocutaneous free flap reconstruction are widely used after total laryngopharyngetomy for the treatment of hypopharyngeal cancer. The aim of this study is to evaluate and compare the functional outcomes between jejunal and fasciocutaneous free flap in the reconstruction of hypopharynx after total laryngopharyngectomy. SUBJECTS AND METHOD: The medical records of 27 patients with hypopharyngeal cancer who underwent total laryngopharyngectomy and free flap reconstruction were reviewed retrospectively. Of 27 patients, 18 (66.7%) were reconstructed with jejunal free flap and 9 (33.3%) with fasciocutaneous free flap. We compared complications, flap success rates, functional outcomes such as swallowing, respiration and quality of life (QOL) between two reconstruction groups. The swallowing function was evaluated by Functional Outcome of Swallowing Scale (FOSS), and QOL was evaluated by EORTC QOL-C30, HN35. RESULTS: Twenty-seven patients consisted of 26 males and 1 female. The mean age of 69+/-9.1. There were 4, 13, and 10 cases for T2, T3, and T4, respectively. Also, there were 8, 5, 7, and 7 for N0, N1, N2 and N3 cases. The success rate of free flap was 96.3%. The complication rate, operative time, the period of hospital stay did not differ between the two groups. The average score of FOSS was 0.92 in the jejunal group and 1.00 in the fasciocutaneous group. Quality of life was satisfactory in both groups. CONCLUSION: Both jejunal and fasciocutaneous free flap are very effective reconstructive methods after total laryngopharyngectomy for hypopharyngeal cancer. The choice of free flap can be determined based on the individual status of patient and preference of surgeon.

The functional preservation treatment progress of laryngeal cancer and hypopharyngeal cancer / 中国癌症杂志

The management of laryngeal cancer and hypopharyngeal cancer has fundamentally changed over the recent years. The optimum treatment protocols should pay close attention to the survival rate and function preservation. The purpose of this article we aimed to define the prevalence of intervention of laryngeal cancer and hypopharyngeal cancer, such as open operation, CO2 laser and non-invasive treatments, and measures that may facilitate standardization of such practices.

Early stage squamous cell carcinoma of the pyriform sinus: A review of treatment options.

The purpose of this review of the literature was to present treatment options for early stage pyriform sinus cancer. Squamous cell carcinoma of the pyriform sinus, as the most frequent cancer arising from the hypopharynx, is rarely diagnosed in its early stage. Based on evidence from retrospective studies, conservation surgery and definitive radiotherapy are considered the available treatment modalities for patients presenting with stage T1 and T2 pyriform sinus carcinomas without clinical evidence of neck lymph node metastases, offering similar results with respect to disease control and functional organ preservation. Also, the high risk of occult metastatic nodal disease even in the earliest stage of pyriform sinus cancer entails elective neck dissection or elective neck irradiation to be considered mandatory. However, for patients with early stage pyriform sinus cancer, no level 1 study exists in which conservation surgery is compared with radiotherapy alone for the evaluation of local control or survival. Randomized multicenter controlled trials evaluating efficacy of conservation surgery and definitive radiotherapy, and correctly interpreting functional outcome for each of the treatment procedures examined are necessary to obtain sufficient evidence to influence the decision in the choice of the most effective treatment for early pyriform sinus cancer.

Modified Design of Anterolateral Thigh Free Flap for Hypopharyngeal Reconstruction

PURPOSE: Defect after ablation of hypopharyngeal cancer often requires reconstruction by free tissue transfer. Since neo-hypopharynx is totally buried, various methods have been suggested for monitoring. We propose a modified design of anterolateral thigh (ALT) free flap for reconstruction of pharyngolaryngectomy defect, which has an exteriorized part for clinical monitoring and allows for primary closure. MATERIALS AND METHODS: Three consecutive patients with hypopharyngeal cancer were reconstructed with ALT flap with modified design: 1) distal part of flap was elongated into fusiform shape and used as exteriorized monitoring segment with a deepithelized bridge and 2) proximal part was designed as curve so the maximum width of the flap was reduced to less than 10 cm. RESULTS: Patient 1, 2 had uneventful postoperative course with healthy skin color and fresh pin prick bleeding. In patient 3, defect after cancer ablation was shorter than usual and deepithelized bridge was longer. When the general hemodynamic status of the patient was aggravated in postoperative course, the color of monitoring skin was changed. Viability of the whole flap was confirmed by endoscopy. However, leakage developed after 3 weeks and repair was necessary. In all patients the donor sites were closed primarily. CONCLUSION: By the modified design of ALT flap, clinical monitoring can be possible by examining exteriorized monitoring flap and also donor site can be closed primarily. However possibility of false positive exists and technical caution and patient selection is needed because of danger of leakage.

A Case of Hypopharyngeal Cancer Treated by Endoscopic Submucosal Dissection / 대한소화기학회지

Recent advances in endoscopic instruments, including narrow-band imaging (NBI) and magnification endoscopy, allowed dramatic increase in the early diagnosis of hypopharyngeal cancers. In addition, endoscopic mucosal resection or endoscopic submucosal dissection has recently been used for the treatment of hypopharyngeal cancer at an early stage, especially in Japan. However, to date, there is no published report in Korea. A 68-year-old man was admitted for preoperative evaluation and treatment for known esophageal cancer initially diagnosed at a local clinic. During the evaluation, magnifying endoscopy combined with the NBI system revealed a concurrent hypopharyngeal cancer not detected by initial conventional endoscopy. In this case report, we describe for the first time in Korea a case of early stage hypopharyngeal carcinoma that was successfully treated by endoscopic submucosal dissection with a review of literature.

Outcomes of Salvage Surgery after Concurrent Chemoradiation for Advanced Hypopharyngeal Cancer / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: We evaluated treatment outcomes of patients with advanced hypopharyngeal cancer for whom surgical salvage was attempted after primary concomitant chemoradiation therapy (CRT) had failed as a treatment. The pre-salvage factors were assess-ed to predict the prognosis of salvage surgery. SUBJECTS AND METHOD: A retrospective analysis was conducted from 1997 to 2006 for 22 patients with stage III-IV hypopharyngeal cancer who had undergone salvage surgery after local and/or regional CRT failures with no distant metastasis. RESULTS: Larynx-sacrificing pharyngectomy was performed in 12 (54.5%) of all patients. Postoperative complications occurred in 9 (40.9%), and carotid artery blowout occurred in two of these patients. After salvage surgery, the 2-year and 5-year overall survival rates were 52.8% and 28.9%, respectively. The 2-year disease specific survival rate and locoregional control rate were 45.5% and 60.0%, respectively. The initial N2-3 stage (p=0.038) and the concurrent local and regional failures (p=0.035) were independent predictors for decreased survival after salvage surgery. Two-year overall survival rates for patients with 2, 1, or none of these predictive factors were 23.3%, 66.7%, and 80.0%, respectively (p=0.027). CONCLUSION: Although salvage surgery after CRT has postoperative complications and unfavorable larynx preservation, it can be considered as a viable option with acceptable oncologic outcomes for advanced hypopharyngeal cancer. The initial N2-3 stage and concurrent local and regional failures were independent predictors that can stratify patients into distinct prognostic groups for postsalvage survival.

The Treatment Outcome of Hypopharynx Cancer : Surgery versus Organ Preservation Therapy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Hypopharynx cancer usually presents with late stage diseases requiring radical resection including total laryngectomy with reconstruction resulting in severe functional deficits. In order to preserve organ function, chemotherapy in combination with radiotherapy was introduced and it showed similar treatment. The aim of this study is to compare the treatment outcomes of surgery and organ preservation therapy. SUBJECTS AND METHOD: A retrospective review of 55 patients who were diagnosed with hypopharynx cancer and underwent curative treatment from 1994 to 2006 was performed. Patients who underwent surgery or surgery plus postoperative radiotherapy were assigned to surgical treatment group and patients who underwent radiotherapy or radiotherapy with chemotherapy were assigned to organ preservation therapy group. RESULTS: Surgical treatment group consisted of 29 patients (52.7%) and organ preservation therapy group consisted of 26 patients (47.3%). The overall 5 year survival rate was 34%. The survival rate was decreased significantly according to the N stage (p=0.02). There was no statistically significant difference in 5 year survival rates between the two groups. The larynx preservation rate was 35.8% for the organ preservation therapy group and 44% for the conservation surgery group. CONCLUSION: Treatment of hypopharynx cancer could be individualized according to the status of diseases.

The Usefullness of Gastric Pull-Up Reconstruction in Advanced Hypopharyngeal Cancer Surgery / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Various methods of reconstruction have been used after resection of hypopharynx. This study is aimed to evaluate the results and usefullness of gastric pull-up reconstruction. SUBJECTS AND METHOD: The clinical data of 12 hypopharyngeal cancer patients, who were treated with gastric pull-up primary surgery (9 patients, 75.0%) or with salvage surgery (3 patients, 25.0%) after radiotherapy with or without chemotherapy, were studiedfrom 1987 to 2002. This study was a retrospective review of 12 patients (8 males and 4 females, mean age 57.3 years). RESULTS: Nine (75.0%) patients were stage IV and 3 (25.0%) patients were stage III. Total pharyngolaryngoesophagectomies were performed and reconstructed by gastric pullup. Five year survival rate was 57.7%. Five patients died of locoregional recurrence or distant metastasis and 3 patients were lost. The mean time forthe initiation of oral feeding was 32.2 days (range 23 to 58 days). Postoperative complications were hemothorax (1), fistula (2), stenosis (1), hypocalcemia (1), and regurgitation (2). There was no flap failure. CONCLUSION: Although gastric pull-up after resection of advanced hypopharyngeal and cervical esophageal lesions has morbidity and mortality of a combined abdominal, thoracic and cervical operation, flap failure rate is relatively low compared with free flap reconstructions such as jejunal free flap, myocutaneous free flap (radial forearm free flap or anterolateral thigh free flap). Gastric transposition constitutes relatively safe and effective method of restoring the continuity of the upper digestive tract following surgery of extensive carcinoma of the hypopharynx, larynx, and cervical esophagus.