Comparative analysis of clinical efficacies between induction chemotherapy and surgery combined with radiotherapy or concurrent chemoradiotherapy in advanced hypopharyngeal carcinoma / 中华耳鼻咽喉头颈外科杂志

ABSTRACT

Objective@#To evaluate the efficacies of different treatment modalities for patients with advanced hypopharyngeal cancers, which were treated by induction chemotherapy and surgery combined with radiotherapy or concurrent chemoradiotherapy.@*Methods@#A retrospective analysis was performed on the complete clinical and follow-up data of 92 patients with pathologically confirmed hypopharyngeal squamous cell carcinoma treated at Liaoning Tumor Hospital from January 2011 to December 2016. The tumor clinical staging was as follows stage Ⅱ in 3 cases, stage Ⅲ in 33 cases, and stage Ⅳ in 56 cases. All patients underwent electronic esophagoscopy before treatment to remove esophageal cancer patients. The patients and their families chose voluntarily their desirable treatments from following modalities A. Induction chemotherapy sensitivity plus radiotherapy or concurrent chemoradiotherapy, otherwise induction chemotherapy insensitivity plus surgical treatment; B. Surgical treatment plus radiotherapy or concurrent chemoradiotherapy, with drugs to control adverse reactions. The Kaplan-Meier method was used to calculate OS rates and Log-rank test was used to compare the OS rates between the two groups. Crosstabs was used to compare the difference in the 1, 3 and 5-year OS rates and the organ preservation rates between group A and group B, using chi-square test as non-parametric test.@*Results@#Fifty-two patients were enrolled in group A, after 2 cycles of induction chemotherapies with TPF(docetaxel, cisplatine, 5-Fu), there were 46 sensitive cases with primary lesions reduced by ≥50% (including 5 cases with tumor complete response) and 6 insensitive cases with primary lesions reduced by <50%. The 46 sensitive patients were treated with radiotherapy or concurrent chemoradiotherapy according to their physical conditions and 6 insensitive patients treated with surgery, including total laryngectomy for 5 cases and partial laryngectomy for one case. The 1, 3, and 5-year OS for 52 patients in group A were 91.93%, 49.59%, and 37.20%, respectively, with an organ preservation rate of 90.4% (47/52). Forty patients were enrolled in group B, including 33 cases with total laryngectomy and 7 cases with partial laryngectomy. The 1, 3, and 5-year OS for 40 patients in group B were 77.50%, 57.86% and 43.41%, respectively, with an organ preservation rate of 17.5%(7/40). The 1-year OS of group A was higher than group B (χ2=4.349, P<0.05), and there was no statistical difference in the 3-year or 5-year OS between two groups. The organ preservation rate of 90.4% (47/52) in group A was higher than that (17.5%, 17/40) in group B, with a significant difference (χ2=49.539, P<0.001).@*Conclusions@#The clinical effectiveness for advanced hypopharyngeal carcinoma is still poor, and surgical treatment is still the main treatment method. According to the results of induction chemotherapy, radiotherapy, concurrent chemoradiotherapy or surgical treatment can be chosen, and ideal and feasible treatment modalities may improve the quality of life of patients, with high OS rate laryngeal preservation rate.