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Definitive Chemoradiotherapy Versus Surgery Followed by Adjuvant Radiotherapy in Resectable Stage III/IV Hypopharyngeal Cancer

 Jun Won Kim  ;  Mi Sun Kim  ;  Se-Heon Kim  ;  Joo Hang Kim  ;  Chang Geol Lee  ;  Gwi Eon Kim  ;  Ki Chang Keum 
 CANCER RESEARCH AND TREATMENT, Vol.48(1) : 45-53, 2016 
Journal Title
Issue Date
Adult ; Aged ; Aged, 80 and over ; Chemoradiotherapy*/adverse effects ; Female ; Humans ; Hypopharyngeal Neoplasms/pathology ; Hypopharyngeal Neoplasms/surgery* ; Hypopharyngeal Neoplasms/therapy* ; Laryngectomy ; Larynx/physiology ; Larynx/surgery ; Male ; Middle Aged ; Neoplasm Staging ; Pharyngectomy/adverse effects ; Radiotherapy, Adjuvant*/adverse effects ; Retrospective Studies ; Treatment Outcome
Adjuvant radiotherapy ; Chemoradiotherapy ; Hypopharyngeal neoplasms ; Organ preservation ; Treatment outcome
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-preservation and reduced treatment-related toxicity.
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1. College of Medicine (의과대학) > Dept. of Radiation Oncology (방사선종양학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Otorhinolaryngology (이비인후과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Keum, Ki Chang(금기창) ORCID logo https://orcid.org/0000-0003-4123-7998
Kim, Se Heon(김세헌)
Kim, Joo Hang(김주항)
Kim, Jun Won(김준원) ORCID logo https://orcid.org/0000-0003-1358-364X
Lee, Chang Geol(이창걸) ORCID logo https://orcid.org/0000-0002-8702-881X
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