Document Type : Original Article(s)
Authors
- Ali Kazemian 1
- Reza Ghalehtaki 1, 2
- Mahdieh Razmkhah 2
- Maryam Taheriyoun 2
- Negin Mohammadi 1
- Mohammad Narimani Kali 3
- Farshid Farhan 2
- Mahdi Aghili 1
- Ebrahim Esmati 2
1 Radiation Oncology Research Center (RORC), Cancer Research Institute, Tehran University of Medical Sciences, Tehran, Iran
2 Department of Radiation Oncology, Cancer Institute, Imam Khomeini Hospital Complex, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
3 School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
Abstract
Background: Hypopharyngeal carcinoma (HPC) is a rare head and neck cancer which poses many therapeutic challenges. There is limited evidence regarding the outcomes of HPC treatment in Iran.
Method: In this retrospective cohort study, we evaluated patients treated with chemoradiation or radiation alone, between 2007 and 2016 in the radiation oncology ward of the cancer institute affiliated to Tehran University of Medical Sciences. The design of the study was reviewed and approved by the local institutional review board (code: 86100142). All patients underwent definitive radiotherapy with or without concurrent or sequential chemotherapy. We assessed the two-year overall survival (OS) as the primary outcome. The progression-free survival (PFS) was our secondary outcome.
Results: We studied 40 patients whose median age was 58 years. 37 patients were stage 3 or 4, while the most common stage was T3N1-2, observed in 35% of the cases. The most common site of involvement was pyriform sinus (47.5%). The twoyear OS rate was 29%. The two-year PFS was 22%. In the univariate analysis, N0-1 vs. N 2-3 and stage 2 vs. stage 3-4 were significant predictors of OS. In addition, distant metastasis had almost a significant association with lower OS.
Conclusion: The outcome of locally advanced HPC was not promising using 3DCRT alone. It is necessary to implement dramatic changes in the management of these patients to achieve better outcomes.
Keywords
How to cite this article:
Kazemian A, Ghalehtaki R, Razmkhah M, Taheriyoun M, Mohammadi N, Narimani Kali M, et al. Definitive radiotherapy with or without concomitant or induction chemotherapy in patients with hypopharyngeal squamous cell carcinoma: a single center study in Iran. Middle East J Cancer. 2022;13(2):308-15. doi: 10.30476/mejc.2020.87158.1404.
- Popescu CR, Bertesteanu SV, Mirea D, Grigore R, lonescu D, Popescu B. The epidemiology of hypopharynx and cervical esophagus cancer. J Med Life. 2010;3(4):396-401.
- Jang JY, Kim EH, Cho J, Jung JH, Oh D, Ahn YC, et al. Comparison of oncological and functional outcomes between initial surgical versus non-surgical treatments for hypopharyngeal cancer. Ann Surg Oncol. 2016;23(6):2054-61. doi:10.1245/s10434-016-5088-4.
- Mozaffari HR, Izadi B, Sadeghi M, Rezaei F, Sharifi R, Jalilian F. Prevalence of oral and pharyngeal cancers in Kermanshah province, Iran: A ten-year period. Int J Cancer Res. 2016;12(3–4):169-75.
- Shangina O, Brennan P, Szeszenia-Dabrowska N, Mates D, Fabiánová E, Fletcher T, et al. Occupational exposure and laryngeal and hypopharyngeal cancer risk in central and eastern Europe. Am J Epidemiol. 2006;164(4):367-75. doi:10.1093/aje/kwj208.
- Klussmann JP, Weissenborn SJ, Wieland U, Dries V, Kolligs J, Jungehuelsing M, et al. Prevalence, distribution, and viral load of human papillomavirus 16 DNA in tonsillar carcinomas. Cancer. 2001;92(11):2875–84.
- Garden AS. Organ preservation for carcinoma of the larynx and hypopharynx. Hematol/Oncol Clin North Am. 2001;15(2):243-60.
- Carvalho AL, Nishimoto IN, Califano JA, Kowalski LP. Trends in incidence and prognosis for head and neck cancer in the United States: A site-specific analysis of the SEER database. Int J Cancer. 2005;114(5):806-16.
- Mirzaei M, Hosseini SA, Ghoncheh M, Soheilipour F, Soltani S, Soheilipour F, et al. Epidemiology and trend of head and neck cancers in Iran. Glob J Health Sci. 2015;8(1):189-93. doi: 10.5539/gjhs.v8n1p189.
- Hoffman HT, Karnell LH, Shah JP, Ariyan S, Brown GS, Fee WE, et al. Hypopharyngeal cancer patient care evaluation. Laryngoscope. 1997;107(8):1005-17.doi: 10.1097/00005537-199708000-00001.
- Zelefsky MJ, Kraus DH, Pfister DG, Raben A, Shah JP, Strong EW, et al. Combined chemotherapy and radiotherapy versus surgery and postoperative radiotherapy for advanced hypopharyngeal cancer. Head Neck. 1996;18(5):405-11. doi: 10.1002/(SICI)
1 0 9 7 - 0 3 4 7 ( 1 9 9 6 0 9 / 1 0 ) 1 8 : 5 < 4 0 5 : : A I D -HED3>3.0.CO;2-9. - Bova R, Goh R, Poulson M, Coman WB. Total pharyngolaryngectomy for squamous cell carcinoma of the hypopharynx: A review. Laryngoscope. 2005;115(5):864-9. doi:10.1097/01.MLG.0000158348.38763.5D.
- Makeieff M, Mercente G, Jouzdani E, Garrel R, Crampette L, Guerrier B. Supraglottic hemipharyngolaryngectomy for the treatment of T1 and T2 carcinomas of laryngeal margin and piriform sinus. Head Neck. 2004;26(8):701-5.
- Gupta T, Chopra S, Agarwal JP, Laskar SG, D’Cruz AK, Shrivastava SK, et al. Squamous cell carcinoma of the hypopharynx: Single-institution outcome analysis of a large cohort of patients treated with primary nonsurgical approaches. Acta Oncol (Madr). 2009;48(4):541-8.
- Krstevska V, Stojkovski I, Lukarski D. Concurrent radiochemotherapy in advanced hypopharyngeal cancer. Radiat Oncol. 2010;5(1):39.
- Studer G, Lütolf UM, Davis JB, Glanzmann C. IMRT in hypopharyngeal tumors. Strahlenther Onkol. 2006; 182(6):331-5. doi: 10.1007/s00066-006-1556-2.
- Mok G, Gauthier I, Jiang H, Huang SH, Chan K, Witterick IJ, et al. Outcomes of intensity-modulated radiotherapy versus conventional radiotherapy for hypopharyngeal cancer. Head Neck. 2015;37(5):655-61. doi: 10.1002/hed.23649.
- Bhayani MK, Hutcheson KA, Barringer DA, Roberts DB, Lewin JS, Lai SY. Gastrostomy tube placement in patients with hypopharyngeal cancer treated with
radiotherapy or chemoradiotherapy: factors affecting placement and dependence. Head Neck. 2013;35(11):1641-6. doi: 10.1002/hed.23199. - Bozec A, Benezery K, Chamorey E, Ettaiche M, Vandersteen C, Dassonville O, et al. Nutritional status and feeding-tube placement in patients with locally advanced hypopharyngeal cancer included in an induction chemotherapy-based larynx preservation program. Eur Arch Oto-Rhino-Laryngology. 2016;273(9):2681-7.