Humans ; Plummer-Vinson Syndrome/drug therapy* ; Carcinoma ; Hypopharyngeal Neoplasms/surgery*

OBJECTIVE: To study clinical efficacy of surgery after the DCF induction chemotherapy in T2-3 laryngeal carcinoma and hypopharyngeal carcinoma. METHOD: To analyze clinical data about 102 cases of T2-3 laryngeal carcinoma and hypopharyngeal carcinoma retrospectively, 62 cases were divided into experimental group and 40 cases in control group, the experimental group completed three cycles of the DCF induction chemotherapy, then the efficacy was evaluated, surgery were carried out in the end, the control group received operation directly. In two groups, tumor response rates, toxicities, positive surgical margin rates and survival rate differences were observed and compared. RESULT: Tumor response rate was 61.3% in experimental group, the laryngeal carcinoma rate was significantly lower than that in hypopharyngeal (44.4% VS 84.6%, P < 0.05). Compared to its control, there were no significant differences about the positive surgical margin rate, the median survival time, 3-year and 5-year survival rate of laryngeal carcinoma(P > 0.05). The foci edges of 0. 3 cm and 0. 5 cm positive margin rate of hypopharyngeal carcinoma in experimental group were significantly lower than in its control (P < 0.05), but among the 1 cm edge' positive rate, the median survival time, 3-year and 5-year survival rate no significant differences were found (P > 0.05). During induction chemotherapy in the experimental group, no serious adverse reactions were found. CONCLUSION Induction chemotherapy of DCF regimen can not only narrow T2-3 laryngeal carcinoma and hypopharyngeal carcinoma' area, but also ensure an adequate safety margin.
Combined Modality Therapy ; Humans ; Hypopharyngeal Neoplasms ; drug therapy ; surgery ; Induction Chemotherapy ; Laryngeal Neoplasms ; drug therapy ; surgery ; Retrospective Studies ; Survival Rate

PURPOSE: The aim of this study was to assess the effectiveness, survival rate and complications of radiation therapy and chemoradiation treatment in hypopharyngeal cancer. METHODS AND MATERIALS: From January 1984 to December 1999, 56 patients who had hypopharyngeal carcinoma treated with curative radiation therapy were retrospectively studied. Twenty four patients (42.9%) were treated with radiation therapy alone (Group I) and 32 (57.1%) treated with a combination of chemotherapy and radiation (Group II). Total radiation dose ranged from 40.5 to 83. 5 Gy (median 67.9 Gy). Radiotherapy was given with conventional technique in 9 patients (16.4%), with hyperfractionation I (1.15~1.2 Gy/fr., BID) in 26 (47.2%), hyperfractionation II (1.35 Gy/fr., BID) in 18 (32.7%), and accelerated fractionation (1.6 Gy/fr., BID) in 2 (3.6%). In chemotherapy, 5-FU (1,000 mg/m2 daily for 5 consecutive days) and cisplatin (100 mg/m2 on day 1) were administered in a cycle of 3 weeks interval, and a total of 1 to 3 cycles (average 2..3 cycles) were given prior to radiation therapy. Follow up duration was 1~195 months (median 28 months). RESULTS: Overall 2 and 5 year survival rates were 40.6% and 27.6%; 50.0% and 30.0% in Group I, and 36.4% and 26.3% in Group II, respectively. Complete local control rates in Group I and II were 70.0% and 67.7%, respectively. The response to radiotherapy and nodal stage were statistically significant prognostic factors. The complication rate was increased in Group II and was decreased in hyperfractionation. CONCLUSION: The response to radiotherapy and nodal stage were valid factors to indicate the degree of control over the hypopharyngeal cancer. The induction cisplatin, 5-Fu chemotherapy was not valid in terms of local control rate and survival rate, but did contribute to an increased complication rate. The use of hyperfractionation was valid to reduce the late radiation complications.
Cisplatin ; Drug Therapy ; Fluorouracil ; Follow-Up Studies ; Humans ; Hypopharyngeal Neoplasms* ; Radiotherapy* ; Retrospective Studies ; Survival Rate

PURPOSE: We tried to evaluate the role of conventional radiotherapy alone or with neoadjuvant chemotherapy in the hypopharyngeal cncer by retrospective analysis. MATERIALS AND METHODS: Between Jul. 1985 and Sep. 1992, 42 patinets of hypopharyngeal cancer were treated by conventional radiotherapy alone or combined with neoadjuvant chemotherapy. The male to female ration was 20:1 with a median age of 58 years. Twelve patients were treated by conventional radiotherapy alone and 30 patients were treated by neoadjuvant chemotherapy and radiotherapy. RESULTS: Seven patients were stage I, II and the patients with stage III and IV were 10 and 25, respectively at the time of presentation. The overall survival and disease-specific survival rates at 24 month were 12.9% and 15.5%, respectively. Two-year survival rates of stage I+II and III+IV patients were 50% and 6.3%, respectively(p<0.05). Sixteen patients (38%) revealed CR and 26 patients(62%) revealed less that CR at the end of radiotherapy and their 2-year survival rates were 31.3% and 0%, respectively(p<0.05). On univariate anaysis, stage, T-stage, N-stage and treatment response were the significant prognositc factors, but only stage an dtreatment response were significant on multivariate analysis. CONCLUSION: This conventional radiotherapy alone or with neoadjuvant chemotherapy does not seem to be sufficient in the treatment of most advanced hypopharyngeal cancer. Therefore other treatment modalities such as hyperfractionation or concurrent chemoradiotherapy should be considered.
Chemoradiotherapy ; Drug Therapy ; Female ; Humans ; Hypopharyngeal Neoplasms* ; Male ; Multivariate Analysis ; Radiotherapy* ; Retrospective Studies ; Survival Rate

PURPOSE: Use of radiotherapy combined with chemotherapy is increasing in hypopharyngeal cancer. However, many show residual tumor after radiotherapy. Timing for treatment evaluation and salvage therapy is essential. However, optimal timing for salvage surgery has not been suggested. In this study, we tried to evaluate optimal timing for salvage surgery. METHODS AND MATERIALS: Patients who were diagnosed with hypopharyngeal squamous cell carcinoma between 2006 and 2015 were retrospectively analyzed. All patients received definitive radiotherapy with or without chemotherapy. Response of all treated patients were analyzed at 1, 3, and 6 months after radiotherapy. Any patients with progression before 6 months were excluded. RESULTS: A total of 54 patients were analyzed. Complete remission (CR) rates at 1 month (CR1), 3 months (CR3) and 6 months (CR6) were 66.7%, 81.5%, and 90.7%, respectively. Non-CR at 1 month (NCR1), 3 months (NCR3), and 6 months (NCR6) showed poor locoregional recurrence-free survival rates (1-year rates of 63.7%, 66.7%, and 0.0%, respectively) compared to CR1, CR3, and CR6 (1-year rates 94.3%, 88.0%, and 91.5%, respectively). Particularly significant differences were seen between CR6 and NCR6 (p < 0.001). Of 10 patients with NCR3, 5 showed CR at 6 months (NCR3/CR6). There was no statistical difference in locoregional recurrence-free survival between CR3 and NCR3/CR6 group (p = 0.990). CONCLUSION: Our data suggest half of patients who did not show CR at 3 months eventually achieved CR at 6 months. Waiting until 6 months after radiotherapy may be appropriate for avoiding additional salvage therapy.
Carcinoma, Squamous Cell ; Drug Therapy ; Humans ; Hypopharyngeal Neoplasms ; Hypopharynx ; Neoplasm, Residual ; Radiotherapy ; Retrospective Studies ; Salvage Therapy ; Survival Rate

BACKGROUND AND OBJECTIVES: Hypopharyngeal cancer is notorious for its poor prognosis and severe surgical morbidity with functional deficits. This study was conducted to compare the efficacy between the neoadjuvant chemotherapy followed by radiotherapy and surgery with postoperative radiotherapy in the treatment of hypophayngeal cancer. MATERIAL AND METHOD: Medical records of 64 patients, treated for hypopharyneal cancer at Pusan National University Hospital from March 1986 through May 2000, were retrospectively reviewed. Thirty-three patients were grouped into the chemotherapy and radiotherapy (CRTx) group, who received neoadjuvant chemotherapy and radiotherapy. Thirty-one patients were grouped into the operation and radiotherapy (ORTx) group, who received laryngectomy with or without reconstruction and postoperative radiotherapy. RESULTS: There was no significant difference of three years survival rate between CRTx group and ORTx group (p>0.05). Laryngeal preservation rate was 45% in CRTx group but 3% in ORTx group (p<0.05). CONCLUSION: Although this had not been a randomized study of chemotherapy followed by radiotherapy versus surgery plus postoperative radiotherapy, the survival rate of CRTx group appears to be as identical as ORTx group and more effective in the preservation of the larynx.
Busan ; Drug Therapy* ; Humans ; Hypopharyngeal Neoplasms* ; Laryngectomy ; Larynx ; Medical Records ; Neoadjuvant Therapy ; Organ Preservation ; Prognosis ; Radiotherapy* ; Retrospective Studies ; Survival Rate

BACKGROUND: We performed a retrospective study in patients with previously untreated advanced(Stage III or IV) laryngeal and hypopharyngeal cancer to compare the results of induction chemotherapy followed by definitive radiation therapy (CT+RT) with those of conventional laryngectomy and postoperative radiation therapy (OP+RT). METHOD: Between 1985 and 1990, twenty four patients were treated with two or three courses of chemotherapy and radiation therapy(66~75 Gy). Twenty-five patients were received laryngectomy and radical neck dissection(except 3 patients) and postoperative radiation therapy (55~04 Gy). RESULT: After a median follow-up of 20 months, the actuarial 5-year overall survival rate was 24% (chemotherapy group) and 36% (op group).(P>0.1). The local control rate was the 65%,(13/20) and 68.2%(15/22).(P>0.1). The rate of laryngeal preservation was 65%(13/20) in chemotherapy group. CONCLUSION: Induction chemotherapy and definitive radiation therapy can be effective in preserving the larynx in a high percentage of patients with advanced laryngeal and hypopharyngeal cancer.
Drug Therapy ; Follow-Up Studies ; Humans ; Hypopharyngeal Neoplasms* ; Induction Chemotherapy* ; Laryngectomy ; Larynx ; Neck ; Radiotherapy ; Retrospective Studies ; Survival Rate

PURPOSE: To see the relationship between the response to chemotherapy and the final outcome of neoadjuvant chemotherapy and radiotherapy in patients with locally advanced hypopharyngeal cancer. METHODS AND MATERIALS: A retrospective analysis was done for thirty-two patients with locally advanced hypopharyngeal cancer treated in the Seoul National University Hospital with neoadjuvant chemotherapy and radiotherapy from August 1979 to July 1997. The patients were treated with Co-60 teletherapy unit or 4MV or 6MV photon beam produced by linear accelerator. Daily fractionation was 1.75 to 2 Gy, delivered five times a week. Total dose ranged from 60.8 Gy to 73.8 Gy. Twenty-nine patients received continuous infusion of cisplatin and 5-FU. Other patients were treated with cisplatin combined with bleomycin or vinblastin. Twenty-four (75%) patients received all three prescribed cycles of chemotherapy delivered three weeks apart. Six patients received two cycles, and two patients received only one cycle. RESULTS: The overall 2-year and 5-year survival rates are 65.6% and 43.0%, respectively. 5-year local control rate is 34%. Organ preservation for more than five years is achieved in 12 patients (38%). After neoadjuvant chemotherapy, 24 patients achieved more than partial remission (PR); the response rate was 75% (24/32). Five patients had complete remission (CR), 19 patients PR, and 8 patients no response (NR). Among the 19 patients who had PR to chemotherapy, 8 patients achieved CR after radiotherapy. Among the 8 non-responders to chemotherapy, 2 patients achieved CR, and 6 patients achieved PR after radiotherapy. There was no non-responder after radiotherapy. The overall survival rates were 60% for CR to chemotherapy group, 35.1% for PR to chemotherapy group, and 50% for NR to chemotherapy group, respectively ( p=0.93). There were significant difference in five-year overall survival rates between the patients with CR and PR after neoadjuvant chemotherapy and radiotherapy (73.3% vs. 14.7%, p< 0.01). The prognostic factor affecting overall survival was the response to overall treatment (CR vs. PR, p<0.01). CONCLUSION: In this study, there were only five patients who achieved CR after neoadjuvant chemotherapy. Therefore the difference of overall survival rates between CR and PR to chemotherapy group was not statistically significant. Only the response to chemo-radiotherapy was the most important prognostic factor. There needs to be more effort to improve CR rate of neoadjuvant chemotherapy and consideration for future use of concurrent chemoradiotherapy.
Bleomycin ; Chemoradiotherapy ; Cisplatin ; Drug Therapy* ; Fluorouracil ; Humans ; Hypopharyngeal Neoplasms* ; Organ Preservation ; Particle Accelerators ; Radiotherapy* ; Retrospective Studies ; Seoul ; Survival Rate

This study was conducted to evaluate the efficacy of the neoadjuvant chemotherapy and radiation therapy in treatment of patients with advanced hypopharyngeal cancer which is notorious for its poor prognosis and severe surgical morbidity with functional deficits. Medical records of 62 patients with squamous cell carcinoma of the hypopharynx, Stage III or IV(AJCC, 1992), were retrospectively reviewed. Neoadjuvant chemotherapy showed an overall response rate of 87% and a complete remission(CR) rate was 67% following chemotherapy and radiation therapy. The patients who did not show CR after chemotherapy had a high likelihood of treatment failure, even though they achieved CR following subsequent radiotherapy. Thirteen of 30 patients were able to preserve their larynges for more than three years by chemotherapy and radiation. This regimen appeared to be as effective as radical surgery with postoperative radiation therapy without comprise of survival. To improve the cure rates, we need to develop better strategies to increase CR rates with chemotherapy and figure out the best treatment option for patients who are partially or non-responsive to chemotherapy.
Carcinoma, Squamous Cell ; Drug Therapy* ; Humans ; Hypopharyngeal Neoplasms ; Hypopharynx ; Medical Records ; Prognosis ; Radiotherapy* ; Retrospective Studies ; Treatment Failure

OBJECTIVES: The aim of this study was to investigate the feasibility and safety of percutaneous ¹²⁵I seed permanent implantation for advanced hypopharyngeal carcinoma from toxicity, tumor response, and short-term outcome. METHODS: ¹²⁵I seeds implant procedures were performed under computed tomography for 34 patients with advanced hypopharyngeal carcinoma. We observed the local control rate, overall survival, and acute or late toxicity rate. RESULTS: In the 34 patients (stage III, n=6; stage IV, n=28), the sites of origin were pyriform sinus (n=29) and postcricoid area (n=5). All patients also received one to four cycles of chemotherapy after seed implantation. The post-plan showed that the actuarial D90 of ¹²⁵I seeds ranged from 90 to 158 Gy (median, 127 Gy). The mean follow-up was 12.3 months (range, 3.4 to 43.2 months). The local control was 2.1–31.0 months with a median of 17.7 months (95% confidence interval [CI], 13.4 to 22.0 months). The 1-, 2-, and 3-year local controls were 65.3%, 28.6%, and 9.5% respectively. Twelve patients (35%) died of local recurrence, fourteen patients (41%) died of distant metastases, and three patients (9%) died of recurrence and metastases at the same time. Five patients (15%) still survived to follow-up. At the time of analysis, the median survival time was 12.5 months (95% CI, 9.5 to 15.4 months). The 1-, 2-, and 3-year overall survival rates were 55.2%, 20.3%, and 10.9%, respectively. Five patients (15%) experienced grade 3 toxic events and nine patients (26%) have experienced grade 2 toxic events. CONCLUSION: This review shows relatively low toxicity for interstitial ¹²⁵I seed implantation in the patients with advanced stage hypopharyngeal cancer. The high local control results suggest that ¹²⁵I seed brachytherapy implant as a salvage or palliative treatment for advanced hypopharyngeal carcinoma merit further investigation.
Brachytherapy ; Drug Therapy ; Follow-Up Studies ; Humans ; Hypopharyngeal Neoplasms ; Neoplasm Metastasis ; Palliative Care* ; Pyriform Sinus ; Recurrence ; Survival Rate