Comparison of different laryngeal preservation strategies based on chemoradiotherapy in locally advanced hypopharyngeal carcinoma.
10.13201/j.issn.2096-7993.2023.09.005
- Author:
Xi LUO
1
;
Shiran SUN
1
;
Yi XU
1
;
Xiaodong HUANG
1
;
Kai WANG
1
;
Runye WU
1
;
Jingbo WANG
1
;
Ye ZHANG
1
;
Jianghu ZHANG
1
;
Xuesong CHEN
1
;
Yuan QU
1
;
Jingwei LUO
1
;
Junlin YI
1
Author Information
1. Department of Radiation Oncology National Cancer Center/ National Clinical Research Center for Cancer/ Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College，Beijing，100021，China.
- Publication Type:Journal Article
- Keywords:
hypopharyngeal carcinoma;
induction chemotherapy;
laryngeal preservation;
multi-disciplinary treatment;
response directed
- MeSH:
Male;
Humans;
Cohort Studies;
Chemoradiotherapy;
Carcinoma;
Hypopharyngeal Neoplasms/therapy*;
Induction Chemotherapy
- From:
Journal of Clinical Otorhinolaryngology Head and Neck Surgery
2023;37(9):708-714
- CountryChina
- Language:Chinese
-
Abstract:
Objective:This study aimed to evaluate the clinical features and treatment outcomes of the value of response-adapted treatment following radiotherapy and induction chemotherapy follwing subsequent comprehensive therapy in patients with resectable locally advanced hypopharyngeal carcinoma. Methods:This cohort study was conducted from September 2010 to September 2020 in our hospital, 231 patients pathologically confirmed stage Ⅲ and ⅣB resectable locally advanced hypopharyngeal carcinoma included. For the IC-directed ART strategy, IC is used to select good candidates to receive radical RT or CCRT, and others undergo surgery. He response-adapted strategy was determined based on the primary tumor response, which was evaluated at a dose of 50 Gy. If the response reached complete response or partial response（more than 80% tumor regression）, patients received radical RT or CCRT; otherwise, they received surgery, if possible, at 4 to 6 weeks after RT. The end points of the study were OS（overall survival）, progression free survival（PFS）, locoregional recurrence-free survival（LRRFS） and LDFS. Results:In IC-directed group, 75.0%（57/76） patients reached PR after 2 cycles of induction chemotherapy. While in RT-directed group, 70.3%（109/155） patients reached large PR at dose of 50 Gy. The median interquartile range follow-up period of the whole cohort was 63.8 months. The 5-year OS, PFS, LRRFS and SFL of the whole cohort were 47.9%、39.6%、44.3% and 36.2%, respectively. In evaluations based on the different treatment strategies, the 5-year OS and SFL were 51.3% versus 37.0%（HR 0.67; 95%CI 0.43-1.05; P=0.07） and 27.8% versus 39.8%（HR 0.68; 95%CI 0.46-0.99; P=0.04） between IC-directed and RT-directed groups. In additional, surgery complications did not significantly differ between these two groups. Conclusion:In this cohort study, the response-adapted strategy based on an early RT response facilitated better treatment tailoring, and higher laryngeal preservation compared with IC-directed strategies. This approach could provide a feasible laryngeal preservation strategy in patients with resectable locally advanced hypopharyngeal carcinoma.
