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

Objective: To analyze the effectiveness, safety and factors influencing the clinical prognosis of patients with hypopharyngeal carcinoma in T4b by nonsurgical treatments. Methods: The clinical data of 77 patients with T4b hypopharyngeal cancer treated in the College of Otolaryngology Head and Neck Surgery of the Chinese People's Liberation Army General Hospital from January 2010 to June 2021 were analyzed retrospectively. All were males, aged(57.0±8.0)years old. Patients were treated with induction chemotherapy plus concurrent chemoradiotherapy. Kaplan Meier survival analysis was used to compare the effects of different factors on prognosis. Adverse reactions during treatments and the causes of death were analyzed. Results: 98.7% of 77 patients with T4b hypopharyngeal cancer completed the chemotherapy plan and 94.8% completed the radiotherapy plan. The most common adverse reactions were grade 2 radiation oral mucositis (50/77, 64.9%) and grade 2 leukopenia (50/77, 64.9%). The incidence of grade 3 severe hoarseness was 7.8% (6/77), one patient (1.3%) underwent gastrostomy due to dysphagia, and pronunciation and swallowing function were effectively preserved in other patients. The overall survival rate was 71.9% at 1 year, 45.6% at 3 years and 29.7% at 5 years. The location of tumor, the presence of liquefaction necrosis in tumor, the use of molecular targeted drugs and the approach of radiotherapy were independent factors,each of which that affected the prognosis of T4b patients with advanced hypopharyngeal cancer [HR (95%CI) were 1.867(1.085-3.213), 3.018 (1.437-6.335), 0.372 (0.181-0.764) and 2.158 (1.015-4.588), respectively, P<0.05]. The two leading causes of death with high incidence were disease recurrence (12/32, 37.5%) and cervical large vessel rupture and hemorrhage (11/32, 34.4%). Conclusions: Non-surgical comprehensive treatment offers a high laryngeal preservation rate in patients with T4b hypopharyngeal cancer. The location of tumor, the liquefaction necrosis within tumor, the use of molecular targeted drugs, and the approach of radiotherapy are independent prognostic factors.
Aged ; Carcinoma, Squamous Cell ; Chemoradiotherapy ; Humans ; Hypopharyngeal Neoplasms/drug therapy* ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome

PURPOSE: To evaluate the prognostic value of 18F-fluorodeoxyglucose positron-emission tomography (FDG PET) with computed tomography (CT) before and during radiotherapy (RT) in patients with head and neck cancer. METHODS: Twenty patients with primary head and neck squamous cell carcinoma were enrolled in this study, of whom 6 had oropharyngeal cancer, 10 had hypopharyngeal cancer, and 4 had laryngeal cancer. Fifteen patients received concurrent cisplatin and 2 received concurrent cetuximab chemotherapy. FDG PET/CT was performed before RT and in the 4th week of RT. The parameters of maximum standardized uptake value, metabolic tumor volume, and total lesion glycolysis (TLG) of the primary tumor were measured, and the prognostic significance of each was analyzed with the Cox proportional hazards model. RESULTS: Higher TLG (>19.0) on FDG PET/CT during RT was a poor prognostic factor for overall survival (OS) (p = 0.001) and progression-free survival (PFS) (p = 0.007). In the multivariate analysis, TLG during RT as a continuous variable was significantly associated with OS and PFS rate (p = 0.023 and p = 0.016, respectively). Tumor response worse than partial remission at 1 month after RT was another independent prognostic factor for PFS (p = 0.024). CONCLUSIONS: Higher TLG of the primary tumor on FDG PET/CT during RT was a poor prognostic factor for OS and PFS in patients with head and neck cancer.
Carcinoma, Squamous Cell ; Cetuximab ; Cisplatin ; Disease-Free Survival ; Drug Therapy ; Glycolysis ; Head and Neck Neoplasms ; Head ; Humans ; Hypopharyngeal Neoplasms ; Laryngeal Neoplasms ; Multivariate Analysis ; Neck ; Oropharyngeal Neoplasms ; Positron-Emission Tomography ; Positron-Emission Tomography and Computed Tomography ; Proportional Hazards Models ; Radiotherapy ; Tumor Burden

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

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

OBJECTIVETo study the radiosensitizing effect of resveratrol on hypopharyngeal carcinoma cell line FADU in vitro.

METHODSHypopharyngeal carcinoma cell line FADU was cultured in in vitro DMEM. Its inhibition on cell proliferation was detected using cytotoxicity test (MTT assay). The cell survival curve was drawn using clone formation to obtain sensitive enhancement ratio (SER). Changes of the cell cycle and cell apoptosis were analyzed using flow cytometry (FCM).

RESULTSResults of MTT showed the inhibition of resveratrol on FADU cells increased along with its concentrations (P < 0.05). Results of clone formation indicated the surviving fraction at 2 Gy (SF2) was 0.717 ± 0.062 in the irradiation group, and 0.426 ± 0.035 in the resveratrol plus irradiation group (with SER ranged 1.684 ± 0.178) with statistical difference (P = 0.007). Results of FCM showed that after radiation of 4 Gy radiation, cells at G2/M phase arrest increased, but cells at G1 decreased. After radiation of resveratrol for 24 h, cells at G1 decreased, but cells at G2/M phase and S phase arrest increased. When 4 Gy radiation combined resveratrol was used, cells at G2/M phase arrest significantly increased, but cells at G1 significantly decreased. The apoptosis rate was 1.94% ± 1.65% in the control group, 4.56% ± 0.92% in the irradiation group, 2.03% ± 1.46% in the resveratrol group, and 23.11% ± 7.22% in the resveratrol plus irradiation group. There was statistical difference between the resveratrol plus irradiation group and the rest 3 groups (P < 0.05).

CONCLUSIONResveratrol could enhance the radiosensitivity of hypopharyngeal carcinoma FADU cells in vitro possibly by inducing cell apoptosis and causing changes in the cell cycle distribution.

Apoptosis ; Carcinoma, Squamous Cell ; Cell Cycle ; drug effects ; Cell Line, Tumor ; Cell Proliferation ; Cell Survival ; Head and Neck Neoplasms ; Humans ; Hypopharyngeal Neoplasms ; drug therapy ; Radiation Tolerance ; Radiation-Sensitizing Agents ; therapeutic use ; Stilbenes ; therapeutic use

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

OBJECTIVETo study the radiosensitizing effect of resveratrol on human hypo pharyngeal squamous cell carcinoma (FaDu) cells in nude mice.

METHODSForty-three nude mice bearing FaDu cell xenografts were randomized into control group, radiotherapy (12 Gy) group, resveratrol treatment (50 mg/kg) group, and radiotherapy plus resveratrol treatment group. After corresponding treatments, the tumor volume in the mice was measured every 3 days, and the microvessel density (MVD) in the tumor was evaluated with CD31 immunofluorescence histochemical staining.

RESULTSThe tumor volume and weight were the smallest in mice receiving radiotherapy plus resveratrol treatment (P<0.05) but comparable between those having resveratrol treatment alone and the control mice. Radiotherapy plus resveratrol treatment resulted in a tumor inhibition rate of 76.64% and a significantly decreased MVD in the tumor compared with the other 3 groups.

CONCLUSIONResveratrol can produce a radiosensitizing effect on human hypopharyngeal carcinoma in nude mice.

Animals ; Carcinoma, Squamous Cell ; drug therapy ; radiotherapy ; Cell Line, Tumor ; radiation effects ; Head and Neck Neoplasms ; drug therapy ; radiotherapy ; Humans ; Hypopharyngeal Neoplasms ; drug therapy ; radiotherapy ; Mice ; Mice, Nude ; Radiation Tolerance ; Radiation-Sensitizing Agents ; pharmacology ; Stilbenes ; pharmacology ; Transplantation, Heterologous ; Tumor Burden

BACKGROUNDLymph node ratio (LNR) has recently been reported as a potential prognostic marker in many malignant diseases. We aimed to analyze the potential prognostic effect of LNR on hypopharyngeal squamous cell carcinoma (HPSCC) after neoadjuvant therapy in our institution.

METHODSWe performed a retrospective study of 279 patients with HPSCC who underwent radiotherapy with or without chemotherapy followed by neck dissection between November 1965 and December 2008. Patients were divided into four groups according to quartiles based on LNR.

RESULTSThe mean LNR was 10.4% (range 0-100%, median 4.3%). Males and advanced clinical N classification significantly increased the LNR (P = 0.014 and P < 0.001, respectively). Compared with those with LNR <0.14, LNR ≥0.14 was associated with reduced overall, disease-specific and disease-free survival (all at P < 0.001). Multivariate analysis revealed that LNR is an independent predictor of prognosis.

CONCLUSIONOur results suggest that LNR is a strong predictor of HPSCC after chemoradiotherapy.

Adult ; Aged ; Aged, 80 and over ; Carcinoma, Squamous Cell ; drug therapy ; pathology ; radiotherapy ; Chemoradiotherapy ; Disease-Free Survival ; Female ; Head and Neck Neoplasms ; drug therapy ; pathology ; radiotherapy ; Humans ; Hypopharyngeal Neoplasms ; drug therapy ; pathology ; radiotherapy ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; pathology ; Male ; Middle Aged ; Prognosis ; Retrospective Studies

OBJECTIVETo study the adjunctive roles of Qingliu Lianghou Recipe (QLR) in treatment of hypopharyngeal carcinoma.

METHODSA total of 156 patients with hypopharyngeal squamous cell carcinoma were recruited, including 21 cases of stage I, 34 in stage II, 55 in stage III, and 46 in stage IV. Of them, 31 patients (Group A) were managed with operation and post-operative radiotherapy, 40 patients (Group B) with operation, post-operative radiotherapy, and QLR, 45 patients (Group C) were managed with concomitant chemoradiotherapy, 40 patients (Group D)with concomitant chemoradiation and QLR. QLR was given for 12 weeks. The radio- and chemotoxic reactions, quality of life (KPS score), and long-term efficacy (the recurrence time and the survival time) were observed.

RESULTSThe toxicity levels were significantly lower in Group B than in Group A, manifested as radioactive dermatitis, mucositis, dysphagia, changes in body weight, and lymphatic edema (P < 0.05, P < 0.01). The toxicity levels were significantly lower in Group D than in Group C, manifested as radioactive dermatitis, mucositis, dysphagia, marrow depression, changes in body weight, and gastrointestinal reactions (P < 0.05, P < 0.01). After treatment the KPS scores of all patients obviously decreased (P < 0.05, P < 0.01). But the KPS scores were significantly higher in Group B than in Group A (P < 0.05), and they were significantly higher in Group D than in Group C (P < 0.05). The 3-year recurrence rate of patients in Group A was 41.94%, 20.00% in Group B, 60.00% in Group C, and 37.50% in Group D (P < 0.05). The 5-year survival rate of patients in Group A was 38.71%, 62.50% in Group B, 22.22% in Group C, and 42.50% in Group D (P < 0.05).

CONCLUSIONSQLR could effectively prevent and reduce the toxicity response caused by operation, radiotherapy and chemotherapy. The combination therapy of integrative medicine could postpone the recurrence and prolong the lifespan of patients. Therefore, we must not neglect the adjunctive therapy of QLR in treating hypopharyngeal carcinoma.

Adolescent ; Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Carcinoma, Squamous Cell ; drug therapy ; Chemotherapy, Adjuvant ; Child ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Hypopharyngeal Neoplasms ; drug therapy ; Male ; Middle Aged ; Phytotherapy ; Treatment Outcome ; Young Adult