Skip to main content
SpringerLink
Log in

Comparison of Oncological and Functional Outcomes between Initial Surgical versus Non-Surgical Treatments for Hypopharyngeal Cancer

  • Head and Neck Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Whether to administer surgical or non-surgical treatments (radiation or chemoradiation therapies) for the initial management of hypopharyngeal cancer (HPC) remains a topic of debate. Herein, we explored the differences between the two approaches in terms of oncological and functional outcomes in 332 HPC patients.

Methods

The primary endpoint was survival probability; secondary outcomes included post-treatment speech and swallowing functions and necessity of additional surgical procedures for salvage or complication management. Cox proportional hazard models using clinical variables were constructed to identify significant factors.

Results

The 2- and 5-year overall survival (OS) rates in all patients were 64.9 and 40.9 %, respectively. In early-stage HPC patients (N = 52), initial surgery ± radiation therapy (RT) or RT alone yielded similar oncological (60 % 5-year OS rate) and functional outcomes. As for resectable advanced-stage cancers (N = 177), initial surgery ± RT/chemoradiation therapy (SRC) and initial concurrent chemoradiation therapy (iCRT) resulted in similar 45–50 % 5-year OS rates. After sacrificing the larynx, 60 % of SRC patients recovered their speaking ability through voice prosthesis, which was less than the rate for iCRT patients (76.6 %; p = 0.008). Additional surgical interventions were required in 28.0–28.6 % of patients in both groups; however, 60 % of patients undergoing additional surgery in the iCRT group received multiple (two or more) surgical interventions (p = 0.029).

Conclusions

Our data revealed similar oncological outcomes, but different functional outcomes, between initial surgical and non-surgical treatments for HPC. In resectable advanced-stage HPC, iCRT resulted in better verbal communication outcomes than SRC; however, more iCRT patients required multiple surgical interventions during clinical courses.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Cooper JS, Porter K, Mallin K, et al. National Cancer Database report on cancer of the head and neck: 10-year update. Head Neck. 2009;31:748–58.

    Article  PubMed  Google Scholar 

  2. Qian W, Zhu G, Wang Y, et al. Multi-modality management for loco-regionally advanced laryngeal and hypopharyngeal cancer: balancing the benefit of efficacy and functional preservation. Med Oncol. 2014;31:178.

    Article  PubMed  Google Scholar 

  3. Vandersteen C, Benezery K, Chamorey E, et al. Contemporary therapeutic management of locally advanced hypopharyngeal cancer: oncologic and functional outcomes: a report on 100 cases. Acta Otolaryngol. 2015;135:193–200.

    Article  PubMed  Google Scholar 

  4. Takes RP, Strojan P, Silver CE, et al. Current trends in initial management of hypopharyngeal cancer: the declining use of open surgery. Head Neck. 2012;34:270–81.

    Article  PubMed  Google Scholar 

  5. Kuo P, Chen MM, Decker RH, Yarbrough WG, Judson BL. Hypopharyngeal cancer incidence, treatment, and survival: temporal trends in the United States. Laryngoscope. 2014;124:2064–9.

    Article  PubMed  Google Scholar 

  6. Ganly I, Patel S, Matsuo J, et al. Postoperative complications of salvage total laryngectomy. Cancer. 2005;103:2073–81.

    Article  PubMed  Google Scholar 

  7. Klozar J, Cada Z, Koslabova E. Complications of total laryngectomy in the era of chemoradiation. Eur Arch Otorhinolaryngol. 2012;269:289–93.

    Article  PubMed  Google Scholar 

  8. Chen LY, Huang CC, Tsou YA, Bau DT, Tsai MH. Prognostic factor of severe complications in patients with hypopharyngeal cancer with primary concurrent chemoradiotherapy. Anticancer Res. 2015;35:1735–41.

    CAS  PubMed  Google Scholar 

  9. Wulff NB, Kristensen CA, Andersen E, Charabi B, Sorensen CH, Homoe P. Risk factors for postoperative complications after total laryngectomy following radiotherapy or chemoradiation: a 10-year retrospective longitudinal study in Eastern Denmark. Clin Otolaryngol. 2015. doi:10.1111/coa.12443.

    PubMed  Google Scholar 

  10. Xu B, Boero IJ, Hwang L, et al. Aspiration pneumonia after concurrent chemoradiotherapy for head and neck cancer. Cancer. 2015;121:1303–11.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Martin A, Jackel MC, Christiansen H, Mahmoodzada M, Kron M, Steiner W. Organ preserving transoral laser microsurgery for cancer of the hypopharynx. Laryngoscope. 2008;118:398–402.

    Article  PubMed  Google Scholar 

  12. Karatzanis AD, Psychogios G, Waldfahrer F, et al. T1 and T2 hypopharyngeal cancer treatment with laser microsurgery. J Surg Oncol. 2010;102:27–33.

    Article  PubMed  Google Scholar 

  13. Suarez C, Rodrigo JP, Silver CE, et al. Laser surgery for early to moderately advanced glottic, supraglottic, and hypopharyngeal cancers. Head Neck. 2012;34:1028–35.

    Article  PubMed  Google Scholar 

  14. Pfister DG, Ang KK, Brizel DM, et al. Head and neck cancers. J Natl Compr Canc Netw. 2011;9:596–650.

    PubMed  Google Scholar 

  15. Kim JW, Kim MS, Kim SH, et al. Definitive chemoradiotherapy versus surgery followed by adjuvant radiotherapy in resectable stage III/IV hypopharyngeal cancer. Cancer Res Treat. 2015. doi:10.4143/crt.2014.340.

    Google Scholar 

  16. Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol. 2010;17:1471–4.

    Article  PubMed  Google Scholar 

  17. Newman JR, Connolly TM, Illing EA, Kilgore ML, Locher JL, Carroll WR. Survival trends in hypopharyngeal cancer: a population-based review. Laryngoscope. 2015;125:624–9.

    Article  PubMed  Google Scholar 

  18. Oken MM, Creech RH, Tormey DC, et al. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol. 1982;5:649–55.

    Article  CAS  PubMed  Google Scholar 

  19. Lefebvre JL, Chevalier D, Luboinski B, Kirkpatrick A, Collette L, Sahmoud T. Larynx preservation in pyriform sinus cancer: preliminary results of a European Organization for Research and Treatment of Cancer phase III trial. EORTC Head and Neck Cancer Cooperative Group. J Natl Cancer Inst. 1996;88:890–9.

    Article  CAS  PubMed  Google Scholar 

  20. Robertson SM, Yeo JC, Dunnet C, Young D, Mackenzie K. Voice, swallowing, and quality of life after total laryngectomy: results of the west of Scotland laryngectomy audit. Head Neck. 2012;34:59–65.

    Article  PubMed  Google Scholar 

  21. Polat B, Orhan KS, Kesimli MC, Gorgulu Y, Ulusan M, Deger K. The effects of indwelling voice prosthesis on the quality of life, depressive symptoms, and self-esteem in patients with total laryngectomy. Eur Arch Otorhinolaryngol. 2015;272(11):3431–7.

    Article  PubMed  Google Scholar 

  22. Finizia C, Bergman B. Health-related quality of life in patients with laryngeal cancer: a post-treatment comparison of different modes of communication. Laryngoscope. 2001;111:918–23.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgment

This study was supported by the National Research Foundation, Grant Numbers 2012R1A1A2040866, 2014R1A1A2055006, and 2015R1D1A1A09056771 (Ministry of Education, Science and Technology, Korea).

Disclosure

Jeon Yeob Jang, Eun-Hye Kim, Jungkyu Cho, Jae-Hoon Jung, Dongryul Oh, Yong Chan Ahn, Young-Ik Son, and Han-Sin Jeong have no conflicts of interest to declare.

Author information

Authors and Affiliations

  1. Department of Otorhinolaryngology–Head and Neck Surgery, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea

    Jeon Yeob Jang MD, PhD

  2. Department of Otorhinolaryngology–Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

    Eun-Hye Kim RN, Jungkyu Cho MD, Young-Ik Son MD, PhD & Han-Sin Jeong MD, PhD

  3. Department of Otorhinolaryngology–Head and Neck Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea

    Jae-Hoon Jung MD

  4. Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

    Dongryul Oh MD, PhD & Yong Chan Ahn MD, PhD

Authors
  1. Jeon Yeob Jang MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Eun-Hye Kim RN
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jungkyu Cho MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jae-Hoon Jung MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Dongryul Oh MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yong Chan Ahn MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Young-Ik Son MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Han-Sin Jeong MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Han-Sin Jeong MD, PhD.

Electronic supplementary material

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jang, J.Y., Kim, EH., Cho, J. et al. Comparison of Oncological and Functional Outcomes between Initial Surgical versus Non-Surgical Treatments for Hypopharyngeal Cancer. Ann Surg Oncol 23, 2054–2061 (2016). https://doi.org/10.1245/s10434-016-5088-4

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-016-5088-4

Keywords

Search

Navigation