[Value of the association of partial surgery and postoperative radiotherapy in the management of tumors of the hypopharynx. A study of 141 T1-T2 cases of hypopharyngeal cancer treated by partial surgery, radical surgery or radiotherapy alone].
A retrospective study of 142 T1-T2 hypopharyngeal cancers treated from 1977 to 1988 was carried out. Forty-seven patients were treated by local conservative surgery, curage and postoperative radiotherapy of the remaining pharyngolarynx and cervical node areas (group 1), 48 by radical surgery and postoperative radiotherapy (group 2) and 47 by radiotherapy alone (group 3). There were more T1 tumors in group 1 (64%), than in group 2 (33%), and group 3 (40%). Sixty two percent of the patients of group 1 had clinical nodes, 56% of group 2 and 49% of group 3. There were 70% N+ and 30% N+ with extracapsular invasion (N+ RC+) in group 1, 81% N+ and 35% N+ RC+ in group 2. A histologically non-satisfactory resection was observed in 21% of patients of group 1 and 6% in group 2. Patients more than seventy years old comprised 11% in group 1, 15% in group 2 and 26% in group 3. Indications for radiotherapy alone was for 75% an impossibility for surgery (surgical contraindications or refusal by the patients). Overall survival was 34% at 5 years and 18% at 10 years. Five-year survival for groups 1, 2 and 3 were 48%, 33.5% and 22%. Deaths by cancer evolution was as frequent in group 2 as in group 3 (43%) but deaths by metastatic evolutions were twice as frequent in group 2 and deaths by local regional evolution twice as frequent in group 1 (2%). Treatment of group 1 was recommended because of the good survival at 5 years, 48%, and the good voice conservation, 100% (despite non-satisfactory resections and N+ RC+). At present, some of these conservative surgeries would be replaced by radiotherapy alone in case of complete response after initial chemotherapy, which would be an advantage for cases with an indication for radical surgery, but not necessarily so for cases with an indication for partial surgery, taking into account the good results that we have achieved with an association of partial surgery and radiotherapy.
Baillet
F
F
Centre des tumeurs, groupe hospitalier Pitié-Salpêtrière, Paris, France.
Simon
J M
JM
Rozec
C
C
Qi
S S
SS
Ronchin
P
P
Diana
C
C
Housset
M
M
D000206:Actuarial Analysis; D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000145:classification / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D007825:Laryngectomy / Q000379:methods; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection; D009367:Neoplasm Staging; D010611:Pharyngectomy / Q000379:methods; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D015996:Survival Rate
Intérêt de l'association chirurgie partielle-radiothérapie postopératoire pour le traitement des tumeurs de l'hypopharynx. Etude à propos de 142 T1-T2 traités par chirurgie partielle, chirurgie radicale ou radiothérapie exclusive.