[Surgical treatment on primary lesion of advanced pyriform sinus cancer].
OBJECTIVE
To evaluate the efficacy of surgical treatment and combined therapy of advanced pyriform sinus cancer.


METHODS
Totally 153 patients with locally advanced pyriform sinus cancer who received surgical treatment in our department from January 1974 to December 1999 were divided into three groups: preoperative radiotherapy with 45.5 Gy followed by surgery (R + S group, n = 125), including 32 laryngeal function sparing surgery; surgery alone (Sa group, n = 13); and surgery followed by postoperative radiotherapy with 56.3 Gy (S + R group, n = 15). Twenty-one patients received piriformectomy, 10 piriformectomy plus partial laryngectomy, and 1 total hypopharyngectomy and pharyngoesophagectomy with laryngeal spared and colon reconstruction. Among 121 patients who did not receive laryngeal function sparing surgery, 13 received near total laryngectomy, 55 total laryngectomy, and 53 total laryngectomy plus total hypopharyngectomy and pharyngoesophagectomy with reconstruction. Eight-six patients received radical neck dissection, 14 modified neck dissection, and 6 lateral neck dissection. Survival rate and laryngeal function sparing rate were analyzed using Kaplan-Meier and COX model respectively.


RESULTS
The overall 5-year survival rates were 46.51% in R + S group, 18.33% in Sa group, and 44.44% in S + R group. Laryngeal sparing rate were 13.61% (R + S group), 0 (Sa group), and 0 (S + R group), respectively. R + S group, S + R group and combined therapy group (R + S group plus S + R group) showed superiority over Sa group in teams of 5-year survival rate (P = 0.0364, P = 0.0462, P = 0.000). R + S group showed superiority over S + R group and Sa group in teams of laryngeal sparing rate. Therapy mode was the most important factor that contributed to 5-year survival rate and laryngeal sparing. No significant differences were found in complication rate among the groups.


CONCLUSIONS
Preoperative radiotherapy conduces to preserve laryngeal function of patients with locally advanced pyriform sinus carcinoma.
Wang
Xiao-Lei
XL
Department of Head and Neck Surgery, Cancer Hospital, CAMS and PUMC, Beijing 100021, China. wangxlcams@263.net
Xu
Zhen-Gang
ZG
Tang
Ping-Zhang
PZ
D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D005260:Female; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D007825:Laryngectomy / Q000379:methods; D007830:Larynx / Q000503:physiopathology*; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D010611:Pharyngectomy / Q000379:methods; D016016:Proportional Hazards Models; D018714:Radiotherapy, Adjuvant; D015996:Survival Rate