title: Non-surgical multimodality treatment for locally advanced (T3-4) hypopharyngeal cancer: the impact of pre-treatment hemoglobin level.
abstract: OBJECTIVE
  To examine the role of a non-surgical multimodality approach in patients with locally advanced pharyngeal cancer who refuse surgery or are inoperable.
  
  
  METHODS
  Between 2006 and 2011, 19 patients with T3-4 hypopharyngeal cancer received multimodality non-surgical treatment. Out of these patients, nine refused surgery, and nine were inoperable. Their age range was 52-86 years (median, 68 years). Ten patients had T3, and 9 had T4 (two with stage III and 17 with stage IV). Neoadjuvant induction chemotherapy was administered in 11 patients. Hyperthermia was performed in patients with advanced lymph node metastasis. Radiotherapy was administered at a median of 61 Gy (60-61.2 Gy) in conventional fractionation. Concurrent chemotherapy was administered to all patients: through intra-arterial infusion in seven, systemic infusion in 10, or both in two. Median follow-up time was 27 months (range: 6-50 months).
  
  
  RESULTS
  At the primary site, 16 patients (84%) achieved a complete response and three (16%) with partial response, resulting in a 100% response rate. Locoregional failure appeared in the form of six local and two regional lesions, and in one case in both types of lesions. Three-year local control, disease-free and overall survival rates, and laryngeal preservation rates were 65%, 48%, 50%, and 83%, respectively. Anemia was the only strong predisposing factor, not only for reduced local control but also for reduced progression-free and overall survival rates. Acute toxicities of grade 3 or more included hematological toxicity in four patients, gastrointestinal toxicity in two, and pneumonia in 6. Late adverse reaction of dysphagia grade 3 was found in one patient, whereas dysphagia grade 4 was not observed.
  
  
  CONCLUSIONS
  Multimodality non-surgical treatment could be a useful option for patients who refuse surgery and have inoperable disease with substantial curative potential without severe adverse reactions.
authors: Department of Radiology, Kyoto Prefectural University of Medicine, 465 Kajiicho Kawaramachi Hirokoji, Kamigyo-ku, Kyoto, Kyoto 602-8566 Japan. hideya10@hotmail.com.
authors: Gen
authors: G
authors: Suzuki
authors: Etsuyo
authors: E
authors: Ogo
authors: Toshi
authors: T
authors: Abe
authors: Naofumi
authors: N
authors: Hayabuchi
authors: Hirohito
authors: H
authors: Umeno
authors: Tadashi
authors: T
authors: Nakashima
authors: Hideya
authors: H
authors: Yamazaki
authors: Satoaki
authors: S
authors: Nakamura
authors: Ken
authors: K
authors: Yoshida
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D059248:Chemoradiotherapy; D005260:Female; D006454:Hemoglobins / Q000032:analysis*; D006801:Humans; D006979:Hyperthermia, Induced; D007012:Hypopharyngeal Neoplasms / Q000628:therapy*; D008297:Male; D008875:Middle Aged
chemical_list: D006454:Hemoglobins
keywords: Hypopharyngeal cancer; chemoradiotherapy; hyperthermia; intra-arterial infusion chemotherapy; larynx preservation