title: Utility of algorithm-based chemoradioselection in the treatment for advanced hypopharyngeal carcinoma.
abstract: BACKGROUND
  Current organ-preserving dose-intensified modalities have apparently reached the limit of human tolerance. To optimize the therapeutic ratio, we evaluated the utility of a chemoradioselection strategy for the treatment of advanced hypopharyngeal carcinoma.
  
  
  METHODS
  Fifty-five patients with advanced hypopharyngeal carcinoma were enrolled in our algorithm-based protocol. After 40 Gy of concurrent chemoradiation therapy (CCRT), patients who were chemoradioselected (chemoradioselected group, complete response [CR] at the primary site) received further 30 Gy of CCRT up to 70 Gy, whereas the remaining nonchemoradioselected (nonchemoradioselected group) patients underwent radical surgery.
  
  
  RESULTS
  Based on this algorithm, 27 patients were chemoradioselected and 28 nonchemoradioselected. The 5-year cumulative disease-specific and overall survival (OS) rates were 76% and 65%, respectively. The chemoradioselected group demonstrated favorable laryngoesophageal dysfunction-free survival (77% at 3 years).
  
  
  CONCLUSIONS
  Although preliminary, our results indicate that algorithm-based chemoradioselection may provide a novel platform for improving the treatment of advanced hypopharyngeal carcinoma by providing the complete advantages of CCRT and radical surgical resection.
authors.affiliation: Department of Head and Neck Surgery, National Kyushu Cancer Center, Minamiku, Fukuoka, Japan.
authors.forename: Muneyuki
authors.initials: M
authors.lastname: Masuda
authors.affiliation: Department of Head and Neck Surgery, National Kyushu Cancer Center, Minamiku, Fukuoka, Japan.
authors.forename: Mioko
authors.initials: M
authors.lastname: Matsuo
authors.affiliation: Department of Head and Neck Surgery, National Kyushu Cancer Center, Minamiku, Fukuoka, Japan.
authors.forename: Takeichiro
authors.initials: T
authors.lastname: Aso
authors.affiliation: Department of Head and Neck Surgery, National Kyushu Cancer Center, Minamiku, Fukuoka, Japan.
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Kiyohara
authors.affiliation: Department of Head and Neck Surgery, National Kyushu Cancer Center, Minamiku, Fukuoka, Japan.
authors.forename: Fumihide
authors.initials: F
authors.lastname: Rikimaru
authors.affiliation: Department of Radiology, National Kyushu Cancer Center, Minamiku, Fukuoka, Japan.
authors.forename: Naonobu
authors.initials: N
authors.lastname: Kunitake
authors.affiliation: Department of Head and Neck Surgery, National Kyushu Cancer Center, Minamiku, Fukuoka, Japan.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Higaki
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D059248:Chemoradiotherapy / Q000379:methods* / Q000401:mortality; D015331:Cohort Studies; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D005260:Female; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000503:physiopathology; D009367:Neoplasm Staging; D018579:Patient Selection; D012189:Retrospective Studies; D018570:Risk Assessment; D000077195:Squamous Cell Carcinoma of Head and Neck; D016019:Survival Analysis
keywords: chemoradioselection; laryngoesophageal dysfunction; therapeutic ratio; toxicity