title: Definitive Chemoradiotherapy Versus Surgery Followed by Adjuvant Radiotherapy in Resectable Stage III/IV Hypopharyngeal Cancer.
abstract: OBJECTIVE
  The purpose of this study is to compare the treatment outcomes for locally advanced resectable hypopharyngeal cancer between organ-preserving chemoradiotherapy (CRT) and surgery followed by radiotherapy (SRT).
  
  
  METHODS
  We reviewed 91 patients with stage III/IV hypopharyngeal squamous cell carcinoma treated with radiotherapy (RT). In the CRT group (n=34), 18 patients were treated with concurrent CRT and 16 patients with induction chemotherapy plus concurrent CRT. In the SRT group (n=57), six patients were treated with total laryngopharyngectomy, 34 patients with total laryngectomy (TL) and partial pharyngectomy (PP), and 17 patients with PP, which were followed by adjuvant radiotherapy (n=41) or CRT (n=16). The median RT dose was 70 Gy for CRT and 59.4 Gy for SRT.
  
  
  RESULTS
  Five-year local control (84.1% vs. 90.9%), and disease-free survival (DFS, 51.0% vs. 52.7%) and overall survival (OS, 58.6% vs. 56.6%) showed no significant difference between the CRT and SRT groups. The functional larynx-preservation rate was higher in the CRT group (88.2% vs. 29.8%). Treatment-related toxicity, requiring surgical intervention, occurred more frequently in the SRT group (37% vs. 12%). In the SRT group, TL resulted in a significantly higher DFS than larynx-sparing surgery (63.9% vs. 26.5%, p=0.027). Treatment outcome of the SRT group improved when only patients with TL were considered (n=40); however, 5-year OS (67.1% vs. 58.6%, p=0.830) and DFS (63.9% vs. 51.0%, p=0.490) did not improve significantly when compared to the CRT group.
  
  
  CONCLUSIONS
  Organ preserving CRT provided a treatment outcome that is comparable to SRT for locally advanced hypopharyngeal cancer, while offering an opportunity for functional larynx-preservation and reduced treatment-related toxicity.
authors.affiliation: Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Jun Won
authors.initials: JW
authors.lastname: Kim
authors.affiliation: Department of Radiation Oncology, Yonsei Cancer Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Mi Sun
authors.initials: MS
authors.lastname: Kim
authors.affiliation: Department of Otorhinolaryngology, Yonsei Cancer Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Se-Heon
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Department of Medical Oncology, Yonsei Cancer Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Joo Hang
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Department of Radiation Oncology, Yonsei Cancer Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Chang Geol
authors.initials: CG
authors.lastname: Lee
authors.affiliation: Department of Radiation Oncology, Yonsei Cancer Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Gwi Eon
authors.initials: GE
authors.lastname: Kim
authors.affiliation: Department of Radiation Oncology, Yonsei Cancer Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Ki Chang
authors.initials: KC
authors.lastname: Keum
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059248:Chemoradiotherapy / Q000009:adverse effects; D005260:Female; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000473:pathology / Q000601:surgery* / Q000628:therapy*; D007825:Laryngectomy; D007830:Larynx / Q000502:physiology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010611:Pharyngectomy / Q000009:adverse effects; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Adjuvant radiotherapy; Chemoradiotherapy; Hypopharyngeal neoplasms; Organ preservation; Treatment outcome