title: Primary Surgery vs Chemoradiation Treatment of Advanced-Stage Hypopharyngeal Squamous Cell Carcinoma.
abstract: OBJECTIVE
  There is no consensus whether primary surgery followed by either adjuvant radiotherapy (RT) or adjuvant chemoradiation (CRT) or definitive CRT should be the standard treatment approach to advanced-stage hypopharyngeal squamous cell carcinoma (HP SCC).
  
  
  OBJECTIVE
  To determine survival outcomes for patients with advanced-stage HP SCC treated at a single institution with either primary surgery plus RT or CRT or definitive CRT.
  We conducted a retrospective analysis of prospectively collected medical records in an institutional database for patients with HP SCC newly diagnosed between January 1999 and April 2013. Overall survival (OS) and recurrence-free survival (RFS) were calculated and compared between treatment groups using the Kaplan-Meier method, with multivariate Cox regression analysis used to control for demographic and clinicopathologic features.
  
  
  RESULTS
  We identified 166 consecutively treated patients, 90 of whom did not meet study criteria. Of the 76 included patients, 48 (63%) had undergone definitive CRT, and 28 (37%) had undergone primary surgery with adjuvant RT or CRT. The groups were well balanced by age, smoking history, and alcohol use. Five-year OS and RFS for patients treated surgically were 66.3% and 53.6%, respectively; for patients treated with definitive CRT, OS and RFS were 41.3% and 34.5%, respectively. Multivariate Cox regression analysis showed that surgical management was associated with clinically improved OS (hazard ratio [HR], 4.78; 95% CI, 0.91-25.03; P = .06) and RFS (HR, 2.97; 95% CI, 0.76-11.53; P = .12), although the difference was not statistically significant.
  
  
  CONCLUSIONS
  Patients with advanced-stage HP SCC treated surgically with adjuvant RT or CRT showed a trend toward clinically improved OS and RFS compared with patients treated with definitive CRT. However, the difference was not statistically significant, and further investigation with larger controlled trials using modern approaches should be undertaken to optimize the initial management of advanced-stage HP SCC.
authors.affiliation: Department of Otolaryngology, University of California, Davis, Sacramento.
authors.forename: Brianna N
authors.initials: BN
authors.lastname: Harris
authors.affiliation: Department of Otolaryngology, University of California, Davis, Sacramento.
authors.forename: Vincent L
authors.initials: VL
authors.lastname: Biron
authors.affiliation: Department of Otolaryngology, University of California, Davis, Sacramento.
authors.forename: Paul
authors.initials: P
authors.lastname: Donald
authors.affiliation: Department of Otolaryngology, University of California, Davis, Sacramento.
authors.forename: D Gregory
authors.initials: DG
authors.lastname: Farwell
authors.affiliation: Department of Otolaryngology, University of California, Davis, Sacramento.
authors.forename: Quang C
authors.initials: QC
authors.lastname: Luu
authors.affiliation: Department of Otolaryngology, University of California, Davis, Sacramento.
authors.forename: Arnaud F
authors.initials: AF
authors.lastname: Bewley
authors.affiliation: Department of Radiation Oncology, University of California, Los Angeles, Los Angeles.
authors.forename: Allen M
authors.initials: AM
authors.lastname: Chen
authors.affiliation: Department of Radiation Oncology, University of California, Davis, Sacramento.
authors.forename: Megan E
authors.initials: ME
authors.lastname: Daly
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality* / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D059248:Chemoradiotherapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection; D010611:Pharyngectomy; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome