title: Retrospective analysis of the clinical efficacy of definitive chemoradiotherapy for patients with hypopharyngeal cancer.
abstract: OBJECTIVE
  A retrospective analysis was performed to evaluate the clinical efficacy of definitive chemoradiotherapy including intensity-modulated radiotherapy for patients with hypopharyngeal cancer.
  
  
  METHODS
  Previously untreated 204 patients with hypopharyngeal cancer were treated with definitive chemoradiotherapy. Of note, 66-70 Gy was delivered to the primary and involved nodes and 36-54 Gy was delivered to the prophylactic lymph node using standard fractionated radiotherapy. One hundred and forty-six patients received induction chemotherapy as a larynx preservation strategy, followed by definitive radiotherapy with or without concurrent chemotherapy. Intensity-modulated radiotherapy was also performed after 2006.
  
  
  RESULTS
  The median follow-up time of this cohort was 43.4 months (range; 6.9-151.0). The 3-year overall survival, progression-free survival and larynx preservation survival rates were 78.8% (95% confidence interval; 73.0-85.0), 58.4% (95% confidence interval; 51.8-65.9) and 67.5% (95% confidence interval; 61.0-74.7), respectively. Multivariate analyses identified the following significant prognostic factors: an advanced age, the T category and N category for overall survival, the T category and N category for progression-free survival and the T category for larynx preservation survival. Acute toxicities of Grade 3 or higher were observed in 47 patients (23.0%). Two patients (1.0%) had Grade 4 pharyngeal edema. Suspicious treatment-related death due to lethal pharyngeal hemorrhage occurred in 1 (0.4%) patient. The rates of Grade 2 xerostomia in patients treated with intensity-modulated radiotherapy were 28.1, 17.4 and 9.5% at 6 months, 1 and 2 years after the completion of radiotherapy, respectively.
  
  
  CONCLUSIONS
  The efficacy and safety of definitive chemoradiotherapy are considered feasible with sufficient laryngeal preservation.
authors.affiliation: Department of Radiation Oncology, Aichi Cancer Center Hospital, Nagoya City.
authors.forename: Keiichi
authors.initials: K
authors.lastname: Takehana
authors.affiliation: Department of Radiation Oncology, Aichi Cancer Center Hospital, Nagoya City 109103@aichi-cc.jp.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kodaira
authors.affiliation: Department of Radiation Oncology, Aichi Cancer Center Hospital, Nagoya City.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Tachibana
authors.affiliation: Department of Radiation Oncology, Aichi Cancer Center Hospital, Nagoya City.
authors.forename: Kana
authors.initials: K
authors.lastname: Kimura
authors.affiliation: Department of Radiation Oncology, Aichi Cancer Center Hospital, Nagoya City.
authors.forename: Arisa
authors.initials: A
authors.lastname: Shimizu
authors.affiliation: Department of Radiation Oncology, Aichi Cancer Center Hospital, Nagoya City.
authors.forename: Chiyoko
authors.initials: C
authors.lastname: Makita
authors.affiliation: Department of Radiation Oncology, Aichi Cancer Center Hospital, Nagoya City.
authors.forename: Natsuo
authors.initials: N
authors.lastname: Tomita
authors.affiliation: Department of Head and Neck surgery, Aichi Cancer Center Hospital, Nagoya City, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Nishikawa
authors.affiliation: Department of Head and Neck surgery, Aichi Cancer Center Hospital, Nagoya City, Japan.
authors.forename: Hidenori
authors.initials: H
authors.lastname: Suzuki
authors.affiliation: Department of Head and Neck surgery, Aichi Cancer Center Hospital, Nagoya City, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Hirakawa
authors.affiliation: Department of Head and Neck surgery, Aichi Cancer Center Hospital, Nagoya City, Japan.
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Hanai
authors.affiliation: Department of Head and Neck surgery, Aichi Cancer Center Hospital, Nagoya City, Japan.
authors.forename: Yasuhisa
authors.initials: Y
authors.lastname: Hasegawa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000628:therapy*; D059248:Chemoradiotherapy; D018572:Disease-Free Survival; D005260:Female; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000628:therapy*; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000473:pathology / Q000628:therapy*; D060828:Induction Chemotherapy; D008198:Lymph Nodes / Q000473:pathology / Q000528:radiation effects; D008297:Male; D008875:Middle Aged; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects; D012189:Retrospective Studies; D000077195:Squamous Cell Carcinoma of Head and Neck; D015996:Survival Rate; D016896:Treatment Outcome; D014987:Xerostomia / Q000209:etiology
keywords: H & N-RadOncol; head and neck; radiation oncology; radiation therapy
references.citation: J Clin Oncol. 2013 Mar 1;31(7):845-52
references.pmid: 23182993
references.citation: Ann Oncol. 2012 Oct;23(10):2708-14
references.pmid: 22492697
references.citation: J Natl Cancer Inst. 2009 Feb 4;101(3):142-52
references.pmid: 19176454
references.citation: J Clin Oncol. 2013 Mar 1;31(7):833-5
references.pmid: 23341522
references.citation: N Engl J Med. 2007 Oct 25;357(17):1705-15
references.pmid: 17960013
references.citation: Radiother Oncol. 2009 Jul;92(1):4-14
references.pmid: 19446902
references.citation: Int J Radiat Oncol Biol Phys. 2000 Jan 1;46(1):195-205
references.pmid: 10656393
references.citation: Arch Otolaryngol Head Neck Surg. 2003 Jan;129(1):44-9
references.pmid: 12525193
references.citation: N Engl J Med. 2003 Nov 27;349(22):2091-8
references.pmid: 14645636
references.citation: N Engl J Med. 1991 Jun 13;324(24):1685-90
references.pmid: 2034244
references.citation: Int J Radiat Oncol Biol Phys. 1995 Mar 30;31(5):1341-6
references.pmid: 7713792
references.citation: J Clin Oncol. 2006 Jun 10;24(17):2636-43
references.pmid: 16763277
references.citation: N Engl J Med. 2007 Oct 25;357(17):1695-704
references.pmid: 17960012
references.citation: J Radiat Res. 2012 Nov 1;53(6):906-15
references.pmid: 22843377
references.citation: Radiother Oncol. 2014 Jan;110(1):9-15
references.pmid: 24332675