Concurrent versus sequential chemoradiotherapy for locally advanced resectable hypopharyngeal carcinoma
Purpose: Both concurrent and sequential chemoradiotherapy have been reported to be good alternatives to total laryngectomy in patients with locally advanced hypopharyngeal cancer. We retrospectively reviewed the results of concurrent vs sequential chemoradiotherapy in two institutions for treatment of locally advanced resectable hypopharyngeal cancer in an effort to optimize future laryngeal preservation treatment.
Methods: Seventy-two patients with locally advanced resectable hypopharyngeal squamous cell carcinoma were reviewed. Arm I included 38 patients treated by concurrent chemoradiotherapy (CCRT) while arm II included 34 patients received sequential chemoradiotherapy. In arm I patients received CCRT of cisplatin 100 mg/m2 d1, 22 of radiotherapy at dose of 65 Gy/1.8 - 2 Gy/f, 5 days/week. Patients in arm II received 2 cycles of induction chemotherapy consisted of 5 - fluorouracil 1000 mg/m2 on d1 - 4 on 24 h continuous infusion plus cisplatin 100 mg/m2 d1; cycle was repeated every 3 weeks followed by radiotherapy as in arm I.
Results: Demographic data were balanced in both arms. The median age was 50 and 48 years in arm I and II respectively. There was male predominance in both arms. Most of the patients were of ECOGPS of 1and of stage III. No recorded deaths due to treatment toxicities .But as expected CCRT was associated with higher toxicity. In order of frequency; mucositis, anemia were higher in arm I. Significantly higher response rate was observed in arm I (p = 0.04).Three-year survival rates were 74% in arm I and 67.9% in arm II with no significant difference (p = 0.074) but 3 - year PFS rate was significantly higher in arm I (52.6% vs. 47%) (p = 0.03). Laryngeal - preservation rate was 78% in arm I vs. 56% in arm II with significant difference.
Conclusion: There was higher benefit of concurrent chemo-radiotherapy over sequential chemoradiotherapy. However, larger number of patients and prospective randomized trials are needed to confirm our findings. New strategies that improve organ preservation with less toxicity are needed.
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