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A comparative study between the effect of radio-chemotherapy versus surgery with or without postoperative radiotherapy on advanced stage hypopharyngeal carcinoma (stage III and IV); review of literature


Journal of Otolaryngology-ENT Research
Ossama Hamid,1 Samia Ahmed,1 Mohamed Fathi El Rashedy,2 Amr Ossama Abdelhamid3

Abstract

Background: The improvement of clinical outcomes for patients with hypopharyngeal squamous cell carcinoma (SCC) has been particularly challenging for head and neck surgeons and oncologists. Chemoradiotherapy (CRT) has been used for patients with advanced hypopharyngeal cancer with the aim of preserving the larynx. The reasons for the un-favorable prognosis of hypopharyngeal cancers are the strong tendency for extensive sub-mucosal spread, the early occurrence of regional lymphatic involvement, and the relatively high rate of distant spread.

Aim: This study was conducted to collect the recent data about the different modalities of management of advanced stage hypopharyngeal carcinoma (stage III and IV), and systematically review the outcomes of each modality either alone or in combination and compare their efficacy.

Methods: Search of published medical articles from 2001 till 2018, on management of advanced hypopharyngeal carcinoma either by radio- chemotherapy versus surgery alone or in combination with postoperative radiotherapy in Medline, Embase, Elsvier. Twenty-one articles fulfilled the inclusion criteria and were included in our study.

Results: Overall survival, regarding surgery group was reported in 8 studies with total 1657 patients achieved overall survival (46.23%); While in CRT group, it was reported in 18 studies with total 2995 patients achieved overall survival (43%). Comparative study between the 2 groups revealed decrease in overall survival rate; in CRT group; compared to surgery group; with significant statistical difference (p=0.019).

Conclusion: The treatment approach had a significant impact on overall survival and recurrence rate, as described in other series. Given the equivalence between these two strategies suggested in several series, definitive CRT seems to be an advantageous option as it improves organ preservation and, consequently, the functional outcome. Recent developments in chemo-radiation treatment techniques could hopefully increase tumor management and survival rates.

Keywords

Advanced hypopharyngeal carcinoma management, Treatment of hypopharyngeal carcinoma stage III and IV, Radio-chemotherapy in advanced hypopharyngeal carcinoma management, Surgery in advanced hypopharyngeal carcinoma management, Radio-chemotherapy versus surgery in hypopharyngeal carcinoma, Pyriform sinus, post cricoid, Posterior wall carcinoma management

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