Utility of algorithm-based chemoradioselection in the treatment for advanced hypopharyngeal carcinoma

Head Neck. 2015 Sep;37(9):1290-6. doi: 10.1002/hed.23759. Epub 2014 Jul 24.

Abstract

Background: Current organ-preserving dose-intensified modalities have apparently reached the limit of human tolerance. To optimize the therapeutic ratio, we evaluated the utility of a chemoradioselection strategy for the treatment of advanced hypopharyngeal carcinoma.

Methods: Fifty-five patients with advanced hypopharyngeal carcinoma were enrolled in our algorithm-based protocol. After 40 Gy of concurrent chemoradiation therapy (CCRT), patients who were chemoradioselected (chemoradioselected group, complete response [CR] at the primary site) received further 30 Gy of CCRT up to 70 Gy, whereas the remaining nonchemoradioselected (nonchemoradioselected group) patients underwent radical surgery.

Results: Based on this algorithm, 27 patients were chemoradioselected and 28 nonchemoradioselected. The 5-year cumulative disease-specific and overall survival (OS) rates were 76% and 65%, respectively. The chemoradioselected group demonstrated favorable laryngoesophageal dysfunction-free survival (77% at 3 years).

Conclusion: Although preliminary, our results indicate that algorithm-based chemoradioselection may provide a novel platform for improving the treatment of advanced hypopharyngeal carcinoma by providing the complete advantages of CCRT and radical surgical resection.

Keywords: chemoradioselection; laryngoesophageal dysfunction; therapeutic ratio; toxicity.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Algorithms*
  • Antineoplastic Combined Chemotherapy Protocols / adverse effects
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Carcinoma, Squamous Cell / mortality
  • Carcinoma, Squamous Cell / pathology
  • Carcinoma, Squamous Cell / therapy*
  • Chemoradiotherapy / methods*
  • Chemoradiotherapy / mortality
  • Cohort Studies
  • Disease-Free Survival
  • Dose Fractionation, Radiation
  • Female
  • Head and Neck Neoplasms / mortality
  • Head and Neck Neoplasms / pathology
  • Head and Neck Neoplasms / therapy*
  • Humans
  • Hypopharyngeal Neoplasms / mortality
  • Hypopharyngeal Neoplasms / pathology
  • Hypopharyngeal Neoplasms / therapy*
  • Male
  • Middle Aged
  • Neoplasm Invasiveness / pathology
  • Neoplasm Recurrence, Local / mortality
  • Neoplasm Recurrence, Local / physiopathology
  • Neoplasm Staging
  • Patient Selection*
  • Retrospective Studies
  • Risk Assessment
  • Squamous Cell Carcinoma of Head and Neck
  • Survival Analysis