Analysis of the results of multidisciplinary treatments based on the tumor response to 40Gy chemoradiotherapy for hypopharyngeal carcinomas

Abstract

The treatment results of 49 patients with hypopharyngeal carcinomas treated at our institute between 2000 and 2007 were analyzed. In general, concurrent chemoradiotherapy (CRT) with low doses of anti-cancer agents (low-dose CRT) was used as an initial treatment. Local tumor responses were evaluated after CRT with radiation doses of 40Gy. Patients whose local tumors showed a complete or almost complete response (CR) to 40Gy CRT subsequently received curative CRT with radiation doses of 70Gy. Patients whose local tumors did not show CR to 40Gy CRT underwent radical surgery for local tumors and cervical lymph nodes. The CR rates of local tumors to 40Gy CRT were 83% for 12 patients with T1 or 2N0 diseases, 67% for 15 patients with T1 or 2N1-3 diseases, and 32% for 22 patients with T3 or 4N0-3 diseases. The disease-specific 5-year survival rates and the larynx preservation rates were 81% and 67% for T1 or 2N0, 47% and 67% for T1 or 2N1-3, and 49% and 27% for T3 or 4N0-3, respectively. It is suggested that larynxes could be preserved in about 70% of the patients with T1 or T2 diseases by low-dose CRT whereas radical surgery or CRT with high doses of anti-cancer agents (high-dose CRT) might be necessary for about 30% of the patients with T1 or T2 diseases whose local tumors show poor response to CRT. High-dose CRT and/or neck dissection should be conducted as appropriate for patients with T1 or 2N1-3 diseases to improve their survival rates. Radical surgery is necessary for most of patients with T3 or 4N0-3 diseases. However, larynxes could be preserved by low-dose CRT for about 30% of patients with T3 or T4 diseases whose local tumors show high sensitivities to CRT. Moreover, intensive CRT such as high-dose CRT or CRT with selective intra-arterial infusion might improve larynx preservation rates for patients with T3 or T4 diseases. Multidisciplinary treatment based on the tumor response to 40Gy CRT is a treatment modality based on tumor sensitivity to CRT and is a useful method for the survival and larynx preservation of patients with hypopharyngeal carcinomas.