Abstract
When head and neck surgeons encounter patients with advanced laryngeal and hypopharyngeal cancer （T3 or T4a）, chemoradiation therapy （CRT） is sometimes carried out besides radical surgery including total laryngectomy. Treatment choices depend on the patient’s desire to preserve the larynx, complications of the patient and social background. In this study, we analyzed the choice of treatment for patients with advanced laryngeal cancer （LC） and hypopharyngeal cancer （HPC）.
From July 2011 to April 2016, there were 76 patients who received radical therapy in our hospital. There were 22 patients with T3 LC, 19 patients with T3 and 35 patients with T4a HPC. Patients with T4a LC were omitted because all of them underwent total laryngectomy. There were 74 squamous cell carcinomas （SCC） except for 1 laryngeal and 1 hypopharyngeal basaloid SCC. There were 72 male patients, and 2 female patients with LC and 2 female patients with HPC. CRT was carried out in 5 patients with T3 LC, 12 with T3 HPC and 14 with T4a HPC as an initial treatment.
According to the patients’ residence, patients were classified into three groups: Iwate prefecture inland （II）, Iwate prefecture coast （IC） and Aomori prefecture around Hachinohe （AH）. Groups II, IC, and AH had 40, 22, and 14 patients, respectively. The Brinkman index and Sake index were 1,058 and 170 in II, 1,171 and 168 in IC, and 875 and 130 in AH, respectively. Although there were 21 （28％） patients with diabetes mellitus in all groups, 9 （41％） of those were in IC.
Forty-five patients （59％） underwent radical surgery as an initial treatment. In II, IC and AH, 55％, 64％, and 64％ of the patients underwent surgery, respectively. Among 13 patients who were living alone, 5 patients （38％） underwent surgery and 8 （62％） underwent CRT. On the contrary, among 63 patients who were living with their family, 69％ underwent surgery and 31％ underwent CRT. Patients living alone significantly tended to choose CRT to preserve the larynx and avoid radical surgery. When overall survival rates were calculated, there were no significant differences among the three groups of patients, between patients who underwent surgery and CRT as an initial treatment. However, there was a significant difference between patients living alone and patients living with their family.
These results suggest that there are differences depending on the patients’ residence in terms of lifestyle habits and preference history of patients with advanced LC and HPC. Our study revealed that the lifestyle of the patients such as living alone or living with family influenced the decision on treatment strategy and also their survival rates. Treatment in consideration of the post-treatment living environment of patients including regional support is needed when treating patients with advanced LC and HPC.
