Skip to main content
Erschienen in: Annals of Surgical Oncology 6/2016

19.01.2016 | Head and Neck Oncology

Comparison of Oncological and Functional Outcomes between Initial Surgical versus Non-Surgical Treatments for Hypopharyngeal Cancer

verfasst von: Jeon Yeob Jang, MD, PhD, Eun-Hye Kim, RN, Jungkyu Cho, MD, Jae-Hoon Jung, MD, Dongryul Oh, MD, PhD, Yong Chan Ahn, MD, PhD, Young-Ik Son, MD, PhD, Han-Sin Jeong, MD, PhD

Erschienen in: Annals of Surgical Oncology | Ausgabe 6/2016

Einloggen, um Zugang zu erhalten

Abstract

Background

Whether to administer surgical or non-surgical treatments (radiation or chemoradiation therapies) for the initial management of hypopharyngeal cancer (HPC) remains a topic of debate. Herein, we explored the differences between the two approaches in terms of oncological and functional outcomes in 332 HPC patients.

Methods

The primary endpoint was survival probability; secondary outcomes included post-treatment speech and swallowing functions and necessity of additional surgical procedures for salvage or complication management. Cox proportional hazard models using clinical variables were constructed to identify significant factors.

Results

The 2- and 5-year overall survival (OS) rates in all patients were 64.9 and 40.9 %, respectively. In early-stage HPC patients (N = 52), initial surgery ± radiation therapy (RT) or RT alone yielded similar oncological (60 % 5-year OS rate) and functional outcomes. As for resectable advanced-stage cancers (N = 177), initial surgery ± RT/chemoradiation therapy (SRC) and initial concurrent chemoradiation therapy (iCRT) resulted in similar 45–50 % 5-year OS rates. After sacrificing the larynx, 60 % of SRC patients recovered their speaking ability through voice prosthesis, which was less than the rate for iCRT patients (76.6 %; p = 0.008). Additional surgical interventions were required in 28.0–28.6 % of patients in both groups; however, 60 % of patients undergoing additional surgery in the iCRT group received multiple (two or more) surgical interventions (p = 0.029).

Conclusions

Our data revealed similar oncological outcomes, but different functional outcomes, between initial surgical and non-surgical treatments for HPC. In resectable advanced-stage HPC, iCRT resulted in better verbal communication outcomes than SRC; however, more iCRT patients required multiple surgical interventions during clinical courses.
Anhänge
Nur mit Berechtigung zugänglich
Literatur
1.
Zurück zum Zitat Cooper JS, Porter K, Mallin K, et al. National Cancer Database report on cancer of the head and neck: 10-year update. Head Neck. 2009;31:748–58.CrossRefPubMed Cooper JS, Porter K, Mallin K, et al. National Cancer Database report on cancer of the head and neck: 10-year update. Head Neck. 2009;31:748–58.CrossRefPubMed
2.
Zurück zum Zitat Qian W, Zhu G, Wang Y, et al. Multi-modality management for loco-regionally advanced laryngeal and hypopharyngeal cancer: balancing the benefit of efficacy and functional preservation. Med Oncol. 2014;31:178.CrossRefPubMed Qian W, Zhu G, Wang Y, et al. Multi-modality management for loco-regionally advanced laryngeal and hypopharyngeal cancer: balancing the benefit of efficacy and functional preservation. Med Oncol. 2014;31:178.CrossRefPubMed
3.
Zurück zum Zitat Vandersteen C, Benezery K, Chamorey E, et al. Contemporary therapeutic management of locally advanced hypopharyngeal cancer: oncologic and functional outcomes: a report on 100 cases. Acta Otolaryngol. 2015;135:193–200.CrossRefPubMed Vandersteen C, Benezery K, Chamorey E, et al. Contemporary therapeutic management of locally advanced hypopharyngeal cancer: oncologic and functional outcomes: a report on 100 cases. Acta Otolaryngol. 2015;135:193–200.CrossRefPubMed
4.
Zurück zum Zitat Takes RP, Strojan P, Silver CE, et al. Current trends in initial management of hypopharyngeal cancer: the declining use of open surgery. Head Neck. 2012;34:270–81.CrossRefPubMed Takes RP, Strojan P, Silver CE, et al. Current trends in initial management of hypopharyngeal cancer: the declining use of open surgery. Head Neck. 2012;34:270–81.CrossRefPubMed
5.
Zurück zum Zitat Kuo P, Chen MM, Decker RH, Yarbrough WG, Judson BL. Hypopharyngeal cancer incidence, treatment, and survival: temporal trends in the United States. Laryngoscope. 2014;124:2064–9.CrossRefPubMed Kuo P, Chen MM, Decker RH, Yarbrough WG, Judson BL. Hypopharyngeal cancer incidence, treatment, and survival: temporal trends in the United States. Laryngoscope. 2014;124:2064–9.CrossRefPubMed
6.
Zurück zum Zitat Ganly I, Patel S, Matsuo J, et al. Postoperative complications of salvage total laryngectomy. Cancer. 2005;103:2073–81.CrossRefPubMed Ganly I, Patel S, Matsuo J, et al. Postoperative complications of salvage total laryngectomy. Cancer. 2005;103:2073–81.CrossRefPubMed
7.
Zurück zum Zitat Klozar J, Cada Z, Koslabova E. Complications of total laryngectomy in the era of chemoradiation. Eur Arch Otorhinolaryngol. 2012;269:289–93.CrossRefPubMed Klozar J, Cada Z, Koslabova E. Complications of total laryngectomy in the era of chemoradiation. Eur Arch Otorhinolaryngol. 2012;269:289–93.CrossRefPubMed
8.
Zurück zum Zitat Chen LY, Huang CC, Tsou YA, Bau DT, Tsai MH. Prognostic factor of severe complications in patients with hypopharyngeal cancer with primary concurrent chemoradiotherapy. Anticancer Res. 2015;35:1735–41.PubMed Chen LY, Huang CC, Tsou YA, Bau DT, Tsai MH. Prognostic factor of severe complications in patients with hypopharyngeal cancer with primary concurrent chemoradiotherapy. Anticancer Res. 2015;35:1735–41.PubMed
9.
Zurück zum Zitat Wulff NB, Kristensen CA, Andersen E, Charabi B, Sorensen CH, Homoe P. Risk factors for postoperative complications after total laryngectomy following radiotherapy or chemoradiation: a 10-year retrospective longitudinal study in Eastern Denmark. Clin Otolaryngol. 2015. doi:10.1111/coa.12443.PubMed Wulff NB, Kristensen CA, Andersen E, Charabi B, Sorensen CH, Homoe P. Risk factors for postoperative complications after total laryngectomy following radiotherapy or chemoradiation: a 10-year retrospective longitudinal study in Eastern Denmark. Clin Otolaryngol. 2015. doi:10.​1111/​coa.​12443.PubMed
10.
11.
Zurück zum Zitat Martin A, Jackel MC, Christiansen H, Mahmoodzada M, Kron M, Steiner W. Organ preserving transoral laser microsurgery for cancer of the hypopharynx. Laryngoscope. 2008;118:398–402.CrossRefPubMed Martin A, Jackel MC, Christiansen H, Mahmoodzada M, Kron M, Steiner W. Organ preserving transoral laser microsurgery for cancer of the hypopharynx. Laryngoscope. 2008;118:398–402.CrossRefPubMed
12.
Zurück zum Zitat Karatzanis AD, Psychogios G, Waldfahrer F, et al. T1 and T2 hypopharyngeal cancer treatment with laser microsurgery. J Surg Oncol. 2010;102:27–33.CrossRefPubMed Karatzanis AD, Psychogios G, Waldfahrer F, et al. T1 and T2 hypopharyngeal cancer treatment with laser microsurgery. J Surg Oncol. 2010;102:27–33.CrossRefPubMed
13.
Zurück zum Zitat Suarez C, Rodrigo JP, Silver CE, et al. Laser surgery for early to moderately advanced glottic, supraglottic, and hypopharyngeal cancers. Head Neck. 2012;34:1028–35.CrossRefPubMed Suarez C, Rodrigo JP, Silver CE, et al. Laser surgery for early to moderately advanced glottic, supraglottic, and hypopharyngeal cancers. Head Neck. 2012;34:1028–35.CrossRefPubMed
14.
Zurück zum Zitat Pfister DG, Ang KK, Brizel DM, et al. Head and neck cancers. J Natl Compr Canc Netw. 2011;9:596–650.PubMed Pfister DG, Ang KK, Brizel DM, et al. Head and neck cancers. J Natl Compr Canc Netw. 2011;9:596–650.PubMed
15.
Zurück zum Zitat Kim JW, Kim MS, Kim SH, et al. Definitive chemoradiotherapy versus surgery followed by adjuvant radiotherapy in resectable stage III/IV hypopharyngeal cancer. Cancer Res Treat. 2015. doi:10.4143/crt.2014.340. Kim JW, Kim MS, Kim SH, et al. Definitive chemoradiotherapy versus surgery followed by adjuvant radiotherapy in resectable stage III/IV hypopharyngeal cancer. Cancer Res Treat. 2015. doi:10.​4143/​crt.​2014.​340.
16.
Zurück zum Zitat Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol. 2010;17:1471–4.CrossRefPubMed Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol. 2010;17:1471–4.CrossRefPubMed
17.
Zurück zum Zitat Newman JR, Connolly TM, Illing EA, Kilgore ML, Locher JL, Carroll WR. Survival trends in hypopharyngeal cancer: a population-based review. Laryngoscope. 2015;125:624–9.CrossRefPubMed Newman JR, Connolly TM, Illing EA, Kilgore ML, Locher JL, Carroll WR. Survival trends in hypopharyngeal cancer: a population-based review. Laryngoscope. 2015;125:624–9.CrossRefPubMed
18.
Zurück zum Zitat Oken MM, Creech RH, Tormey DC, et al. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol. 1982;5:649–55.CrossRefPubMed Oken MM, Creech RH, Tormey DC, et al. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol. 1982;5:649–55.CrossRefPubMed
19.
Zurück zum Zitat Lefebvre JL, Chevalier D, Luboinski B, Kirkpatrick A, Collette L, Sahmoud T. Larynx preservation in pyriform sinus cancer: preliminary results of a European Organization for Research and Treatment of Cancer phase III trial. EORTC Head and Neck Cancer Cooperative Group. J Natl Cancer Inst. 1996;88:890–9.CrossRefPubMed Lefebvre JL, Chevalier D, Luboinski B, Kirkpatrick A, Collette L, Sahmoud T. Larynx preservation in pyriform sinus cancer: preliminary results of a European Organization for Research and Treatment of Cancer phase III trial. EORTC Head and Neck Cancer Cooperative Group. J Natl Cancer Inst. 1996;88:890–9.CrossRefPubMed
20.
Zurück zum Zitat Robertson SM, Yeo JC, Dunnet C, Young D, Mackenzie K. Voice, swallowing, and quality of life after total laryngectomy: results of the west of Scotland laryngectomy audit. Head Neck. 2012;34:59–65.CrossRefPubMed Robertson SM, Yeo JC, Dunnet C, Young D, Mackenzie K. Voice, swallowing, and quality of life after total laryngectomy: results of the west of Scotland laryngectomy audit. Head Neck. 2012;34:59–65.CrossRefPubMed
21.
Zurück zum Zitat Polat B, Orhan KS, Kesimli MC, Gorgulu Y, Ulusan M, Deger K. The effects of indwelling voice prosthesis on the quality of life, depressive symptoms, and self-esteem in patients with total laryngectomy. Eur Arch Otorhinolaryngol. 2015;272(11):3431–7.CrossRefPubMed Polat B, Orhan KS, Kesimli MC, Gorgulu Y, Ulusan M, Deger K. The effects of indwelling voice prosthesis on the quality of life, depressive symptoms, and self-esteem in patients with total laryngectomy. Eur Arch Otorhinolaryngol. 2015;272(11):3431–7.CrossRefPubMed
22.
Zurück zum Zitat Finizia C, Bergman B. Health-related quality of life in patients with laryngeal cancer: a post-treatment comparison of different modes of communication. Laryngoscope. 2001;111:918–23.CrossRefPubMed Finizia C, Bergman B. Health-related quality of life in patients with laryngeal cancer: a post-treatment comparison of different modes of communication. Laryngoscope. 2001;111:918–23.CrossRefPubMed
Metadaten
Titel
Comparison of Oncological and Functional Outcomes between Initial Surgical versus Non-Surgical Treatments for Hypopharyngeal Cancer
verfasst von
Jeon Yeob Jang, MD, PhD
Eun-Hye Kim, RN
Jungkyu Cho, MD
Jae-Hoon Jung, MD
Dongryul Oh, MD, PhD
Yong Chan Ahn, MD, PhD
Young-Ik Son, MD, PhD
Han-Sin Jeong, MD, PhD
Publikationsdatum
19.01.2016
Verlag
Springer International Publishing
Erschienen in
Annals of Surgical Oncology / Ausgabe 6/2016
Print ISSN: 1068-9265
Elektronische ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-016-5088-4

Weitere Artikel der Ausgabe 6/2016

Annals of Surgical Oncology 6/2016 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

CME: 2 Punkte

Prof. Dr. med. Gregor Antoniadis Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

CME: 2 Punkte

Dr. med. Benjamin Meyknecht, PD Dr. med. Oliver Pieske Das Webinar S2e-Leitlinie „Distale Radiusfraktur“ beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

CME: 2 Punkte

Dr. med. Mihailo Andric
Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.