Radiat Oncol J.  2018 Sep;36(3):192-199. 10.3857/roj.2018.00311.

Optimal timing for salvage surgery after definitive radiotherapy in hypopharyngeal cancer

Affiliations
  • 1Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea. wuhg@snu.ac.kr
  • 2Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
  • 3Department of Otorhinolaryngology, Bundang Jesaeng Hospital, Seongnam, Korea.
  • 4Department of Otorhinolaryngology, Seoul National University College of Medicine, Seoul, Korea.
  • 5Sensory Organ Research Institute, Medical Research Center, Seoul National University, Seoul, Korea.
  • 6Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.
  • 7Department of Pathology, Seoul National University College of Medicine, Seoul, Korea.
  • 8Department of Cancer Research Institution, Seoul National University College of Medicine, Seoul, Korea.
  • 9Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul, Korea.

Abstract

PURPOSE
Use of radiotherapy combined with chemotherapy is increasing in hypopharyngeal cancer. However, many show residual tumor after radiotherapy. Timing for treatment evaluation and salvage therapy is essential. However, optimal timing for salvage surgery has not been suggested. In this study, we tried to evaluate optimal timing for salvage surgery.
METHODS
AND MATERIALS: Patients who were diagnosed with hypopharyngeal squamous cell carcinoma between 2006 and 2015 were retrospectively analyzed. All patients received definitive radiotherapy with or without chemotherapy. Response of all treated patients were analyzed at 1, 3, and 6 months after radiotherapy. Any patients with progression before 6 months were excluded.
RESULTS
A total of 54 patients were analyzed. Complete remission (CR) rates at 1 month (CR1), 3 months (CR3) and 6 months (CR6) were 66.7%, 81.5%, and 90.7%, respectively. Non-CR at 1 month (NCR1), 3 months (NCR3), and 6 months (NCR6) showed poor locoregional recurrence-free survival rates (1-year rates of 63.7%, 66.7%, and 0.0%, respectively) compared to CR1, CR3, and CR6 (1-year rates 94.3%, 88.0%, and 91.5%, respectively). Particularly significant differences were seen between CR6 and NCR6 (p < 0.001). Of 10 patients with NCR3, 5 showed CR at 6 months (NCR3/CR6). There was no statistical difference in locoregional recurrence-free survival between CR3 and NCR3/CR6 group (p = 0.990).
CONCLUSION
Our data suggest half of patients who did not show CR at 3 months eventually achieved CR at 6 months. Waiting until 6 months after radiotherapy may be appropriate for avoiding additional salvage therapy.

Keyword

Hypopharynx; Radiotherapy; Neoplasms

MeSH Terms

Carcinoma, Squamous Cell
Drug Therapy
Humans
Hypopharyngeal Neoplasms*
Hypopharynx
Neoplasm, Residual
Radiotherapy*
Retrospective Studies
Salvage Therapy
Survival Rate
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