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KMID : 0361020110540100703
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Korean Journal of Otolaryngology - Head and Neck Surgery
2011 Volume.54 No. 10 p.703 ~ p.710
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Outcomes of Salvage Surgery after Concurrent Chemoradiation for Advanced Hypopharyngeal Cancer
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Ryu In-Sun
Han Myung-Woul
Roh Jong-Lyel
Nam Soon-Yuhl
Choi Seung-Ho
Kim Sang-Yoon
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Abstract
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Background and Objectives : We evaluated treatment outcomes of patients with advanced hypopharyngeal cancer for whom surgical salvage was attempted after primary concomitant chemoradiation therapy (CRT) had failed as a treatment. The pre-salvage factors were assess-ed to predict the prognosis of salvage surgery.
Subjects and Method : A retrospective analysis was conducted from 1997 to 2006 for 22 patients with stage III-IV hypopharyngeal cancer who had undergone salvage surgery after local and/or regional CRT failures with no distant metastasis.
Results: Larynx-sacrificing pharyngectomy was performed in 12 (54.5%) of all patients. Postoperative complications occurred in 9 (40.9%), and carotid artery blowout occurred in two of these patients. After salvage surgery, the 2-year and 5-year overall survival rates were 52.8% and 28.9%, respectively. The 2-year disease specific survival rate and locoregional control rate were 45.5% and 60.0%, respectively. The initial N2-3 stage (p=0.038) and the concurrent local and regional failures (p=0.035) were independent predictors for decreased survival after salvage surgery. Two-year overall survival rates for patients with 2, 1, or none of these predictive factors were 23.3%, 66.7%, and 80.0%, respectively (p=0.027).
Conclusion: Although salvage surgery after CRT has postoperative complications and unfavorable larynx preservation, it can be considered as a viable option with acceptable oncologic outcomes for advanced hypopharyngeal cancer. The initial N2-3 stage and concurrent local and regional failures were independent predictors that can stratify patients into distinct prognostic groups for postsalvage survival.
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KEYWORD
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Hypopharyngeal cancer, Treatment failure, Surgery, Locoregional failure, Salvage therapy
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