Clinical evaluation of radiotherapy for N0 hypopharyngeal cancer

Seventy-five hypopharyngeal cancer patients without lymph-node metastasis, treated with radiotherapy (RT) at Kyushu University Hospital from 1976 through 2003, were evaluated. T category was 10 in T1, 41 in T2, 13 in T3, and 11 in T4. Median total doses of RT were 62.5 Gy (range: 60-74 Gy) in radical intent, and 30 Gy (28.5-41.4 Gy) in the preoperative setting. Patient selection as to radical RT or preoperative irradiation plus surgery was performed at 30-40 Gy by an oncologist of head and neck surgery and a radiation oncologist, according to the tumor response to RT. Most patients were treated with RT combined with concurrent chemotherapy including 5-fluorouracil (5-FU) and Vitamin A. As the result, radical RT was selected for 48 patients (T1, 9; T2, 30; T3, 4; T4, 5), and preoperative irradiation plus surgery was selected for 27 patients (T1, 1; T2, 11; T3, 9; T4, 6). For 75 T1-4 cancer patients, the 5-year overall and cause-specific survival rates were 62% and 75%, respectively. The 5-year cause-specific survival (5-year CSS) rates were 100% for T1, 85% for T2, 83% for T3, and 30% for T4. For patients with T1-2 cancers, there was no significant difference in survival between the RT+Surgery group and the RT group; 5-year CSS was 92% vs. 85%, respectively. In the RT group, however, the prognosis of patients with T3-4 cancers (5-year CSS: 29%) was significantly poor compared with that of patients with T1-2 cancers. The 5-year local progression-free survival with laryngeal preservation was 65% in T1-2 cancers, 6% in T3-4 cancers, and 45% in all patients. RT has an advantage for the preservation of laryngeal function compared with surgery. For stage I - II cancers, therefore, RT should be first considered as a radical treatment option. For T3-4 cancers, however, the combination of RT and surgery was thought to be proper treatment. (author)