Strategies for advanced carcinoma of the hypopharynx at OMCCCD

Our recent strategies for advanced hypopharyngeal carcinoma were described. Since 1998, planned postoperative radiotherapy (60 Gy) for pN2-3 neck has been performed (compliance: 71.9%). The recurrence rate in the neck decreased significantly to 21.1% (12/57), compared with 46.0% (46/100) for the former period of 1989-97 (p<0.01). The 5-year overall and cause-specific survival rates of pN2-3 neck were 44.9% and 65.8%, respectively; these were also significant improvements, compared with 22.3% and 36.2% for the former period (p<0.05). The indication of concurrent chemotherapy with postoperative radiotherapy should be investigated. The influence of ipsi-lateral neck dissection on the swallowing function for patients who underwent laryngeal preservation surgery was investigated. The intervals until the start of oral intake were not related with the procedures of the neck dissection. This suggested the procedures of neck dissection do not need to be taken into account when the indication of laryngeal preservation surgery is considered. Radiotherapy of small primary lesions (T1-2) preceded by neck dissection for extensive nodal metastases (N2-3) has been performed since 1991. Of 17 patients who underwent the strategy, four distant metastases (23.5%) and two recurrences in the paratracheal region (11.8%) were found, in spite of only one recurrence in the primary site. The propriety of this strategy needs to be examined furthermore. (author)