Pyriform sinus cancer: a clinical and laboratory study.

In our patient population, cancer of the hypopharynx arose 19 times as often in the pyriform sinus as in the postcricoid space (152:8). Most of the growths were far advanced when first seen (90% T3), and enlarged cervical nodes were present in 66% of the patients. Three year survival rates free of disease were as follows: primary surgical treatment (laryngectomy, radical neck dissection) (8/28) 29%; primary radiotherapy (2/55) 4%; and combined preoperative radiation (12/33) 36%. Serial section studies of 51 surgical specimens indicate that T1 and T2 lesions, especially those confined in the medial wall, are probably curable by radiotherapy. Larger lesions invade deeply into the larynx and resemble transglottic growth in their pattern of spread. Conservation surgery would have been inadequate for all but perhaps one growth in this series of 51 lesions, because of the high rate of invasion by cancer into and through the thyroid cartilage and cricoid ring (22/51). Although surface presentation of this group of pyriform sinus cancers rarely reflected the extent of invasion, each of the 22 growths that invaded portions of the thyroid or cricoid cartilages was characterized by clinical involvement of the apex and lateral wall of the pyriform sinus on laryngoscopy or barium swallow.