Kim Nalee, Lee Jeongshim, Kim Kyung Hwan, Park Jong Won, Lee Chang Geol, Keum Ki Chang
Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea.
Radiat Oncol J. 2016 Dec;34(4):280-289. doi: 10.3857/roj.2016.01711. Epub 2016 Oct 31.
Early hypopharyngeal squamous cell carcinoma (HPSCC) is a rarely diagnosed disease, for which the optimal treatment has not been defined yet. We assessed patterns of failure and outcomes in early HPSCC treated with various therapeutic approaches to identify its optimal treatment.
Thirty-six patients with stage I (n = 10) and II (n = 26) treated between January 1992 and March 2014 were reviewed. Patients received definitive radiotherapy (RT) (R group, n = 10), surgery only (S group, n = 19), or postoperative RT (PORT group, n = 7). All patients in both the R and PORT groups received elective bilateral neck irradiation. In the S group, 7 patients had ipsilateral and 8 had bilateral dissection, while 4 patients had no elective dissection.
At a median follow-up of 48 months, the 5-year locoregional control (LRC) rate was 65%. Six patients had local failure, 1 regional failure (RF), 3 combined locoregional failures, and 2 distant failures. There was no difference in 5-year LRC among the R, S, and PORT groups (p = 0.17). The presence with a pyriform sinus apex extension was a prognosticator related to LRC (p = 0.01) in the multivariate analysis. Patients with a bilaterally treated neck showed a trend toward a lower RF rate (p = 0.08).
This study shows that patients with early stage HPSCC involving the pyriform sinus apex might need a tailored approach to improve LRC. Additionally, our study confirms elective neck treatment might have an efficacious role in regional control.
早期下咽鳞状细胞癌（HPSCC）是一种诊断罕见的疾病，其最佳治疗方案尚未确定。我们评估了采用各种治疗方法治疗的早期HPSCC的失败模式和结局，以确定其最佳治疗方案。
回顾性分析了1992年1月至2014年3月期间接受治疗的36例Ⅰ期（n = 10）和Ⅱ期（n = 26）患者。患者接受了根治性放疗（RT）（R组，n = 10）、单纯手术（S组，n = 19）或术后放疗（PORT组，n = 7）。R组和PORT组的所有患者均接受了双侧颈部选择性照射。在S组中，7例患者进行了同侧淋巴结清扫，8例进行了双侧淋巴结清扫，4例未进行选择性淋巴结清扫。
中位随访48个月时，5年局部区域控制（LRC）率为65%。6例患者出现局部失败，1例出现区域失败（RF），3例出现局部区域联合失败，2例出现远处失败。R组、S组和PORT组之间的5年LRC无差异（p = 0.17）。多因素分析显示，梨状窝尖部扩展的存在是与LRC相关的预后因素（p = 0.01）。双侧颈部接受治疗的患者RF率有降低趋势（p = 0.08）。
本研究表明，累及梨状窝尖部的早期HPSCC患者可能需要采用个体化方法来提高LRC。此外，我们的研究证实选择性颈部治疗可能在区域控制中发挥有效作用。
