Radiation Oncology Journal

The Korean Society for Radiation Oncology (대한방사선종양학회)
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Optimal timing for salvage surgery after definitive radiotherapy in hypopharyngeal cancer

  • Chun, Seok-Joo (Department of Radiation Oncology, Seoul National University College of Medicine) ;
  • Keam, Bhumsuk (Department of Internal Medicine, Seoul National University College of Medicine) ;
  • Heo, Dae Seog (Department of Internal Medicine, Seoul National University College of Medicine) ;
  • Kim, Kwang Hyun (Department of Otorhinolaryngology, Bundang Jesaeng Hospital) ;
  • Sung, Myung-Whun (Department of Otorhinolaryngology, Seoul National University College of Medicine) ;
  • Chung, Eun-Jae (Department of Otorhinolaryngology, Seoul National University College of Medicine) ;
  • Kim, Ji-hoon (Department of Radiology, Seoul National University College of Medicine) ;
  • Jung, Kyeong Cheon (Department of Pathology, Seoul National University College of Medicine) ;
  • Kim, Jin Ho (Department of Radiation Oncology, Seoul National University College of Medicine) ;
  • Wu, Hong-Gyun (Department of Radiation Oncology, Seoul National University College of Medicine)
  • Received : 2018.06.29
  • Accepted : 2018.08.06
  • Published : 2018.09.30
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Abstract

Purpose: Use of radiotherapy combined with chemotherapy is increasing in hypopharyngeal cancer. However, many show residual tumor after radiotherapy. Timing for treatment evaluation and salvage therapy is essential. However, optimal timing for salvage surgery has not been suggested. In this study, we tried to evaluate optimal timing for salvage surgery. Methods and Materials: Patients who were diagnosed with hypopharyngeal squamous cell carcinoma between 2006 and 2015 were retrospectively analyzed. All patients received definitive radiotherapy with or without chemotherapy. Response of all treated patients were analyzed at 1, 3, and 6 months after radiotherapy. Any patients with progression before 6 months were excluded. Results: A total of 54 patients were analyzed. Complete remission (CR) rates at 1 month (CR1), 3 months (CR3) and 6 months (CR6) were 66.7%, 81.5%, and 90.7%, respectively. Non-CR at 1 month (NCR1), 3 months (NCR3), and 6 months (NCR6) showed poor locoregional recurrence-free survival rates (1-year rates of 63.7%, 66.7%, and 0.0%, respectively) compared to CR1, CR3, and CR6 (1-year rates 94.3%, 88.0%, and 91.5%, respectively). Particularly significant differences were seen between CR6 and NCR6 (p < 0.001). Of 10 patients with NCR3, 5 showed CR at 6 months (NCR3/CR6). There was no statistical difference in locoregional recurrence-free survival between CR3 and NCR3/CR6 group (p = 0.990). Conclusion: Our data suggest half of patients who did not show CR at 3 months eventually achieved CR at 6 months. Waiting until 6 months after radiotherapy may be appropriate for avoiding additional salvage therapy.

Keywords

References

  1. Lefebvre JL, Andry G, Chevalier D, et al. Laryngeal preservation with induction chemotherapy for hypopharyngeal squamous cell carcinoma: 10-year results of EORTC trial 24891. Ann Oncol 2012;23:2708-14.
  2. Pignon JP, le Maitre A, Maillard E, Bourhis J; MACH-NC Collaborative Group. Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): an update on 93 randomised trials and 17,346 patients. Radiother Oncol 2009;92:4-14.
  3. Newman JR, Connolly TM, Illing EA, Kilgore ML, Locher JL, Carroll WR. Survival trends in hypopharyngeal cancer: a population-based review. Laryngoscope 2015;125:624-9.
  4. Silver CE, Beitler JJ, Shaha AR, Rinaldo A, Ferlito A. Current trends in initial management of laryngeal cancer: the declining use of open surgery. Eur Arch Otorhinolaryngol 2009;266:1333-52.
  5. Takes RP, Strojan P, Silver CE, et al. Current trends in initial management of hypopharyngeal cancer: the declining use of open surgery. Head Neck 2012;34:270-81.
  6. Huang SH, O'Sullivan B, Xu W, et al. Temporal nodal regression and regional control after primary radiation therapy for N2- N3 head-and-neck cancer stratified by HPV status. Int J Radiat Oncol Biol Phys 2013;87:1078-85.
  7. Eisenhauer EA, Therasse P, Bogaerts J, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer 2009;45:228-47.
  8. Department of Veterans Affairs Laryngeal Cancer Study Group. Induction chemotherapy plus radiation compared with surgery plus radiation in patients with advanced laryngeal cancer. N Engl J Med 1991;324:1685-90.
  9. Wang YF, Liu RS, Chu PY, et al. Positron emission tomography in surveillance of head and neck squamous cell carcinoma after definitive chemoradiotherapy. Head Neck 2009;31:442-51.
  10. Zundel MT, Michel MA, Schultz CJ, et al. Comparison of physical examination and fluorodeoxyglucose positron emission tomography/computed tomography 4-6 months after radiotherapy to assess residual head-and-neck cancer. Int J Radiat Oncol Biol Phys 2011;81:e825-32.
  11. Mehanna H, Wong WL, McConkey CC, et al. PET-CT surveillance versus neck dissection in advanced head and neck cancer. N Engl J Med 2016;374:1444-54.
  12. Kapoor V, Fukui MB, McCook BM. Role of 18FFDG PET/CT in the treatment of head and neck cancers: principles, technique, normal distribution, and initial staging. AJR Am J Roentgenol 2005;184:579-87.
  13. Boscolo-Rizzo P, Maronato F, Marchiori C, Gava A, Da Mosto MC. Long-term quality of life after total laryngectomy and postoperative radiotherapy versus concurrent chemoradiotherapy for laryngeal preservation. Laryngoscope 2008;118:300-6.
  14. Hanna E, Sherman A, Cash D, et al. Quality of life for patients following total laryngectomy vs chemoradiation for laryngeal preservation. Arch Otolaryngol Head Neck Surg 2004;130:875-9.
  15. Stoeckli SJ, Pawlik AB, Lipp M, Huber A, Schmid S. Salvage surgery after failure of nonsurgical therapy for carcinoma of the larynx and hypopharynx. Arch Otolaryngol Head Neck Surg 2000;126:1473-7.
  16. Taki S, Homma A, Oridate N, et al. Salvage surgery for local recurrence after chemoradiotherapy or radiotherapy in hypopharyngeal cancer patients. Eur Arch Otorhinolaryngol 2010;267:1765-9.
  17. Wong LY, Wei WI, Lam LK, Yuen AP. Salvage of recurrent head and neck squamous cell carcinoma after primary curative surgery. Head Neck 2003;25:953-9.