Multimodal approach for local tumor control and preservation of function

Introduction: Hypopharyngeal cancer has an unfavourable prognosis despite aggressive treatments including total laryngectomy. These experiencies are the reason why actual approaches focus on oncologic and functional (psychosocial) aspects.

Material und methods: After a careful staging patients were selected for primal surgery and postoperative radio-(chemo-)therapy when R0-resection and function-preservation seemed to be achievable. Further criteria were the exclusion of distant metastases and operability of the patient due to general conditions. Such excluded patients underwent primal radio-chemotherapy.

Patients: 45 patients (42 male, 3 female, average 56 years) with often advanced-stage primaries (T3-4: 35/45), frequent locoregional (N+: 40/45) and distant metastases (total 14/45) were treated.

Results: 31/45 underwent primal organ preserving surgery with (30/31) or without (1/31) postoperative radio-(chemo-)therapy. The complete tumor-resection was histopathologically proved in 27/31 and non-in-sano-resection in 4/31 (including L+ and Ca.i.situ). After a 2-years-period 23/31 were tumor-free alive, 6/31 had letal tumor recurrences (2 local, 4 distant), 2 patients died because of other reasons. 4/31 patients needed permanent tracheotomy, 4/31 a permanent feeding tube. 14/45 recieved primal radio-chemotherapy, 9 of those because of the diagnosis of distant metastases at the first staging. Functional results were worse than in the surgery group: permanent tracheostoma in 10/14 and permanent feeding tube in 10/14. No patient survived 2 years after diagnosis.

Discussion: In carefully staged and selected carcinomas of the hypopharynx surgery, usually in combination with postoperative radio-chemotheray provides satisfying local control and function-preservation. Distant metastases are the essential for prognosis.