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.

Study Design: Retrospective review of the records of 28 consecutive patients who underwent pharyngoesophagectomy and reconstruction with radial forearm free flaps between 1996 to 2001.

Methods: The Kaplan-Meier method was used to estimate survival and recurrence-free time.

Results: The minimum follow-up time was 2 years, and there were 14 (50%) patients who had recurrences. Analysis revealed that only one (3%) patient experienced a recurrence at the inferior resection margin, the junction of the free flap reconstruction, and the cervical esophagus. Estimated 4 year survival was 48.5%.

Conclusions: Total laryngopharyngectomy and partial esophagectomy with radial forearm free flap reconstructions in appropriately selected patients with hypopharyngeal cancer does not compromise local recurrence rates at the distal esophageal margin.

From the University of Michigan Medical Center, Ann Arbor; Wayne State University Medical Center, Detroit, MI; Southwest Oncology Group Statistical Center, Seattle, WA; Eastern Virginia Medical School, Norfolk, VA; Cleveland Clinic Foundation, Cleveland; Ohio State University Medical Center, Columbus, OH; and University of Arkansas for Medical Science, Little Rock, AR

Address reprint requests to Southwest Oncology Group (SWOG-9451), Operations Office, 14980 Omicron Dr, San Antonio, TX 78245-3217; e-mail: pubs@swog.org

PURPOSE: The Southwest Oncology Group designed a phase II trial for patients with base of tongue or hypopharyngeal cancer to evaluate the complete histologic response rate at the primary site after induction chemotherapy followed by chemoradiotherapy for responders. Secondary end points were the rate of organ preservation and the need for salvage surgery.

PATIENTS AND METHODS: Fifty-nine eligible patients were enrolled; 37 had base of tongue cancer, and 22 had hypopharynx cancer. Forty-two percent had stage III disease, and 58% had stage IV disease. Induction chemotherapy was two cycles of cisplatin 100 mg/m² and fluorouracil 1,000 mg/m²/d for 5 days. Patients who had a greater than 50% response at the primary site were treated with radiation 72Gy and concurrent cisplatin 100 mg/m² for three cycles. Patients with less than partial response at the primary had immediate salvage surgery.

RESULTS: Forty-five patients (76%) had a greater than 50% response at the primary after induction chemotherapy; 43 went on to receive definitive chemoradiotherapy. Thirty-two patients (54%) achieved a histologic complete response at the primary site, and an additional nine patients had a complete clinical response, but biopsy was not done. Seventy-five percent of patients did not require surgery at the primary tumor site. The 3-year overall survival was 64%. The 3-year progression-free survival with organ preservation was 52%.

CONCLUSION: Patients with base of tongue or hypopharyngeal cancer treated with this regimen of induction chemotherapy followed by definitive chemoradiotherapy have a good rate of organ preservation without compromise of survival.

Methods: The immunohistochemical expression of galectin 7 was determined on a series of 81 stage IV hypopharyngeal SCCs and was compared with that of galectins 1 and 3.

Results: High levels of galectin 7 expression were associated with rapid recurrence rates and dismal prognoses in these 81 stage IV hypopharyngeal SCCs, a feature not observed with galectin 3 and one observed weakly, if at all, with galectin 1.

Conclusions: These data suggest that the immunohistochemical determination of galectin 7 expression in the case of high-risk hypopharyngeal cancers is a meaningful tool to identify patients who should benefit from aggressive postsurgical adjuvant therapy after surgery, including not only radiotherapy, but also chemotherapy.