Concurrent chemoradiotherapy for squamous cell carcinoma of the hypopharynx

Abstract

Subjects were 32 patients, 30 men and 2 women, with squamous cell carcinoma of the hypopharynx. Their median age was 61 years, ranging from 41 to 71 years. Subsites were the piriform sinus in 28, and the post-cricoid area in 4. Eight had stage III disease and 24 had stage IV disease. The twenty-six cases were resectable and 6 cases were unresectable. These patients were treated with concurrent chemoradiotherapy. The treatment regimen consisted of 5-fluorouracil (5-FU) and cisplatin (CDDP). 5-FU was given at 1000 mg/m2 per day as a continuous infusion during 4 days, and 60 mg/m2 of CDDP was given on day 4 after the beginning of 5-FU administration. Two courses of chemotherapy were performed, on day 1 and on day 35. Radiation was given in a single daily fraction of 2 Gy and 5 fractions per week to a total dose of 60 to 70 Gy. A radiation break was scheduled from day 26 to 35. The median total delivered dose of radiation was 66 Gy. Toxicities included mucositis (grade 3, 21.9%, grade 4, 28.1%), vomiting (grade 3, 6.3%), and leukopenia (grade 3, 12.5%). Twenty-nine patients (90.6%) received scheduled treatment. Nine (28.1%) had a complete response and 22 (71.9%) partial response. Mean overall survival was 23.5 months (4.7-61.6) and progression-free survival (PFS) was 20.8 months (4.7-61.6). The preservation rate of the hypopharynx without recurrent sites was 58.8% of patients during two years. The two-year overall survival rate (OS) was 67.0% and PFS rate was 54.0%. Two-year OS was 75.9% and PFS rate was 57.9% in resectable cases. Failure patterns showed in 9 cases with locoregional recurrence and 1 with distant metastasis. Based on the results, concurrent chemoradiotherapy is effective in preserving the hypopharynx in a high percentage of patients and improving two-year OS and PFS rates without compromising QOL. © 2005, Japan Society for Head and Neck Cancer. All rights reserved.