A 13-Year Single Institutional Experience with Definitive Radiotherapy in Hypopharyngeal Cancer.

Dear Editor, Patients with hypopharyngeal carcinoma often present with locally advanced disease. Treatment options are usually multimodality and involve surgery, radiotherapy (RT) and chemotherapy. Definitive RT with or without chemotherapy present a functional organ preservation strategy in selected patients or in patients with extensive inoperable local disease. Whereas upfront surgery followed by adjuvant RT may be more appropriate in patients with disease which limits the adequate recovery of speech and swallowing function with organ preservation strategy. Patients with significant cartilage destruction or bilateral vocal cord destruction may also have better function after laryngectomy and rehabilitation following surgery. The landmark VA trial investigated the feasibility of organ preservation in laryngeal cancer patients using sequential chemotherapy-RT as an alternative to upfront surgery.1 More than half of the patients had their larynx preserved with comparable survival to the surgical group. This encouraging result opened new avenues for application of this strategy in patients with locally advanced cancer of other head and neck primary sites. Similar conclusion was also established in the subsequent EORTC 24981 trial which included 152 hypopharyngeal cancer patients.2,3 Concomitant radio-chemotherapy (CRT) strategy arose from the RTOG 91-11 trial and meta-analysis which demonstrated improved loco-regional control (LRC) and laryngeal preservation rates compared to induction chemotherapy followed by radical RT.4-7 This approach is now widely practised in many centres worldwide. We adopted the concurrent CRT approach as the organ preservation strategy in treating selected patients with hypopharyngeal cancer. The aim of our study was to retrospectively review the outcome following curative intent RT with or without chemotherapy in hypopharyngeal cancer patients treated in our centre and also to determine the prognostic factors on LRC and survival in this group of patients.