Akademik Veri Yönetim Sistemi
Journal of B.U.ON., cilt.6, sa.2, ss.135-141, 2001 (Scopus)
Purpose: To present our multidisciplinary therapeutic approach in hypopharyngeal carcinoma with particular emphasis on our ability to deliver combined modality treatment and/or altered fractionation radiotherapy (RT). Patients and methods: Between January 1992 and December 1998, 46 patients (34 males and 12 females) with squamous-cell carcinoma of the hypopharynx were treated by the DEHNCG. Their median age was 59 years (range 13-76 years) and 89% of them had stage IV disease. Nineteen patients were treated with combined surgery and postoperative RT, while the remaining 27 were treated with Rt alone (19 patients) or chemoradiotherapy alone (8 patients). The median postoperative RT dose was 60 Gy (range 36-70 Gy), the median time from surgery until the start of RT was 46 days (range 26-84 days), and the median duration of RT was 43 days (range 22-55 days). Of the patients treated with RT alone, 23 received conventional fractionation (70 Gy, 2 Gy/day), and 4 where treated with a concomitant boost technique with a median dose of 70 Gy (range 60-72 Gy) and a median duration of 51 days (range 42-71 days). Chemotherapy consisted of either 2 courses of intravenous (i.v.) administration of cisplatic (100 mg/m2), bleomycin (30mg total dose) and methotrexate (40 mg/m2), all given 3-weekly prior to RT (3 patients), or cisplatin (100 mg/m2), given 3-weekly during RT (5 patients). Results: The median follow-up was 13 months (range 2-93 months), and the 1,2,3, and 5- year overall survival rates were 57%, 22%, 20%, and 13%, respectively. The survival rate at 2 years was 42% for those patients treated with surgery and postoperative RT, and 7% in the RT-alone group. On univariate analysis, males (p=0.0002), stage II-III disease (p=0.0218), Karnofsky performance status (KPS) ≥ 80 (p=0.0000), pyriform sinus location (p-0.0141), combined surgery and RT (p=0.0041), response to RT (p-0.0000), and no gap in RT (p=0.0013) were associated with a significantly increased survival. Haemoglobin level <12 g/dl, advanced nodal stage, positive surgical margins, and delay greater than 6 weeks between operation and initiation of RT had a negative but nonsignificant impact on survival. Multivariate analysis revealed that KPS and combined surgery and RT were significant prognostic factors for survival (p=0.0027, and p=0.039, respectively). Conclusion: The majority of these patients present with locally advanced disease. Whenever possible a combined surgery plus RT approach should be employed. For patients in whom surgery is not feasible, results with RT alone are very poor. This requires development of more extensive and intensive patient support.