(S005) Radiotherapy for Carcinoma of the Hypopharynx Over Five Decades: Experience at a Single Institution

Julian Johnson, MD, Stephen Shiao, MD, PhD, Vivian Weinberg, PhD, Jeanne Quivey, MD, Sue Yom, MD, PhD; University of California, San Francisco; Cedars Sinai

BACKGROUND AND PURPOSE: To determine the effect of treatment decade and utilization of intensity-modulated radiation therapy (IMRT) on locoregional control and overall survival in patients with squamous cell carcinoma of the hypopharynx.

METHODS: Between 1962 and 2008, 116 patients with squamous cell carcinoma of the hypopharynx underwent definitive radiotherapy. We retrospectively reviewed our experience treating these patients with radiotherapy (IMRT, 3-dimensional conformal radiotherapy [3DCRT], intraoperative radiotherapy [IORT], and external beam radiation therapy [EBRT]). This report focuses on the pattern of locoregional control, overall survival, and toxicity rates over the study period. 

RESULTS: Median follow-up duration from diagnosis was 17 months (range: < 2–441 mo). The 2-year estimates of overall survival and locoregional control were 41% (95% confidence interval [CI], 32%–50%) and 55% (95% CI, 44%–65%), respectively. The 5-year estimates of overall survival and locoregional control for the entire patient population were 25% (95% CI, 17%–33%) and 49% (95% CI, 37%–60%), respectively. The median overall survival for all patients was 18.3 months (range: 2–441 mo). With respect to treatment type, the median overall survival with EBRT was 13.8 months, 20.1 months for 3DCRT, and 37.8 months for IMRT (log-rank test: P = .04). Median overall survival estimates by decade were not statistically significantly different: 10.5 months for 1960–1969, 11.3 months for 1970–1979, 18.2 months for 1980–1989, 17.0 months for 1990–1999, and 37.8 months for 2000–2010 (P = .22). There was a trend for improved locoregional control comparing post-1980 treatment to pre-1980 treatment (P = .09) but not for overall survival (P = .52). Treatment with chemotherapy was increasingly more common over the 5 decades studied (P < .001) but did not impact locoregional or survival control (P = .69). Having surgery did not impact overall survival (P = .28) but improved locoregional control, resulting in 2-year and 5-year estimates of 66% vs 48% and 60% vs 41%, respectively (P = .045). The frequency of grade ≥ 3 mucositis decreased over time by decade (P = .01), whereas dysphagia did not. Data on xerostomia were not consistently recorded. 

CONCLUSIONS: With similar 10-year follow-up, there is a trend for improved locoregional control if treated as of 1980. Our data suggest that overall survival is longer for patients treated with IMRT. Our data also suggest that toxicity from mucositis has declined over time. The current study lends further support to the body of evidence suggesting that in contrast to squamous cell carcinoma of the larynx, overall survival is improving for patients with squamous cell carcinoma of the hypopharynx. 

Proceedings of the 97th Annual Meeting of the American Radium Society - americanradiumsociety.org