| Part ⅠResponse-adapted treatment following radiotherapy in patients with resectable locally advanced hypopharyngeal carcinomaObjective:This study aimed to evaluate the clinical features,treatment outcomes,failure patterns and evaluate the value of response-adapted treatment following radiotherapy in patients with resectable locally advanced hypopharyngeal carcinoma.Materials and Methods:This cohort study was conducted from May 2009 to October 2019 in our hospital,423 patients pathologically confirmed stage Ⅲ and ⅣB resectable locally advanced hypopharyngeal carcinoma included.All primary treatment regimens were determined on the advice of the head and neck multi-disciplinary team advice and the preference of the patient.313(74.0%)patients were assessed as needing total laryngectomy and 110(26.0%)patients were assessed as needing laryngeal-preservation surgery.The primary surgery group(n=144)underwent surgery primarily with or without postoperative radiotherapy(RT)or concurrent chemoradiotherapy(CCRT).Patients in the primary RT group(n=67)received radical RT or CCRT.Patients in the response-adapted group underwent the response-adapted strategy(n=212).The response-adapted strategy was determined based on the primary tumor response,which was evaluated at a dose of 50 Gy.If the response reached complete response or partial response(more than 80%tumor regression),patients received radical RT or CCRT;otherwise,they received surgery,if possible,at 4 to 6 weeks after RT.Results:The median interquartile range follow-up period of the whole cohort was 66.5(44.7-97.0)months.The 5-yearoverall Survival(OS),progression-free survival(PFS),and survival with a functional larynx(SFL)of the whole cohort were 49.5%,43.5%,and 36.3%,respectively.The 5-year OS,PFS,and SFL according to the AJCC system were,respectively,as follows:stage Ⅲ(n=58),58.8%,55.3%and 44.4%;stage IVA(n=284),54.6%,47.0%,and 38.7%;stage ⅣB(n=81),25.8%,22.9%,and 22.0%.In evaluations based on the different treatment strategies,the 5-year OS,PFS,and SFL were,respectively,27.7%,26.6%and 27.5%in the primary RT group(n=67).No significant differences were observed between the primary surgery and response-adapted groups at OS and PFS.The response-adapted group still showed a better 5-year SFL than the primary surgery group(40.6%vs 33.9%,P=0.001).In additional,surgery complications did not significantly differ between these two groups.Conclusions:In this cohort study,the response-adapted strategy based on an early RT response facilitated better treatment tailoring,maximum tumor control,and higher laryngeal preservation compared with primary surgery and primary RT strategies.This approach could provide a feasible laryngeal preservation strategy in patients with resectable locally advanced hypopharyngeal carcinoma.Part ⅡInduction TPF followed by concurrent chemoradiotherapy versus concurrent chemoradiotherapy alone in locally advanced hypopharyngeal cancer:A preliminary result of a randomized phase 2 trialObjective:Concurrent chemoradiotherapy(CCRT)is a standard treatment choice for locally advanced hypopharyngeal carcinoma.The aim of this study was to investigate whether induction chemotherapy(IC)followed by CCRT is superior to CCRT alone to treat locally advanced hypopharyngeal carcinoma.Materials and Methods:Patients(n=142)were randomized to receive two cycles of paclitaxel/cisplatin/5-fluorouracil(TPF)IC followed by CCRT or CCRT alone.The primary end point was overall survival(OS).The secondary end points included the larynx preservation rate,progression-free survival(PFS),distant metastasis-free survival(DMFS),and toxicities.Results:Ultimately,113 of the 142 patients were analyzed.With a median follow-up of 45.6 months(interquartile range 26.8-57.8 months),the 3-year OS was 53.1%in the IC+CCRT group compared with 54.8%in the CCRT group(hazard ratio[HR],1.004;95%confidence interval[CI],0.573-1.761;P=0.988).There were no statistically significant differences in PFS,DMFS,and the larynx-preservation rate between the two groups.The incidence of grade 3-4 hematological toxicity was much higher in the IC+CCRT group than in the CCRT group(54.7%vs.10%,P<0.001).Conclusions:Adding induction TPF to CCRT did not improve survival and the larynx preservation rate in locally advanced hypopharyngeal cancer,but caused a higher incidence of acute hematological toxicities.Part ⅢSecond primary malignancies in hypopharyngeal carcinoma:an analysis of 594 real-world casesObjective:To evaluate the prevalence,clinical characteristics and treatment efficacy of second primary malignancies(SPMs)among patients with hypopharyngeal carcinoma(HPC)in real-world analysis.Materials and Methods:The prevalence,clinical characteristics and treatment efficacy of 594 HPC patients admitted to our institution from 2010 to 2018 were retrospectively analyzed.Results:With a median follow-up time of 66.9 months,SPMs were present in 36.4%of the patients:22.2%(132/594)were synchronous and 14.2%(84/594)were metachronous.The upper aerodigestive tract was the most common involved region.Patients with synchronous Tis and metachronous Tis groups had similar 5-year overall survival(OS)of 42.2%versus 44.5%(hazard ratio[HR],0.992;95%confidence interval[CI],0.680-1.447,P=0.958)and 62.2%versus 44.5%(HR,0.656;95%CI,0.324-1.329,P=0.240),respectively,compared with patients without SPMs.Patients with synchronous invasive SPMs had a worse 5-year OS of 27.2%versus 44.5%(HR,1.626;95%CI,1.210-2.187,P=0.001).While patients with metachronous invasive SPMs had a same 5-year OS of 50.2%versus 44.5%(HR,0.910;95%CI,0.649-1.277,P=0.587).SPMs accounted for 42.5%of total death in metachronous invasive SPMs group.Conclusions:Patients with HPC have a high probability of developing SPMs.Moreover,patients with Tis or metachronous SPMs had no influence on prognosis,while the occurrence of synchronous SPMs significantly affectes the prognosis of patients.However,SPMs was still one of the main death causes in metachronous invasive SPMs group.Routine surveillance of Met-SPMs,especially for UADT was requisite for patients with HPC. |
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