| Objective: To analyze prognosis and the factors affecting the prognosisof radiotherapy for hypopharyngeal carcinoma without distant metastasis, andto evaluate the acute toxicities and the patterns of failure.Method: Patients of hypopharyngeal carcinoma without distantmetastasis were collected from January2006to December2011. All patientswere squamous cell carcinoma and were treated with radiotherapy. There were136patients entered into this retrospective study. Ninety-two patients receivedradiotherapy alone (R group) and forty-four patients received surgery pluspostoperative radiotherapy (S+R group). The median follow-up period was24months. Survival analysis was performed by using Kalan-Meier method，Log-Rank test and Cox proportional hazard model.Results:1. Comparison of R group with S+R group:(1) The overall1-,3-, and5-year survival rates of entire cohort were74.8%,47.9%,41%,respectively. The overall1-,3-and5-year local control rates of entire cohortwere79%,63.5%,63.5%, respectively. The overall1-,3-and5-year survivalrates of R group and S+R group were71.4%,37.1%,33.4%and80.0%,66.5%,53.5%, respectively (P=0.018). The overall1-,3-and5-year control rates ofR group and S+R group were76.3%,55.9%,55.9%and84.0%,77.6%,77.6%,respectively(P=0.038).(2) Stratification: The1-,3-and5-year survival ratesof the patients with pyriform sinus cancer in R group and S+R group were74.6%,42.3%,35.8%and84.2%,68.2%,54.2%respectively (P=0.035). The1-,3-and5-year survival rates of the patients with stage T3-T4in R group andS+R group were57.4%,28.6%,22.9%and77.8%,70.4%,53.4%respectively(P=0.002). The1-,3-and5-year survival rates of the patients without cervicallymph nodes metastasis in R group and S+R group were70.3%,33.8%,28.6%and80%,62.6%,62.6%, respectively (P=0.011). The1-,3-and5-year survival rates of the patients with Stage of III-IV in R group and S+R groupwere69.1%,34.5%,30.5%and81.0%,66.5%,52.9%respectively (P=0.010).(3) The patterns of failure: There were25cases (27.2%) with locoregionalfailure,8cases（8.7%） with neck lymph nodes metastasis and14cases(15.2%) with distant metastasis in R group. There were7cases (15.9%) withlocoregional failure,2cases (4.5%) with cervical lymph nodes metastasis and9cases (20.5%) with distant metastasis in S+R group.2. Analysis ofprognostic factors of patients in R group.(1) Univariate analysis: The1-,3-and5-year survival rates of the patients younger than60years and older than60years were63.3%,32.9%,26.3%and75.4%,39.3%,36.7%respectively(P=0.373). The1-,3-and5-year survival rates were74.6%,40.3%,35.8%forthe patients with pyriform sinus cancer,54.5%,0,0for patients withpostcricoid cancer;69.2%,40.4%,40.4%for the patients with posterior wallcancer respectively (P=0.584). The1-,3-and5-year survival rates of thepatients with T1-T2were91.9%,50.8%,50.8%; and the1-,3-and5-yearsurvival rates of the patients with T3and T4were75.9%,36.5%,24.3%and36%,18%,18%respectively (P=0.000). The1-,3-and5-year survival rateswere69.2%,40.3%,40.3%for the N0patients, were76.9%,51.3%,0for N1patients, were67.4%,33.7%,27%for N2patients and were88.9%,33.3%,33.3%for N3respectively,(P=0.618). The1-,3-and5-year survival rates ofthe patients with stage I-II were90%,60%,60%, and the1-,3-and5-yearsurvival rates of the patients with stage III and Stage IV were82.4%,50.3%,50.3%and65.6%,30.4%,26.1%(P=0.030). The1-,3-and5-year survivalrates of the patients with chemotherapy and without chemotherapy were76.6%,41.4%,38.4%and65.9%,31.8%,26.5%respectively (P=0.249). The1-,3-,5-year survival rates of the patients with conventional radiotherapywere57.1%,14.3%,0; The1-,3-and5-year survival rates of the patients withthree dimensional conformal radiotherapy and with intensity modulatedradiotherapy were66.7%,33.3%,27.8%and74.2%,41.9%,38.7%respectively (P=0.424). The1-,3-and5-year survival rates of the patientsexcluding nasopharynx and including nasopharynx were72.7%,45.8%,45.8% and70.2%,33.8%,29%respectively (P=0.437).(2). Multivariate analysisshowed that stage T was an independent factor for the survival (P=0.014).3.The rates of grade1,2and3acute skin toxicity in R group and S+R groupwere95.6%,2.2%,2.2%and90.9%,9.1%,0%respectively. The rates ofgrade1,2and3acute mucositis toxicity in R group and S+R group were13.0%,5.4%,81.5%and24.5%,13.3%,62.2%. There were significantdifferences for grade3acute mucositis toxicity between R group and S+Rgroup (P=0.014).Conclusions:1. Radiotherapy is effective in patients withhypopharyngeal squamous cell carcinoma. Surgery with postoperativeradiation confers a better survival and local control than radiotherapy alone.2.The main pattern of treatment failure of hypopharyngeal primary is localrecurrence.3. The survival of patients with Surgery and postoperativeradiation is better than that of R group when the patient is pyriform sinuscancer, in stage T3-T4, N0or stage III-IV.4. T stage is an independent factorfor the survival.The earlier stage T the better prognosis.5. No significantsurvival benefit is obtained when plus chemotherapy in the treatment ofhypopharyngeal cancer.6. The grade3acute mucositis toxicity of R group ismore than S+R group. |
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