Retrospective Analysis Of The Effect Of Surgery Combined With Chemoradiotherapy And Definitive Chemoradiotherapy In The Treatment Of Locally Advanced Hypopharyngeal Squamous Cell Carcinoma

Purpose: Hypopharyngeal cancer is highly malignant,prone to local recurrence and distant metastasis,and the prognosis is often very poor.The treatment of early tumors is based on surgery and radiotherapy,while protecting organs and local functions as much as possible.However,there is no clear treatment standard for advanced hypopharyngeal carcinoma.This study aims to compare the survival and adverse reactions of patients with stage III and IV hypopharyngeal squamous cell carcinoma undergoing surgery combined with chemoradiotherapy and definitive chemoradiotherapy,and to analyze the prognostic factors of the patients.Methods: A retrospective analysis of the clinical case data of 85 patients with stage III and IV hypopharyngeal squamous cell carcinoma who were admitted to the department of radiation oncology of Bengbu Medical College First Affiliated Hospital from August 2013 to December 2018,and divided the patients into categories according to treatment methods Surgery combined with chemoradiotherapy group(n=30)and definitive chemoradiotherapy group(n=55).The median follow-up time was 32(10-90)months.The main observation indicators were overall survival(OS),progression-free survival(PFS)and local control rate(LCR).COX regression model was used to analyze the independent effects of patient prognosis factor.Results: The 3-year and 5-year OS of 85 patients were 37.5% and 30.9%,and the3-year PFS and LCR were 33.4% and 35.3%,respectively.The median survival time of 85 patients was 16 months.Among them,the 1,3,and 5-year OS of patients in the surgery combined with chemoradiotherapy group were 76.7%,51.1%,and 46.0%,respectively,and the definitive chemoradiotherapy group were50.8%,30.9%,and 21.6%,respectively.The difference was statistically significant(?2= 6.109,P=0.013);The 1,2,and 3-year PFS of patients in the surgery combined with chemoradiotherapy group were 66.0%,58.8%,and 46.5%,respectively,and the definitive chemoradiotherapy group were 45.3%,30.7%,and 26.8%,respectively.There were differences Statistically significant(?2=4.545,P=0.033);the 1,2,and 3-year LCR of patients in the surgery combined with chemoradiotherapy group were 72.9%,58.2%,and 46.0%,respectively,and the definitive chemoradiotherapy group were 47.1%,33.2%,30.7%,respectively,the difference is statistically significant(? 2=4.718,P=0.030).The independent prognostic factors of OS,PFS and LCR in patients with locally advanced hypopharyngeal squamous cell carcinoma are tumor T stage,N stage and treatment method.During the treatment period,there was a statistically significant difference in the incidence of radiation pharyngitis(P=0.002)and radiation dermatitis(P=0.020)between the surgery combined chemoradiotherapy group and the definitive chemoradiotherapy group.Conclusion: The OS,PFS and LCR of patients in the surgery combined with chemoradiotherapy group were higher than those in the definitive chemoradiotherapy group,and the incidence of adverse reactions was low.Tumor T stage,N stage,and treatment are all independent prognostic factors for OS,PFS and LCR in patients with locally advanced hypopharyngeal squamous cell carcinoma.