The treatment results of 65 patients with hypopharyngeal
carcinomas treated at our institute between 1995 and 2000 were analyzed. In general,
concurrent radiochemotherapy (RCT), consisting of intravenous
5-FU injection, intra-muscular
vitamin A injection, and radiation (FAR
therapy) was used as an initial treatment for advanced hypopharyngeal
carcinomas and early hypopharyngeal
carcinomas.
Tumor responses were evaluated at the time of radiation doses of 30Gy. Patients who showed a complete response (CR) subsequently received curative radiation doses of 60 to 70Gy. Patients who did not show a CR underwent radical surgery consisting of pharyngo-laryngo-cervical
esophagectomy,
neck dissection for positive cervical nodes and/or the primary
tumor sides, and reconstruction using a free jejunum flap. The disease-specific 5-year survival rates were 92%, 55%, 35% and 49% for stage I/II, III, IV and all cases, respectively. Eight out of 9 patients with stage I/II disease who showed a CR after receiving 30Gy of RCT survived with an intact larynx after definitive RCT. All the patients with stage II/III disease who underwent radical surgery after receiving 30Gy of RCT did not have a recurrence, whereas the 5-year survival rate of patients with stage IV disease who underwent RCT and radical surgery was 45%. Seventeen out of 19 patients with clinically negative cervical nodes on the opposite side of their primary
tumors showed no nodal
metastasis after RCT without
neck dissection. This result suggests that elective
neck dissection after RCT is not necessary. To improve the treatment results for hypopharyngeal
carcinomas, early detection of this disease is prerequisite. In addition, the clinical diagnosis of highly malignant cases and new
molecular-targeted therapies based on an analysis of distant
metastasis mechanisms should be developed to overcome the poor prognosis of advanced hypopharyngeal
carcinomas.