Analysis of surgical therapy versus chemoradiation in advanced hypopharyngeal cancer

Presentation: C066
Topic: Pharynx / Larynx Cancer
Type: Poster
Date: Thursday, April 19, 2018
Session: 9:00 AM - 7:00 PM
Authors: Viran J Ranasinghe, Jason G Newman, MD, Jason A Brant, MD
Institution(s): University of Pennsylvania

Background: Current treatment guidelines for advanced hypopharyngeal cancer include chemoradiation and primary surgery with adjuvant therapy. Smaller studies have indicated that treatment modalities including surgery may have improved survival. The goal of our study was to compare the effect of different treatment modalities on overall survival, specifically surgical vs. nonsurgical options.

Methods: All patients diagnosed with clinical stage III to IVB (excluding T4B) primary hypopharyngeal SCC between 2004 and 2012 were selected from the National Cancer Database. Overall survival was analyzed using Kaplan-Meier survival curves. Univariable analysis and multivariable Cox regression analysis were used to identify factors associated with improved survival.

Results: 7,467 patients met inclusion criteria. The most common treatment modality was chemoradiation (CRT) (4,456, 59.7%), followed by primary radiation (RT) (544, 7.3%), and surgery with CRT (517, 6.9%). The highest 5-year survival was seen in surgery with RT (40.6%) followed by surgery with CRT (39.5%), primary surgery (34.8%) and primary CRT (34%). Primary RT had a 15% 5-year survival. In multivariate analysis, surgery with RT (HR 0.79, p = 0.006) and surgery with CRT (HR 0.81, p = 0.001) showed improved survival compared to primary chemoradiotherapy, while primary RT showed decreased survival (HR 1.72, p < 0.001).

Conclusions: Survival analysis of advanced hypopharyngeal cancer patients showed overall 5-year survival rates were higher in patients treated with surgery with adjuvant therapy and equivalent in primary surgery when compared to primary CRT.