HYPOPHARYNX

ANATOMY of HYPOPHARYNX

  • pharyngeal walls
  • piriform sinus
    • medial wall is lateral larynx
    • supriorly is aryepiglottic fold
    • lateral is lateral wall of the oropharynx
  • postcricoid pharynx

TREATMENT SUMMARY

TREATMENT INDICATIONS
CONVENTIONAL RADIATION T1 N0
* 66 Gy in 33 fractions
ALTERED FRACTIONATION T2 N0
* 81.6 GY in 1.2 GY BID or
* 72 Gy in 1.8 Gy BID with 1.5 Gy last 12 fractions with PM dose
CONCURRENT CHEMORADIATION T3-4 ("small") or N+ (Except as noted in post-op section)
* 70 Gy in 2 Gy per fraction with Cisplatin 100 mg/m2 on days 1, 22, 43
POST-OP Post-operative RT +/- Chemo as indicated

COMPLICATIONS OF RADIATION

Laryngeal

  • edema

Esophageal

  • stenosis or stricture
  • Persistent dysphagia,
  • tissue necrosis

Spinal Cord

  • Lhermitte’s syndrome.

Endocrine

  • Hypoparathyroidism
  • hypothyroidism

TRIALS EORTC [1]

Eligibility

  • SCCA of pyriform sinus or hypopharyngela aspect of aryepiglottic fold
  • T2 (excluding exophytic T2 of membranous portion of the pyriform sinus or of the AE-fold)
  • T3, or T4 with N0, N1, N2a, or N2b or N3 (N2c were excluded)

Chemotherapy

  • Cisplatin 100 mg per square meter
  • 5-FU 1000 mg per squre meter over days 1-5

Radiation

  • 70 Gy in 35 fractions

Surgery

  • Total laryngectomy and partial pharyngectomy

Response

  • An endoscopic evaluation was performed after each cycle of chemotherapy.
  • CR was
    • complete disappearance of macroscopic disease
    • and complete recovery of larynx mobility
  • Partial Response was decrease in primary tumor area ≥ 50%.
  • Progressive Disease was increase in primary tumor area ≥ 25%

Results

EORTC (JNCI 96) Chemo x 2 or 3 cycles
less than CR radical resection
then PORT 50-70 Gy
Chemo x 2 or 3 cycles
CR had definitive RT 70 Gy
Organ Preservation 0% 42% (64% for patients with CR)
OS-5 29% 34%

Conclusion

  • No difference in overall survival at 5 years. The OS-3 favored organ preservation arm.
  • no statistical difference between the arms in either of the rates of local and regional failures.
Bibliography
1. Lefebvre J-L, Chevalier D, Luboinski B, et al. Larynx preservation in pyriform sinus cancer: Preliminary results of a European Organization for Research and Treatment of Cancer phase III trial. J Natl Cancer Inst 1996;88:890-899.
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