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Primary surgery may improve advanced-stage hypopharyngeal squamous cell carcinoma outcomes
Patients with advanced-stage hypopharyngeal squamous cell carcinoma who underwent surgical management demonstrated a trend toward clinically improved OS and RFS compared with patients who underwent definitive chemoradiation, according to the results of a single-institution, retrospective analysis.
However, this association did not reach statistical significance and requires further examination, according to the researchers.
Patients with stage III or IV hypopharyngeal squamous cell carcinoma (HP SCC) often have poor outcomes (5-year OS, 36%; 5-year RFS, 24%), according to study background. Further, there is currently no consensus regarding a standard treatment approach for these patients.
Megan E. Daly, MD, of the department of radiation oncology at the University of California, Davis, and colleagues sought to compare the survival outcomes associated with primary surgery plus adjuvant radiation therapy or chemoradiation vs. definitive chemoradiation in 76 patients (median age, 63.3 years; range, 27-84) with newly diagnosed advanced-stage HP SCC. All patients received treatment at UCD between 1999 and 2013.
Researchers included patients who underwent surgery or definitive chemoradiation with curative intent. Exclusion criteria included presentation at an early disease stage, palliation treatment or the presence of a second primary lesion.
Sixty-three percent of patients (n = 48) underwent definitive chemoradiation with or without salvage surgery. The other 37% (n = 28) of patients underwent primary surgery followed by adjuvant radiotherapy (n = 22) or chemoradiation (n = 6). Both cohorts were similarly matched regarding age, sex, smoking status, alcohol use and tumor stage.
Median follow-up was 17 months (range, 6-120).
Surgically treated patients demonstrated an estimated 5-year OS of 66.3% and 5-year RFS of 53.6%, whereas patients who underwent definitive chemoradiation demonstrated an estimated 5-year OS of 41.3% and 5-year RFS of 34.5%. These differences demonstrated a trend toward improved outcomes but did not reach statistical significance.
In a multivariate analysis, researchers observed an association between higher Karnofsky performance status and improved OS and RFS (P = .01 for both).
Up-front surgical management improved OS (HR = 4.78; 95% CI, 0.91-25.03) and RFS (HR = 2.97; 95% CI, 0.76-11.53) compared with definitive chemoradiation; however, these associations remained statistically insignificant.
The researchers identified selection bias due to non-randomization as a potential study limitation. They also acknowledged the small patient cohort and abbreviated median follow-up as potential limitations to these findings.
“In a single-institution analysis of survival, patients with advanced-stage HP SCC treated surgically showed improved RFS over those treated with chemoradiation, and both cohorts had excellent outcomes compared with historical controls,” Daly and colleagues concluded. “Although institutional studies are limited in scope and power, they remain a realistic approach and potentially account for real-world differences better than randomized clinical trials, which in this population remain difficult to execute … Further prospective investigations using modern concurrent chemoradiation and modern surgical techniques remain necessary.” – by Cameron Kelsall
Disclosure: The researchers report no relevant financial disclosures.