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Surgical treatment improves OS in advanced throat cancers
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Primary surgery yielded more favorable OS outcomes than concurrent chemoradiotherapy among patients with oropharyngeal and hypopharyngeal cancer, according to research presented at European Society of Medical Oncology’s European Cancer Congress.
Whether to recommend primary surgery or concurrent chemoradiotherapy (CCRT) for patients with advanced throat cancers remains controversial, according to the researchers.
“The emphasis on organ preservation has led to declining use of surgery,” Chih-Tao Cheng, MD, medical research at Koo Foundation Sun Yat-Sen Cancer Center in Taipei City, Taiwan, said in a press release. “CCRT has become a standard approach for head and neck cancers which cannot be operated on, and it is being used alone even when surgery is possible. With the improvement of surgical techniques, including minimally invasive procedures, there’s a need to revisit the various treatment options and look at the OS of different treatment groups.”
Randomized clinical trials seeking to compare treatment approaches have experienced recruitment issues. Thus, Cheng and colleagues conducted a retrospective database study to investigate OS outcomes in patients who underwent primary surgery, compared with those who did not.
Researchers used the Taiwan National Health Insurance Claims Database and Taiwan Cancer Registry Database to identify 2,387 patients with newly diagnosed oropharyngeal cancer and 2,315 patients with newly diagnosed hypopharyngeal cancer between 2004 and 2009.
Follow-up continued until 2012.
The final analysis included data from 3,317 patients (oropharyngeal cancer, n = 1,698; hypopharyngeal cancer, n = 1,619), all of whom had stage III or stage IVA disease. Thirty-five percent of patients with stage III oropharyngeal cancer and 38% of patients with stage IVA oropharyngeal cancer had radical surgery.
Among patients with hypopharyngeal cancer, 55% of patients with stage III disease and 49% patients with stage IVA disease underwent surgery.
A significantly higher proportion of patients who underwent surgery — regardless of whether they also received CCRT — remained alive at 5 years in the cohort of patients with oropharyngeal cancer (stage III, 59% vs. 48%; stage IVA, 51% vs. 40%) and hypopharyngeal cancer (stage III, 54% vs. 33%; stage IVA, 39% vs. 26%).
“Substantial improvements in the treatment of head and neck cancer have been made in the past 2 decades,” Cheng said. “Many patients do not agree to surgery because of a fear of functional impairment, such as the impact on speech and swallowing. This study suggests that avoiding surgery may significantly reduce their survival chances.” – by Cameron Kelsall
Reference:
Cheng CT, et al. Abstract 2804. Presented at: European Cancer Congress; September 25-29, 2015; Vienna.
Disclosure: The researchers report no relevant financial disclosures.