Clinical Investigation
Definitive Radiotherapy for T1-T2 Squamous Cell Carcinoma of Pyriform Sinus

https://doi.org/10.1016/j.ijrobp.2008.01.003Get rights and content

Purpose

To report the long-term results after definitive radiotherapy (RT) for T1-T2 pyriform sinus squamous cell carcinoma.

Patients and Methods

The data from 123 patients with T1-T2 pyriform sinus squamous cell carcinoma treated with RT with or without neck dissection between November 1964 and June 2003 were analyzed. The median follow-up for all patients was 3.2 years, and the median follow-up for living patients was 10.7 years.

Results

The 5-year local control, locoregional control, freedom from distant metastasis, cause-specific survival, and overall survival rate was 85%, 70%, 75%, 61%, and 35%, respectively. The ultimate local control rate, including successful salvage of RT failure, for T1 and T2 cancer patients was 96% and 94%, respectively. The overall local control rate with a functional larynx was 83%. Pretreatment computed tomography tumor volume data were available for 55 patients. The median computed tomography tumor volume was 4.2 cm3 (range, 0–22.4). Local control was worse for patients with a tumor volume >6.5 cm3 compared with those with a smaller tumor volume. Of the 123 patients, 16% developed moderate to severe acute (2%), late (9%), or postoperative (5%) complications.

Conclusions

Local control with larynx preservation after definitive RT for T1-T2 pyriform sinus squamous cell carcinoma likely results in local control and survival similar to that after total laryngectomy or larynx-conserving surgery. Two-thirds of our living patients retained a functional larynx.

Introduction

Cancer of the pyriform sinus, because of its close anatomic association with the larynx, frequently requires removal of the entire larynx when tumors in this region are managed surgically. The options for treating pyriform sinus tumors include total laryngectomy with or without radiotherapy (RT), larynx preservation with partial laryngopharyngectomy with or without adjuvant RT, or definitive RT with or without concomitant chemotherapy 1, 2. Although total laryngectomy has a high probability of controlling the tumor, it is associated with a disruption of speech, and only 20–25% of patients are rehabilitated long term with a tracheoesophageal prosthesis (3). For Stage T1 and low-volume T2 cancer, the choice between partial laryngopharyngectomy and RT with larynx conservation is controversial, although the preferred treatment for larger, more advanced tumors is total laryngectomy, partial pharyngectomy, and neck dissection combined with pre- or postoperative RT 4, 5, 6, 7, 8, 9, 10.

At the University of Florida, patients with favorable Stage T1 and T2 pyriform sinus carcinoma have routinely been treated with RT alone or RT followed by neck dissection 1, 11. In recent years, we have added concomitant cisplatin chemotherapy for patients with Stage III or IV disease after the published data showed that this approach improves locoregional control and survival compared with RT alone 2, 12, 13. The purpose of this report was to update the University of Florida experience treating Stage T1-T2 pyriform sinus squamous cell carcinoma (SCC) with a larynx-conserving approach of definitive RT alone or combined with neck dissection and/or chemotherapy.

Section snippets

Patients and Methods

A total of 123 patients with previously untreated Stage T1-T2N0-N3M0 SCC of the pyriform sinus were treated with curative intent with definitive RT between November 1964 and June 2003. The patients were excluded if they had been treated with a planned split-course, postoperative, or palliative RT. The follow-up was 0.2–22.2 years (median, 3.2), and the follow-up of the living patients was 3.5–18.7 years (median, 10.7). No patient was lost to follow-up. The median age was 63 years (range,

Time to recurrence

Of the 123 patients, 46 (37%) developed local, regional, and/or distant recurrence. Of the recurrences, 95% and 97% were observed within 2 and 5 years of RT, respectively. One patient developed a recurrence at the primary site 5 years, 8 months after RT and was successfully salvaged with total laryngectomy.

Local control

The local control and ultimate local control rates, including those successfully salvaged after local recurrence, are given in Table 2. The 5-year local control rate after RT was 85% for

Discussion

The results of our study have shown that patients with Stage T1 and low-volume Stage T2 pyriform sinus cancer can be treated with either partial laryngectomy or RT with a relatively high likelihood of local control. Whether the larynx can be preserved in surgically treated patients depends on the training and experience of the surgeon and the medical condition of the patient. In particular, patients must have an adequate pulmonary reserve to withstand aspiration in the postoperative period.

Conclusions

Patients with Stage T1 and low-volume Stage T2 pyriform sinus carcinoma have a relatively high chance of local control with larynx preservation after either definitive RT or partial laryngopharyngectomy. Survival depends primarily on the extent of the nodal disease. The likelihood of complications might be greater after surgery, and because a substantial proportion require postoperative RT, the likelihood of complications is possibly greater after combined modality treatment compared with

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