Factors affecting results of treatment of Hypopharyngeal Carcinoma

A retrospective review of patients with malignant neoplasms of the hypopharynx treated with combined surgery and radiotherapy is presented to highlight the results of treatment and the factors of treatment success for this malignant disease.

Between 1995 and 2004 at the University ORL Clinic Nis 89 patients with malignant neoplasms of hypopharynx (85 males, 4 females, and age ranging from 44 to 77 years) were treated. In the 89 patients (stage I, n=4; stage II, n=3; stage III, n=34; stage IV, n=48), the sites of origin were pyriform sinus (n=75), postcrycoid (n=8), posterior pharyngeal wall (n=3) and superior hypopharynx (n=3).

Laryngeal preservation surgery was achieved in 11.2% of patients, while 88.8% had laryngectomy with partial or total pharyngectomy. Pyriform sinus was the most common site of origin of hypopharyngeal carcinoma in 84.3%. Totally 93% of patients had neck metastases, and tumors extended beyond the hypopharynx in 41.6% of patients. TNM stage was highly significant parameter of outcome. Five year survival was 100% for stage I, 66.6% for stage II, 53.9% for stage III, and 33.3% for stage IV. Residual disease (5.6%) and recurrent disease (2.2%) were low. Postoperative fistula developed in 16.8% of patients, and in 60% it was closed successfully using local flaps, while in 40% pectoralis flap was needed. Localization of disease was also an important factor of survival. Retrocrycoid carcinoma resulted in very poor survival rate (12.5%), high residual disease, lymph node metastasis, and pharyngocutaneous fistula formation.

Localization and TNM stage are highly significant factors for clinical course, treatment, and outcome of hypopharyngeal carcinoma.