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Neoadjuvant treatment combined with planned surgery in laryngeal function preservation for locally advanced pyriform
Yue Yu1, Xiaolei Wang, Zhengang Xu
1From the *Department of Head and Neck Surgery; and †Department of Radiation Oncology, Cancer Hospital, Cancer Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China.
Objectives:
This study aimed to determine the efficacy and feasibility of preoperative radiotherapy with or without chemotherapy (XRT) followed by surgery of locally advanced pyriform sinus carcinoma.
Materials And Methods:
We performed a retrospective study of 482 patients with T3 and T4 pyriform sinus carcinoma treated with curative intent between 1979 and 2008. The patients were divided into 4 groups according to different treatment patterns.
Results:
The 5-year disease-special survival rate was 32%. Survival was best for the patients treated with surgery followed by XRT (41.1%) and with neoadjuvant XRT followed by surgery (39.4%), but it was worse with surgery only (27.1%) and XRT alone (23%). The disease-special survival was significantly different between the patients who accepted multidisciplinary therapy and those who accepted single therapy (P<0.001). The 5-year laryngeal function preservation survival rate of the patients with XRT followed by surgery was 13.6%, which was similar to those with XRT alone (16.2%), and superior to those who accepted surgery followed by XRT (3.8%) and surgery alone (0). Multivariate analysis results revealed that treatment pattern is an independent predictor of both overall and laryngeal function preservation survival rates (P < 0.001; hazard ratio, 0.56; 95% confidence interval, 0.44-0.71). Perioperative wound complications were not different among the patients in the 3 groups who accepted surgical treatment (P > 0.05).
Conclusions:
The results suggested that neoadjuvant XRT followed by planned surgery was feasible with satisfactory oncological and functional outcomes.
