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Published on: April 20, 2018
A Comparative Study of Initiated Chemotherapy Versus Initiated Surgery Combined with Primary-Radiotherapy in
D-W Zhao1, H-Y Jiang2, W-J Fan3
1Department of Oncology, Characteristic Medical Center of Chinese People's Armed Police Force, Tianjin, China; Department of Radiation Oncology, First Medical Center of Chinese PLA General Hospital, Beijing, China; Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China.
Background:
Laryngeal preservation is a pivotal treatment goal in managing locally advanced hypopharyngeal carcinoma (LAHPC). This study compares the outcomes of induction chemotherapy followed by concurrent chemoradiotherapy (IcRT) and surgery followed by radiotherapy or concurrent chemoradiotherapy (SurRT) in patients with LAHPC.
Methods:
This study included 182 patients with LAHPC treated with either IcRT (n = 137) or SurRT (n = 45). Survival with a functional larynx (SFL), overall survival (OS), progression-free survival (PFS), local failure-free survival (LFFS), locoregional failure-free survival (LRFFS), and distant metastasis-free survival (DMFS) were analyzed. Propensity score matching (PSM) was performed to balance baseline characteristics between the two treatment groups.
Results:
The IcRT group demonstrated significantly superior 5-yr SFL compared to the SurRT group (50.4% vs. 30.5%, HR 2.38, 95% CI 1.40-4.03, P < 0.001). However, there were no significant differences between the two groups in 5-yr OS (55.2% vs. 56.8%, HR 0.80, P = 0.41), PFS (48.5% vs. 45.7%, HR 0.99, P = 0.99), LFFS (55.1% vs. 57.7%, HR 0.86, P = 0.57), or DMFS (50.2% vs. 42.8%, HR 1.02, P = 0.90), in both pre- and post-PSM analyses. The IcRT group exhibited greater radiation-related toxicities but achieved better local control and distant metastasis rates, while the SurRT group had a lower rate of regional recurrence. T classification and clinical stage were identified as independent prognostic factors for survival outcomes.
Conclusions:
IcRT may offer enhanced laryngeal preservation compared to SurRT in select patients, albeit with higher acute toxicities. Treatment decisions should prioritize both oncologic outcomes and patient tolerance.
