Radical irradiation for carcinoma of the pyriform sinus

Radiation therapy is sometimes prescribed as an alternative to partial or total laryngopharyngectomy in the initial management of carcinoma of the pyriform sinus. Forty-two patients were irradiated for cure and have a follow-up period of 2-14 years. Local control by irradiation alone was 11 of 14 for T1, 6 of 10 for T2, 3 of 6 for T3, and 1 of 7 T4. Three T2 failures were salvaged by laryngopharyngectomy for an ultimate control of 9 of 10 for T2. Management of the neck is critical since 79% of the patients presented with clinically positive necks, and many had substantial neck disease. Complete or partial neck dissection was added after irradiation on an individualized basis. In spite of the extensive degree of neck disease, only three patients died of uncontrolled neck disease with the primary controlled. The two-year absolute survival for Stages I and II was 83%, Stage III 62% and Stage and Stage IV 52%. The five-year absolute survival for Stages I and II was 66%, Stage III 38%, and Stage IV 10%. Complications of irradiation, neck dissection, and surgical salvage procedures are reviewed.