Cancer of the pyriform sinus: trends towards conservative treatment

Despite progress in diagnostic methods, radiotherapeutic and surgical techniques, and the development of new chemotherapeutic agents, the prognosis of pyriform sinus carcinomas has not improved in a significant way over the last 2 decades. Whatever the treatment approach, for all stages combined, the overall survival at 5 years remains modest and rarely exceeds 30%. Deaths from distant metastases, second cancers and intercurrent diseases represent 30-40% of cases. For this, any improvement in loco-regional control does not necessary translate into a gain in survival. Thus, for these patients it is judicious to consider not only the loco-regional control but also the quality of life since larynx preservation is concerned. In this review article, the results of different treatment approaches are illustrated by the most representative series in the recent literature. Early stages (T1-2) are managed conservatively either by radical radiotherapy or conservative surgery, although the former is the most frequently utilized as it requires less stringent patient selection. For more advanced stages (T3-4), recent tendencies appear to lean toward the use of primary radical radiotherapy with or without chemotherapy, with surgery reserved for persistent or recurrent tumor. However, this strategy is still under study and the initial results should be confirmed.