Survival outcomes in Hypopharyngeal cancer in the West of Scotland
Aim Approximately 5% 1 of all mucosal head and neck
(H&N) squamous cell cancers (SCC) arise from the hypopharynx.
1 Patients with hypopharyngeal SCC (HPSCC) tend to
have a poor prognosis compared with other subsites with reported 5-year
survival of 27% in the UK.2 Most patients (80%) have
stage III/IV disease at presentation.3 There are very
few HPSCC-specific studies and this subsite is not well represented in
more general H&N SCC trials. Thus, deciding the best treatment plan is
difficult and relies on the expertise of an experienced
multi-disciplinary team (MDT).4 Patient fitness for
treatment complicates matters further. The incidence of H&N cancer
increases with age and is closely correlated with
deprivation.1 The aim of this series was to review
outcomes of patients with HPSCC in our cancer network. Method This
retrospective study included all patients with a histological or
radiological diagnosis of HPSCC made from August 2016 to August 2018.
They were identified from the cancer network MDT database. Subsites
included pyriform fossa, post cricoid and posterior pharyngeal wall.
Data including patient demographics, treatment details, toxicity and
disease control were extracted from case records. Results 118 patients
were evaluable. 8 (6.7%) patients had a radiological diagnosis, the
remainder were biopsy proven HPSCC. The probability of survival at 24
months was higher in patients of good performance status (PS 0-1:
41.7%, 95% CI 29.7-53.2% Vs. PS ≥2: 27.5%, 95% CI 13.9-43.0%).
Patients aged >70 years had a lower probability of survival
at 24 months compared to those <70 (<70yrs 44.5%,
95% CI 27.1 – 55.9% Vs ≥70yrs 24.4%, 95% CI 12.6 – 38.3). 57
(48.3%) of the 118 patients were treated with radical intent, of which
19 (33%) died at time of follow-up. 14 of these deaths were cancer
related. The median time from primary surgery to adjuvant RT was 17
weeks. Conclusion Most patients with HPSCC present with locally advanced
disease and are unsuitable for active anti-cancer treatment. For those
treated radically the pattern of treatment failure is loco-regional. A
multimodality approach for locally advanced disease with surgery and
radiotherapy appears to be advantageous in terms of survival.