In this study, we evaluated the potential for induction chemotherapy to be used in the management of advanced hypopharyngeal carcinoma with cervical oesophageal invasion. Seventy percent of hypopharyngeal cancers are advanced at the time of diagnosis (6); advanced hypopharyngeal cancer can spread submucosally and tends to invade the cervical oesophagus (7). From February 2003 to November 2016, we treated approximately 800 patients diagnosed with hypopharyngeal cancer, and 75 patients had lesions involving the cervical oesophagus, accounting for approximately 9.38% of all hypopharyngeal cancers. In this study, the 3- and 5-year OS rates were 20.59% and 5.88% in all patients, respectively, which was similar to that shown in the previously reported study on concomitant hypopharyngeal and oesophageal cancers (4).
Surgery is still the main treatment strategy for advanced hypopharyngeal cancer with cervical oesophageal invasion. Surgical treatment mainly includes three aspects: primary tumour excision; cervical lymph node dissection; and pharynx and digestive tract reconstruction, among which the reconstruction of the pharynx and digestive tract is the biggest challenge. In recent years, there have been many reports on the postoperative repair and reconstruction of advanced hypopharyngeal cancer (8–9). In this study, the reconstruction of the pharynx and digestive tract was performed mainly by one of the three different methods described in previous studies (8, 10, 11). For unilateral piriform sinus carcinoma, the lesion invaded the oesophageal inlet and did not reach the circumference of the oesophageal canal cavity but infiltrated downward for up to 2–3 cm, and it is feasible to repair the residual hypopharyngeal mucosa and the upper oesophageal mucosa with a pectoralis major myocutaneous flap. For pyriform sinus carcinoma or posterior pharyngeal wall carcinoma with a large range that has crossed the midline and has a 2–3 cm downward infiltration, the digestive tract can be repaired by residual laryngeal anastomosis instead of hypopharyngeal and oesophageal anastomosis. For annular tumours that infiltrated more than 2–3 cm from the inlet of the oesophagus, total esophagectomy can be performed, and the oesophagus can be replaced by a gastric lift or free jejunum or colon.
Induction chemotherapy, also known as neoadjuvant chemotherapy, refers to the chemotherapy administered before surgery or radiotherapy, which can reduce the tumour load in a short period of time. Induction chemotherapy has been widely used in clinical practice in recent years. Commonly used induction chemotherapy regimens in clinical practice include the TPF regimen and the PF (platinum + fluorouracil) regimen; TPF is significantly more effective than PF (12). Induction chemotherapy can increase the retention of organ function by shrinking the tumour (13). It also acts as a screening procedure to identify patients sensitive to treatment by either radiotherapy or concurrent chemoradiotherapy; for insensitive patients, surgical treatment is preferable. Induction chemotherapy is responsible for creating a more individualized, standardized, and precise treatment for advanced hypopharyngeal cancer (14).
According to our results, before 2010, patients were mainly treated surgically, and the treatment methods were relatively simple. With the increase in the volume of related studies and the advancements in treatment methods, treatment options after 2010 were no longer dominated by surgery, and adjuvant management methods such as chemotherapy and radiotherapy were added.
The differences in the 3- and 5-year OS rates between Groups A and B were not statistically significant, but the laryngeal and oesophageal retention rates in patients in Group A were significantly higher than those in Group B. The laryngeal and oesophageal retention rates are the important indicators of survival quality in patients with hypopharyngeal and oesophageal cancers. Using induction chemotherapy, we could screen for sensitive patients, for whom radiotherapy or concurrent chemoradiotherapy regimens were administered. The survival rate of these patients was not affected, but their quality of life was improved. For patients insensitive to the induction chemotherapy, surgical treatment was not delayed, and in some cases, tumour size was reduced, which can improve the response to surgery and postoperative adjuvant therapy. This can also serve as an effective treatment. We found that there was no significant difference in the incidence of postoperative complications between the two groups, indicating that induction chemotherapy did not increase the incidence of surgical complications. Generally speaking, surgery is the main treatment method for advanced hypopharyngeal carcinoma, and patients who undergo surgery tend to have a longer OS; however, the surgical resection is large, the postoperative quality of life is poor, and the incidence of postoperative complications is high, which are the disadvantages of surgery.
This study does have limitations. When we performed the univariate analysis of survival, there was no significant difference between the two groups, regardless of age, sex, anatomic sub-region, the degree of differentiation, cervical lymph node metastasis, smoking status, and alcohol consumption. This could be due to the small number of cases included in this study. Further studies with larger sample sizes are needed to determine the relevance of the factors affecting survival.