Postoperative Radiotherapy in Hypopharyngeal Cancer: Single-institution Outcome Analysis

Purpose: To retrospectively review the outcomes of adjuvant postoperative radiotherapy (PORT) following surgery in patients with advanced hypopharyngeal cancer treated at an academic tertiary referral center. Methods: Data of patients treated with curative intent in a single radiotherapy unit over a 15-year period (1990-2004) with upfront surgery followed by PORT was retrieved from an electronic database. Local control (LC), locoregional control (LRC) and disease-free survival (DFS) were considered as outcome measures. Results: The study dataset constituted 159 patients with a median age of 55 years (range 30-79 years). Patients underwent either radical surgery (total laryngectomy with or without pharyngectomy) or voice-conserving surgery. All patients underwent appropriate comprehensive neck dissection. The median radiotherapy dose was 60 Gy (inter-quartile range 50-60 Gy). With a mean follow-up of 21 months (inter-quartile range 6-29 months), the 3-year LC, LRC, and DFS was 87.8%, 70.3% and 62.2% respectively. Cut margin negativity and pyriform sinus subsite predicted for improved LRC and DFS on univariate analysis. Cut margin status was the only independent predictor of outcome on multivariate analysis. Conclusion: Hypopharyngeal cancer characterized by advanced disease at presentation. Definitive surgery (either voice-conserving or radical) followed by adjuvant radiotherapy provides good LRC and DFS and continues to remain a valid upfront treatment option for advanced hypopharyngeal cancer. Cut margin status and primary subsite are important determinants of outcome.