Comparison of different treatment modalities in advanced laryngeal hypopharyngeal squamous cell carcinoma.

OBJECTIVE To compare outcome of patients with advanced laryngeal hypopharyngeal squamous cell carcinoma treated surgically or with chemotherapy and/or radiotherapy. STUDY DESIGN Observational study. PLACE AND DURATION OF STUDY The Aga Khan University Hospital, Karachi, from January 2000 to December 2005. METHODOLOGY Medical records of already treated stage-III and IV squamous cell carcinoma of larynx/hypopharynx patients were reviewed. Group-A comprised of patients treated with surgery +/- adjuvant therapy whereas non-surgically managed patients were labeled as group-B. One hundred and nineteen out of 275 met the inclusion criteria. Kaplan Meier technique was used to estimate mean recurrence time with standard errors. Cox proportional hazard regression was used to estimate the hazard ratio with 95 percent confidence interval for gender, age and tumour location. RESULTS Sixty two percent of group-A and 49% patients of group-B were stage-III. In group-A, 40% patients received postoperative adjuvant therapy while in group-B, 45% received concomitant chemoradiation. Mean follow-up duration was 18.3 months. Mean recurrence time was 1369+193 days. In group-A, mean recurrence time was 2097+277 days. It was 399+/-68 days for group-B patients (p < 0.001). The hazard ratio of recurrence in hypopharyngeal tumours was 1.5 times (95% CI 0.68, 3.30) as compared to tumours of larynx. The hazard ratio of recurrence was 1.98 times (95% CI 0.99, 3.95) when both larynx and hypopharynx were involved as compared to when tumour was localized to larynx only. No residual disease was noted at the completion of treatment in surgical group-A while 62% patients of the group-B had residual disease at the completion of treatment. Larynx was retained in only 25% patients in group-B. CONCLUSION Statistically significant difference was noted in disease free outcome when stage-III and IV larynx hypopharynx cancer was managed surgically as compared to non-surgical management. Chances of retaining larynx are only 25% when managed non-surgically.