Extended voice-sparing surgery in selected pyriform sinus carcinoma: Techniques and outcomes
Corresponding Author
Marc Hamoir MD
Department of Head and Neck Surgery, Head and Neck Oncology Program, St Luc University Hospital Cancer Center, Catholic University of Louvain, Brussels, Belgium
Department of Head and Neck Surgery, St Luc University Hospital Cancer Center, Brussels, Belgium. E-mail: [email protected]Search for more papers by this authorJuliette Fievez MD
Department of Head and Neck Surgery, Head and Neck Oncology Program, St Luc University Hospital Cancer Center, Catholic University of Louvain, Brussels, Belgium
Search for more papers by this authorSandra Schmitz MD
Department of Head and Neck Surgery, Head and Neck Oncology Program, St Luc University Hospital Cancer Center, Catholic University of Louvain, Brussels, Belgium
Search for more papers by this authorDorris Velasco MD
Department of Head and Neck Surgery, Head and Neck Oncology Program, St Luc University Hospital Cancer Center, Catholic University of Louvain, Brussels, Belgium
Search for more papers by this authorBenoît Lengele MD, PhD
Department of Plastic and Reconstructive Surgery and Unit of Experimental Morphology, St Luc University Hospital Cancer Center, Catholic University of Louvain, Brussels, Belgium
Search for more papers by this authorCorresponding Author
Marc Hamoir MD
Department of Head and Neck Surgery, Head and Neck Oncology Program, St Luc University Hospital Cancer Center, Catholic University of Louvain, Brussels, Belgium
Department of Head and Neck Surgery, St Luc University Hospital Cancer Center, Brussels, Belgium. E-mail: [email protected]Search for more papers by this authorJuliette Fievez MD
Department of Head and Neck Surgery, Head and Neck Oncology Program, St Luc University Hospital Cancer Center, Catholic University of Louvain, Brussels, Belgium
Search for more papers by this authorSandra Schmitz MD
Department of Head and Neck Surgery, Head and Neck Oncology Program, St Luc University Hospital Cancer Center, Catholic University of Louvain, Brussels, Belgium
Search for more papers by this authorDorris Velasco MD
Department of Head and Neck Surgery, Head and Neck Oncology Program, St Luc University Hospital Cancer Center, Catholic University of Louvain, Brussels, Belgium
Search for more papers by this authorBenoît Lengele MD, PhD
Department of Plastic and Reconstructive Surgery and Unit of Experimental Morphology, St Luc University Hospital Cancer Center, Catholic University of Louvain, Brussels, Belgium
Search for more papers by this authorAbstract
Background
Organ-preservation approaches are frequently favored in the treatment of advanced pyriform sinus carcinoma. In selected cases, use of free flaps allows voice-sparing surgery.
Methods
Thirteen patients underwent conservative extended laryngopharyngectomy. In 11 patients, the resection included the supraglottic larynx, whereas the whole hemilarynx was resected in 2. Reconstruction was achieved with a radial forearm free flap with the palmaris longus tendon. In hemilarynx resection, a costal graft was also used. Functional results were assessed by nasofibroscopy and swallowing videofluoroscopic tests.
Results
At 12 months, no patient was gastrostomy dependent, whereas 1 patient remained tracheostomy dependent. At 1, 3, and 5 years, the locoregional control was 100%, 100%, and 83%; overall survival was 69.4%, 46.3%, and 30.8%; and disease-specific survival was 81.2%, 54.5%, and 36.4%, respectively.
Conclusions
In selected patients, extended conservative laryngopharyngectomy challenges the oncologic results of organ-preservation protocols and allows a good quality of life. © 2012 Wiley Periodicals, Inc. Head Neck 35: 1482–1489, 2013
REFERENCES
- 1Hamoir M, Machiels JP, Schmitz S, Gregoire V. Multidisciplinary management of hypopharyngeal carcinoma. In: J Bernier, editor. Head and neck cancer. Multimodality management. New York: Springer; 2011. pp 431–456.
10.1007/978-1-4419-9464-6_30 Google Scholar
- 2Shah JP, Shaha AR, Spiro RH, Strong EW. Carcinoma of the hypopharynx. Am J Surg 1976; 132: 439–443.
- 3Plouin Gaudon I, Lengelé B, Desuter G, et al. Conservation surgery for selected pyriform sinus cancer. Eur J Surg Oncol 2004; 30: 1123–1130.
- 4Kajanti M, Mäntylä M. Carcinoma of the hypopharynx. A retrospective analysis of the treatment results over a 25-year period. Acta Oncol 1990; 29: 903–907.
- 5Kraus DH, Zelefsky MJ, Brock HA, et al. Combined surgery and radiation therapy for squamous cell carcinoma of the hypopharynx. Otolaryngol Head Neck Surg 1997; 116: 637–641.
- 6Ogura JH, Marks JE, Freeman RB. Results of conservation surgery for cancers of the supraglottis and pyriform sinus. Laryngoscope 1980; 90: 591–600.
- 7Vandenbrouck C, Eschwege F, De La Rochefordiere A, et al. Squamous cell carcinoma of the pyriform sinus: retrospectivestudy of 351 cases treated at the Institut Gustave-Roussy. Head Neck Surg 1987; 10: 4–13.
- 8Chevalier D, Watelet JB, Darras JA, Piquet JJ. Supraglottic hemilaryngopharyngectomy plus radiation for the treatment of early lateral margin and pyriform sinus carcinom. Head Neck 1997; 19: 1–5.
10.1002/(SICI)1097-0347(199701)19:1<1::AID-HED1>3.0.CO;2-A CAS PubMed Web of Science® Google Scholar
- 9Eckel HE, Staar S, Volling P, Sittel C, Damm M, Jungehuelsing M. Surgical treatment for hypopharynx carcinoma: feasibility, mortality and results. Otolaryngol Head Neck Surg 2001; 124: 561–569.
- 10Urken ML, Blackwell K, Biller HF. Reconstruction of the laryngopharynx after hemicricoid/hemithyroid cartilage resection. Preliminary functional results. Arch Otolaryngol Head Neck Surg 1997; 123: 1213–1222.
- 11Hamoir M, Lengelé B, Rombaux P, Badr El-Din E, El Fouly P. Stretched radial forearm flap for reconstruction of the laryngopharynx: an alternative conservation procedure for radiation failure carcinoma of the pyriform sinus Laryngoscope 1999; 109: 1339–1343.
- 12Kim MS, Joo YH, Cho KJ, Park JO, Sun DI. A classification system for the reconstruction of vertical hemipharyngolaryngectomy for hypopharyngeal squamous cell carcinoma. Arch Otolaryngol Head Neck Surg 2011; 137: 88–94.
- 13Mendenhall WM, Parsons JT, Cassisi NJ, Million RR. Squamous cell carcinoma of the pyriform sinus treated with radical radiation therapy. Radiother Oncol 1987; 9: 201–208.
- 14Ho CM, Ng WF, Lam KH, Wei WJ, Yuen AP. Submucosal tumor extension in hypopharyngeal cancer. Arch Otolaryngol Head Neck Surg 1997; 123: 959–965.
- 15Ogura JH, Watson RK, Jurema AA. Partial pharyngectomy and neck dissection for posterior hypopharyngeal cancer. Immediate reconstruction with preservation of voice. Laryngoscope 1960; 70: 1523–1534.
- 16Ogura J, Jurema A, Watson R. Partial laryngopharyngectomy and neck dissection for pyriform sinus cancer. Conservation surgery with immediate reconstruction. Laryngoscope 1960; 70: 1399–1417.
- 17Andre P, Pinel J, Laccourreye H. La chirurgie partielle verticale dans les cancers du sinus piriforme [in French]. Ann Oto-Laryngol (Paris) 1965; 82: 901–908.
- 18Laccourreye O, Mérite-Drancy A, Brasnu D, et al. Supracricoid hemilaryngopharyngectomy in selected pyriform sinus carcinoma staged as T2. Laryngoscope 1993; 103: 1373–1376.
- 19Baillet F, Simon JM, Rozec C, et al. Intérêt de l'association chirurgie paritelle- radiothérapie postopératoire pour le traitement des tumeurs de l'hypopharynx. Etude à propos de142 T1–T2 traités par chirurgie partielle, chirurgie radicale ou radiothérapie exclusive [in French]. Bull Cancer Radiother 1996; 83: 65–69.
- 20Garden AS, Morrisson WH, Clayman GL, Ang KK, Peter LJ. Early squamous cell carcinoma of the hypopharynx: outcomes of treatment with radiation alone to the primary disease. Head Neck 1996; 18: 317–322.
10.1002/(SICI)1097-0347(199607/08)18:4<317::AID-HED2>3.0.CO;2-0 CAS PubMed Web of Science® Google Scholar
- 21Godballe C, Jorgensen K, Hansen O, Bastholt L. Hypopharyngeal cancer: results of treatment based on radiation therapy and salvage surgery. Laryngoscope 2002; 112: 834–838.
- 22Kania R, Hans S, Garcia D, et al. Supracricoid hemilaryngopharyngectomy in patients with carcinoma of the pyriform sinus. Part II: Incidence and consequences of local recurrence. Ann Otol Rhinol Laryngol 2005; 114: 95–104.
- 23Hirano S, Tateya I, Kitamoura M, et al. Organ preservation surgery for advanced hypopharyngeal cancer. Acta Otolaryngol Suppl 2010; 563: 50–55.
- 24Papacharalampous X, Kotsis G, Vlastarakos P, et al. Supracricoid hemilaryngopharyngectomy for selected pyriform sinus carcinoma patients: a retrospective chart review. World J Surg Oncol 2009; 7: 65.
- 25Joo YH, Cho KJ, Park JO, Nam IC, Kim MS. Role of larynx-preserving partial hypopharyngectomy with and without postoperative radiotherapy for squamous cell carcinoma of the hypopharynx. Oral Oncol 2012; 48: 90–94.
- 26Lefebvre JL, Chevalier D, Luboinski B, et al. Larynx preservation in pyriform sinus cancer: preliminary results of a European Organization for Research and Treatment of Cancer phase III trial. EORTC Head and Neck Cancer Cooperative Group. J Natl Cancer Inst 1996; 88: 890–899.
- 27Forastiere AA, Goepfert H, Maor M, et al. Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer. N Engl J Med 2003; 349: 2091–2098.
- 28Pignon JP, le Maître A, Maillard E, Bourhis J. Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): an update on 93 randomised trials and 17,346 patients. Radiother Oncol 2009; 92: 4–14.
- 29Denis F, Garaud P, Bardet E, et al. Final results of the 94–01 French head and neck oncology and radiochemotherapy in advanced-stage oropharynx carcinoma. J Clin Oncol 2004; 22: 69–76.
- 30Driscoll WG, Nagorsky MJ, Cantrell RW, Johns ME. Carcinoma of the pyriform sinus: analysis of 102 cases. Laryngoscope 1983; 93: 556–560.
- 31Gourin CG, Terris DJ. Carcinoma of the hypopharynx. Surg Oncol Clin N Am 2004; 13: 81–98.
- 32Holsinger C, Motamed M, Garcia D, Brasnu D, Ménard M, Laccourreye O. Resection of selected invasive squamous cell carcinoma of the pyriform sinus by means of the lateral pharyngotomy approach: the partial lateral pharyngectomy. Head Neck 2006; 8: 705–711.
- 33Kotwall C, Sako K, Razack et al. Metastatic patterns in squamous cell cancer of the head and neck. Am J Surg 1987; 154: 439–442.
- 34Marks JE, Kurnik B, Powers WE, Ogura JH. Carcinoma of the pyriform sinus. An analysis of treatment results and patterns of failure. Cancer 1978; 41: 1008–1015.
10.1002/1097-0142(197803)41:3<1008::AID-CNCR2820410332>3.0.CO;2-F CAS PubMed Web of Science® Google Scholar
- 35Merino OR, Lindberg RD, Fletcher GH. An analysis of distant metastases from squamous cell carcinoma of the upper respiratory and digestive tracts. Cancer 1977; 40: 145–151.
10.1002/1097-0142(197707)40:1<145::AID-CNCR2820400124>3.0.CO;2-9 CAS PubMed Web of Science® Google Scholar
- 36Senft A, de Bree R, Hoekstra OS, et al. Screening for distant metastases in head and neck cancer patients by chest CT or whole body FDG-PET: a prospective multicenter trial. Radiother Oncol 2008; 87: 221–229.
- 37Schwartz LH, Ozsahin M, Zhang GN, et al. Synchronous and metachronous head and neck carcinomas. Cancer 1994; 74: 1933–1938.
10.1002/1097-0142(19941001)74:7<1933::AID-CNCR2820740718>3.0.CO;2-X CAS PubMed Web of Science® Google Scholar
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