[When is laryngectomy indicated in hypopharyngeal carcinoma?].

Introduction: We studied the histories of 121 patients with hypopharyngeal carcinoma treated at our clinic from 1990-1998. From 1990-1993 all patients with curable hypopharyngeal carcinoma were treated by surgery. Radiotherapy was used for those in whom surgery was impossible or who refused laryngectomy. In 1994 we changed our therapy and only patients in whom the voice could be preserved were treated surgically. All others received radiotherapy as primary treatment. The goal of this study was to ascertain whether and how this shift in therapy was influenced by T and N stage.

Methods: From 1990-1993, 57 patients with hypopharyngeal carcinoma were registered at our clinic. Surgery was performed in 32, 16 received radiotherapy and 9 only palliative treatment. During this time there was no difference in diseased specific survival between the radiotherapy and surgical groups. Therapy was therefore changed in 1994 to preserve voice function. From 1994-1998, 64 patients were diagnosed. Only 10 were treated surgically. 40 received radiotherapy and 14 no curative therapy. Age, N and T stage were comparable in both groups. To show differences we performed Kaplan Meier survival rates for both groups and for the N and T stage of patients undergoing surgery or radiotherapy respectively.

Results: 3-year survival was 68% in patients treated from 1990-1993 and 38% from 1994-1998. The difference was statistically significant (p-value 0.02). Survival for nodal stages 0 and 1 was much better in patients undergoing surgery than those receiving radiotherapy. Multivariant analysis was highly significant. T-category showed no tendency for either treatment modality.

Discussion: After a switch in the treatment of hypopharyngeal carcinoma in 1994 there was a significant change in survival. For patients with nodal stage 0 and 1 surgery brought much better survival. We conclude that surgery should be the primary treatment for all patients in these small nodal stages, even if total laryngectomy is necessary.