Session Item

The functional outcome after treatment for hypopharyngeal cancer is strongly related to patients’ quality of life and prognosis. The purpose of this study is to identify predictive factors for laryngo-esophageal function preservation in patients with hypopharyngeal cancer treated with definitive radiotherapy.

Patients with hypopharyngeal squamous cell carcinoma treated with curative-intent intensity-modulated radiation therapy (IMRT) between 2007 and 2019 at our institution were retrospectively reviewed. Laryngo-esophageal dysfunction-free survival (LDFS) and overall survival (OS) rates were estimated using Kaplan-Meier method. LDFS was measured from the initiation of radiation therapy until the date of local recurrence, laryngo-esophageal dysfunction (defined by tracheostomy or feeding tube dependence) or death from any cause, whichever occurred first. Possible predictive factors of LDFS were explored in the univariable and multivariable analyses using the Cox proportional hazards model.

A total of 80 patients were included in the study. Seventy-two patients were male and 8 were female, and their median age was 69 years old (range: 40-84). Concurrent and/or induction chemotherapy was delivered in 65 and 37 patients, respectively. With a median follow-up period of 58 months, the 5-year rates for LDFS and OS were 48% and 60%, respectively. The events for LDFS were observed in 49 (61%) patients, including 23 local recurrences, 10 dysfunctions and 16 deaths. The univariable analysis showed that cT4-category (hazard ratio [HR]= 3.16; 95% CI [confidence interval]: 1.65-6.05; p<0.001) and lower pretreatment prognostic nutritional index (PNI; calculated as 10 × serum albumin [g/dL] + 0.005 × peripheral lymphocyte count [/mm3]) taking the cut-off value as <48 (HR= 2.18; 95% CI: 1.22-3.89; p=0.009) were significantly associated with lower LDFS. Smoking/alcohol history, age, comorbidities, body mass index and cN-category were not significantly associated with LDFS. On multivariable analysis, cT4-category (HR= 2.79; 95% CI: 1.44-5.41; p=0.002) and lower PNI (HR= 1.95; 95% CI: 1.08-3.51; p=0.027) remained as independent predictors for lower LDFS.

Advanced primary tumor stages and lower pretreatment PNI were identified as predictors for poor laryngo-esophageal functional outcome after definitive radiotherapy for hypopharyngeal cancer.