Hyperfractionated Radiation Therapy for Hypopharyngeal Carcinoma Compared with Conventional Radiation Therapy: Local Control, Laryngeal Preservation and Overall Survival

Background: Recent randomized trials have revealed the effectiveness of hyperfractionated radiation therapy for treating head and neck carcinomas, especially in their local control. Because the hypopharynx is located near the larynx, increasing local control of hypopharyngeal carcinomas achieves greater laryngeal preservation, which is very important for patients’ quality of life. In consideration of this, our facility adopted hyperfractionated radiation therapy for hypopharyngeal carcinoma in 1996. In this study we compared the results of this therapy with those of conventional radiation therapy. Methods: Forty-two patients with hypopharyngeal carcinoma whose tumors were inoperable or who refused surgery were treated with curative intended radiation therapy between April 1975 and January 2002 at Tokyo Metropolitan Komagome Hospital. Of these patients, 23 were treated with hyperfractionated radiation therapy (the HF group) and 19 were treated with conventional fractionated radiation therapy (the CF group). In the HF group, the numbers of patients at each clinical stage were as follows: stage I, 2; stage II, 5; stage III, 6; stage IV, 10. The fraction size was 1.2 Gy and the mean total dose was 73.4 Gy (range, 66–79.2 Gy). In the CF group, the corresponding numbers were as follows: stage I, 3; stage II, 1; stage III, 5; stage IV, 10. The fraction size was 1.8–2.0 Gy and the mean total dose was 65.4 Gy (range, 60–70 Gy). Results: The 3-year local control rates for the HF group and the CF group were 61.5 and 18.4%, respectively (P = 0.016). The 3-year pharyngolaryngectomy-free survival rates for the HF group and the CF group were 64.7% and 5.3%, respectively (P = 0.0008). The 3-year overall survival rates for the HF group and the CF group were 69.3 and 31.6%, respectively (P = 0.075). Conclusion: This study suggests that hyperfractionated radiation therapy for hypopharyngeal carcinoma is promising with a better local control rate, a greater laryngeal preservation rate and a relatively better overall survival rate.