Vol.99 No.7 contentsPRACTICA OTO-RHINO-LARYNGOLOGICA
Vol. 99 No. 7 July 2006
Change and its Significance in the Treatment
of Hypopharyngeal Carcinoma
Shinzo Tanaka
(Kyoto University)
Change and its significance in the treatment of the hypopharyngeal carcinoma (HPC) are discussed, chiefly based on the author's experiences. In the nineteen-seventies and eighties, the prognosis of HPC was poor, and the 5-year over-all survival was only 24％ in 173 patients. Locoregional recurrence was the most serious problem. To improve locoregional control, we introduced extended surgery with reconstruction using a free jejunal graft, in which a safety margin of 3 cm or more was secured at the primary site while bilateral retropharyngeal and paratracheal dissections were added to bilateral radical neck dissections. This treatment achieved a disease-specific 3-year survival of 64％ for patients with advanced (stage III, IV) HPC, which was significantly better than that of patients treated by previous methods. Furthermore, postoperative radiotherapy was introduced for advanced HPC treatment, in which a 50 Gy dose was basically used to irradiate the bilateral neck and a 10 Gy dose was locally added when a retropharyngeal lymphnode metastasis was histopathologically identified or the number of lymphnode metastasis was three or more. In the recent five years, the disease-specific 3-year survival reached 81％ in 39 advanced HPC patients. During this period, we endeavored to conserve in laryngeal functions for patients with early (stage I, II) HPC by performing a radiotherapy or partial pharyngectomy. In 14 early HPC patients, there was no recurrence and the larynx was well conserved in eleven. We also developed a new method of reconstruction after partial laryngopharyngectomy, in which aspiration was well prevented by reconsfructing the supraglottis and hypopharynx using hyoid bone attached to sternohyoid muscle and free forearm flap. Progress in surgical reconstruction techniques and radiotherapy changed the treatment of HPC, providing a better prognosis for advanced HPC patients and a better life quality for early HPC patients.
Key words : hypopharyngeal carcinoma, extended surgery, free jejunal graft, radiotherapy,
partial laryngopharyngectomy