A comparison of pre-operative and primary radiotherapy in the treatment of carcinoma of the hypopharynx

Abstract

The results of a comparison of 51 patients treated by combined therapy using a high-dose policy and 98 by primary radiotherapy are discussed. Pre-operative radiotherapy in pyriform sinus lesions gives a crude three-year survival of 39 per cent and five-year of 36 per cent as compared with 23 per cent and 16 per cent when radiotherapy is given alone. Similar differences are apparent when analysed by stage. Pre-operative radiotherapy is the treatment of choice for all pyriform sinus growths which do not have fixed or bilateral regional lymph nodes. It is suggested that posterior pharyngeal wall lesions are best treated by radiotherapy initially and that further evaluation is needed for post-cricoid lesions. The morbidity rate of surgery following pre-operative radiotherapy has not been increased. The local recurrence rate is reduced after pre-operative radiotherapy and histopathological evidence is presented to support this. The interval to the first recurrence is also significantly longer after pre-operative radiotherapy. There is, however, a greater incidence of distant metastatic disease after pre-operative radiotherapy.