下咽頭癌症例の臨床的検討

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  • Clinical Analysis of Hypopharyngeal Cancer
  • カイントウ ガン ショウレイ ノ リンショウテキ ケントウ

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Fifty patients with squamous cell carcinoma of the hypopharynx were treated at Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital from September 1993 to August 2005. Of these 50 cases, 45 were male and 5 were female and the average of age was 64.4. All cases were pathologically diagnosed as squamous cell carcinoma. The primary lesion was located in the pyriform sinus in 26 cases, the postcricoid in 13 cases, the posterior pharyngeal wall in 10 cases and was unclassified in 1 case. Our guideline for the treatment of hypopharyngeal cancer is a combination of radiotherapy, chemotherapy and surgery. The schedule of combination therapy is as follows: all patients were treated with irradiation of 40Gy (and chemotherapy if possible). When the primary lesion responded almost completely to 40Gy irradiation, the patient subsequently received full-dose irradiation. If a complete response was not obtained, the patient underwent radical surgery. Of 50 patients, 44 patients could be treated radically in this schedule. As a result, almost all of the patients treated with surgery were especially advanced cases. The cause-specific 5-year survival rate of all patient was 46.0%. There were significant differences in suvival between T3 stage and T4 stage, between below N1 stage and beyond N2 stage. Of 15 patients who died of disease, 9 (60%) died of distant metastasis. Eight of these 9 patients were diagnosed with N2b stage. We thought that our guideline for the treatment of hypopharyngeal cancer was reasonable because of the increased possibility of preservation of larynx and that patients with multiple metastasis to cervical lymph nodes should receive chemotherapy strictly.

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