Introduction
Hypopharyngeal squamous cell carcinoma (HPSCC) is a rare malignancy,
merely accounting for about 3%-5% of head and neck
cancers.1, 2 Due to the distinct local anatomical
characteristics and enriched lymphatic and vascular networks, HPSCCs are
commonly diagnosed at an advanced stage.3, 4 According
to previous reports, the 5-year overall survival (OS) was only
30%-35%. 3, 5
Although advances in oncology treatment for head and neck cancers have
been proposed, treatment outcomes in patients with HPSCC are still
unsatisfactory, and only minimal improvement in survival has been
achieved over the years. In a retrospective study of 6647 HPSCC
patients, the average 5-year OS increased marginally from 37.5%
(1973-1989) to 41.3% (1990-2003).6
Therefore, an ideal therapeutic strategy for HPSCC remains a challenge
that requires multidisciplinary teams (MDT) to collaborate for the best
outcomes. Before the 1990s, whereas total laryngectomy was the main
treatment for locally advanced HPSCCs, its negative impact on the
patients was unignorable which vastly affect the patient’s quality of
life.7 Considering the disadvantages of surgical
method, non-surgical strategies were prioritized from two of the
representative random clinical trials in laryngeal
cancer8 and hypopharyngeal cancer,9which demonstrated that induction chemotherapy (IC) plus radiotherapy
(RT) outperformed laryngectomy in terms of both laryngeal preservation
and non-jeopardization of survival.
A variety of studies were recently conducted for the optimization of
non-surgical therapy; however, the trials were conducted in patients
with head and neck cancers,10-12 leading to an
insufficient evidence regarding non-surgical therapy for HPSCCs. And
there were still lacking the unified standard non-surgical therapies.
Further, according to the National Comprehensive Cancer Network (NCCN)
guideline,13 locally advanced HPSCCs are often managed
by IC followed by (chemo)radiotherapy as a non-surgical strategy.
However, the overall benefits of IC followed by concurrent chemotherapy
(CCRT) (IC+CCRT) and IC followed by RT alone (IC+RT) were not clear;
thus, our study was performed to assess the efficacy and toxicity
associated with the two approaches.