The management of early hypopharyngeal cancer: primary radiotherapy and salvage surgery.

Carcinoma of the hypopharynx tends to present late and to occur in old age. Surgical treatment almost always involves a total laryngectomy as well as a major procedure to reconstruct the pharynx. Early tumours up to and including T3 tumours with no, or very early (nodes < 2 cm) nodal disease may be treated with radiotherapy with the option of salvage surgery if recurrence supervenes. In 106 previously untreated patients the 5-year recurrence rate was 50% and the 5-year survival rate was 41%. Sixty-nine patients were referred from other departments because of recurrent disease. The 5-year survival for those patients was 21%. The 5-year survival for those who developed a recurrence at the primary site was 23%. Seventy-eight patients had a resection and 42% suffered a major complication. Only 2 of the methods of reconstruction appear to be satisfactory: for disease confined to the neck free revascularized jejunal loop-repair is effective whereas for more extensive disease gastric transposition is recommended. Twenty-three per cent of patients developed neck node metastases and the 5-year survival rate for patients was 16%. Cox's regression showed that no host or tumour factors predicted survival. At 5 years, 46% of patients were alive with a larynx, 4% were alive without a larynx, 34% were dead of the original cancer and 16 were dead of other causes.