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ECC 2015: Association Between Primary Surgery and Survival Benefit in Patients With Advanced Throat Cancers

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Key Points

  • Radical surgery was performed on slightly more than one-third of patients with oropharyngeal cancer and half of the patients with hypopharyngeal cancer. 
  • In stage III oropharyngeal cancer, 5-year overall survival was 59% for those who had surgery vs 48% for those who did not. In stage IVa oropharyngeal cancer, 5-year overall survival was 51% among those who had surgery vs 40% without.
  • In stage III hypopharyngeal cancer, 54% of those who had surgery were alive at 5 years, compared with 33% of those who did not. In stage IVa hypopharyngeal cancer, those figures were 39% and 26%, respectively. 

Patients with cancers of the mid and lower throat may have higher survival rates if their initial treatment includes surgery, according to new research (Abstract 2804) presented at the 2015 European Cancer Congress in Vienna, Austria.

Researchers explained that a nationwide study in Taiwan found that, 5 years after diagnosis, radical surgery was associated with significant overall survival benefits among patients whose cancers of the throat had started to spread. However, fewer than half of the patients in the study received surgery.

Chih-Tao Cheng, MD, a medical researcher at the Koo Foundation Sun Yat-Sen Cancer Center in Taipei City, Taiwan, said, “The emphasis on organ preservation has led to declining use of surgery. Concurrent chemoradiotherapy has become the standard approach for head and neck cancers which cannot be operated on, and it is being used alone, even where surgery is possible. With the improvement of surgical techniques, including minimally invasive procedures, there’s a need to revisit the various treatment options and look at the overall survival of different treatment groups.”

Study Background

The study included cancers of the oropharynx and hypopharynx. Dr. Cheng and his colleagues used the Taiwan National Health Insurance Claims Database and the Taiwan Cancer Registry Database to identify all newly diagnosed oropharyngeal and hypopharyngeal cancer patients in Taiwan. They found 2,387 oropharyngeal and 2,315 hypopharyngeal cancer patients diagnosed between 2004 and 2009. They followed the patients until 2012. Their analysis is based on 1,698 patients with oropharyngeal and 1,619 with hypopharyngeal cancer. All patients had stage III or IVa disease.

This observational study found that radical surgery was performed on slightly more than one-third of oropharyngeal cancer patients: 35% of 424 stage III patients, and 38% of 1,274 stage IVa patients. Approximately half of the hypopharyngeal cancer patients had surgery: 55% of stage III patients and 49% of stage IVa patients. 

The researchers then compared outcomes in those who had surgery and those who did not, regardless of whether they received concurrent chemoradiotherapy. In both surgery and no-surgery groups, therefore, patients may or may not have received concurrent chemoradiotherapy.

Study Findings

For both cancers, patients who had surgery were significantly more likely to be alive 5 years after diagnosis than those who did not. In stage III oropharyngeal cancer, rates of overall survival at 5 years were 59% for those who had surgery vs 48% for those who did not. In stage IVa oropharyngeal cancer, rates were 51% among those who had surgery vs 40% without.

Similarly, in stage III hypopharyngeal cancer, 54% of those who had surgery were alive at 5 years, compared with 33% of those who did not. In stage IVa hypopharyngeal cancer, those figures were 39% and 26%, respectively.

Dr. Cheng said that multidisciplinary treatment now includes surgery, chemotherapy, radiotherapy, and targeted therapy. “Substantial improvements in the treatment of head and neck cancer have been made in the past two decades. However, overall survival rates for locoregionally advanced head and neck cancer remain unsatisfactory. We found that primary surgery was associated with better overall cancer survival in most subset analyses, which suggests that surgery may provide a survival benefit.”

He added, “Many patients do not agree to surgery because of a fear of functional impairment such as the impact on speech and swallowing. This study suggests that avoiding surgery may significantly reduce their chance of survival.”

Head-to-head comparisons of primary surgery vs concurrent chemoradiotherapy in these cancers have faced problems in recruiting patients, partly because of the low incidence of these diseases and the diversity of treatment standards. On this observational approach, Dr. Cheng said, “We should be aware of confounding factors involved in the link between surgery and improved survival. These factors include gender, age, cancer stage, association with human papillomavirus, and the site of the tumor.”

He stressed that more research is needed. “Recommending primary surgery or concurrent chemoradiotherapy for advanced oropharyngeal and hypopharyngeal cancer patients remains controversial. These preliminary results were in line with our expectations, but further well-designed studies are required to confirm our findings.”

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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