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. 2018 Jan;275(1):181-189.
doi: 10.1007/s00405-017-4766-6. Epub 2017 Oct 28.

Trends in treatment, incidence and survival of hypopharynx cancer: a 20-year population-based study in the Netherlands

Japke F Petersen  1 , Adriana J Timmermans  2 , Boukje A C van Dijk  3   4 , Lucy I H Overbeek  5 , Laura A Smit  6 , Frans J M Hilgers  2   7 , Martijn M Stuiver  2   8 , Michiel W M van den Brekel  2   7   9
Affiliations

Trends in treatment, incidence and survival of hypopharynx cancer: a 20-year population-based study in the Netherlands

Japke F Petersen et al. Eur Arch Otorhinolaryngol. 2018 Jan.

Abstract

Hypopharynx cancer has the worst prognosis of all head and neck squamous cell cancers. Since the 1990s, a treatment shift has appeared from a total laryngectomy towards organ preservation therapies. Large randomized trials evaluating treatment strategies for hypopharynx cancer, however, remain scarce, and frequently this malignancy is evaluated together with larynx cancer. Therefore, our aim was to determine trends in incidence, treatment and survival of hypopharynx cancer. We performed a population-based cohort study including all patients diagnosed with T1-T4 hypopharynx cancer between 1991 and 2010 in the Netherlands. Patients were recorded by the national cancer registry database and verified by a national pathology database. 2999 patients were identified. The incidence increased significantly with 4.1% per year until 1997 and decreased non-significantly afterwards. For women, the incidence increased with 1.7% per year during the entire study period. Total laryngectomy as primary treatment significantly decreased, whereas radiotherapy and chemoradiation increased. The 5-year overall survival significantly increased from 28% in 1991-2000 to 34% in 2001-2010. Overall survival for T3 was equal for total laryngectomy and (chemo)radiotherapy, but for T4-patients the survival was significantly better after primary total laryngectomy (± adjuvant radiotherapy). This large population-based study demonstrates a shift in treatment preference towards organ preservation therapies. The 5-year overall survival increased significantly in the second decade. The assumed equivalence of organ preservation and laryngectomy may require reconsideration for T4 disease.

Keywords: Chemoradiotherapy; Hypopharynx cancer; Radiotherapy; Survival; Total laryngectomy.

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Conflict of interest statement

Conflict of interest

The Department of Head and Neck Oncology and Surgery of the Netherlands Cancer Institute receives a research grant from ATOS Medical Sweden which contributes to the existing infrastructure for health-related quality of life research of the department of Head and Neck Oncology and Surgery. Japke Petersen, Adriana Timmermans, Michiel van den Brekel and Frans Hilgers work at this department. Boukje van Dijk declares that she has no potential conflict of interest. Lucy Overbeek declares that she has no potential conflict of interest. Laura Smit declares that she has no potential conflict of interest. Martijn Stuiver declares that he has no potential conflict of interest.

Research involving human participants

Retrospective data collection from national cancer registries.

Informed consent

This study does not fall under the scope of the Medical Research Involving Human Subjects Act (WMO), which means that it does not have to be reviewed by an accredited Multicentre Research Ethics Committee and no informed consent had to be obtained. The privacy committees of the NCR and the PALGA foundation approved this study.

Figures

Fig. 1
Fig. 1
Incidence rate for T1–T4 hypopharynx cancer. The estimated annual percentage change over the standardized incidence and mortality rates (ESR) was calculated with the log-linear model, allowing for a maximum of four joinpoints
Fig. 2
Fig. 2
Trends in treatment for T1–T4 hypopharynx cancer. The X axis depicts the year of diagnosis; the Y axis depicts the primary treatment divided by the total number of patients treated with CRT (green), RT (blue) or TL (black) that year, for T1T2 (dotted lines) and T3T4 (straight lines) in percentages
Fig. 3
Fig. 3
a–d. Kaplan–Meier OS curves. Kaplan–Meier OS rates for T3 hypopharynx cancer diagnosed in the first decade (a) or second decade (b) and T4 hypopharynx cancer diagnosed in the first (a) or second (b) decade
See this image and copyright information in PMC

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