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. 2023 Sep 7:13:1089275.
doi: 10.3389/fonc.2023.1089275. eCollection 2023.

Matched-pair analysis of the impact of low-dose postoperative radiotherapy on prognosis in patients with advanced hypopharyngeal squamous cell carcinoma without positive surgical margins and extracapsular extension

Hengmin Tao  1 , Yumei Wei  1 , Zhong Shen  1 , Zhichao Liu  1
Affiliations

Matched-pair analysis of the impact of low-dose postoperative radiotherapy on prognosis in patients with advanced hypopharyngeal squamous cell carcinoma without positive surgical margins and extracapsular extension

Hengmin Tao et al. Front Oncol. .

Abstract

Background: We conducted a comparative analysis between low and high-dose postoperative radiotherapy in patients with hypopharyngeal squamous cell carcinoma (HPSCC) in stage III or IV without positive surgical margins and extracapsular extension (ECE). Propensity score matching (PSM) was used to eliminate confounding factors and reduce bias.

Methods: The matched-pair analysis included 156 patients divided into two groups: the low-dose radiotherapy group (LD-RT 50 Gy, 78 cases) and the high-dose radiotherapy group (HD-RT 60 Gy, 78 cases). Both cohorts were statistically comparable in terms of age, gender, subsite, and TNM classification.

Results: The median follow-up time was 49 months (ranging from 5 to 100 months). The overall survival (OS) rate, progression-free survival (PFS) rate, locoregional control rate (87% vs. 85.7%; p = 0.754), distant metastases-free survival (79.2% vs. 76.6%; p = 0.506), and the occurrence of second primary tumors (96.1% vs. 93.5%; p = 0.347) showed no significant differences between the LD-RT group and the HD-RT group. The 3-year OS was 64.9% and 61% in the low-dose and high-dose group, respectively, and 63% in the entire group (p = 0.547). The 3-year PFS was 63.6% and 54.5% (p = 0.250), respectively, and the 3-year PFS of the entire group was 59.1%. Multivariate analyses revealed that pathological T and N classification, and pathological differentiation were associated with 3-year OS, PFS, and LRFS and were independent prognostic factors (p < 0.05). LD-RT was not associated with an increased risk of death and disease progression compared to HD-RT.

Conclusion: The results of postoperative low-dose radiotherapy did not show inferiority to those of high-dose radiation for patients with advanced hypopharyngeal cancer without positive surgical margins and ECE in terms of OS, PFS, locoregional control, and metastases-free survival.

Keywords: extracapsular extension; head and neck cancer; hypopharyngeal squamous cell carcinoma; positive surgical margins; postoperative radiotherapy.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Kaplan–Meier curves of 5-year overall survival for hypopharyngeal cancer patients in LD-RT Group (blue line) and HD-Group (red line).
Figure 2
Figure 2
Kaplan–Meier of 5-year progression-free survival for hypopharyngeal cancer patients in LD-RT Group (blue line) and HD-Group (red line).
Figure 3
Figure 3
Kaplan–Meier curves of 5-year locoregional recurrence-free survival for hypopharyngeal cancer patients in LD-RT Group (blue line) and HD-Group (red line).
Figure 4
Figure 4
Kaplan–Meier curves of 5-year distant metastases-free survival for hypopharyngeal cancer patients in LD-RT Group (blue line) and HD-Group (red line).
Figure 5
Figure 5
Kaplan–Meier curves of 5-year second primary tumor-free survival for hypopharyngeal cancer patients in LD-RT Group (blue line) and HD-Group (red line).
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