Surgery May Be Best Treatment for Advanced Head and Neck Cancers

Undergoing primary surgery may be the best treatment option for patients with advanced oropharyngeal and hypopharyngeal cancers, according to the results of a study conducted in Taiwan comparing surgery with concurrent chemoradiotherapy.

The data, presented by Chih-Tao Cheng, MD, a medical researcher at the Koo Foundation Sun Yat-Sen Cancer Center in Taipei City, Taiwan, at the 2015 European Cancer Congress in Vienna (abstract 2804), showed that patients who underwent surgery had significantly improved overall survival 5 years after diagnosis compared with those who underwent chemoradiotherapy with no surgery.

“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,” Cheng said in a prepared statement. “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.”

According to the researchers, the best treatment approach for patients with oropharyngeal and hypopharyngeal cancer is controversial, and it has been difficult to recruit patients for trials comparing surgery and concurrent chemoradiotherapy head to head. Therefore, in this study, Cheng and colleagues used a nationwide dataset to investigate survival outcomes in these two patient groups.

They gathered data from the Taiwan National Health Insurance Claims Database and the Taiwan Cancer Registry Database, identifying 2,387 patients with oropharyngeal cancer and 2,315 patients with hypopharyngeal cancer. Patients were diagnosed between 2004 and 2009 and followed until 2012.

At the conference, Cheng presented data analysis on 1,698 patients with oropharyngeal cancer and 1,619 with hypopharyngeal cancer. In patients with oropharyngeal cancer, primary surgery was performed in 35.29% of patients with stage III disease and 37.63% of patients with stage IVa disease; for hypopharyngeal cancer, surgery was performed in 54.52% of patients with stage III disease and 48.85% of patients with stage IVa disease.

When comparing outcomes of patients whose treatment did or did not include surgery, Cheng and colleagues found that rates of overall survival at 5 years were higher for the surgical group.

In patients with stage III oropharyngeal cancer, the 5-year overall survival was 59% for those who had surgery compared with 48% for those who did not. In stage IVa oropharyngeal cancer, rates were 51% for those who had surgery compared with 40% for those who did not.

Similarly, the researchers found that 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, the overall survival was 39% compared with 26%.

“Substantial improvements in the treatment of head and neck cancer have been made in the past 2 decades. However, overall survival rates for locoregionally advanced head and neck cancer remain unsatisfactory,” Cheng said. “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.”