Long-term functional and nutritional outcomes in patients with retropharyngeal lymph node-positive hypopharyngeal cancer treated with concurrent chemoradiotherapy.

BACKGROUND

Retropharyngeal lymph node (RPLN) metastasis is considered a poor prognostic factor in hypopharyngeal cancer because of its anatomical inaccessibility and association with distant failure. RPLN involvement often necessitates expanded radiation fields encompassing critical swallowing and breathing-related structures such as the pharyngeal constrictors, raising concerns that organ-preserving chemoradiotherapy (CCRT) might compromise long-term functional and nutritional outcomes. However, the long-term functional and nutritional impact of RPLN irradiation in the era of contemporary definitive concurrent IMRT-based CCRT has not been well characterized.

METHODS

We retrospectively reviewed 62 consecutive patients with previously untreated Hypopharyngeal squamous cell carcinoma (HPSCC) who underwent definitive CCRT between 2015 and 2024 at our institution. Fourteen patients (22.6%) had radiologically diagnosed RPLN metastasis. Clinicopathological factors, survival outcomes (OS, DSS, PFS, DMFS), recurrence patterns, late adverse events, and laryngo-esophageal dysfunction-free survival (LEDFS) were compared according to RPLN status. Longitudinal change in nutritional indices and functional outcomes were assessed.

RESULTS

RPLN metastasis was significantly associated with posterior pharyngeal wall tumors and bilateral cervical lymph node involvement. Five-year OS, DSS, PFS, and DMFS did not differ significantly between RPLN + and RPLN- patients. Although the cumulative incidence of distant metastasis was higher in the RPLN + group, this did not translate into inferior survival. Importantly, functional outcomes including late dysphagia, feeding tube dependence, aspiration events, nutritional deterioration, and LEDFS were not significantly different between groups, suggesting no clear signal of excess long-term functional or nutritional deterioration in the RPLN + group.

CONCLUSION

In this exploratory retrospective cohort, no statistically significant worsening of long-term functional or nutritional outcomes was observed in RPLN + patients with HPSCC treated with definitive concurrent chemoradiotherapy. Given the limited sample size and number of events, these findings should be interpreted cautiously and considered hypothesis-generating.