Carcinoma of the pyriform sinus a comparison of treatment modalities.

One hundred four patients with epidermoid carcinoma of the pyriform fossa were reviewed retrospectively. Survival, local recurrence and metastatic rates were all compiled for the purpose of comparing the efficacy of combined therapy with radiation therapy and surgery alone in treating such lesions. Combined therapy consisted of 4500 rad Cobalt60 therapy at 200 rad per day preoperatively. All lesions were staged according to AJC classification. There was a similar stage distribution of patients in each therapeutic category. Three-year determinate survival rates were as follows: radiation therapy --10%, surgery--56%, and combined therapy--40%. Evaluation of the local recurrence rate revealed it to be: radiation therapy--19/33 (58%), surgery--1/19 (5%), and combined therapy--9/32 (28%). We interpret this data to suggest that preoperative irradiation impaired the determination of adequate resection margins, despite the use of frozen sections from those margins at the time of surgery. The incidence of late contralateral palpable nodes was greatest in the surgery group--5/19 (26%), compared with radiation therapy--0/33, and combined therapy--1/32 (3%). This supports other studies which indicate that radiation therapy is very effective in controlling subclinical nodal metastases.