[Management of hypopharyngeal and cervical esophageal cancer (HCEC): a comparative study of primary-surgical and primary-radiotherapeutic regimens].

The results of two treatment regimens for HCEC were compared. Surgery played a main role in the first regimen (Group A), in which patients underwent total pharyngo-laryngo-esophagectomy (with bilateral neck dissection and primary reconstruction by pectoralis major myocutaneous flap or gastric tube) after receiving 20 Gy of irradiation therapy. Chemotherapy was combined in some patients. In the second regimen (Group B), radiation was employed as the main treatment in order to conserve the larynx. Chemotherapy (UFT 300 to 600 mg/day; in some patients one or two courses of intra-venous cisplatinum therapy) was combined with radiation therapy (60 Gy) to improve the effectiveness of this regimen. In case of radiation failure, a salvage operation was performed. We investigated 60 HCEC patients who visited the Kitasato University Hospital during the period from 1983 to 1992. The tumor was located in the PC, PS, PW, and Ce areas in 3, 48, 5, and 4 patients, respectively. There were 25 cases in group A and 35 in group B. Five-year cumulative survival rates were 52% and 55%, respectively. In group B, tumor remained or recurred after the initial treatment in 13 patients. Three patients refused to receive salvage operation. Four of the 10 patients who received salvage operation became tumor free. The larynx preservation rate was 71% in group B. From the standpoint of improving QOL, the group B regimen is recommended.