Patterns of failure and results of preoperative irradiation vs radiation therapy alone in carcinoma of the pyriform sinus

From 1968 to 1977, 53 of 78 patients with carcinoma of the pyriform sinus completed planned therapy and were eligible for followup a minimum of two years. Of the 53, 35 (66%) were treated with high dose preoperative irradiation and surgery, while 18 (33 % ) were treated with radiation therapy alone. Preoperative irradiation averaged 5800 rad in 51/2 weeks, whereas for irradiation alone doses ranged from 5700–7200 rad in 4–8 weeks (average 6400 rad in 6 weeks). Partial pharyngectomy, total laryngectomy and radical neck dissection usually followed preoperative irradiation within 4–6 weeks. Of all patients, 73 % presented with T3 or T4 primaries and 79 % had clinically positive neck nodes. Actuarial five year survival was 13% for irradiation alone group and 12% for the combined therapy group. All of the irradiation alone relapses and 85 % of the combined therapy relapses occurred within two years. Failure rates in the primary site were 30% for combined therapy and 72% for irradiation alone; the nodal failure rates were 51 % and 61 %, respectively. The radiation therapy fields for both groups were reviewed for adequacy of coverage of the known and potential tumor volume and of all the failures in the primary site and nodes, 17% were felt to be at the margin of the irradiated field. There was a 34% (12 of 35) rate of pharyngocutaneous fistulae with the combined therapy. Three of the 12 fistulae were a result of recurrent tumor and 2 of these had carotid rupture.