Published online Aug 26, 2023. doi: 10.12998/wjcc.v11.i24.5666
Peer-review started: April 2, 2023
First decision: May 31, 2023
Revised: June 11, 2023
Accepted: July 31, 2023
Article in press: July 31, 2023
Published online: August 26, 2023
Processing time: 144 Days and 13.6 Hours
Hypopharyngeal cancer, characterized by extensive submucosal involvement, advanced tumor stage, and limited surgical reconstruction options, has the poorest prognosis among head and neck cancers. Its primary causes include alcohol consumption, tobacco use, genetic predisposition, diet, and socioeconomic conditions. Although squamous cell carcinoma (SCC) comprises the majority of hypopharyngeal tumors, it remains a rare form, representing only 3%-5% of all SCC cases in the head and neck region. The high incidence rates in Central and Eastern Europe, with Romania ranking 24th in incidence rate and reporting 634 new cases in 2020, emphasize the importance of understanding this seemingly uncommon condition.
The motivation of the present study was to conduct a descriptive, observational, nonrandomized retrospective epidemiological clinical study on patients diagnosed and treated for hypopharyngeal cancer, to assess various factors such as diagnosis methods, treatment approaches, laboratory data, comorbidity evaluation, performance status, and quality-of-life (QoL) aspects. The study's motivation includes the need to understand the epidemiology and clinical characteristics of hypopharyngeal cancer in the given population and contribute to the existing knowledge in this field.
Our objectives were to assess epidemiological characteristics of hypopharyngeal cancer by analyzing demographic and clinical data, to evaluate diagnostic methods, including ear, nose, throat (ENT) assessments and various imaging techniques. Investigate treatment approaches aligned with national guidelines, to evaluate the risk of toxicities in chemoradiation therapy and prognostic value of Adult Comorbidity Evaluation-27 (ACE-27) scale, to evaluate functional capacity and quality of life using Karnofsky Performance Status Scale and the European Organisation for Reasearch and Treatment of Cancer (EORTC) using the module for head and neck cancer (QLQ-H&N35) questionnaire and to identify limitations and challenges in the retrospective study design, considering socioeconomic factors and the impact of the coronavirus disease 19 (COVID-19) pandemic on healthcare access.
This retrospective epidemiological clinical study analyzed data from 53 patients diagnosed and treated for hypo
In this study, 53 patients with hypopharyngeal cancer were included based on the predefined criteria. The majority of patients were male (94.3%), and the average age at diagnosis was 62.5 years. Smoking was prevalent among 69.81% of patients, while alcohol consumption was reported in 32.07% of cases. The tumors were predominantly SCC, with most cases diagnosed at an advanced stage. Comorbidities were present in 83.01% of patients, with cardiovascular diseases being the most common. Imaging reports were used for differential diagnosis and evaluating disease extent. Karnofsky Performance Status Scale indicated that the majority of patients had reduced functional capacity at the time of diagnosis. Dysphagia and neck mass were the most frequent symptoms reported. Treatment approaches varied, including surgery, radiation therapy, chemotherapy, and organ-conservation therapies. The treatment response was favorable in 22.64% of cases, while relapse occurred in 6 patients. A proportion of patients lacked follow-up data.
Hypopharyngeal cancer patients in this high-incidence region were predominantly diagnosed at advanced stages, unlike previous studies reporting a small percentage of early-stage cases. The average age at diagnosis was 62.5 years, consistent with previous research. The majority of patients had a low economic status, with unemployment, retirement, or disability status. Prevalent social behaviors included chronic smoking, frequent alcohol intake, and occupational exposure to hazards. Common symptoms reported were dysphagia, neck mass, and hoarseness, indicative of late-stage diagnosis. Histopathology revealed SCC variants, mostly graded as moderate to severe. Reduced functional capacity was observed in many patients, reflecting late-stage diagnosis and disease progression. Comorbidities were common, with moderate to severe decompensations. Organ conservation therapies were favored, considering similar survival rates to radical surgery and QoL considerations. Challenges in follow-up evaluations were noted, potentially influenced by the COVID-19 pandemic. In the surgically treated group, no major complications occurred, except for a successfully managed pharyngocutaneous fistula.
Perspectives for further research include an improved follow-up rates as future research should focus on understanding the reasons behind the high number of missed follow-up appointments in hypopharyngeal cancer patients. Investigating barriers to follow-up, such as socioeconomic factors, patient education, and healthcare system accessibility, can provide insights into strategies to improve compliance and ensure continuity of care. Also, the impact of the COVID-19 pandemic, now greatly diminished, should allow us to examine the long-term consequences of delayed or interrupted care for hypopharyngeal cancer patients. Understanding the impact of the pandemic on diagnosis, treatment, and outcomes can inform future strategies for managing cancer care during similar crises. Further research should investigate healthcare disparities and access barriers for this population, including factors such as socioeconomic status, health insurance coverage, and geographic location. Identifying and addressing these disparities can contribute to more equitable and effective cancer care delivery.