Abstract 384P
Background
Betel nut chewing might contribute to strong invasion and treatment refractoriness. In western countries where HPV+ OPC prevalence is high, induction TPF response rate in locally advanced HNSCC is around 70%; Erbitux and TP (Argiris in JCO2008) response rate is 86%. In the analysis from KGMH in Taiwan, induction response for locally advanced HNSCC was 55% in betel-nuts chewers compared with 75% in non-users(p=0.038; From Su in World Journal of Surgical Oncology 2016). Erbitux-TPF induction response rate was 88% from VGH in Taiwan by Lu in Head & Neck2019. In our previous study from unresectable stage IVA & IVB betal-nuts related HNSCC patients in ASCO2023, flexible chemotherapy backbones, such as TP/DP-HDFL(weekly docetaxel or paclitaxel with cisplatin and 24-hr high dose 5-fluorouracil/leucovorin infusion) with Biotherapy(EGFR or VEGFR-targeting)or Bio-immunotherapy had encouraging induction response with favorable toxicity to conversion surgery or definite CCRT.
Methods
Hypopharyngreal cancer in Taiwan in Taiwan often had advaced stage(stage IV 70%) and double cancers easily(esp. lung cancer and esophageal cancer). We prepared to compare the outcomes of different treatment strategies in stage IVA/IVB hypophryngeal cancer, from 2012 to 2023.
Results
Table: 384P
| Treatment strategies(total 75 patients) | Definite CCRT 9 | Curative surgery then adjuvant CCRT 14(all receiving total laryngectomy & bilateral neck dissection) | Induction therapy then definite CCRT 29 | Induction therapy then curative surgery then adjuvant CCRT 23 |
| Induction response(total 52 patients) | N/A | N/A | 69%(20/29) | 87%(20/23) |
| 2-year DFS(total 64 patients) | 57.1% | 63.6% | 68% | 81% |
| 5-year OS(total 50 patients) | 20% | 26.7% | 37.5% | 50% |
All with maintenance UFUR
Conclusions
CCRT is still one standard option; if no need for organ preservation, curative surgery followed by adjuvant CCRT still works in resectable and medically operable patients. Maintenance UFUR yielded relatively favorable 2-year DFS and 5-year OS. Induction Bio-CT or Bio-chemoimmunotherapy followed by CCRT may be promoted beyond TAX323/324. Aggressive induction therapy followed by mini-invasive surgery and then adjuvant CCRT with maintenance UFUR might be administered in selected patients with high induction response. Encouraging outcomes have been shown by sequential multi-modality strategies for locally advanced betel-nuts related hypopharyngeal cancer in Taiwan.
Clinical trial identification
N/A
Editorial acknowledgement
Legal entity responsible for the study
Institutional Review Board in National Taiwan University Hospital.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.
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