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Incidence of head and neck (H&N) cancer is related to increasing age, with more than a fifth of UK cases in those aged over 75, and closely correlated to deprivation.¹ The West of Scotland (WOS) has some of the worst areas of socio-economic deprivation and life expectancy for those areas is lower than the UK average.²

Approximately 5% ² of all H&N cancers arise from the hypopharynx. Patients with hypopharyngeal squamous cell cancers (HPSCC) tend to have a poor prognosis compared with other subsites. The UK survival for HPSCC at 1 year is 60% and 27% at 5 years. Survival for HPSCC is higher in women and younger patients.² Only 1-2% of HPSCC cases are T1N0 and 80% are stage III/IV at presentation.³

There are very few HPSCC-specific studies and this subsite is not well represented in general H&N trials. Thus, deciding the best treatment plan is difficult and relies on the expertise of a multi-disciplinary team (MDT).⁴ The challenges of older age, co-morbidities and advanced stage compound the difficulty in treating these patients.

The aim of this series was to review outcomes of HPSCC patients in our cancer network.

This was a retrospective series of histologically or radiologically diagnosed HPSCC made from August 2016 to August 2018, identified from the WOS Cancer Network MDT database.  Subsites included pyriform fossa, post cricoid and posterior pharyngeal wall.

118 patients were evaluable. 35.6% were aged >70 and 33.1% were PS 2+. 26.3% patients had a prior cancer diagnosis, with 16% having a previous H&N cancer. PET-CT was performed in 11.5% of the T4 patients. 5 (4.24%) were upstaged post-operatively.

For stage 1-2 patients, primary surgery (PS) had a 100% overall survival (OS) at 2 years compared with radiotherapy (RT) alone (64.8%, CI 25.3-87.2).

For stage 3 patients, PS +/- adjuvant RT had a 1 year OS of 100% compared with primary chemoradiotherapy (CRT) (83.3%, CI 27.3-97.5) and RT alone (66.7%, 5.4-94.5). However, the 2 year OS rate for PS alone was 0%, whereas PS and adjuvant RT and CRT remained at 100% and 83.3% respectively.

For stage 4a/b patients, the 2yr OS with PS and adjuvant RT, PS alone, CRT and RT alone was 100%, 50% (20.8-73.6), 0% and 53.3% (12.5-82.7) respectively. Palliative platinum-based chemotherapy had a 2 year OS of 40% (5.2-75.3).

Of note, over 50% of patients received best supportive care (BSC).

The most common site of recurrence was at the primary site. Initial treatment modality did not appear to affect this.

Compared to other H&N SCC subsites, HPSCC continues to have poor outcomes. Our data supports the UK 1 year survival of 60%. A combination of advanced stage, poor fitness and age precluded many of our patients untreatable. A multimodality approach using combinations of surgery and radiotherapy appears to be advantageous.  However, this needs to be balanced with the patient’s age and fitness, low long-term outcomes and the morbidity of multimodality treatment.