MEDIAL VS LATERAL WALL PYRIFORM SINUS CARCINOMA - IMPLICATIONS FOR MANAGEMENT OF REGIONAL LYMPHATICS

Background. Our purpose in performing this review is to analyze the re lationship between the anatomic site of hypopharyngeal lesions and the pattern of recurrent disease, particularly cervical recurrence. This clinical information can subsequently be used to influence treatment o ptions. Methods. The records of 169 patients with carcinoma of the hyp opharynx treated between 1975 and 1986 were reviewed retrospectively. Patients were classified as having medial wall pyriform sinus disease (MP) lesions, lateral wall pyriform sinus (LP) lesions, posterior wall (PW), or postcricoid (PC) lesions. All patients were followed a minim um of 36 months. Patients with evidence of recurrent carcinoma were ch aracterized according to the site of recurrence. Results. Recurrent ca rcinoma in the hypopharynx was noted in seven (4%) of 169 patients. Ce rvical metastases was the sole site of failure in 27 (16%) of 69 patie nts, whereas distant metastases developed in 25 (15%) of 169 patients. Failure in the contralateral unoperated neck occurred in 14% (10/71) of patients with MP lesions and, in contrast, 5% (4/76) LP patients. T his difference was statistically significant (p 0.04). Radiotherapy wa s not effective in preventing cervical recurrence in 20 (74%) of 27 ov erall neck failures and 11 (79%) of 14 contralateral NO neck failures. Conclusion. These data suggest that patients with carcinoma involving the MP are at greater risk for contralateral cervical metastases. We recommend bilateral neck dissection be offered to patients with MP les ions. (C) 1994 John Wiley & Sons, Inc.