CANCER OF THE PYRIFORM SINUS - THE TREND TOWARDS CONSERVATIVE TREATMENT

Despite progress in diagnostic method radiotherapeutic and surgical te chniques, and the development of new chemotherapeutic agents, the prog nosis of pyriform sinus carcinomas hac not improved in a significant w ay over the last 2 decades. Whatever the treatment approach, for all s tages combined the overall survival at 5 years remains modest and rare ly exceed 30%. Deaths from distant metastases, second cancers and inte rcurrent diseases represent 30-40% of cases. For this, any improvement in locoregional control does not necessary translate into a gain in s urvival Thus, for there patients it is judicious to consider not only the loco-regional control but also the quality of life since larynx pr eservation is concerned. In this review article, the results of differ ent treatment approaches are illustrated by the most representative se ries in the recent literature. Early stages (T1-2) are managed conserv atively either by radical radiotherapy or conservative surgery althoug h the former is the most frequently utilized as it requires less strin gent patient selection. For more advanced stages (T3-4), recent tenden cies appear to lean toward the use of primary radical radiotherapy wit h or without chemotherapy, with surgery reserved for persistent or rec urrent tumor. However, this strategy is still under study and the init ial results should be confirmed.