In what way complementary therapies can prevent a neck recurrence in hypopharynx and larynx tumors?

There has been a shift to preferential use of chemotherapy and radiotherapy (CTRT) after surgery contrary to the choice of radiotherapy (RT) in case of metastatic cervical lymph nodes larger than 3 cm, presence of extracapsular nodal spread and signs of vascular or perineural permeability. We performed a retrospective study of 100 patients with advanced squamous cell carcinoma of the larynx and / or hypopharynx who underwent laryngectomy or pharyngolaryngectomy and bilateral neck dissection. Every patients had lymph nodes positive for malignancy and three years minimum follow-up. 50 of these patients underwent adjuvant RT and 50 underwent adjuvant CTRT. The two groups were clinically similar in age (p = 0.915), tumor size (p = 0.603) and RT dose administered (p = 0.329), making it possible to compare them. The association CTRT post-surgery showed better control of regional metastases (4% vs 16%, p = 0.046). There was a trend to higher specific survival of patients who underwent adjuvant CTRT (66% at 3 years vs 54%), but not statistically significant (p = 0.154). In relation to distant metastasis, no protective effect was shown in patients undergoing adjuvant CTRT (18% vs 20%, p = 0.5). The only identified predictor of increased risk of metastasis is the presence of extracapsular invasion (77.8%, p = 0.04). The adjuvant CTRT only provides better regional protection from the disease. Patients with extracapsular lymph node invasion must have a special surveillance to allow early diagnosis of distant metastases and start appropriate systemic treatment.