Introduction

Hypopharyngeal squamous cell carcinoma (HPSCC) is a rare malignancy, merely accounting for about 3%-5% of head and neck cancers.1, 2 Due to the distinct local anatomical characteristics and enriched lymphatic and vascular networks, HPSCCs are commonly diagnosed at an advanced stage.3, 4 According to previous reports, the 5-year overall survival (OS) was only 30%-35%. 3, 5
Although advances in oncology treatment for head and neck cancers have been proposed, treatment outcomes in patients with HPSCC are still unsatisfactory, and only minimal improvement in survival has been achieved over the years. In a retrospective study of 6647 HPSCC patients, the average 5-year OS increased marginally from 37.5% (1973-1989) to 41.3% (1990-2003).6
Therefore, an ideal therapeutic strategy for HPSCC remains a challenge that requires multidisciplinary teams (MDT) to collaborate for the best outcomes. Before the 1990s, whereas total laryngectomy was the main treatment for locally advanced HPSCCs, its negative impact on the patients was unignorable which vastly affect the patient’s quality of life.7 Considering the disadvantages of surgical method, non-surgical strategies were prioritized from two of the representative random clinical trials in laryngeal cancer8 and hypopharyngeal cancer,9which demonstrated that induction chemotherapy (IC) plus radiotherapy (RT) outperformed laryngectomy in terms of both laryngeal preservation and non-jeopardization of survival.
A variety of studies were recently conducted for the optimization of non-surgical therapy; however, the trials were conducted in patients with head and neck cancers,10-12 leading to an insufficient evidence regarding non-surgical therapy for HPSCCs. And there were still lacking the unified standard non-surgical therapies. Further, according to the National Comprehensive Cancer Network (NCCN) guideline,13 locally advanced HPSCCs are often managed by IC followed by (chemo)radiotherapy as a non-surgical strategy. However, the overall benefits of IC followed by concurrent chemotherapy (CCRT) (IC+CCRT) and IC followed by RT alone (IC+RT) were not clear; thus, our study was performed to assess the efficacy and toxicity associated with the two approaches.