A systematic review of different treatment strategies for the squamous cell carcinoma of the posterior pharyngeal wall
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REVIEW ARTICLE
A systematic review of different treatment strategies for the squamous cell carcinoma of the posterior pharyngeal wall Armando De Virgilio1,2 · Elena Russo1,2 · Andrea Costantino1,2 · Luca Malvezzi1 · Giovanni Colombo1 · Giovanni Cugini1 · Stefano Miceli1 · Vanessa Rossi1 · Giuseppe Spriano1,2 · Giuseppe Mercante1,2 Received: 13 March 2020 / Accepted: 15 April 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Objective To perform a systematic review of the literature available about the posterior pharyngeal wall squamous cell carcinomas, with a special focus on oncologic outcomes. Methods A comprehensive research was performed on PubMed/MEDLINE, Google Scholar, and Cochrane Library datasets for published studies meeting the established criteria. The last search was conducted on December 8, 2019. Results Eleven studies were included in the review, for a total of 534 patients (median age 60.4; male: n = 359, 67.2%). Six of the studies evaluated the oncologic outcomes of primary surgery, while three studies focused on results achieved through primary radiotherapy. Two studies evaluated both surgery and radiotherapy outcomes for the treatment of early or advanced posterior pharyngeal wall carcinoma. Conclusions Primary surgery associated with adjuvant radiotherapy would seem to ensure better oncologic outcomes, especially for locally advanced tumors. Moreover, this systematic review showed that oro- and hypo-pharyngeal wall tumors are similar in terms of clinical and biological behavior. Keywords Posterior pharyngeal wall · Squamous cell carcinoma · Radiotherapy · Surgery · Treatment outcomes
Introduction The posterior pharyngeal wall (PPW) extends from the level of the junction of the hard and soft palate to the level of the crico-arytenoid joints. It consists of two components, represented by the oro-pharyngeal and hypo-pharyngeal walls [1]. Posterior pharyngeal wall squamous cell carcinomas (PPWSCC) are extremely rare, accounting only for 12–20% of the pharyngeal squamous cell carcinomas [2–4]. PPWSCC usually lack of symptoms in the early stage of the disease. In particular, the difficulties in tumor detection and the tendency to submucosal spread of this tumor lead to a late diagnosis, usually at an advanced stage. As a * Andrea Costantino [email protected] 1
Otorhinolaryngology Unit, IRCCS Humanitas Clinical and Research Center, Via Manzoni 56, 20089 Rozzano, MI, Italy
Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele, MI, Italy
2
consequence, PPWSCC are associated with poor prognosis, with a 5-year survival rate of 3–32% [5–7]. Different therapeutic options have been described for the treatment of the PPWSCC, such as conventional surgery [3], transoral laser microsurgery (TLM) [8], transoral robotic surgery (TORS) [9], and primary (chemo) radiotherapy [1]. However, the optimal primary treatment of these tumors is still controversial. The two main treatment modalities currently employed
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