Krstevska et al. Radiation Oncology 2010, 5:39 http://www.ro-journal.com/content/5/1/39 Open Access RESEARCH BioMed Central © 2010 Krstevska et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Research Concurrent radiochemotherapy in advanced hypopharyngeal cancer Valentina Krstevska 1 , Igor Stojkovski* †1 and Dusko Lukarski †2 Abstract Background: Concurrent platinum-based radiochemotherapy has been recommended as a standard of care in patients with locally advanced squamous cell head and neck carcinomas. Unfortunately, there is a lack of level one evidence on best treatment approach for advanced hypopharyngeal cancer. This report aims to summarize the results of our study on concurrent radiochemotherapy in patients with advanced hypopharyngeal cancer. Methods: A retrospective analysis of 41 patients with stage III-IV hypopharyngeal cancer was performed. All patients were treated with three dimensional conformal radiotherapy and received 70 Gy in 35 fractions (2 Gy per fraction, 5 fractions per week). In dependence of the period when radiotherapy was realized, two different treatment techniques were used. Concurrent chemotherapy consisted of cisplatin 30 mg/m 2 given on a weekly basis. Results: The median age was 52 years (range 29-70). Stage IV disease was recognized in 73.2% of the patients. Complete response rates at the primary site and at the metastatic neck lymph nodes were 68.3% and 36.6%, respectively. A complete composite response was present in 27 patients (65.9%). Median follow-up was 13 months (range 7-36). Distant metastases as initial failure occurred in 7 patients (46.7%). The 2-year local relapse-free survival and regional relapse-free survival rates were 55.2% and 75.8%, respectively. The 2-year locoregional relapse-free survival rate was 51.3%. The 2-year disease-free survival and overall survival rates were 29.3% and 32.8%, respectively. Confluent mucositis was developed in 46.3% of patients. Leucopenia grade 1 was the most frequent hematological toxicity. The median weight loss at the end of treatment was 12% (range 5-21). The worst grade of late toxicity was most commonly pronounced in the skin and in the subcutaneous tissue. Conclusions: Based on unsatisfactory results in our study we suggest that the use of sequential radiochemotherapy or chemotherapy given concomitantly with altered fractionation radiotherapy with the implementation of intensity- modulated radiotherapy as radiotherapy technique could represent treatment approaches able to improve outcome in patients with advanced hypopharyngeal cancer. Background Hypopharyngeal cancer is a rare disease representing about 0.5% of all human malignancies with an incidence of less than 1 per 100 000 population and constituting only 3-5% of all head and neck cancers [1,3]. Hypopha- ryngeal cancers are often at an advanced stage at diagno- sis and are associated with a poor prognosis [4,6]. The reasons for the unfavourable prognosis of hypopharyn- geal cancers are the strong tendency for extensive submu- cosal spread, the early occurrence of regional lymphatic involvement, and the relatively high rate of distant spread [7,8]. In the 1970s and 1980s, surgery, followed by postopera- tive radiotherapy was the standard form of therapy for advanced stage disease [9,10]. This radical approach of treatment, lead to the loss of natural speech function and impairment of swallowing ability with a consequent neg- ative impact on the quality of life, and low cure rates, reported 5-year survival between 20.0% and 50.0% [1,2,7,11,12]. The necessity for improvement of survival rates and preserving organ function resulted in introduction of chemotherapy as a third treatment modality for patients with advanced hypoharyngeal cancer. The combined modality treatment was subject of analysis in two ran- * Correspondence: istojkovski@gmail.com 1 Department of Head and Neck Cancer, University Clinic of Radiotherapy and Oncology, Skopje, Macedonia † Contributed equally Full list of author information is available at the end of the article