| Objective:To explore the clinical effect of different treatment on stage IV pyriform sinus squamous cell cancer, and summary the impact of the experiences.Methods:62 cases of stage IV pyriform sinus squamous cell cancer patients who accepted treatments in the Guangxi Medical University Tumor Hospital from January 1,2000 to December 30,2006 were reviewed retrospectively. These cases were divided into surgery+chemotherapy group and surgery+radiotherapy+chemotherapy group according to the treatment. We accessed the imformations of the patients through medical records, telephone follow-up, out-patient review. And compared the differences with the survival rates and quality of life between the groups.Results:1. There were 27 cases in the first group, of wich 15 cases were surgically treated with laryngeal functions preserved and 12 cases total laryngectomy. At the same time,26 patients required flap. postoperative one case had partial flap necrosis and 2 cases had pharyngeal fistula, which needed re-surgery.14-56 days feeding tube removed after surgury. To resume oral intake function average needed 19 days.15 cases of laryngeal surgery, of which one case occurred to cough, two cases occurred to low hoarse sound and the communication function in the others 13 cases can be resumed.3-year cumulative survival rate was 52%,5-year cumulative survival rate was 30%. 2. There were 35 cases in the second group, of wich 22 cases were surgically treated with laryngeal functions preserved and 13 cases total laryngectomy. At the same time,34 patients required flap. postoperative 2 case had partial flap necrosis and 3 cases had pharyngeal fistula, after radiotherapy one case had flap necrosis and pharyngeal fistula in 2 cases, which healed after reoperation.14-70 days removal all of the feeding tube after surgury, an average of 21 days to resume oral intake function. All removal of tracheal tube. Preservation of laryngeal function of 22 cases,2 cases of choking occurred; two cases of low hoarse sound, more than 20 patients to resume normal verbal communication. 3-year cumulative survival rate of 77%,5-year cumulative survival rate of 68%. Compared with the survival curves between the two groups was statistically significant (P= 0.015).3. There were 62 cases in the two groups, the total three-year cumulative survival rate was 66%,5-year cumulative survival rate was 51%, and 37 cases treated with laryngeal functions preserved,3-year cumulative survival rate was 78%,5-year cumulative survival rate was 58%,25 cases treated with total laryngectomy,3-year cumulative survival rate was 50%,5-year cumulative survival rate was 42%. Compared with the survival curves between the two groups was statistically significant (P= 0.015).4. Two groups total had 48 cases teated with T3,T4.29 cases preoperative treatment, which included 23 cases of laryngeal function preserved,6 cases of total laryngectomy; 19 patients underwent total laryngectomy treatment. Preoperative treatment with preservation of laryngeal function whose cumulative survival rate was 65% in 3-year and 39% in 5-year; treatment with total laryngectomy whose cumulative survival rate was 42% in 3-year and 26% in 5-year. Compared with the survival curves between the two groups was no significant difference (P= 0.113).5.62 cases of stage IV cases of pyriform sinus squamous cell carcinoma of wich 43 cases had contralateral neck lymph node CN0 need of selective neck dissection.13 cases of cancer metastasis were found. Contralateral CN0 cases of cervical lymph node-positive rate was 30.2%.Conclusion:1. Stageâ…£of squamous cell carcinoma of pyriform sinus treated witth surgery+radiotherapy+chemotherapy can improve survival, not increase the side effects.2. As to pyriform sinus squamous cell carcinoma stageâ…£with T3,T4 preoperative treatment combined with selective laryngeal function preserved was feasible, beneficial to improving the quality of life.3. Selective neck dissection in stageâ…£squamous cell carcinoma of pyriform CN0 can reduce the risk of recurrence.
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