Hypopharynx

Anatomy

Portion of pharynx from the hyoid bone to cricoid cartilage

After cricoid, cervical esophagus begins

Subsites: piriform sinus (most common), postcricoid area, posterior pharyngeal wall

Epidemiology

~3,000 cases per year

Strong association with smoking; alcohol may potentiate the effects of smoking

Often locally advanced at diagnosis; 80% T3-4, 50%N+

Pathology

Nearly always squamous cell

Prognostic factors

Age (older is worse), site (piriform sinus better)

Treatment

Outcomes seem to be worse than other primary sites

EORTC performed a larynx preservation trial (chemoradiation vs. resection and adjuvant RT, PMID 8656441). Five year survival was about the same in both arms (30-35%).  In the larynx preservation arm, 60% of the patients were alive and had a larynx at five years.