Satyanarayana D1, A. Sesha Prasad2, S. Muneeruddin Ahmed3, M. Mahendra Kumar4
INTRODUCTION: Malignant growths of Hypo Pharynx are one of the common Head and Neck malignancies in India. Males are commonly affected due to their smoking habit and use of Tobacco products, chewing habits. The combined use of Smoking and alcohol has a synergistic role in causing these malignant tumors. Post cricoid region is commonly involved in the development of malignant growth in females. Iron deficiency plays an important role as an etiologic factor in causing P.V. Syndrome which is a pre malignant condition in women. Malignant growths of hypo pharynx are observed in patients aged above 55 years and rare in age groups below 30 years. Pyriform sinus is the common site of involvement. Squamous cell carcinoma is the common histological finding among these malignancies. It usually presents with the complaints of foreign body sensation on swallowing which is neglected by the patients. This is followed by Hoarseness of voice and Dysphagia. Confirmation is by Direct Laryngoscopy and Biopsy. Multiple modalities of treatment are available now which includes surgery, Radiotherapy and chemotherapy. Nowadays a combination of these modalities is being used frequently to achieve a 5 year survival of more than 60%. The present study is based on chemo radiation in stage III and IV malignant growths of hypo pharynx in a tertiary hospital in Telangana. The study attempts to review the demographic and etiological factors playing a role in the disease process. It also analyses the post therapy effects on normal tissue as well as tumor mass. A 3 year post chemo radiation follow up results are analyzed.
MATERIALS AND METHODS: The study includes 30 patients attending the OPD of ENT department of GGH, Kurnool, with the complaints of foreign body sensation on swallowing, dysphagia and hoarse voice. Patients are investigated after a thorough history taking. The nature of the growths is confirmed by Biopsy and HPE examination. A treatment protocol consisting of chemo radiation is followed depending on the stage of the lesion. Cisplatin is used as an anchor of chemotherapy prior to radiation. 60 to 66 c Gy cobalt 60 radiations are given over a period of 7 weeks. All the patients are followed up for 3 years. Observed data is analyzed for demographic details and etiological factors are searched for.
OBSERVATIONS: Complete response at the primary site at the end of 2 weeks is 90%. Complete response to chemo radiation is seen in 90% of the patients with neck metastases after 2 weeks of chemo radiation. At the end of 2 months the overall complete response is 50%, which also remained same at the end of 6 months. Progressive response is seen in 11 patients (36.6%), showing progression of the disease process in spite of therapy.
CONCLUSIONS: All patients could tolerate the chemo radiotherapy with minimum toxicity due good supportive and nutritional care without a gap in the treatment. In our study group 15 patients shows complete response, 2 patients show partial response, 11 patients show progressive disease, 2 patients show stable disease.
