Radiotherapy modality as a predictor of survival in hypopharyngeal cancer

Background The impact of radiotherapy (RT) modality and dose on survival in hypopharyngeal cancer managed with definitive RT is unclear. Methods The National Cancer Database was queried for patients with hypopharyngeal squamous cell carcinoma (HPSCC) treated with definitive RT. Intensity-modulated radiotherapy (IMRT) was compared with other RT techniques. Clinicopathologic variables, RT modality, and dose impact on overall survival (OS) were assessed using log-rank test and Cox proportional hazard models. Results A total of 3928 patients with HPSCC were identified. Patients receiving IMRT (2098 patients) were more likely to be white, have higher income, have advanced classification, receive >= 66 Gy, and receive chemoradiotherapy compared with those receiving non-IMRT techniques (1830 patients). The 5-year OS was 41.9% (95% CI = 39.4%-44.4%) for the IMRT group and 36.8% for the non-IMRT group (95% CI = 34.3%-39.2%). After propensity score matching, IMRT had significantly better OS (P = .013). Conclusion In HPSCC treated with definitive RT, IMRT may provide a significant survival benefit over non-IMRT modalities.