Carcinomas of the hypopharynx and cervical esophagus: A systematic review and quality of evidence assessment.

PURPOSE Hypopharyngeal cervical esophageal carcinoma (HPCEC) is a group of highly malignant entities usually presenting at an advanced stage. Our purpose was to systematically review and synthesize all available data on the management and outcomes of patients with these upper gastrointestinal malignancies. METHODS A systematic literature search of the PubMed and Cochrane databases was performed with respect to the PRISMA statement (end-of-search date: May 1st, 2017). Data on the study design, interventions, participants, and outcomes were extracted by two independent reviewers. Quality assessment of included studies was performed using the tool developed by the National Heart, Lung, and Blood Institute. RESULTS Thirty-four observational studies were included in this review. Overall, 20,409 patients with HPCECs were included. Mean patient age was 61.3 years. The most widely implemented therapeutic modalities were chemoradiation (38%), radiation alone (16%), and surgery plus radiation (13%). Overall, mean relapse rates were 15±2.6% for local recurrence, 14.7±2.6% for regional recurrence. and 10±2.3% for distant metastases. Cumulative mean 5- and 3-year survival rates were 20±2.6% and 22±2.6%, respectively, while mean 5-year disease-free survival rates were 22±2.3%. The most common complications were fistulae and pulmonary complications. Mean 30-day mortality rate was 7±2.2% and the mean long-term mortality rate was 22±3.3%. CONCLUSIONS Multimodal approaches are typically needed for the management of HPCECs. Radiotherapy is the mainstay of treatment for local tumors. Locally advanced non-metastatic tumors are typically managed with chemoradiation or a combination of pharyngolaryngoesophagectomy and chemoradiation. For metastatic carcinomas, an arsenal of surgical and medical treatment options can help relieve tumor burden and improve quality of life.