Treatment of Cancer of the Pharynx and Cervical Oesophagus

CARCINOMA of the pharynx has so far resisted almost all attempts at cure or control and palliation is often unsatisfactory. Of those considered suitable for radical treatment, only one in three survive 2 years and less than one in five survive 5 years. Some of the survivors will have a gastrostomy, some a pharyngeal fistula and some a strictured artificial gullet requiring periodic dilatation. Radiotherapy is still the most widely used form of treatment for these cancers although it frequently fails to control the disease. A recent survey of cases of carcinoma of the pharynx treated at the Department of Radiotherapy at the United Bristol Hospitals, revealed an occasional case of retro-cricoid cancer which had survived 5 years, but no case of cancer of the pyriform fossa which had survived more than 2 years. Perhaps as important as the failure to cure the disease, is the failure of radiotherapy to achieve adequate palliation, because of dysphagia from oedema, stricture or recurrence of the disease or because of dyspnoea from tracheal obstruction or infection. Although in many centres (Mustard, i960), there has been a trend towards surgery as the treatment of choice, only 38 per cent, of those thought suitable for radical extirpation of the disease survive more than 2 years (Ranger, 1964), many with a recurrence of the cancer or a complication of the surgical procedure. However, we think that surgery gives better palliation than radiotherapy and therefore offers the best hope at present for these unfortunate people. Until the last decade, most attempts at surgical cure were based on radical excision of the pharynx and larynx and reconstruction of the gullet by means of skin flaps from the neck, after the method pioneered by Trotter (1913) and Wookey (1942), although as early as the 1940*5 an isolated jejunal loop had been used for reconstruction (Yudin, 1944). Many patients have been successfully treated by the former method, though the incidence of failure has been very high and, even in the successful cases there have been a large number with stenosis of fistula. Furthermore, the method entails long periods in hospital and at least 30 per cent, of the patients develop a recurrence in the neck before the re-