Efficacy and Safety of Induction Chemotherapy Followed by Concurrent Chemoradiotherapy in Locoregionally Advanced Hypopharyngeal Carcinoma

Purpose: For locoregionally advanced hypopharyngeal carcinoma (LAHPC), organ preservation via induction chemotherapy followed by concurrent chemoradiotherapy (IC-CCRT) is a key strategy, yet robust data from homogeneous cohorts treated with modern radiation therapy are scarce. This prospective study evaluated the efficacy and safety of IC-CCRT in a contemporary LAHPC cohort. Methods and Materials: From January 2015 to December 2021, 259 patients with LAHPC receiving curative-intent IC-CCRT with intensity-modulated radiation therapy were enrolled. Endpoints included survival with functional larynx (SFL), overall survival, progression-free survival, and disease control measures. AJCC stage and T classification, but not N stage, remained independent prognostic factors across all endpoints. Age was also an independent prognostic factor. Based on these factors, a prognostic nomogram was developed, demonstrating good discrimination (C-index 0.696) and calibration, with decision curve analysis confirming its clinical utility. Grade 3 to 4 hematologic toxicity occurred in 13.9% of patients. Functional impairments were common, including hoarseness (42.1%) and dysphagia (23.2%), with 14.3% requiring feeding tube dependence. Conclusions: IC-CCRT provides meaningful survival and larynx preservation in LAHPC, but efficacy is highly dependent on AJCC stage and T classification. Patients with T4b tumors have particularly poor outcomes. The developed nomogram offers a practical tool for individual outcome prediction. Treatment should be individualized, balancing survival benefits against significant treatment-related toxicities.