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Background: The prognosis of patients with advanced oropharyngeal carcinoma (OPSCC) is generally poor. The aim of this study is to investigate the different therapeutic approaches and identify prognostic factors associated with a worse outcome for patients treated for T4a OPSCC, in order to improve treatment selection for the individual., Methods: A retrospective study was conducted on 426 patients with T4a OPC treated between 1980 and 2010. Eleven prognostic factors including treatment modality, lymph node staging, and p16 status as a surrogate marker for human papillomavirus (HPV) infection were analyzed., Results: Univariate analysis showed a significant difference in DSS between N0 and N+ (57.1% versus 26.9%, P < 0.001), primary surgical and primary nonsurgical treatment (52.7% versus 31.4%, P < 0.001), and perinodal invasion (51.7% versus 19.9%, P = 0.011). P16-negative patients tended towards a worse DSS than p16-positive patients (40.2% versus 64.6%, P = 0.126) but responded better to primary surgery than to nonsurgical treatment (71.4% versus 34.0%, P = 0.113). Multivariate analysis identified the N category as an independent prognostic factor for survival., Conclusion: The survival of p16-negative patients was worse than p16-positive patients, although they seem to respond better to primary surgery. The strongest independent prognostic factor for T4a carcinomas proved to be the presence of lymph node metastases.

Objective: To compare long-term quality of life outcomes after treating early stage oropharyngeal carcinoma either with surgery, surgery combined with radiotherapy, or surgery combined with chemoradiotherapy., Methods: Questionnaire based method: 111 eligible patients agreed to fill out a quality of life questionnaire., Results: Of the 32 scales contained in the EORTC's combined QLQ-C30 and HN35, 11 scales show significantly better results for the surgery-only treatment group when compared to either surgery combined with radiotherapy or surgery combined with any type of adjuvant therapy. These eleven scales are role function (P = 0.019/0.008), social function (P = 0.01/0.034), nausea (P = 0.017/0.025), pain (P = 0.014/0.023), financial problems (P = 0.030/0.012), speech (P = 0.02/0.015), social eating (P = 0.003/<0.001), mouth opening (P = 0.033/0.016), sticky saliva (P = 0.001/<0.001), swallowing (P < 0.001/<0.001), and dry mouth (P < 0.001/0.001)., Conclusion: Treatment of early stage oropharyngeal carcinoma with surgery alone has definite advantages over treatments including any form of adjuvant therapy when considering quality of life. Advantages manifest themselves especially in functional aspects of the head and neck realm; however general health aspects as well as psychosocial aspects show improvements as well. This study does not show any indication of QOL-related drawbacks of surgery-only treatment approaches.

The increase in the incidence of thyroid cancer is accompanied by a mortality rate that is stable or perhaps even slightly decreasing. This phenomenon is due to the increased frequency of papillary microcarcinomas (thyroid tumors with a diameter of less than 1 cm), which is presumably attributable to the improved diagnosis enabled by high resolution ultrasound and fine needle aspiration cytology. The American and European Thyroid Associations have recently published new guidelines for the diagnosis and therapy of differentiated thyroid tumors. These guidelines are aimed at minimizing the diagnostic and therapeutic procedures without reducing their effectiveness. This goal is particularly important for papillary thyroid microcarcinoma patients, who have an excellent prognosis and almost normal life expectancy. This article summarizes the history of thyroid surgery and introduces papillary thyroid microcarcinoma--an important topic in modern thyroid oncology. Current methods for diagnosis, treatment and follow-up care of this disease are discussed.

Background: Comparison of the diagnostic validity of positron emission tomography (PET) alone with integrated PET and CT (PET/CT) in the search for occult primary tumors in patients with cancer of unknown primary (CUP) site in the head and neck., Methods: Thirty-nine consecutive patients with clinical CUP were investigated with PET and 38 patients with PET/CT. After initial diagnostic panendoscopy and histological confirmation of the cervical lymph node metastasis, either PET or PET/CT scanning was performed., Results: Integrated PET/CT had a significantly higher overall detection rate than dedicated PET alone (55.2% vs 30.8%; p = .039) and positive prediction rate (93.3% vs 46.1%; p = .01)., Conclusion: Integrated PET/CT showed to be superior to PET in the detection of the primary site of clinically occult tumors in CUP syndrome. However, a negative result should still be investigated further by means of panendoscopy with tonsillectomy and blind biopsies., (Copyright © 2010 Wiley Periodicals, Inc.)

Treatment of small carcinoma of the larynx may lead to voice handicap and restricted quality of life. The relationship between the two is revealed. Sixty-five patients aged 62.1 ± 10.0 years rated their voice handicap and quality of life after treatment of T1 (n = 35) or T2 (n = 30) laryngeal carcinoma during regular out-patient examinations. For the self-assessment of the voice, the Voice Handicap Index (VHI) and the disease-independent Short Form-36 Health Survery (SF-36) questionnaires were used. Voice handicap (total score 38.9 ± 26.0) did not differ in the two tested groups, T1 and T2, and the data of SF-36 (physical score 43.0 ± 10.7; mental score 50.2 ± 9.1) showed significant differences for the mental score. Patients rated their voice handicap worse than healthy persons did after treatment of laryngeal carcinoma. VHI and SF-36 data were strongly correlated. Voice handicap is significantly related to the quality of life, especially affecting the mental domain. Thus, the rehabilitation of voice disorders should have a beneficial impact on quality of life., (Copyright © 2010 S. Karger AG, Basel.)

The latest revision of the UICCs TNM classification in 2002 subdivided advanced laryngeal carcinoma into the subcategories T4a and T4b, in order to emphasise the poor prognosis and inoperability of the latter group. Our study aims at evaluating the prognostic relevance of this subclassification. This retrospective analysis includes 163 patients treated for advanced laryngeal carcinoma between 1980 and 2002. The disease-free 5-year-survival rates for patients suffering from T4a and T4b laryngeal carcinoma were 32.4 and 6.7%, respectively (P = 0.003). The T-category and free margins proved to be significant prognostic factors. The survival of patients suffering from T4a carcinoma proved to be independent of specific location and number of invaded structures. This study confirms the much poorer prognosis for patients suffering from T4b carcinoma and thus supports the modified TNM classification.