The role of radioactive iodine in the management of patients with differentiated thyroid cancer - An oncologic surgical perspective.

With improved understanding of the biology of differentiated thyroid carcinoma its management is evolving. The approach to surgery for the primary tumour and elective nodal surgery is moving from a "one-size-fits-all" recommendation to a more personalised approach based on risk group stratification. With this selective approach to initial surgery, the indications for adjuvant radioactive iodine (RAI) therapy are also changing. This selective approach to adjuvant therapy requires understanding by the entire treatment team of the rationale for RAI, the potential for benefit, the limitations of the evidence, and the potential for side-effects. This review considers the evidence base for the benefits of using RAI in the primary and recurrent setting as well as the side-effects and risks from RAI treatment. By considering the pros and cons of adjuvant therapy we present an oncologic surgical perspective on selection of treatment for patients, both following pre-operative diagnostic biopsy and in the setting of a post-operative diagnosis of malignancy.

Elective neck dissection versus observation in primary parotid carcinoma.

OBJECTIVE: To evaluate the efficacy of elective neck dissection in the clinically negative neck of patients with primary carcinoma of the parotid gland. Study design and setting A retrospective analysis was undertaken at a university Department of Otorhinolaryngology-Head and Neck Surgery on 83 previously untreated patients with primary carcinoma of the parotid gland and a clinically negative neck. The reliability of fine needle aspiration cytology, frozen section, and the clinico-pathologic findings of patients with occult neck metastases were analyzed. The regional recurrence rate and the outcome were compared among 2 groups; one with elective neck dissection (N = 41) and one without elective neck dissection (N = 42). RESULTS: The diagnosis of malignancy was known preoperatively in 59 (71%) cases, the exact histologic tumor type in 36 (43%) and the grade in 37 (44%) of 83 cases. Occult metastases were detected in 8 (20%) of 41 cNO patients, in 5 cases associated with a high-grade and in 3 cases with a low-grade carcinoma. Recurrence of disease developed in 5 (12%) patients in the elective neck dissection group and in 11 (26%) patients in the observation group. All of the 7 neck recurrences occurred in the observation group. The 5-year actuarial and disease-free survival rate was 80% and 86% for patients with elective neck dissection and 83% and 69% for patients without neck dissection. Conclusion and significance A routine elective neck dissection is suggested in all patients with primary carcinoma of the parotid gland. The efficacy of elective neck dissection, nevertheless, has never been evaluated prospectively.

[Virtual laryngoscopy and multiplanar reformats with multirow detector CT for detection and grading of upper airway stenosis]. / Virtuelle Laryngoskopie und multiplanare Reformationen mit Mehrzeilen-Spiral-CT zur Detektion und Graduierung von Stenosen der oberen Luftwege.

PURPOSE: A controlled trial was performed to compare non-invasive multislice CT (virtual laryngoscopy, axial CT slices, coronal and sagittal reformats) in the detection and grading of upper airway stenosis with fiberoptic laryngoscopy. MATERIAL AND METHODS: Multislice CT and fiberoptic laryngoscopy were used to examine 111 upper airway sections (supraglottis, glottis, subglottis, trachea) in 29 patients. CT data were acquired on a multirow detector CT (collimation 4 x 1 mm, reconstruction interval 1 mm, IV contrast) and postprocessing was performed using multiplanar reformatted images (MPR) and virtual laryngoscopy. RESULTS: All CT methods accurately detected upper airway stenosis (accuracy was 96 % for virtual laryngoscopy and MPR and 94 % for axial CT-slices). Correlation of fiberoptic and virtual laryngoscopy (r = 0.94) for grading of stenosis was closer than with sagittal reformats (r = 0.80), coronal reformats (r = 0.72), and axial CT slices (r = 0.57). Even high grade stenosis could be passed with virtual laryngoscopy that was impassable for fiberoptic laryngoscopy. CONCLUSIONS: Virtual laryngoscopy enabled better assessment of stenosis as compared to reading of axial CT slices or MPR. Virtual laryngoscopy is complementary to fiberoptic laryngoscopy and should be combined with axial CT slices and MPR readings for evaluation of the surrounding structures.

Establishing radiological percutaneous gastrostomy with balloon-retained tubes as an alternative to endoscopic and surgical gastrostomy in patients with tumours of the head and neck or oesophagus.

The purpose of this study was to report our experience introducing radiological percutaneous gastrostomy (RPG) catheters at a hospital where hitherto only endoscopic and surgical methods have been used. The feasibility, success, time requirements, and complications of RPG were prospectively evaluated during a 12-month period. 26 consecutive patients (median age 63 years, range 41-91 years) underwent gastropexy with T-fasteners followed by insertion of a 12-18 F balloon tube through a peel-away introducer and were followed-up clinically and radiologically. Success and complications occurring within 30 days were assessed. RPG was technically successful in all cases. Median procedure time was 34 min (range 20-90 min), median fluoroscopy time 6.9 min (range 2.3-30 min). 13 surgical gastrostomies were avoided. One minor complication (peristomal leakage) occurred in a patient with gastric reflux and atony. Another patient destroyed the balloon of his tube by injecting food into the balloon port, which led to tube dislocation and peritonitis. In conclusion, radiological gastrostomy can be quickly learned by radiologists and is readily accepted by clinicians. It is an alternative to surgical gastrostomy when percutaneous endoscopic gastrostomy is not feasible, but can also be used as the primary method instead of the endoscopic method.

Value of fine-needle aspiration cytology of parotid gland masses.

OBJECTIVE: To evaluate the usefulness and accuracy of fine-needle aspiration cytology (FNAC) in the diagnosis of parotid gland masses. STUDY DESIGN: Retrospective chart review of patients undergoing FNAC. METHODS: Between January 1990 and December 1998, 410 parotid glands were resected at the Department of Otorhinolaryngology-Head and Neck Surgery at the University of Berne, Inselpital (Berne, Switzerland). Included in the study were 228 cases with preoperative FNAC. In a retrospective study the results of FNAC were analyzed and compared with the corresponding histopathological diagnosis. RESULTS: Histological evaluation revealed 65 malignant tumors and 163 benign lesions (150 neoplasms and 13 nonneoplastic lesions). The cytological findings were nondiagnostic in 13 (5.7%), true-negative in 146 (64%), true-positive in 39 (17%), false-negative in 22 (9.8%) and false-positive in 8 (4.5%) cases in detecting malignant tumors. Nineteen of 39 (49%) malignant tumors (true-positive) and 123 of 146 (84%) benign lesions (true-negative) were classified accurately. The accuracy, sensitivity, and specificity were 86%, 64%, and 95% respectively. CONCLUSIONS: Fine-needle aspiration cytology is a valuable adjunct to preoperative assessment of parotid masses. Preoperative recognition of malignant tumors may help prepare both the surgeon and patient for an appropriate surgical procedure.

[Quality of life stress in patients with large tumors of the mouth. 3: Indications for preoperative assessment of individual coping capacity]. / Lebensqualitätsbelastung von Patienten mit grossen Tumoren der Mundhöhle. Teil 3: Hinweise zur präoperativen Abschätzung der individuellen therapeutischen Belastbarkeit.

A three-part empirical study investigated in detail the effects of illness and therapy on patients with large tumors of the oral cavity (n = 50). Part 1 compared the limitations of quality of life (LQL) of these patients with those of patients after total laryngectomy (n = 34) and with a group of patients "without cancer" (n = 40). Part 2 dealt with the individual coping strategies applied by the patients. The aim of this third part was to evaluate those biopsychosocial variables which could serve preoperatively in determining whether a planned surgical intervention could benefit the patient's quality of life. For this purpose a dependent variable ("subjective burden of illness and therapy") was defined as the weighted sum of 9 scores (including "duration of survival" and LQL). 51 variables (19 medical, 7 demographic and many psychological) were chosen as potentially explanatory variables. 7 of the 8 exploratory variables correlating most strongly with the dependent variable had an emotional content: depressive personality, intensified preoperative anxiety and depression, emotional indifference, reinforced control of emotions, reservation and compulsiveness. The somatic variables with the highest correlations to the dependent variable were "more pronounced preoperative dysfunction" (4th place) and "extent of primary tumor" (9th place). The findings suggested that the primary reason for a delay (postponement of the first medical consultation) often resulting in a poorer prognosis is not the growth of the tumor in the meantime but the fact that the delay represents an existing resignation. This resignation and the reduced self-esteem generally underlying it would then be concomitant causes of poorer courses of the illness. The opportunities for the surgeon to support the patient's self-esteem are discussed.

[Quality of life stress in patients with larger tumors of the mouth. A descriptive study of psychosocial effects of illness and primary surgery therapy in 3 parts--1: Quantity and quality of life]. / Lebensqualitätsbelastung von Patienten mit grossen Tumoren der Mundhöhle. Eine deskriptive Studie der psychosozialen Auswirkungen von Krankheit und primär chirurgischer Therapie in 3 Teilen--Teil 1: Quantität und Qualität des Lebens.

Up to about 40 years ago, the therapy of large tumors of the oral cavity often resulted in severe disfigurement and dysfunctions. Modern resection and reconstruction techniques now enable tumors of this type to be removed in such a way that virtually normal eating and speech functions are restored and traces of the extensive surgery are barely noticeable in many patients. After rehabilitation, most of these patients seem objectively to have a high quality of life, but it is less clear whether their subjective experience is the same. In a three-part empirical study the "limitations of quality of life" (LQL) of 50 patients with large tumors of the oral cavity were investigated at four points of time: preoperatively as well as 1, 4 and 12 months postoperatively. Our self constructed questionnaire for LQL includes 241 questions covering 19 fields of limitation. The results were compared with those of a group of patients after total laryngectomy (n = 34) and a group of patients "without cancer" (n = 40). One year after surgery the limitations of quality of life of patients with large tumors of the oral cavity are still large but seem less so than those of patients after total laryngectomy. However, objectively marginal problems such as a change of body image through a minor disfigurement, slightly indistinct articulation, or a prolonged period of accustomization to dentures are experienced as a severe strain by many patients. The apparent hypersensitivity of many patients to minor discomfort is seen as an effect of the demands made by modern society for fast, subtle adaptive processes. The second part of the study deals with the coping strategies applied by patients, and the third part is focused on a search for variables which could serve as preoperative indicators of the individual ability to bear the burden of illness and therapy.

[Quality of life stress in patients with large tumors of the mouth. 2: Dealing with the illness: coping, anxiety and depressive symptoms]. / Lebensqualitätsbelastung von Patienten mit grossen Tumoren der Mundhöhle. Teil 2: Krankheitsverarbeitung: Coping, Angst und Depressivität.

The psychosocial effects of disfigurements and dysfunctions after combined surgical and radio-oncological therapy of patients with large tumors of the oral cavity (n = 50) are investigated in a three-part study. Part 1 compared the "limitations of quality of life" (LQL) of these patients with those of patients after total laryngectomy (n = 34) and with a group of patients "without cancer" (n = 40). This second part records the coping strategies of the three groups of patients and relates them to the following variables: anxiety (STAI), depression (D-S'), despair (H-scale), self-image (GT), locus of control (KKG), intellectual capacity (shortend SPM) and psychosocial burden in early childhood (new questionnaire). The coping strategies of "compliance" and "self-encouragement" were used most often. Patients with a higher psychosocial burden in early childhood often chose defensive strategies (distrust, cognitive avoidance, distraction, reinforced control of emotions). Only few patients used strategies of healthy regression ("coasting values", A. Maslow). It seems that no specific single coping strategy (in particular not the frequently recommended "positive thinking") but an individualized selection of different strategies is of special value to patients. The self-esteem of the patient was identified as a crucial factor in increasing the effectiveness of coping strategies. The surgeon can support patients in their self-esteem by showing a genuine interest not only in their state of health but also in their personal background. The third part of the study is focused on a search for variables which could serve as preoperative indicators of the individual ability to bear the burden of illness and therapy.

Endovascular treatment of acute and subacute hemorrhage in the head and neck.

OBJECTIVE: Acute and subacute hemorrhage in the head and neck often represent a life-threatening situation. The goal of this study is to evaluate the indications for and contributions of endovascular techniques in the diagnosis and management of such severe cases. DESIGN: Seventy-two patients with acute or subacute intractable hemorrhage of the head and neck were treated over a period of 5 years: 2 patients had experienced trauma; in 6 cases the cause of bleeding was iatrogenic; and in 2 patients intraosseous arteriovenous malformations were manifested. Fifteen patients had tumors, 9 of whom had prior radiotherapy. Forty-seven patients presented with epistaxis (41 idiopathic and 6 during anticoagulation therapy). The endovascular therapy was performed using polyvinyl alcohol particles, fibered platinum or electrolytically detachable coils (Guglielmi detachable coils; Target Therapeutics, Fremont, Calif), a stent, glue (Ethibloc; Ethicon GmbH, Norderstedt, Germany, and Histoacryl; B. Braun Melsungen AG, Melsungen, Germany), or with a combination of these different embolic materials. RESULTS: The acute bleeding was successfully controlled in all cases. Fourteen patients (7 with epistaxis, 5 with tumors, and 2 with arteriovenous malformations) had to be embolized more than once before the bleeding could be controlled. The idiopathic, traumatic, iatrogenic, and remaining tumoral cases were treated only once. The long-term morbidity was 1.9%. CONCLUSIONS: Owing to the recent continuous advances in interventional radiologic techniques, it is possible to treat both acute and subacute life-threatening head and neck hemorrhage most efficiently. In many cases the endovascular therapy complements surgery.

[Follow-up after histologically verified radical resection of early cancers of the mouth cavity: results of a prospective multicenter study]. / Verlauf nach histologisch radikaler Resektion früher Mundhöhlenkarzinome: Ergebnisse einer prospektiven Multizenterstudie.

INTRODUCTION: Early stage oral cavity carcinoma is curable in most cases. This study follows the course of early stage squamous cell carcinoma of the oral cavity after radical surgical resection, in order to assess the necessity of further treatment modalities. MATERIAL AND METHODS: In a prospective multicentric study, 110 patients with T1-T2 and N0-N1 (without capsular invasion) squamous cell carcinoma of the oral cavity were enrolled. All patients were treated exclusively by surgical resection with histopathologically proven negative margins. RESULTS: Among 96 patients (14 excluded because of positive margins), followed-up for 3 years, 18 presented a local or regional recurrence. In 12 of these 18 loco-regional control was reestablished by second treatment. Overall, the 4-year disease-specific survival probability was 94%. Patients treated initially by selective neck dissection had significantly lower recurrence rates than those without neck surgery. CONCLUSION: Early (T1-2, N0-1) squamous cell carcinoma of the oral cavity is adequately treated by surgery alone. The surgical procedure should include margin-free resection of the primary combined with selective neck dissection. Systematic postoperative radiotherapy does not appear necessary. Neck dissection is advocated in N0 patients as well.

[Results of voice rehabilitation with Provox prostheses]. / Ergebnisse der Stimmrehabilitation mit Provox-Prothesen.

From 1992 to 1998, 105 patients of the Department of Otorhinolaryngology, Head and Neck Surgery in Berne underwent laryngectomy with primary implantation of a Provox prosthesis. These patients were followed up in an open prospective study and evaluated by the HRS scale, based on speaking ability and quality as well as on prosthesis care. 46 patients (44%) attained successful rehabilitation of the voice, defined as 12-15 points according to the HRS scale. Age, tumour stage and postoperative irradiation did not influence the results. Compared to the patient group with less than 12 HRS points, frequent replacements or short in situ lifetime of the prosthesis improve the results of rehabilitation. Patient compliance is an important factor in achieving success with the Provox prosthesis.

Carcinoma of the oropharynx: local failure as the decisive parameter for distant metastases and survival.

OBJECTIVE: How important and predictive are clinical parameters and locoregional failure after radical radiotherapy of oropharyngeal carcinomas for the probability of the occurrence of distant metastases? PATIENTS AND METHODS: From 1 August 1990 to 1 October 1998, 139 patients with carcinomas of the oropharynx were treated in a prospective study by radical radiotherapy and evaluated in regard to the clinical parameters reflex-otalgia, predominant structure of tumor growth, T-category, presence of involved lymph nodes, and smoking and drinking habits. Twenty-nine patients received a concomitant chemotherapy. Twenty-five out of 139 patients had a planned neck dissection after completion of radiotherapy. Ten patients received a salvage operation. RESULTS: The median follow up time was 24 months (range, 4 to 74). Two- and 5-year overall survival rates according to Kaplan Meier were 56.1 and 49.6%. The tumors were controlled in 77/139 patients (55%). The therapy failed in 62/139 patients (45%). Both groups, 62 patients with locoregional therapy failure and 77 patients with locoregionally control led tumors, were comparable in regard to performance status (Karnofsky index), age, gender, TNM-categories, histological differentiation, drinking habits, pretherapeutic diagnostics, total dose (Gy), and number of simultaneous chemotherapy cycles. Locoregional tumor control was significantly determined by the parameters reflex-otalgia (p < 0.0078), predominant growth pattern (p < 0.012), T-category (p < 0.03), and smoking (p < 0.0285). The median survival time of patients with locoregional failure is 17 months. At this moment 81% of locoregionally controlled patients are still alive. In 14/62 patients (23%) with locoregional failure, distant metastases were detectable against 4/77 (5%) of locally controlled patients, p < 0.0026. Probability of local control and distant metastases, predominantly pulmonary, reached a plateau after 24 months. CONCLUSIONS: Locoregional tumor control, determined by several clinical parameters, is an important parameter for the probability of the development of distant metastases. Failure of local therapy is caused by the biologic aggressiveness of the tumor.

Surgical treatment of Zenker's diverticulum: transcutaneous diverticulectomy versus microendoscopic myotomy of the cricopharyngeal muscle with CO2 laser.

In a retrospective study, we analyzed 97 patients who were treated by either transcutaneous diverticulectomy (n = 66) or microendoscopic myotomy of the cricopharyngeal muscle with CO(2) laser (n = 31). Two (6.4%) of 31 patients in the microendoscopic myotomy group had complications, compared with 10 (15%) of 66 patients in the diverticulectomy group. In addition, the complications observed in the microendoscopic myotomy group were less severe than those observed in the transcutaneous diverticulectomy group. The average length of hospitalization was shorter in the microendoscopic myotomy group than in the diverticulectomy group (8 days versus 11.4 days). We conclude that microendoscopic CO(2)-laser myotomy is a less invasive, more precise, and safer procedure, which results in a shortened period of hospitalization and complete relief of symptoms in the vast majority of cases.

Facial nerve function after petrosectomy.

OBJECTIVES: Evaluation of facial nerve function after petrosectomy in a patient series with facial nerve denudation-decompression, forward or backward rerouting, and facial nerve suture and grafting. STUDY DESIGN: Fifty-six patients with petrosectomies performed for 24 benign and 9 malignant tumors of the petrous bone, 13 malignant tumors of the parotid gland or of the infratemporal spaces with infiltration of the petrous bone, 8 traumatic facial nerve disruptions, and 2 osteoradionecroses were retrospectively evaluated with respect to facial nerve function. Sixteen cases involved a partial, 25 a subtotal, and 15 an extended subtotal petrosectomy. METHODS: The treatment of the facial nerve included 15 denudation-compressions, 23 denudation-compressions with rerouting, 4 primary sutures, and 14 nerve grafts. The House-Brackmann grading system was used for facial nerve evaluation. RESULTS: Normal or nearly normal facial nerve function was obtained in facial nerve denudation-decompression with and without rerouting (House-Brackmann Grade I or II) except in cases of malignant tumors and osteoradionecrosis, where preoperative impaired function remained. Satisfactory results were obtained with nerve suturing and nerve grafting after petrous bone fracture (Grade III or IV, in one case practically Grade II) except in a case of late repair 3 years after the trauma (Grade V). Variable results were obtained with nerve grafting in cases with tumor infiltration: Satisfactory results (5 of Grade III or IV) were obtained when the tumor was healed and also when postoperative radiotherapy was applied; poor results were obtained in the case of tumor recurrence (6 of Grade V or VI). CONCLUSIONS: Our results show that petrosectomy with denudation-decompression of the facial nerve with or without rerouting usually results in a normal mimic of the face. When the facial nerve is disrupted by trauma or when the nerve is infiltrated by tumor, early reconstruction with nerve suture or grafting mostly leads to a partial and quite acceptable reinnervation of the face.

Atypical squamous cell carcinoma of the larynx and hypopharynx: radiologic features and pathologic correlation.

The objective of this study was to analyze the radiologic features of atypical forms of squamous cell cancer and correlate them with clinical, endoscopic, and histopathologic findings. The CT and MRI images of 31 patients with atypical forms of squamous cell carcinoma were reviewed retrospectively and the radiologic findings were correlated with clinical, endoscopic, and histopathologic findings. Histopathologic diagnoses included undifferentiated carcinoma of nasopharyngeal type (n = 8), verrucous carcinoma (n = 18), spindle cell carcinoma (n = 3), and basaloid cell carcinoma (n = 2). Undifferentiated carcinoma of nasopharyngeal type was located in the supraglottis or piriform sinus beneath an intact mucosa and initial endoscopic biopsy was most often negative. The discrepancy between an intact mucosa at endoscopy and a solid mass with homogenous enhancement at CT or MRI was characteristic for these tumors and warranted further investigations to obtain the definitive histologic diagnosis. Verrucous carcinoma displayed characteristic clinical, radiologic, and pathologic features, namely, an exophytic tumor arising from the glottic level displaying a rugged surface with finger-like projections but with only minor submucosal infiltration. Spindle cell carcinoma appeared as a polypoid mass with a thin stalk arising from the supraglottis. Basaloid cell carcinoma displayed a distinct lobulated enhancement pattern which was observed on contrast-enhanced T1-weighted SE images. Although the MR and CT features of atypical forms of squamous cell carcinoma cannot be considered pathognomonic they should raise the differential diagnosis even if endoscopic biopsy has been negative. The radiologist's awareness of the appearance of these unusual tumors on CT and MR images may greatly facilitate the diagnostic work-up and helps to guide the endoscopist to the adequate biopsy site in order to establish the correct diagnosis.

Non-squamous cell neoplasms of the larynx: radiologic-pathologic correlation.

A variety of benign and malignant non-squamous cell neoplasms may affect the larynx. Most of these uncommon laryngeal neoplasms are located beneath an intact mucosa, making diagnosis difficult with endoscopy alone, and sampling errors may occur if only traditional superficial biopsies are performed. In some laryngeal neoplasms, radiologic evaluation allows the correct diagnosis. Hemangiomas have very high signal intensity at T2-weighted magnetic resonance (MR) imaging and strong enhancement at both computed tomography (CT) and MR imaging after administration of contrast material. Phleboliths, which are pathognomonic for hemangiomas, are easily identified at CT. Chondrogenic tumors typically manifest with coarse or stippled calcifications at CT. Because of their high water content, chondrogenic tumors have very high signal intensity on T2-weighted MR images, whereas only moderate enhancement is observed after administration of contrast material. Lipomas typically manifest at both CT and MR imaging as homogeneous nonenhancing lesions. They are isoattenuating to subcutaneous fat at CT and isointense relative to subcutaneous fat with all MR pulse sequences. Metastases from renal adenocarcinoma typically demonstrate strong contrast enhancement and flow voids at MR imaging, and metastases from melanotic melanoma usually have high signal intensity on T1-weighted MR images and low signal intensity on T2-weighted images owing to the paramagnetic properties of melanin. Although radiologic findings are nonspecific in most other non-squamous cell neoplasms of the larynx (eg, Kaposi sarcoma, hematopoietic tumors, tumors of the minor salivary glands, metastases from amelanotic melanoma), cross-sectional imaging can play an important role in the diagnostic work-up of these unusual tumors by delineating the extent of submucosal tumor spread and directing the endoscopist to the appropriate site for the deep, transmucosal biopsies needed to establish the diagnosis. In addition, CT and MR imaging are crucial for posttherapeutic monitoring and early detection of local recurrence.

[Malignancies of the mouth cavity, pharynx and larynx--symptoms, diagnosis and therapy]. / Malignome der Mundhöhle, des Rachens und des Kehlkopfes--Symptome, Diagnose und Therapie.

In Switzerland, 7.1% of all malignancies are localized in the oral cavity, pharynx or larynx. These malignancies are diagnosed too often in an advanced stage with a subsequent relatively poor prognosis. To achieve a better survival rate, these malignancies have to be diagnosed in an earlier stage. Therefore, it is important to know the main symptoms, the diagnostic procedure and the treatment possibilities of these cancers, which are described in the following text.

[Predictive significance of reflex otalgia in local radical radiotherapy of oropharyngeal carcinomas]. / Prädiktive Bedeutung der Reflexotalgie in der lokal radikalen Radiotherapie von Oropharynxkarzinomen.

BACKGROUND: Patients with carcinomas of the upper aero-digestive tract often suffer from ear pain as a tumor associated syndrome. This prospective study examines the predictive and prognostic value of this symptom. PATIENTS AND METHODS: Ninety-six consecutive patients who completed a locally radiotherapy of a carcinoma of the oropharynx were prospectively evaluated and followed. Forty-nine out of 96 patients stated the symptom, either spontaneously or after questioning. The 2 groups showed no difference regarding TNM-classification, histology and total dose. Overall survival, local control and disease specific survival were calculated according to Kaplan-Meier and compared by the log-rank test. RESULTS: A clinically complete remission was obtained in significantly fewer patients with reflex-otalgia as compared to patients without reflex-otalgia, 61.2% versus 89.3%, p < 0.002. Local control of patients with reflex-otalgia was significantly less with 49%, mean follow-up 564 days, in comparison to local control in patients without reflex-otalgia, mean follow-up 613 days, p = 0.01. Disease specific survival was significantly worse for patients with reflex-otalgia, p < 0.012. The probability of local control of T1/T2 tumors with reflex-otalgia was similar to T3/T4 tumors without reflex-otalgia. Local control for all tumor categories combined is 74% for patients without reflex-otalgia versus 49% for patients with reflex-otalgia. CONCLUSION: In our patients, reflex-otalgia is a new and statistically significant parameter for the probability of local control and disease specific survival.

[Invasive carcinomas of the hypopharynx with esophageal involvement--multidisciplinary treatment concept]. / Organübergreifende Karzinome des Hypopharynx mit Oesophagusbefall--multidisziplinäres Behandlungskonzept.

In UICC stage IV hypopharnygeal cancer, a radical approach with circular laryngo-pharyngo-esophagectomy with ipsilateral radical neck dissection and contralateral modified radical neck dissection, reconstruction of the pharynx defect with a fundus-rotation-gastroplasty, and postoperative high-dose cervical radiotherapy improves long term survival and maintains a good quality of life.