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The purpose of this study was to evaluate the outcome of primary treatment and treatment of recurrences in patients with nasopharyngeal carcinoma. The material included 149 consecutive patients seen at the Aarhus University Hospital from 1963 to 1991 (49 females and 100 males). The stage distribution was: Stage I –9%, II–3%, III–28%, and IV–60%. Primary treatment was delivered with curative intent in 145 patients (97%). Persistent or recurrent disease after primary radical treatment was observed in 82 of the patients; 54% at the T-level, 40% at the N-level, and 33% at the M-level. A curative salvage attempt was carried out in 14 patients only, all with nodal recurrence: surgery in 8 patients (4 controlled) and radiotherapy in 6 patients (2 controlled). The 5-year local tumour control, locoregional tumour control, disease-specific survival rate and the overall survival rate for the patients treated with curative intent were 66%, 53%, 50% and 43%, respectively. Most of the patients (88%) had poorly differentiated tumours and these patients had the best prognosis. A major complication in three patients was radiation-induced myelopathy due to high-dose radiation delivered to the brain stem. Significant positive prognostic factors for treatment outcome in univariate analyses were early T-classification, small clinical stage, poor differentiation and low age. The Cox multivariate analysis showed that early T-categories, low N-categories and poor differentiation were independent, positive prognostic factors. Nasopharyngeal carcinoma is curable with primary radiotherapy; patients with poorly differentiated tumours have the best prognosis. Only a few patients were salvaged after recurrence. The factor most essential for success is primary control of the disease at the T- and N-levels. [ABSTRACT FROM AUTHOR]

Two treatment options are widely used for the cure of T1 glottic squamous cell carcinoma: radiotherapy and surgical removal. There is ongoing controversy about whether laser excision should be offered to patients with T1 glottic carcinoma. The purpose of this study is to present a review of studies dealing with treatment outcome after laser excision of T1 glottic carcinoma. Eighteen original papers on outcomes were identified. Recurrence rates ranged from 4% to 35%. The disease-specific survival rate at 5 years was found to be from 89% to 100% and crude survival from 74% to 100%. Of the six studies dealing with voice quality, radiation therapy was found to be more effective in preservation of the voice in three, while in the other three studies, no significant difference could be detected. With respect to costs of treatment, in three out of four studies laser surgery was found to be the more economical treatment option. Laser surgery seems to provide comparably low recurrence rates and high disease-specific survival as compared with radiotherapy. In T1 cancer, laser resection leaves the patient with a poorer voice quality than is the case with radiation therapy, but laser treatment seems to be the cheaper option. [ABSTRACT FROM AUTHOR]

In this retrospective study the results of primary and salvage treatment of oropharyngeal carcinoma were evaluated. A total of 289 consecutive patients (103 females and 186 males) were included in the study. Most tumours originated in the tonsil area (58%) and comprised stages I 8%, II 19%, III 46% and IV 28%. The primary treatment was delivered with curative intent in 276 cases (96%). Of these, 266 received primary radiotherapy. The median radiation dose was 62 Gy, given as laterally opposed fields to the primary tumour and bilateral neck. Eight patients were treated with primary surgery and two with chemotherapy as part of a curatively intended treatment programme including radiotherapy. Six patients received palliative treatment, and seven were not treated at all. Out of 276 tumours treated with curative intent, 173 reappeared; 72% recurred in T position, 38% in N position, and 12% at distant metastatic sites, some in combination. Salvage surgery was possible in 52 patients, and 24 treatments were successful. Salvage radiotherapy or cryotherapy was used in 22 patients and 4 were controlled. For the entire group, the 5-year locoregional tumour control, disease-specific survival and overall survival rates were 38%, 44% and 31%, respectively. For patients treated with curative intent, clinical T- and N-stage, stage, tumour size, gender, age, and pretreatment haemoglobin were significant prognostic parameters in a univariate analysis. The Cox multivariate analysis showed that T-stage, N-stage and gender were independent prognostic factors. It is concluded that T-stage, N-stage and gender are significant independent prognostic factors. The primary control of the carcinoma in the T-position is crucial for overall success, but salvage surgery is found to have a favourable success rate in patients suitable for relapse treatment. [ABSTRACT FROM AUTHOR]

To determine whether the endoscopic stapling technique for the treatment of Zenker's diverticulum provides a relief of symptoms and an acceptably low number of complications. Previous studies have indicated that endosurgical stapling of the common wall between the oesophagus and the diverticulum is a safe and effective method that has a low complication rate and only necessitates a few days of hospitalization. To the present only a few investigations including a limited number of patients have reported the clinical outcome with regard to relief of symptoms and degree of satisfaction in a group of patients treated with this new approach. Twenty-three consecutive patients with Zenker's diverticulum treated with endoscopic staple-assisted oesophagodiverticulotomy were investigated. The median age was 70 years and the median observation time was 12 months. All patients but one (96%), reported significant relief of symptoms and 76% had no symptoms at all at the time of follow-up. In one patient, a postoperative episode of uncomplicated fever occurred, which was managed successfully with gastric tube and antibiotics. Most patients resumed oral intake of fluids and foods within the first postoperative day. The high degree of patient satisfaction, the low rate of complications and the few recurrences of symptoms reported in the present study indicate that the endoscopic stapling technique is an efficient and reliable treatment for Zenker's diverticulum. [ABSTRACT FROM AUTHOR]

Cochlear implantation (CI) is a relatively new type of treatment that aims to re-establish hearing in deaf people. This paper reports on the results from CI operations on 34 adults and 17 children. All patients benefited from the treatment. The adults' communication with other people improved. Almost all patients use their implant 16 h a day and some of them are able to communicate by telephone. Among children the results show that the treatment is safe, as no complications have developed. Hearing and speech improved in all children, and thus also their ability to communicate. The results obtained are dependent on the individual patient's condition, the time of operation in relation to the development of deafness, and the type of CI used. CI treatment of deaf people may be considered to be one of the greatest advances in otology. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the results of the initial and salvage treatment for hypopharyngeal carcinoma. The study was conducted in 1963 to 1991and included 138 patients (38 females (28%) and 100 males (73%)). Most of the tumours originated in the piriform sinus (86%). Tumour stage distribution was T1: 20%, T2: 27%, T3: 37% and T4: 17% and nodal stage distribution was N0: 45%, N1: 25%, N2: 10%, and N3: 20%. Primary treatment was delivered with curative intent in 124 out of 138 cases (90%). Treatment failure was noted in 98 patients, with 55% recurrence in T-position, 39% in N-position, and 14% at distant metastases sites. Salvage surgery was successful in 9 out of 32 patients. The overall 5-year locoregional tumour control, cause-specific and overall survival rates were 20%, 25% and 19%, respectively. Univariate actuarial analysis showed that T- and N-stage, clinical stage, tumour size and well-differentiated tumours were significant prognostic parameters. A Cox multivariate analysis showed that only the T- and N-stages were independent prognostic factors. In conclusion, the prognosis for advanced hypopharyngeal carcinoma is extremely poor and the meagre results with conventional radiotherapy alone indicate that other treatment modalities should be introduced in the management of this disease. [ABSTRACT FROM AUTHOR]

We describe a 45 year-old man with a fibrovascular polyp attached to the entrance of the oesophagus. The patient had a history with regurgitation of polypose foreign body 4-5 years ago with spontaneous remission. Later the patient developed dysphagia, chest pain and weight loss. Gastroscopy revealed a large polyp in the oesophagus and biopsies showed no malignancy. Excision was intended to be performed endoscopically, but due to size, risk of bleeding and recurrence the operation was changed to a transcervical procedure. After one week the patient could eat and drink normally.

The purpose of this study was to evaluate the ultimate neck control after primary radiotherapy and surgical salvage in laryngeal and pharyngeal cancer patients. Some 1782 consecutive patients with squamous cell carcinoma were treated by radiotherapy. At presentation 26% of the patients had metastatic lymph nodes. A total of 298 primary or secondary nodal recurrences were seen, 159 were treated, and 53 (53/298 approximately 18%) were controlled. Isolated N-recurrence was fatal in 2.7% (36/1324) of the N0 patients. Univariate actuarial analysis of nodal control demonstrated that the region of origin, T-classification, T-size, N-classification, tumor stage, differentiation, hemoglobin, and radiation time were significant prognostic factors. In a Cox analysis the independent significant parameters were gender, region of origin, N-classification, and differentiation. The conclusions were that in patients with nodal recurrence a little over half were treated and of these a third of the nodal recurrences were controlled. Significant prognostic factors in multivariate analysis were gender, region of origin, N-classification, and tumor differentiation.