Performance Status Scale For Head And Neck Cancer Research Articles

Revisiting Feeding Tube Utilization in Oropharynx Cancer: 6-Year Prospective Registry Analysis.

Patients treated for oropharyngeal cancer (OPC) have historically demonstrated high feeding tube rates for decreased oral intake and malnutrition. We re-examined feeding tube practices in these patients. Retrospective analysis of prospective cohort from 2015 to 2021. Single-institution NCI-Designated Comprehensive Cancer Center. With IRB approval, patients with new oropharyngeal squamous cell cancer or (unknown primary with neck metastasis) were enrolled. Baseline swallowing was assessed via videofluoroscopy and Performance Status Scale for Head and Neck Cancer (PSSHN). G-tubes or nasogastric tubes (NGT) were placed for weight loss before, during, or after treatment. Prophylactic NGT were placed during transoral robotic surgery (TORS). Tube duration was censored at last disease-free follow-up. Multivariate regression was performed for G-tube placement (odds ratio [OR] [95% confidence interval [CI]) and removal (Cox hazard ratio, hazard ratio [HR] [95% CI]). Of 924 patients, most had stage I to II (81%), p16+ (89%), node-positive (88%) disease. Median follow-up was 2.6 years (interquartile range 1.5-3.9). Most (91%) received radiation/chemoradiation, and 16% received TORS. G-tube rate was 27% (5% after TORS). G-tube risk was increased with chemoradiation (OR 2.78 [1.87-4.22]) and decreased with TORS (OR 0.31 [0.15-0.57]) and PSSHN-Diet score ≥60 (OR 0.26 [0.15-0.45]). G-tube removal probability over time was lower for T3 to T4 tumors (HR 0.52 [0.38-0.71]) and higher for PSSHN-Diet score ≥60 (HR 1.65 [1.03-2.66]). In this modern cohort of patients treated for OPC, 27% received G-tubes-50% less than institutional rates 10 years ago. Patients with preserved baseline swallowing and/or those eligible for TORS may have lower G-tube risk and duration.

Early Post-operative Feeding: An Investigation of Early Functional Outcomes for Oral Cancer Patients Treated with Surgical Resection and Free Flap Reconstruction

Traditionally patients can remain nil by mouth (NBM) for up to 12 days after oral tumour resection with free flap reconstruction to reduce the risk of flap dehiscence, poor healing and fistulae. The literature reports that patients could on average remain an inpatient for up to 20 days post-surgery. An evaluation of the impact of a defined early oral feeding protocol was undertaken investigating functional outcomes and complications rates. We prospectively reviewed tracheostomy use, length of hospital stay, non-oral feeding status and swallowing function using the Performance Status Scale for Head and Neck Cancer (PSS-HN) within a defined early feeding protocol. Twenty-nine patients underwent surgical resection with free flap reconstruction for advanced primary oral cancer between January 2018 and December 2019. Average age was 59.5 (range 24–88). Tumour sites included oral tongue (n = 10), maxilla (n = 6), mandible (n = 6), floor of mouth (n = 5) and buccal mucosa (n = 2). Median time to decannulation was 7 days (range 3–20 days, n = 11). The majority of patients were able to tolerate at least oral fluids on day 1 post-operatively (86%, n = 25). In addition to oral intake, non-oral feeding was required in 90% (n = 26), the majority of which included a nasogastric tube (NGT) placed intraoperatively 54% (n = 14), others required gastrostomy 46% (n = 12). Median time to nasogastric tube removal was 6 days (range 3–15 days). Median length of hospital stay was 10 days (range 3–51). Mean PSS-Normalcy of Diet (NOD) score at point of hospital discharge was 36.55 (95% CI 30.9–42.2). Flap failure was noted in 3% (n = 1). The adoption of an early oral feeding protocol suggests that there is the potential for a shorter hospital stay and earlier swallowing rehabilitation.

Preliminary Functional Outcomes and Quality of Life after Tongue Reconstruction with the Vastus Lateralis Myofascial Free Flap.

The aim of the present study is to report our preliminary experience with the vastus lateralis myofascial free flap (VLMFF) for tongue reconstruction according to tongue and donor site functional outcomes. Twelve consecutive patients (F: 5; median age: 54.0 years, interquartile range or IQR 42.75-69.0) were included. The validated European Organization for Research and Treatment of Cancer of the Head and Neck 35 Quality of Life Questionnaire (EORTC QLQ-H&N35) and the performance status scale for head and neck cancer (PSS-HN) questionnaires were used to assess the health-related quality of life (HRQOL). The lower extremity functional scale (LEFS) was used to self-report the donor area function. All patients were successfully treated, and no VLMFF failure was detected during a median follow-up period of 10.5 months (IQR: 6.5-33.0). The HRQOL showed a median EORTC QLQ-H&N35 score of 56.0 (IQR: 50.0-72.5). The median PSS-HN score was 80.0 (IQR: 45.0-95.0), 75.0 (IQR: 62.5-100.0), 75.0 (IQR: 62.5-100.0) for "Normalcy of Diet," "Public Eating," and "Understandability of Speech," respectively. The self-reported function of the lower extremities (donor area) showed a median LEFS of 59.0 (IQR: 32.5-74.0). This study reports optimistic data regarding the functional and quality of life outcomes after tongue reconstruction using VLMFF. Prospective controlled studies are needed to demonstrate advantages and disadvantages when compared with other reconstructive techniques.

Surgical rehabilitation of swallowing with polydimethylsiloxane injections after open partial horizontal laryngectomy: Long-term functional results and quality of life.

Swallowing disorders are common problems after partial laryngectomy. The aim of this study is to illustrate the long-term functional results of rehabilitation of swallowing by polydimethylsiloxane (PDMS) injection. Twenty-eight patients with dysphagia after partial laryngectomy who underwent injection of PDMS for rehabilitation of swallowing were included in the study. Impairment of swallowing and quality of life (QoL) were investigated with questionnaires: M. D. Anderson Dysphagia Inventory (MDADI) and Performance Status Scale for Head and Neck Cancer (PSS-HNC). Functional results at fiberoptic endoscopic evaluation of swallowing (FEES) were analyzed using a modified penetration-aspiration scale. Mean follow-up was 8.5 years. Twenty-six patients showed an improvement at questionnaires (p < 0.001). Median improvement was 6 (p < 0.001) in the modified penetration-aspiration scale. Total laryngectomy was required in one patient. PDMS injection is a good option for rehabilitation of swallowing in case of dysphagia after partial laryngectomy. It improves QoL and the results persist after a long follow-up period.

The natural history of weight and swallowing outcomes in oropharyngeal cancer patients following radiation or concurrent chemoradiation therapy.

Patients treated for oropharyngeal cancer (OPC) are at increased risk for functional decline due to cancer-related impairments and treatment toxicities, often leading to recommendations for enteral nutritional support. This study investigated the natural history of weight and swallowing outcomes in patients with and without feeding tube (FT) placement. Data were collected from electronic medical records of OPC patients treated with (chemo)radiotherapy at a single regional cancer center between January 2013 and December 2015. Weight measurements, Functional Oral Intake Scale (FOIS) scores, Performance Status Scale for Head and Neck Cancer (PSS-HN) normalcy of diet scores, and M.D. Anderson Dysphagia Inventory (MDADI) composite scores were gathered at baseline and at 3-, 6-, and 12-months post-treatment. Patients were grouped based on FT placement and change over time was assessed using linear mixed effects analysis. Of 122 eligible patients, 38 (31.1%) received a FT (FT group). Compared with baseline, weight decreased significantly at 3 and 6months in both groups and at 12months for patients without a FT (NFT group). Swallowing-related quality of life (QoL) decreased significantly at 3 and 6months only in the NFT group. OPC patients experience clinically relevant decreases in weight and swallowing-related QoL in the first-year post-treatment irrespective of FT placement. These findings will contribute to improved patient monitoring and communication within the clinical setting which may ultimately lead to better outcomes for those with OPC.

Routine Use of Swallowing Outcome Measures Following Head and Neck Cancer in a Multidisciplinary Clinic Setting.

Introduction Chemoradiotherapy treatment for head and neck cancer (HNC) can have a major impact on swallowing function and health-related quality of life. The use of outcome measures in early detection of patients with swallowing problems provides the opportunity for targeting speech and language therapy (SLT) interventions to aid adaption and promote better clinical outcomes. Objective The purpose of the present study was to assess relationships between four outcomes measures over time, in a cohort of HNC patients, treated by (chemo-)radiotherapy. Methods Data were collected at 3 months and 12 months, on 49 consecutive patients with primary squamous cell cancer of the oropharynx, nasopharynx or hypopharynx stage T1–4, N0–2b, M0 disease. Results Out of 49 eligible patients, 45 completed assessment at 3 months and 20 at 12 months. The 3-month outcomes gave a strong indication of performance at 1 year. There were several strong correlations found between measures. The strongest was between the 3-month Performance Status Scale for Head and Neck Cancer (PSSHN) and the 12-month PSSHN (rs = 0.761, n = 17), the 12-month PSSHN and the 12-month Functional Oral Intake Scale (FOIS) (rs = 0.823, n = 20), and the 12-month University of Washington Head and Neck Quality of Life (UWQoL) swallow and the 12-month Water Swallow Test (WST) capacity (rs = 0.759, n = 17). Conclusion The UW-QoL swallow item and WST are easy to incorporate into routine care and should be used as part of a standard assessment of swallow outcome. These measures can serve to help screen patients for dysfunction and focus allocation of resources for those who would benefit from more comprehensive assessment and intervention by SLT.

Abstract A36: Impact of feeding tube use on swallowing-related quality of life and weight in oropharyngeal cancer

Abstract Purpose: This study investigated differences in swallowing-related quality of life (QoL) and weight outcomes in patients treated for oropharyngeal cancer (OPC) based on feeding tube (FT) use. Methods: A retrospective chart review of OPC patients treated with definitive radiotherapy (± chemotherapy) was performed. Swallowing QoL and weight outcomes were collected from electronic medical records for patients seen at a single regional cancer center between January 2013 and December 2015. M.D. Anderson Dysphagia Inventory (MDADI) composite scores, Performance Status Scale for Head and Neck Cancer (PSS-HN) Normalcy of Diet scores, and weight measurements were gathered at baseline and at 3, 6, and 12 months post-treatment. Patients were grouped based on FT use. Bivariate associations were evaluated using the chi-square test and change over time was analyzed by group using a linear mixed effects analysis. The proportion of patients with clinically meaningful change was also determined. Results: Of 126 eligible patients, 46 (36.5%) received a reactive gastrostomy or gastro-jejunostomy FT (FT group). Compared to baseline, MDADI composite scores were significantly lower at 3 and 6 months (p &amp;lt; .001) for those who did not receive a FT (NFT group), while no significant change occurred in the FT group over time. No significant change was noted in PSS-HN scores for either group. Significant decreases in weight occurred in both groups at 3 and 6 months, and at 12 months for the NFT group alone (p &amp;lt; .001). Clinically meaningful decreases in MDADI composite scores at 3, 6, and 12 months were observed in 53%, 43%, and 29% of FT patients and 45%, 44%, and 33% of NFT patients, respectively. Clinically meaningful decreases in weight were observed at 3, 6, and 12 months in 30%, 23%, and 13% of FT patients and for 50%, 44%, and 40% of NFT patients, respectively. There was no significant association between FT use and clinically meaningful decreases in either MDADI composite scores or weight. Conclusions: Despite selective use of enteral feeding for nutritional support in patients at risk, the impact of FT utilization on functional outcomes is not well understood. Statistically significant decreases in short-term swallowing-related QoL were noted preferentially in patients without FTs, and there was a concerning trend for NFT patients to not return to baseline weight by 12 months post-treatment. However, this study also identified that patients in both groups experienced clinically meaningful decreases in swallowing-related QoL and weight in the first year post-treatment irrespective of FT use. Based on this evidence, it is prudent to monitor weight change closely, particularly in patients who do not meet initial risk criteria for reactive FT placement. Understanding the potential for clinically meaningful change in swallowing QOL and weight will contribute to improved patient monitoring and intervention, and may ultimately lead to better outcomes for those with OPC. Citation Format: Nedeljko Jovanovic, Colleen Dreyer, Sarah Hawkins, Kendra Thouless, David Palma, Philip C. Doyle, Julie A. Theurer. Impact of feeding tube use on swallowing-related quality of life and weight in oropharyngeal cancer [abstract]. In: Proceedings of the AACR-AHNS Head and Neck Cancer Conference: Optimizing Survival and Quality of Life through Basic, Clinical, and Translational Research; 2019 Apr 29-30; Austin, TX. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(12_Suppl_2):Abstract nr A36.

Transoral robotic-assisted supracricoid partial laryngectomy with cricohyoidoepiglottopexy: Procedure development and outcomes of initial cases.

We report on the feasibility and functional outcome of transoral robotic (TORS) supracricoid partial laryngectomy (SCPL) with cricohyoidoepiglottopexy (CHEP). Cadaveric studies and functional outcome at 3 years using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ-H&N35), the Functional Outcome Swallowing Scale (FOSS), the Performance Status Scale for Head and Neck Cancer (PSS-HN), computerized voice analysis, and videotape recordings. Data were compared with a historical cohort of open CHEPs/cricohyoidopexies (CHPs). The EORTC-QLQ-H&N35 scores, FOSS scores, and PSS-HN scores at 3 years of 2 operated patients were 46 and 43, 2 and 1, and 75 of 100 (eating in public) and 100 of 100 (normalcy of diet), respectively. The mean fundamental frequency, jitter, shimmer, noise-to-harmonic ratio (NHR), and maximum phonation time (MPT) were 85 HZ and 81 Hz, 8.52% and 6.39%, 28.2% and 13.5%, 0.61 and 0.71, 19 seconds and 15 seconds, respectively. Functional outcome data suggest that the procedure is feasible and safe.

Quality of Life and Performance Status From a Substudy Conducted Within a Prospective Phase 3 Randomized Trial of Concurrent Accelerated Radiation Plus Cisplatin With or Without Cetuximab for Locally Advanced Head and Neck Carcinoma: NRG Oncology Radiation Therapy Oncology Group 0522

To analyze the quality of life (QOL) and performance status (PS) (secondary outcome) in patients with stage III to IV head and neck cancer (HNC) enrolled on a prospective randomized phase 3 trial comparing radiation-cisplatin without cetuximab (CIS) or with cetuximab (CET/CIS). The QOL hypothesis proposed a between-arm difference in Functional Assessment of Cancer Therapy-Head and Neck (FACT-HN) total score of ≥10% of the instrument range from baseline to 1year. Patients who gave consent to the QOL/PS study completed the FACT-HN, Performance Status Scale for HNC (PSS-HN), and EuroQol (EQ-5D) at baseline through to 5years. The pretreatment QOL/PS scores were correlated with outcome and p16 status in patients with oropharyngeal cancer (OPC). Of 818 analyzable patients, the 1-year change from baseline score for FACT-HN total was -0.41 (CIS arm) and -5.11 (CET/CIS arm) (P=.016), representing a 3.2% between-arm change of the FACT-HN total score. The mean EQ-5D index and PSS-HN scores were not significantly different between arms. The p16-positive OPC patients had significantly higher baseline and 1-year scores for PSS-HN, FACT-HN total, physical and functional subscales, and 2-yearsfor the EQ-5D index compared with p16-negative OPC patients. Higher pretreatment PSS-HN diet, PSS-HN eating, FACT-HN, and EQ-5D index scores were associated with better overall survival (OS) and progression-free (PFS) survival on multivariate analysis. Higher baseline FACT-HN total, functional, physical subscale, and EQ-5D index scores were associated with improved OS and PFS in p16-positive OPC patients but not in p16-negative and non-OPC patients. There was no clinically meaningful difference in QOL/PS between arms. The p16-positive OPC patients had significantly higher QOL/PS than did p16-negative patients. Pretreatment QOL/PS is a significant independent predictor of outcome in locally advanced HNC.

Preliminary results of the validation of a patient (pt) self-administered questionnaire (Oral Mucositis Weekly Questionnaire-Head and Neck [OMWQ-HN]) to assess the impact of OM on pain and functioning in head and neck cancer (HNC)

5548 Background: Pt self-reported questionnaires measuring acute and specific effects of OM are needed to assess effects of interventions and guide patient care. We evaluated the feasibility, validity, and reliability of the OMWQ-HN on OM and its impact on pts’ abilities to perform alimentary and other routine functions. Methods: Validity and reliability of the OMWQ-HN was assessed in 75 pts from a prospective multicenter study receiving radiotherapy ± chemotherapy (RTCT). Assessments included test-retest reliability, internal consistency reliability, and cross-sectional validity. The OMWQ-HN’s sensitivity to detect change was demonstrated by using the changes in the Performance Status Scale for HNC (PSS-HN) and the Functional Assessment of Cancer Therapy (FACT-HN) to form 3 independent groups (better, no change, worse) for comparison. Effect sizes (ES) were calculated for group comparisons to measure the clinical significance of differences. Results: Compliance rates were &gt;90% throughout the study. The OMWQ-HN demonstrated good test-retest reliability (r = 0.89). Cronbach’s alpha was &gt;0.85 and mouth, throat, and pain-related items correlated highly with each other (r&gt;0.7). Cross-sectional analyses to assess validity showed that OMWQ-HN scores were different across levels of pain, with those in the worst pain category reporting the most severe OMWQ-HN scores (ES &gt;0.5 for all comparisons). The OMWQ-HN was sensitive to change in FACT-HN and PSS-HN (p &lt; 0.001 and p = 0.013, respectively). Patients reported increases in mouth and throat soreness (MTS) that corresponded with a steady decline in oral function. Conclusions: These results indicate the OMWQ-HN is a feasible, valid, and reliable instrument for assessing the impact of mucositis on patients receiving RTCT in the HNC patient care setting. [Table: see text]

Performance and side effect evaluation of sequentially reduced radiotherapy doses in a phase II trial of induction chemotherapy (IndCT) followed by concomitant chemoradiotherapy (CTX) for advanced head and neck cancer (HNC)

5558 Background: CTX regimens are often limited by severe acute toxicities and long-term functional impairment. This paper presents patient (pt) reported side effects and performance outcome in 3 sequential groups of stage IV HNC pts treated at the University of Chicago with IndCT and lowering radiation doses with the goal of maintaining survival while minimizing negative sequelae. Methods: Pts. were treated with IndCT followed by alternating weeks of concurrent CTX with lowering doses of radiotherapy to gross disease/ high risk microscopic/low risk microscopic disease: Group A - 75/60/45 Gy (n = 36 pts); Group B - 75/54/39 Gy (n = 34 pts); Group C - 72/51/36 Gy (n = 60 pts), respectively (treatment details &amp; survival analyses presented separately). Pts were assessed for quality of life, performance (Performance Status Scale for HNC) and side effects (Radiotherapy Questionnaire) pretreatment, during CTX, at 3 &amp; 12 months and annually thereafter. Controlling for baseline scores, differences between the groups were examined on- treatment and at 12-months. Results: Baseline and 12-month data were available for 81/114 pts. While all pts declined in performance (e.g., diet) and reported increased side effects (e.g., dry mouth, mouth pain, swallowing problems) on CTX, there were no statistically significant differences based on radiation dose. Similarly, there was improvement in most symptoms by 12 months with little difference among groups. In contrast, on normalcy of diet, fewer patients in Group C (20%) showed declines of more than 20 points from baseline compared to A (46%; p = .085) and B (45%, p = .09). Overall, 4% of patients were unable to take anything orally at 12-months with no difference among groups. Conclusions: This study showed no differences in pt reported symptoms on-treatment or at 12-months based on lowered radiation doses during CXT. On the other hand, while there continued to be some restriction in long-term diet, pts in the lowest radiation dose group showed somewhat less decline from baseline. These findings suggest the continued need to explore ways of decreasing both acute and long term toxicities in the use of CTX regimens. [Table: see text]

Measures of health-related quality of life and functional status in survivors of oral cavity cancer who have had defects reconstructed with radial forearm free flaps

The aim of this study was to evaluate (by postal questionnaire) quality of life and function in patients who have had resections of oral cancer and reconstruction by radial forearm flaps. Between October 1987 and December 2002, 258 patients had reconstructions by radial forearm flaps after resection of tumours in the oral cavity. Of these, 139 surviving patients were identified from the database and were sent questionnaires comprising five sections: Functional Assessment of Cancer Therapy-General (FACT-G) and -Head and Neck (FACT-HN); University of Washington Quality of Life Scale (UWQoL); Performance Status Scale for Head and Neck Cancer (PSS-HN); and the final section addressed dental rehabilitation and morbidity at the donor site. Sixty-three questionnaires (45%) were returned. In 17 (27%), parts of the questionnaire were incomplete. The median UWQoL score was 623/900, FACT-G was 92/108, FACT-HN was 31/48, and PSS-HN showed that eating in public, understandability of speech and normality of diet were 75/100, 75/100 and 50/100, respectively. The effect of stage and site on quality of life and function did not reach statistical significance. The effect of radiotherapy on speech ( p = 0.036) and diet ( p = 0.007) was significant. Patients who worried about their cancer returning had a lower UWQoL score ( p = 0.016). Ninety percent regarded their arm as disfigured, but 81% felt comfortable wearing short-sleeved shirts. Sensation and function of the hand were reported as normal in 87 and 92%, respectively. We conclude that patients who have had oral cancer have a persistent reduction in quality of life and function long after completion of treatment. The effects can be assessed by postal questionnaire, but the low rate of return (45%) and difficulties with completion reduce the quality of the data. Quality of life and function are essential components of improvements in outcome.

Functional evaluation after reconstruction of the anterior floor of the mouth with free flaps in patients with head and neck cancer

The aim of this study was to evaluate functional results in two type of free flaps applied in a series of patients with cancer of the the anterior floor of the mouth.From 1992 to 1997, 15 patients with a diagnosis of squamous cell carcinoma of the anterior floor of the mouth were submitted to surgical excision and primary reconstruction with free fascio-cutaneous or osteo-myocutaneous flaps. Functional assessment of each patient included application of the Performance Status Scale for Head and Neck Cancer (PSS-HNC), Karnofsky scale, articulation test and flouroscopy.Ten patients received a free radial forearm flap and one of them required an additional non-vascularized free iliac crest graft. Five patients received a free iliac crest flap. Dental implants were inserted in eight cases. A functional evaluation was performed on nine patients: PSS-HNC median score for diet was 80 (range: 50–100), for speech was 75 (range: 50–100) and for «eating in public» category, it was 75 (range: 75–100); Karnofsky scale median score was 90. All patients showed good communication skills by evaluation. Eight patients had articulation errors of the type tip-tonge consonants /t,d,n,s,z,l/ and/or posterior-tongue consonants /k,g,r/; physical and social activities were normal for all patients. Flouroscopy showed anatomical and physiological alterations following large resections of soft tissue.The type of reconstruction selected for each patient must be individualised. The quality of functional rehabilitation achieved in the floor of the mouth is inversely proportional to the degree of the soft tissue resection, mostly that of the tongue.

Quality of life and recurrence concern in survivors of head and neck cancer.

A cohort of 3-year survivors of head and neck cancer was evaluated for persistent quality of life (QOL) concerns and long-term treatment effects. Mailed questionnaire. The questionnaire with the University of Washington Quality of Life (UWQOL) scale, the Performance Status Scale for Head and Neck Cancer (PSS-HN), the Functional Assessment of Cancer Therapy (FACT) scale, and the Functional Assessment of Cancer Therapy Head and Neck (FACT-HN) scale and locally prepared questions was sent to 111 3-year disease-free survivors. Analysis was performed to statistically evaluate the effect of stage, site, treatment type, surgery, and cancer concern on QOL. Current smoking information was gathered. Seventy-two survivors completed the questionnaire. Advanced stage was correlated with lower QOL scores in the domains of disfigurement, chewing ability, speech, and eating in public. QOL scores did not vary by initial tumor site. Patients treated with irradiation alone had statistically better QOL scores than those treated with combined surgery/radiation therapy in the pain, disfigurement, chewing, and speech domains. Laryngectomy and composite resection survivors reported lower QOL scores than patients treated with irradiation alone. A low level of cancer concern persisted in about half of the long-term survivors. Cancer concern was associated with continued pain, disfigurement, and limitations on eating in public. Three-quarters of the tobacco users had quit by the time of the questionnaire. Nevertheless, the patients were not thoroughly convinced that tobacco had caused their cancer. Long-term survivors of head and neck cancer experience QOL effects well after completion of treatment. Effects are most pronounced in survivors who required combined surgery/radiation therapy. Continuing low levels of cancer concern persist in about half of the survivors. Many cancer survivors successfully quit smoking.

Assessment of quality of life in patients treated with accelerated radiotherapy for laryngeal and hypopharyngeal carcinomas

This study was conducted to evaluate quality of life (QOL) and functional outcome in patients with carcinomas of the larynx and hypopharynx treated with accelerated radiotherapy (RT). Between January 1991 and September 1996, 21 patients treated with accelerated concomitant boost RT schedule (69.9 Gy in 5. 5 weeks) for laryngeal (n = 10) or hypopharyngeal (n = 11) carcinomas and who remained free of disease at 1-year minimum follow-up were evaluated. The functional outcome was assessed by the subjective Performance Status Scale for Head and Neck cancer (PSSHN) and general QOL by the European Organization for Research and Treatment of Cancer Core QOL questionnaire (EORTC QLQ-C30). The median length of follow-up was 37 months (range, 13 to 75). The PSSHN scores were 89, 84, and 86, respectively, for eating in public, understandability of speech and normalcy of diet (100 = normal function). Significantly lower scores for understandability of speech were observed in patients with advanced and laryngeal carcinomas. Normalcy of diet was affected negatively by the severity of xerostomia. All mean functional scale scores of the EORTC QLQ-C30 module were 20% to 25% below the higher score. Most of these scale scores were significantly affected by the severity of xerostomia. Patients treated with concomitant boost RT for laryngeal and hypopharyngeal carcinomas appear to have similar QOL and functional outcome to those reported for patients treated with conventional or hyperfractionated RT. As expected, many QOL scales were affected by the severity of xero- stomia.