Squamous Cell Carcinoma Of Pyriform Sinus Research Articles

Lymph node ratio predicts recurrence-free survival and disease-specific survival of patients with pyriform sinus squamous cell carcinoma

ObjectiveThis study assessed positive lymph node ratio (LNR) as a prognostic marker for patients with pyriform sinus cancer. MethodsThe present study retrospectively analyzed 101 patients with pyriform sinus cancer to determine the association of LNR with recurrence-free survival (RFS) and disease-specific survival (DSS). ResultsThe patients were followed up for a median duration of 28 months (range: 6–196 months). The number of median dissected lymph nodes (LNs) was 41, and the number of median positive LNs was three. The receiver operating characteristic curve revealed an LNR cut-off value of 8.6%. Lymphovascular invasion (LVI) or perineural invasion (PNI) (P = 0.001), thyroid gland invasion (TGI, P = 0.000), positive LNs >4 (P = 0.036), and LNR >8.6% (P = 0.008) were significantly associated with poor RFS, and LVI or PNI (P = 0.005), tumor pT3/T4 stage (P = 0.028), positive LNs >4 (P = 0.033), TGI (P = 0.001), and LNR >8.6% (P = 0.003) were significantly associated with poor DSS. The multivariate analysis revealed that LVI or PNI (P = 0.010), TGI (P = 0.000), and LNR >8.6% (P = 0.022) were independent predictors for poor RFS, while tumor pT3/T4 stage (P = 0.049), TGI (P = 0.015), and LNR >8.6% (P = 0.001) were independent predictors for poor DDS. ConclusionLNR and other clinicopathological data can be used to predict the RFS and DSS of pyriform sinus cancer patients.

Lung cancer Detected as a Metachronous Second Primary Malignancy in a patient with Pyriform Sinus Carcinoma during 18F FDG PET-CT scan

Pyriform sinus squamous cell carcinoma is the most prevalent type of hypopharyngeal carcinoma. The presence of a second primary malignancy in pyriform sinus carcinoma is uncommon. We present a case of metachronous second primary lung cancer detected by whole-body 18F-FDG PET-CT imaging during the follow-up evaluation in a treated case of well-differentiated squamous cell carcinoma of the left pyriform fossa. Bangladesh J. Nuclear Med. 24(1&2): 64-67, 2021

Pathological Level VI Lymph Node Metastasis in Clinical N3b Pyriform Sinus Squamous Cell Carcinoma.

The frequency of metastasis to level VI lymph nodes in advanced pyriform sinus squamous cell carcinoma (PSSCC) is unknown. We intended to analyze the clinical features and pathological presence or absence of level VI lymph node metastasis in patients with PSSCC. The data of 270 patients with previously untreated hypopharyngeal squamous cell carcinoma from 2006 to 2016 were obtained. Patients who underwent pharyngolaryngectomy for the pyriform sinus subsite with a curative intent with level VI dissection were included. We retrospectively analyzed the clinical Tumor-Node (TN) status (TNM classification of malignant tumors, eighth edition) and the presence or absence of pathological level VI lymph node metastasis. A total of 34 patients were included. Eight patients (24%) had pathological level VI lymph node metastasis. The rate of pathological level VI lymph node metastasis was directly proportional to the clinical N status (P = .0002, Chi-square test for trend). In all, 5 patients with cN2b- 3 were classified as cN3b. Ipsilateral pathological level VI lymph node metastasis was observed in 1 patient, and bilateral metastasis was observed in 3 patients. There was no association between clinical T status or pyriform sinus apex invasion and pathological level VI metastasis (both P > .99, Fisher's exact test). PSSCC with cN3b is prone to bilateral level VI metastasis. We recommend that patients with PSSCC with cN3b should undergo bilateral level VI lymph node dissection.

Risk stratification and corresponding postoperative treatment strategies for occult contralateral lymph node metastasis in pyriform sinus squamous cell carcinoma patients with ipsilateral node-positive necks.

BackgroundTo quantitatively predict the probability of occult contralateral lymph node metastasis (cLNM) for pyriform sinus squamous cell carcinoma (PSSC) patients with ipsilateral node-positive necks to guide postoperative adjuvant treatment.MethodsTwo hundred and twenty-seven PSSC patients with ipsilateral lymph node metastasis (iLNM) were retrospectively analyzed.ResultsMultivariate logistic analyses showed that five factors including maximum tumor diameter (MTD) of more than 4.0 cm, existence of tumor extension across the midline (EAM), internal jugular vein adhesion (IJVA), lymphovascular invasion (LVI), and lymph nodal fusion (LNF) were independent risk factors for cLNM. A predictive nomogram was created based on these factors. The accuracy and validity of our model were verified by concordance index (C-index) 0.862 [95% confidence interval (CI): 0.810–0.914] in development cohort and 0.860 (95% CI: 0.820–0.900) after 1,000 bootstrapping. The calibration curve also showed a relatively favorable agreement. We then stratified patients into three groups based on their cLNM risk scores. Possible cLNM rates for low-risk, moderate-risk, and relatively high-risk subgroups were 3.6%, 21.8%, and 60.7%, respectively.ConclusionsA new postoperative adjuvant radiotherapy (PART) strategy selection flow chart was created for PSSC patients based on our newly built nomogram which can effectively predict the individualized possibility of cLNM. For patients in high-risk subgroup, therapeutic-dose PART is highly recommended even for those with contralateral clinical N0 neck disease. For those in moderate-risk subgroup, prophylactic-dose PART is recommended. However, for patients in low-risk subgroup, regular follow-up is sufficient given the extremely low occult cLNM rate.

Long-term outcome of patients with pyriform sinus squamous cell carcinoma treated with planned preoperative (chemo-) radiotherapy plus laryngeal function sparing surgery

Objective: To analyze the long-term outcome of patients with pyriform sinus squamous cell carcinoma treated with planned preoperative (chemo-) radiotherapy plus laryngeal function sparing surgery. Methods: Patients with stage Ⅲ/Ⅳ pyriform sinus squamous cell carcinoma treated with planned preoperative (chemo-) radiotherapy plus laryngeal function sparing surgery during 1999 to 2000 were retrospectively analyzed. Data including concurrent chemotherapy or not, postoperative pathological diagnosis, postoperative complications, recurrence and survival were collected. Twenty patients were treated with preoperative radiotherapy while 14 patients with preoperative chemo-radiotherapy. Results: Among 31 cases of postoperative pathological diagnosed as pyriform sinus, 12 (38.7%) cases without tumor residue, 7 (22.5%) cases with severe radiation response and 12 (38.7%) cases with tumor residue. The 5-year cumulative local recurrence rate, regional recurrence rate and distant metastasis rate was 14.5%, 13.7% and 23.5%, respectively. Five-year cumulative overall survival rate and recurrence-free survival rate were 69.6% and 65.4%, respectively. Nine deaths were attributed to distant metastasis (8 cases) and regional recurrence (1 case). Conclusion: Most patients with pyriform sinus squamous cell carcinoma acquire long-term survival after treated with planned preoperative (chemo-) radiotherapy plus laryngeal function sparing surgery, and distant metastasis is the main cause of death.

Validity of prophylactic neck dissection for pyriform sinus squamous cell carcinoma

Validity of prophylactic neck dissection for pyriform sinus squamous cell carcinoma

Clinical outcomes of weekly cisplatin chemoradiotherapy for patients with pyriform sinus cancer.

Pyriform sinus squamous cell carcinoma (SCC) has one of the worst prognoses of all upper aerodigestive tract cancers. Improving clinical outcomes for patients with hypopharyngeal SCC has been particularly challenging for head and neck surgeons and oncologists. We investigated 30 patients with pyriform sinus SCC to verify the effectiveness of weekly cisplatin chemotherapy with concurrent radiotherapy. Cisplatin was administered at a dose of 40 mg/m(2) on weeks 1, 2, 3, 5, 6, and 7 during definitive radiotherapy with the aim of preserving the larynx. All 30 patients achieved definitive radiotherapy at a median dose of 70 Gy (range 64-70 Gy). Cisplatin was administrated concomitantly a median of five times (range 2-6 times). Persistent or recurrent primary disease was observed in four patients (13 %). Persistent or recurrent nodal metastasis was observed in five patients (17 %). Nine salvage surgeries were performed for eight patients, of whom seven survived without any evidence of disease. Post-operative complications were observed in two patients (22 %). The 5-year overall survival and locoregional control rates were 87 and 96 %, respectively. The 5-year laryngeal preservation rate was 74 %. The regimen of weekly cisplatin CRT may be effective for pyriform sinus SCC; however, there were problems with strong selection bias in the current study due to the large number of T2 patients. Salvage surgery was safe and was able to improve the survival rate. This chemoradiation regimen was considered successful in preserving laryngeal function.

A pyriform sinus cancer organ preservation strategy comprising induction chemotherapy with docetaxel, cisplatin, and 5-fluorouracil, followed by potentiated radiotherapy: a multicenter, retrospective study.

No specific study has evaluated the role of neoadjuvant DCF (docetaxel, cisplatin, 5-fluorouracil) followed by radiotherapy in pyriform sinus cancer, which are often included in studies focusing on laryngeal and hypopharyngeal cancer. We assessed the proportion of patients treated sequentially for a pyriform sinus cancer with a preserved larynx. Overall survival, event-free survival (EFS), survival with 'local control', and treatment tolerance were assessed as well. We retrospectively reviewed 88 patients with advanced pyriform sinus squamous cell carcinoma treated with DCF between 2005 and 2010. After induction, radiation could be potentiated with cetuximab or cisplatin. Most patients (82%) had been treated with organ preservation intent. The response rate to DCF was 85%, including 42% with complete response. Primary tumor was operated in 13 patients (eight with total laryngectomy). Radiotherapy had been delivered to 78 (89%) patients (30 with cisplatin, 39 with cetuximab). Potentiation had been achieved as planned in 52 and 79% of patients treated with cisplatin and cetuximab, respectively. Twenty-three local and three neck recurrences were found. Median overall survival was 16.8 months and 38.3% at 3 years. EFS at 3 years was 29.1% with a hazard ratio for partial responders versus nonresponders of 0.18 (P<0.001), and 0.13 (P<0.001) for complete responders versus nonresponders. Thirty-five percent of patients were alive with their larynx preserved at 3 years. This study confirms the efficacy of induction followed by chemoradiation for pyriform sinus cancer and that response to DCF is predictive of EFS.

Larynx Preservation Protocols: Long-Term Functional Outcomes in Good Responders to Induction Chemotherapy for Pyriform Sinus Carcinoma

Background/Aims: Larynx preservation for laryngopharyngeal carcinomas aims to avoid the mutilation of a total laryngectomy without compromising survival or functionality. The aim of the present study on pyriform sinus squamous cell carcinoma (SCC) is to evaluate the long-term functional outcomes of larynx preservation in good responders to induction chemotherapy (ICT). Methods: The study was carried out in a tertiary referral cancer center in France. The subjects were good responders to ICT for pyriform sinus SCC, subsequently treated with adjuvant radiation therapy (RT) - with or without concomitant chemotherapy - between 1999 and 2008. Only patients without recurrence at 3 years were included. The evaluated pharyngolaryngeal functions were airway patency, oral communication and oral feeding, based on a self-administered questionnaire and the patients' medical records. Results: Twenty-eight patients were retained. Two (7%) patients needed a tracheotomy during or after the treatment and 2 (7%) had total laryngectomy for a late local recurrence. At least 3 years after the end of treatment, all patients were exclusively fed by mouth. All the evaluated patients judged their voice performance as ‘adequate for everyday oral communication'. Conclusions: In the long run, patients with pyriform sinus SCC who are candidates for larynx preservation and respond favorably to ICT present a satisfactory functional outcome when treated with adjuvant RT.

Pyriform sinus squamous cell carcinoma: oncological outcomes in good responders of induction chemotherapy-based larynx preservation protocols.

Induction chemotherapy-based larynx preservation protocols use chemotherapy to select exclusively patients with 'chemosensitive' tumors for a nonsurgical treatment with radiation therapy. This study on pyriform sinus squamous cell carcinoma (SCC) is interested in the oncological outcome of treatment based on radiation therapy when offered to patients with tumors responding to induction chemotherapy. This was a retrospective cohort study. The cohort included good responders to induction chemotherapy, subsequently treated with definite radiation therapy (with or without concomitant chemotherapy) for pyriform sinus SCC, in a tertiary referral cancer center. The primary endpoints were overall, laryngectomy-free and disease-free survival and the secondary endpoints were analysis of treatment failures and possibilities of salvage treatment. Forty-two patients fulfilled the inclusion criteria and were retained for analysis; 7% were stage II (3/42), 48% stage III (20/42) and 45% stage IV (19/42). At 1, 3 and 5 years, the overall survival was 95% (40/42), 74% (31/42), and 60% (SE ≈ 0.08), respectively. For the same intervals, the laryngectomy-free survival was 90% (38/42), 69% (29/42) and 50% (SE ≈ 0.08), respectively. The estimated 5-year disease-free survival was also 50%. Disease-free survival was significantly better for N0 patients. There was a 28% recurrence rate, mainly in the primary tumor site (9/11), with or without simultaneous nodal recurrence. Interestingly, more than one-third of all oncologic failures occurred beyond the first 3 years of follow-up. Salvage treatment was not possible or definitely inefficient in at least 2/3 of all recurrences. In candidates for larynx preservation for a pyriform sinus SCC, good response to induction chemotherapy followed by definite radiation therapy seems to be associated with a more favorable prognosis. Nevertheless, in case of locoregional recurrence the possibilities for efficient salvage treatment are limited.

Pattern of cervical lymph node metastasis in medial wall pyriform sinus carcinoma

The aim of this study was to analyze the prevalence and distribution of histologic cervical lymph node metastases in medial wall pyriform sinus squamous cell carcinoma (SCC). Retrospective study of medical records. We reviewed the medical records of 68 medial wall pyriform sinus SCC patients who underwent bilateral neck dissection for primary treatment with curative intent. Thirty-nine patients underwent central compartment neck dissection. Primary tumor was removed using conservative laryngeal surgery with partial pharyngectomy in 39 cases, near total/total laryngectomy with partial pharyngectomy in 24 cases, and total laryngopharyngectomy in five cases. The overall N(+) contralateral lymph nodes rate on pathology was 14.7%. The rate of contralateral occult cases was 5.2%. Advanced primary (T3-4) and nodal (N2b-3) disease, and primary lesion across the midline were correlated with contralateral nodal metastasis. Multivariate analysis revealed that a primary lesion across the midline was an independent factor for contralateral neck nodal metastasis. The rate of level VI node metastasis was 16.2%. The disease-specific survival rate was significantly different according to level VI node metastasis (71% vs. 40%). Pyriform sinus apex invasion and extralaryngeal spread were correlated with level VI nodal metastasis. Multivariate analysis revealed that pyriform sinus apex invasion was an independent factor for level VI nodal metastasis. Contralateral nodal metastasis was less frequent than expected. Bilateral neck dissection is mandatory for primary lesion across the midline. Ipsilateral level VI lymph node should be removed in pyriform sinus apex invasion cases. 4.

OP134: Pattern of cervical lymph node metastasis in medial wall pyriform sinus carcinoma: When do contralateral and paratracheal node dissection necessary?

The aim of this study was to analyze the prevalence and distribution of histologic cervical lymph node metastases in medial wall pyriform sinus squamous cell carcinoma (SCC). Sixty-eight medial wall pyriform sinus SCC patients were retrospectively analyzed in this study. All patients underwent bilateral therapeutic/elective neck dissection. Thirty-nine patients underwent central compartment neck dissection. Eleven patients underwent retropharyngeal lymph node (RPLN) dissection. Primary tumor was removed using conservative laryngeal surgery with partial pharyngectomy in 39 cases, near total/total laryngectomy with partial pharyngectomy in 24 cases, and total laryngopharyngectomy in five patients. The overall N-positive contralateral lymph nodes rate on pathology was 14.7%. The rate of contralateral occult cases was 5.2%. Contralateral nodal metastasis was not significantly associated with disease-specific survival. Multivariate analysis revealed that primary lesion across the midline was an independent factor for contralateral neck nodal metastasis. The rate of level VI node metastasis was 16.2%. The disease-specific survival rate was significantly different according to level VI node metastasis (71% vs 40%). In multivariate analysis, pyriform sinus apex invasion was an independent factor for level VI nodal metastasis. RPLN metastasis was confirmed by pathological analysis in two of the 11 (18.2%) subjects. Contralateral nodal metastasis was less frequent than expected. Bilateral neck dissection is mandatory for primary lesion across the midline. Ipsilateral level VI lymph node should be removed in pyriform sinus apex invasion case. We recommend elective RPLN dissection in case with posterior pharyngeal wall invasion.

Definitive radiotherapy for squamous cell carcinoma of the pyriform sinus

Background and purposeTo report the long-term results after definitive radiotherapy (RT) for pyriform sinus squamous cell carcinoma (SCC). Material and methodsThe data concerning all patients treated for pyriform sinus SCC with RT with a curative intent between 1990 and 2006 were reviewed. ResultsA total of 249 patients were included. The median follow-up is 6.5years. Overall 123 patients had relapsed. For the entire population, the 5-year local control, regional control, freedom-from-distant metastasis, and overall survival rate were 68%, 69%, 78% and 38%, respectively. The 5-year local control rate for the 107 T1–T2 tumors was 85% (95% confidence interval (CI): 75–91). N stage was the main risk factor for the development of distant metastases, with a hazard ratio of 8.9 (95% CI: 2.1–39) and 15.6 (95% CI: 3.6–67.8) for N2 and N3 patients respectively. For patients with N2–N3 disease, pre-RT neck dissection improved regional control but not overall survival. Moderate to severe late complications occurred in 50 patients (28% of the patients without local relapse). ConclusionA high local control rate can be achieved when treating T1–T2 hypopharynx cancers with definitive radiotherapy. The high rate of nodal and distant relapses among patients with N2–N3 disease warrants intensification of therapy.

A physician's personal experience as a cancer of the neck patient

The author presents his personal experiences as a physician who had several surgical procedures to remove pyriform sinus squamous cell carcinoma, which included laryngectomy. He recently published a book that captures the three years of his life that followed his throat cancer diagnosis and tells his story of facing and dealing with medical and surgical treatments and adjusting to life afterwards. The editorial highlights some of the book's features that relate to the important role of head and neck surgeons in the care of patients with cancer.

Randomized phase III trial comparing induction chemotherapy followed by radiotherapy to concomitant chemoradiotherapy for laryngeal preservation in T3M0 pyriform sinus carcinoma

Conclusions. Conventional radiotherapy with concurrent cisplatin is significantly superior to induction cisplatin fluorouracil chemotherapy followed by radiotherapy in terms of laryngeal preservation in patients with T3 hypopharyngeal carcinoma. Despite a high rate of laryngeal preservation no survival benefit was recorded in this selected population. Objectives. To compare conventional radiotherapy with concurrent cisplatin to induction chemotherapy with cisplatin fluorouracil followed by conventional radiotherapy. The primary end point was the preservation of the larynx. The secondary end points included toxicity, causes of death, and survival rates. Patients and methods. Seventy-one adult patients with previously untreated resectable T3 pyriform sinus squamous cell carcinoma were enrolled in the multicenter prospective randomized phase III trial. They were evaluated for organ preservation, survival rates, and toxic reactions. Results. The rates of laryngeal preservation at 2 years were 68% for the induction chemotherapy (IC) group and 92% for the chemoradiotherapy (CR) group (p = 0.016). At 2 years, the event-free survival rates were 36% and 41% for the IC group and CR group, respectively.

The impact of paratracheal lymph node metastasis in squamous cell carcinoma of the hypopharynx

The aim of this study was to analyze the prevalence and prognostic importance of paratracheal lymph nodes in squamous cell carcinoma of the hypopharynx. A retrospective review of 64 previously untreated patients with squamous cell carcinoma (SCC) of the hypopharynx that underwent surgery was performed. Ipsilateral paratracheal lymph node metastases occurred in 22% (14 out of 64) and the mean number of paratracheal lymph nodes dissected per side was 2.3 (range 1–6). Contralateral paratracheal lymph node metastases were present in 2% (1 out of 42). Sixty-seven percent with postcricoid SCC and 22% with pyriform sinus SCC developed clinical node-positive ipsilateral paratracheal lymph node metastases, whereas 11% with posterior pharyngeal wall SCC developed paratracheal metastases. There was a significant correlation between paratracheal lymph node metastasis and cervical metastasis (p = 0.005), and the primary tumor site (postcricoid, 57.1%; pyriform sinus, 20.0%; posterior pharyngeal wall, 8.3%) (p = 0.039). Patients with no evidence of paratracheal lymph node metastasis may have a survival benefit (5-year disease-specific survival rate, 60 vs. 29%). However, this result did not reach statistical significance (p = 0.071). The patients with SCC of the postcricoid and/or pyriform sinus were at risk for ipsilateral paratracheal lymph node metastasis; furthermore, patients with paratracheal node metastasis had a high frequency of cervical metastasis and a poorer prognosis. Therefore, routine ipsilateral paratracheal node dissection is recommended during the surgical treatment of patients with SCC of the postcricoid and/or pyriform sinus with clinical node metastases.

Definitive Radiotherapy for T1-T2 Squamous Cell Carcinoma of Pyriform Sinus

To report the long-term results after definitive radiotherapy (RT) for T1-T2 pyriform sinus squamous cell carcinoma. The data from 123 patients with T1-T2 pyriform sinus squamous cell carcinoma treated with RT with or without neck dissection between November 1964 and June 2003 were analyzed. The median follow-up for all patients was 3.2 years, and the median follow-up for living patients was 10.7 years. The 5-year local control, locoregional control, freedom from distant metastasis, cause-specific survival, and overall survival rate was 85%, 70%, 75%, 61%, and 35%, respectively. The ultimate local control rate, including successful salvage of RT failure, for T1 and T2 cancer patients was 96% and 94%, respectively. The overall local control rate with a functional larynx was 83%. Pretreatment computed tomography tumor volume data were available for 55 patients. The median computed tomography tumor volume was 4.2 cm(3) (range, 0-22.4). Local control was worse for patients with a tumor volume >6.5 cm(3) compared with those with a smaller tumor volume. Of the 123 patients, 16% developed moderate to severe acute (2%), late (9%), or postoperative (5%) complications. Local control with larynx preservation after definitive RT for T1-T2 pyriform sinus squamous cell carcinoma likely results in local control and survival similar to that after total laryngectomy or larynx-conserving surgery. Two-thirds of our living patients retained a functional larynx.

Conservation laryngeal surgery for selected pyriform sinus cancer.

Aims This study reports the treatment of a cohort of patients with pyriform sinus squamous cell carcinoma, using conservative surgery and radiotherapy. Methods Thirty-four patients with pyriform sinus SCC were treated between 1986 and 2001, using partial laryngopharyngectomy with or without complementary radiotherapy. Seventy-six percent had stage III–IV lesions. Quality of life questionnaire and clinical examination were used for evaluation of laryngeal function. Results Conservation surgery was undertaken. All patients underwent neck dissection. Two thirds of the patients received post-operative radiotherapy. Reconstruction was achieved by local muscular flap in 13 cases, radial forearm free flap in 18 and pectoralis major flap in three. Five-year overall and disease-specific survival rates were 50 and 65%, respectively. Successful laryngeal function preservation with local control was achieved in 80% of the patients. Conclusion Partial laryngopharyngectomy is a suitable treatment for early and selected advanced stage pyriform sinus carcinoma with a good functional and oncologic outcome.

Concomitant radiation therapy and targeted cisplatin chemotherapy for the treatment of advanced pyriform sinus carcinoma: Disease control and preservation of organ function

Background Squamous cell carcinoma of the pyriform sinus is an unfavorable disease which frequently presents in advanced stages. Despite aggressive “standard treatment” involving debilitating surgery and postoperative radiation therapy treatments, the survival and functional outcome for pyriform sinus carcinoma remains poor. Hence, we reviewed our experience in the management of advanced pyriform sinus carcinoma using “organ preservation” chemoradiation therapy. Methods Twenty-five patients diagnosed with stage III/IV pyriform sinus squamous cell carcinoma treated with supradose, intra-arterial targeted cisplatin, and concomitant radiotherapy were analyzed for response rates, survival, pattern of failure, and function of the preserved organs. Our protocol consisted of weekly intra-arterial infusions of cisplatin at 150 mg/m2 × 4 and concurrent radiation therapy at 1.8 Gy or 2.0 Gy/fraction to a planned total of 68–74 Gy to the primary site/overt nodal disease. Results Nineteen (76%) of the 25 patients were diagnosed with stage IV disease, 17 of whom were first seen with bulky lymphadenopathy (ie, N2-N3 disease) while 10 had T4 lesions. Twenty-four of 25 patients were evaluable for response assessment. Complete response rates of 92% and 76% were achieved at the primary site and in lymph nodes, respectively. Hence, the overall complete response rate in the neck was 76% (16/21). At a median follow up interval of 42 months (range = 30–58 months), the projected 5-year overall and disease-specific survival using the Kaplan-Meier method are 23% and 50% respectively. No patient has developed recurrence at the primary site and only one patient relapsed regionally, which was surgically salvaged for an “above clavicle” disease control rate of 88% and an organ preservation rate of 88%. Almost 90% of the patients have achieved a satisfactory voice and 70% are able to swallow at 12 months postcompletion of therapy. Conclusion Our chemoradiation protocol is as effective as other treatment modalities for patients with advanced pyriform sinus carcinoma while maintaining organ preservation and function in the majority of the patients. © 1999 John Wiley & Sons, Inc. Head Neck 21: 595–601, 1999.

Deposition of microorganisms on human prosthesis material, a SEM study of a silicone voice prosthesis and a H.E.M.A. contact lens

This manuscript presents my personal experiences as a physician undergoing several surgical procedures including radical neck surgery for removal of pyriform sinus squamous cell carcinoma. I am telling my personal story in hopes that health care providers will realize the difficult challenges that a patient diagnosed with cancer and undergoes extensive surgeries must face. Facing and living through the difficulties and tribulations of a post-laryngectomy patient has illustrated to me how dependent and helpless one can be after this surgery. Being unable to speak, eat, and breathe normally, while dealing with a potential fatal illness, makes the patient extremely vulnerable, both physically and emotionally. During this difficult and challenging time, a proficient, competent, compassionate and caring approach that understands what the patient is experiencing should be practiced.