Primary surgery for oropharyngeal cancer.

OBJECTIVE: The development of new techniques for transoral resection has led to a renewed interest in primary surgical treatment of oropharyngeal squamous cell cancer (SCCA). We reviewed our experience with primary surgery for oropharyngeal SCCA to identify factors associated with survival. STUDY DESIGN: Case series with chart review. SETTING: Tertiary medical center. SUBJECTS AND METHODS: Patients who underwent primary surgical treatment of oropharyngeal SCCA from 1985 to 2002 were analyzed. Patients who failed nonoperative treatment or had distant metastases at presentation were excluded. RESULTS: A total of 105 patients met study criteria. The majority of patients (91%) had advanced stage disease (III/IV). All patients received postoperative radiation; chemotherapy was used in eight patients. Five-year disease-free survival was 83 percent for stage I, 67 percent for stage II, 56 percent for stage III, and 43 percent for stage IV disease. Crude local control rates were 94 percent for T1 disease, 90 percent for T2 disease, 81 percent for T3 disease, and 80 percent for T4 disease; crude regional control rates were 100 percent for N0 disease, 90 percent for N1 disease, 84 percent for N2 disease, and 82 percent for N3 disease. Cox proportional hazards models revealed that nodal stage (hazard ratio [HR] 2.3, P = 0.02) and black race (HR 2.6, P = 0.004) were the only significant predictors of disease-free survival. CONCLUSION: Primary surgical treatment of oropharyngeal SCCA is effective in achieving excellent locoregional control and permits deintensification of adjuvant therapy, even in patients with advanced stage disease. Nodal status and race are the primary determinants of disease-free survival. These data provide useful information for counseling and treatment planning.

The relationship between depressive symptoms and Voice Handicap Index scores in laryngopharyngeal reflux.

OBJECTIVES/HYPOTHESIS: To determine if a relationship exists between depression and Voice Handicap Index (VHI) scores in patients with laryngopharyngeal reflux (LPR) disease. STUDY DESIGN: Retrospective analysis of prospectively collected data. METHODS: One hundred nineteen patients were prospectively evaluated with the VHI questionnaire and the Beck Depression Inventory Fast Screen (BDI-FS) survey. Patients with a pre-existing diagnosis of depression were excluded. RESULTS: Complete data was available for 36 patients with LPR and 53 controls. No significant differences existed between groups with respect to age, race, or gender. Mild depressive symptoms were identified in 9% of controls and 3% of LPR patients by BDI-FS screening (P = .4); no patients had moderate or severe depression symptoms. Compared to controls, patients with LPR had significantly higher mean scores for total VHI (16.2 vs. 6.6, P = .002), functional VHI (5.8 vs. 2.4, P = .02), and physical VHI (6.9 vs. 2.5, P = .008) domains. Mean scores for the VHI emotional domain (3.5 vs. 1.7, P = .2) and BDI-FS (0.2 vs. 0.8, P = .3) did not differ between patients with LPR and controls. For all participants, a positive correlation was found between BDI-FS score and VHI emotional domain score (r = 0.3, P = .008). CONCLUSIONS: Patients with LPR report poorer VHI functional and physical scores compared to controls; however, LPR symptoms do not result in significantly worse VHI emotional domain scores or depressive symptoms. There is a correlation between VHI emotional domain scores and BDI-FS scores. These data suggest that LPR patients with poor VHI emotional domain scores might benefit from screening for depressive symptoms.