Intensity-modulated radiation therapy as primary treatment for oropharyngeal squamous cell carcinoma.

BACKGROUND: Over the past decade, intensity-modulated radiation therapy (IMRT) has gained widespread use in the treatment of head and neck cancer. METHODS: All patients with squamous cell carcinoma of the oropharynx treated with primary IMRT with or without chemotherapy over a 5-year period were reviewed. Outcomes and morbidity were analyzed and compared with previously published data. RESULTS: In all, 170 patients were included in the analysis. The 3-year local control, locoregional control, disease-free survival, and overall survival rates were 92%, 91%, 80%, and 87%, respectively. Feeding tubes were present in 55% of patients during treatment, but remained in only 1% 2 years following treatment. CONCLUSIONS: This study confirms that IMRT yields excellent treatment outcomes for oropharyngeal carcinoma. Although acute toxicity remains a problem, late toxicity rates are low and long-term feeding tube dependence is rare compared with conventional radiation therapy.

Endoscopic repair of Zenker's diverticulum by harmonic scalpel.

PURPOSE: Although endoscopic staple-assisted esophagodiverticulostomy (ESED) has become the initial treatment of choice for most patients with Zenker's diverticulum (ZD), anatomical restraints prevent its use in all cases. We describe an endoscopic approach for treating ZD using the harmonic scalpel, which can be used in certain cases where diverticulum anatomy precludes ESED. MATERIALS AND METHODS: Medical records of 7 consecutive patients who underwent endoscopic repair of ZD using the harmonic scalpel (Harmonic Ace, Ethicon Endo-Surgery, Inc, Cincinnati, OH) were reviewed. Data collected included demographics, symptoms, surgical details, complications, and postoperative outcomes. Main outcome measures were time to resumption of oral diet, symptom resolution, and complications. RESULTS: All patients (N = 7) who underwent endoscopic repair of ZD using the harmonic scalpel resumed an oral diet at initial follow-up visit after surgery (mean, 7 days; range, 4-9 days) and rated their symptoms as being completely resolved at subsequent follow-up (mean, 4 months; range, 1.5-8 months). There were no complications. CONCLUSIONS: Endoscopic repair of ZD using the ultrasonic cutting shears is a safe and efficacious procedure that allows for endoscopic treatment in certain cases that cannot be treated by ESED. Further study is warranted in larger series to determine efficacy and safety compared with established endoscopic techniques.

Transoral robot-assisted excision of a lingual thyroid gland.

Lingual thyroid is a rare condition in which ectopic thyroid tissue is present in the base of tongue. We present a case of a 46-year-old patient with a symptomatic lingual thyroid that was successfully removed with minimal morbidity using transoral robotic surgery. The traditional treatment algorithm for lingual thyroid is reviewed. The advantages of using transoral robotic surgery to remove lingual thyroid tissue are described along with the reasons why the addition of this technique should shift treatment of lingual thyroid towards more frequent use of surgical ablation. This report is, to our knowledge, the first describing the use of transoral robotic surgery for treating lingual thyroid.

Keratoacanthoma-type squamous cell carcinoma developing in a skin graft donor site after tumor extirpation at a distant site.

The development of squamous cell carcinoma in split-thickness skin graft donor sites is rare in the reported literature. We report a case of keratoacanthoma-type squamous cell carcinoma developing in a split-thickness skin graft donor site 6 weeks after orbital exenteration for squamous cell carcinoma. We review the literature and discuss possible causes.