George H. Petti

Relationship Between Quality of Life and Depression in Patients With Head and Neck Cancer

Objective: This study describes the relationship between health‐related quality of life (HRQOL) and depression in patients following major surgery for head and neck cancer.

Factors related to quality of life and functional status in 50 patients with head and neck cancer.

Quality of life (QOL) and functional status (FS) have become important outcome measures in cancer therapy. Valid and reliable instruments recently have been developed for examining QOL and FS in patients with head and neck (HN) cancer. The present study evaluated the relationships of QOL and FS to physical and psychological variables assumed to affect QOL and FS. Fifty patients were evaluated up to 6 years after HN cancer surgery using one general QOL instrument and three HN‐specific instruments. Analysis of variance showed physical variables such as tumor site to be related to HN‐specific scores, while psychosocial variables such as marital status were related to general QOL scores (P≤.05). Several relationships were seen between physical or psychosocial variables and FS or QOL measures; however the relationships were not as strong or direct as expected.

Adjuvant methotrexate escalated to toxicity for resectable stage III and IV squamous head and neck carcinomas--a prospective, randomized study.

To determine if adjuvant methotrexate (MTX), escalated weekly to toxicity, could improve disease-free survival (DFS) and overall survival by preventing recurrent disease, 60 patients with potentially resectable stage III or IV squamous head and neck carcinomas were stratified by primary site, stage, and nutritional status, then randomized by pairs to receive or not receive adjuvant MTX. All received standard surgery and postoperative radiation therapy. Five patients were taken off study because of unresectability at the time of surgery, leaving 55 evaluable patients. There were no statistically significant imbalances in known prognostic factors between the two treatment arms. MTX was begun at 40 mg/m2 and escalated 10 mg/m2 weekly (four doses preoperatively; four doses postoperatively, preradiation therapy; eight doses postradiation therapy) to mucosal or hematologic toxicity. The median peak MTX dose achieved was 80 mg/m2. Although three patients were hospitalized with MTX toxicity, none died of MTX toxicity. No patient receiving MTX had disease progression during treatment, and there was no increase in postoperative complications. Thirty-two patients died (median survival, 19 months); 23 patients are alive with median follow-up of 43 months. There was no statistically significant difference in actuarial DFS (P = 1.0) or overall survival (P = .61). Although patients on the MTX arm appeared to have less local and regional recurrences at first recurrence (thus more distant metastases), this did not reach statistical significance (P = .06). There was no significant difference between the sites of recurrence at death or last follow-up (P = .38).

Parathyroid carcinoma: Two new cases — diagnosis, therapy, and treatment

Carcinoma of the parathyroid gland is a disease only rarely encountered in clinical practice. As most of these tumors retain the ability to manufacture active parathyroid hormone, most patients with the disease present with hypercalcemia, many times symptomatic. Since the tumor accounts for only 0.5% to 4.0% of cases of primary hyperparathyroidism, the diagnosis of parathyroid carcinoma may be unsuspected and delayed. The clinical index of suspicion should be elevated if there is a palpable neck mass, an exceptionally high serum calcium level, and/or recurrence of hypercalcemia following surgery.

Treatment of thyroid carcinoma

In a review of thyroid surgery performed at Loma Linda University and its affiliated hospitals during the past 20 years, 254 (26%) of the thyroid surgery patients had thyroid carcinoma. The majority of these patients underwent total thyroidectomy and received postoperative radioactive iodine. At the present time, there is considerable disagreement in the literature regarding the extent of treatment needed for what, in many cases, is a low‐grade malignancy. In the present series, there are a significant number of patients with extensive disease in which aggressive treatment is warranted to improve the chance of cure. We believe that total thyroidectomy with central node dissection is the minimum surgical procedure required.