Photodynamic therapy (PDT) involves the administration of photosensitizer followed by local illumination with visible light of specific wavelength(s). In the presence of oxygen molecules, the light illumination of photosensitizer can lead to a series of photochemical reactions and consequently the generation of cytotoxic species. The quantity and location of PDT-induced cytotoxic species determine the nature and consequence of PDT. Much progress has been seen in both basic research and clinical application in recent years. Although the majority of approved PDT clinical protocols have primarily been used for the treatment of superficial lesions of both malignant and non-malignant diseases, interstitial PDT for the ablation of deep-seated solid tumors are now being investigated worldwide. The complexity of the geometry and non-homogeneity of solid tumor pose a great challenge on the implementation of minimally invasive interstitial PDT and the estimation of PDT dosimetry. This review will discuss the recent progress and technical challenges of various forms of interstitial PDT for the treatment of parenchymal and/or stromal tissues of solid tumors.

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The standard of care of laryngeal cancer surgery is wide field excision of the larynx combined with ipsilateral thyroid lobectomy. A retrospective review of 247 laryngectomies performed between 1979 and 1989 was undertaken to determine specific intraoperative indications for thyroid gland removal. The incidence of thyroid disease in our patients with laryngeal cancer was compared to the normal population. Eight percent of thyroid specimens removed during laryngeal cancer surgery demonstrated invasion by squamous cell carcinoma. All patients having thyroid invasion had T3 or T4 laryngeal lesions that were stage IV at the time of surgery. All these lesions were found to have transglottic growth and laryngeal cartilage invasion by the pathologist. All of these patients also had abnormal thyroid glands intraoperatively and laryngeal cartilage destruction that was evident intraoperatively. Total thyroidectomy with bilateral paratracheal and pretracheal lymph node dissection is indicated when squamous cell carcinoma of the larynx involves the thyroid gland. Prophylactic ipsilateral thyroid lobectomy and isthmusectomy is warranted for large laryngeal cancers (T3, T4) that involve the anterior commissure, the subglottic area, or extend transglottically. Routine thyroid gland removal is not indicated for the majority of laryngeal cancers that do not meet the aforementioned criteria. Finally, abnormal thyroid histopathology was diagnosed in 37% of the surgical thyroid gland specimens removed during laryngectomy.

Autopsy findings and case histories of 64 cases of epidermoid carcinoma of the head and neck at the Denver Veterans Administration Hospital between 1967 and 1977 were reviewed. Forty percent of these cases had metastases below the clavicles at autopsy. Incidence of metastasis was related to size of the primary lesion. Correlation with nodal involvement was equivocal. Our data was combined with that of similar studies done by O'Brien in 1970 and Gowen in 1963 and resulted in a combined autopsy series of 247 cases. Overall, 47% had distant metastases at autopsy.

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Pharyngocutaneous fistulae occur in 15%-25% of patients after total laryngectomy. Factors that may predispose to fistulae formation include prior radiation, surgical technique, tumor size and location, and patient nutritional status. In addition, many surgeons believe that the timing of oral feeding after surgery contributes to fistula development. Thus, they advocate delaying feeding postoperatively, especially in high-risk patients. The traditional guideline has been to wait until the seventh postoperative day. The purpose of this study was to examine the relationship between the timing of postoperative oral feeding and the development of pharyngocytaneous fistulae after total laryngectomy with primary closure in patients with squamous cell carcinoma. A questionnaire was sent to 210 members of the American Society for Head and neck Surgery to determine practice patterns toward feeding after laryngectomy. We also reviewed the records of 137 patients who underwent total laryngectomy at the University of Colorado Health Sciences Center and the Denver VA Medical Center from January 1975 through December 1987. Of the surgeons polled, 84.5% waited at least 7 days after surgery to begin oral feeding. However, in reviewing 94 patients eligible for study, we found no difference in the rate of fistula formation between patients fed on or before the fifth postoperative day and those fed on or after the sixth postoperative day. In fact, most fistulae were evident before the patient started oral feeding. Pyriform sinus tumors were predisposed to fistulae but prior radiotherapy and neck dissection seemed to have no effect. Earlier oral feeding after total laryngectomy may improve patient comfort and shorten hospital stay without increasing the incidence of complications.(ABSTRACT TRUNCATED AT 250 WORDS)

Surgical resection of head and neck cancer results in predictable patterns of dysphagia and aspiration due to disruption of the anatomic structures of swallowing. Common procedures undertaken in the treatment of head and neck cancer include tracheostomy, glossectomy, mandibulectomy, surgery on the palate, total and partial laryngectomy, reconstruction of the pharynx and cervical esophagus, and surgery of the skull base. An overview is presented of normal swallowing physiology, as well as swallowing perturbations that are frequently encountered in postoperative head and neck cancer patients.

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