Purpose. Because parathyroid carcinoma is rare, clear consensus is not available regarding the optimal management of patients with this condition. Treatment strategies generally derive from clinical and anecdotal experiences. We report our experience with this entity.Methods. We included all patients with parathyroid carcinoma seen at The University of Texas M. D. Anderson Cancer Center since January 1, 1980. The medical records and pathology specimens were reviewed and verified in all cases.

The M. D. Anderson Symptom Inventory-Head and Neck (MDASI-HN) is a reliable and valid instrument to measure head and neck cancer symptom burden, and the interference symptoms cause in the major aspects of a patient's daily life. A subset of specifically distressing symptoms was identified, many of which are not included in commonly used head and neck cancer quality of life instruments.

Purpose-To quantify the differences between planned and delivered parotid gland and target doses, and to assess the benefits of daily bone alignment for head-and-neck cancer patients treated with intensity-modulated radiotherapy (IMRT).Methods and Materials-Eleven head-and-neck cancer patients received 2 CT scans/week with an in-room CT scanner over their course of radiotherapy. The clinical IMRT plans, designed with 3-4mm planning margins, were recalculated on the repeat CT images. The plans were aligned using (1) the actual treatment isocenter marked with radiopaque markers (BB) and (2) bone alignment to the cervical vertebrae to simulate image-guided setup. In-house deformable image registration software was used to map daily dose distributions to the original treatment plan and to calculate a cumulative, delivered dose distribution for each patient.Results-Using conventional BB alignment led to increases in the parotid gland mean dose above the planned dose by 5-7Gy in 45% of the patients (median = 3.0Gy ipsilateral (p=0.026); median = 1.0Gy contralateral (p=0.016)). Use of bone alignment led to reductions relative to BB alignment in 91% of patients (median=2Gy; range=0.3-8.3Gy; 15 of 22 parotids improved). However, the parotid dose from bone alignment was still greater than planned (median=1.0Gy (p=0.007)). Neither approach affected tumor dose coverage.Conclusions-With conventional BB alignment, the parotid gland mean dose was significantly increased above the planned mean dose. Using daily bone alignment reduced the parotid dose compared to BB alignment in almost all patients. A 3-4 mm planning margin was adequate for tumor dose coverage.Correspondence and reprint requests to:

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BACKGROUNDMany patients with small primary tumors of the oropharynx have AJCC Stage III/IV disease on the basis of lymphadenopathy. In the current retrospective study, the authors hypothesized that these patients have high rates of locoregional control when treated with radiotherapy, either alone or combined with neck surgery, and may not require concurrent chemotherapy.METHODSTwo hundred ninety‐nine patients met staging and inclusion criteria. Stage distribution was as follows: T1, 99 patients (33%); T2, 182 patients (61%); Tx, 18 patients (6%); N1, 74 patients (25%); N2, 170 patients (57%); N3, 39 patients (13%); and Nx, 16 patients (5%). Primary tumor resection or tonsillectomy had been performed in 36 patients (12%) and excisional lymph node biopsy or formal neck dissection in 192 patients (64%). Thirty‐three additional patients (10%) received chemotherapy and were analyzed separately.RESULTSThe median follow‐up was 82 months (range, 8–299 months). The actuarial 5‐year rates of locoregional failure, distant metastases, and overall survival were 15%, 19%, and 64%, respectively. T status was associated with the 5‐year rate of locoregional control: 95% for patients with T1‐/Tx disease, compared with 79% for patients with T2 disease (P < 0.01). The 5‐year rate of distant metastases for patients with N1/2a disease was 11%, compared with 28% for patients with N2b/N2c/N3 disease (P < 0.001).CONCLUSIONSPatients with early–T status oropharyngeal carcinoma, which is considered advanced due to the presence of lymphadenopathy, have high rates of locoregional control when treated with radiotherapy without or with neck surgery. Local treatment intensification by the addition of concurrent chemotherapy to radiotherapy would not significantly benefit most of these patients. Cancer 2004. © 2004 American Cancer Society.