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The study objective is to evaluate the quality of life as one of the main parameters that determines the effectiveness of treatment of patients with head and neck squamous cell carcinoma.Materials and methods. Thirty-three stage III—IV oral cancer patients aged between 39 and 70 years were asked to fill EORTC QLQ-C30 (European Organisation for Research and Treatment of Cancer quality of life questionnaire core 30-questions) and QLQ-H&N35 (head and neck cancer-specific module) before and 12—18 months after completion of the treatment that consisted of surgery followed by radiation with or without chemotherapy. Surgery included neck dissection with removal of the primary tumor via transoral (n = 5) or combined (n = 28) approach. Reconstruction was performed by primary closure (n = 5), with pedicled (n = 8) or free (n = 20) flaps.Results. According to EORTC QLQ-C30 questionnaire only positive shifts turned out to be statistically significant: general health, emotional function, pain, insomnia and diarrhea. Site-specific EORTC QLQ-H&N35 questionnaire revealed several positive (pain in the head and neck, feeling ill, use of painkillers and weight gain) and negative (public eating, problems with taste and smell, sticky saliva and dry mouth) changes. Applying algorithms for determining clinical significance changed the number and value of several scales and domains. Changes in general health, emotional function, pain, insomnia, pain in the head and neck, taste and smell disorders, mouth opening, sticky saliva, dry mouth, painkillers and weight gain were found to have some clinical relevance. Moreover, for one of them (mouth opening) statistical significance was not reached.Conclusions. Further research of clinical significance of changes and differences in scales and domains that determine and affect quality of life are needed. They will allow to understand more fully problems that every patient with oral cavity cancer tries to cope with.

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Introduction. Surgery with adjuvant radiation is the standard for treatment of advanced oral and oropharyngeal cancer. with the absence of randomized trials the assessment of the role of postoperative radiotherapy is difficult. Such assessments are usually based on retrospective analyses, whereas patient and tumor status during the time period between the operation and planned start of radiotherapy is not addressed.The study objective is to assess the role of adjuvant radiotherapy in the treatment of stage III—IV oral and oropharyngeal cancer not associated with human papillomavirus with regard to rapid clinical disease progression after upfront surgical treatment.Materials and methods. The case histories and outpatient records of 260 patients with oral and oropharyngeal cancer of stage III—IV, not associated with human papillomavirus, from 30 to 82 years old (average age - 56.52 years), operated in 2009-2018, were analyzed. Two groups of patients were identified. group 1 included 152 patients (58 %) irradiated postoperatively and group 2 consisted of 108 patients (42 %) treated surgically only. 22 patients of group 2 experienced rapid clinical disease progression, were deemed unsuitable for adjuvant treatment and formed group 2a. Comparison of the Kaplan-Meier overall survival and locoregional control was made for group 1 and the entire group 2 (formal analysis) and after exclusion from the latter patients of group 2a, based on the hypothesis of inability of radiotherapy to improve oncologic results in patients with such an unfavorable disease course.Results. Mean follow up was 33.2 months (range 2-121 months). Locoregional control and 5 year overall survival were statistically higher in group 1: 70.4 % versus 45.4 % (р = 0.000) and 40.2 % versus 24.9 % (р = 0.000) that may imply a significant advantage of the combined over monomodal approach. After exclusion of group 2a patients from the analysis both differences considerably narrowed and were 70.4 % versus 55.8 % for locoregional control, 40.2 % versus 31.3 % for overall survival and became statistically insignificant (p = 0.067 and 0.111, respectively).Conclusion. Rapid clinical disease progression in the time frame between surgical treatment and adjuvant radiotherapy is not a rare phenomenon with a very poor prognosis. It can be one of the reasons for postoperative treatment refusal. formal retrospective analyses of the role of adjuvant treatment without considering causes for its refusal may lead to the overestimation of the combined approach effectiveness.

The study objectiveis to assess effect of the reconstructive stage on the course of the postoperative period in patients with oral cancer.Materials and methods.A retrospective analysis of medical records of 174 patients (121 men and 53 women) aged 36 to 84 years (average 58.26 ± 8.72 years) with oral cancer undergoing treatment from January 2009 to June 2016 was performed. Depending on the nature of the reconstructive stage, the patients were divided into 3 groups. The group 1 consisted of 59 patients, to eliminate the defects of which flaps were taken on axial blood supply, the group 2 included 83 patients who had a reconstructive phase of the operation included a microsurgical reconstruction; 32 patients who had not used additional plastic material to eliminate the defect made up the control group. The following parameters were taken as evaluation parameters: the duration of the operation and hospitalization, the time spent in the intensive care unit, the frequency of serious and frivolous complications. The criterion for distinguishing serious and unserious complications is the fact that the patient returned to the operating room.Results.The reconstructive stage increased the operation duration by 72.12 min in the group 1 and by 285.72 min in the group 2, the length of stay in the intensive care unit – by 0.67 and 2.58 days, respectively, the hospital stay – by 33.9 and 40.4 %. The incidence of complications was higher in the groups 1 and 2 than in the control (6.6 %), and the type of reconstruction had almost no effect on it (42.37 % in the group 1 and 38.55 % in group 2). The frequency of serious complications was higher in the group 2, the frequency of partial flap necrosis – in the group 1.Conclusion.The inclusion of a reconstructive stage into the protocol of surgical treatment for oral cancer is absolutely reasonable, because it gives the patients a chance to return to their normal lives. Microsurgical reconstruction is a costly and labour-consuming procedure; however, it has almost the same number of complication as reconstructive surgery with flaps with an axial blood supply.