Figure 1 CT scan showing tumor of the left vocal cord.

Figure 2 Left. Patient’s midface after right partial nasal ablation with resection of the right nasal bony and cartilaginous pyramid, lobule and anterior septum and after 4 further resections. Right. After right residual nasal ablation with resection of the left bony and cartilaginous nasal pyramid, as well as resection of both frontal beaks and ethmoid cells. Visible metal prosthesis for preliminary care with nasal epithesis.

Figure 3 MRI scans show the infiltration of the nasopharyngeal carcinoma in the right maxillary sinus, the orbit, the optic nerve, the right retropharyngeal space and the anterior skull base. Left. Level of the orbit; Right. Level of maxillary sinus.

Figure 4 CT scan of the head and neck shows the infiltration of the oropharyngeal carcinoma in the parapharyngeal space, deep tongue muscles and mandible.

Case No

1

2

3

4

Age*/Sex

52/Male

47/Male

54/Female

50/Male

Comorbidities

Hepatitis B

Hepatitis B

Hepatitis C, cardiac arrhythmia, bipolar disorder, renal insufficiency

None

CD4†/HIV RNA‡; §

21/4.90

87/4.23

703/0.67

44/5.88

CD4†/HIV RNA‡; II

245/<1.70

600/<1.70

<250/<1.70

146/<1.70

<250 CD4†; ¶

21

0

72

45

Tumor Site

Larynx

Nose

Nasopharynx

Oropharynx

HPV/p16

Negative

Negative

Unavailable

Negative

cTNM

T3N0M0

T2N0M0

T4N1M0

T4aN2bM0

*Years; †cell count/µL; ‡log10 copies/ml; § at cART initiation; II at cancer diagnosis; ¶ time (in months) of less than 250 CD4 cells/µL direct before cancer diagnosis;

Table1 Patients’ demographic and tumor characteristics

Case No

Primary treatment

Specific disease characteristics

Specific treatment related event

1

Laryngectomy and bilateral SND* II-IV

2nd primary

2nd primary

2

Partial nasal ablation

Perineural and lymphovascular spread

Repeated R1 Resections

3

None due to multiple comorbidities

None

None

4

Tumor resection, left MRND†, right SND*

None

R1 Resection; Acute abdomen

* Selective neck dissection; † Modified radical neck dissection;

Table 2Treatment course of the disease

Case No

Further course

Relapse §

Survival §

1

Total thyroidectomy

No relapse II

21 II

2

1. Diagnostic cervical lymph node exstirpation in level Ib
2. Hyper-fractionated radiotherapy of primary tumor region, right cheek and right level Ib
3. Tumor resection of nasion and oral vestibule
4. Rest nasal ablation with resection of both frontal beaks and ethmoidal cells
5. Chemotherapy

5

34

3

Refusal of treatment

No treatment

17

4

1. Adjuvant RCTH ‡
2. Chemotherapy

26

30

† Modified radical neck dissection; ‡ chemoradiotherapy; § in months; II until December 2017

Table 3Further course and outcome of the disease