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