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Biomedical subjects

E W Strong

Publications and source records attributed to E W Strong.

At least 73 records · Page 4Linked to original sources
PubMed1987

Craniofacial resections for tumors involving the base of the skull.

Over a 10 year period, 42 patients with tumors involving the base of the skull underwent operation at our institution. Twenty-six patients had tumors involving the anterior fossa and cribriform plate, 3 patients had tumors involving the anterior fossa and orbit, 3 patients had invasion of the middle fossa, 5 patients had invasion of the temporal bone, and 5 patients had invasion of the clivus. A detailed analysis of the 26 patients who underwent craniofacial resection for tumors invading the anterior fossa cribriform plate region has been presented. Histologic studies revealed epithelial tumors in 18 patients, sarcoma in 6 patients, melanoma in one patient, and ossifying fibroma in one patient. The median survival in this group of patients was 60 months. Survival was influenced by histologic diagnosis. Malignant tumors involving the base of the skull can be successfully resected using a craniofacial approach with minimum morbidity and acceptable operative mortality as demonstrated in this experience. Unfavorable prognostic factors included massive intracranial extension, high grade tumor, and previous treatment failure.

Adenocarcinoma↗
PubMed1987

Aneurysmal bone cysts of the jaws: a case study and review of the literature.

Although first documented in 1958, the definitive explanation of the etiology and pathogenesis of the aneurysmal bone cyst has yet to be elucidated. This may be attributable to the relatively small number of cases contained within the literature. The following report and review of the pertinent literature is presented to add to the current body of knowledge on the subject.

Adolescent↗
PubMed1987

Tracheal reconstruction: in vitro and in vivo animal pilot study.

In order to further address the problem of tracheal stenosis, an animal model was created to simulate both local and regional tracheal injury. An epithelial equivalent created from a fibroblast-collagen matrix was used to attempt to either inhibit or lessen the degree of tracheal stenosis that was evident in animal models. Preliminary data appears to show that the epithelial equivalent is effective in limiting and perhaps even abolishing the development of tracheal stenosis.

Animals↗
PubMed1986

A pilot study of cisplatin-vinblastine as the initial treatment of advanced head and neck cancer.

Twenty patients with Stage IV and five patients with Stage III carcinoma of the head and neck were treated with the combination of cisplatin and vinblastine before locoregional therapy. Among 24 patients evaluable for response after chemotherapy, there were four complete responders and 16 partial responders for an overall major response rate of 83%. No complete responses were observed in patients with T4 primary lesions or N3a nodal disease. Toxicity was limited primarily to nausea and vomiting (76%) and myelosuppression (72%). Four patients, all treated at the higher vinblastine dose, required hospitalization for fever associated with neutropenia. Two patients had a transient increase in the serum creatinine clearance to greater than 3 mg/dl. The combination of high-dose cisplatin and frequent vinblastine has significant activity in locally advanced squamous cell carcinoma of the head and neck, has mild and reversible toxicity, and does not require prolonged hospitalizations for continuous intravenous infusions.

Adult↗
PubMed1986

Predictive value of tumor thickness in squamous carcinoma confined to the tongue and floor of the mouth.

In this review of 105 consecutive patients who underwent operation for previously untreated, N0 squamous carcinomas arising in the oral tongue or the floor of the mouth, 86 percent of the determinate patients remained alive and well 2 years after treatment. Included were 48 patients, 49 patients, and 8 patients who had T1, T2, and T3 tumors respectively. Elective cervical lymphadenectomy was performed in about a third, but tumor staging did not facilitate selection of those who were most likely to have occult metastases. For this reason, we retrospectively assessed the impact of tumor thickness using an optical micrometer to measure the thickness in millimeters of the excised tumors in routinely prepared paraffin sections. Disease-related death appears to be unusual when oral tumors are thin (2 mm or less), regardless of the tumor stage. Multivariate analysis confirms that increasing tumor thickness, rather than tumor stage, had the best correlation with treatment failure and survival. These findings need to be verified in prospective studies involving a larger patient population and other head and neck sites, but they strongly suggest that measurement of tumor thickness may be a better way to select those oral cancer patients who are most likely to benefit from elective treatment of the N0 neck.

Carcinoma, Squamous Cell↗
PubMed1985

Cricopharyngeal obstruction in inflammatory myopathy (polymyositis/dermatomyositis). Report of three cases and review of the literature.

Three adults, 2 of whom had polymyositis and 1 with dermatomyositis, developed dysphagia during the course of their illness. Results of esophageal manometry supplemented with esophageal radiography indicated the presence of cricopharyngeal achalasia. Because of the severity of this disorder, which is associated with aspiration of esophageal contents into the airways, surgery to divide the cricopharyngeal musculature was performed in 2 patients, giving complete relief of their symptoms. Prednisone dosage was not increased to treat this condition since it arose not from weakness but from obstruction. A biopsy specimen taken from 1 patient demonstrated inflammatory changes in the obstructing muscle. A review of these 3 patients and 3 previously reported cases indicates that cricopharyngeal obstruction can be a dominant cause of dysphagia in patients with myositis. The recognition of this entity is important in the management of patients with myositis because: it has serious and potentially life-threatening implications; and in certain cases, it can be effectively treated with surgery.

Adult↗
PubMed1985

Mandibulotomy approach to oropharyngeal tumors.

We have reviewed our experience with 120 selected patients who had pharyngeal tumors resected through a median mandibulotomy approach with paralingual extension (mandibular swing). Clinical findings, technique, and complications are discussed. Results were gratifying in terms of salvage, patient appearance, and function. We believe that this surgical approach, in combination with postoperative radiotherapy when appropriate, offers an attractive alternative to high dose radiotherapy alone in patients with oropharyngeal carcinoma.

Combined Modality Therapy↗
PubMed1985

Intraoperative radiotherapy in patients with recurrent head and neck cancer.

Patients with head and neck cancer who have a relapse of the disease above the clavicles can sometimes be salvaged by additional surgery. However, if all gross tumor cannot be removed during surgery or if the resection margins are unsatisfactory, the likelihood of salvage is remote, especially when postoperative radiotherapy is not feasible due to previous radiotherapy. Between 1979 and 1983, we employed intraoperative brachytherapy for 21 such patients. Sixteen patients had a recurrence after previous surgery and radiotherapy, and 5 after radical radiotherapy. All gross tumor could not be removed in 15 patients, whereas satisfactory margins could not be obtained in 6. In 11 patients, we delivered radiotherapy by a temporary implant of iridium-192 (median dose 4,800 rads in 6 days). In 10 patients, radiotherapy was delivered by a permanent implant of iodine-125 (median activity 13 mCi). Three patients (14 percent) had a relapse within the surgical field, whereas six others (28 percent) had a relapse elsewhere or had development of metastases. Complications developed in four patients (19 percent) and were fatal in one patient. The actuarial disease-free survival rate at 2 years was 55 percent, whereas the rate of local disease control was 81 percent. Our experience suggests that intraoperative brachytherapy can salvage certain high-risk patients with head and neck cancer.

Adult↗
PubMed1985

Patterns of failure in carcinoma of the nasopharynx: I. Failure at the primary site.

Between 1970 and 1980, we treated 107 previously untreated patients with biopsy proven carcinoma of the nasopharynx by megavoltage external radiation therapy to the primary site, base of the skull and both sides of the neck. Fifty-three percent of the patients had T4 primaries and 87% had Stage IV disease. The histology was poorly differentiated, undifferentiated or anaplastic carcinoma in 81% of the patients, and well differentiated or moderately well differentiated epidermoid carcinoma in 19%. The dose of irradiation to the primary site ranged from 5700 to 7700 rad. Fifty-five patients have suffered relapse of the cancer, 33 of whom (60%) relapsed at the primary site. Seventy-two percent of the relapses at the primary site appeared within two years after treatment and 91 percent within 3 years. Median survival following relapse at the primary site was 10 months. Those patients who received a dose to the primary between 5700 and 6700 rad had a lower rate of local control than those who received a dose between 6700 and 7700 rad. However, regardless of the dose, those patients whose radiation therapy was interrupted (for whatever reason) for a total of three weeks or longer had poorer local control than those patients whose treatment was not so interrupted. The highest rate of local control (84%) was observed in those patients who did not have such interruptions and received a dose of 6700-7700 rad to the primary. Improved local control with the higher doses was especially striking for T4 primaries, suggesting a dose-response relationship. The local control rate did not appear to be significantly influenced by age, sex, birthplace or histology. These data suggest that a high rate of local control is possible in carcinoma of the nasopharynx, even with T4 disease, if a sufficiently high dose of radiation therapy is delivered without undue interruptions.

Adolescent↗
PubMed1985

Enteral nutrition support in head and neck cancer: tube vs. oral feeding during radiation therapy.

This comparison of tube feeding with oral nutrition was made in patients with advanced head and neck cancer during intensive outpatient radiation therapy. Twenty-six patients with Stage III and IV head and neck cancers were stratified by site (nasopharynx vs. all other tumors, including recurrent nasopharynx) and randomized to receive oral or tube feeding during radiation therapy. All patients were counseled to have an intake of 40 kcal/kg and 1 gm protein per kilogram body weight. Body weights and dietary recalls were obtained weekly, along with evaluation of toxicities to therapy. Serum albumins were obtained at baseline, week 4, end of radiation therapy, and 1 month after radiation therapy. Patients with nasopharyngeal carcinoma presented with significantly less body weight loss (means = -2.6%) than patients with all other carcinomas (means = -9.8%; p = .008). No differences in toxic responses were observed despite larger radiation field size in the tube-fed group (p = .02). Serum albumins in both groups dropped during radiation therapy, with no difference between groups. The tube-fed group maintained higher caloric and protein intakes (35 to 42 kcal/kg, 1.2 to 1.6 gm protein per kilogram) than the oral-fed group (15 to 34 kcal/kg, 0.3 to 1.3 gm protein per kilogram). No differences in body weights were observed between the tube-fed (means = 3.8%) and the oral-fed (means = 3.3%) patients with nasopharyngeal carcinoma. Patients with oropharyngeal and recurrent nasopharyngeal carcinoma had significantly less weight loss with tube feeding (means = 0.2%) than with oral feeding (means = -7.3%; p = .005); thus, tube feeding is recommended during radiation therapy in such patients.

Adult↗
PubMed1984

Improved survival in carcinoma of the nasopharynx.

Between 1970 and 1980, we treated 107 previously untreated patients with biopsy-proven carcinoma of the nasopharynx by megavoltage external radiation therapy to the primary site, base of the skull, and both sides of the neck. Eighty-seven percent of the patients had stage IV disease (American Joint Committee 1980), 53% had T4 primaries, and 73% had palpable cervical metastases. The histology was anaplastic or poorly differentiated carcinoma in 81%. The observed 5-year survival rate was 35% for the patients treated between 1970 and 1976, and increased to 72% for those treated between 1977 and 1980 (P less than 0.01). The two patient populations were similar except that the dose of irradiation (median and modal) to the primary site was 6,000 rad during 1970-1976 and 7,000 rad during 1977-1980. The survival rate was not significantly influenced by age, sex, birthplace, histology, or stage. These data suggest that a relatively high cure rate might be possible in carcinoma of the nasopharynx, even though most patients present with locally advanced disease. The patterns of relapse are discussed.

Adolescent↗
PubMed1984

Changing trends in the management of squamous carcinoma of the tongue.

An analysis of 412 patients with primary squamous carcinoma of the tongue seen from 1969 through 1978 reveals that the age and clinical stage of patients with tongue cancer have remained constant when compared with previous reports from our hospital. The proportion of female patients has increased, and we are seeing more patients with tumors located in the base of the tongue. Treatment methods are changing. Mandible-sparing procedures were used more often, and significantly more patients received primary and adjuvant radiotherapy in the early study period. At the same time, there were fewer composite neck, tongue, and jaw resections and fewer laryngectomies, although more patients had elective treatment of the neck. The overall determinate cure rate has not changed since the 1957 through 1963 period. Age, sex, and adjuvant radiotherapy did not seem to affect survival. When patients with oral tongue primary lesions were compared with those with tumors in the base of the tongue, the prognosis seemed to be better in those with oral primary lesions when the patient had stage I or II disease. Finally, patients with tongue cancer have at least a 1 in 5 chance of development of a second aerodigestive tract malignancy and require lifelong scrutiny. Although current therapy results in lower morbidity, the proportions of patients with stage III and IV tumors remain high, and the cure rates remain disappointingly stable.

Adult↗
PubMed1984

Squamous carcinoma of the floor of the mouth.

We reviewed our experience with 320 patients treated for squamous cell carcinoma of the floor of the mouth from 1964 through 1977. The patients were evenly distributed according to clinical stage. Treatment consisted of surgery (77 percent of patients), surgery and adjunctive radiation therapy (19 percent of patients), or radiation therapy only (4 percent of patients). Most of the patients with favorable (T1) primary tumors had a simple peroral excision (78 percent) with marginal mandibulectomy when indicated (22 percent). Marginal mandibulectomy was still possible in many patients with T2 or T3 lesions (56 percent). Synchronous or metachronous second primary cancers were documented in 33 percent of the patients, most of which occurred in the head and neck region. Seventeen percent of the patients who had elective neck dissection had microscopic metastasis. More than a third of the patients with clinically positive nodes had negative neck specimens histologically. In patients with histologically positive nodes, 60 percent had involvement at multiple levels. The 5 year determinate cure for the entire group was 65 percent. According to stage, 88, 80, 66 and 32 percent of patients with stages I, II, III, and IV disease, respectively, were alive and well 5 years after treatment. This seems to be a significant improvement when compared with the last report from our hospital.

Adult↗
PubMed1984

Prostaglandins in carcinomas of the head and neck.

Abnormalities of 5 cyclooxygenase products were studied in tumours from patients with head and neck cancer. The studies were designed to measure tissue prostaglandin content (ng/g wet tissue) as well as production in vitro by tumour microsomes (ng/mg protein/10 min). Head and neck tumours contained large amounts of 5 eicosanoids in the order. PGE2 greater than PGE1 greater than 6-keto-PGF1 alpha greater than PGF2 alpha greater than TXB2. When tumours less than or equal to 2 cm were compared with tumours equal to or more than 3 cm in size, amounts of all but PGF2 alpha were higher in the larger tumours. However, the capacity of tumour microsomes to synthesize PGs in vitro was inversely related to tumour size. These results suggest a defect in removal of eicosanoids from large tumours. The physiological significance of this increase in local levels of eicosanoids remains to be determined in head and neck cancer.

6-Ketoprostaglandin F1 alpha↗
PubMed1984

Radiation therapy in adenoid-cystic carcinoma.

Between 1949 and 1977, 74 patients with adenoid-cystic carcinoma of various head and neck sites were treated by radiation therapy at Memorial Sloan-Kettering Cancer Center. Radiation therapy alone was employed in 49 patients for recurrent, unresectable disease, and in 25 patients it was given as an adjunct to surgical resection. Among the 49 patients treated with radiation therapy alone, tumor regression was seen in 47 (96%). However, 44 of the 47 (93.5%) subsequently relapsed locally. Relapse occurred within 18 months in one-half of the patients and within 5 years in all of them. Of the 25 patients who received adjunctive radiation therapy about one-half relapsed locally within five years. There were 9 patients in this group, however, whose field size exceeded 8 X 8 cm and the dose of radiation also exceeded 4500 rad: 88% of these patients remained relapse-free at 5 years, compared with only 22% of the other 16 whose dose, or field size, or both, were inadequate by comparison. These data suggest that when irradiation is employed for advanced, inoperable adenoid-cystic carcinoma, it offers useful palliation but is rarely, if ever, curative. Postoperative irradiation, on the other hand, might improve the local control and the survival in patients with operable adenoid-cystic carcinoma who are at high risk for relapse, but only if the field size and the dose are adequate.

Adult↗
PubMed1983

Permanent Iodine-125 implants in head and neck cancer.

One hundred twenty-four patients were treated with advanced recurrent head and neck cancer for palliation with radioactive permanent Iodine-125 (125I) implants. Complete regression occurred in 71% of the 118 lesions for which evaluation was possible and greater than 50% regression occurred in 18%; no meaningful regression occurred in 11%. Local recurrence of cancer was subsequently seen in 21% of the lesions which had regressed completely, in 55% of those which had regressed incompletely, and in 100% of those which had not regressed. The incidence of serious complications was 5.5%. Overall, in 64% of the instances the implanted lesions remained controlled until the patient's death, usually due to progression of cancer elsewhere in the body. It is concluded that permanent 125I implants offer useful palliation to the patient with recurrent head and neck cancer with a minimum of toxicity and inconvenience. Because of their low toxicity even after prior full-course external radiation therapy, the authors are currently investigating their use as planned adjunct to external radiation therapy and chemotherapy in the initial definitive management of patients with locally advanced head and neck cancer.

Brachytherapy↗
PubMed1983

Neoplastic changes in transposed deltopectoral skin.

In a patient who had undergone pharyngeal resection and reconstruction with transposed deltopectoral skin, multiple benign verrucous tumors developed in the neopharynx. These did not resemble the carcinoma for which the original ablative surgery was performed but required extensive resection for restoration of adequate swallowing. Although this complication appears to be rare, the number of patients at risk is sizable, and further examples may be expected in the future.

Cell Transformation, Neoplastic↗