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Biomedical subjects

E W Strong

Publications and source records attributed to E W Strong.

At least 91 records · Page 5Linked to original sources
PubMed1983

Cervical node metastasis of occult origin.

This study reviewed a 12 year experience with 132 patients who were treated for metastatic carcinoma of the cervical lymph nodes with no apparent primary tumor. Using radical neck dissection as the main treatment modality, a 5 year survival of 50 percent was achieved in 79 patients with epidermoid carcinoma. Survival varied significantly depending on the extent of the tumor in the neck. It was 74 percent in those with stage N1 disease compared with 41 percent in patients with N2 or N3 disease. Recurrence in the neck, the major reason for treatment failure, can probably be reduced by more aggressive use of adjunctive radiotherapy. Primary tumors were identified after therapy in only 15 percent of these patients, and this appeared to have relatively little impact on the outcome. Irradiation and chemotherapy were the preferred treatment modalities in 29 patients with metastatic adenocarcinoma of occult origin. All but one patient died within 29 months. A 53 percent 5 year survival was achieved in 13 patients with anaplastic or undifferentiated carcinoma. Radical neck dissection was employed in 11 patients with melanoma. No primary tumor was ever identified in this group and only one patient remained alive and well after 5 years.

Adenocarcinoma↗
PubMed1983

Effect of retinoids on oral leukoplakia.

This two phase study was designed to observe the toxicity and effectiveness of retinoids on oral leukoplakia. The study design included patients who had visible and measurable oral leukoplakia without history of synchronous oral cancer or oral cancer within the previous 2 years. Documentation of the lesion by direct measurement and photography, as well as a biopsy at the beginning and at the end of the study (for verification of the histologic appearance of the lesion), were performed in each patient. Sixteen patients with oral leukoplakia were treated with 13-cis-retinoic acid formulated in a troche in the strength of 1 mg. Three patients received 3 mg/day, 8 patients received 5 mg/day, and 5 patients received 10 mg/day. The initial visible responding event appeared to be a thinning of the leukoplakia with reduction in the whitish surface leaving a reddish, velvety epithelium. If resolution occurred, the velvety area became pink, assuming the color and texture of the normal adjacent mucosa. Toxicity of the drug appeared to be acceptable among the evaluable patients. Of the 11 patients, 3 demonstrated complete response and 6 demonstrated partial response after 6 months of treatment with the drug under study. Recurrences developed in two of the three patients with complete response, and neither of the two showed complete histologic and cytologic regression. One of the patients with partial response went on to complete response after cessation of treatment. Under the condition of our study, a treatment effect was observed with small amounts of topical 13-cis-retinoic acid and that the level of toxicity was acceptable.

Administration, Topical↗
PubMed1983

Gastric transposition in head and neck surgery. Indications, complications, and expectations.

From 1973 through 1982 a total of 63 of our patients had their upper alimentary tracts reconstructed after major ablative neck operations by transposition of the mobilized stomach into the neck through the bed of the resected esophagus. This gastric pull-up procedure was performed without thoracotomy using two surgical teams for resection of locally extensive primary tumors arising in the hypopharynx, cervical esophagus, and thyroid gland. Morbidity and mortality were significant but acceptable. Relatively few patients were cured, but excellent palliation was often achieved. In our experience, use of the transposed stomach for restoration of alimentary continuity after cervical esophagectomy or circumferential pharyngectomy offered greater reliability and versatility than other available methods.

Adenocarcinoma↗
PubMed1982

Adenocarcinoma of salivary origin. Clinicopathologic study of 204 patients.

We have reviewed a 30 year experience with 204 patients treated for adenocarcinomas of salivary origin. Seventy-one percent had histologically typical adenocarcinomas, whereas 12 percent had papillary, 12 percent mucinous, and 5 percent other unusual variants. Despite these morphologic differences, almost all of the lesions could be classified into one of three histologic grades. The tumors arose most often in the minor salivary glands (138 patients, 68 percent) and the less common variants of adenocarcinoma usually involved the oral cavity, nasal cavity, or paranasal sinuses. High-grade tumors were more often high stage at the time of diagnosis. Treatment almost always consisted of surgical resection which was tailored according to the site and extent of the lesion. Five, 10, and 15 year cure rates were 41, 34, and 28 percent, respectively, and salvage was determined by the grade and stage of the tumor rather than by the extent of the surgery. Local recurrence of this most lethal of salivary tumors exceeded 50 percent. Postoperative teletherapy is probably indicated in most patients if survival rates are to increase, but the role of systemic chemotherapy remains to be defined.

Adenocarcinoma↗
PubMed1980

Serum zinc, serum copper, and the Cu/Zn ratio in patients with epidermoid cancers of the head and neck.

Serum zinc levels (SZL), serum copper levels (SCL), and the Cu/Zn ratio were evaluated in 50 patients with epidermoid cancer of the head and neck to treatment with respect to site and stage of disease. There was no significant difference in these parameters compared to healthy normal controls. We could not appreciate any diagnostic or prognostic value in these parameters in patients with head and neck cancer. There was, however, a sex-related difference for SZL in men with oral cavity and women with laryngeal lesions, and a trend toward decreasing SZL and increasing SCL and the Cu/Zn ratio with advanced stage of disease.

Adult↗
PubMed1980

Elective postoperative radiation therapy in stages III and IV epidermoid carcinoma of the head and neck.

One hundred five patients with advanced (American Joint Committee stages III and IV) but resectable epidermoid carcinoma of the head and neck were treated with radical surgery and elective postoperative radiation therapy. Follow-up periods range from 16 to 66 months. Nineteen patients (18 percent) have had recurrence in the head and neck area. This is better than our past experience with surgical treatment alone in advanced head and neck cancer, in which 50 to 75 percent of patients had local recurrence within the 1st 18 months. When radiation therapy was started no later than 6 weeks after surgery, only 3 of 54 patients (5.5 percent) had local recurrence, but when there was a longer delay 16 of 51 patients (31.5 percent) had recurrence. These results suggest that elective postoperative radiation therapy improves local control in patients with advanced head and neck cancer, but that it should be delivered soon after surgery for maximum effectiveness.

Carcinoma, Squamous Cell↗
PubMed1979

Adenoid cystic carcinoma: factors influencing survival.

We have reviewed our experience with 264 patients treated for adenoid cystic carcinoma of salivary origin. This study updates a previous report from our hospital and includes all patients treated during a 30 year period who were eligible for a minimum follow-up of 10 years. The tumor arose in minor salivary (mucous) glands in two thirds of the patients; half had received treatment elsewhere, and both sexes were equally represented. Actuarial survival curves and "cure" rates calculated by the direct method confirm that clinical staging provides a reliable prognostic guide. We are unable to demonstrate that the microscopic appearance of the tumor exerts a predictable effect on treatment results. Although some patients lived for many years after resection despite local recurrence and distant metastases, prolonged survival was unusual in patients with stage 3 lesions, particularly in those with sinus or submaxillary gland primaries. Based on the site of origin of the tumor and its clinical stage, it is now possible to select which patients with adenoid cystic carcinoma have the most ominous prognosis and perhaps plan a more appropriate operation. More importantly, these data may help focus on the subpopulation at greatest risk, which is vital to the design of any prospective study to assess the value of adjunctive irradiation and chemotherapy.

Adult↗
PubMed1979

Carotid arterial hemorrhage after radical head and neck surgery.

From 1960 to 1974, 63 patients treated by the Head and Neck Service of Memorial Hospital underwent carotid arterial ligation for control of actual or threatened carotid rupture. Twenty-one of these patients died without leaving the hospital. Fourteen of these deaths were the direct result of carotid ligation or hemorrhage. Five of the surviving patients suffered permanent neurologic damage. Factors predisposing to carotid rupture included a history of radiation, advanced disease, the presence of an oral or pharyngeal suture line in continuity with a dissected neck, and the postoperative development of skin necrosis or fistulas. Because elective carotid ligation did not prevent the consequences of carotid rupture and because reestablishment of vascular continuity is almost never possible, all attempts should be made to avoid the conditions that are precursors to this most serious complication of radical head and neck surgery.

Aged↗
PubMed1978

Combination therapy of advanced head and neck cancer: induction of remissions with diamminedichloroplatinum (II), bleomycin and radiation therapy.

Patients with unresectable, previously untreated head and neck cancer were given cis-diamminedichloroplatinum (II) (DDP), 3 mg/kg, with mannitol diuresis (day 1), followed by a continuous infusion of bleomycin, 0.25 mg/kg/day, days 3 through 10, after an initial loading dose of 0.25 mg/kg by rapid IV injection on day 3. The DDP was repeated on day 22, following which radiotherapy was delivered using standard doses, fractionations and portals. Patients were evaluated for response on day 22 and again at the conclusion of radiotherapy. Of 21 patients evaluable at day 22, there were four CR and 11 PR (greater than 50% reduction of all measureable disease), for a major response rate of 71%. Of five MR, four showed 30-60% reduction at the primary site. Of 16 who have finished the radiation phase of treatment, there are six CR, five PR and one MR with durations four to eight months. Toxicity in 33 patients included vomiting (33), alopecia (33), WBC less than 3000 (five), platelets less than 100,000 (one), dose-limiting mucositis during bleomycin (six) and peak serum creatinine greater than 2 (five), with one fatality. The regimen thus appears promising as initial therapy for the previously untreated patient. The same chemotherapy has produced much less encouraging results in prviously treated patients.

Adult↗
PubMed1978

Acinic cell carcinoma of salivary origin. A clinicopathologic study of 67 cases.

This study reviews a 30 year experience with acinic cell carcinoma. The tumor arose in the parotid gland in 64 patients, the submaxillary gland in one and minor salivary glands in two. In untreated patients with small tumors, clinical findings usually suggested a benign mixed tumor and a subtotal parotidectomy which spared the facial nerve was highly effective therapy. In contrast, local recurrence and death was the rule in those few who had locally extensive disease, regardless of how radical an operation was performed. Determine "cure" rates for the entire group were 76, 63 and 55% at 5, 10 and 15 years, respectively. Cervical lymph node metastasis occurred in 16% of the patients, and distant metastasis in 12%. Survival was most directly influenced by the clinical extent of the primary tumor, and also correlated with certain histologic features which are described.

Adolescent↗
PubMed1978

Adjuvant trial of levamisole in patients with squamous cancer of the head and neck: a preliminary report.

A preliminary report is made of a randomized double-blind study comparing levamisole with placebo as surgical adjuvant treatment of patients with squamous cancer of the head and neck. The study groups were comparable according to the prognostic factors of type (primary or recurrent), site (oral cavity, pharynx, larynx), and stage of disease and were also similar in pretreatment immune function and in radiation exposure. Of 65 evaluable patients, 31 were treated with levamisole and 34 received placebo. Although there was no difference in the distribution of the time to recurrence of the overall treatment group, there was a difference of borderline significance in favor of levamisole in the primary disease patients (P less than 0.006). Further analysis of subgroups in the primary disease category showed decreased recurrence rates in patients receiving levamisole who had cancer of the oral cavity P less than 0.01 or who had stage II disease, P less than 0.02. Considering site and stage simultaneously, the only significant difference was in stage II patients with oral cancer. The above results, though encouraging, must be viewed with caution due to small sample sizes and relatively short follow-up of most patients.

Antigens, Bacterial↗
PubMed1978

Mucoepidermoid carcinoma of salivary gland origin. A clinicopathologic study of 367 cases.

A thirty year experience with 367 patients who had mucoepidermoid carcinoma of salivary origin is reviewed. The tumor arose in the parotid gland in 254 patients. The presentation and clinical course depended significantly on whether the tumor was low, intermediate, or high grade in histologic appearance. Metastasis and tumor-related death were occasionally noted in patients with low grade lesions, suggesting that even the most innocuous-appearing mucoepidermoid tumor has malignant potential. Significant correlation was demonstrated between the clinical stage of a tumor and its histologic appearance. Stage I tumors were usually of low histologic grade and were effectively controlled by conservative surgical procedures. Radical operations were often ineffective in patients with stage III tumors, most of which proved to be of high histologic grade. Considering the poor prognosis in the latter patients, adjunctive therapy in the form of postoperative external radiation seems indicated. In our experience, "cure" rates in patients who had intermediate or high grade lesions varied widely, depending upon the stage of the tumor. This strongly suggests that therapeutic decisions should not be based on histologic appearance alone.

Adolescent↗
PubMed1978

Randomized trial of levamisole in patients with squamous cancer of the head and neck: a preliminary report.

This is a preliminary report of a randomized double-blind study comparing levamisole with placebo as surgical adjuvant treatment of patients with squamous cancer of the head and neck. The study groups were comparable according to the prognostic factors of type (primary or recurrent), site (oral cavity, pharynx, or larynx), and stage of disease and were also similar in pretreatment immune function and in radiation exposure. Of 65 evaluable patients, 31 received levamisole and 34 received placebo. Although there was no difference in the distribution of the time to recurrence of the overall treatment group, there was a difference of borderline significance in favor of levamisole in the primary disease patients (P less than 0.06). Further analysis of subgroups in the primary disease category showed decreased recurrence rates in patients receiving levamisole who had cancer of the oral cavity (P less than 0.01) or who had stage II disease (P less than 0.02). Considering site and stage simultaneously, the only significant difference was in stage II patients with oral cancer. The above results, although encouraging, must be viewed with caution due to small sample sizes and the relatively short followup of most patients.

Carcinoma, Squamous Cell↗
PubMed1977

Malignant mixed tumor of salivary origin: a clinicopathologic study of 146 cases.

A 30-year Memorial Hospital experience with 146 patients with malignant mixed tumor is reviewed. These comprised 5% of 2,743 patients who were treated for salivary neoplasms from 1939 through 1968. The tumors arose in the parotid gland in 108 patients, submaxillary gland in 23 patients, mucus or so-called minor salivary glands in 16 patients, and sublingual gland in one. In terms of our total experience, 11% of all submaxillary tumors proved to be of the malignant mixed variety as compared to 6% of parotid tumors and 3% of minor salivary tumors, respectively. Seventy-one patients (48%) had previously received therapy elsewhere. Results of treatment are presented and the factors which influenced the results are discussed.

Adenocarcinoma↗