BACKGROUND: The psychosocial adaptation of patients who had undergone a resection of the maxilla for cancer of the maxillary antrum and/or hard palate with the placement of an obturator prosthesis to restore speech and eating function was studied. METHODS: Forty-seven patients were interviewed who had a maxillectomy with an obturator prosthesis at Memorial Sloan-Kettering Cancer Center, an average of 5.2 years (SD = 2.4 years) ago, 94% of whom had some of their soft palate resected. Interviews were conducted by telephone by a trained research interviewer, using a series of questionnaires to assess their satisfaction with the functioning of their obturator, and the psychological, vocational, family, social, and sexual adjustment. Measures included the Obturator Functioning Scale (OFS). Psychosocial Adjustment to Illness Scale (PAIS), Mental Health Inventory (MHI), Impact of Event Scale, and Family Functioning Scale. RESULTS: Using multiple regression and discriminant function analyses, satisfactory functioning of the obturator prosthesis, as measured by the OFS, was found to be (1) the most highly significant predictor of adjustment, as measured by the PAIS (p < .0001) and the MHI Global Psychological Distress Subscale (MHI-GPD) (p < .001), and (2) significantly related to their perception of the negative socioeconomic impact of cancer upon their lives. The most significant predictor of better obturator functioning were the extent of resection of their soft palate (one third or less, p < .001), and hard palate (one fourth or less, p < .01). Specific aspects of obturator functioning that most significantly correlated with better adjustment (PAIS, MHI-GPD) were: less difficulty in pronouncing words (r = .40 and r = .51, respectively, p < .01), chewing and swallowing food (r = .27-.46, p < .05), and less change in their voice quality after surgery (r = .52 and r = .56, respectively, p < .001). CONCLUSIONS: These findings suggest that a well-functioning obturator significantly contributes to improving the quality of life of maxillectomy patients.

Adaptation, Psychological↗

PubMedDate not supplied

Combined chemotherapy and radiotherapy versus surgery and postoperative radiotherapy for advanced hypopharyngeal cancer.

BACKGROUND: Although the standard therapy for locally advanced hypopharyngeal cancer remains surgery and postoperative radiotherapy (RT), alternative treatment approaches include induction chemotherapy and RT. The purpose of this retrospective study was to compare the long-term outcome of these treatments performed in a single institution. METHODS: Twenty-six patients with advanced, resectable, squamous cell carcinoma of the hypopharynx were treated with induction chemotherapy and definitive RT (group I), reserving laryngectomy for salvage. The induction phase of therapy consisted of 2-3 cycles of cisplatin-based chemotherapy followed by conventional fractionated RT to doses of 66-70 Gy. The outcomes of this group of patients were compared with the outcomes of 30 patients with hypopharyngeal cancer who were treated at our institution with surgery and postoperative RT (group II). The median follow-up times of the surviving patients in groups I and II were 5 and 9 years, respectively. RESULTS: The local recurrence-free survival at 5 years from the completion of therapy for group I was 50%, compared with 69% for group II (p = .41). Among patients with T3-T4 primary tumors, the 5-year local control rates were 58% and 59% for groups I and II, respectively (p = .78). The likelihood of larynx preservation, free of local disease at 5 years for group I, was 52%. The 5-year neck recurrence-free survival for groups I and II were 47% and 69%, respectively (p = .66). Among patients with N2-N3 stage disease, the 5-year incidence of neck failure for groups I and II were 73% and 68%, respectively (p = .74). The 5-year distant metastases-free survival for groups I and II were 67% and 57%, respectively (p = .19). The 5-year disease-free survival rates for groups I and II were 30% and 42%, respectively (p = .9). The 5-year overall survival rates for groups I and II were 15% and 22%, respectively (p = .65). CONCLUSIONS: Nonsurgical therapy for advanced stage hypopharyngeal cancer provides survivorship comparable with that achieved with standard approaches of surgery and postoperative RT. However, despite the therapy, the outcome is poor. Future studies will need to explore new treatment strategies in an effort to improve upon the outcome for this group of patients.

Adult↗

PubMedDate not supplied

Postoperative radiotherapy for oral cavity cancers: impact of anatomic subsite on treatment outcome.

We have retrospectively reviewed the treatment results of postoperative radiotherapy (RT) for advanced oral cavity cancers. The purpose of this study was to determine the impact of anatomic subsite on the results of treatment. Between 1975 and 1985, 51 patients with squamous cell carcinoma of the oral tongue (OT = 29 patients) and floor of mouth (FOM = 22 patients) were treated with combined surgery plus RT. All had an indication(s) for RT including advanced primary disease (T3 or T4) (29 patients), close or positive margins (34 patients), and multiple positive neck nodes and/or extracapsular extension (41 patients). With a median follow-up of 6 years, the 5-year actuarial local control rate was 74% and the rate of distant metastasis (DM) was 34%. Despite the similar T stage, margin status and median RT dose, the 5-year actuarial local failure rate was 38% for OT vs. 11% for FOM (p = 0.03). Furthermore, the median survival after recurrence was 9 months for OT and 40 months for FOM (p = 0.02). At 5 years the determinate survival for both sites was (55%), and the likelihood of developing a second malignancy was 31%. The likelihood of developing DM was 50% for FOM (N0-N1 = 3 of 12, N2-N3 = 8 of 10) and 21% for OT (N0-N1 = 4 of 21, N2-N3 = 1 of 8). This study highlights significant differences between FOM and OT cancers in response to combined surgery and RT. Future strategies should be directed at the enhancement of local control for OT and better systemic therapy for those with advanced N-stage FOM.(ABSTRACT TRUNCATED AT 250 WORDS)

Carcinoma, Squamous Cell↗

PubMedDate not supplied

Innervation of the trapezius muscle by the intra-operative measurement of motor action potentials.

Although the surgical anatomy of the spinal accessory nerve and the cervical plexus has been extensively described, the exact motor innervation of the trapezius has been controversial. Attempts to resolve this question have involved anatomic or electrophysiologic studies in human embryos and animals. Extrapolation of the results to adult humans may not be correct. Accurate identification of muscle innervation is obtainable by intra-operative measurement of motor action potentials produced by direct stimulation of the accessory nerve and the cervical plexus. The study involved 14 patients undergoing supraomohyoid or modified neck dissections. Under direct vision, stimulating electrodes were placed on the identified nerves and motor action potentials, and latencies were recorded by surface electrodes placed over the three portions of the trapezius. In 13 patients, when the accessory nerve was stimulated, motor action potentials were obtained in 13 of 13 in the first portion, 11 of 13 in the second portion, and 10 of 13 in the third portion of the trapezius. In the last patient, the accessory nerve ended in the sternocleidomastoid muscle, and innervation of the trapezius was via C3 as demonstrated by motor action potentials. Responses when the roots of the cervical plexus were stimulated varied. Three patterns were seen: In the first group (seven patients), motor action potentials were distinct from those recorded when the accessory nerve was stimulated. Additionally, latencies were different from those of the accessory nerve. The second group (four patients) had motor action potentials that were similar to those obtained from stimulation of the accessory nerve, although their corresponding latencies were different.(ABSTRACT TRUNCATED AT 250 WORDS)

Accessory Nerve↗

PubMedDate not supplied

Complications of craniofacial resection for tumors involving the anterior skull base.

BACKGROUND: A consecutive series of 85 patients undergoing craniofacial resection for malignant tumors involving the anterior cranial base between 1974 and 1992 was reviewed. RESULTS: There were two (2%) postoperative deaths. Postoperative complications occurred in 33 (39%) patients. Local major complications occurred in 26 (31%) patients, local minor in 7 (8%), and systemic in 5 (6%). More than one complication occurred in a number of patients. Bacterial contamination led to a significant proportion of local, septic complications. Repair of the skull base defect with a pedicled pericranial flap was unsatisfactory and was associated with an increased incidence of local major complications. A local major complication was associated with a dramatic lengthening of hospitalization. CONCLUSION: Future endeavors for prevention of complications should focus on antibiotic prophylaxis and reconstruction of the cranial base defect with better vascularized flaps.

Adolescent↗

PubMedDate not supplied

The significance of "positive" margins in surgically resected epidermoid carcinomas.

Sixty-two patients with epidermoid carcinomas of the head and neck (excluding glottic larynx and skin), in whom surgical-resection margins were classified as "positive", were studied to determine the incidence of local recurrence, the subsequent clinical course, and survival. The recurrence rate in this group was compared with that of patients who had "negative" margins. Four histologic findings are classified as positive margins: (1) margin closeness (tumor within 0.5 cm), (2) premalignant change in the margin, (3) in-situ cancer in the margin, and (4) invasive microscopic cancer at the margin. Patients with these variants showed a significant increase in local recurrence and in mortality when compared to those with negative margins. A review of the literature is presented, and recommendations are made for this clinical setting.

Adult↗

PubMedDate not supplied

Mandibular "swing" approach for oral and oropharyngeal tumors.

This study reviews the history, indications, and operative technique for median mandibulotomy with paralingual extension (mandibular "swing"). A 21-year experience is presented, during which this operative approach was used in 49 patients with tongue cancer and 16 others with oropharyngeal lesions. Mandibular "swing" appears to offer more versatility and fewer problems than either median labiomandibular glossotomy or lateral mandibulotomy. Good local control can be anticipated in properly selected patients because the tumor exposure is comparable to that achieved in operations involving jaw resection.

Adenocarcinoma↗

PubMedDate not supplied

Head and neck cancer in the elderly.

One hundred fifty-nine patients, 80 years of age or older, with cancer of the head and neck were reviewed. Patients tolerated head and neck resection well and an absolute survival of 36 months for all treated patients and 41 months for all surgically treated patients suggests the efforts are worthwhile. Treatment offered the elimination of uncontrolled cancer in 68% of the patients. Prompt and adequate treatment reduces time, effort, cost, and the actual suffering of the patients. There is little justification for therapeutic nihilism even in the elderly patient.

Aged↗

PubMedDate not supplied

Scaling of disfigurement and dysfunction in postoperative head and neck patients.

The primary purpose of this investigation was to construct a quantitative scale to measure the perception of severity of visible disfigurement and dysfunction following ablative head and neck cancer surgery. Facial disfigurement and disruption of physical function induced by head and neck surgery pose formidable obstacles to the medical and psychosocial adaptation of cancer patients. Although this problem is widely acknowledged, virtually no research has attempted reliable and valid measurement of such concepts. Consequently, the present study investigated the psychological perceptions of 100 registered nurses regarding 11 disfiguring surgical procedures and loss of associated functions. Results indicated that the nurses' judgments of disfigurement and dysfunction were highly consistent and not a function of patient gender. Judgments of the severity of disfigurement, moreover, were independent of the perceived severity of associated dysfunction. It was concluded that this is a reliable method for measuring the relative degree of disfigurement and dysfunction and represents a critical precursor to prediction of a patient's psychological rehabilitation and compliance with medical care after surgery.

Adaptation, Psychological↗