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Biomedical subjects

E W Strong

Publications and source records attributed to E W Strong.

154 records · Page 9Linked to original sources
PubMedDate not supplied

Failure at the primary site following multimodality treatment in advanced head and neck cancer.

Recurrence at the primary site is an important cause of morbidity and mortality in head and neck cancer. In patients with stages III and IV disease treated surgically at Memorial Sloan-Kettering Cancer Center between 1960 and 1970, cancer recurred at the primary site in 39% even when the margins had been deemed satisfactory, and in 73% when the margins were unsatisfactory. Between 1975 and 1980, we treated 114 previously untreated patients with stages III and IV epidermoid carcinoma of the oral cavity, oropharynx, hypopharynx, or larynx with a combination of surgery and postoperative radiation therapy. Twenty-seven patients also received preoperative chemotherapy. One hundred seven patients were evaluable for disease control at the primary site by the combined treatment. Cancer recurred at the primary site in 6 patients, including 2% of 47 patients whose surgical margins had been satisfactory and 10.5% of 60 patients whose surgical margins had been unsatisfactory. Of the latter, recurrence was seen in 5% of the 25 patients whose margins were less than 5 mm but were microscopically uninvolved, and in 15% of the 35 patients whose margins were microscopically involved by cancer. Comparison of these data with our historical control group suggests a decrease in the failure rate at the primary site with multimodality treatment. However, it still appears important to secure microscopically negative margins for the best results.

Antineoplastic Agents↗
PubMedDate not supplied

Failure in the neck following multimodality treatment for advanced head and neck cancer.

Failure in the neck is an important cause of morbidity and mortality in head and neck cancer. Patients who underwent therapeutic or elective radical neck dissection at Memorial Sloan-Kettering Cancer Center between 1960 and 1966 developed recurrence of cancer in the dissected neck in 36.5% of the cases when metastatic carcinoma was present in the cervical lymph nodes at one level, and in 71.3% when metastases were present at multiple levels. Between 1975 and 1980, we treated 114 previously untreated patients with stages III and IV epidermoid carcinoma of the oral cavity, oropharynx, hypopharynx, or larynx with the combination of surgery and elective postoperative radiation therapy. Of these, 106 patients underwent radical neck dissection and 94 were proven to have metastatic carcinoma in the neck. Eleven patients developed recurrences in the neck. Recurrence developed in 16% of 19 patients with metastases at one level, and in 13% of 75 patients with metastases at multiple levels. For 53 patients, radiation therapy was started within 6 weeks after neck dissection and only 2% of them developed recurrence in the neck; for 41 patients, radiation therapy started later than 6 weeks and 29% of them developed recurrence (P less than 0.01). Comparison of these data with our historical control group suggests a decrease in the number of failures in the neck when a multimodality treatment is used. It appears, however, that irradiation must be started within 6 weeks after surgery for the best results.

Carcinoma, Squamous Cell↗
PubMedDate not supplied

Failure at distant sites following multimodality treatment for advanced head and neck cancer.

Failure at distant sites has generally not been regarded as a major cause of morbidity and mortality in head and neck cancer. Among patients with advanced cancer of the mouth and throat, treated at Memorial Sloan-Kettering Cancer Center between 1960 and 1965, over 75% succumbed because of failure to control the disease, but distant metastases were the primary cause of failure in only 4%. More recently, with better local-regional control of cancer using multimodality treatment, failure at distant sites has become much more of a problem, however. Between 1975 and 1980, we treated 114 previously untreated patients with stages III and IV epidermoid carcinoma of the oral cavity, oropharynx, hypopharynx, and larynx with a combination of surgery and postoperative radiation therapy. Twenty-seven patients also received preoperative chemotherapy. Twenty patients developed distant metastases (12 in the lungs, 7 in the spine, and 1 on the trunk). The incidence of distant metastases was higher in those patients who presented with palpable cervical lymph nodes than in those who did not (25% vs. 4%, P less than 0.05), and especially in those patients who pathologically had metastases at multiple levels in the neck than in those who had metastases at a single level or had negative nodes (35% vs. 5%, P less than 0.05). Therapeutic strategies aimed at decreasing the incidence of distant metastases in patients with advanced head and neck cancer should be studied in patients who are pathologically found to have lymph node metastases at multiple levels in the neck.

Antineoplastic Agents↗
PubMedDate not supplied

Second malignant neoplasms in patients successfully treated with multimodality treatment for advanced head and neck cancer.

One hundred fourteen patients with advanced (stage III or IV) epidermoid carcinoma of the oral cavity, pharynx, larynx, and hypopharynx were treated by surgery and postoperative radiation therapy between 1975 and 1980. Twenty-seven patients also received preoperative platinum-containing chemotherapy. Sixteen patients developed second malignant neoplasms. The site of the second malignant neoplasm was in the esophagus in seven patients (44%), in the lung in six patients (37.5%), and at other sites in three patients (18.5%). Relapse of the head and neck cancer (at the primary site in 6 patients, in the neck in 11 patients, and at distant sites in 20 patients) appeared within the first 2 years in virtually all cases. In contrast, second malignant neoplasms have appeared at a steady rate of approximately 6% per year, for at least the first 4 years. Future efforts at improving the survival of patients with advanced head and neck cancer, therefore, must include strategies aimed at decreasing the incidence and the morbidity and mortality from second malignant neoplasms.

Adult↗
PubMedDate not supplied

Patterns of failure in carcinoma of the nasopharynx: failure at distant sites.

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, the base of the skull, and both sides of the neck. Eighty-seven percent of the patients had stage IV disease (American Joint Committee, 1980). Eighteen patients developed distant metastases as the first site of relapse. Metastases appeared within 6 months after treatment in 50% of these 18 patients, and in 94% within 2 years. Median survival after the development of distant metastases was 6 months. The most sensitive predictor of which patients would develop distant metastases was the size of cervical lymph node metastases at initial presentation (P = 0.003); patients without palpable cervical nodes or with cervical nodes smaller than 3 cm were the least likely to develop distant metastases (10%), followed by those patients who had cervical nodes measuring 3 to 6 cm (25%), followed by those who had cervical nodes larger than 6 cm, (almost 50%). The incidence of distant metastases was not significantly influenced by age, sex, birthplace, histology, or T-stage. Studies aimed at decreasing the morbidity and mortality from distant metastases in carcinoma of the nasopharynx should be undertaken in patients who present with bulky cervical metastases.

Adolescent↗
PubMedDate not supplied

Surgical approach to squamous carcinoma confined to the tongue and the floor of the mouth.

This retrospective study concerns 105 patients treated between 1977 and 1981 who had resections of previously untreated squamous carcinomas that were localized to the oral tongue or the floor of the mouth. Almost 80% had simple peroral excisions. Elective lymphadenectomy was performed in about one-third, all but one of whom had either T2 or T3 primaries or a surgical approach that involved entry into the neck. The determinate "cure" rate at 24 mo (median follow-up 50 mo) was 86%. Ninety-three percent and 78%, respectively, of those with T1 and T2 lesions remained alive and well after conservative operations, which yielded good functional results. Uncontrolled neck disease was evident in 10 of the 13 determinate patients who died as a result of their tumor. Although more of our patients with localized oral cancer now undergo elective lymphadenectomy when the primary is resected, T staging has not accurately predicted which patients are at greatest risk of metastasis. Preliminary data suggest that measurement of tumor depth may be a better way to select those patients who need elective neck therapy.

Adult↗
PubMedDate not supplied

Mucus gland tumors of the larynx and laryngopharynx.

During the 30-year period from 1939 through 1968, 20 patients were seen who had "minor salivary" tumors arising in the mucus glands of the larynx or laryngopharynx. This group comprised about 3% of more than 600 patients with mucus gland tumors of the upper aerodigestive tract treated at Memorial Sloan-Kettering Cancer Center during the same interval. In each instance the tumor was malignant, and all but three of these patients were men. Location and histology of these uncommon tumors is described. Only 2 of 18 treated cases were "cured." Uncontrolled cervical lymph node involvement or distant metastasis was more often the reason for treatment failure, rather than local recurrence at the primary site.

Adenocarcinoma, Mucinous↗
PubMedDate not supplied

Selecting variants in pharyngeal reconstruction.

A dramatic change in the techniques of immediate pharyngeal reconstruction in the last 10 years is largely due to the availability of myocutaneous flaps, microvascular techniques, and the increasing popularity of the "gastric pull-up" operation. The experience of the Head and Neck Service of Memorial Sloan-Kettering Cancer Center in repair of the pharynx following pharyngeal resection between 1974 and 1983 is reviewed and the changing trends in the philosophy of pharyngeal reconstruction are highlighted. The methods of reconstruction used were deltopectoral flap, gastric pull-up, free microvascular bowel transfer, and pectoralis myocutaneous flap. The indications, morbidity, effectiveness, and complications for each of these procedures are discussed. The optimal reconstructive methods for partial and total pharyngeal reconstruction are as follows: 1) primary closure for defects not exceeding one third of the circumference of the pharynx; 2) pectoralis myocutaneous flap repair for pharyngeal defects with loss of up to 70% of the circumference of the pharynx; 3) gastric pull-up with pharyngogastrostomy for defects exceeding 70% of the circumference of the pharynx; 4) gastric pull-up for all pharyngoesophageal defects where the lower margin of resection is below the tracheostome; and 5) reversed pectoralis myocutaneous flap with split thickness skin graft on the muscle for secondary closure of the pharyngostome.

Colon↗
PubMedDate not supplied

CIS-Dichlorodiammineplatinum(II) in the treatment of epidermoid carcinoma of the head and neck.

Twenty-six patients with far-advanced epidermoid carcinoma of the head and neck were treated with cis-dichlorodiammineplatinum(II) (DDP) in high doses, utilizing the technique of concurrent mannitol-induced diuresis. All 26 patients had received prior radical radiotherapy to local disease, 14 had had major ablative surgical procedures, and all but five had been previously treated with chemotherapy. Responses were as follows (duration in months): two complete (2+, 6+), six partial (1, 2, 3, 4, 5+, 8+), ten minor (all but one less than 1.5), and eight no change or progression. Responses were seen in primary tumors, neck nodes, and pulmonary metastases. Nausea and vomiting were seen consistently in all patients but were never dose-limiting. Myelosuppression was mild, with only three patients developing platelet counts less than 50,000/mm3 and no patient with a wbc count less than 2000/mm3. Transient elevations of serum creatinine were common but no patient developed peak levels greater than 2 mg/dl. Transient tinnitus was also common although only four patients developed clinically significant hearing loss during the trial and DDP could be definitely implicated in only one instance. DDP in this dose and schedule is thus effective and safe therapy in a very heavily pretreated group of patients with advanced head and neck cancer and is now being used in combination with other agents in the initial treatment of these patients.

Aged↗