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Biomedical subjects

H J Shaw

Publications and source records attributed to H J Shaw.

At least 55 records · Page 3Linked to original sources
PubMed1984

Treatment of advanced squamous cell carcinomas of the head and neck with initial combination chemotherapy prior to surgery and/or radiotherapy: five-year survival data.

One hundred and thirty-nine patients with advanced head and neck cancer were treated with a combination of vincristine, bleomycin, methotrexate with a folinic acid rescue, 5-fluorouracil and hydrocortisone given over 24 hours, as initial therapy on days one and 14 prior to conventional local therapy on day 28. One hundred and thirty-six patients were assessed for chemotherapy response on day 28. Ninety-one patients (67 per cent) had an objective response and 45 (33 per cent) were classed as non-responders, although 13 had a minimal (20-30 per cent) response. The complete remission rate following local therapy was significantly greater in chemotherapy responders (76 per cent) than in nonresponders (54 per cent) p less than 0.05. Toxicity was minimal, provided standard medical precautions were observed, and 87 patients (63 per cent) reported no side-effects. There was 100 per cent patient compliance. Sex or histological grade did not significantly influence response to chemotherapy. Oral cavity or nasopharyngeal tumours responded better than other sites (p less than 0.05). Patients under 49 were more likely to respond to chemotherapy than older patients (p less than 0.01). Survival data are available for a mean follow-up time of 48 months (range 12-78 months). Chemotherapy responders have a longer median survival than non-responders, 33 versus 20 months (p less than 0.05). Patients who achieve a complete remission after local therapy live significantly longer than those with residual disease, median durations of survival being 52.4 and 7.8 months respectively (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

Cancer of the paranasal sinuses and nasal cavities. Part II. Results of treatment.

Part I of this account of a large consecutive series of 561 patients with cancer of the paranasal sinuses and nasal cavities treated at the Royal Marsden Hospital reveals some significant clinical and radiological features. The histopathology of every case has been carefully reviewed by one pathologist. Carcinoma was found to account for almost 80 per cent of tumours. An account is given of treatment methods in present use. End-results are reported in Part II of the paper and demonstrate that patients with sinus cancer receiving combined treatment in one centre have a better prognosis than when it is given in two or more hospitals. The discussion also concentrates on the use of main treatment methods and emphasizes some advances in surgical techniques. The value of initial cytotoxic chemotherapy is unproven but may offer some further advantage in prognosis. Precise comparison with the results of other series is not possible owing to lack of agreement on classification, variable case selection and differing treatment techniques.

Combined Modality Therapy↗
PubMed1984

24-hour combination chemotherapy without cisplatin in patients with recurrent or metastatic head and neck cancer.

Sixty-three patients with advanced histologically proven squamous cell carcinomas of the head and neck, considered untreatable other than by chemotherapy, received a combination of vincristine, bleomycin, methotrexate, 5-fluorouracil, and hydrocortisone administered over 24 hours, followed by a folinic acid rescue, every 3 weeks. Fifty-seven patients had received prior radiotherapy and 78% of recurrences were within the radiation field. Sixty-one patients were assessable for response to chemotherapy and 25 (41%) achieved objective responses. Side effects from 167 courses of chemotherapy were minimal and were present only in 38% of patients. There were no cases of bone marrow depression and no drug-induced deaths. Patient compliance was 98%. Chemotherapy responders had a longer median duration of survival of 11.9 months (with four patients still alive at 10, 22, 30, and 90 months) compared with 4.96 months for nonresponders (with two patients alive at 7 and 15 months), p less than 0.001. Ten of 24 chemotherapy responders went on to surgery and eight achieved a complete remission (CR), while only 6/36 nonresponders underwent salvage surgery and all became disease-free. Patients achieving a complete remission had improved survival (median 24.5 months). The presence of metastatic disease was a poor prognostic sign; only 8/30 (27%) responded to chemotherapy and none subsequently achieved complete remission. This safe drug protocol appears to benefit only a small subset of patients, namely those who respond to chemotherapy rendering their tumors operable, but is of no general value in this group of previously irradiated patients since 92% of all patients treated were dead at 2 years.

Actuarial Analysis↗
PubMed1984

Radioiodine treatment of metastatic thyroid carcinoma: the Royal Marsden Hospital experience.

The case records of 235 patients who were treated for differentiated thyroid cancer between 1949 and 1981 were reviewed. Forty-two (18%) had distant metastatic spread outside the neck and received radioiodine (131I) therapy. In cases where the distant spread was confined to the lungs, 54% of patients were alive, free of disease, 10 years after 131I treatment was started. By contrast, no patient with skeletal involvement has survived for 10 years and only one for five years after treatment. A variety of cytotoxic drugs has been tried on an ad hoc basis with no notable success. One patient developed preleukaemia three months after completion of 131I treatment, but no other serious side effects were observed. Factors that influence the behaviour of metastatic thyroid carcinoma are discussed and a possible revised approach to 131I therapy is suggested in the light of these findings.

Adenocarcinoma↗
PubMed1983

Patterns and mechanisms of bone invasion by squamous carcinomas of the head and neck.

Patterns and mechanisms of local bone invasion by squamous carcinomas of the head and neck have been investigated. Detailed surgical pathology has shown that these tumors invade contiguous skeletal or metaplastic bone principally through an indirect process; the normal bone resorbing cells of the host (osteoclasts) are activated and erode bone in front of the advancing tumor edge. Tumor cells take over the destructive process when the osteoclast response has waned. These morphologic patterns have been reproduced in an in vitro model where calcium-45-labelled mouse calvaria, cocultured with a tumor for 3 days, are resorbed by osteoclasts. Freshly excised tumors, established tumor cell lines, and tumor xenografts release osteolysins in vitro which act as osteoclastic stimulants. They include both prostaglandins E2 and F2 alpha, and nonprostaglandin factors, and are derived from tumor cells and from the associated host stroma. Virtually all the tumors examined released osteolysins and resorbed bone in vitro independent of their site, size, degree of differentiation, and the presence or absence of clinical bone invasion.

Bone Neoplasms↗
PubMed1983

Synovial sarcoma of the pharynx and oesophagus.

Two patients with synovial sarcomas of the pharynx and oesophagus respectively are reported and their clinical features are described. These tumours in the head and neck rarely metastasize to lymph nodes and their management is discussed.

Aged↗
PubMed1982

Colon transposition in the management of upper gastrointestinal cancer.

Restoration of swallowing after the resection of malignant disease in the upper gastrointestinal tract, including the pharynx, remains a surgical challenge. Recontructive techniques using a viscus are reviewed and 40 consecutive cases treated at the Royal Marsden Hospital (1965-1980) by colon transposition are reported. The major indication for this procedure was postradiation relapse of pharyngolaryngeal cancer requiring pharyngolaryngectomy. In 60% of the cases, a long-segment colon transposition was carried out through a retrosternal tunnel. The presternal subcutaneous route was used in one third of the cases and the posterior mediastinum in 7%. The 30-day operative mortality was 20% overall, but in recent years it was lowered to 7%. The major complications were cervical fistula (25%) and bronchopneumonia (20%), which frequently occurred together in patients who had undergone prior radiation therapy. Colon necrosis occurred in two cases. The functional outcome was satisfactory, with good results in 78%. Late structures due to marginal arteritis were observed if further radiation therapy was used in the cervical region. Where follow-up data was available, the mean survival was 36 months (range, 2-180; median 18 months) and the three-year survival rate was 32%. Colon transposition must remain an alternative to gastric transposition and is a durable esophageal substitute for long-term palliation.

Adult↗
PubMed1982

Greater omentum used for carotid cover after pharyngolaryngoesophagectomy and gastric 'pull-up' or colonic 'swing'.

An excellent method of rehabilitation for swallowing after total pharyngolaryngoesophagectomy is the reconstruction of the pharyngoesophagus with an autogenous visceral transplant. The most popular and reliable methods are the gastric "pull-up" and colonic "swing." A complication of this procedure--which can result in morbidity as well as mortality--is carotid artery rupture, especially when a neck dissection is performed. This is usually the result of wound breakdown secondary to adjunctive use of radiotherapy. When we have performed a radical neck dissection in conjunction with a visceral transplantation, we have used pedicled omentum as a live, durable cover for the carotid artery. ?

Carotid Artery Diseases↗
PubMed1982

Results and prognostic factors in salvage surgery for squamous carcinomas of the tongue.

Fifty-six patients who had undergone salvage surgery for residual or recurrent squamous carcinomas of the tongue between 1967 and 1977 were reviewed. Failure to obtain operative clearance led to certain local recurrence. The tongue or cervical lymph nodes were involved in 27 of the 28 patients who died with recurrent tumour. The overall age-corrected actuarial postoperative survival was 45.1 per cent at 2 years and 35.3 per cent at 5 years. Survival was reduced in women and patients aged over 60 years at operation, and in patients whose tumors were at first biopsy moderately or poorly differentiated, classified as stage III or IV at initial presentation or preoperatively, or recurred within 6 months of completing primary treatment.

Actuarial Analysis↗
PubMed1982

Rehabilitation after major head and neck surgery--the patients' view.

Forty-nine patients who were free of tumour 5 months to 14 years (mean 30 months) after total laryngectomy or a commando procedure were given questionnaires designed to obtain the patient's assessment of their resulting disability. Sixteen areas of disability were studied grouped under five main headings: speech, eating, cosmetic, employment and social. Following laryngectomy more than half of the patients achieved successful communication by oesophageal speech. Success in this was usually associated with minimal problems in other areas. The disabilities after commando procedures were more varied and complex. More patients reported severe disability in more than one area. Difficulties with chewing and swallowing were prominent. The results are illustrated with patients' comments. Ways in which rehabilitation might be improved are considered.

Adult↗
PubMed1981

The vascular anatomy of the pectoralis major myocutaneous flap.

The vascular anatomy of the pectoralis major muscle and overlying skin and subcutaneous tissue was investigated in seventeen cadaver specimens by cannulation of the arterial supply and injection of contrast medium. A rich anastomosis between the internal mammary artery and the pectoral branch of the thoraco-acromial artery and between the pectoral branch and the lateral thoracic artery was demonstrated. In 36% of cases a major axial cutaneous vessel, originating close to the thoraco-acromial artery, was shown to extend caudad. The lateral thoracic artery, in addition to the pectoral branch, contributed significantly to the vascularity of the pectoralis major muscle and was the main blood supply to the female breast. The skin overlying the muscle was abundantly supplied from the muscle vasculature. Both the major arteries were enclosed within the muscle's fascial envelope. A technique for developing a standard pectoralis major myocutaneous island flap is described. Our studies show that a hemichest flap incorporating all the skin of the chest over the muscle is feasible.

Arteries↗
PubMed1980

Direct bone invasion in squamous carcinomas of the head and neck: pathological and clinical implications.

Direct bone invasion by tumour--an uncommon event at most sites--has been demonstrated in 18 out of 150 consecutive major surgical specimens from patients with squamous carcinomas of the head and neck. Intra-oral carcinomas invading the jaw(s) comprise the single commonest group. The tumour gains access to bone by direct spread or along perineural spaces: infiltration of periosteal lymphatics was rare. The morphological phases of bone invasion are described, the main feature being bone destruction by osteoclasts in front of the advancing tumour; tumour cells do not directly impinge on the bone surface until the late stages of invasion. Osteoblastic activity is less marked. Evidence that osteoclasts are directly stimulated by local tumour is discussed. The clinical implications relate to the possible uses of scintigraphy and the need to ensure adequate bone resections in operable lesions: the tumours sometimes infiltrate laterally beneath apparently intact bone cortex (cf. submucosal spread), and the normal tissue planes at the bone-soft tissue interface are usually distorted by previous radiotherapy.

Adult↗
PubMed1980

The irradiated radical neck dissection in squamous carcinoma: a clinico-pathological study.

A preliminary clinico-pathological survey is presented of radical neck dissections from 50 patients with advanced (T3, T4) squamous carcinomas of the head and neck, previously treated by irradiation and combination chemotherapy. The total yield of lymph nodes (1411) from these dissections was high--mean of 28 nodes/dissection, range 8-60; the proportion of nodes containing metastatic carcinoma was low--100 (7%)--with only 1 or 2 nodal masses/dissection in most instances. The involved nodes tended to be concentrated in 1 or 2 anatomical groups, principally in the upper anterior neck, with apparent sparing of nodes in the posterior triangle. There was a high incidence (88%) of transcapsular spread. Keratin granulomas, with or without intact metastatic carcinoma, were commonly found; on occasions they formed large masses simulating nodal metastases. The morphological patterns in uninvolved lymph nodes were shown to be of no prognostic significance. Initial data on postoperative follow-up indicated a crude survival of 52% (24 patients) at 30 months. Most deaths (80%) occurred within 12 months of major surgery; the majority (72%) died with residual malignant disease; and uncontrolled primary tumour, particularly in the oral cavity and oropharynx, was found more frequently than metastatic disease in the neck or elsewhere. Clinical implications are discussed with reference to the use of modified radical neck dissection in the surgical salvage of this poor-risk group of previously irradiated patients.

Adult↗