Search PubMed⌕ Search

Biomedical subjects

M S Strong

Publications and source records attributed to M S Strong.

At least 19 recordsLinked to original sources
PubMed1991

Larynx preservation using induction chemotherapy plus radiation therapy as an alternative to laryngectomy in advanced head and neck cancer. A long-term follow-up report.

Since 1977, we have used induction chemotherapy (CT) plus radiation therapy (RT) with curative intent in 35 advanced head and neck cancer (Ca) patients who otherwise would have required total laryngectomy. Fourteen patients had advanced Ca of the larynx or supraglottic larynx (SGL); 21 patients had Ca of the hypopharynx. In six patients the Ca was Stage III; in 26 patients it was Stage IV. Three patients had Stage II disease--2 with cancer of the pyriform sinus and one patient with Stage II SGL Ca who refused surgery. Chemotherapy consisted of platinum (P) + bleomycin in 18 patients until 1982, then P + fluorouracil in the next 17 patients. Total response rate was 77%--complete (CR) in 26% and partial (PR) in 51%. There were two toxic deaths. Surgery was limited to tracheostomy in 4 patients prior to CT and to radical neck dissection after CT in 4 others. Two patients required salvage laryngectomy at 11 and 31 months, respectively. One patient underwent partial laryngectomy with voice preservation. Thirty-two patients were evaluable for overall response after RT. Final disease-free status was achieved in 20/34. One long-term survivor was lost to follow-up (44 months) and 8 patients remained alive at 13+ to 109+ months. Median failure-free survival for all patients was no less than 24 months. Not counting 4 early deaths free of disease, 2-year local control using only chemotherapy plus radiation was 52% (16:31). Overall, 33 of 35 patients retained their voices. Sixteen patients (46%) have survived 2 years or longer. Survival of patients who achieved CR after induction chemotherapy was 48 months versus 14 months for those with less than a CR (p = 0.001). Patients with a hypopharyngeal primary had only a 33% 2-year local control rate with chemotherapy and radiation and a median survival of only 12 months versus 77% control and a minimum 39-month survival for those whose tumor arose in the larynx (p = 0.009). Induction chemotherapy plus radiation therapy is an effective strategy which can produce a high rate of larynx preservation, local control, and long-term survival in patients with advanced cancer of the larynx. Patients with hypopharyngeal primaries have a lesser rate of long-term survival and local control, despite similar overall response rates.

Aged↗
PubMed1985

Plasma exchange in six patients with advanced cancers of the head and neck.

Six patients with advanced squamous cell cancers of the head and neck, with serum IgA greater than or equal to 400 mg/dl and IgE less than or equal to 1000 IU/ml, underwent a trial of six 2-liter plasma exchanges over a 2-3-week period. Disease progressed in patients 1, 2, and 4, who died on days 44, 72, and 159. The tumor in patients 3 and 6 regressed significantly, repeatedly in patient 3 over each of four courses of apheresis. Tumor recurred in both patients after cessation of treatment, and they died at days 420 and 79. Patient 5, with inoperable disease, received full-dose radiotherapy immediately following the course of apheresis, and showed complete response in the primary lesion and a major response in the extensive lymph node metastases, dying on day 421 of apparently unrelated causes. Serum IgE in the three patients experiencing tumor regression rose paradoxically during plasmapheresis. Only patient 3 had an elevated level of soluble E-receptor suppressor factor prepheresis; the serum of patient 6 was lymphocytotoxic prepheresis but this activity decreased or disappeared during each of the exchanges studied. Controlled trials are now indicated.

Aged↗
PubMed1984

The incidence of hypercalcemia in squamous cell carcinoma of the head and neck.

Hypercalcemia is a well-recognized phenomenon in squamous cell carcinoma of the head and neck, but the incidence of hypercalcemia in this group of patients is not clear. We have reviewed the records of 166 patients with squamous cell carcinoma of the head and neck presented at the Boston VA Medical Center over a 2-year period (October 1981 to September 1983). Hypercalcemia (greater than 11 mg/dl), for which a benign etiology could not be identified, occurred in the clinical course of seven patients (4.2%). Of the hypercalcemic patients, 5/7 (71.4%) had advanced stage IV disease and serum calcium levels ranging from 11.2 to 15 mg/dl at presentation. The incidence of hypercalcemia in this stage IV group was 5/78 (6.4%). On the basis of concomitant serum alkaline phosphatase, x-ray films, and radionuclide bone scans in these patients, bone metastases or a humoral factor were felt to be the etiologic agent. Six of the seven patients died within 77 days of the onset of the hypercalcemia despite vigorous antihypercalcemic and chemotherapeutic measures, and the remaining patient is under chemotherapy at present. We conclude that hypercalcemia is a late manifestation of advanced squamous cell carcinoma of the head and neck and is an ominous prognostic sign. Hypercalcemia without bone metastases is presumably due to the production of ectopic parathormone (PTH)-like substances from the tumor. To control this hypercalcemia, the underlying tumor must be treated vigorously in conjunction with symptomatic treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

Induction bleomycin infusion in head and neck cancer.

Twenty-one male patients with previously untreated advanced squamous cell carcinoma of the head and neck were treated with an induction regimen of bleomycin 15 mg/m2 I.V. bolus followed by a continuous 24-hour I.V. infusion at a dose of 15 mg/m2/day for 7 days. One week following induction therapy, patients were reevaluated for response and then received definitive therapy with surgery and/or radiation therapy. The chemotherapy yielded a major response rate of 33% (one CR, six PR). Toxic manifestations of this regimen were mild, consisting of fever, alopecia, rash, and mucositis. There was no pulmonary toxicity detected. The response rate obtained with bleomycin infusion is inferior to the combination of cis-platinum with a bleomycin infusion as induction therapy in previously untreated patients with squamous cell carcinoma of the head and neck.

Adult↗
PubMed1984

Argon laser and soft tissue interaction.

The interaction of the argon laser with the mucous membrane of the upper aerodigestive tract was studied. The advantages of the argon laser are a small spot that can be varied in size and intensity, selective vascular absorption, the capability of being incorporated into a flexible delivery system, and a coincident aiming beam. The acute soft tissue effects are characterized by subepithelial extension, with a variable delayed reaction between the application of the laser and a detectable break in the epithelium. Postoperative edema persisted, with an increase in the lateral spread of the lesion over 3 days and an acute inflammatory reaction extending over 7 days. By 21 days the lesions were reepithelialized and healed, but their width was 30% greater than the original defect. The unpredictable interaction with soft tissue, the postoperative edema, and the quality of wound healing are disadvantages. The argon laser appears to have limited clinical potential as a surgical tool for the air and food passages.

Animals↗
PubMed1984

Complications of CO2 laser surgery of the aerodigestive tract: experience of 4416 cases.

The CO2 laser was first introduced for surgery of the aerodigestive tract in 1971. Since that time, great advances in application have been made in both the adult and pediatric population. Recent reports of isolated complications have appeared in the literature. However, a realistic complication rate in a large series of patients has yet to be reported. This report relates the combined experience of the authors in a total of 4416 cases during the 11-year period from 1971 to 1982. There were nine instances of complications, representing a complication rate of 0.2%. These complications provided a unique learning experience for the authors, and led to the establishment of certain basic principles that should be followed in all laser operations. This survey indicates that the CO2 laser is a safe, extremely useful surgical modality in the aerodigestive tract.

Adolescent↗
PubMed1984

Excisional biopsy in the selective management of T1 glottic cancer: a three-year follow-up study.

Transoral excisional biopsy has been used in the evaluation and management of 103 T1 glottic cancers. A 3-year follow-up on these patients indicates that excisional biopsy unequivocally established the diagnosis and stage of the disease and that it is adequate treatment for micro and mini squamous cell cancers of the glottis in which the margins of excision are clear. Excisional biopsy with positive margins and larger T1 tumors establishes the absolute need for radiotherapy. Excisional biopsy is ideal for the diagnosis and management of verrucous carcinoma and spindle cell carcinoma. Recurrent/residual squamous cell carcinoma after radiotherapy should be explored by excisional biopsy which may be curative or will establish the need for partial or total laryngectomy. The appropriate use of excisional biopsy in the selective management of early T1 glottic cancers requires attention to detail by the surgeon and the pathologist and sound clinical judgment.

Biopsy↗
PubMed1984

Medical management of organic laryngeal disorders.

Medical management of organic laryngeal disorders always involves evaluation and advice; it frequently includes reassurance and sometimes voice therapy. Occasionally medication is also necessary.

Combined Modality Therapy↗
PubMed1984

Field cancerization in the aerodigestive tract--its etiology, manifestation, and significance.

Field cancerization of the mucous membranes of the aerodigestive tract frequently develops in response to tobacco and alcohol usage; it is characterized by a variety of premalignant and frankly malignant epithelial changes that may lead to the development of multiple primary cancers of the aerodigestive tract. Field cancerization can be demonstrated by supravital staining with toluidine blue or by electron microscopic study of random biopsies taken from apparently normal mucosa. Field cancerization should be taken into account in treatment planning of a patient with cancer so that all treatment options, including the use of radiation therapy, be kept open for as long as possible in the event that the patient may develop multiple primary tumors.

Alcoholism↗
PubMed1983

Transoral partial supraglottic resection using the CO2 laser.

Transoral epiglottis resection or partial supraglottic resection was done with the CO2 laser in 20 highly selected patients. Visualization was best accomplished using the Lynch suspension system, but was satisfactory with the Jako-Pilling laryngoscope. The best indications for this procedure were: 1. for visualization of the true vocal cords in previously treated cancer patients whose epiglottis obstructed indirect mirror examination, 2. for removal of obstructing benign epiglottic lesions, 3. as an excisional biopsy in limited epiglottic cancer, especially of the suprahyoid epiglottis. No major complications or operative morbidity occurred. This approach obviated the potential morbidity of external surgical procedures In a select group of patients. Shortened hospitalization, avoidance of tracheotomy, minimal postoperative discomfort and edema, and excellent wound healing were additional advantages seen.

Adult↗
PubMed1983

Natural history and management of keratosis, atypia, carcinoma-in situ, and microinvasive cancer of the larynx.

Keratosis, atypia, carcinoma in situ, and microinvasive cancer occurring as white or red patches on the vocal cords are part of the diathesis of cancer of the aerodigestive tract and represented a sequential continuum. Excisional biopsy is the preferred treatment for identification and potential cure of the lesion. If the margins of excision are inadequate, further treatment options are either reexcision or radiotherapy. Radiotherapy should be used only when the need for voice conservation prevails. Cessation of smoking does not remove the potential for progression of the disease, therefore, all patients must be followed indefinitely. Excisional biopsy of keratosis, carcinoma in situ, and microinvasive cancer of the larynx offers an excellent prognosis for voice preservation and survival.

Adult↗
PubMed1983

Continuous vindesine infusion in advanced head and neck cancer.

Sixteen patients with advanced squamous cell carcinoma of the head and neck were treated with a 48-hour I.V. vindesine infusion. The dosage was 3 mg/m2/48 hours every 2 weeks. Toxicity consisted of leukopenia, paresthesias, and phlebitis. Major objective responses were seen in four patients (one CR, three PR), with a median duration of 4 months.

Aged↗
PubMed1983

Predictive factors of cricoid ring size in adults in relation to acquired subglottic stenosis.

Subglottic stenosis secondary to endotracheal intubation is a distinct clinical entity. Prolonged intubation is an important causative factor, but even short-term endotracheal intubation with too large a tube can damage the cricoid sufficient to cause delayed subglottic stenosis. After studying cricoid size and other factors in 130 adult laryngectomy and autopsy specimens, the following conclusions were reached: (1) The subglottic cricoid is the smallest, fixed cross section in the upper airway. (2) Even if height is comparable, women have smaller cricoid diameters than men. (3) Height is the best predictor of cricoid size. (4) Weight and race are not accurate predictors. (5) Third finger length and cricoid size correlate well, particularly in men. (6) Thus height and third finger length can be used to choose the proper endotracheal tube for adults.

Adult↗
PubMed1983

Palliation of airway obstruction from tracheobronchial malignancy: use of the CO2 laser bronchoscope.

A CO2 laser rigid bronchoscope system has been used to palliate symptoms of a malignancy obstructing the tracheobronchial airway. Fifty-nine endoscopic laser operations (34 patients) were done between 1975 and 1981. Severe dyspnea and obstructive atelectasis were the most common indications for treatment. Contraindications for treatment included extrinsic tracheobronchial compression, widespread distant metastases, rapidly progressing tumors, and highly vascular neoplasms. There were nine primary tracheal malignancies, five metastases from distant sites, and 20 primary lung cancers with tracheobronchial obstructions. Most patients were previously treated with one or more standard modalities (radiation therapy, surgery, and chemotherapy). Removal of airway obstruction was occasionally indicated prior to radiation therapy to facilitate treatment. There were seven instances of complications in this group of patients and one mortality. Most patients (23 of 34) have died from their malignancy. The best palliation was achieved in proximal (tracheal and main stem bronchial), slower growing tumors.

Aged↗
PubMed1983

Surgical lasers and soft tissue interactions.

The different physical and biological qualities of the carbon dioxide, argon, and neodymium-YAG lasers provide the otolaryngologist and head and neck surgeon with a surgical tool with specific qualities and applications. The specific wave lengths of laser energy produce a varied soft tissue action. The carbon dioxide laser energy is absorbed by all biological tissues, whereas argon laser energy is an effective photocoagulator and penetrates into the subepithelial plane; the Nd-YAG laser creates a coagulation effect, which penetrates deep into the tissues. Each laser has specific physical qualities. The argon laser and the Nd-YAG laser can be transmitted through a flexible fiberoptic delivery system, whereas the carbon dioxide laser currently requires a rigid optical delivery system. The Nd-YAG and carbon dioxide lasers both require a second coincident aiming beam because of the invisibility of their laser energy, whereas the argon laser does not have such a requirement. The spot size of the laser beam can be much smaller for the argon laser than for the carbon dioxide laser. Protective lenses are necessary for the argon, carbon dioxide, and Nd-YAG lasers. The carbon dioxide laser energy is not transmitted through glass; thus most media (glass, plastic) are suitable to prevent any ocular injury. The argon laser requires a special yellowish protective mechanism, and the Nd-YAG laser requires a green protective lens mechanism. With further technical advances and improvements in the fiberoptic delivery system, smaller laser spot sizes, and changes in operating laser modes and color specifications of lasers, the advantages of laser surgery over conventional surgical techniques will become increasingly more apparent.

Aluminum↗