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Biomedical subjects

N J Cassisi

Publications and source records attributed to N J Cassisi.

At least 73 records · Page 4Linked to original sources
PubMed1988

Hyperfractionation for head and neck cancer.

Between March 1978 and April 1984, 144 patients with 148 moderately advanced to advanced primary squamous cell carcinomas of the head and neck received treatment with curative intent with twice-a-day irradiation (120 cGy/fraction, 4-6 hour interfraction interval). Eighty-eight percent of the patients had AJCC Stage III-IV cancers. One hundred and thirty-two patients received irradiation alone to the primary site with or without radical neck dissection, with surgery reserved for salvage. The total doses administered were 7440-7920 cGy in the majority of instances. In 19 patients with oropharyngeal lesions, a 1000-1500 cGy radium needle boost was added after the basic dose. Twelve patients received preoperative irradiation (5040-6000 cGy) followed by primary resection and radical neck dissection. Local control results following irradiation alone to total doses of greater than 7000 cGy with minimum 2-year follow-up were 25/31 (81%), 38/50 (76%), and 5/25 (20%) for T2, T3, and T4 cancers, respectively. Local control rates did not correlate well with total dose. Local control following preoperative irradiation plus primary resection was obtained in 4 of 5 T3 and 2 of 3 T4 primary lesions. The 5-year actuarial rates of neck control were 100% for N0 (45 patients), 90% for N1 (25 patients), 77% for N2 (23 patients), 50% for N3A (9 patients), and 70% for N3B (42 patients). The 5-year actuarial rates of continuous disease control above the clavicles were 73% for Stage III, 64% for Stage IVA, and 32% for Stage IVB. The actuarial 4-year rate of continuous disease control above the clavicles was 78% for Stage II. For patients whose disease was controlled above the clavicles, distant metastases developed in 4% of patients with Stage II-III disease and in 18% of patients with Stage IV disease. Radiation complications following irradiation alone to the primary site correlated with total dose. Complications of planned neck dissection(s) were acceptable. Complications of salvage surgery at the primary site were similar to those seen in patients treated once a day. The actuarial 5-year survival rates, according to modified AJCC stage, were 59% for Stage III, 37% for Stage IVA, and 23% for Stage IVB. The actuarial 4-year survival rate for Stage II was 69%. Compared to historical control groups treated with once-a-day, continuous-course irradiation at our institution, twice-a-day treatment has produced local control results that are higher by 10-15 percentage points.

Adult↗
PubMed1988

The use of radiation therapy in the management of minor salivary gland tumors.

Between 1964 and 1985, 52 patients were treated with curative intent by radiation therapy alone or in combination with surgery for malignant tumors of minor salivary gland origin. All patients had a minimum follow-up of 2 years, and 80% had a minimum follow-up of 5 years. Twenty-six (50%) were adenoid cystic carcinomas; the remaining histologies included adenocarcinoma, mucoepidermoid carcinoma, and malignant mixed tumors. The most common sites of origin were in the oral cavity/oropharynx (49%) and the nasal cavity or paranasal sinuses (40%). Twenty-seven patients (52%) presented with an advanced or unresectable stage (AJCC Stage III or IV, extensive bone or nerve invasion, or tumor greater than 5 cm). Treatment was highly individualized; 50% of the patients received radiation therapy alone, and 50% received combined treatment with either postoperative or preoperative radiation therapy. Early-stage minor salivary gland tumors were controlled equally well with radiation therapy alone or with a combined approach. For the advanced tumors, a combined approach yielded significantly superior absolute local control rates as compared with radiation therapy alone (10/13 vs. 2/13). For adenoid cystic carcinoma, the local control rate at 10 years was 45% (actuarial); the tumor was not controlled locally in any patients with advanced/unresectable stage who were treated with radiation therapy alone. The absolute local control rate was 75% for 4 early-stage tumors treated with radiation therapy alone and 60% for 5 advanced tumors treated with a combined approach. The average time to local recurrence was 67 months for adenoid cystic carcinoma. Severe complications of radiation therapy occurred in 11 (27%) of 40 evaluable patients, with unilateral blindness being the most common. Seven of 9 patients who became blind had unresectable disease with close proximity to or invasion of the orbit. A time-dose analysis is also presented.

Actuarial Analysis↗
PubMed1988

Squamous cell carcinoma of the head and neck treated with radiation therapy: the impact of neck stage on local control.

There have been several recent reports in the literature to indicate that the risk of failure at the primary site following radiation therapy is greater in patients with a clinically positive neck as opposed to those with a clinically negative neck at diagnosis. This is an analysis of 526 patients with squamous cell carcinoma of the head and neck who were treated with irradiation alone to the primary lesion with curative intent. All patients had follow-up for at least 2 years and were evaluable for analysis of local control. For each site and T stage, no evidence was found to indicate that the primary lesions were controlled less often in patients whose necks were clinically positive than in those whose necks were clinically negative.

Carcinoma, Squamous Cell↗
PubMed1988

Treatment results for simultaneous primary squamous cell carcinomas of the head and neck.

Forty patients with simultaneous multiple primaries of the head and neck were treated with curative intent between June 1964 and April 1983. The primary sites were treated with radiation therapy alone or in combination with surgery. Surgery was used to salvage local failures of radiation treatment. Neck disease was treated with radiation therapy alone or with neck dissection added after completion of radiation therapy to the primary lesions. Minimum follow-up was 2 years with a range of 2 to 20 years. For the 32 patients whose primary tumors were treated with radiation alone, the 2-year local control rates for the 53 individual tumors evaluated were as follows: T1, 18/21; T2, 16/23; and T3-T4, 1/9. In the T3-T4 group, there was only one successful surgical salvage. Local control rates for disease at all primary sites in each patient according to highest T-stage were as follows: T1, 4/5; T2, 9/15; and T3-T4, 1/9. Eight patients whose primary tumors were treated with radiation and surgery are discussed. The absolute disease-free survival rate at 2 years for 40 patients was 42%. Complications of treatment are described.

Carcinoma, Squamous Cell↗
PubMed1988

Carcinoma of the cervical esophagus treated with radiation therapy.

This is an analysis of 34 patients with carcinoma of the cervical esophagus treated with radiation therapy with curative intent at the University of Florida between September 1966 and May 1985. All patients have a minimum 2-year follow-up and 28 (82%) have at least 5 years of follow-up. Patients were staged according to the recommendations of the AJCC. Patients who died within 2 years of treatment with the primary site continuously disease-free were excluded from the local control analysis; all patients were included in the analysis of complications and survival. Irradiation resulted in control of the primary lesion in 1 of 2 patients who presented with T1 lesions, in 4 of the 12 patients with T2 lesions, and 3 of 17 patients who presented with T3 lesions. One patient with a T3 lesion that recurred locally was successfully salvaged by an operation. The 5-year absolute survival rates by stage were as follows: no patients with stage I lesions survived; of 11 stage II patients, one survived; and of 16 stage III patients, three survived. Interestingly, all four of the 5-year survivors were women.

Adenocarcinoma↗
PubMed1987

Time-dose relationships for local tumor control and complications following irradiation of squamous cell carcinoma of the base of tongue.

Between October 1964 and September 1981, 114 previously untreated patients with squamous cell carcinoma of the base of the tongue were treated with curative intent by a radical course of irradiation at the University of Florida. With a minimum 2-year follow-up, local control was achieved in 78, 65, 76, and 17% of T1, T2, T3, and T4 lesions, respectively. Control results could be correlated with time-dose factors and treatment techniques. No patient required mandibulectomy for osteoradionecrosis following radiation therapy. Complications of bone and soft tissue could not be related to time-dose factors.

Bone and Bones↗
PubMed1987

Squamous cell carcinoma of the supraglottic larynx treated with surgery and/or radiation therapy.

This is an analysis of 195 patients with squamous cell carcinoma of the supraglottic larynx treated with curative intent at the University of Florida between October 1964 and February 1984. The patients were staged according to the AJCC staging system. There was a minimum follow-up of 2 years, with 76% having at least a 5-year follow-up. Patients were treated with preoperative irradiation and resection (28), surgery and postoperative irradiation (35), surgery alone (26), or radiation therapy alone, with or without neck dissection(s) (106). This paper will compare the rate of local-regional control, the incidence of complications, voice preservation, and survival for radical irradiation, as opposed to surgery, with or without adjuvant irradiation.

Carcinoma, Squamous Cell↗
PubMed1987

Squamous cell carcinoma of the tonsillar area treated with radical irradiation.

This is an analysis of 136 patients treated with radiation therapy alone (104) or in conjunction with planned neck dissection (32) for squamous cell carcinoma of the tonsillar area between October 1964 and August 1983. All patients have a 2-year follow-up and 94 (69%) have a minimum 5-year follow-up. Patients were excluded from analysis of disease control at the primary site and/or neck if they died within 2 years of treatment with that site continuously disease-free. All patients were treated with continuous-course irradiation; those treated with the planned split-course technique are not included. Once-a-day fractionation was used in 105 patients and twice-a-day fractionation in 31 patients. External beam alone was used in 93 patients, and external beam followed by a radium needle implant boost to the primary site was employed in 43 patients. Rates of initial local control with irradiation and ultimate local control after surgical salvage of irradiation failures are as follows: T1, 10/12 (83%) and 12/12; T2, 36/46 (78%) and 41/46 (89%); T3, 28/39 (72%) and 28/39 (72%); T4, 5/16 (31%) and 5/16 (31%). Local control data are also presented as a function of tumor site within the tonsillar area, total dose, dose per fraction, and external beam alone versus external beam plus radium needle implant. The 5-year determinate survival rates by modified AJCC stage are as follows: I, 3/3; II, 13/14; III, 14/17; IVA, 6/14; and IVB, 4/19.

Carcinoma, Squamous Cell↗
PubMed1987

Carcinoma of the soft palate treated with irradiation: analysis of results and complications.

This is an analysis of 75 patients with squamous cell carcinoma of the soft palate and/or uvula treated with radical radiation therapy alone (64) or in conjunction with planned neck dissection (11) between October 1964 and September 1983. All patients have a minimum follow-up of 2 years and 60 (80%) have a minimum follow-up of 5 years. Patients were excluded from analysis of disease control at the primary site and/or neck if they died within 2 years of treatment with the site(s) continuously disease free. The initial local control rates and ultimate local control rates after surgical salvage of irradiation failures for patients treated with continuous-course irradiation were as follows: T1, 8/8 (100%) and 8/8 (100%); T2, 14/19 (74%) and 16/19 (84%); T3, 5/11 (45%) and 5/11 (45%); and T4, 1/4 (25%) and 1/4 (25%). Overall, 7/55 patients (13%) treated with continuous-course irradiation experienced irradiation-related bone or soft tissue complications; there was only one severe complication. The 5-year determinate survival rates by modified AJCC stage for patients treated with continuous-course irradiation are as follows: I, 83%; II, 78%; III, 38%; IVA, 0/2; and IVB, 25%.

Aged↗
PubMed1987

Squamous cell carcinoma of the pyriform sinus treated with radical radiation therapy.

This is an analysis of 54 patients with squamous cell carcinoma of the pyriform sinus treated with radical irradiation at the University of Florida between October 1964 and March 1984. There is a 2-year minimum follow-up on all patients and 85% have at least 5 years of follow-up. Patients were excluded from analysis of disease control at the primary site, neck, and/or above the clavicles if they died less than 2 years from treatment with the site(s) continuously disease-free. All patients were included in the analysis of complications and survival. The rates of local control following initial treatment with irradiation and the ultimate local control rates, including surgical salvage of irradiation failures, were as follows: T1, 8/9 and 8/9; T2, 15/20 (75%) and 18/20 (90%); T3, 2/5 and 3/5; and T4, 0/4 and 0/4. The 5-year determinate survival rates as a function of modified AJCC stage were I, 1/1; II, 3/3; III, 5/8; IVA, 7/12; and IVB, 2/8.

Carcinoma, Squamous Cell↗
PubMed1987

Carcinoma of the nasal vestibule treated with radiation therapy.

Twenty-two patients with squamous carcinoma of the nasal vestibule were treated at the University of Florida Division of Radiation Therapy with curative intent. Fifteen lesions were de novo and seven recurrent after surgery. By AJCC classification, 7 lesions were Tx or T1, 2 were T2, 2 were T3, and 11 were T4. Management of the primary tumor and regional lymphatic drainage was highly individualized. Local control was achieved in 19 out of 22 lesions. The ultimate regional lymph node control rate was 22 out of 22, although two patients required radical neck dissection after development of lymph node disease in untreated regional lymphatics. Two patients have died of cancer and three of intercurrent disease. Cosmetic results are generally excellent but may be compromised by previous surgery in recurrent lesions or tumor destruction of normal tissues in advanced lesions. Complications of treatment are minimal.

Carcinoma, Squamous Cell↗
PubMed1987

Postoperative radiation of open head and neck wounds.

Complication rates are lower using postoperative radiation therapy and cure rates at least compatible to preoperative radiation therapy. However, one of the concerns with postoperative radiation treatment is the possibility of delay in beginning the treatment because of an unhealed surgical wound. A delay of more than 6 weeks is detrimental. In order to study the effect of radiation therapy on incompletely healed wounds, a retrospective chart review of such cases during the period 1977 to 1984 was undertaken. One hundred and eighty-five patients had planned postoperative radiation therapy, and 13 of these began radiation therapy with an unhealed wound or fistula. Six of 10 wounds closed spontaneously, 4 required surgical closure, and 3 failed to heal. Seven patients in this study died with cancer, 2 died of other causes, 3 are alive without disease, and 1 patient remains alive with disease. We conclude that giving radiation therapy to an open wound with appropriate precaution can be done without serious complications.

Adult↗
PubMed1986

Chemodectoma of the carotid body and ganglion nodosum treated with radiation therapy.

A total of six chemodectomas of the carotid body or ganglion nodosum in four patients were treated with radiation therapy. The purpose of this paper is to present the results of treatment in these patients. One patient experienced complete regression of her bilateral carotid body tumors over the ensuing 2.5 years and the other 3 patients have had no evidence of disease progression of their chemodectomas for 2, 3, and 4.5 years, respectively.

Carotid Body Tumor↗
PubMed1986

Squamous cell carcinoma of the head and neck treated with radiation therapy: the role of neck dissection for clinically positive neck nodes.

This is an analysis of 161 patients with squamous cell carcinoma of the head and neck treated with irradiation to the primary site and neck followed by a neck dissection(s) for clinically positive neck nodes. Patients were treated between October 1964 and December 1982; there was a minimum 2-year follow-up. Fifty-two patients were deleted from analysis of neck disease control because they died of intercurrent disease or cancer less than 2 years from treatment with the neck continuously disease-free. All patients are included in the analysis of complications. Neck disease control rate was the same for radiation plus neck dissection or radiation therapy alone for solitary nodes less than 3 cm. As the size and number of nodes increased, there was a higher rate of neck disease control for combined treatment as compared with irradiation alone. The neck disease control rate, size for size, was lower for patients with fixed nodes and for those with residual tumor in the pathologic specimen. There was no difference in neck disease control as a function of the interval between irradiation and neck dissection. For nodes less than or equal to 6 cm, a minimum node dose of 5000 rad appeared to be sufficient for control, whereas for nodes greater than 6 cm, at least 6000 rad appeared to be required for optimal control. Fixed nodes required a higher dose compared to mobile masses. The incidence of postoperative complications was increased with maximum subcutaneous doses of greater than or equal to 6000 rad. There was also an increased incidence of postoperative complications for patients undergoing simultaneous, as compared with staged, bilateral neck dissection.

Carcinoma, Squamous Cell↗
PubMed1986

A rare manifestation of metastatic adenocarcinoma.

We report a very rare case of adenocarcinoma metastatic to the epiglottis and cervical lymph nodes that presented clinically with symptoms of dysphagia. The method of diagnosis, including recent advances in the evaluation of head and neck metastases, is discussed.

Adenocarcinoma↗
PubMed1985

Twice-a-day irradiation technique for squamous cell carcinomas of the head and neck.

A twice-a-day treatment schedule has been used to manage 57 patients with moderately advanced and advanced squamous cell carcinomas of the head and neck between March 1978 and July 1981. Fifty patients received radiation therapy alone to the primary site with neck dissection added in 13; seven received preoperative irradiation followed by resection of the primary lesion and clinically positive lymph nodes. A dose of 120 rad was delivered twice daily to the primary site and upper neck nodes with a 4- to 6-hour interval. The dose from external beam was usually 7440 to 7680 rad for irradiation alone to the primary site. An interstitial implant boost of 1000 to 1500 rad was added in four patients. When at least 7440 was used, 2 of 3 and 11 of 13 T3 lesions were locally controlled with a 2- to 5-year follow-up. T4 lesions were initially treated with 7440 rad, but only one of ten lesions was controlled; the dose was then increased to 7680 to 8100 rad, with or without an implant, and three of eight T4 lesions were controlled. The acute effects were tolerable, and similar to those seen with once-a-day treatments. There has been one possible severe complication of irradiation and two severe complications of salvage operations. The late normal tissue effects of radiation are probably reduced, but the number of patients observed for 4 and 5 years is limited. Determinate survival free of disease at 2 years for the entire group is 47%. The 2-year determinate disease-free survival for Stage III was 86% (6/7), for Stage IVA, 63% (12/19), and for Stage IVB, 22% (5/23).

Brachytherapy↗
PubMed1985

Parotid area lymph node metastases from carcinoma of the skin.

From January 1966 through April 1980, 38 patients with squamous cell carcinoma and one patient with basal cell carcinoma of the skin with lymphatic metastases to the parotid area were treated with curative intent at the University of Florida. Fourteen were initially treated with surgery, nine inoperable patients were treated primarily with radiation therapy, and 16 were treated with planned combined therapy, i.e., superficial or total parotidectomies with preoperative or postoperative radiation therapy. The ultimate parotid area control rate for the group treated with radiation alone was 50%; there were no failures at doses above 6500 rad. The parotid area control rate was 88% in the combined-treatment group with no failures when the surgical margins of resection were free; however, when gross residual disease was left behind, only 4 of 6 lesions were controlled. In the surgery-alone group, the ultimate parotid area and neck control rate was only 15%. The major sequela from combined therapy was sacrifice of the seventh nerve at surgery. Treatment methods are discussed.

Aged↗