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Biomedical subjects

R H Spiro

Publications and source records attributed to R H Spiro.

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

The role of parotidectomy in the treatment of cutaneous head and neck melanoma.

Sixty-five patients with melanoma underwent parotidectomy as part of the initial treatment. Clinical evaluation of the parotid nodal status was inaccurate. Patients with parotid nodal metastases had a significantly decreased survival at 5 years, 22 percent compared with 67 percent in the patients with uninvolved nodes. Distant metastasis was the first indication of treatment failure in most of the patients with parotid involvement.

Adolescent↗
PubMed1988

New strategies for avoiding total laryngectomy in patients with head and neck cancer.

Cisplatin-based chemotherapy has yielded high response rates in patients with head and neck cancer but has failed to improve the survival rates in randomized studies. Thus, its place in the management of head and neck cancer remains unclear. We have been investigating whether the combination of chemotherapy and radical irradiation as an alternative to morbid surgery in selected patients might yield an improved quality of life without compromising survival. Between January 1983 and December 1985, we treated 32 patients with epidermoid carcinoma arising from the larynx, base of the tongue, or hypopharynx, using an interdisciplinary regimen, with the objective of avoiding total laryngectomy. All of these patients had large primary tumors that could not have been removed without total laryngectomy. Patients who could be treated by conservation laryngeal surgery were excluded, as were patients who presented with clearly unresectable disease. The regimen employed cisplatin-based chemotherapy together with brachytherapy and external radiation therapy, with highly individualized treatment planning. Seven patients had T2 lesions, 19 had T3, and 6 had T4. The follow-up periods ranged from 8 to 38 months (median, 18). The actuarial survival rate at 2 years is 85%, and the laryngectomy-free rate at 2 years is also 85%. None of the 11 patients with laryngeal cancer has relapsed, and none has required laryngectomy. None of the 12 patients with base of the tongue cancer treated by brachytherapy has relapsed above the clavicles and none has required laryngectomy, but 1 patient has died of complications of treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

A pilot study of cisplatin-vinblastine as the initial treatment of advanced head and neck cancer.

Twenty patients with Stage IV and five patients with Stage III carcinoma of the head and neck were treated with the combination of cisplatin and vinblastine before locoregional therapy. Among 24 patients evaluable for response after chemotherapy, there were four complete responders and 16 partial responders for an overall major response rate of 83%. No complete responses were observed in patients with T4 primary lesions or N3a nodal disease. Toxicity was limited primarily to nausea and vomiting (76%) and myelosuppression (72%). Four patients, all treated at the higher vinblastine dose, required hospitalization for fever associated with neutropenia. Two patients had a transient increase in the serum creatinine clearance to greater than 3 mg/dl. The combination of high-dose cisplatin and frequent vinblastine has significant activity in locally advanced squamous cell carcinoma of the head and neck, has mild and reversible toxicity, and does not require prolonged hospitalizations for continuous intravenous infusions.

Adult↗
PubMed1986

Predictive value of tumor thickness in squamous carcinoma confined to the tongue and floor of the mouth.

In this review of 105 consecutive patients who underwent operation for previously untreated, N0 squamous carcinomas arising in the oral tongue or the floor of the mouth, 86 percent of the determinate patients remained alive and well 2 years after treatment. Included were 48 patients, 49 patients, and 8 patients who had T1, T2, and T3 tumors respectively. Elective cervical lymphadenectomy was performed in about a third, but tumor staging did not facilitate selection of those who were most likely to have occult metastases. For this reason, we retrospectively assessed the impact of tumor thickness using an optical micrometer to measure the thickness in millimeters of the excised tumors in routinely prepared paraffin sections. Disease-related death appears to be unusual when oral tumors are thin (2 mm or less), regardless of the tumor stage. Multivariate analysis confirms that increasing tumor thickness, rather than tumor stage, had the best correlation with treatment failure and survival. These findings need to be verified in prospective studies involving a larger patient population and other head and neck sites, but they strongly suggest that measurement of tumor thickness may be a better way to select those oral cancer patients who are most likely to benefit from elective treatment of the N0 neck.

Carcinoma, Squamous Cell↗
PubMed1986

Difficult decisions in parotid surgery.

Six atypical case presentations of parotid tumors are presented along with solutions proposed by two experts on the topic. The differences and similarities of the opinions expressed are summarized and discussed by the editor.

Adenoma↗
PubMed1985

Identical laryngeal cancers in two non-twin sibling pairs: case reports and a review of the literature.

The occurrence of identical laryngeal cancers in two nontwin sibling pairs is reported for the first time. To understand the relative importance of genetic and environmental factors in the etiology of laryngeal cancer, the evidence in the literature for the development of identical cancers in genetically unrelated and related pairs sharing the same environments was examined.

Alcohol Drinking↗
PubMed1985

Mandibulotomy approach to oropharyngeal tumors.

We have reviewed our experience with 120 selected patients who had pharyngeal tumors resected through a median mandibulotomy approach with paralingual extension (mandibular swing). Clinical findings, technique, and complications are discussed. Results were gratifying in terms of salvage, patient appearance, and function. We believe that this surgical approach, in combination with postoperative radiotherapy when appropriate, offers an attractive alternative to high dose radiotherapy alone in patients with oropharyngeal carcinoma.

Combined Modality Therapy↗
PubMed1985

Intraoperative radiotherapy in patients with recurrent head and neck cancer.

Patients with head and neck cancer who have a relapse of the disease above the clavicles can sometimes be salvaged by additional surgery. However, if all gross tumor cannot be removed during surgery or if the resection margins are unsatisfactory, the likelihood of salvage is remote, especially when postoperative radiotherapy is not feasible due to previous radiotherapy. Between 1979 and 1983, we employed intraoperative brachytherapy for 21 such patients. Sixteen patients had a recurrence after previous surgery and radiotherapy, and 5 after radical radiotherapy. All gross tumor could not be removed in 15 patients, whereas satisfactory margins could not be obtained in 6. In 11 patients, we delivered radiotherapy by a temporary implant of iridium-192 (median dose 4,800 rads in 6 days). In 10 patients, radiotherapy was delivered by a permanent implant of iodine-125 (median activity 13 mCi). Three patients (14 percent) had a relapse within the surgical field, whereas six others (28 percent) had a relapse elsewhere or had development of metastases. Complications developed in four patients (19 percent) and were fatal in one patient. The actuarial disease-free survival rate at 2 years was 55 percent, whereas the rate of local disease control was 81 percent. Our experience suggests that intraoperative brachytherapy can salvage certain high-risk patients with head and neck cancer.

Adult↗
PubMed1985

The management of salivary neoplasms: an overview.

From 1939 through 1973, 2,807 patients with salivary gland tumors received definitive treatment at the Memorial Sloan Kettering Cancer Center. This included 1,965 patients (70%) with parotid gland lesions, 244 patients (8%) with neoplasms in the submandibular gland, and 607 patients (22%) with tumors which arose in the predominantly mucus secreting glands (minor salivary) which line the upper aerodigestive tract. The proportion with malignant tumors was 25, 43, and 82% in the parotid, submandibular and minor salivary glands, respectively; benign tumors occurred more often in women. Mucoepidermoid, acinic cell and most adenocarcinomas were subdivided according to histologic grade and all patients were retrospectively staged according to criteria established by the American Joint Committee on Cancer Staging. Treatment was almost exclusively surgical and the extent of the operation performed depended on the extent of the tumor rather than its histology. In patients with malignant parotid tumors, the facial nerve was sacrificed only if it was adherent to or directly involved by the tumor. Lymphadenectomy was usually reserved for those patients who had palpable metastases. Prolonged follow-up (10 years minimum in this study) is necessary in order to appreciate the slow growth of some salivary neoplasms. Results depended upon the complex interplay between the site of origin, the clinical stage, and the histologic appearance of the tumors. This study antedates our current interest in postoperative radiation therapy, but other reports suggest that combination therapy enhances local control.

Adolescent↗
PubMed1984

Changing trends in the management of squamous carcinoma of the tongue.

An analysis of 412 patients with primary squamous carcinoma of the tongue seen from 1969 through 1978 reveals that the age and clinical stage of patients with tongue cancer have remained constant when compared with previous reports from our hospital. The proportion of female patients has increased, and we are seeing more patients with tumors located in the base of the tongue. Treatment methods are changing. Mandible-sparing procedures were used more often, and significantly more patients received primary and adjuvant radiotherapy in the early study period. At the same time, there were fewer composite neck, tongue, and jaw resections and fewer laryngectomies, although more patients had elective treatment of the neck. The overall determinate cure rate has not changed since the 1957 through 1963 period. Age, sex, and adjuvant radiotherapy did not seem to affect survival. When patients with oral tongue primary lesions were compared with those with tumors in the base of the tongue, the prognosis seemed to be better in those with oral primary lesions when the patient had stage I or II disease. Finally, patients with tongue cancer have at least a 1 in 5 chance of development of a second aerodigestive tract malignancy and require lifelong scrutiny. Although current therapy results in lower morbidity, the proportions of patients with stage III and IV tumors remain high, and the cure rates remain disappointingly stable.

Adult↗
PubMed1984

Squamous carcinoma of the floor of the mouth.

We reviewed our experience with 320 patients treated for squamous cell carcinoma of the floor of the mouth from 1964 through 1977. The patients were evenly distributed according to clinical stage. Treatment consisted of surgery (77 percent of patients), surgery and adjunctive radiation therapy (19 percent of patients), or radiation therapy only (4 percent of patients). Most of the patients with favorable (T1) primary tumors had a simple peroral excision (78 percent) with marginal mandibulectomy when indicated (22 percent). Marginal mandibulectomy was still possible in many patients with T2 or T3 lesions (56 percent). Synchronous or metachronous second primary cancers were documented in 33 percent of the patients, most of which occurred in the head and neck region. Seventeen percent of the patients who had elective neck dissection had microscopic metastasis. More than a third of the patients with clinically positive nodes had negative neck specimens histologically. In patients with histologically positive nodes, 60 percent had involvement at multiple levels. The 5 year determinate cure for the entire group was 65 percent. According to stage, 88, 80, 66 and 32 percent of patients with stages I, II, III, and IV disease, respectively, were alive and well 5 years after treatment. This seems to be a significant improvement when compared with the last report from our hospital.

Adult↗
PubMed1984

Carcinoma of the cervical esophagus: changing therapeutic trends.

Carcinoma of the cervical esophagus is a lethal tumor because of its advanced stage at the time of diagnosis. The records of 71 patients with this disease treated at Memorial Sloan-Kettering Cancer Center from 1965 through 1980 have been reviewed herein. Epidermoid carcinoma was the prevailing histologic finding, and extramural penetration was present in 77 percent of the evaluable patients. Tracheal invasion and vocal cord paralysis were noted in 35 and 24 percent of the patients, respectively and were predictive of significantly decreased survival. Primary radiotherapy in doses greater than 5,000 rads produced short lived responses in 13 of 21 patients (62 percent). Surgery was performed in 45 patients (63 percent), including 35 esophagectomies for cure and palliative procedures in the 10 other patients. There were five operative deaths (11 percent), but only two followed esophageal resection (5.6 percent). Locoregional treatment failure, present in 46 of 52 evaluable patients (88 percent) at last follow-up, continues to be a major problem. Overall, the 5 year survival rate was 9.6 percent. The longest survival and best palliation was achieved with aggressive resection and immediate reconstruction using the transposed stomach (gastric pullup).

Adult↗
PubMed1984

Radiation therapy in adenoid-cystic carcinoma.

Between 1949 and 1977, 74 patients with adenoid-cystic carcinoma of various head and neck sites were treated by radiation therapy at Memorial Sloan-Kettering Cancer Center. Radiation therapy alone was employed in 49 patients for recurrent, unresectable disease, and in 25 patients it was given as an adjunct to surgical resection. Among the 49 patients treated with radiation therapy alone, tumor regression was seen in 47 (96%). However, 44 of the 47 (93.5%) subsequently relapsed locally. Relapse occurred within 18 months in one-half of the patients and within 5 years in all of them. Of the 25 patients who received adjunctive radiation therapy about one-half relapsed locally within five years. There were 9 patients in this group, however, whose field size exceeded 8 X 8 cm and the dose of radiation also exceeded 4500 rad: 88% of these patients remained relapse-free at 5 years, compared with only 22% of the other 16 whose dose, or field size, or both, were inadequate by comparison. These data suggest that when irradiation is employed for advanced, inoperable adenoid-cystic carcinoma, it offers useful palliation but is rarely, if ever, curative. Postoperative irradiation, on the other hand, might improve the local control and the survival in patients with operable adenoid-cystic carcinoma who are at high risk for relapse, but only if the field size and the dose are adequate.

Adult↗
PubMed1983

Cervical node metastasis of occult origin.

This study reviewed a 12 year experience with 132 patients who were treated for metastatic carcinoma of the cervical lymph nodes with no apparent primary tumor. Using radical neck dissection as the main treatment modality, a 5 year survival of 50 percent was achieved in 79 patients with epidermoid carcinoma. Survival varied significantly depending on the extent of the tumor in the neck. It was 74 percent in those with stage N1 disease compared with 41 percent in patients with N2 or N3 disease. Recurrence in the neck, the major reason for treatment failure, can probably be reduced by more aggressive use of adjunctive radiotherapy. Primary tumors were identified after therapy in only 15 percent of these patients, and this appeared to have relatively little impact on the outcome. Irradiation and chemotherapy were the preferred treatment modalities in 29 patients with metastatic adenocarcinoma of occult origin. All but one patient died within 29 months. A 53 percent 5 year survival was achieved in 13 patients with anaplastic or undifferentiated carcinoma. Radical neck dissection was employed in 11 patients with melanoma. No primary tumor was ever identified in this group and only one patient remained alive and well after 5 years.

Adenocarcinoma↗
PubMed1983

Gastric transposition in head and neck surgery. Indications, complications, and expectations.

From 1973 through 1982 a total of 63 of our patients had their upper alimentary tracts reconstructed after major ablative neck operations by transposition of the mobilized stomach into the neck through the bed of the resected esophagus. This gastric pull-up procedure was performed without thoracotomy using two surgical teams for resection of locally extensive primary tumors arising in the hypopharynx, cervical esophagus, and thyroid gland. Morbidity and mortality were significant but acceptable. Relatively few patients were cured, but excellent palliation was often achieved. In our experience, use of the transposed stomach for restoration of alimentary continuity after cervical esophagectomy or circumferential pharyngectomy offered greater reliability and versatility than other available methods.

Adenocarcinoma↗
PubMed1983

Complications after laryngectomy.

The charts of 100 consecutive patients who underwent laryngectomy at Memorial Hospital were reviewed to assess those factors that contribute to postoperative complications. Laryngectomy was performed for epidermoid carcinoma in 94 patients and for laryngeal incompetence in 6. Total laryngectomy was performed in 48 patients and partial and circumferential pharyngectomies in addition to laryngectomy in 40 and 12 patients, respectively. Significant complications, which delayed discharge, occurred in 13 patients (27 percent) who had simple laryngectomy, including the formation of two fistulas (4 percent). After laryngopharyngectomy, the complication rate was 77 percent (40 of 52 patients) with pharyngocutaneous fistulas in 19 patients (37 percent). The fistula rate of formation was not increased in irradiated patients; however, the duration of time to closure of a pharyngocutaneous fistula, if it occurred, was longer. Planned pharyngostomy or staged deltopectoral flap reconstruction after extended laryngopharyngectomy was associated with excessive morbidity. Newer techniques of reconstruction utilizing flaps or gastric transposition offer the prospect of reduced morbidity after laryngopharyngectomy.

Carcinoma, Squamous Cell↗
PubMed1983

Laryngeal transposition flap for reconstruction of large oral cavity defects.

Resection of the entire tongue and floor of the mouth, with or without the anterior mandibular arch, may necessitate sacrifice of the larynx to prevent life-threatening aspiration and poses a significant reconstructive dilemma. Regional cutaneous or myocutaneous flaps can provide adequate healthy tissue for repair, but share the inherent disadvantage of resurfacing the oral cavity with skin (which may be hair bearing), rather than mucosa. Moreover, cutaneous flaps usually necessitate a planned orocutaneous fistula and secondary closure, and bulky myocutaneous flaps may interfere with oral competence. Larynx transposition has been used for some time at Memorial Sloan-Kettering Cancer Center to repair selected large oral cavity defects resulting from resection of the entire tongue and floor of the mouth. This report illustrates the laryngeal transposition flap which is developed from the skeletonized, laryngofissured larynx based on the superior laryngeal arteriovenous pedicle. The advantages and disadvantages of this technique, as compared with alternative methods of reconstruction, are discussed.

Humans↗