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R H Spiro

Publications and source records attributed to R H Spiro.

At least 91 records · Page 5Linked to original sources
PubMed1982

Adenocarcinoma of salivary origin. Clinicopathologic study of 204 patients.

We have reviewed a 30 year experience with 204 patients treated for adenocarcinomas of salivary origin. Seventy-one percent had histologically typical adenocarcinomas, whereas 12 percent had papillary, 12 percent mucinous, and 5 percent other unusual variants. Despite these morphologic differences, almost all of the lesions could be classified into one of three histologic grades. The tumors arose most often in the minor salivary glands (138 patients, 68 percent) and the less common variants of adenocarcinoma usually involved the oral cavity, nasal cavity, or paranasal sinuses. High-grade tumors were more often high stage at the time of diagnosis. Treatment almost always consisted of surgical resection which was tailored according to the site and extent of the lesion. Five, 10, and 15 year cure rates were 41, 34, and 28 percent, respectively, and salvage was determined by the grade and stage of the tumor rather than by the extent of the surgery. Local recurrence of this most lethal of salivary tumors exceeded 50 percent. Postoperative teletherapy is probably indicated in most patients if survival rates are to increase, but the role of systemic chemotherapy remains to be defined.

Adenocarcinoma↗
PubMed1980

Carcinoma of the cheek mucosa. A retrospective analysis.

A 16 year experience with 121 patients treated for squamous cell carcinoma arising in the cheek mucosa is described. Treatment was almost exclusively surgical, and 5 year determinate cure rates ranged from 77 and 65 percent in stage I and II lesions to 27 and 18 percent in those with stage III and IV lesions, respectively. Twenty-four percent of previously treated patients remained alive and well at 5 years. The 42 percent overall salvage rate was low, reflecting the high proportion of patients who developed cervical metastasis during the course of the disease. In an attempt to improve local control, we now advocate irradiation of the primary tumor and neck after aggressive resection with radical neck dissection in any patient who has clinical evidence of nodal involvement or other unfavorable findings.

Adult↗
PubMed1980

Elective postoperative radiation therapy in stages III and IV epidermoid carcinoma of the head and neck.

One hundred five patients with advanced (American Joint Committee stages III and IV) but resectable epidermoid carcinoma of the head and neck were treated with radical surgery and elective postoperative radiation therapy. Follow-up periods range from 16 to 66 months. Nineteen patients (18 percent) have had recurrence in the head and neck area. This is better than our past experience with surgical treatment alone in advanced head and neck cancer, in which 50 to 75 percent of patients had local recurrence within the 1st 18 months. When radiation therapy was started no later than 6 weeks after surgery, only 3 of 54 patients (5.5 percent) had local recurrence, but when there was a longer delay 16 of 51 patients (31.5 percent) had recurrence. These results suggest that elective postoperative radiation therapy improves local control in patients with advanced head and neck cancer, but that it should be delivered soon after surgery for maximum effectiveness.

Carcinoma, Squamous Cell↗
PubMed1979

Spindle and giant cell carcinoma of the thyroid: report of a five-year survival after lobectomy and postoperative irradiation.

We have described a patient who remains alive and well five years after lobectomy and planned postoperative irradiation for a sizable spindle and giant cell carcinoma arising in the right thyroid lobe which was adherent to the trachea and the esophagus. The dismal experience of others with this highly lethal tumor has been reviewed. A trial of surgical resection and full-dose postoperative teletherapy seems warranted in selected patients who have a resectable tumor.

Aged↗
PubMed1979

Tumors arising in accessory parotid tissue.

A summary is presented of our experience with 23 patients who had accessory parotid tumors, comprising 1% of all primary parotid neoplasms seen during a 40 year period. Although more than half of the tumors proved malignant, adequate excision was usually curative. We prefer to approach these tumors through an extended cheek-flap incision. Once the lesion is exposed, either local excision or resection in conjunction with subtotal parotidectomy can be performed, depending on the clinical findings.

Adult↗
PubMed1979

Adenoid cystic carcinoma: factors influencing survival.

We have reviewed our experience with 264 patients treated for adenoid cystic carcinoma of salivary origin. This study updates a previous report from our hospital and includes all patients treated during a 30 year period who were eligible for a minimum follow-up of 10 years. The tumor arose in minor salivary (mucous) glands in two thirds of the patients; half had received treatment elsewhere, and both sexes were equally represented. Actuarial survival curves and "cure" rates calculated by the direct method confirm that clinical staging provides a reliable prognostic guide. We are unable to demonstrate that the microscopic appearance of the tumor exerts a predictable effect on treatment results. Although some patients lived for many years after resection despite local recurrence and distant metastases, prolonged survival was unusual in patients with stage 3 lesions, particularly in those with sinus or submaxillary gland primaries. Based on the site of origin of the tumor and its clinical stage, it is now possible to select which patients with adenoid cystic carcinoma have the most ominous prognosis and perhaps plan a more appropriate operation. More importantly, these data may help focus on the subpopulation at greatest risk, which is vital to the design of any prospective study to assess the value of adjunctive irradiation and chemotherapy.

Adult↗
PubMed1979

Pharyngolaryngectomy, total extrathoracic esophagectomy and gastric transposition.

Total pharyngolaryngectomy, extrathoracic esophagectomy and immediate reconstruction using transposed stomach were performed without operative mortality in 16 patients using a two team approach. The intact transposed stomach appears to be a highly reliable esophageal substitute. Significant palliation was achieved since all were able to swallow by mouth until their death. Results in terms of survival were disappointing but, possibly, may be improved by better patient selection and the judicious use of adjuvant chemotherapy and radiation.

Adult↗
PubMed1978

Combination therapy of advanced head and neck cancer: induction of remissions with diamminedichloroplatinum (II), bleomycin and radiation therapy.

Patients with unresectable, previously untreated head and neck cancer were given cis-diamminedichloroplatinum (II) (DDP), 3 mg/kg, with mannitol diuresis (day 1), followed by a continuous infusion of bleomycin, 0.25 mg/kg/day, days 3 through 10, after an initial loading dose of 0.25 mg/kg by rapid IV injection on day 3. The DDP was repeated on day 22, following which radiotherapy was delivered using standard doses, fractionations and portals. Patients were evaluated for response on day 22 and again at the conclusion of radiotherapy. Of 21 patients evaluable at day 22, there were four CR and 11 PR (greater than 50% reduction of all measureable disease), for a major response rate of 71%. Of five MR, four showed 30-60% reduction at the primary site. Of 16 who have finished the radiation phase of treatment, there are six CR, five PR and one MR with durations four to eight months. Toxicity in 33 patients included vomiting (33), alopecia (33), WBC less than 3000 (five), platelets less than 100,000 (one), dose-limiting mucositis during bleomycin (six) and peak serum creatinine greater than 2 (five), with one fatality. The regimen thus appears promising as initial therapy for the previously untreated patient. The same chemotherapy has produced much less encouraging results in prviously treated patients.

Adult↗
PubMed1978

Acinic cell carcinoma of salivary origin. A clinicopathologic study of 67 cases.

This study reviews a 30 year experience with acinic cell carcinoma. The tumor arose in the parotid gland in 64 patients, the submaxillary gland in one and minor salivary glands in two. In untreated patients with small tumors, clinical findings usually suggested a benign mixed tumor and a subtotal parotidectomy which spared the facial nerve was highly effective therapy. In contrast, local recurrence and death was the rule in those few who had locally extensive disease, regardless of how radical an operation was performed. Determine "cure" rates for the entire group were 76, 63 and 55% at 5, 10 and 15 years, respectively. Cervical lymph node metastasis occurred in 16% of the patients, and distant metastasis in 12%. Survival was most directly influenced by the clinical extent of the primary tumor, and also correlated with certain histologic features which are described.

Adolescent↗
PubMed1978

Mucoepidermoid carcinoma of salivary gland origin. A clinicopathologic study of 367 cases.

A thirty year experience with 367 patients who had mucoepidermoid carcinoma of salivary origin is reviewed. The tumor arose in the parotid gland in 254 patients. The presentation and clinical course depended significantly on whether the tumor was low, intermediate, or high grade in histologic appearance. Metastasis and tumor-related death were occasionally noted in patients with low grade lesions, suggesting that even the most innocuous-appearing mucoepidermoid tumor has malignant potential. Significant correlation was demonstrated between the clinical stage of a tumor and its histologic appearance. Stage I tumors were usually of low histologic grade and were effectively controlled by conservative surgical procedures. Radical operations were often ineffective in patients with stage III tumors, most of which proved to be of high histologic grade. Considering the poor prognosis in the latter patients, adjunctive therapy in the form of postoperative external radiation seems indicated. In our experience, "cure" rates in patients who had intermediate or high grade lesions varied widely, depending upon the stage of the tumor. This strongly suggests that therapeutic decisions should not be based on histologic appearance alone.

Adolescent↗
PubMed1977

Malignant mixed tumor of salivary origin: a clinicopathologic study of 146 cases.

A 30-year Memorial Hospital experience with 146 patients with malignant mixed tumor is reviewed. These comprised 5% of 2,743 patients who were treated for salivary neoplasms from 1939 through 1968. The tumors arose in the parotid gland in 108 patients, submaxillary gland in 23 patients, mucus or so-called minor salivary glands in 16 patients, and sublingual gland in one. In terms of our total experience, 11% of all submaxillary tumors proved to be of the malignant mixed variety as compared to 6% of parotid tumors and 3% of minor salivary tumors, respectively. Seventy-one patients (48%) had previously received therapy elsewhere. Results of treatment are presented and the factors which influenced the results are discussed.

Adenocarcinoma↗
PubMed1977

Chemotherapy of head and neck cancer: combination treatment with cyclophosphamide, adriamycin, methotrexate, and bleomycin.

A combination of cyclophosphamide, adriamycin, methotrexate, and bleomycin (CAMB) was explored in patients with advanced, nonresectable epidermoid carcinoma from primary sites in the head and neck, recurrent or persistent after radiation or surgery. Objective regression (greater than 50%) of measurable tumor was present in 35% of the patients. The median duration of response was 2.5 months. Median survival of responders was slightly less than the nonresponders, but the difference was not significant. Drug-related morbidity was substantial; leukopenia, mucositis, and weight loss were the most frequent major side effects. Three deaths were attributable to the regimen. The results seem comparable to those one might expect from methotrexate alone.

Adult↗
PubMed1976

Carcinoma of the hypopharynx.

The data in this study suggest that radical surgical treatment offers the best chance for control of disease in patients with cancer of the hypopharynx. The cervical lymph nodes are at a very high risk for early involvement by metastatic disease. Elective treatment of cervical lymph nodes must be considered in initial treatment planning to obtain better control of regional disease.

Adult↗
PubMed1976

Tumors of the submaxillary gland.

This study reviews a thirty year experience with 217 patients who had a tumor of the submaxillary gland, comprising about 9 per cent of all patients with salivary neoplasms seen during the same period. Most of the tumors were malignant (56 per cent), with adenoid cystic carcinoma predominating, but the histologic type most frequently encountered was benign mixed tumor (43 per cent). Median age was fifty-four years in patients with malignant tumors compared with forty-six years in those with benign tumors, and 58 per cent were women. Asymptomatic swelling was the usual presenting complaint, and the clinical findings are summarized using a staging system recently proposed for patients with parotid tumors. Cervical lymph node metastasis occurred in at least 50 per cent of patients who had an adenocarcinoma or epidermoid, mucoepidermoid, or anaplastic carcinoma. Treatment was surgical and complete gland excision proved adequate in those with benign tumors. Radical neck dissection was performed in conjunction with submaxillary resection in most patients with malignant lesions, but radical en bloc resection was reserved for those few who had extensive or fixed disease. Net determinate "cure" rates at five and ten years (30 and 20 per cent, respectively) are distressingly low and compare unfavorably with those previously reported in patients treated for carcinoma of the parotid. The high local recurrence rate and the greater incidence in the submaxillary gland of more aggressive tumor types which metastasize readily suggest that current treatment should be more radical. It seems reasonable to expect that results might be improved if en bloc resections were more often performed in patients with less advanced disease, possibly in conjuction with intensive postoperative irradiation in selected cases.

Adenocarcinoma↗