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R S Weber

Publications and source records attributed to R S Weber.

At least 55 records · Page 3Linked to original sources
PubMed1995

Laryngeal preservation for advanced laryngeal and hypopharyngeal cancers.

OBJECTIVE: To compare a single institutional experience with combination chemotherapy and radiation for laryngeal preservation with historical age-, sex-, stage-, and site-matched controls who underwent laryngectomy for cancer of the larynx or hypopharynx. DESIGN: Fifty-five patients with stage III or IV laryngeal and hypopharyngeal squamous carcinoma were prospectively entered into a protocol to receive three cycles of cisplatin (+/- bleomycin sulfate) and fluorouracil and radiation therapy from 1986 to 1991 (group 1). Following two cycles of chemotherapy, the clinical tumor response was assessed and responders received a third cycle of chemotherapy followed by definitive radiation therapy. Nonresponders underwent surgical salvage. Two patients in the surgical control group were matched to each protocol patient (n = 110, group 2) regarding site, stage, sex, and age (+/- 7 years) without knowledge of patient outcome. SETTING: A tertiary cancer referral center, The University of Texas M. D. Anderson Cancer Center, Houston. RESULTS: Following chemotherapy, the tumor response rate for group 1 was complete in 38% and partial in 31%. With a median follow-up of 24 months (group 1) and 37 months (group 2), the Kaplan-Meier 2-year disease-specific survival for group 1 and 2 was 63% and 74%, respectively (P = .251). Among group 1 patients, 67% retained their larynges. Local recurrences were more frequent among the laryngeal preservation group (P = .001), whereas distant metastasis was more frequent among controls (P = .35). Thirty-three percent (18/55) of group 1 patients required total laryngectomy. Examining these subsets of patients showed that of the 67% (n = 37) of patients who retained their larynges, their 2-year survival was 56%, not significantly different from their respective controls (n = 74), 71%. Additionally, 2-year survival among the 18 group 1 patients who required salvage laryngectomy was 75% as compared with 80% for their matched controls (n = 36). CONCLUSIONS: These results document the results of chemotherapy and radiation therapy in the treatment of patients with advanced laryngeal and hypopharyngeal cancers in preserving the larynx. Although local control is significantly compromised among these patients, there is no compromise in overall survival when combined with prompt surgical salvage.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1995

Split-thickness skin graft donor site management. A randomized prospective trial comparing a hydrophilic polyurethane absorbent foam dressing with a petrolatum gauze dressing.

OBJECTIVE: Traditionally, skin graft donor sites have been covered with fine-mesh gauze dressings, and a dry eschar has been allowed to form. Newer dressings that can provide a moist wound environment may facilitate reepithelialization. We compared a hydrophilic semipermeable absorbent polyurethane foam dressing that provides a moist wound environment with a petrolatum gauze dressing for donor sites. DESIGN: Prospective randomized trial; follow-up at 14 days. SETTING: Department of head and neck surgery in a tertiary care center. PATIENTS: Sixty-eight eligible patients received one of the two dressings. Harvested skin grafts were 0.375-mm (0.015-in) thick; donor site surface areas were recorded. At postoperative day 14, the dressings were removed, and wound epithelialization was scored: 1, none; 2, scattered or spotty; and 3, complete. Donor site and operative site pain intensities were assessed by a visual numeric scale: none (0) to the worst (100) experienced over the preceding 24-hour period. Pain scores were available for 58 patients. MAIN OUTCOME MEASURES: Dressings were compared based on these criteria: healing at 14 days, infection, and donor site and operative site pain. RESULTS: A healing score of 3 was seen in 37% (14/38) of patients with hydrophilic semipermeable absorbent polyurethane foam dressings and in 17% (5/30) of patients with petrolatum gauze dressings (P = .06) by day 14. Overall, however, mean healing scores were similar in both groups. Mean healing scores for the patients who received a hydrophilic semipermeable absorbent polyurethane foam dressing was 2.3 (SD = 0.6) vs 2.2 (SD = 0.6) for patients who received the petrolatum gauze dressing (P = .20). Numbers of days required for complete epithelialization in these groups were 20.6 (SD = 10.1) and 19.3 (SD = 5.1), respectively (P = .49). One infection occurred in the group who received the petrolatum gauze dressing. The mean maximum pain intensity scores were lower for those who were given the hydrophilic semipermeable absorbent polyurethane foam dressing on postoperative days 1 through 3 (P = .003, .03, and .04, respectively). Pain increased with a larger donor site surface area for the patients with the petrolatum gauze dressing but not for the patients with the hydrophilic semipermeable absorbent polyurethane foam dressing. CONCLUSIONS: The hydrophilic semipermeable absorbent polyurethane foam dressing appears to have potential advantages over the petrolatum gauze dressing; it produces less initial patient donor site discomfort and tends to produce more complete donor site healing by postoperative day 14.

Absorption↗
PubMed1995

Outcome and complications of extended cranial-base resection requiring microvascular free-tissue transfer.

OBJECTIVES: To determine the complications of extensive cranial-base resection requiring free-tissue transfer (FTT) and the effect of these resections on local control and survival among patients with malignant neoplasms of the skull base. BACKGROUND: Before the advent of FTT, cranial-base surgery was often limited by our inability to adequately repair defects comprising communication between the central nervous system and upper aerodigestive tract. The use of FTT in cranial-base resections was therefore assessed to determine whether the improved procedure (ie, extensive resections) would improve local control and prolong survival. DESIGN: A retrospective review of 39 consecutive craniofacial resections with FTT reconstruction in patients with malignant neoplasms involving the cranial base. PATIENTS: All 39 patients had malignant neoplasms, including 20 squamous cell carcinomas, eight basal cell carcinomas, two melanomas, two neuroendocrine carcinomas, two adenoid cystic carcinomas, and various other malignant neoplasms. Resections involved the anterior, middle, or posterior cranial fossa in 19 patients (49%), 10 patients (26%), and three patients (8%) of cases, respectively. The remaining seven surgeries (18%) involved resection of more than one of these cranial base sites. RESULTS: Early (< 14 days after surgery) complications occurred in 14 (36%) of 39 patients. Major complications included failure of microvascular anastomosis (n = 1), pneumonitis (n = 3), perioperative myocardial infarction (n = 1), and cerebrovascular accident (n = 1). The microvascular anastomosis failure was promptly treated with surgical intervention. Two patients (5%) experienced late postoperative complications; one had cellulitis at the donor site, and the other had pneumonitis. No perioperative deaths or complications such as meningitis, epidural abscess, or tension pneumocephalus occurred. The 2-year disease-specific survival rate was 55%, and the 2-year local control rate, 49%; both were determined by the Kaplan-Meier method. The nine patients who died of their disease had a median survival of 9 months. Log-rank testing showed that pathologically positive margins and transdural pathology were the most significant predictors of local recurrence and death of disease. CONCLUSIONS: Contemporary surgical approaches provide an opportunity for wide surgical excision of dura and skull-base structures that normally separate the intracranial and extracranial cavities. These major skull-base resections can be reconstructed safely and effectively with FTT. Patients with malignant neoplasms of the dura and skull base should be approached with the understanding that transdural disease portends an increased risk of local recurrence and death of disease.

Adolescent↗
PubMed1995

Rhabdomyosarcoma of the nose and paranasal sinuses in adults and children.

OBJECTIVE: To determine the biologic behavior, risk factors for recurrence, and influence of multimodality therapy on outcome for children and adults with rhabdomyosarcoma of the nose and paranasal sinuses. DESIGN: Retrospective review of medical records. PATIENTS: During a 36-year period 37 patients (median age, 23.0 years) with histologically confirmed rhabdomyosarcoma of the nose and paranasal sinuses were treated for cure. Median follow-up was 28 months (range, 1 to 260 months). Histologic subtypes included embryonal, 16; alveolar, 15; mixed, 1; and unclassified, 5. Cervical metastases were present in 38%. Patients were treated with surgery, 4; radiotherapy, 3; chemotherapy, 3; surgery and radiotherapy, 1; surgery and chemotherapy, 1; chemotherapy and radiotherapy, 24; and chemotherapy, radiotherapy, and surgery, 1. RESULTS: The overall 5-year survival was 44%. For patients treated with chemotherapy and radiotherapy or chemotherapy, radiotherapy, and surgery, the 5-year survival was 60%, compared with 19% for patients treated with the other forms of therapy. Factors associated with poorer survival were adult onset of disease, alveolar histology, and treatment with systemic chemotherapy for less than 1 year. Patients receiving chemotherapy for greater than 1 year had a 5-year survival of 82%, compared with 71% for those with less than 1 year of treatment. Improved survival was associated with a lower incidence of distant metastasis. CONCLUSIONS: A combination of chemotherapy and radiotherapy may provide the best means of obtaining local-regional control for rhabdomyosarcoma arising in the nose and paranasal sinuses. The risk of regional disease is high, requiring comprehensive radiotherapy to the neck in addition to the primary site. Surgical resection should be reserved for patients with residual disease after chemotherapy and radiotherapy. Administration of chemotherapy for more than 1 year is associated with improved survival because of a decreased incidence of metastatic disease.

Adolescent↗
PubMed1995

A model for predicting transfusion requirements in head and neck surgery.

INTRODUCTION: Although allogeneic blood transfusions have allowed surgeons increased latitude in resecting advanced cancers, they can cause significant morbidity or even death in rare instances. Potential side effects may include transmission of infection and immunosuppression leading to an increased risk of cancer recurrence. Because patients have become more reluctant to receive transfusions, they frequently request preoperative autologous blood donation (PABD). In practice, however, only 50% or less of the donated blood is ultimately transfused while the remainder is discarded. PURPOSE: The purpose of this study was to develop a transfusion prediction and risk assessment (TPRA) model for predicting the need for perioperative blood transfusions in patients undergoing major head and neck oncologic surgical procedures. By knowing the probability for blood transfusion, the physician and patient can make an educated decision regarding the need for PABD. PATIENTS AND METHODS: Over a 4-year period, 436 patients underwent major head and neck surgical procedures for neoplasms of the upper aerodigestive tract, the thyroid gland, and the salivary glands. Data obtained prospectively on each patient included age and gender, the TNM stage, primary disease site, type of prior treatment, estimated intraoperative blood loss, duration of surgery, transfusion requirements, preoperative and postoperative hemoglobin and hematocrit levels, type of procedure and method of reconstruction. These variables were examined singly and in combination both for descriptive purposes and to evaluate their interrelationships. In order to develop the TPRA model, only the 12 variables available prior to the surgical procedure were examined. Variables associated with transfusion need were evaluated further in a multivariate analysis. The logistic regression model allowed a linear expression of patient characteristics to be related to a function of the probability of transfusion need. Analyses of association between categorical variables and transfusion status were based on chi-squared, Fisher's Exact, and Mann-Whitney U tests. RESULTS: Overall, 51 (11.7%) patients required blood transfusions. The median number of units transfused was 2.0 (range, 1 to 13 U). Univariate analysis demonstrated a higher probability for blood replacement in patients with oropharyngeal or hypopharyngeal primary tumor sites, a preoperative hemoglobin level below normal, prior chemotherapy, composite resection, flap reconstruction, between 50 and 59 years of age, and T3 or T4 tumor stage. Logistic regression analysis demonstrated that the need for flap reconstruction, a preoperative hemoglobin below the normal level, and T3 or T4 primary stage were the three factors most significantly associated with the need for transfusion (P < .03). Based on eight combinations of these three variables, transfusion risk predictions were obtained. The TPRA model predicted that patients with a normal hemoglobin level who did not require flap reconstruction and did not have either a T3 or T4 primary stage tumor had the lowest probability (.02) for requiring blood transfusion. Patients at highest risk (.65) were those with less than a normal hemoglobin level, who required flap reconstruction, and had T3 or T4 primary tumor stage. Based on the TPRA model, an algorithm was developed which could serve as a guideline for preoperative transfusion planning. CONCLUSION: By using the TPRA model to change guidelines for preoperative transfusion planning, costs can theoretically be reduced by 50% without significantly increasing the risk of exposing patients to allogeneic blood transfusion. If the TPRA model proves accurate in a follow-up study to test its validity, it may have clinical utility for aiding the surgeon in more cost-effective transfusion planning.

Adolescent↗
PubMed1995

Minor salivary gland tumors of the palate: clinical and pathologic correlates of outcome.

Minor salivary gland tumors of the palate are rare and may pose a diagnostic and therapeutic dilemma for the head and neck surgeon. The authors reviewed their 46 years of experience with minor salivary gland tumors of the palate to determine the factors that influence outcome and their implications for treatment. Malignant tumors were seen in 116 patients (78%) and benign tumors were found in 33 patients (22%). Adenoid cystic carcinoma was the most common malignant tumor, occurring in 43 patients, and pleomorphic adenoma was the most common benign tumor, occurring in 30 patients. Univariate analysis on the malignant lesions showed that grade 3 tumor histology (P < .001), tumor size greater than 3 cm (P < .001), perineural invasion (P = .031), bone invasion (P = .012), positive surgical margins (P < .001), and positive initial but negative final margins (P = .004) were all associated with decreased survival. With multivariate analysis, tumor size, margin status, and grade were shown to be independently associated with decreased survival (P < .05). The recurrence rate at the primary site was significantly higher for adenoid cystic carcinoma than for other histologies (P = .0059). The 2-, 5-, and 10-year disease-specific survival rates for patients with malignant disease were 96%, 87%, and 80%, respectively. Wide surgical excision with adequate margins is essential for a favorable outcome in patients with malignant minor salivary gland tumors. Postoperative radiotherapy is reserved for patients with grade 3 tumor histology, large primary lesions, perineural invasion, bone invasion, cervical lymph node metastasis, and positive margins, although a clear-cut survival advantage has not been proven. Recurrence, especially regional and distant metastasis, portends an extremely poor prognosis.

Adenoma, Pleomorphic↗
PubMed1994

Postoperative radiotherapy for cutaneous melanoma of the head and neck region.

PURPOSE: To assess the efficacy and toxicity of elective-adjunctive radiotherapy given in five 6-Gy fractions to patients with cutaneous melanoma of the head and neck at high risk for local-regional relapse. METHODS AND MATERIALS: From 1983 to August 1992, 174 patients (132 men and 42 women) were enrolled. The ages ranged from 16 to 89 years (median: 54 years). One group (n = 79) received elective irradiation after wide local excision of lesions > or = 1.5 mm thick, or Clark's level IV-V, a second group (n = 32) received adjunctive irradiation after excision of primary lesions plus limited neck dissection, and a third group (n = 63) received irradiation after neck dissection for nodal relapse. Each group had a projected local-regional recurrence rate of approximately 50%. The radiotherapy consisted of five fractions of 6 Gy each, specified at Dmax, delivered twice a week, to a total dose of 30 Gy in 2.5 weeks. Electron beams of appropriate energies were used whenever possible. Junction lines between adjoining fields were moved twice to minimize dose heterogeneity. Patients were seen at regular intervals to assess disease status and therapy-related complications. Patients who relapsed were treated as indicated by the clinical status. RESULTS: With a median follow-up of 35 months, 111 of 174 patients were alive. The disease recurred above the clavicles only in six patients, at distant sites in 58 patients, and both local-regionally and at distant sites in nine patients. The actuarial 5-year local-regional control (LRC) and survival rates for the whole group were 88% and 47%, respectively. The thickness of the primary lesion, presence of more than three positive nodes, and extracapsular extension did not influence the LRC rate after radiotherapy (range: 85-92%). However, lesion thickness strongly affected the 5-year survival rate of group 1 patients (i.e., 100% for < or = 1.5 mm thick, but Clark's level IV, 72% for > 1.5-4 mm, and 30% for > 4 mm). In groups 2 and 3, the 5-year survival rate of patients with > three involved nodes was lower than that of patients with one to three positive nodes (23% vs. 39%). The acute tolerance to adjunctive radiotherapy was excellent. Late radiation complications were observed in only three patients. These were moderate neck fibrosis, mild ipsilateral hearing impairment, and transient exposure of external auditory canal cartilage. CONCLUSION: The safety of this hypofractionated radiotherapy regimen in the management of cutaneous melanoma was established in this study. The overall 5-year actuarial LRC rate of 88% was much higher than that of our historical group and that reported in the literature (50%). The survival rate of patients with lesion of 1.5-4 mm thickness was also higher than that observed in other series. Based on these results a prospective randomized study to further define the role of adjunctive postoperative radiotherapy is planned.

Adolescent↗
PubMed1994

Postoperative radiation therapy for malignant tumors of minor salivary glands. Outcome and patterns of failure.

BACKGROUND: In the treatment of major salivary gland cancers, the addition of adjuvant postoperative radiation therapy for patients with high risk features has been shown to reduce the incidence of local failure. This retrospective study was done to determine the effectiveness of this approach for minor salivary gland cancers, to document patterns of failure, and to define prognostic variables for treatment outcome. METHODS: Between 1961 and 1990, 160 patients received postoperative radiation at the University of Texas M. D. Anderson Cancer Center (UTMDACC) after gross total removal of their tumors. These operations ranged from excisional biopsies to craniofacial resections with orbital exenterations depending on the original site and size of the tumor. The primary tumor site was in the oral cavity-oropharynx in 111 patients and in the nasal cavity or paranasal sinuses in 46 patients. The most prevalent histologic type was adenoid cystic carcinoma (71%). Microscopic positive margins were present in 64 (40%) patients. Half of the patients had pathologic evidence of perineural invasion. Radiation therapy techniques varied, depending on the site and extent of disease and the era of treatment. Doses ranged from 50 to 75 Gy (median, 60 Gy; mean 59.2 Gy). Follow-up for surviving patients ranged from 24 to 270 months (median, 110 months). RESULTS: Fifty-seven (36%) patients experienced disease relapse. Nineteen (12%) patients had a local recurrence: 6 within 5 years of treatment, 8 between 5 and 10 years, and 5 after 10 years. Regional failures occurred in 3 of 13 patients with initially node-positive disease but were uncommon (less than 5%) in patients with node-negative disease, regardless of elective neck treatments. Distant metastases developed in 43 patients, mostly (79%) within 5 years of treatment. Actuarial overall survival rates at 5, 10, and 15 years were 81%, 65%, and 43%, respectively. Complications occurred in 51 patients and were of three predominate types: hearing loss (26 patients), ocular injury (15 patients), and bone exposure/necrosis (12 patients). Improved techniques, including better immobilization, customized beam shaping, and treating multiple fields per day, have substantially reduced the risk of serious complications during the past decade. CONCLUSIONS: Postoperative radiation therapy is effective in preventing local recurrence in most patients with minor salivary gland tumors after gross total excision. When local failure occurs, it tends to be a late event. For most patients, the authors recommend a postoperative dose of 60 Gy in 30 fractions to the operative bed; if there is named nerve invasion, the path of the nerve is treated electively to its ganglion.

Adolescent↗
PubMed1994

Human papillomavirus in laryngeal and hypopharyngeal carcinomas. Relationship to survival.

OBJECTIVE: To determine the relationship between human papillomavirus (HPV) DNA detection in upper aerodigestive tract malignancies and patient outcome. DESIGN: Archival paraffin-embedded specimens from 78 previously untreated patients with squamous carcinomas of the larynx and hypopharynx were pathologically verified and analyzed by polymerase chain reaction for detection of HPV DNA. Charts were independently reviewed and coded until final analysis. SETTING: The University of Texas M. D. Anderson Cancer Center, Houston, a tertiary cancer referral center. RESULTS: DNA was successfully extracted from 65 archival patient samples (83%). The mean (+/- SEM) duration of follow-up for these patients was 42 +/- 21 months. Thirty specimens (46%) exhibited detectable HPV DNA. Detection of HPV was significantly related to decreased survival, independent of disease stage. Log rank testing revealed that HPV detection, pathologic vascular invasion, and nodal status were the most significant predictors of death of disease. CONCLUSIONS: Laryngeal and hypopharyngeal carcinomas with detectable HPV may represent a biologically distinct subset of tumors that carry a poorer prognosis than do cancers with no detectable HPV.

Adult↗
PubMed1994

Two perplexing skin tumors: microcystic adnexal carcinoma and keratoacanthoma.

Microcystic adnexal carcinoma and keratoacanthoma have a marked predilection for the skin of the head and neck. The adnexal carcinoma continues to be underrecognized, and the consequences for the patient are locally aggressive recurrences. The keratoacanthoma, on the other hand, may be inappropriately overdiagnosed, causing squamous cell carcinoma of the skin to be missed. In the instance of the solitary keratoacanthoma a conservative complete excision is recommended.

Adult↗
PubMed1993

Evaluation of the dose for postoperative radiation therapy of head and neck cancer: first report of a prospective randomized trial.

PURPOSE: This study was designed to determine in a prospective randomized trial the optimal dose of conventionally fractionated postoperative radiotherapy for advanced head and neck cancer in relation to clinical and pathologic risk factors. METHODS AND MATERIALS: Between January 1983 and March 1991, 302 patients were enrolled on the study. This analysis is based on the first 240 patients entered through September 1989, of whom 221 (92%) had AJC Stage III or IV cancers of the oral cavity, oropharynx, hypopharynx, or larynx. The patients were stratified by postulated risk factors and randomized to one of three dose levels ranging between 52.2 Gy and 68.4 Gy, all given in daily doses of 1.8 Gy. Patients receiving > 57.6 Gy had a field reduction at this dose level such that boosts were only given to sites of increased risk. RESULTS: The overall crude and actuarial 2-year local-regional recurrence rates were 25.4% and 26%, respectively. Patients who received a dose of < or = 54 Gy had a significantly higher primary failure rate than those receiving > or = 57.6 Gy (p = 0.02). No significant dose response could be demonstrated above 57.6 Gy except for patients with extracapsular nodal disease in the neck in whom the recurrence rate was significantly higher at 57.6 Gy than at > or = 63 Gy. Analysis of prognostic factors predictive of local-regional recurrence showed that the only variable of independent significance was extracapsular nodal disease. However, clusters of two or more of the following risk factors were associated with a progressively increased risk of recurrence: oral cavity primary, mucosal margins close or positive, nerve invasion, > or = 2 positive lymph nodes, largest node > 3 cm, treatment delay greater than 6 weeks, and Zubrod performance status > or = 2. Moderate to severe complications of combined treatment occurred in 7.1% of patients; these were more frequent in patients who received > or = 63 Gy. CONCLUSION: With daily fractions of 1.7 Gy, a minimum tumor dose of 57.6 Gy to the whole operative bed should be delivered with a boost of 63 Gy being given to sites of increased risk, especially regions of the neck where extracapsular nodal disease is present. Treatment should be started as soon as possible after surgery. Dose escalation above 63 Gy at 1.8 Gy per day does not appear to improve the therapeutic ratio.

Adult↗
PubMed1993

Comparison of low-dose isotretinoin with beta carotene to prevent oral carcinogenesis.

BACKGROUND: High-dose isotretinoin therapy has been determined to be an effective treatment for leukoplakia. However, a high rate of relapses and toxic reactions led us to conduct a trial of a much lower dose of isotretinoin in the hope of maintaining a response and limiting toxicity. METHODS: In the first phase of the study, 70 patients with leukoplakia underwent induction therapy with a high dose of isotretinoin (1.5 mg per kilogram of body weight per day) for three months; in the second phase, patients with responses or stable lesions were randomly assigned to maintenance therapy with either beta carotene (30 mg per day) or a low dose of isotretinoin (0.5 mg per kilogram per day) for nine months. RESULTS: In the first phase, the rate of response to high-dose induction therapy in the 66 patients who could be evaluated was 55 percent (36 patients). The lesions of seven patients progressed, and therefore they did not participate in the second phase of the trial. Of the 59 patients included in the second phase, 33 were assigned to beta carotene therapy and 26 to low-dose isotretinoin therapy; these two groups did not differ significantly in prognostic factors. Of the 53 patients who could be evaluated, 22 in the low-dose isotretinoin group and 13 in the beta carotene group responded to maintenance therapy or continued to have stable lesions (92 percent vs. 45 percent, P < 0.001). In situ carcinoma developed in one patient in each group, and invasive squamous-cell carcinoma in five patients in the beta carotene group. Toxicity was generally mild, though greater in the group given low-dose isotretinoin therapy. CONCLUSIONS: When preceded by high-dose induction therapy, low-dose isotretinoin therapy was significantly more active against leukoplakia than beta carotene and was easily tolerated.

Adult↗
PubMed1993

Phase II trial of 13-cis-retinoic acid plus interferon-alpha in recurrent head and neck cancer.

13-cis-retinoic acid (isotretinoin) and interferon-alpha have limited activity as single agents in advanced cancer. Preclinical data indicate that these agents have different mechanisms of action and, in combination have greater activity (that is, the ability to modulate growth and differentiation) in a number of malignant cell types than either agent alone. In clinical trials, the new biological regimen of 13-cis-retinoic acid and interferon-alpha was shown to have major activity in advanced squamous cell carcinoma of the skin and cervix. We conducted a phase II trial of this regimen in recurrent squamous cell carcinoma of the head and neck. Of the 21 evaluable patients, none had a complete response, and only one had a partial response (5%). Two patients had minor responses, four had stable disease, and 14 experienced disease progression. Five patients developed grade 3 toxic effects, including skin toxicity, fatigue, headache, and anorexia/weight loss. The median survival duration was 25.5 weeks (range, 4-95). The combination of 13-cis-retinoic acid and interferon-alpha at this dose and schedule is ineffective for the treatment of recurrent squamous cell carcinoma of the head and neck.

Adult↗
PubMed1993

Complications of surgery of the thyroid and parathyroid glands.

Surgery of the thyroid and parathyroid glands can be performed safely in the majority of patients. The greatest risk for postoperative morbidity arises from injury to the laryngeal nerves or the parathyroid glands. A sound knowledge of regional anatomy combined with an unhurried, meticulous operative technique are essential if injury to these structures is to be avoided.

Blood Loss, Surgical↗
PubMed1993

Paratracheal lymph node dissection for carcinoma of the larynx, hypopharynx, and cervical esophagus.

Paratracheal lymph node (PTLN) metastasis has been implicated as an etiologic factor in peristomal recurrence after laryngectomy. To determine the relationship between the primary site, the risk of peristomal recurrence, and the prognostic significance of PTLN metastasis, the medical records of 645 patients who underwent total laryngectomy between 1978 and 1990 for squamous cell carcinoma of the larynx, hypopharynx, and cervical esophagus were reviewed. Criteria for inclusion were the surgeon's description of PTLN dissection and hemi- or total thyroidectomy, as well as gross and microscopic pathologic identification of PTLNs. These requirements were fulfilled in 141 patients, who composed the cohort analyzed. There were 117 males and 24 females, with a median followup of 20 months (range, 1 to 94 months). Fifty-three patients were treated previously; among these, 21 underwent tracheostomy before laryngectomy. The primary site of origin was the larynx in 64.5% of patients, the hypopharynx in 25.5%, and the cervical esophagus in 9.9%. Of the patients with endolaryngeal primary tumors, 33% had subglottic extension. Postoperative stomal irradiation was administered to 61 patients. The mean number of PTLNs removed was 3.9 (range, 1 to 30), and metastasis was present in 29 patients (20.5%). PTLN metastasis by primary tumor site was the cervical esophagus, 10 of 14 (71.4%) (p < 0.001); the larynx, 16 of 91 (17.6%); and the hypopharynx, 3 of 36 (8.3%). Of the 30 patients with subglottic extension, eight (26.7%) had PTLN metastases. Peristomal recurrences developed in six of 141 patients (4%), and metastasis to PTLNs was identified in one third of these patients. No peristomal recurrence developed in any of the patients who received postoperative radiotherapy to the stoma (p = 0.057). Survival was significantly reduced by the presence of PTLN metastases.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Effectiveness of combined induction chemotherapy and radiotherapy in advanced nasopharyngeal carcinoma.

PURPOSE: This prospective trial was conducted with the goal of achieving an improvement in both overall and progression-free survival in previously untreated patients with stage IV nasopharyngeal carcinoma who received an induction chemotherapy regimen of fluorouracil (5-FU) and cisplatin followed by radiotherapy. PATIENTS AND METHODS: From January 1985 to January 1990, 47 patients with T1-4N2-3M0 squamous cell carcinoma of the nasopharynx were treated at The University of Texas M.D. Anderson Cancer Center with two to three cycles of 5-FU (1,000 mg/m2 continuous infusion per day x 5 days) plus cisplatin (100 mg/m2 continuous infusion on day 1 only) followed by radiotherapy using the conventional time/dose schedule. RESULTS: The response rate to chemotherapy was 93.2% (20.5% complete response [CR]; 72.7% partial response [PR]), and the overall CR rate after radiotherapy was 86%. With a median follow-up period of 53 months, the 2-, 4-, and 6-year survival rates were 80%, 71.6%, and 67.4%; the overall treatment failure rate was 27%. Treatment was well tolerated and without significant acute or chronic toxic effects. CONCLUSION: The results of this prospective study demonstrate that 5-FU plus cisplatin followed by radiotherapy can induce a durable remission in a high proportion of patients with poor-prognosis stage IV nasopharyngeal carcinoma.

Adolescent↗