摘要:

AbstractThis study examines patterns of early metastatic spread as recorded in 19 clinically negative, histologically positive (occult) neck dissection specimens. Microscopic metastatic deposits were detected in this study in nodes measuring 10 mm and less. No nodes with extension of tumor beyond the capsule and into adjacent structures were noted. Central necrosis was detected in only one node. We suggest that the first stages of metastatic disase as evaluated by the pathologist in clinically occult nodes are minimal and may easily evade the eyes of both pathologists and radiologists. Imaging proved to be efficacious in upstaging clinically occutt necks that were previously irradiated.

ISSN:1043-3074    

DOI:10.1002/hed.2880140302

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1992

数据来源: WILEY

摘要:

AbstractThe serratus muscle (SAM) can be raised as an isolated muscular or osteomuscular flap on its nutrient vessels or in combination with a latissimus dorsi (LD) myocutaneous flap on the thoracodorsal pedicle for various reconstructive purposes. The aim of the present is to report on the results achieved after the use of the SAM alone (n= 7) and in combination with an LD (n= 3) after tumor resection or osteoradionecrosis (ORN) in ten patients with defects of the head and neck. One flap was lost due to venous thrombosis. The donor site morbidity was minimal. Emphasis is given on a new indication, namely ORN of the mandible. Short‐term results show that the use of the SAM prevents a pathologic fracture in cases of a class IIIa osteoradionecrotic mandible. More extensive use of the SAM flap is advocate

ISSN:1043-3074    

DOI:10.1002/hed.2880140303

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1992

数据来源: WILEY

摘要:

AbstractThe anterior rib, osteomyocutaneous composite flap (AROCF) incorporating both vessels, supracostal and intercostal, has been harvested for primary reconstruction in advanced head and neck cancer patients. The adequacy of the periosteal circulation alone for the successful free osseous transfer has been well proved.1,2The available length of the internal mammary vessels is sufficient for the successful microvascular anastomosis in the neck. This same AROCF can be used as a pedicled flap based on the pectoralis major musculo‐vascular pedicle for successful primary reconstruction in cases in which it is deemed unsuitable for use as a free flap. This is possible because of the unique functional blood supply of the ri

ISSN:1043-3074    

DOI:10.1002/hed.2880140304

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1992

数据来源: WILEY

摘要:

AbstractWe retrospectively analyzed 99 patients with 115 sites of skin cancer, predominantly involving the head and neck, treated with electron beam therapy. Our objective was to determine the local control rate, radiotherapy reactions, cosmesis, and salvage treatment. Forty‐three percent of patients received radiotherapy after biopsy, 41% were treated for recurrence following other modalities of treatment, and 16% had positive margins after surgical excision. With minimum and mean follow‐up of 24 and 47 months, respectively, local control was achieved in 88% of patients. Six of 14 local recurrences were salvaged by surgery (five patients) and radiotherapy (one patient) for a total local control of 93%. Serial photographs and data were available to analyze cosmesis in 56 patients. Excellent or good cosmesis was achieved in 91%. Side effects were mild and self‐limiting. EBT is highly efficacious and offers excellent cos

ISSN:1043-3074    

DOI:10.1002/hed.2880140305

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1992

数据来源: WILEY

摘要:

AbstractSquamous cell carcinoma (SCC) cell lines recently established from head and neck tumors were studied for their capability of repairing sublethal radiation induced damage (SLDR). Total doses of 1.25, 2.50, 5.00, and 7.50 Gy were used either as a single dose or split in two equal fractions with a 24 h interval. Cell survival was determined using a 96‐well plate clonogenic assay based on limiting dilution. Survival data was fitted by linear quadratic model, and the area under the survival curve (AUC) was obtained with numerical integration. The amount of SLDR was expressed as AUC‐ratio comparing survivals from split dose vs single dose experiments.SLDR capacity was observed to vary markedly between individual cell lines (AUC‐ratios 1.0‐1.5). The relatively radiationsensitive cell lines had a tendency toward higher SLDR proficiency (correlation coefficient 0.85). The differences in repair capacity could not be explained by the differences in doubling times of the cell lines. The inverse relationship between SLDR capacity and inherent radiosensitivity could explain the poor radiocurability of the sensitive donor tumors. Two of the most resistant cell lines were found SLDR deficient. This is a novel finding, since SLDR has been previously reported in all studie

ISSN:1043-3074    

DOI:10.1002/hed.2880140306

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1992

数据来源: WILEY

摘要:

AbstractRadiotherapy with curative intent was administered to 159 of 167 consecutively admitted patients with nasopharyngeal carcinoma. The classification (UICC 1982) gave the staging: stage I 8%, stage II 2%, stage III 28%, and stage IV 61%.The actuarial local tumor control was 54% and correlated to the T‐classification. Primary control of neck nodes was 67% but was not correlated to the N‐classes. Distant failure occurred in 20% of the patients; this was correlated to the N‐classification. The 10‐year actuarially corrected survival rate was 37% (stage I + II 60%, stage III 49%, stage IV 27%). Late reactions were seen in 69%, and most patients had mild to moderate xerostomia. Men with high hemoglobin had a better prognosis than men with values in the lower part of thenormal range.It is concluded that primary control in the T‐ and N‐positions is the parameter most crucial

ISSN:1043-3074    

DOI:10.1002/hed.2880140307

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1992

数据来源: WILEY

摘要:

AbstractThree hundred seventy‐nine new patients with nasopharyngeal carcinoma (NPC) were followed clinically and the physical examination, including that of the nasopharynx by indirect mirror for symptoms after treatment. At the time of analysis, with a median follow‐up of 34.8 months, 47 patients had developed recurrent disease in the nasopharynx and in the immediately adjacent regions. In 31 patients the first clinical features to suggest local recurrence were progressive symptoms (group A). In another 13 patients recurrence of tumor in the nasopharynx was detected by indirect mirror examination (group B). In the remaining three patients, the diagnosis was made during investigation for neck node recurrence. The more common symptoms at diagnosis of local recurrence were headache; cranial nerve palsy involving the third, fourth, fifth, and sixth nerves; and ear and nasal symptoms. Group B patients tended to have less of these symptoms. The presence of tumor was confirmed by fiberscopic examination and biopsy in all group B patients and 14 of 31 group A patients, the tumor was submucosal in the remaining 17 group A patients. The recurrence in group B patients was diagnosed significantly earlier than the group A patients (p= 0.0294), and group A patients suffered from more invasive and extensive disease in comparison with group B patients (p= 0.0044). There were significantly less patients in group A who were amenable to curative brachytherapy (p= 0.0280). Clinical follow‐up for local NPC recurrence was found to be useful. More frequent use of fiberscopic examination in the follow‐up, especially for those not adequately examined by indirect mirror examination, will improve the detection rate. Cross‐sectional imaging techniques and the monitoring of tumor markers may supplement clinical and fiberscopic examinations. An algorithm for diagnosing recurrent NPC and possible treatment are

ISSN:1043-3074    

DOI:10.1002/hed.2880140308

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1992

数据来源: WILEY

摘要:

AbstractSixty‐six patients, surgically treated for head and neck cancer and free of disease, were interviewed at the outpatient clinic from 6 months to 8 years after surgery. The patients were divided by the physician into two groups, according to the patients' degree of disfigurement, i.e., minor (24 patients, 36%, minor disfigurement group = MDG) or extensive (42 patients, 64%, extensive disfigurement group = EDG). Subsequently, the patients were interviewed with close‐ended questions. The following subjective aspects were assessed: self‐image; relationship with the partner, family, and friends; and the overall impact of the therapy. The results of the study showed a significantly higher impact in the EDG versus the MDG as regards a changed self‐image (57% vs 25%, P<0.05), a worsened relationship with the partner (27% vs 0%, P<0.05), a reduced sexuality (74% vs 39%, P<0.01), and an increased social isolation (36% vs 12%, P<0.05). On the whole, 18% of the subjects stated that the disadvantages of therapy outweighed the advantages, and 30% felt that the difficulties encountered were “too harsh.” In such cases, the opportunity of setting up a rehabilitation program offering psychosocial support should be

ISSN:1043-3074    

DOI:10.1002/hed.2880140309

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1992

数据来源: WILEY

摘要:

AbstractWe report a series of 3,294 patients with squamous cell carcinoma of the head and neck seen by one of us between 1963 and 1990. Two thousand and seven patients had a histologically proven and graded, but previously untreated, squamous cell carcinoma of the mucosal surfaces of the head and neck. These tumors had been graded previously by many different pathologists in many different hospitals, both in the United Kingdom and the United States, as well as continental Europe, over this period. Of the host factors both sex and age were associated with differentiation: 34% of patients less than age 50 had a well‐differentiated tumor compared with 44% greater than age 50; 32% of women had a poorly differentiated tumor compared with 26% of men. General condition had no correlation with degree of differentiation. Site was closely associated with grading: well‐differentiated tumors were more common in the mouth and larynx and poorly differentiated tumors in the pharynx. Furthermore, of poorly differentiated tumors, 19% arose from areas normally lined by keratinized squamous epithelium, 22% from a nonkeratinized area, 36% from respiratory epithelium, and 45% from areas normally covered by lymphoid epithelium. T stage had no significant correlation with differentiation. However, 46% of patients with poorly differentiated tumors had a nodal metastasis at presentation compared with only 28% of well‐differentiated tumors. Distant metastases at presentation were found in 3.4% of poorly differentiated tumors compared with 1.8% of well‐differentiated tumors. The survival fell significantly from 33% for well‐differentiated tumors to 27% for poorly differentiated tumors. The recurrence rate at the primary site rose from 25% for well‐differentiated tumors to 27% for poorly differentiated tumors, and recurrence in the lymph nodes rose from 26% to 30%. Both differences were just

ISSN:1043-3074    

DOI:10.1002/hed.2880140310

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1992

数据来源: WILEY

摘要:

AbstractInflammatory pseudotumor of the upper airway is an uncommon lesion of unknown etiology, clinically mimicking a neoplastic process. We document a case of inflammatory pseudotumor of the parapharyngeal space, occurring in a patient with history of cocaine abuse. Corticosteroid treatment was successful in reducing the symptoms. The difficulties in establishing this clinicopathologic diagnosis are discussed and the pertinent literature is reviewed.

ISSN:1043-3074    

DOI:10.1002/hed.2880140311

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1992

数据来源: WILEY