ISSN:0148-6403    

DOI:10.1002/hed.2890040202

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

年代:1981

数据来源: WILEY

摘要:

AbstractTo evaluate an effective, cell‐cycle‐specific combination chemotherapy which could be administered on an outpatient basis, COMB of Maryland (Cytoxan, Oncovin, methotrexate and bleomycin) was used in 20 patients with stage IV squamous cell carcinoma of head and neck origin. All patients had unresectable but measurable disease. Nine patients had distant metastases. Prior to this chemotherapy, 15 (75%) patients underwent radiation therapy, 12 (60%) had radical surgery, and 3 (15%) were administered other chemotherapeutic drugs. The distribution of the primary site of tumor was identical to the overall distribution of squamous cell carcinoma of head and neck found in this country. Drug dosages were: Cytoxan 100 mg/m2p.o. days 1‐14, Oncovin 1 mg/m2IV days 1 and 8, methotrexate 25 mg/m2IV days 1 and 8, and bleomycin 15 units/m2IM days 1 and 8. This cycle was repeated every four weeks. Two (10%) patients had complete response and 7 (35%) had partial response, thus giving the total response rate of 9 (45%). Seven (35%) patients had static disease and 4 (20%) had progression of disease. Duration of response was from 8 to 26+ weeks with a median duration of 17+ weeks. Response rate was statistically related to performance status and previous chemotherapy. However, it was not related to age, sex, site of origin, previous radiation therapy, or differentiation of the tumor. Increased survival (P<0.01) was seen in responders (median 16+ weeks) as compared to nonresponders (9 weeks). Hematologic toxicity was seen in 9 (45%) patients, resulting in one chemotherapy‐related death. Overall, this chemotherapy has been well tolerated on an outpatient basis. Although 15 (75%) patients received prior radiation therapy, the results were comparable to those obtained by other, more toxic combination chemotherapeutic r

ISSN:0148-6403    

DOI:10.1002/hed.2890040203

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

年代:1981

数据来源: WILEY

摘要:

AbstractBleomycin (Blenoxane) and cisplatin (Platinol) are two anticancer drugs with activity for head and neck tumors. Introduced into clinical use in the past ten years, bleomycin is used primarily in the chemotherapy of squamous cell carcinomas, lymphomas, and testicular carcinoma, while cisplatin is effective against testicular and ovarian carcinoma, head and neck cancer, bladder cancer, and neuroblastoma. Bleomycin is rapidly excreted renally (T1/2β= 2‐4 hr) although enzymatic inactivation also occurs in many tissues. Cisplatin is nonenzymatically converted to highly protein‐bound metabolites, which then undergo renal elimination, but total body clearance occurs much more slowly than with bleomycin (T1/2β= 40‐50 hr). Both agents have acute and chronic toxicities; the acute toxicities are generally reversible but cause a great deal of patient discomfort, while the chronic toxicities are often irreversible and dose‐limiting. For bleomycin, the acute toxicities are mucocutaneous and pyretic, while severe nausea and vomiting represent the major acute toxicities of cisplatin therapy. Cumulative dose‐related pulmonary toxicity is the most serious chronic toxicity of bleomycin. The clinical, radiographic, and pathologic presentations are nonspecific, although identification of high‐risk patients may be possible with serial pulmonary function tests. Cumulative nephrotoxicity occurs with cisplatin use and its incidence and severity can be reduced by maintaining adequate hydration and diuresis during and following administratio

ISSN:0148-6403    

DOI:10.1002/hed.2890040204

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

年代:1981

数据来源: WILEY

摘要:

AbstractFifty‐one patients (32 previously untreated, 19 previously treated) with advanced squamous cell carcinoma of the head and neck received a single course of combination chemotherapy consisting of high dosecis‐platinum (DDP), bleomycin (Bleo), ± high dose methotrexate (MTX). Thirty‐three (65%) patients responded to therapy; 5 (10%) of these patients had a complete response. Previously untreated patients and those who received the three drugs (DDP, Bleo and MTX) had the highest response rates. The duration of response was 8 to 12 weeks. Seven (15%) patients showed a two‐year survival rate. All nonresponders were dead of disease within two years. Three (56%) of the five complete‐response patients and 4 (21%) of the partial‐response patients survived for two years. The role of preoperative chemotherapy in head and neck cancer is yet to be conclusi

ISSN:0148-6403    

DOI:10.1002/hed.2890040205

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

年代:1981

数据来源: WILEY

摘要:

AbstractIntraarterial infusion chemotherapy has not been widely accepted for the treatment of head and neck cancer due to the high rate of complications it involves. To avoid these complications, a totally implantable infusion pump has been developed to achieve continuous low‐level drug delivery for long periods of time. The pump is implanted in a subcutaneous pocket and connected to a permanent, indwelling, arterial catheter. It can be repeatedly refilled with chemotherapeutic agents by hypodermic needle injection through the skin and through a self‐sealing septum located at the entry to the pump. Refilling the pump recharges an inexhaustible power source for the next delivery cycle. Preliminary results suggest that long term intraarterial infusion chemotherapy for the treatment of head and neck cancer is practical for outpatie

ISSN:0148-6403    

DOI:10.1002/hed.2890040206

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

年代:1981

数据来源: WILEY

摘要:

AbstractForty‐two patients with squamous cell carcinoma of the nasal vestibule were reviewed. The patients were treated at either the Southern California Permanente Medical Group or the UCLA Medical Center. Thirty‐eight patients (90%) had early lesions and 4 (10%) had late disease (involving the nodes or bone). The following conclusions were formed from this study:(1)Patients without bone destruction or lymph node metastases will do well with either irradiation or surgery. Those with bone destruction or lymph node metastases will do poorly in spite of radical treatment.(2)Early lesions can often be cured with either partial rhinectomy or irradiation.(3)A surgical recurrence following partial rhinectomy can be salvaged with irradiation.(4)A radiation recurrence of an early lesion can be salvaged with surgery.(5)The routine use of total rhinectomy for early carcinoma or radiation failure is unwarranted.(6)Other primary cancers are not uncommon when followup is extended to the 5‐ to 10‐year i

ISSN:0148-6403    

DOI:10.1002/hed.2890040207

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

年代:1981

数据来源: WILEY

摘要:

AbstractThe advent of both improved imaging systems and new radioactive agents has increased the effectiveness of nuclear medicine in diagnosing and treating diseases of the head and neck. In this first in a series of two articles, the role of nuclear medicine is discussed in the evaluation of diseases of the salivary and parathyroid glands, and in the identification and staging of head and neck tumors. Radionuclide studies of the salivary glands are useful in the identification of tumors and the evaluation of gland function. Such studies are a valuable adjunct in the diagnosis of Sjögren's syndrome and of acute and chronic inflammatory disease. Radionuclide imaging also has been helpful in the detection of adenomata and hyperplasia of the parathyroid glands and often complements ultrasonography localization procedures. The advent of gallium‐67 imaging has improved the staging of head and neck tumo

ISSN:0148-6403    

DOI:10.1002/hed.2890040208

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

年代:1981

数据来源: WILEY

ISSN:0148-6403    

DOI:10.1002/hed.2890040209

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

年代:1981

数据来源: WILEY

摘要:

AbstractA retrospective review of 143 patients with head or neck tumors who had received radiation therapy in the head and neck area for benign conditions during childhood or adolescence was conducted. This included an analysis of 1,080 patients from the Evanston Hospital Irradiated Thyroid Evaluation Clinic, which was established to define the relationship between irradiation and the subsequent development of thyroid neoplasia. The data support the following concepts of irradiation‐induced neoplasia:(1)The thyroid, parathyroid, and salivary glands can develop benign and malignant changes after irradiation for benign conditions, with latent periods averaging about 30 years;(2)Once a glandular abnormality within the irradiated field appears, the risk of other glands in the field developing neoplastic changes is significantly increase

ISSN:0148-6403    

DOI:10.1002/hed.2890040210

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

年代:1981

数据来源: WILEY

摘要:

AbstractRecent advances in paranasal sinus surgery have occurred in the treatment of trauma and neoplasia, rather than in the more traditional management of inflammatory disease. Cranialization of the frontal sinus in severe penetrating trauma was first described in 1978. By removal of the sinus posterior wall, excision of the mucosa, and preservation of the anterior wall fragments, the forehead contour can be preserved and the cavity ablated by the forward expansion of the frontal lobes. Craniofacial surgery for malignancies of the paranasal sinuses has vastly improved the survival rate for these patients. Simultaneous en bloc resection, done transcranially to establish the margins of resection of the superior‐most extent and transfacially to ablate the site of origin of the neoplasm, has produced five‐year survival rates of 50%. Involvement of even the cavernous sinus can be handled, providing initial control of the internal carotid artery is achieved and an adequate cerebral circulation is ensured. Decompression of the optic nerve following facial trauma that results in fractures of the orbital apex remains controversial. Documented cases of progressively failing vision in such patients provides the clearest indication. Surgical decompression through the transethmoidal sphenoidal route provides excellent access to remove the maximum amount of bone from the optic ca

ISSN:0148-6403    

DOI:10.1002/hed.2890040211

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

年代:1981

数据来源: WILEY