ISSN:0148-6403    

DOI:10.1002/hed.2890080302

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

年代:1986

数据来源: WILEY

摘要:

AbstractThe changes that occur in a child's life following the diagnosis of cancer extend to other members of the family and, through time, far beyond the biologic cure of the disease. The responses of the family to this stress and the ways in which they cope with it will depend partially on their own resources and partially on the severity of the disease and its treatment. This paper describes the factors that influence the family's adaptation to illness and presents a case example that illustrates criteria useful in assessing the need for psychologic consultation in childhood cancer patients and their families. Also presented are guidelines for the physician in his/her continuing observation and follow‐up of these patients and familie

ISSN:0148-6403    

DOI:10.1002/hed.2890080303

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

年代:1986

数据来源: WILEY

摘要:

AbstractThere were 79 patients with squamous cell head and neck cancer randomized to receive simultaneous or 1 hour sequential methotrexate‐5 fluorouracil (MTX—5‐FU) chemotherapy: 47 patients were previously untreated and 32 patients had recurrent disease. The treatment groups were comparable for important prognostic features. The median survival for the 47 newly prsenting patients was 22 months and for recurrent disease patients was 14 months. No difference could be detected in the survival of patients who received simultaneous versus sequential chemotherapy. When only chemotherapy responders were compared, no difference in survival was detected for those who received sequential versus simultaneous therapy. Subsequently, 19 chemotherapy responders received radical radiation therapy, and 15 were rendered disease‐free whereas only 4 of 17 chemotherapy nonresponders were rendered disease‐free by subsequent radiation (P=.002). The survival of the 19 chemotherapy responders was 34 months compared with 16 months for the 17 chemotherapy nonresponders treated with radiation. We conclude that there is no therapeutic advantage for 1 hour sequential MTX‐5 FU chemotherapy compared with simultaneous use of these drugs in squamous cell head and neck cancer. Chemotherapy responders are more likely to respond to radiat

ISSN:0148-6403    

DOI:10.1002/hed.2890080304

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

年代:1986

数据来源: WILEY

摘要:

AbstractTwenty‐seven patients with assessable, regionally advanced, or metastatic upper aerodigestive cancer of diverse histology received a combination of mitomycin C, adriamycin, andcis‐diamminedichloroplatinum. All patients had previously received extensive surgery and/or radiation therapy. We observed an overall 46% partial response rate (12/26). This included seven of 15 (47%) responders with squamous cell carcinoma. Six of those seven patients responded within the initial month of treatment. For all study participants, the median time to progression and survival was 3.8 months and 7.3 months, respectively. Moderate‐to‐severe nausea, vomiting, anorexia, and alopecia were the most common toxicities. Myelosuppression (WBC<4,100 cells/mm3) and thrombocytopenia (PLTS<130,000 cells/mm3) occurred in 100% and 71% of the 21 patients with nadir data recorded, respectively. There were no episodes of sepsis nor did we detect any meaningful impairment in renal function. This regimen is active in the previously treated head and neck cancer patient and can be conveniently administered on an outpatient basis with acceptable and manageable side

ISSN:0148-6403    

DOI:10.1002/hed.2890080305

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

年代:1986

数据来源: WILEY

摘要:

AbstractSynchronously administered cis‐platinum (cis‐DDP) and radiation therapy have been used to treat unresectable squamous cell carcinomas of the head and neck. The purpose of this study was to evaluate the efficacy and tolerance of preoperative adjuvant cis‐DDP plus radiation therapy in operable stage III and IV head and neck cancers. Radiation therapy (4,500 rad) was delivered in 180‐rad daily fractions. Cis‐DDP (20 mg/M2) was given before radiotherapy on days 1–4 and 21–24. Eighteen patients began therapy; 16 completed the combined regimen. Toxicity included stomatitis (3) and WBC below 2,500/mm3(2). One patient died from therapy of a cerebrovascular accident. Sixteen patients (89%) achieved a complete or partial response to therapy. Complete responses were observed in 13 of 18 primary tumors (72%), and in all three patients with cervical lymphadenopathy. Complete responses were noted for lesions of the nasopharynx, oral cavity, pharynx, hyopharynx, and larynx, for all histologic grades of squamous cell carcinoma. Twelve patients underwent curative surgery. Site‐related morbidity occurred in two patients (15%) and a third patient developed postoperative pneumonia. Five of 10 resected primary tumors with preoperative complete responses were pathologically negative for tumor. Concurrent bolus cis‐DDP and radiation therapy are welltolerated and result in impressive tumor reduction. Morbidity after subsequent curative surgery is low, and histologic complete responses are frequent. Trials of this promising combined modality approach to advance operable cancers of the head and neck, when compared to other treatment sequences,

ISSN:0148-6403    

DOI:10.1002/hed.2890080306

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

年代:1986

数据来源: WILEY

摘要:

AbstractThree cases are presented demonstrating the use of a pedicled myocutaneous flap of latissimus dorsi muscle to reconstruct large defects of the anterior and middle skull after ablative surgery for carcinoma. This method is proposed as an alternative to reconstruction with a free myocutaneous flap in selected patients.

ISSN:0148-6403    

DOI:10.1002/hed.2890080307

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

年代:1986

数据来源: WILEY

摘要:

AbstractThe incidence, severity, and location of pain was evaluated in 30 head and neck cancer patients prior to treatment after the first phase of their treatment and upon the completion of treatment. The incidence of pain was relatively high (40%–70%) and tended to increase slightly over treatment. Patients having advanced disease (stage III or IV) had a higher incidence of pain. Pain severity ratings were stable over treatment. Pain was located close to tumor or incision sites, and a trend for patients to report a greater number of pain sites over treatment was noted. While medical status variables (disease stage and site) were found to predict pain status after the initial phase of cancer treatment, initial pain measurements were more likely to predict pain status at the completion of treatmen

ISSN:0148-6403    

DOI:10.1002/hed.2890080308

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

年代:1986

数据来源: WILEY

摘要:

AbstractWe have reviewed a 35‐year experience with 2,807 patients treated for salivary tumors which arose in the parotid gland (1,695 patients; 70%), submandibular gland (235 patients; 8%), and seromucinous glands of the upper aerodigestive tract (607 patients; 22%). Pleomorphic adenomas comprised 45% of the total, most of which occurred in the parotid gland. The clinical findings and the distribution of patients according to the histology and the site of origin are summarized. Treatment was surgical and the resection was conservative when possible, depending upon the extent of the tumor. The impact of site, histology, grade, and tumor stage on the results is show

ISSN:0148-6403    

DOI:10.1002/hed.2890080309

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

年代:1986

数据来源: WILEY

摘要:

AbstractThe complications following 100 consecutive laryngectomies performed at our hospital during a recent 18‐month period are reviewed. The complication rates for total laryngectomy (63 patients) and extended laryngectomy (37 patients) were 19% and 49%, respectively, while the fistula rates were 8% and 27%, respectively. These rates were influenced primarily by the extent of surgery and the type of reconstruction, which during this interval included primary closure, pectoralis major myocutaneous flap, or gastric transposition. In comparison to our previous study, when the deltopectoral flap was used for patching the pharynx, the fistula rate for extended laryngectomy has decreased as a result of our use of myocutaneous flaps and greater expeience with gastric transposition. Currently, we use the pectoralis major myocutaneous flap for pharyngeal repair if the mucosa would otherwise be closed under tension. All circumferential defects are repaired with a gastric transpositio

ISSN:0148-6403    

DOI:10.1002/hed.2890080310

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

年代:1986

数据来源: WILEY

摘要:

AbstractThe mandible is an uncommon presentation site for lymphoma and misdiagnosis is common. Eleven patients with lymphoma of the mandible were seen between 1947 and 1983. In 5 of the 11 patients, the diagnosis of lymphoma could not be established from the initial biopsy and additional material for examination was required. In three patients, this resulted in a partial or total removal of the mandible. In a recent histopathologic review, the diagnosis of diffuse large cell was made in seven, diffuse undifferentiated (non‐Burkitt's) in two, diffuse undifferentiated (Burkitt's) in one, and unclassified in one. Using the Ann Arbor method of staging, six patients were determined to have stage IE disease; three had stage IIE, and two had stage IV. In 10 patients definitive treatment consisted of radiotherapy, chemotherapy, or a combination of both. Treatment was limited to surgery in one patient. The 5‐year overall and disease‐free survival rates were 62% and 50%, respectively. These results are comparable to those for lymphoma of other extranodal head and neck

ISSN:0148-6403    

DOI:10.1002/hed.2890080311

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

年代:1986

数据来源: WILEY