ISSN:0148-6403    

DOI:10.1002/hed.2890060302

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

年代:1984

数据来源: WILEY

摘要:

AbstractRecurrence at the primary site is an important cause of morbidity and mortality in head and neck cancer. In patients with stages III and IV disease treated surgically at Memorial Sloan‐Kettering Cancer Center between 1960 and 1970, cancer recurred at the primary site in 39% even when the margins had been deemed satisfactory, and in 73% when the margins were unsatisfactory. Between 1975 and 1980, we treated 114 previously untreated patients with stages III and IV epidermoid carcinoma of the oral cavity, oropharynx, hypopharynx, or larynx with a combination of surgery and postoperative radiation therapy. Twenty‐seven patients also received preoperative chemotherapy. One hundred seven patients were evaluable for disease control at the primary site by the combined treatment. Cancer recurred at the primary site in 6 patients, including 2% of 47 patients whose surgical margins had been satisfactory and 10.5% of 60 patients whose surgical margins had been unsatisfactory. Of the latter, recurrence was seen in 5% of the 25 patients whose margins were less than 5 mm but were microscopically uninvolved, and in 15% of the 35 patients whose margins were microscopically involved by cancer. Comparison of these data with our historical control group suggests a decrease in the failure rate at the primary site with multimodality treatment. However, it still appears important to secure microscopically negative margins for the best resu

ISSN:0148-6403    

DOI:10.1002/hed.2890060303

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

年代:1984

数据来源: WILEY

摘要:

AbstractFailure in the neck is an important cause of morbidity and mortality in head and neck cancer. Patients who underwent therapeutic or elective radical neck dissection at Memorial Sloan‐Kettering Cancer Center between 1960 and 1966 developed recurrence of cancer in the dissected neck in 36.5% of the cases when metastatic carcinoma was present in the cervical lymph nodes at one level, and in 71.3% when metastases were present at multiple levels. Between 1975 and 1980, we treated 114 previously untreated patients with stages III and IV epidermoid carcinoma of the oral cavity, oropharynx, hypopharynx, or larynx with the combination of surgery and elective postoperative radiation therapy. Of these, 106 patients underwent radical neck dissection and 94 were proven to have metastatic carcinoma in the neck. Eleven patients developed recurrences in the neck. Recurrence developed in 16% of 19 patients with metastases at one level, and in 13% of 75 patients with metastases at multiple levels. For 53 patients, radiation therapy was started within 6 weeks after neck dissection and only 2% of them developed recurrence in the neck; for 41 patients, radiation therapy started later than 6 weeks and 29% of them developed recurrence (P<0.01). Comparison of these data with our historical control group suggests a decrease in the number of failures in the neck when a multimodality treatment is used. It appears, however, that irradiation must be started within 6 weeks after surgery for the best result

ISSN:0148-6403    

DOI:10.1002/hed.2890060304

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

年代:1984

数据来源: WILEY

摘要:

AbstractFailure at distant sites has generally not been regarded as a major cause of morbidity and mortality in head and neck cancer. Among patients with advanced cancer of the mouth and throat, treated at Memorial Sloan‐Kettering Cancer Center between 1960 and 1965, over 75% succumbed because of failure to control the disease, but distant metastases were the primary cause of failure in only 4%. More recently, with better local‐regional control of cancer using multimodality treatment, failure at distant sites has become much more of a problem, however. Between 1975 and 1980, we treated 114 previously untreated patients with stages III and IV epidermoid carcinoma of the oral cavity, oropharynx, hypopharynx, and larynx with a combination of surgery and postoperative radiation therapy. Twenty‐seven patients also received preoperative chemotherapy. Twenty patients developed distant metastases (12 in the lungs, 7 in the spine, and 1 on the trunk). The incidence of distant metastases was higher in those patients who presented with palpable cervical lymph nodes than in those who did not (25% vs. 4%,P<0.05), and especially in those patients who pathologically had metastases at multiple levels in the neck than in those who had metastases at a single level or had negative nodes (35% vs. 5%,P<0.05). Therapeutic strategies aimed at decreasing the incidence of distant metastases in patients with advanced head and neck cancer should be studied in patients who are pathologically found to have lymph node metastases at multiple levels in the

ISSN:0148-6403    

DOI:10.1002/hed.2890060305

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

年代:1984

数据来源: WILEY

摘要:

AbstractOne hundred fourteen patients with advanced (stage III or IV) epidermoid carcinoma of the oral cavity, pharynx, larynx, and hypopharynx were treated by surgery and postoperative radiation therapy between 1975 and 1980. Twenty‐seven patients also received preoperative platinum‐containing chemotherapy. Sixteen patients developed second malignant neoplasms. The site of the second malignant neoplasm was in the esophagus in seven patients (44%), in the lung in six patients (37.5%), and at other sites in three patients (18.5%). Relapse of the head and neck cancer (at the primary site in 6 patients, in the neck in 11 patients, and at distant sites in 20 patients) appeared within the first 2 years in virtually all cases. In contrast, second malignant neoplasms have appeared at a steady rate of approximately 6% per year, for at least the first 4 years. Future efforts at improving the survival of patients with advanced head and neck cancer, therefore, must include strategies aimed at decreasing the incidence and the morbidity and mortality from second malignant neopla

ISSN:0148-6403    

DOI:10.1002/hed.2890060306

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

年代:1984

数据来源: WILEY

摘要:

AbstractTwenty‐eight patients with measurable or evaluable, regionally advanced or metastatic head and neck cancer received the combination of cyclophosphamide (C), adriamycin (ADR), and a 24‐hour infusion of cis‐diamminedichloroplatinum (II) (P). Most patients had received extensive prior surgery and radiation therapy, but only two had prior chemotherapy. We observed a 46% response rate (13/28) which included five complete responders and eight partial responders. Nine of the 13 patients responded within the initial month of treatment. The median response duration for the 13 responding patients was 7.5 months. Moderate to severe nausea and vomiting, and alopecia were the most significant toxicities. Myelosuppression (WBC<4,100 cells/mm3) occurred in 90% of patients but there were no episodes of sepsis, nor did we detect any meaningful impairment in renal fun

ISSN:0148-6403    

DOI:10.1002/hed.2890060307

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

年代:1984

数据来源: WILEY

摘要:

AbstractMost benign and malignant lesions of the posterior third of the tongue may be approached through a median labiomandibular glossotomy. This is accomplished by splitting the lower lip, mandible, floor of the mouth, and tongue in the midline to expose such areas as the posterior tongue, pharynx, and nasopharynx. This technique is useful for lesions of the posterior third of the tongue for several reasons: 1) it provides excellent exposure, 2) it is cosmetically superior to most other approaches, 3) it allows for several alternatives to reconstruction, such as retrusion or rotation tongue flaps, 4) the procedure sustains minimum blood loss since the tongue is bisected in the midline in an avascular plane, (5) when preoperative radiation therapy has been included, this approach minimizes the amount of surgery performed through the radiated field, and 6) postoperative tongue mobility is usually sufficient to permit articulation and deglutition to approach normal. The Cleveland Clinic Foundation's experience with this approach is reviewed, the technique is described, and a variety of cases are presented to illustrate its applicability.

ISSN:0148-6403    

DOI:10.1002/hed.2890060308

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

年代:1984

数据来源: WILEY

摘要:

AbstractDespite almost 3 decades of experience, the use of intraarterial (IA) chemotherapy for the treatment of head and neck cancer is not universally accepted. The overall reported response rates are not substantially different from the therapeutic results obtained with systemic therapy. The additional complications associated with establishing and maintaining arterial access have further dampened enthusiasm for this approach. It is clear that considerable improvement in the techniques and efficacy of IA chemotherapy is necessary. This second and last part of this article considers the past and present clinical experience with IA therapy in the treatment of head and neck cancer and explores future developments.

ISSN:0148-6403    

DOI:10.1002/hed.2890060309

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

年代:1984

数据来源: WILEY

摘要:

AbstractMalignant tumors of the paranasal sinuses are often found to be greatly advanced by the time a clinical or radiologic diagnosis is established. Therefore, the overall cure rate is low, even when surgery and radiation therapy are combined. The clinical manifestations and pathologic findings are analyzed in 200 cases to illustrate the wide spectrum of these tumors as to their type, specific location, and the extent to which they can spread within the sinuses and to adjacent anatomic areas. The various radiologic modalities, including conventional x‐ray films, angiography, and conventional and computed tomography are presented. Their relative merit in the diagnosis and staging of these tumors is evaluate

ISSN:0148-6403    

DOI:10.1002/hed.2890060310

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

年代:1984

数据来源: WILEY

ISSN:0148-6403    

DOI:10.1002/hed.2890060311

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

年代:1984

数据来源: WILEY