Biomedical subjects

Glenn Peters

Publications and source records attributed to Glenn Peters.

3 recordsLinked to original sources

PubMed2004

Simplifying head and neck microvascular reconstruction.

BACKGROUND: Free-tissue transfer has become the preferred method of head and neck reconstruction but is a technique that is considered to use excessive hospital resources. METHODS: This study is a retrospective review of 125 consecutive free flaps in 117 patients over a 16-month period at a tertiary care university hospital. RESULTS: Defects of the oral cavity/oropharynx (60%), midface (9%), hypopharynx (15%), or cervical and facial skin (16%) were reconstructed from three donor sites: forearm (70%), rectus (11%), and fibula (19%). Microvascular anastomoses were performed with a continuous suture technique or an anastomotic coupling device for end-to-end venous anastomoses. A single vein was anastomosed in 97% of tissue transfers. There were five flaps (4%) requiring exploration for vascular compromise, and the overall success rate was 97.6%. The major complication rate was 13%. Mean hospital stay was 7 days for all patients and 5 days for those with cutaneous defects. Combined ablative and reconstructive operative times were 6 hours 42 minutes, 7 hours 40 minutes, and 8 hours 32 minutes for forearm, rectus, and fibular free grafts, respectively. A subset of this patient series with oral cavity and oropharynx defects (76 patients; 58%) available for follow-up (74 patients) was assessed for deglutition. Forty-three patients (58%) had a regular diet, 22 patients (30%) had a limited diet or required supplemental tube feedings, and nine patients (12%) were dependent on tube feedings with a severely limited diet. CONCLUSIONS: This series suggests that most head and neck defects can be reconstructed by use of a simplified microvascular technique and a limited number of donor sites. Analysis of operative times and length of stay suggest improved efficiency with this approach to microvascular reconstruction. Complications and functional results are comparable to previously published results.

Adult↗

PubMed2003

Outcome of salvage total laryngectomy following organ preservation therapy: the Radiation Therapy Oncology Group trial 91-11.

OBJECTIVE: To evaluate the incidence of morbidity, mortality, and disease control for patients requiring salvage total laryngectomy (TL) following organ preservation therapy. DESIGN: Patients entered into a 3-arm randomized prospective multi-institutional trial for laryngeal preservation who required TL following initial treatment. SETTING: The Radiation Therapy Oncology Group 91-11 trial for laryngeal preservation. PATIENTS: From 1992 to 2000, 517 evaluable patients were randomized to receive chemotherapy followed by radiation therapy (arm 1), concomitant chemotherapy and radiation therapy (arm 2), or radiation therapy alone (arm 3). RESULTS: Overall, TL was required in 129 patients. The incidence was 28%, 16%, and 31% in arms 1, 2, and 3, respectively (P =.002). Of these, 7 patients (5%) required TL for aspiration or necrosis. Following TL, the incidence of major and minor complications ranged from 52% to 59% and did not differ significantly among the 3 arms. Pharyngocutaneous fistula was lowest in arm 3 (15%) and highest in arm 2 (30%) (P>.05). There was 1 perioperative death. Local-regional control following salvage TL was 74% for arms 1 and 2 and 90% for arm 3. At 24 months, the overall survival was 69% (arm 1), 71% (arm 2), and 76% (arm 3) (P>.73). CONCLUSIONS: Laryngectomy following organ preservation treatment is associated with acceptable morbidity. Perioperative mortality is low but up to one third of patients will develop a pharyngocutaneous fistula. Local-regional control is excellent for this group of patients. Survival following salvage TL was not influenced by the initial organ preservation treatment.

Carcinoma, Squamous Cell↗

PubMed2003

Phase 1 trial of combined chemotherapy and reirradiation for recurrent unresectable head and neck cancer.

BACKGROUND: The management of recurrent unresectable head and neck cancer remains a challenging problem. Based on the circadian rhythm concept, we sought to determine the maximum tolerated dose (MTD) of infusional 5-flourouracil (5-FU), hydroxyurea (HU), and reirradiation (RT). METHOD: Bolus 5-FU was escalated from 300 mg/m(2)/d to a 10-hour infusion beginning at midnight, increased at 150 mg/m(2)/d increments. HU, 1.5 g, remained constant. Chemotherapy was given on weeks 1 and 4. RT was given daily, 2.0 Gy per fraction on weeks 1 and 2 followed by a 1-week break, then hyperfractionated weeks 4 and 5, total dose 50 Gy. The goal was to deliver a continuous course of RT to 60 Gy after the MTD was determined with an additional week of chemotherapy. RESULTS: Six cohorts were treated to establish the 5-FU MTD of 900 mg/m(2)/d. The seventh cohort received continuous RT and 5-FU, 750 mg/m(2)/d, one dose level below the MTD. Two hematologic, three skin, and six mucosal >or= grade 3 toxicities were noted in 7 of 16 patients. The median survival was 10.2 months and the 1-year survival was 41%. The median survival for the entire group was 9.4 months, with a 1- and 2-year survival of 39% and 15%, respectively. CONCLUSION: RT can be given in a continuous fashion with concurrent 5-FU and HU. Because radiation sensitization should be achievable at nontoxic doses of 5-FU, we recommend 600 mg/m(2)/d in phase a II setting.

Adult↗