Chemotherapy of head and neck cancer.
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Head and Neck Neoplasms↗
Biomedical subjects
H Goepfert
Publications and source records attributed to H Goepfert.
The violated neck: cervical node biopsy prior to definitive treatment.
The intent of this study was to determine whether open neck biopsy for patients with squamous cell carcinoma metastatic to the neck influenced the biologic course of the disease or the response to treatment. One hundred ninety-two patients, treated over a 10-year period at M.D. Anderson Hospital and Tumor Institute, were reviewed; 102 of the 139 patients, whose primary site of disease was identified prior to definitive treatment, were matched with a control group of 204 patients. The results showed no significant difference in wound complications, neck recurrence, distant metastases, and 5-year survival. Also, time interval from the biopsy to subsequent treatment and the type of node biopsy did not appear to have any significant detrimental effect. On the basis of these findings, we conclude that, although it is important to refrain from proceeding with an open biopsy until a complete head and neck evaluation has been done, violation of the neck does not signify a poorer prognosis--provided adequate treatment is subsequently given.
Adolescent↗
Desmoid fibromatosis: a clinicopathologic study of 25 children.
We studied 25 patients under 15 years of age with desmoid fibromatosis (DF). There were 15 boys and 10 girls; 13 were under seven years of age and 12 were above. Histologically, DF was identical to DF in adult patients, except for a higher mitotic rate in children's tumors. The tumors were located on the head and neck (8), upper (7) or lower (6) extremities, or the trunk (4). Patients with head and neck DF received preoperative adriamycin and 5-(dimethyltriazeno) imidazole-4-carboxamide or a combination of vincristine, actinomycin D, and cyclophosphamide. In seven patients, tumor reduction began to occur during chemotherapy, while in one patient, there was no response at all. Five patients underwent conservative resections of their residual tumors, and in two patients, all tumor disappeared necessitating no additional surgery. Follow-up in these patients indicates that 6 have no evidence of disease, 1 is alive with recurrent disease, and 1 is lost to follow-up. Surgery was the primary modality of treatment for the trunk and extremity lesions. Twelve patients had no evidence of disease from 2 months to 25 years and 5 months, two died from complications of chemotherapy, and three were lost to follow-up. Our experience agrees with that of other investigators that DF is best managed surgically. However, preoperative chemotherapy should be strongly considered for patients with tumors occurring in the head and neck areas.
Adolescent↗
Malignant fibrous histiocytoma of jaws. A clinicopathologic study of 11 cases.
Malignant fibrous histiocytoma (MFH) of the jaws is a highly malignant tumor that recurs, metastasizes, and usually causes death despite aggressive surgical therapy. This clinicopathologic review looks at five patients with MFH of the maxilla and six with MFH of the mandible. Five male and six female patients ranged in age from 12 to 75 years (mean, 35.4 years). All patients had large lytic areas of bone destruction, often with soft tissue extension. Two cases were postirradiation sarcomas, one of the maxilla and the other of the mandible. All patients underwent surgery and eight patients received chemotherapy when disease recurred locally or metastasized. Seven patients had local recurrences 3 to 13 months following surgery, and six patients had distant metastases. Of the 11 patients, 7 died of their disease, 1 died of unknown causes, and another with extensive local disease was lost to follow-up after 1.7 years. Two patients with recurrent disease are alive at 18 and 27 months postoperatively.
Adolescent↗
DNA flow cytometry of thyroid neoplasms.
Mechanically dispersed cell suspensions from 23 thyroid lesions were studied by acridine orange flow cytometry. Eight of 14 carcinomas (three papillary, two medullary, two Hürthle cell, and one follicular) manifested abnormal DNA indices ranging from 0.6 to 2.0. Six carcinomas (four papillary and two medullary) were diploid. Four patients having papillary carcinomas with diploid DNA content were young women whose clinical course of disease was indolent. Three papillary carcinomas with abnormal DNA content were found in older men with clinically aggressive disease. One benign adenomatoid nodule displayed a small population with a low-degree hyperdiploid stemline (DNA index = 1.1) with low proliferative activity. Differentiation between clinically indolent and aggressive carcinomas may be possible by nuclear DNA determination, but further work is needed to determine the importance of proliferative activity in thyroid carcinoma.
Adenocarcinoma↗
Chemotherapy for aggressive juvenile nasopharyngeal angiofibroma.
Five patients with recurrent juvenile nasopharyngeal angiofibromas were treated with antineoplastic chemotherapy. All patients had tumor remission without recurrence; there were no sequelae after this therapy.
Adolescent↗
Pharyngoesophageal reconstruction.
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Humans↗
The effect of surgery on natural killer cell activity in head and neck cancer patients: in vitro reversal of a postoperatively suppressed immunosurveillance system.
Curative surgery diminished natural killer (NK) cell activity in 17 patients with previously untreated squamous cell carcinoma of the head and neck (37% +/- 17%, preoperatively vs. 21% +/- 11%, postoperatively; p less than 0.001). This operatively induced suppression was dependent on the presence of a nylon wool adherent cell population. With the removal of this surgically generated suppressor population from the in vitro assay, postoperative suppression of natural killer activity was significantly diminished (21% +/- 13%, vs. 30% +/- 23%, p less than 0.01). The capability of fully restoring postoperatively suppressed NK cell activity was subsequently demonstrated by the synergistic effect of removing a nylon wool adherent suppressor population and stimulating NK cells with a naturally occurring immunopotentiator, tuftsin (from 21% +/- 13% to 41% +/- 23%; p less than 0.0001). In utilizing biological response modifiers in the perioperative period in the cancer patient, the interaction of these agents and the surgically generated suppressor cell population needs to be considered.
Aged↗
A comparative analysis of lymphomas involving Waldeyer's ring and the nasal cavity and paranasal sinuses.
The two major extranodal sites for malignant lymphoma of the head and neck are Waldeyer's ring and the nasal cavity and paranasal sinuses. The clinical manifestations, treatment, and survival results are presented for 137 patients with primary lymphoma of Waldeyer's ring and 38 patients with primary lymphoma of the nasal cavity and paranasal sinuses. The similarities of and differences between the two sites are discussed and compared to their more common counterparts the carcinomas. The results of this study indicate that the TNMAJCC method of staging Ann Arbor stage IE and IIE non-Hodgkin's lymphoma is a reliable prognostic indicator for these sites and should be considered when determining treatment.
Adult↗
Antibody-dependent cellular cytotoxicity and disease course in North American patients with nasopharyngeal carcinoma: a prospective study.
It has previously been reported that antibody-dependent cellular cytotoxicity (ADCC) levels determined at diagnosis against Epstein-Barr virus (EBV)-specific membrane antigens (MA) are predictive of disease course following therapy in patients with nasopharyngeal carcinoma (NPC). In general, survival was significantly shorter following therapy in patients with low ADCC titers at diagnosis versus those with high titers. To examine this further, a prospective study on North Americans with different histopathological types of this disease was initiated approximately 5 years ago. The results to date tend to support the conclusions drawn from the retrospective study for patients with the more poorly differentiated types (WHO 2 and WHO 3) of this disease. Over the first 3 years of this study, approximately 75% of the patients in the "high" category have remained clinically disease-free for 3 years or longer as opposed to approximately 35% of the patients in the "low" group. Disease progression rates were calculated to be approximately four times higher in the low group. Similar trends were noted in actual survival rates over a 3-year period. ADCC titers were in general found to be relatively stable in sequential serum samples from the same patient, with some exceptions. With the exceptions, however, changes in ADCC titers also reflected disease course. These results indicate, therefore, that anti-EBV ADCC titers are predictive of disease course in patients with the poorly differentiated types of NPC.
Actuarial Analysis↗
Lymphoepithelial carcinoma (malignant lymphoepithelial lesion) of the salivary glands.
Lymphoepithelial carcinoma is a rare tumor of the salivary gland of exceptionally high incidence among Eskimo. Three of our patients (one Hispanic, one Filipino, and one American white) had this neoplasm in the parotid gland. Electron microscopic examination of one of these tumors confirmed the squamous epithelial origin of the lesion. These three new cases bring the total number of cases reported thus far to 29. Some clinical features and treatment are briefly reviewed.
Adult↗
Thyroid cancer in children and teenagers.
A study of thyroid cancer in patients younger than 20 years showed most tumors to be of the differentiated type. Histological types were pure papillary adenocarcinoma (9.5%), mixed papillary and follicular adenocarcinoma (77%), pure follicular adenocarcinoma (2.7%), and medullary carcinoma (10.8%). Of the patients with differentiated carcinoma, 84% had palpable cervical lymphadenopathy and 11% had pulmonary metastasis on admission. Patients with differentiated carcinoma were followed up for a mean of 15.4 years, and patients with medullary carcinoma for a mean of 7.3 years. No patient died as a result of papillary or follicular carcinoma, but two (25%) died of medullary carcinoma. Permanent hypoparathyroidism was found in 17% of patients after total thyroidectomy.
Adenocarcinoma↗
Oat cell carcinoma of the larynx and Eaton-Lambert syndrome.
Oat cell or undifferentiated small cell carcinoma is a rare malignant tumor of the larynx. Since this lesion was first described, only 23 cases have been reported in the literature. Oat cell carcinoma of the lung, however, accounts for 20% to 25% of all lung cancers and is frequently associated with a variety of paraneoplastic syndromes. A 64-year-old woman had a primary oat cell carcinoma of the supraglottic larynx associated with clinical and electromyographic evidence of the myasthenic syndrome of Eaton-Lambert. To our knowledge, this is the first description an oat cell carcinoma of the larynx associated with this syndrome, which supports the theory that oat cell cancers of the larynx and lung have a common histogenesis.
Carcinoma, Small Cell↗
Are we making any progress?
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Head and Neck Neoplasms↗
Merkel cell carcinoma (endocrine carcinoma of the skin) of the head and neck.
Merkel cell carcinoma, also known as endocrine carcinoma of the skin, is a recently recognized and particularly aggressive form of skin cancer that exhibits histologic features similar to those of endocrine malignant neoplasms arising from other tissues. Forty-one patients with Merkel cell carcinoma arising from the cutaneous surfaces of the head and neck were seen at the University of Texas M. D. Anderson Hospital, Houston, between 1966 and 1983. Regional lymph node metastasis occur early and frequently, with a 79% overall incidence observed during the course of the disease. Treatment should consist of a wide resection of the primary tumor. A regional lymphadenectomy, when feasible, is successful in controlling nodal metastases. Postoperative radiation is recommended as an important adjuvant.
Adult↗
Management of stage T3 and T4 glottic carcinomas.
Between 1959 and 1979, 242 patients with T3 and T4 lesions of the vocal cords were treated at our institution. Treatment consisted of total laryngectomy in all patients. Different modalities of regional node dissections were performed on 187 patients. In addition, 50 patients received irradiation with cobalt-60 postoperatively for specific features of the disease. In the group of 192 patients whose treatment consisted of surgery alone, 28 (14 percent) had recurrence in the neck and 10 (5 percent) had stomal recurrence. Of the patients treated with combined therapy, three (6 percent) had ipsilateral neck recurrences and one (2 percent) had stomal recurrence. For lesions staged N0, failure rates above the clavicles were 16 percent and 31 percent for patients with T3 and T4 lesions, respectively, in the group treated by surgery alone, 9 percent and 6 percent for patients with T3 and T4 lesions, respectively, in the combined therapy group. The rate of failure above the clavicles for lesions staged N+ was 32 percent in the group treated with surgery alone and 8 percent in the combined therapy group. In this study, a correlation was made between the failure rates above the clavicles and different clinical and histologic characteristics of the tumor, surgical findings, and the different modalities of cervical node dissection used. From analysis of the data, recommendations have been made for the selective treatment of patients with advanced glottic carcinomas.
Adult↗
Perineural invasion in squamous cell skin carcinoma of the head and neck.
On review of 520 patients with 967 squamous cell carcinomas of the skin of the face treated at The University of Texas M.D. Anderson Hospital and Tumor Institute at Houston during a 10 year period, 14 percent of the patients were noted to have perineural extension of tumor. Study of the patients with perineural tumor demonstrated an increased incidence of spindle cell and adenosquamous cell types, an increased incidence of cervical lymphadenopathy and distant metastasis, and significantly reduced survival curves compared with those of patients with squamous cell skin carcinoma without perineural invasion. Tabulation confirmed that the maxillary and mandibular branches of the trigeminal nerve and the facial nerve were most commonly involved. For patients with squamous cell skin carcinomas with perineural invasion, aggressive therapy is recommended, specifically, resection of involved tissues and nerves and appropriate regional lymphadenectomy followed by postoperative radiotherapy. This plan affords the best opportunity for tumor control. The indications for exploration of the middle fossa of the intracranial portion of the trigeminal nerve deserve further study.
Adult↗
Does the diagnosis of depression in head and neck cancer mask organic brain disease?
Scant attention has been paid to emotional changes as possible symptoms of impaired cerebral functioning in cancer patients. A retrospective study was conducted to determine the variety of organic brain syndromes (OBS) that presented with depressive symptoms in 20 head and neck cancer patients. The impressions of referring surgeons were in error in 16 patients (80%). Twelve (60%) had unsuspected OBS, with treatment resulting in reversal of symptoms in almost half. Of the eight patients with functional disorders, four received a final diagnosis of depression. Head and neck surgeons should be aware that (1) emotional changes in their patients frequently reflect OBS, some potentially reversible, (2) because of the ages of the patients, senile dementia may be a more common occurrence in head and neck cancer than suspected, and (3) because of the difficulties of evaluating changes in higher mental functions, more neuropsychiatric consultations may be warranted for head and neck patients.
Aged↗