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Biomedical subjects

H Goepfert

Publications and source records attributed to H Goepfert.

At least 91 records · Page 5Linked to original sources
PubMed1989

Prognostic factors in patients dying of well-differentiated thyroid cancer.

While some well-differentiated cancers of the thyroid gland are unusually aggressive, most have a more benign clinical behavior, making it difficult to evaluate factors possibly influencing patient survival such as initial surgical treatment. By studying 135 patients who received their initial surgical therapy at our institution, we have defined the prognostically significant factors. Sixteen patients (11.9%) died of disease during a ten- to 20-year follow-up period. Significant factors associated with death from disease were aged 40 years or older, primary lesion size of 2.5 cm or greater, presence of invasive characteristics, and presence of distant metastases. We recommend total thyroidectomy and postoperative sodium iodide I 131 therapy in patients 40 years of age or older, while suggesting a less aggressive approach may be appropriate in the younger patients.

Actuarial Analysis↗
PubMed1989

Desmoplastic melanoma. Histologic correlation with behavior and treatment.

Desmoplastic (neurotrophic) melanoma is a histologic variant of cutaneous melanoma that has a distinct clinical behavior. To better understand this behavior and to treat the disease more effectively, the medical records of 16 patients treated for this disease over a 12-year period were reviewed. Thirteen patients had head and neck lesions, the ear being a common site. The average thickness of the lesions was 5.75 mm. Six (46.2%) of 13 patients had local recurrence of disease. Only two patients (15.4%) developed regional node metastases. None of the patients with clinically NO desmoplastic melanoma were found to have positive nodes after elective neck dissection, regardless of the thickness of the primary lesion. Wide excision of the primary lesion with frozen section control of surgical margins and careful examination for the presence of perineural invasion is important in determining the extent of surgical resection.

Adult↗
PubMed1989

Superselective intra-arterial chemotherapy of advanced paranasal sinus tumors.

Twenty-four patients with advanced paranasal sinus tumors were treated with combined superselective intra-arterial and systemic chemotherapy, yielding an immediate satisfactory tumor response rate of 91%, significantly better than previously reported. Eight patients had craniofacial surgery circumvented because of complete or near complete response. Repetitive uncomplicated catheterization of the pterygoid segment of the internal maxillary artery using a coaxial system is the cornerstone of successful induction chemotherapy. Strenuous screening of medical status is mandatory for this aggressive introduction chemotherapy.

Adult↗
PubMed1989

Hyperfractionated radiotherapy in the treatment of squamous cell carcinomas of the supraglottic larynx.

From January 1984 through December 1987, 41 patients with squamous cell carcinomas of the supraglottic larynx were treated with hyperfractionated radiotherapy at The University of Texas M. D. Anderson Cancer Center. Two patients had T1 primary tumors, 23 had T2, 15 had T3, and 1 had T4; 29 patients had no clinical evidence of nodal disease in the neck, 4 had N1, 5 had N2, and 3 had N3. Radiotherapy was delivered in 120 cGy fractions twice per day, with at least 4 hr between treatments. Total doses ranged from 7200 to 7900 cGy (median, 7680 cGy). Three patients had planned neck dissections before or after radiotherapy, and three patients with fixed vocal cord lesions were treated with preradiation chemotherapy. At the time of analysis, median follow-up was 22 months. Four patients have had failures at the primary tumor site. There has been one recurrence in the neck in a patient who also had a recurrence at the primary site. Three of the four patients with recurrences have been successfully treated with salvage surgery. Exclusive of surgical salvage, the actuarial disease-free local control rates above the clavicles in the 38 patients with T2 and T3 cancers were 96% at 1 year and 87% at 2 years. In comparison, the rates were 82% and 76% for a group of 98 patients with T2 and T3 lesions treated at this institution from 1970 to 1981 with 6500-7000 cGy given in 200 cGy fraction per day. As predicted, acute reactions were more severe but late complications were not increased in patients who received hyperfractionated radiotherapy compared with those treated by conventionally fractionated therapy. Only two patients have developed severe late complications one of whom required laryngectomy. Hyperfractionated radiotherapy appears to provide improved local control with a similar incidence of late complications when compared with conventionally fractionated therapy. To further improve the therapeutic ratio, our current protocol has been amended by reducing the large field dose per fraction to 110 cGy (with a 2 day protraction of overall time) and requiring a minimum interfraction interval of 6 hr.

Adult↗
PubMed1989

DNA content and proliferative activity of myoepitheliomas.

This report adds 16 myoepitheliomas of salivary glands to the 47 already recorded in the literature. It includes, for the first time, a flow cytometric analysis of their ploidy (DNA content) and proliferative capacity (S-phase fraction). Thirteen myoepitheliomas were diploid; three were aneuploid in their DNA content. A high proliferative capacity was always associated with an abnormal DNA content. Only one diploid myoepithelioma had a high S-phase fraction. Both flow-cytometric parameters are good predictors of an aggressive biological behaviour. Recurrences, however, were all the outcome of incomplete primary removal of the myoepitheliomas. Four of the twelve (33 per cent) diploid myoepitheliomas recurred and one, with high S-phase fraction, led to the death of the patient. Two of the three (67 per cent) aneuploid myoepitheliomas recurred. Extensive loco-regional invasion by one killed the patient. The other has clinical evidence of distant metastasis.

Adolescent↗
PubMed1989

Transcranial resection of tumors of the paranasal sinuses and nasal cavity.

Combined cranial and facial procedures for resection of malignancies of the paranasal sinuses and nasal cavity have been used with variable success and complication rates in the last 25 years. A series of nine patients undergoing 10 exclusively transcranial procedures for these tumors is presented, and an effective technique for reconstruction without free tissue transfer is described. The patients in this series suffered no major complications, and all have remained free of disease during the short follow-up period. The technique described in this report offers the advantage of wide exposure, symmetrical approach to the superstructures of the face and orbits, the potential for resection of a large portion of the anterior cranial floor, and substantial reconstruction which is a major factor in avoiding complications.

Adolescent↗
PubMed1988

The implication of tobacco use in the young adult with head and neck cancer.

To define the biologic characteristics of head and neck cancer in the young adult, the clinical course of 83 previously untreated patients less than or equal to 40 years of age with head and neck cancer was reviewed retrospectively. Their course was compared to that in a randomly chosen, concurrently treated, site-matched and stage-matched older head and neck cancer population (matched control). Patterns of recurrence as well as overall disease-free survival in each of the two populations were not significantly different. An important stratification factor, however, was related to tobacco usage. Thirty percent of the young patients denied using tobacco compared with only 9% of the controls (P less than 0.05). The 5-year disease-free survival rate of the young adults who did not use tobacco was 66% compared with 86% for their matched control group with a history of smoking. These differences were most significant in young adults with Stage II disease (P less than 0.05 by log-rank testing). The growth and progression of head and neck cancer in the young adults is characterized by tobacco use patterns; a family history of head and neck cancer in five of 17 nontobacco using young adults raises the issue of an inherent genetic determinant.

Actuarial Analysis↗
PubMed1988

Squamous cell carcinoma of the upper aerodigestive tract. A case comparison analysis.

Although the etiologic importance of tobacco in risk of upper aerodigestive malignancies is unquestioned, quantification of subsite-specific risks is less well delineated. Risk estimates from this case-control study are derived from self-administered comprehensive risk factor questionnaires distributed to newly registered patients at The University of Texas M.D. Anderson Hospital and Tumor Institute, Houston. Cases included 185 white patients with histologically confirmed squamous cell carcinoma of the upper aerodigestive tract. An equal number of age-frequency and sex-frequency matched patients was randomly selected from the same patient population excluding only patients with diagnoses of squamous cell carcinoma of any site. A statistically significant dose-response relationship for three categories of cigarette pack-years was evident for both males (odds ratios [OR] = 1.8, 4.0, and 7.5) and females (OR = 1.5, 9.0, and 12.0). Highest risks were documented for laryngeal cancer (OR = 15.1) and lingual cancer (OR = 14.5). There was interaction between alcohol use and smoking among men, but no independent effect of alcohol consumption among either gender. After 15 years of smoking abstinence, males no longer exhibited increased risk (OR = 1.0) whereas the risk for females after 15 years of cessation was 1.5. There were also significantly increased risks among men associated with snuff dipping, cigar, and pipe use (OR = 3.4, 2.8, and 1.8, respectively). The differences in the magnitude of the risk estimates and dose-response curves by subsite and by sex suggest a variable susceptibility to carcinogenic action.

Adult↗
PubMed1988

Conservation surgery for T2 and T3 carcinomas of the supraglottic larynx.

The treatment of choice for supraglottic carcinomas of intermediate size (stages T2 and T3) remains controversial. Between 1974 and 1983 in our institution, 139 patients with supraglottic carcinoma of intermediate size were judged retrospectively to have been technically amenable to conservation surgery. Primary disease control at three years was achieved in 100% of the patients treated by supraglottic laryngectomy, 91% (34 patients) of those treated by total laryngectomy, and 69% (81 patients) of those treated by radiotherapy. Of the latter group, 62% were salvaged by total laryngectomy yielding a net three-year local control of 85%. Determinate five-year survival rates were 89% for supraglottic laryngectomy, 78% for total laryngectomy, and 70% for radiotherapy. Significant problems with aspiration occurred in four patients (16%) who were treated by conservation surgery, and two patients (8%) required a permanent tracheostomy. The results of this study show that supraglottic laryngectomy with postoperative radiotherapy as indicated is a highly effective method for the local control of supraglottic carcinoma of intermediate size that is amenable to conservation surgery.

Adult↗
PubMed1988

Acute and late toxicity associated with sequential bleomycin-containing chemotherapy regimens and radiation therapy in the treatment of carcinoma of the nasopharynx.

Between 1975 and 1984, 33 patients with squamous cell carcinoma of the nasopharynx received adjuvant chemotherapy before and/or after definitive radiotherapy at UT M. D. Anderson Hospital. The favored chemotherapy regimens during this time were BCMF (bleomycin, cyclophosphamide, methotrexate, and 5-FU) and PMB (cisplatinum, methotrexate, and bleomycin). Total radiation doses to the primary site averaged 65 Gy for T1 and T2 lesions and 70 Gy for T3 and T4 lesions. Neck nodes were given boost treatments to a maximum of 70 Gy, depending on the extent of the disease. The outcome of treatment in these patients was compared to that of a stage-matched group of 71 patients treated during the same time period with radiotherapy alone. However, the groups were not matched with regard to histologic subtypes: 45% of the radiation-only group had prognostically unfavorable keratinizing squamous carcinomas (WHO 1) compared with 18% of the combined modality group. Overall disease-free survival at 5 years was 63% in the combined modality group and 44% in the radiation only group (p = 0.15). Both acute reactions and late treatment complications were much more frequent and severe in patients receiving combined modality treatment. In patients treated with chemotherapy prior to radiation therapy, 10/20 (50%) experienced severe acute toxicity (RTOG Grade 3 or 4) versus 9/71 (13%) in the radiotherapy-only group. Severe late normal tissue injury occurred in 15/33 (45%) of the combined modality group versus 5/71 (7.0%) in the control group. The majority of the late complications in the adjuvant chemotherapy group consisted of severe soft tissue and muscle fibrosis. The average total bleomycin dose in the patients with severe late soft tissue and muscle fibrosis was 336 mg. The actuarial risk of developing a severe late complication by 2 years after treatment was 68% in the combined modality group versus 8% in the radiation-therapy-only group (p = .001). The probability of remaining both disease-free and complication-free at 5 years was 40% in the radiation-only group and 22% in the combined-modality group (p = 0.08). Comparison of these results with other published reports emphasizes the importance of late toxicity data in assessing the ultimate value of combined modality therapy.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1988

Interferon alfa-n1 (Wellferon) in juvenile onset recurrent respiratory papillomatosis: results of a randomized study in twelve collaborative institutions.

Sixty-six patients with clinically severe juvenile-onset recurrent respiratory papillomatosis (RRP) were entered into a 12-month randomized crossover study to evaluate interferon alpha-n1 Wellferon (WFN) as an adjuvant to CO2 laser surgical excision. Eligibility required disease onset to be before age 16, and an endoscopic excision requirement of at least three operations in the 6 months immediately prior to entry. Patients were randomized to Observation versus WFN at a dose of 5 MU/m2 daily for 28 days and three times weekly for 5 months. The patient groups were comparable in extent of disease at entry. Total extent of disease was determined by a composite score derived from the number of diseased anatomic sites and extent of surface area and lumen encroachment present at each site. Standard endoscopic excisions were performed every 2 months and clinical courses compared on a basis of composite scores determined at each endoscopy. Statistically significant improvement occurred in the patient group which received WFN. We conclude that interferon alpha n-1 is an effective adjuvant to surgery in RRP management.

Adolescent↗
PubMed1988

Wound prophylaxis with metronidazole in head and neck surgical oncology.

Anaerobic organisms are thought to be an important source of wound infection in head and neck oncologic surgery. Antibiotic prophylaxis consisting of agents specific for anaerobes combined with broad-spectrum agents that provide coverage for other well-recognized pathogens should be an effective combination regimen for this group of patients. We conducted a prospective, randomized study comparing the efficacy of prophylaxis using combination of metronidazole and cefazolin-designated group A, to prophylaxis using cefazolin alone-group B, for patients undergoing oncologic procedures of the head and neck. The rate of wound infection in the cefazolin-metronidazole group (158 patients) was 9.5%, compared with 18.6% in the cefazolin group (172 patients) (p = 0.03). Patients undergoing clean procedures had a 4.9% infection rate overall, compared with 17.9% for clean-contaminated procedures, and 33.3% for contaminated procedures. The average length of hospitalization was 20.7 days for patients who developed infections, compared with 8.9 days for patients without infection. Anaerobic organisms were cultured in 12 of 26 patients, ten of whom did not receive metronidazole. The lower rate of wound infection among patients who received metronidazole suggests that anaerobic organisms are an important source of wound infection in head and neck oncologic surgery. Chemoprophylaxis for these patients should, therefore, include specific anaerobic coverage in addition to the broad-spectrum agents that cover the more familiar aerobic organisms.

Bacteria, Anaerobic↗
PubMed1988

Pleomorphic adenoma of parotid with myoepithelial cell predominance.

Primary tumors of the parapharyngeal space are uncommon. We herein report a case of a pleomorphic adenoma of the parotid gland in a 43-year-old woman who presented with a parapharyngeal mass that was initially interpreted as a soft tissue sarcoma. Electron microscopic and immunohistochemical studies demonstrated the myoepithelial origin of the tumor.

Adenoma, Pleomorphic↗
PubMed1987

Adjuvant chemotherapy for advanced nasopharyngeal carcinoma.

The outcome of therapy is reported in 34 previously untreated patients with advanced-stage (AJC IV) nasopharyngeal carcinoma treated with combination chemotherapy (cisplatin and non-cisplatin based) and sequential radiation therapy. Sixty-nine patients treated with radiotherapy alone were used as a control group. The control group was matched for T and N stage grouping but differed in that 45% had keratinizing squamous carcinoma, 14.5% had nonkeratinizing squamous carcinoma, and 40.6% had undifferentiated carcinoma, compared with 18%, 50%, and 32.4%, respectively in the combined-treatment group. Seventeen of 21 patients (81%) who received chemotherapy followed by radiotherapy achieved complete remission (CR), whereas 11 of 13 patients (85%) who received radiotherapy followed by chemotherapy achieved CR (P = NS). Patients treated by radiotherapy alone had a 91% CR rate. The combined treatment yielded a relapse-free rate of 78% versus 44% for the radiotherapy group (P = 0.001). Median survival in the combined-treatment group has not been reached (111+ months), compared with 67 months in the group receiving radiotherapy alone (P = 0.04). The recurrence rate at the primary site and in regional nodes was more frequent in the radiotherapy group (36%), compared with the combined-therapy group (7%) (P = 0.004), but the occurrence of distant metastases was similar in each group (P = 0.41). The acute toxicity of the treatment was well tolerated. The major long-term toxic effect experienced by patients in the combined-therapy group was soft tissue fibrosis. These data suggest that a prospective trial comparing chemotherapy and radiotherapy versus radiotherapy alone is warranted.

Adolescent↗
PubMed1987

In situ hybridization of papillomavirus DNA in head and neck squamous cell carcinomas.

Cytospin preparations of fine-needle aspirates obtained from five squamous cell carcinomas of the head and neck (four metastatic in lymph nodes and one primary) were tested for human papillomavirus (HPV) genotypes 6, 11, 16, and 18 by in situ hybridization using biotinylated DNA probes. All five carcinomas showed hybridization with HPV-11, four strongly reactive, and one also weakly hybridized with HPV-16. Genotypes 6 and 18 showed no evidence of hybridization.

Carcinoma, Squamous Cell↗
PubMed1987

Estrogen receptors in normal salivary gland and salivary gland carcinoma.

To access for possible hormone dependence, 19 samples of normal salivary gland tissue and 14 samples of salivary gland carcinoma were quantitatively analyzed for estrogen receptor (ER) content. A receptor protein content of greater than or equal to 1 fmol/mg of cytosol protein was considered positive. Ten (77%) of 13 histologically normal samples, and four (80%) of five tumor samples obtained from male patients contained ER by this criterion, as did five (83%) of six normal samples and eight (88%) of nine tumor samples obtained from female patients. Mean ER concentrations plus or minus SE in male-derived samples were 2.02 +/- .42 fmol/mg of cytosol protein for normal tissue and 4.35 +/- 1.5 fmol/mg of cytosol protein for tumor tissue; mean ER concentrations in female-derived samples were 3.48 +/- 1.1 fmol/mg of cytosol protein for normal tissue and 12.64 +/- 6.4 fmol/mg of cytosol protein for tumor tissue. Four of eight tumors in women had levels considered to be "hormonally dependent" in breast carcinoma. These findings indicate that salivary gland carcinomas may be hormone-dependent.

Adenocarcinoma↗