Biomedical subjects
Publications and source records attributed to M B Spaulding.
A painless lateral neck mass in an otherwise healthy 58-year-old man is a frequent diagnostic problem. We have recently seen such a patient with a cervical neck mass whose preoperative evaluation findings were normal. Excisional biopsy revealed a lymph node exhibiting changes compatible with extramedullary hematopoiesis. This becomes an additional unusual cause of enlarged lateral neck nodes.
Two courses of triple-agent chemotherapy were given to 47 patients with advanced head and neck cancer. All but one patient with a nasopharyngeal carcinoma had resectable stage III and IV squamous cell carcinoma. Eighty-eight percent of the patients responded to the chemotherapy with a 50 percent or greater decrease in tumor size. Forty-three patients underwent surgical resection and 19 were histologically upgraded to stage II or better (T less than 2 cm, N0). None of these 19 patients have relapsed, with follow-up ranging from 12 to 42 months. In 12 of the 47 patients, recurrent tumor developed within the first 18 months of follow-up.
Methylglyoxal bis-dihydrochloride is a drug that has been available for use in cancer chemotherapy since 1955. In earlier studies, it was used on a daily schedule with resulting severe gastrointestinal toxicity and myelosuppression. To avoid that toxicity, a new weekly schedule has been adopted in several Phase II studies. With the weekly schedule, new types of toxicity have been described and we report four patients who have developed a severe sensory-motor neuropathy with the chemotherapy which appears to be drug-related.
In May 1978 a multimodal approach was begun for the management of patients with squamous cell carcinoma of the head and neck who presented with stage III and IV disease and whose chance of control by surgery alone was estimated to be 20 percent or less. Twenty-eight patients received two courses of chemotherapy consisting of cis-diamminedichloro platinum, vincristine and infusion bleomycin before undergoing surgery. The clinical response to this therapy judged preoperatively was surprisingly high. Three patients had no histologic evidence of tumor in the resected specimens, and toxicity was minimal. Twenty-five patients were treated surgically. No pre- or postoperative complications were attributable to chemotherapy. Three patients were treated with radiation therapy, one of whom died at 12 months with recurrent disease. Two patients died from causes unrelated to the tumor. Two patients have had recurrence of tumor. All others remain free of disease with follow-up of up ot 18 months.
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