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Biomedical subjects

N J Cassisi

Publications and source records attributed to N J Cassisi.

At least 19 recordsLinked to original sources
PubMed1992

Otolaryngology residency selection process. Medical student perspective.

In an effort to improve the otolaryngology matching process at the University of Florida, Gainesville, we sought to obtain the medical student's perspective of the current system. All students who interviewed here over a 3-year period were surveyed regarding the application, interview, and ranking process. In addition, suggestions for improving the system were sought from the students. The application and interviewing patterns of the students surveyed were found to be similar to those of the entire otolaryngology residency applicant pool. We were unable to identify any factors that influence a student's rank list that could be prospectively used to help select applicants for interview. A variety of suggestions for improvements in the match were received, several of which could easily be instituted. A uniform interview invitation date as requested by the students could be rapidly implemented and would provide benefits for both the students and the residency programs.

Florida↗
PubMed1992

Stage T3 squamous cell carcinoma of the glottic larynx: a comparison of laryngectomy and irradiation.

One-hundred eighteen patients with previously untreated T3 squamous cell carcinoma of the glottic larynx were treated with curative intent between March 1965 and November 1988 at the University of Florida. All patients were observed for at least 2 years and 83% were observed for 5 or more years. Fifty-three patients were treated with irradiation alone and 65 patients were treated with surgery alone (32) or combined with irradiation (33). Thirty-two patients treated with irradiation alone had twice-daily fractionation and the remainder had once-daily fractionation. The local-regional control rates, including patients successfully salvaged after a local-regional recurrence, were 81% after irradiation alone and 81% after surgery alone or combined with adjuvant irradiation. The local control rates for patients treated with irradiation alone were 53% after once-daily fractionation and 71% after twice-daily fractionation. There was no relationship between vocal cord mobility at 5000 cGy, at the end of radiotherapy, or at 1 month after treatment and subsequent local control. The 5-year cause-specific survival rates were 74% for patients treated with irradiation alone and 63% for patients treated surgically. The incidence of severe complications, including those associated with salvage procedures, was 15% for both treatment groups. The rates of laryngeal voice preservation were 66% after irradiation alone and 2% after surgery. Irradiation alone for selected patients with T3 glottic cancer resulted in similar rates of local-regional control, survival, and severe complications, with a significantly higher likelihood of voice preservation, compared with surgery.

Carcinoma, Squamous Cell↗
PubMed1992

Mandibular lingual releasing approach.

The mandibular lingual releasing approach to oral cavity and oropharyngeal tumors provides excellent visualization for resection while integrity of the mandibular arch is preserved. A lingual floor-of-mouth flap is created, which allows delivery of these structures directly into the neck without lip splitting, mandibulotomy, or mandibulectomy. The procedure was carried out on 15 patients between 1987 and 1991, with followup ranging from 2 to 50 months. Nine patients had received previous radiation, whereas planned postoperative radiation was administered to five patients. The visualization afforded by this technique was very good, in that 12 patients had clear margins of resection. Three patients had close margins; recurrent disease developed in one of these patients 18 months later. Twelve of the patients were able to maintain their weight with an oral diet alone. Four postoperative fistulae occurred, three of these were in patients who had not been previously irradiated. The single fistula that did not spontaneously heal occurred in a patient who had received previous radiation and was also on long-term corticosteroids. Mandibular osteoradionecrosis developed in two patients who received postoperative radiation. The complication rate after previous radiation is acceptable; however, there is risk of mandibular osteoradionecrosis after high-dose postoperative radiation.

Adult↗
PubMed1991

Primary subglottic cancer: results of radical radiation therapy.

Between October 1964 and December 1985, six patients with primary squamous cell carcinoma of the subglottis were treated with radical radiation therapy at the University of Florida. The disease was staged as Tis (one patient), T2N0 (two patients), and T4N0 (three patients). Local control was achieved with irradiation in four patients (66%) who were observed for 3.5, 4, 4, and 5 years after radiation therapy. Two patients whose tumors recurred at the primary site underwent salvage laryngectomy, which was successful in one patient.

Aged↗
PubMed1990

Is interstitial implantation essential for successful radiotherapeutic treatment of base of tongue carcinoma?

The role of interstitial implantation in the radiotherapeutic treatment of base of tongue carcinoma remains controversial. At the University of Florida, essentially all patients with base of tongue cancer have been managed initially by radiation therapy (with or without neck dissection) with operation reserved for radiation therapy failure. Eighty-four patients with invasive squamous cell carcinoma of the base of the tongue were treated with continuous-course external-beam irradiation without interstitial implantation between October 1964 and July 1986. Treatment was administered once-a-day in 59 patients and twice-a-day in 25 patients. The median follow-up was 99 months (range, 25-284 months). No patient was lost to follow-up. Local failure occurred in 1/9 patients (11%) with T1 lesions, 3/30 (10%) with T2, 6/31 (19%) with T3, and 9/14 (64%) with T4. If one excludes from the local control analysis those patients who died of intercurrent or metastatic disease within 2 years with their primary tumor continuously controlled, then the rates of local control are as follows: T1, 3/4; T2, 22/25 (88%); T3, 20/26 (77%); T4, 5/14 (36%). An improved local control rate for T4 tumors was noted with twice-a-day fractionation. Eighty-eight percent of N0-N1 necks and 79% of N2-N3 necks were treated successfully by irradiation with or without planned neck dissection. Five-year rates of continuous disease control above the clavicles were as follows: Stage I-II, 100%; Stage III, 72%; Stage IVA, 78%; Stage IVB, 44%. Five-year absolute and relapse-free survival rates for the entire group were 43% and 58%, respectively. The incidence of bone exposure was 6%, and that of soft-tissue necrosis was 19%. In all but one case, the complication was mild to moderate in severity and healed with conservative management. These results compare favorably with those recently published in the literature supporting moderate-dose external-beam irradiation combined with interstitial implantation. We conclude that interstitial implantation is not essential for the successful radiotherapeutic treatment of base of tongue carcinoma.

Adult↗
PubMed1989

Treatment with preoperative irradiation and surgery of squamous cell carcinoma of the head and neck.

This is an analysis of 103 patients with squamous cell carcinoma of the head and neck treated with preoperative radiation therapy (4000-6143 cGy; mean 4980 cGy) followed by primary resection and neck dissection. Patients were treated between March 1965 and April 1985; there was a minimum 2-year follow-up. Most of the patients in this study had clinical Stage III (28%) or IV (68%) disease. The actuarial survival rates were 51.5% at 2 years, 31.4% at 5 years, and 18.9% at 10 years. The rates of disease control above the clavicles at 5 years (actuarial method) as a function of modified AJCC stage were as follows: 100% for Stage II, 70.5% for Stage III, 44.8% for Stage IVA, and 45.7% for Stage IVB. T stage, N stage, neck node status (number, size, and fixation), and the pathology of the surgical specimen (tumor in the specimen, surgical margin positive, number of metastatic nodes, and presence of extracapsular extension) were important prognostic factors. The interval, between radiotherapy and surgery, and primary site (oral cavity vs. other sites) were not important prognostic factors. The rate of moderate-to-severe complications was 33.9% including eight patients who developed lethal complications after treatment. The influence of the radiation course, dose, and other factors on control of disease above the clavicles and on complications is presented.

Adult↗
PubMed1989

T2 oral tongue carcinoma treated with radiotherapy: analysis of local control and complications.

The purpose of this paper is to analyze the time factor and the proportion of the total dose delivered with external-beam irradiation versus interstitial implant in 42 patients with previously untreated T2 squamous cell carcinoma of the oral tongue managed with irradiation alone between 1964 and 1986. All patients had a 2-year minimum follow-up, and 93% were observed for at least 5 years. Seven patients died within 2 years of treatment with the primary site continuously disease-free and were excluded from analysis of local control. All patients were included in the analysis of complications. Patients were staged according to the 1983 AJCC staging system. Treatment was delivered with interstitial implant alone (4 patients), external-beam radiotherapy and implant (34 patients), or external-beam radiotherapy alone (4 patients). The following are the rates of local control with radiotherapy and ultimate local control, including patients successfully salvaged after a local recurrence: 21/35 (60%) and 26/35 (74%). In the group of patients treated with external-beam radiotherapy and an interstitial implant, local control was 12/16 (75%) for an implant plus less than or equal to 3000 cGy external-beam radiotherapy compared with 6/15 (40%) for an implant plus greater than 3000 cGy external-beam radiotherapy. For the entire group of patients, local control was 16/21 (76%) if the treatment time was less than 40 days and 5/14 (36%) if the overall treatment time was greater than 40 days.(ABSTRACT TRUNCATED AT 250 WORDS)

Brachytherapy↗
PubMed1989

Is elective neck treatment indicated for T2N0 squamous cell carcinoma of the glottic larynx?

This is an analysis of 98 patients with T2N0 squamous cell carcinoma of the glottic larynx treated with radiation therapy. Patients received irradiation to the primary lesion alone; the neck was not treated electively. All patients had at least 2 years of follow-up; patients who died within 2 years from treatment with the neck continuously disease-free were excluded from the analysis. The rate of control of neck disease following irradiation was as follows: primary site continuously disease-free, 73/75 (97%); primary tumor recurrence, 18/23 (78%). Salvage treatment was successful in 4 of 7 patients who developed recurrent disease in the neck. We conclude that elective treatment to the clinically negative neck is not indicated for patients with T2N0 squamous cell carcinoma of the glottic larynx. However, patients who develop a local recurrence following irradiation have a substantial risk of harboring disease in the neck and should undergo a neck dissection in conjunction with the surgical procedure selected to resect the recurrent disease at the primary site.

Carcinoma, Squamous Cell↗
PubMed1989

Postoperative irradiation for squamous cell carcinoma of the head and neck: an analysis of treatment results and complications.

One hundred thirty-four patients with advanced head and neck cancer were treated with radical surgery and postoperative radiation therapy between October 1964 and October 1984. All patients had greater than or equal to 2 years and 84% had greater than or equal to 5 years of follow-up. All patients included in the study were scheduled to receive continuous-course irradiation following a major cancer operation for previously untreated squamous cell carcinoma of the oral cavity, oropharynx, hypopharynx, or larynx and began radiation treatment less than or equal to 3 months after the surgical procedure. Ninety-six percent had AJCC pathologic Stage III or IV cancer, and all were without evidence of gross disease at the start of irradiation. The majority of recurrences above the clavicles occurred in the primary field (84%) as opposed to the posterior strip (8%) or low neck (8%). Based on multivariate analysis and tabular comparisons, 4 factors were found to be significantly important for predicting disease control above the clavicles: (a) Surgical margin (5-year actuarial control with invasive cancer at the margin, 53%, versus 81% with negative margins, p = .009). Patients with close margins or in situ cancer at the margins had the same rate of control as those with negative margins. (b) Primary site (oral cavity, 64%, versus other sites, 83%; p = .029). (c) Neck Stage (N0-1 versus N2-3). (d) Number of indications for irradiation--for example, bone invasion, multiple positive nodes, perineural invasion (1-3 indications, 85%, versus greater than or equal to 4, 62%; p = .06). The rate of disease control above the clavicles did not correlate well with AJCC pathologic stage: Stage I-II, 67%; Stage III, 81%; Stage IVA (T1-3, N2-3A), 68%; Stage IVB (T4 and/or N3B), 80%. The interval between surgery and the start of irradiation (range 1-10 weeks) also was not prognostically important, even with stratification by tumor dose, surgical margin, and number of indications for irradiation. At 5 years, the actuarial survival rate was 33% for the entire group; for patients with invasive cancer at the margin, the survival rate was approximately half that of those whose margins were free of invasive cancer (17% versus 37%). Based on multivariate analysis, 2 factors were found to significantly increase the probability of death due to cancer: (a) neck Stage (N0-1 versus N2-3); (b) extension of tumor from the primary site into the skin or soft tissues of the neck.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1989

Split-course versus continuous-course irradiation in the postoperative setting for squamous cell carcinoma of the head and neck.

There is very little published information comparing split-course and continuous-course irradiation in the adjuvant setting. To evaluate this issue, a retrospective analysis was performed of 161 patients with squamous cell carcinoma of the head and neck who received split-course (27 patients) or continuous-course (134 patients) irradiation following radical surgical resection. At 5 years, the actuarial rate of disease control above the clavicles for continuous-course irradiation was 80% versus 44% for split course (p = .002). Stratification of patients by primary site, surgical margin, AJCC stage, and tumor dose revealed a statistically significant (p less than or equal to .05) advantage in most of the subgroups for patients treated with continuous-course irradiation. The overall and cause-specific survival rates were also much better for patients treated with continuous-course irradiation, and the difference was highly statistically significant (overall 5-year survival, continuous course, 33%; split course, 15% [p = .005]; cause-specific 5-year survival, continuous course, 57%; split course, 37% [p less than .001]). A stepwise multivariate analysis confirmed that the type of irradiation course (continuous vs. split) was an independent prognostic variable of statistical significance for both control of disease above the clavicles and death with cancer present, with the split-course patients having worse results in both categories. The incidence of acute intolerance (4%) and late complications (7%) was the same in both the split- and continuous-course groups. As has previously been reported from this institution for patients treated with irradiation alone, these results demonstrate that in the postoperative setting, split-course irradiation yields lower local-regional control and survival rates compared with continuous-course therapy with no difference in the rate of severe complications. It is therefore recommended that split-course irradiation as used in this series be avoided whenever possible in patients with squamous cell carcinoma of the head and neck.

Adult↗
PubMed1988

Squamous cell carcinoma of the pharyngeal wall treated with irradiation.

This is an analysis of 74 patients with 75 squamous cell carcinomas of the pharyngeal wall treated with radical irradiation at the University of Florida between October 1964 and December 1984. All patients have a 2-year follow-up and 69% have a minimum 5-year follow-up. All patients were treated with continuous-course irradiation: 56 with once-a-day fractionation and 18 with twice-a-day fractionation. Patients treated with the split-course technique are not included in this series. Sixty-three patients were treated with external beam irradiation alone; 11 patients underwent an interstitial implant to the primary lesion following external beam irradiation. The local control rates with irradiation are as follows: T1, 3/4; T2, 12/21; T3, 12/27; and T4, 2/10. Only two patients were salvaged by operation for a local recurrence following irradiation. There was an improvement in the rate of local control with the use of twice-a-day fractionation and a decrease in the rate of local control with the combination of external beam irradiation and interstitial implant, compared with external beam irradiation alone. The 5-year determinate survival rates by AJCC stage are as follows: I, no data; II, 4/9; III, 3/16; and IV, 1/18.

Brachytherapy↗
PubMed1988

Malignant tumors of the nasal cavity and ethmoid and sphenoid sinuses.

Between October 1964 and December 1983, 48 patients with malignant tumors of the nasal cavity (31), ethmoid sinus (13), or sphenoid sinus (4) were treated with curative intent by radiation therapy. There were 21 squamous cell carcinomas, 14 minor salivary gland tumors (adenocarcinoma, adenoid cystic carcinoma, and mucoepidermoid carcinoma), 3 malignant melanomas, 2 soft tissue sarcomas, and 8 esthesioneuroblastomas. Forty-two patients were treated with irradiation alone and six with planned combined irradiation and surgery. The 10-year actuarial local control rate for Stage I (limited to site of origin; 7 patients) was 100%; for Stage II (extension to adjacent sites, e.g., adjacent sinuses, orbit, pterygomaxillary fossa, nasopharynx; 19 patients) was 53%; and for Stage III (destruction of skull base or pterygoid plates, or intracranial extension; 22 patients) was 30%. Of 24 failures at the primary site, 10 occurred greater than 24 months after completion of irradiation. With the exception of adenoid cystic carcinoma (17% local control at 15 years), the ultimate local control rates for all histologies were in the range of 40% to 60%. Of 7 patients with documented intracranial extension, 3 (43%) remained free from local recurrence 3.5, 4, and 9 years after treatment. The 5-, 10-, 15-, and 20-year uncorrected actuarial survival rates for all 48 patients were 52%, 30%, 22%, and 22%, respectively. Continuous disease-free survival according to stage at 10 years was 86% for Stage I, 42% for Stage II, and 22% for Stage III. The single failure in a patient with Stage I disease was a lymph node metastasis that was successfully managed by radical neck dissection. The orbit was grossly invaded by tumor prior to treatment in 22 patients (46%). Sixteen (33%) of 48 patients developed unilateral blindness secondary to radiation retinopathy or optic neuropathy; in the majority of these patients the complication was anticipated because the ipsilateral eye was irradiated to a high dose. Four patients (8%) unexpectedly developed bilateral blindness 17, 35, 46, and 90 months following treatment owing to optic nerve injury. A discussion of possible means of avoiding this latter, unacceptable complication is included.

Ethmoid Sinus↗
PubMed1988

Hyperfractionation for head and neck cancer.

Between March 1978 and April 1984, 144 patients with 148 moderately advanced to advanced primary squamous cell carcinomas of the head and neck received treatment with curative intent with twice-a-day irradiation (120 cGy/fraction, 4-6 hour interfraction interval). Eighty-eight percent of the patients had AJCC Stage III-IV cancers. One hundred and thirty-two patients received irradiation alone to the primary site with or without radical neck dissection, with surgery reserved for salvage. The total doses administered were 7440-7920 cGy in the majority of instances. In 19 patients with oropharyngeal lesions, a 1000-1500 cGy radium needle boost was added after the basic dose. Twelve patients received preoperative irradiation (5040-6000 cGy) followed by primary resection and radical neck dissection. Local control results following irradiation alone to total doses of greater than 7000 cGy with minimum 2-year follow-up were 25/31 (81%), 38/50 (76%), and 5/25 (20%) for T2, T3, and T4 cancers, respectively. Local control rates did not correlate well with total dose. Local control following preoperative irradiation plus primary resection was obtained in 4 of 5 T3 and 2 of 3 T4 primary lesions. The 5-year actuarial rates of neck control were 100% for N0 (45 patients), 90% for N1 (25 patients), 77% for N2 (23 patients), 50% for N3A (9 patients), and 70% for N3B (42 patients). The 5-year actuarial rates of continuous disease control above the clavicles were 73% for Stage III, 64% for Stage IVA, and 32% for Stage IVB. The actuarial 4-year rate of continuous disease control above the clavicles was 78% for Stage II. For patients whose disease was controlled above the clavicles, distant metastases developed in 4% of patients with Stage II-III disease and in 18% of patients with Stage IV disease. Radiation complications following irradiation alone to the primary site correlated with total dose. Complications of planned neck dissection(s) were acceptable. Complications of salvage surgery at the primary site were similar to those seen in patients treated once a day. The actuarial 5-year survival rates, according to modified AJCC stage, were 59% for Stage III, 37% for Stage IVA, and 23% for Stage IVB. The actuarial 4-year survival rate for Stage II was 69%. Compared to historical control groups treated with once-a-day, continuous-course irradiation at our institution, twice-a-day treatment has produced local control results that are higher by 10-15 percentage points.

Adult↗
PubMed1988

The use of radiation therapy in the management of minor salivary gland tumors.

Between 1964 and 1985, 52 patients were treated with curative intent by radiation therapy alone or in combination with surgery for malignant tumors of minor salivary gland origin. All patients had a minimum follow-up of 2 years, and 80% had a minimum follow-up of 5 years. Twenty-six (50%) were adenoid cystic carcinomas; the remaining histologies included adenocarcinoma, mucoepidermoid carcinoma, and malignant mixed tumors. The most common sites of origin were in the oral cavity/oropharynx (49%) and the nasal cavity or paranasal sinuses (40%). Twenty-seven patients (52%) presented with an advanced or unresectable stage (AJCC Stage III or IV, extensive bone or nerve invasion, or tumor greater than 5 cm). Treatment was highly individualized; 50% of the patients received radiation therapy alone, and 50% received combined treatment with either postoperative or preoperative radiation therapy. Early-stage minor salivary gland tumors were controlled equally well with radiation therapy alone or with a combined approach. For the advanced tumors, a combined approach yielded significantly superior absolute local control rates as compared with radiation therapy alone (10/13 vs. 2/13). For adenoid cystic carcinoma, the local control rate at 10 years was 45% (actuarial); the tumor was not controlled locally in any patients with advanced/unresectable stage who were treated with radiation therapy alone. The absolute local control rate was 75% for 4 early-stage tumors treated with radiation therapy alone and 60% for 5 advanced tumors treated with a combined approach. The average time to local recurrence was 67 months for adenoid cystic carcinoma. Severe complications of radiation therapy occurred in 11 (27%) of 40 evaluable patients, with unilateral blindness being the most common. Seven of 9 patients who became blind had unresectable disease with close proximity to or invasion of the orbit. A time-dose analysis is also presented.

Actuarial Analysis↗
PubMed1988

Squamous cell carcinoma of the head and neck treated with radiation therapy: the impact of neck stage on local control.

There have been several recent reports in the literature to indicate that the risk of failure at the primary site following radiation therapy is greater in patients with a clinically positive neck as opposed to those with a clinically negative neck at diagnosis. This is an analysis of 526 patients with squamous cell carcinoma of the head and neck who were treated with irradiation alone to the primary lesion with curative intent. All patients had follow-up for at least 2 years and were evaluable for analysis of local control. For each site and T stage, no evidence was found to indicate that the primary lesions were controlled less often in patients whose necks were clinically positive than in those whose necks were clinically negative.

Carcinoma, Squamous Cell↗