Biomedical subjects

Russell W Hinerman

Publications and source records attributed to Russell W Hinerman.

At least 19 recordsLinked to original sources

PubMed2006

Definitive radiotherapy for squamous cell carcinoma of the base of tongue.

OBJECTIVE: To evaluate definitive radiotherapy (RT) for treatment of base of tongue cancer. METHODS: There were 333 patients with squamous cell carcinoma of the base of tongue treated with definitive RT and had follow-up from 0.2 to 26.2 years. Follow-up on living patients ranged from 1.2 to 26.2 years (median, 6.6 years). RESULTS: Local control rates at 5 years were: T1, 98%; T2, 92%; T3, 82%; and T4, 53%. The 5-year rates of local-regional control rates were: I-II, 100%; III, 82%; IVA, 87%; and IVB, 58%. The rates of absolute and cause-specific survival at 5 years were as follows: I-II, 67% and 91%; III, 66% and 77%; IVA, 67% and 84%; and IVB, 33% and 45%. Severe complications developed in 52 patients (16%). CONCLUSION: Our data and review of the pertinent literature reveal that the local-regional control rates and survival rates after RT were comparable to those after surgery, and the morbidity associated with RT was less.

Adult↗

PubMed2006

Definitive radiotherapy for tonsillar squamous cell carcinoma.

PURPOSE: The purpose of this study is to update our experience with definitive radiotherapy (RT) for carcinoma of the tonsillar area. PATIENTS AND METHODS: There were 503 patients treated between October 1964 and May 2003 (potential follow-up for at least 2 years). Of these, 198 patients underwent a planned neck dissection and 57 patients received induction (18 patients) or concomitant (39 patients) chemotherapy. RESULTS: The 5-year local control rates were as follows: T1, 88%; T2, 84%; T3, 78%; and T4, 61%. Multivariate analysis revealed that local control was significantly influenced by T stage, primary site, and fractionation. Local control after RT for early stage cancers was higher for tonsillar fossa/posterior pillar tumors than for those arising from the anterior tonsillar pillar. The 5-year cause-specific survival rates were as follows: I, 100%; II, 86%; III, 84%; IVA, 73%; and IVB, 46%. Multivariate analysis revealed that cause-specific survival was significantly influenced by T stage, overall stage, neck dissection, race, and gender. The incidence of severe late complications was 9%. CONCLUSION: Based on our data and a review of the literature, definitive RT provides cure rates that are as good as those after surgery, and is associated with a lower rate of severe complications. Patients with lateralized tumors may be safely treated with ipsilateral field arrangements. Our limited experience with intensity modulated radiotherapy suggests that it is as efficacious as conventional RT.

Adult↗

PubMed2006

Surgery and postoperative radiotherapy for squamous cell carcinoma of the larynx and pharynx.

OBJECTIVE: To determine the rates of local-regional control, survival, and complications for patients treated with postoperative radiation for squamous carcinomas of the larynx, hypopharynx, and oropharynx. METHODS: There were 295 patients with previously untreated squamous cell carcinomas of the larynx (n = 199), hypopharynx (n = 80), and oropharynx (n = 16) treated postoperatively with radiotherapy (RT). RESULTS: Five-year local-regional control rates according to site and pathologic American Joint Committee on Cancer (AJCC) stage were: stage III larynx, 89% versus stage IVA larynx, 85% (P = 0.33); stage III oropharynx/hypopharynx, 76% versus stage IVA oropharynx/hypopharynx, 79% (P = 0.72). Local-regional control rates steadily declined as the number of indications for administering postoperative RT increased. Five-year absolute survival rates versus pathologic AJCC stage for the entire group were: stage III 59% and stage IVA 40% (P = 0.40). CONCLUSION: Rates of local-regional control, survival, and complications support the use of postoperative radiation in selected patients. Tumor control and survival will hopefully improve further with the addition of chemotherapy to postoperative radiation.

Adult↗

PubMed2006

Definitive radiotherapy for nasopharyngeal carcinoma.

PURPOSE: We sought to report the outcomes after definitive radiotherapy (RT) for nasopharyngeal carcinoma. METHODS: Between March 1983 and November 2003, 82 patients were treated with curative intent and followed from 0.2 to 22 years (median, 5 years). Follow-up on living patients ranged from 2.8 to 22 years (median, 10.8 years). Thirty-two patients (39%) were treated once daily, 45 patients (55%) were treated with hyperfractionation, and 5 patients (6%) were treated with the concomitant boost technique. Eight patients (10%) received intensity-modulated radiotherapy. Thirty-one patients (38%) received induction (17 patients) or concomitant (14 patients) chemotherapy. Fourteen patients (17%) underwent a planned neck dissection. RESULTS: The 5-year outcomes after treatment were: local control, 78%; regional control, 90%; local-regional control, 76%; distant metastasis-free survival, 80%; cause-specific survival, 66%; and survival, 57%. The impact of T-stage, N-stage, overall stage, World Health Organization class, fractionation schedule, and adjuvant chemotherapy were evaluated in a multivariate analysis of various outcomes. Only N-stage and World Health Organization class impacted regional control. CONCLUSIONS: The likelihood of cure after RT is relatively high. Although the likelihood of cure diminished with increasing stage, none of the parameters evaluated significantly influenced outcomes aside from N-stage and WHO class.

Adolescent↗

PubMed2006

Postoperative radiotherapy for squamous cell carcinoma of the head and neck.

This review discusses the role of postoperative radiotherapy (RT) for patients with squamous cell carcinoma of the head and neck. Patients with unfavorable pathologic features have a high-risk of local-regional recurrence and a decreased likelihood of survival after surgery alone. Postoperative RT reduces the risk of local-regional failure and probably improves survival. Patients who are at high risk for recurrence may benefit from more aggressive altered fractionation schedules to decrease the overall time from surgery to the completion of RT. Adjuvant cisplatin-based chemotherapy also appears to improve the probability of cure in high-risk patients.

Carcinoma, Squamous Cell↗

PubMed2005

Late xerostomia after intensity-modulated radiation therapy versus conventional radiotherapy.

PURPOSE: To evaluate xerostomia following intensity-modulated radiation therapy (IMRT). MATERIALS AND METHODS: An institutional review board-approved study of xerostomia was conducted in 210 head and neck cancer patients who were beyond the acute recovery phase (> 1 year) after radiation therapy. Xerostomia was evaluated with the 8-question XQ developed and validated at the University of Michigan. RESULTS: Median XQ scores (normalized so that no xerostomia = 0 and maximum xerostomia = 100) were larynx-only group, 4 points, ipsilateral radiotherapy, 34 points; bilateral radiotherapy, 64 points; IMRT with mean contralateral parotid dose more than 26 Gy, 44 points; and IMRT with mean contralateral parotid dose 26 Gy or less, 32 points (P < 0.05 for all major comparisons). CONCLUSION: The XQ is an excellent tool for identifying important differences in xerostomia after radiation therapy for head and neck cancer. The authors' IMRT program decreases the severity of xerostomia symptoms compared with what is typically seen after conventional radiation therapy.

Adult↗

PubMed2005

Head and neck mucosal melanoma.

PURPOSE: The purpose of this article is to discuss the optimal treatment and outcomes for head and neck mucosal melanoma. METHODS: Review the pertinent literature. RESULTS: Head and neck mucosal melanoma is a rare entity comprising less than 1% for all Western melanomas. It usually arises in the nasal cavity, paranasal sinuses, and oral cavity. The optimal treatment is surgery. The likelihood of local recurrence after resection is approximately 50%. Radiotherapy (RT) reduces the likelihood of local failure but probably does not enhance survival, which is primarily impacted by advanced T stage and the presence of regional metastases. The 5-year survival rates vary from approximately 20 to 50%. Although the median time to relapse is roughly 1 year or less, late failures are common and cause-specific survival continues to decline after 5 years. CONCLUSION: The optimal treatment is surgery. Postoperative RT improves local-regional control but may not impact survival. Definitive RT may occasionally cure patients with unresectable local-regional disease or at least provide long-term palliation.

Adult↗

PubMed2004

Management of T1-T2 glottic carcinomas.

T1-T2 glottic carcinomas may be treated with conservative surgery or radiotherapy. The goals of treatment are cure and laryngeal voice preservation. The aim of the current study was to review the pertinent literature and discuss the optimal management of early-stage laryngeal carcinoma. Literature review indicated that the local control, laryngeal preservation, and survival rates of patients were similar after transoral laser resection, open partial laryngectomy, and radiotherapy. Voice quality depended on the extent of resection for patients undergoing surgery; results for patients undergoing laser resection for limited lesions were comparable to the corresponding results for patients receiving radiotherapy, whereas open partial laryngectomy yielded poorer results. Costs were similar for laser resection and radiotherapy, but open partial laryngectomy was more expensive. Patients with well defined lesions suitable for transoral laser excision with a good functional outcome were treated with either laser or radiotherapy. The remaining patients were optimally treated with radiotherapy. Open partial laryngectomy was reserved for patients with locally recurrent tumors.

Biopsy, Needle↗

PubMed2004

Unnecessary laryngeal irradiation in the IMRT era.

PURPOSE: The purpose of this review is to address the issue of unnecessary irradiation of the normal larynx. METHODS: We performed a literature review and dosimetry evaluation of intensity modulated radiotheraphy (IMRT) techniques. RESULTS: Data suggest that matching conventional parallel opposed photon fields through adenopathy is a reasonable alternative to the common practice of unnecessarily irradiating the normal larynx to high doses. The dosimetry evaluation demonstrates that the laryngeal dose is much higher when the entire neck is included in the IMRT field as opposed to using a standard anterior low-neck field below the level of the thyroid notch. CONCLUSIONS: Lateral opposed fields should not be extended to include the larynx to avoid matching fields through adenopathy. IMRT fields should not include the normal larynx when the laryngeal dose would be substantially lower with a technique that shields the larynx in an anterior low-neck field.

Head and Neck Neoplasms↗

PubMed2004

Radiotherapy alone or combined with surgery for adenoid cystic carcinoma of the head and neck.

BACKGROUND: The purpose of this study was to analyze the results of radiotherapy (RT) alone or combined with surgery for adenoid cystic carcinoma. METHODS: Between September 1966 and November 2001, 101 previously untreated patients were treated with curative intent with RT alone or combined with surgery. Follow-up ranged from 0.4 to 30.6 years (median, 6.6 years). All living patients had follow-up for at least 1 year. RESULTS: The 5- and 10-year rates of local control were as follows: RT alone, 56% and 43%; surgery and RT, 94% and 91%; and overall, 77% and 69%. Multivariate analysis of local control revealed that T stage (p=.0101) and treatment group (p=.0008) significantly influenced this endpoint. The 5- and 10-year rates of distant metastases-free survival were 80% and 73%. The 5- and 10-year absolute survival rates were as follows: RT alone, 57% and 42%; surgery and RT, 77% and 55%; and overall, 68% and 49%. Multivariate analysis of absolute survival revealed that T stage (p=.0043) and clinical nerve invasion (p=.0011) significantly influenced this endpoint. The 5- and 10-year cause-specific survival rates were as follows: RT alone, 65% and 48%; surgery and RT, 81% and 71%; and overall, 74% and 61%. Multivariate analysis revealed that T stage (p=.0008) and clinical nerve invasion (p=.0005) significantly influenced cause-specific survival. CONCLUSIONS: The optimal treatment for patients with adenoid cystic carcinoma is surgery and adjuvant RT. A significant proportion of patients with incompletely resectable disease are cured after RT alone. Improvements in locoregional control are offset, in part, by the relatively high incidence of distant metastases.

Adolescent↗

PubMed2004

Postoperative irradiation for squamous cell carcinoma of the oral cavity: 35-year experience.

BACKGROUND: The purpose of this study was to analyze factors influencing outcome in patients who received postoperative irradiation for advanced squamous cell carcinoma of the oral cavity. METHODS: Between October 1964 and November 2000, 226 patients with 230 previously untreated primary invasive squamous cell carcinomas of the oral cavity were treated postoperatively with continuous-course external beam irradiation. All patients had a minimum follow-up of 2 years (analysis, November 2002). No patient was lost to follow-up. RESULTS: The 5-year actuarial rates of locoregional control by pathologic American Joint Committee on Cancer stage were: stage I, 100%; stage II, 84%; stage III, 78%; and stage IV, 66%. Recurrence of cancer above the clavicles developed in 55 patients (24%). In multivariate analysis of locoregional control, positive margins, vascular invasion, perineural invasion, extracapsular extension, and T classification remained significant. CONCLUSIONS: This article provides additional data defining relatively favorable and unfavorable groups of patients in the postoperative setting. Dose recommendations are re-examined and selectively increased for high-risk patients.

Adolescent↗

PubMed2003

Impact of race on outcome after definitive radiotherapy for squamous cell carcinoma of the head and neck.

BACKGROUND: The objective of the current study was to evaluate the impact of race (black vs. white) on the outcome of patients with invasive squamous cell carcinoma of the head and neck. METHODS: Between 1983 and 1997, 686 patients completed definitive, twice-daily radiotherapy (RT) alone or combined with a planned neck dissection; no patients received adjuvant chemotherapy. The minimum follow-up was 2 years, and median follow-up was 7 years for living patients. No patients were lost to follow-up. Fifty-five patients were black (8%). RESULTS: Although the two groups had similar 5-year local-regional control rates (black patients vs. white patients: 70% vs. 76%, respectively; P = 0.275), black patients had double the risk for distant recurrence compared with white patients (27% vs. 13%; P = 0.012). The 5-year cause-specific and absolute survival rates were lower for black patients (52% vs. 74% [P = 0.001] and 29% vs. 52% [P < 0.001], respectively). Multivariate analyses revealed that race was an independent predictor of freedom from distant metastasis (P = 0.013), cause-specific survival (P = 0.005), and absolute survival (P < 0.001). CONCLUSIONS: Although equal local-regional control rates can be achieved in black patients and white patients with squamous cell carcinoma of the head and neck, the risk of distant recurrence was significantly higher in black patients and resulted in decreased survival. Reevaluation of current strategies for pretreatment metastatic work-ups and development of more effective systemic therapy will be key to improving the survival disparity in this group.

Black or African American↗

PubMed2003

Definitive radiotherapy alone or combined with a planned neck dissection for squamous cell carcinoma of the pharyngeal wall.

BACKGROUND: In the current study,the authors analyzed the results of definitive radiotherapy for squamous cell carcinoma of the pharyngeal wall. METHODS: Between 1964 and 2000, 148 patients were treated with definitive radiotherapy. All patients had a 2-year minimum follow-up. RESULTS: The following 5-year rates of local and ultimate local control were obtained: T1 disease, 93% and 93%; T2 disease, 82% and 87%; T3 disease, 59% and 61%; and T4 disease, 50% and 50%, respectively. Multivariate analysis revealed that twice-daily fractionation (P = 0.0009), American Joint Committee on Cancer Stage I-II disease (P = 0.0051), and oropharyngeal primary site (P = 0.0193) were associated with improved locoregional control. The following 5-year absolute and cause-specific survival rates were obtained: Stage I, 56% and 89%; Stage II, 52% and 88%; Stage III, 24% and 44%; Stage IV, 22% and 34%; and overall, 30% and 49%, respectively. Eight patients (5%) died of complications. CONCLUSIONS: Locoregional control and survival were found to be related to site, extent of disease, and fractionation schedule. Although outcomes have improved in recent years, the morbidity of treatment was significant in the current study and a substantial proportion of patients died secondary to the malignancy.

Adult↗

PubMed2003

Breast boost: are we missing the target?

BACKGROUND: Randomized trials have shown improved local control with the use of a breast boost for patients given breast-conserving treatment for breast carcinoma. Although the use of a breast boost is routine practice, no standard technique has been established. The authors compared the commonly used clinical technique with a technique based on computed tomography (CT) imaging of surgical clips in the tumor bed. METHODS: Thirty patients underwent CT simulation for postoperative radiation treatment planning as part of breast conservation therapy. During simulation, a CT-compatible wire was placed on the patient's skin, outlining the intended electron boost field; an electron boost volume (EBV) was generated by contouring the tissue underlying the wire. Also contoured was a CT-based clinical target volume (CTV) using surgical clips and postsurgical changes in the tumor bed as a guide. A planning target volume (PTV) was generated using a 1 cm margin around the CTV. An electron beam treatment plan was generated for each technique using the FOCUS three-dimensional treatment planning system. Dose-volume histograms (DVH) were generated to determine the fraction of the PTV receiving 90% of the prescribed dose if treatment was delivered using the EBV. In addition, DVH analysis was done to determine the volume of normal tissue unnecessarily irradiated when using the EBV. RESULTS: Although the electron cone size remained unchanged in most patients for both EBV and PTV, the isocenter differed more than 1 cm in the medial-lateral direction in 5 patients and in the cephalocaudal direction in 12 patients. The en face gantry angle differed for most patients. On average, only 51% (range, 27-79%) of the PTV received 90% or more of the prescribed dose when the electron plan was generated using the EBV (P < 0.0001). Ten patients received the prescription dose to less than 50% of the PTV. Mean volume of normal tissue receiving more than 50% of prescribed dose was 64.5 cm(3) (range, 24-119 cm(3)). CONCLUSIONS: Clinical delineation of the tumor bed not only carries a significant risk of missing the target, but unnecessarily treats breast tissue that may otherwise be spared. Better delineation of the tumor bed, which optimizes coverage of the target volume and spares normal breast tissue, has the potential to improve both local control and cosmetic outcome. The authors recommend the use of surgical clips to delineate the target volume, followed by CT-based treatment planning, accounting for not only microscopic disease, but also organ motion and daily setup error.

Breast Neoplasms↗

PubMed2003

Radiation therapy for esthesioneuroblastoma: rationale for elective neck irradiation.

PURPOSE: Esthesioneuroblastoma is an uncommon malignancy of neural crest origin arising in the upper nasal cavity. We describe the University of Florida experience using radiation therapy (RT) in the treatment of this neoplasm, particularly the use of elective nodal irradiation. MATERIALS AND METHODS: Between May 1972 and August 1998, 22 patients received RT for esthesioneuroblastoma. Two additional patients were treated with palliative intent and were excluded from analysis. Equal numbers of male and female patients were treated, with a median age of 54 years (range, 3-82). The modified Kadish stage was A in 1 patient, B in 4 patients, C in 15 patients, and D in 2 patients. Treatment modalities included primary RT in 6 patients, preoperative RT in 1 patient, postoperative RT after craniofacial resection in 12 patients, and salvage RT in 3 patients treated for recurrence after surgery. Elective neck RT was performed in 11 of 20 patients; 2 patients had cervical metastases at presentation for RT. RESULTS: Rates of local control, cause-specific survival, and absolute survival at 5 years were 59%, 54%, and 48%, respectively. The cause-specific survival rate at 5 years was lower after primary RT (17%) than after craniofacial resection and postoperative RT (56%). Cervical metastases occurred in 6 of 22 patients (27%). No neck recurrences occurred in 11 patients treated with elective neck RT compared with 4 neck recurrences in 9 patients (44%) not receiving elective neck RT (p =.02). CONCLUSIONS: Combined modality therapy is preferred over RT alone in advanced-stage esthesioneuroblastoma. Our data and review of the current literature suggest a higher cervical failure rate than previously recognized. Elective neck RT seems to correlate with improved nodal control and should be considered in the treatment of esthesioneuroblastoma.

Adolescent↗

PubMed2003

Parameters that predict local control after definitive radiotherapy for squamous cell carcinoma of the head and neck.

PURPOSE: To analyze parameters that may influence the likelihood of local control after definitive radiotherapy for head and neck cancer. METHODS: Between April 1980 and January 2000, 404 patients were treated with definitive RT alone (358 patients) or combined with adjuvant chemotherapy (46 patients) at our institution and were followed up for 0.25 to 20.25 years (median, 3.5 years.) All living patients were followed up for at least 2 years. All patients had the primary tumor volume calculated on pretreatment CT. End points were local control after RT and local control after RT without a severe late complication. Parameters evaluated in multivariate analyses of these end points included primary site, T stage, primary tumor volume, N stage, histologic differentiation, fractionation schedule, adjuvant chemotherapy, and gender. RESULTS: The rates of local control and local control without a severe late complication after RT were significantly influenced by primary tumor volume for patients with cancer of the supraglottic larynx and true vocal cord. In contrast, the rates of local control and local control without severe complications for patients with tumors of the oropharynx and hypopharynx were less influenced by tumor volume. Multivariate analysis of the overall population revealed that the only parameter that was significantly related to the probability of local control after RT was T stage. Multivariate analyses stratified by primary site revealed that tumor volume significantly influenced local control for patients with cancers of the supraglottis (p =.0220) and glottis (p =.0042) but not for those with lesions of the tonsillar fossa/posterior tonsillar pillar (p =.0892), base of tongue (p =.9493), anterior tonsillar pillar/soft palate (p =.5909), and hypopharynx (p =.2282). CONCLUSIONS: The most important parameter that has an impact on local control after RT is T stage. Primary tumor volume also significantly influences the probability of local control in cancers of the supraglottis and glottis.

Adolescent↗

PubMed2003

Distant metastases after definitive radiotherapy for squamous cell carcinoma of the head and neck.

PURPOSE: To analyze parameters that influence the risk of distant metastases after definitive radiotherapy. METHODS: Between 1983 and 1997, 873 patients were treated with definitive radiotherapy and had follow-up for 2 years or more. Univariate and multivariate analyses were performed to evaluate risk factors that might influence the risk of distant metastases. RESULTS: The 5-year distant metastasis-free survival rate was 86%. Univariate analyses revealed that the risk of distant metastases was significantly influenced by gender (p =.0092), primary site (p =.0023), T stage (p <.0001), N stage (p <.0001), overall stage (p <.0001), level of nodal metastases in the neck (p <.0001), histologic differentiation (p =.0096), control above the clavicles (p <.0001), and time to locoregional recurrence (p <.0001). Multivariate analysis of freedom from distant metastases revealed that gender (p =.0390), T stage (p <.0001), N stage (p =.0060), nodal level (p <.0001), and locoregional control (p <.0001) significantly influenced this end point. Multivariate analysis revealed that gender (p =.0049), T stage (p <.0001), N stage (p <.0001), and locoregional control (p <.0001) significantly influenced cause-specific survival. CONCLUSIONS: The risk of distant metastases after definitive radiotherapy is 14% at 5 years and is significantly influenced by gender, T stage, N stage, nodal level, and locoregional control.

Carcinoma, Squamous Cell↗

PubMed2003

Does feeding tube placement predict for long-term swallowing disability after radiotherapy for head and neck cancer?

PURPOSE: To evaluate feeding tube use. MATERIALS AND METHODS: Nine hundred thirty-four patients were treated with radiotherapy (RT). RESULTS: Feeding tubes were placed in 235 patients (25%): 212 patients (22.5%) for acute toxicity, 18 patients (2%) for late effects, and 5 patients (0.5%) for both. Median duration of tube dependence for acute toxicity was 3.8 months. Multivariate analysis revealed that feeding tube placement for acute toxicity was increased with higher RT dose (p <.0001), adjuvant chemotherapy (p =.0002), advanced age (p =.0002), and the presence of neck disease (p =.0045). The risk of a feeding tube for late effects was 2% at 5 years. The likelihood of feeding tube placement for late effects was greater for women (p =.0293), higher RT dose (p =.0345), and primary sites, including the hypopharynx and multiple synchronous primary tumors (p =.0360). Feeding tube placement for late effects was unrelated to tube placement for acute toxicity. CONCLUSION: Likelihood of long-term feeding tube dependence was low and unrelated to placement for acute effects.

Carcinoma, Squamous Cell↗