The role of hemilaryngectomy in the management of T1 vocal cord cancer.
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Carcinoma, Squamous Cell↗
Biomedical subjects
S P Stringer
Publications and source records attributed to S P Stringer.
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↗
Diagnosis, causes, and management of vertigo.
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Humans↗
Natural history of treated T1N0 squamous cell carcinoma of the glottis.
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Carcinoma, Squamous Cell↗
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↗
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↗
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↗
A randomized trial for outpatient management of peritonsillar abscess.
In order to compare the efficacy of permucosal needle drainage with that of incision and drainage in the outpatient management of peritonsillar abscess, 52 patients with aspiration-proven peritonsillar abscess were entered into a randomized, prospective protocol. A symptomatic scale scoring system was employed to evaluate treatment results. In the needle drainage group, 92% (22/24) were cured with a single aspiration. Ninety-three percent (26/28) of the patients in the incision and drainage group were cured on the initial attempt. The remainder of the patients in both groups were cured with a single retreatment. Only one patient required hospitalization, and no patients required tonsillectomy to resolve the abscess. These data indicate that outpatient permucosal needle drainage of peritonsillar abscess is an acceptable, inexpensive treatment comparing favorably with incision and drainage.
Adolescent↗
Rambo procedure: modification and application.
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Humans↗
Radiotherapy for squamous cell carcinoma of the supraglottic larynx: an alternative to surgery.
BACKGROUND: The purpose of this article is to present the results of radiotherapy with or without neck dissection for squamous cell carcinoma of the supraglottic larynx at the University of Florida and to compare these data with those obtained after conservation surgery. METHODS: Continuous-course radiotherapy alone or combined with a planned neck dissection was used to treat 209 patients with 211 supraglottic carcinomas between 1964 and 1992; all patients had follow-up for > or = 2 years. RESULTS: The 5-year rates of local control after radiotherapy were as follows: T1, 100%; T2, 83%; T3, 68%; and T4, 56%. Tumor volume, as calculated on pretreatment computed tomography (CT) scan, and vocal cord mobility influenced the likelihood of local control. CONCLUSIONS: Based on our data and the literature, early or moderately advanced supraglottic carcinomas may be treated successfully with either supraglottic laryngectomy or radiotherapy. Supraglottic laryngectomy probably produces a higher initial local control rate but, based on anatomic and coexisting medical constraints, is suitable for a smaller subset of patients and has a higher risk of complications compared with radiotherapy.
Carcinoma, Squamous Cell↗
Salvage surgery after radiotherapy failure in T1-T2 squamous cell carcinoma of the glottic larynx.
BACKGROUND: This study was undertaken to analyze the clinical course of patients who developed local (primary) recurrence after high-dose irradiation of T1 -T2 squamous cell carcinoma of the glottic larynx. METHODS: Between May 1977 and December 1989, 247 patients with previously untreated T1 and T2 invasive squamous cell carcinoma of the glottic larynx were treated for curative intent with radiotherapy. Local recurrence occurred in 26 of 247 patients (11%). Successful surgical salvage was defined as no evidence of recurrent cancer for at least 2 years after salvage surgery and continuously thereafter. RESULTS: Two patients refused to undergo salvage surgery and one patient had unresectable disease. Of 23 patients who underwent salvage surgery, 19 had a total laryngectomy and 4 had a voice-sparing procedure. One patient who was continuously free of disease, died less than 24 months after salvage surgery; this patient was excluded from all local control and survival analyses, leaving 22 patients available for analysis. Successful salvage was achieved initially in 13 (59%) of the 22 patients. Two patients with local failure after voice-sparing salvage surgery underwent completion laryngectomy; one was salvaged, so that 14 of 22 (64%) were ultimately salvaged. The rate of successful salvage did not correlate with preirradiation T stage, time to failure after irradiation, or time from clinical suspicion of recurrence to histologic proof. In a subgroup of patients (those with positive margins, tumor extension into the soft tissues of the neck, or two or more adverse histologic features), the risk of local-regional recurrence after salvage laryngectomy was 80%. CONCLUSION: There are few data in the literature regarding the clinical outcome of patients whose tumors are not controlled by initial radiotherapy. This series and previous publications from other institutions indicate that most patients who develop primary failure undergo salvage surgery, which is successful in approximately 50-80% of the patients. The rate of surgical complications is acceptable and is related to radiotherapy dose. At our institution, most patients who had recurrence after radiotherapy underwent total laryngectomy. More than 50% of the patients who experienced recurrence after irradiation originally had tumors of such extent that they would have required total laryngectomy if surgery had been recommended instead of radiotherapy for the initial treatment. It is reasonable to consider reirradiation in patients with a very high risk of local-regional recurrence after salvage laryngectomy.
Biopsy↗
Twice-a-day radiotherapy for T3 squamous cell carcinoma of the glottic larynx.
Between March 1978 and April 1986, 21 previously untreated patients with T3 squamous cell carcinoma of the true vocal cord received radical courses of twice-a-day radiotherapy (120 cGy twice daily) to total doses of 7,440-7,680 cGy. The rate of local control at the primary site was 67% after radiotherapy. The ultimate control rate after salvage surgery was 83%. Five-year absolute and cause-specific survival rates were 59% and 81%, respectively. It is concluded that radiotherapy is a rational approach for many patients with T3 glottic cancer.
Adult↗
Radiotherapy after excisional biopsy of carcinoma of the oral tongue/floor of the mouth.
This is an analysis of 16 patients with excisionally biopsied (TXN0) squamous cell carcinoma of the oral tongue (nine patients) and floor of mouth (seven patients) treated with radiotherapy. All patients had a minimum 2-year follow-up and 81% had at least 5 years of follow-up. One patient died of intercurrent disease 16 months after treatment and was excluded from analysis of local control. All patients were evaluable for analysis of survival and complications. Local control was achieved in 14 of 15 patients; one patient with local recurrence underwent a surgical salvage procedure, which was unsuccessful. No patients developed recurrent disease in the neck or in distant sites. Five-year absolute and cause-specific survival rates were 10 of 13 and 10 of 11, respectively.
Carcinoma, Squamous Cell↗
Carcinoma of the skin of the head and neck with perineural invasion.
This is an analysis of 25 patients with carcinoma of the skin of the head and neck with clinical evidence of perineural invasion, who were managed with curative intent by radiotherapy alone (16) or surgery and radiotherapy (9). All patients had a minimum of 5 years of follow-up. Local control following treatment was observed in 20% of patients treated with radiotherapy alone and 38% of those treated with surgery and radiotherapy. Local control was diminished for recurrent lesions and for tumors that also invaded bone and/or cartilage. The 5-year absolute survival rates were 31% for patients treated with radiotherapy alone and 33% for those in the combined-treatment group. The incidence of significant complications was similar: 25% with radiotherapy alone and 33% with surgery and adjuvant radiotherapy.
Basal Cell Carcinoma↗
Neck dissection after twice-a-day radiotherapy: morbidity and recurrence rates.
Between March 1978 and April 1986, 56 patients underwent planned unilateral, and five patients underwent planned bilateral, radical neck dissections following high-dose twice-a-day radiotherapy, usually with 60Co. Neck dissections were generally performed 6 weeks after radiotherapy. The overall rate of control of disease in the neck in all 61 patients was 81% at 5 years. Patients who underwent neck dissections following radiotherapy had significantly higher rates of neck-disease control than patients treated by radiotherapy alone during the same time period for stages N2A-N3A and N2B-N3B, but not for N1 disease. No carotid ruptures or fatal complications occurred. The rate of wound complications was judged to be acceptable.
Head and Neck Neoplasms↗
Carcinoma of the supraglottic larynx: a basis for comparing the results of radiotherapy and surgery.
An analysis of 129 patients with 131 squamous cell carcinomas of the supraglottic larynx treated between October 1964 and April 1987 with radiotherapy alone or radiotherapy followed by neck dissection is presented. All patients had a minimum 2-year follow-up. Patients were excluded from analysis of disease control at the primary site and/or neck if they died within 2 years of treatment with the site(s) continuously disease-free. Local control rates with radiotherapy and ultimate local control rates, including patients successfully salvaged after a local recurrence, were as follows: T1, 13 of 13 and 13 of 13; T2, 34 of 42 (81%) and 37 of 42 (88%); T3, 25 of 41 (61%) and 34 of 41 (83%); and T4, 3 of 9 and 6 of 9. There was no significant difference in local control rates when comparing patients who were anatomically suitable for a supraglottic laryngectomy with those who would have required a total laryngectomy. Local control rates were slightly diminished in patients with T2-T3 lesions who had impaired or absent vocal cord mobility. The overall rates of ultimate local control with voice preservation for the entire series of 129 patients were as follows: T1, 100%; T2, 87%; T3, 69%; and T4, 57%. Cause-specific survival rates at 5 years by stage were I, 2 of 2; II, 10 of 12 (83%); III, 9 of 13 (69%); IVA, 4 of 6; and IVB, 7 of 22 (32%). The incidence of severe complications was 4 of 115 (3%) for T1-T3 lesions and 4 of 14 (29%) for T4 lesions.
Carcinoma, Squamous Cell↗
Cancer in neck nodes with unknown primary site: role of mucosal radiotherapy.
Sixty-nine patients with metastatic squamous cell carcinoma in neck nodes with an unknown primary lesion were treated with curative intent between October 1964 and December 1986. Sixty-five patients received radiotherapy to the neck and at least part of the mucosa of the head and neck, whereas 4 patients received treatment to the neck only. Mucosal doses were approximately 5,000 cGy-6,000 cGy at 170 cGy-180 cGy per fraction. Eight patients (12%) subsequently developed mucosal site failures, a figure that did not differ significantly from the incidence of a second metachronous head and neck cancer following definitive irradiation in a series of 393 patients with lesions of the supraglottic larynx, pharyngeal wall, pyriform sinus, or tonsillar area. This suggests that radiotherapy was highly effective in preventing the appearance of cancer at the unknown primary site from which the neck metastasis arose. Absolute and cause-specific 5-year survival rates were 48% and 66%, respectively.
Adult↗
Incisional or excisional neck-node biopsy before definitive radiotherapy, alone or followed by neck dissection.
An analysis of 508 patients (660 heminecks) with head and neck squamous cell carcinoma and clinically positive neck nodes who were treated with radiotherapy alone to the primary lesion (with or without a neck dissection) was conducted to determine if open neck-node biopsy before definitive treatment adversely affected the probability of control of neck disease, the risk of distant metastasis, or the cause-specific survival rate. The prognostic factors analyzed included biopsy status of the neck, N stage, neck treatment, node mobility, node location, T stage, primary site, and control of disease above the clavicles. Sixty-six patients who had undergone an open neck-node biopsy before definitive radiotherapy were compared with a control group of 442 patients who did not undergo a neck-node biopsy; no detrimental effect of the biopsy on neck control, distant metastasis, or cause-specific survival was demonstrated. We conclude that the potential adverse effect of violating the neck before definitive treatment cannot be demonstrated if radiotherapy is the next step in the patient's management.
Biopsy↗