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Biomedical subjects

S P Stringer

Publications and source records attributed to S P Stringer.

At least 91 records · Page 5Linked to original sources
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Carcinoma of the skin metastatic to parotid area lymph nodes.

This is a retrospective analysis of 60 patients with previously untreated metatypical basal cell (3 patients) or squamous cell (57 patients) carcinoma of the skin, metastatic to the parotid area. All patients had a minimum 2-year follow-up, and 43% had a minimum 5-year follow-up. Treatment was surgery alone (8 patients), irradiation alone (16 patients), or planned combined surgery and irradiation (36 patients). The ultimate rates of control of disease in the parotid area were surgery alone, 5 of 8 (63%); irradiation alone, 6 of 13 (46%); planned combined surgery and irradiation, 32 of 36 (89%). In the combined-treated group, all 4 recurrences were in patients who had positive surgical margins and gross involvement of the facial nerve. In patients with negative surgical margins, without involvement of the facial nerve, who had combined treatment, the control rate was 100%. Of the surgery-alone group, only 1 patient ultimately had the disease controlled and retained a functioning facial nerve.

Adult↗
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Management of squamous cell carcinoma of the floor of mouth.

Between 1964 and 1987, 194 patients with previously untreated squamous cell carcinoma of the floor of mouth were managed at the University of Florida. A retrospective analysis was undertaken in order to evaluate the treatment results and associated complication rates. Surgery or irradiation alone was found to result in similar local control rates for stage I and II lesions, whereas more advanced tumors had better local control rates with a combination of surgery and irradiation. Radiotherapy had a higher incidence of minor and moderate complications, whereas a greater number of severe complications occurred after surgery. We recommend surgery for early lesions due to the lower overall incidence of associated complications. Despite a higher risk of severe complications, combination therapy is recommended for more advanced lesions due to improved local control as compared to single modality therapy.

Carcinoma, Squamous Cell↗
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Relative roles of computed tomography and endoscopy for determining the inferior extent of pyriform sinus carcinoma: correlative histopathologic study.

Ten laryngopharyngectomy specimens were dissected to determine the relative accuracy of computed tomography (CT) and endoscopy under anesthesia for evaluating the inferior extent of pyriform sinus carcinoma. Endoscopic examination failed to detect involvement of the pyriform sinus apex in one patient, and considerably underestimated disease at this level in two others; CT accurately predicted the status of the apex in these three and all other patients. Endoscopy underestimated the inferior extent of tumor in six patients; CT revealed the inferior limit relative to the esophageal verge more accurately in all six of these submucosal extensions. Endoscopy revealed one case of mucosal spread to the esophageal verge not demonstrated by CT. Endoscopy and CT were both correct in revealing the esophageal verge to be involved (one case) and free of disease (two cases). This study also confirmed a common tendency of pyriform fossa cancer to spread through thyrohyoid membrane adjacent to the course of superior laryngeal neurovascular bundle (six cases). High-resolution CT, in experienced hands, is a useful adjunct to endoscopy for detecting submucosal, inferior extension of pyriform sinus carcinoma. This information can influence the choice of the lower margin of resection and method of pharyngeal reconstruction.

Aged↗
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Twice-a-day radiotherapy for squamous cell carcinoma of the head and neck: the University of Florida experience.

Between March 1978 and March 1989, 419 patients with 439 moderately advanced or advanced primary squamous cell carcinomas of the head and neck received treatment with curative intent with twice-a-day radiotherapy (120 cGy per fraction with a 4- to 6-hour interfraction interval). Seventy-nine percent of the patients had AJCC stage III or stage IV cancers. The primary site in most patients was the oropharynx, hypopharynx, or larynx. All patients received radiotherapy alone to the primary site, with or without planned neck dissection after radiotherapy. Surgery at the primary site was reserved for salvage of radiotherapy failures. No patient received chemotherapy as part of the initial treatment plan. Total doses were 7440 cGy to 7920 cGy in the majority of patients. In 54 patients with oropharyngeal lesions, an interstitial implant was used to add a 1,000- to 1,500-cGy boost after the basic dose. Local control results were compared on a site-by-site and stage-by-stage basis with the results of continuous-course, once-a-day radiotherapy at the University of Florida; the control results were the same as or better than after once-a-day radiotherapy for each site and stage (T2 to T4). Severe complications of radiotherapy occurred in 4% of patients and correlated with tumor dose, T stage, and disease site (oropharynx or larynx/hypopharynx). The addition of a neck dissection 4 to 6 weeks after radiotherapy of patients with advanced-stage neck disease was accomplished with an acceptable rate of morbidity and significantly improved the rate of control of neck metastases compared with radiotherapy alone.

Actuarial Analysis↗
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Radiotherapy for adenoid cystic carcinoma of the palate.

This is an analysis of 16 patients with adenoid cystic carcinoma of the palate who were treated with curative intent by radiotherapy alone (9) or surgery and radiotherapy (7). No patient received adjuvant chemotherapy. Follow-up ranged from 3 years to 19 years with 69% of the patients having follow-up of more than 5 years. Two patients in the radiotherapy alone group developed local recurrences, and both have had long-term surgical salvage. No local failures were seen in the combined therapy group. Twelve patients (75%) are alive and disease-free. Two patients died with distant disease, one within each treatment group. One patient in the combined therapy group is alive at 8 years with distant metastases, while one in the radiotherapy alone group died of intercurrent disease at 12 years. No significant complications were seen in either treatment group. The role of radiotherapy in the treatment of adenoid cystic carcinoma of the palate is reviewed.

Adult↗
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Carcinoma of the tonsillar region: a multivariate analysis of 243 patients treated with radical radiotherapy.

Between October 1964 and June 1990, 243 patients with squamous cell carcinoma of the tonsillar region were treated with continuous-course radical radiotherapy at the University of Florida. All patients had a minimum 2-year follow-up. Patients were staged according to the AJCC system; stage IV was stratified into two subsets: favorable, IVA (T1-T3 or N2A-N3A); and unfavorable, IVB (T4 or N3B). The initial and ultimate local control rates (including surgical salvage) according to T stage were as follows: T1, 87% and 100%, T2, 79% and 92%; T3, 71% and 76%; and T4, 44% and 48%. Multivariate analysis demonstrated that anterior extension of the primary tumor (p = .0001) and T stage (p = .014) were the most significant parameters affecting local control after radiotherapy. For T4 lesions, twice-daily irradiation significantly improved local control (p = .04). The 5-year absolute and cause-specific survival rates as a function of modified AJCC stage were as follows: I, 37% and 100%; II, 55% and 90%; III, 55% and 85%; IVA, 35% and 60%; and IVB, 23% and 38%. The probability of a severe complication was 3% for the entire group of patients.

Brachytherapy↗
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Carcinoma of the oral tongue: a comparison of results and complications of treatment with radiotherapy and/or surgery.

BACKGROUND: Oral tongue cancer may be treated primarily with radiotherapy or with surgery alone or combined with adjuvant radiotherapy; the choice between these two approaches is controversial. METHODS: To evaluate the results of a shift in treatment policy in 1985 in favor of primary surgical treatment for carcinoma of the oral tongue, the results of radiotherapy (with or without neck dissection, 105 patients) were compared with those for surgery (with or without radiotherapy, 65 patients). RESULTS: Local control rates were improved for T3 (p = .03) and 14 (p = .08) patients treated surgically but were similar for T1-T2 patients. Local-regional control and survival rates were not significantly different. The rate of severe complications was significantly higher (p = .01) for T3 patients treated with surgery, particularly in the subset of patients who received postoperative radiotherapy. CONCLUSIONS: We generally recommend surgical treatment for T1-T2 patients with the addition of postoperative twice-a-day radiotherapy in selected cases. For selected T3-T4 patients we are investigating split-course twice-a-day preoperative radiotherapy in the hope that the extent of the surgical procedure, and hence the rate of severe complications, will be reduced.

Adult↗
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Radiotherapy for Merkel cell carcinoma of the skin of the head and neck.

BACKGROUND: Merkel cell carcinoma is a relatively rare neuroendocrine carcinoma of the skin. It arises in the head and neck region in approximately 50% of cases. Its aggressive behavior predisposes patients to local-regional recurrence and distant metastases after surgical excision alone. In this article, we describe our experience with Merkel cell carcinoma of the head and neck. METHODS: Of 18 patients with Merkel cell carcinoma treated in the Department of Radiation Oncology at the University of Florida, 12 patients who had primary tumors in the head and neck region are reported. Eight patients were treated at initial diagnosis (group A), and four were treated at the time of local-regional recurrence (group B). RESULTS: Local-regional control was achieved in seven of eight patients in group A and all four patients in group B. One patient in group A and all patients in group B developed distant metastases and eventually died of their disease. Bone exposure developed in one patient, requiring surgical debridement and hyperbaric oxygen treatment. CONCLUSION: Patients with Merkel cell carcinoma of the head and neck should be treated aggressively. Our data suggest that local-regional recurrence is a harbinger of distant metastases. We recommend that these patients receive treatment to both the primary site and draining lymphatics at initial presentation. The role of chemotherapy remains unclear.

Aged↗
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Retropharyngeal adenopathy as a predictor of outcome in squamous cell carcinoma of the head and neck.

BACKGROUND: Little information about the incidence of retropharyngeal adenopathy and its impact on prognosis has been published. METHODS: For 774 patients with squamous cell carcinoma of the nasopharynx, oropharynx, hypopharynx, or supraglottic larynx, pretreatment CT and, in selected cases, MRI scans were reviewed to determine the presence of retropharyngeal adenopathy. Results were analyzed in 619 patients treated with curative intent to determine the prognostic impact of retropharyngeal adenopathy. RESULTS: The highest incidence of retropharyngeal adenopathy was seen in patients with nasopharyngeal (74%) and pharyngeal wall (19%) cancers. The number of cervical nodal groups involved was the most significant factor (p < .0001) relating to the incidence of retropharyngeal adenopathy. The rates of neck relapse (40% at 5 years) and distant metastasis were significantly higher in patients with retropharyngeal adenopathy, and the rates of 5-year relapse-free survival and absolute survival were significantly lower. CONCLUSIONS: Retropharyngeal adenopathy is a strong predictor of poor prognosis, particularly for patients with advanced neck disease.

Carcinoma, Squamous Cell↗
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T1-T2 vocal cord carcinoma: a basis for comparing the results of radiotherapy and surgery.

This is an analysis of 304 patients with invasive, previously untreated T1-T2 squamous cell carcinoma of the glottic larynx treated with radiotherapy between October 1964 and December 1984. All patients had a minimum 2-year follow-up and 82% had at least 5 years of follow-up. Patients were excluded from the analysis of local control if they died within 2 years of treatment with the primary site continuously disease-free. Patients were staged according to the AJCC system and stratified by the surgical procedure that would have been required to resect the tumor. Stage T2 was subdivided into two subsets: T2a (normal mobility) and T2b (decreased mobility). The rates of local control with radiotherapy and the ultimate rates of local control, including patients salvaged surgically for a local recurrence, were as follows: T1, 159 of 171 (93%) and 166 of 171 (97%); T2a, 50 of 65 (77%) and 63 of 65 (97%); and T2b, 31 of 43 (72%) and 38 of 43 (88%). The rate of local control for patients with T1 lesions limited to one cord was not influenced by tumor extension to the anterior commissure. The overall incidence of serious complications was 5 of 304 (1.6%). The 5-year determinate survival rates were as follows: T1, 130 of 134 (97%); T2a, 43 of 46 (93%); and T2b, 29 of 33 (88%).

Carcinoma, Squamous Cell↗
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Adult parapharyngeal extracardiac rhabdomyoma.

The case of a parapharyngeal adult extracardiac rhabdomyoma (ER) in a 69-year-old man is presented focusing on computed tomographic diagnosis, surgical approach, and pathologic diagnosis. Although a rare neoplasm, adult ER has a propensity for occurring in the head and neck. Systematic computed tomography evaluation with contrast serves to define the extent of the lesion and assist in the differential diagnosis of parapharyngeal masses. In this case, a transcervical extra-pharyngeal approach for excision was utilized with minimal associated morbidity and a rapid return of normal function. Careful pathologic diagnosis is required to distinguish ER from other neoplasms, especially granular cell myoblastoma.

Aged↗
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Advances in radiotherapy for head and neck cancer.

Selected advances in radiotherapy for treatment of head and neck cancer are reviewed. These include the role of postoperative radiotherapy, planned postirradiation neck dissection, altered fractionation, neoadjuvant chemotherapy and radiotherapy for laryngeal preservation, three-dimensional conformal treatment planning, charged particle irradiation for skull base tumors, and stereotactic radiosurgery.

Chemotherapy, Adjuvant↗
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Radiation therapy in inverted papillomas of the nasal cavity and paranasal sinuses.

PURPOSE: Between December 1969 and September 1989, a total of 10 patients with advanced and/or recurrent inverted or cylindrical cell papillomas were treated with irradiation at the University of Florida in Gainesville. MATERIALS AND METHODS: Nine of 10 patients had 1 or more recurrences before they received radiation therapy. Three patients were treated with irradiation alone, and 7 patients received surgery and irradiation (preoperatively in 1 patient and postoperatively in 6 patients). Eight patients had inverted papillomas (3 with concomitant squamous cell carcinoma), and 2 patients had cylindrical cell papillomas. RESULTS: Local recurrence developed in 4 patients at 1.5, 6.5, 12, and 13 years after treatment. No evidence of recurrence was observed in 6 patients at 7, 8.5, 8.5, 9, 9, and 20.5 years after treatment. Four patients died of intercurrent disease. No patient developed a malignant transformation. Significant complications of treatment included, in 1 patient, an area of bone exposure in the orbit that necessitated debridement. CONCLUSION: Surgery is the primary treatment of this entity. Radiation therapy should be considered in patients with incompletely resectable lesions, multiply recurrent tumors, and tumors associated with malignancy.

Adult↗
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Long-term results of radiation therapy for juvenile nasopharyngeal angiofibroma.

PURPOSE: To analyze 15 patients treated with radiation therapy for juvenile nasopharyngeal angiofibroma (JNA) between June 1975 and March 1996. MATERIALS AND METHODS: All patients had a 2.5-year minimum follow-up. All patients had advanced disease (Chandler stage III or stage IV); two thirds of the patients had intracranial extension. RESULTS: Local control after radiotherapy was obtained in 13 of 15 patients (85%). Two patients had local recurrences, and both were salvaged with surgery for an ultimate local control rate of 100%. Late complications included cataracts in 3 patients, delayed transient central nervous system (CNS) syndrome in 1 patient, and a basal cell carcinoma of the skin in 1 patient. Of 15 patients, 13 (85%) had a complete response (CR) on physical examination following radiation therapy. The median time to CR was 13 months (range, 1 to 39 months). Of 6 patients with residual disease in more than 24 months, 2 (33%) had a recurrence, whereas no patient achieving CR in less than 24 months experienced a recurrence. CONCLUSIONS: Radiotherapy is an effective treatment for advanced JNA. Tumor regression usually occurs slowly over several months. JNAs that are slow to regress (greater than 2 years) may have an increased risk of recurrence.

Adolescent↗
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Squamous cell carcinoma metastatic to the neck from an unknown head and neck primary site.

Squamous cell carcinoma metastatic to the neck from an unknown head and neck primary site is relatively uncommon and presents a challenging diagnostic and therapeutic dilemma. Diagnostic evaluation includes fine-needle aspiration of the neck mass, chest roentgenography, computed tomography, and/or magnetic resonance imaging of the head and neck, followed by panendoscopy and biopsies. The primary tumor will be detected in approximately 40% of patients; approximately 80% of cancers are located in the base of the tongue or tonsillar fossa. Management options include treatment of the neck alone or both sides of the neck and the potential head and neck primary sites. The latter approach is associated with better long-term control above the clavicles. The 5-year survival rate is approximately 50% after treatment and is influenced by the extent of neck disease. In this article, we review the pertinent literature.

Biopsy, Needle↗
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Planned postradiotherapy bilateral neck dissection for head and neck cancer.

PURPOSE: This is a retrospective analysis of 50 patients with squamous cell carcinoma of the head and neck treated with radiotherapy (RT) to the primary site and bilateral neck followed by a planned bilateral neck dissection approximately 4 to 6 weeks after completion of RT. PATIENTS AND METHODS: Between November 1964 and March 1997, 50 patients underwent bilateral neck dissections after RT, with minimum 2-year follow-up. Forty-eight patients had bilateral positive neck nodes. RESULTS: At 5 years, the rates of neck disease control, local-regional control, and cause-specific survival were 76%, 70%, and 39%, respectively. Five severe complications developed after surgery, and 1 developed after RT. CONCLUSIONS: Radiotherapy followed by a planned bilateral neck dissection resulted in a high rate of local-regional control with acceptable morbidity. The likelihood of severe complications after simultaneous (as opposed to staged) neck dissection was not significantly different (P =.24).

Carcinoma, Squamous Cell↗
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CT of submucosal and occult laryngeal masses.

Computed tomographic examinations were performed on 24 patients with entirely submucosal laryngeal mass lesions. Presenting complaints were hoarseness (17 patients), dysphagia (1 patient), airway obstruction (5 patients), and a cervical nodal metastasis (1 patient). The masses were visible endoscopically as submucosal bulges in 21 patients. Three other patients presenting with hoarseness and vocal cord paresis or paralysis had otherwise negative endoscopy and a mass demonstrated on CT. Thirteen patients were eventually diagnosed as having squamous cell carcinoma, which was the primary working diagnosis following CT in 12 cases. The group of 13 carcinoma patients had a range of two to five endoscopic procedures with one to four negative biopsies and a 6 week to 9 month delay in histologic confirmation of cancer. Other lesions included five laryngoceles, two chondrosarcomas, and one case each of paraganglioma, fibrosarcoma, lymphoma, and tuberculous laryngitis. Computed tomography is an indispensable tool for evaluating submucosal laryngeal masses or otherwise unexplainable symptoms (usually hoarseness) that might herald such a mass. A definite submucosal mass on CT should prompt a deep or wedge biopsy to reach a pathologic diagnosis. This will avoid the delay in diagnosis that frequently occurs in these patients.

Humans↗