Local interferon therapy for lip carcinoma

In a prospective non-randomized study 21 patients with lower lip squamous cell carcinoma were treated with human natural leukocyte interferon (HNLI). The response rate was measured by a size reduction of more than 25% and was 81%. A complete response rate was considered to be a cure according to histopathological and clinical findings and was 48%. The response rate of six lower lip squamous cell carcinoma cases treated with recombinant interferon alpha 2c was 67% and the complete response rate was 17%. Three patients with basal cell carcinoma of the upper lip were also treated with HNLI. All three patients were cured, as determined by histopathological and clinical findings. These findings indicate that interferon can be a useful alternative therapy for lip carcinoma either with or without surgery.     

Carcinoma of the lip.

We reviewed 250 patients with carcinoma of the lip who were treated with radiation therapy during a 30-year period. Although radiation techniques underwent continued refinement, the radiation dose delivered to the tumor remained relatively constant. Nearly all tumors were squamous cell carcinoma (247/250) and located on the lower lip (240/250). Only 9% initially manifested lymph node metastases. The median survival was 13.8 years. Treatment failure occurred in 11% of patients. Surgery salvaged half of these patients. Eighteen patients died from carcinoma of the lip, and six others had persistent tumor when last seen. Our experience would support the work of others. Early lesions can be successfully managed by either surgical or radiation treatment. The intermediate tumors and those near the commissure are better handled by radiation. Late lesions and those with lymph node metastases challenge the best surgical and radiation techniques.     

Squamous cell carcinoma of the lower lip.

PURPOSE: Most patients with squamous cell carcinoma of the lower lip present with early disease and follow a rather indolent clinical course. Determinant 5-year survival rates range from 85% to 95%. This study was undertaken in an attempt to gain insight into the cause of failure in those few patients who develop recurrent disease. PATIENTS AND METHODS: A retrospective review was completed on patients treated between 1964 and 1990. Patients were staged according to the American Joint Committee. Patients with no palpable adenopathy had either a unilateral or bilateral suprahyoid dissection performed. Patients with palpable adenopathy underwent radical neck dissection. All patients were followed for evidence of recurrent disease. RESULTS: The records of 92 patients treated surgically for squamous cell carcinoma of the lower lip were available and complete. Palpable adenopathy was present in 38 patients; however, only 8 of these patients (21%) were histologically positive. Of the 54 patients judged to be free of disease, 3 (5.5%) had histologic evidence of metastasis. Overall, the incidence of cervical metastasis was 12%. CONCLUSION: The incidence of cervical metastasis in patients with squamous cell carcinoma of the lip is low; however, these data suggest that the size of the primary tumor does not correlate closely with predicting the incidence of regional lymph node metastases.     

Carcinoma in situ of the vocal cords: a retrospective study

Between the years 1960 and 1981, 21 patients with the diagnosis of carcinoma in situ of the vocal cords were treated in the ENT department of Beilinson Medical Center. All 21 patients received initial irradiation therapy, identical to patients with invasive squamous cell carcinoma--7200 rads Co60 tumour dose. No patient died as a result of tumour. One patient had local recurrence of invasive carcinoma after 3 years and subsequently underwent total laryngectomy. One patient died after 15 years as a result of myocardial infarction. It is important to mention that 20 patients (95.2%) were free of tumour during a follow-up of 4-25 years (mean 11 years). This study shows that radiotherapy is a highly effective method of management for carcinoma in situ of the glottic region.     

Nasopharyngeal cancer: a clinical study with special reference to age and occupation

A survey of 63 patients with malignant tumour of the nasopharynx, treated over a 20-year period (1958–1977) is presented. The major types of tumour were squamous cell and anaplastic carcinoma (including lymphoepithelioma) and non-Hodgkin's lymphoma. In some patients other tumours were found, such as cylindroma, rhabdomyosarcoma and extramedullary plasmocytoma. A particularly high incidence of men younger than 40 years was seen with carcinoma and an occupation in a particular branch of industry, indicated as ‘metallurgic or allied’ (light engineering factories, garages etc.). ^e0Co irradiation was the primary therapy. Adjuvant chemotherapy was used in lymphoma or sarcoma. The survival was significantly better in the younger age group as far as carcinoma is concerned. The possible role of occupational factors is discussed in relation to findings in the literature.     

Treatment of oropharyngeal carcinoma by irradiation or by surgery

Of previously untreated patients with squamous cell carcinoma of the oropharynx, 145 are reviewed in this study. All were treated in the Department of Head and Neck Surgery at the University of Liverpool from 1990 to 1997. Seventy-seven patients were treated with irradiation, 28 patients by surgery and 40 patients were deemed not suitable for any curative treatment. Univariate analysis showed no difference in the two groups treated by curative modalities but multivariate analysis did suggest that the surgical group tended to have larger neck node metastases. The 5-year tumour specific actuarial survival for all patients was 53%, 65% for the radiotherapy group and 51% for the surgery group. The difference was not statistically significant (χ²₁ = 1.5070). The modality of treatment had no affect on either the development of a primary or neck node recurrence or the survival after such a recurrence. Where neck node disease was present it was treated as appropriate. As is generally standard practice, lymph nodes over 2 cm were treated with radical neck dissection whether the patient was having irradiation therapy or surgery. If the patient was having irradiation therapy, the neck dissection was carried out before and irradiation after operation, both on the primary and on the neck, if appropriate. It is concluded that irradiation therapy in properly selected cases in combined head and neck clinics is a safe and effective treatment for squamous cell carcinoma of the oropharynx. Neck node disease should be treated appropriately, but there is no support for the old adage that whatever form of treatment is being used for the neck node should also be used for the primary site.     

Critical remarks on the chemotherapy of squamous cell carcinomas of the oropharynx

The results of chemotherapy for T3 and T4 squamous cell carcinoma of the oropharynx treated by chemotherapy, surgery and irradiation (n = 19), or by surgery plus irradiation (n = 28) were analysed. The two groups were similar as regards site and extent of the tumour, but the first group had a much worse prognosis. The selection of the patients, the method and results of therapy are described. The probable reasons for the failure of the chemotherapy are discussed.     

Treatment of squamous cell carcinoma of the tongue base: irradiation, surgery, or palliation?

OBJECTIVES: Squamous cell carcinoma of the tongue base has a poor prognosis, and treatment is accompanied by a number of major problems. In view of this, it is important to recognize which patients will benefit from treatment with curative intent and which treatment method to use. METHODS: One hundred sixty-five patients with squamous cell carcinoma of the tongue base were identified on our database. Eighty-two patients were treated by radical irradiation, and 41 by surgery. A further 42 patients were considered unsuitable for curative treatment. RESULTS: The 5-year cause-specific survival rate was 41% for those treated by irradiation, 58% for those treated by surgery, and 9% for untreated patients. There was no difference in the efficacy of treatment methods (p = .5362), but a highly significant difference was seen in survival rate between treated and untreated patients (p = .0028). The decision regarding administration of curative treatment was based on the extent of locoregional involvement at the primary site (p = .0139; odds ratio, 0.43) and in the neck (p = .0078; odds ratio, 0.23). No factors affected the decision to treat by irradiation or surgery. When the observed survival rate was calculated, there was no significant difference in 5-year survival rate between treated and untreated patients (p = .2762). Those with early (T1-2) disease at the primary site had an improved survival rate from 0.5 to 4 years compared with those who were untreated (T3-4; p = .0081; odds ratio, 2.2). In addition, those with early (T1-2) disease had a better survival rate than those with advanced cancers (p = .0139; odds ratio, 2.09). There was, however, no difference in survival rate at 5 years. Those with early disease compared with those with advanced disease were twice as likely to be alive at 2 years; however, all survival advantages had disappeared by 5 years. CONCLUSIONS: In terms of observed survival, treating tongue base squamous cell carcinoma that is locally advanced (T3-4) at presentation offers no survival advantage over palliation alone. Treating early disease (T1-2) doubles the survival rate for up to 4 years, but by 5 years this survival advantage is lost. The present study finds radiotherapy and surgery to be equivalent at controlling this disease.     

Post-operative radiotherapy in advanced laryngeal cancer: effect on local and regional recurrence, distant metastases and second primaries

This was a retrospective study of patients who did or did not receive post-operative radiotherapy for squamous cell carcinoma of the larynx.The rates of local and regional recurrences, distant metastases and second primaries were evaluated in 236 patients who received radiotherapy following surgery. These rates were evaluated and compared with those from 294 patients treated with surgery alone. Multivariate analysis of irradiated patients revealed that local and regional recurrences were determined independently by tumour (T) and pathologic node (pN) stages (p < 0.05). The distant metastasis rate significantly depended on N stage (p < 0.05). Multiple primary tumours were not significantly affected by any of the factors studied (p > 0.05). Analysis of both irradiated and non-irradiated patients revealed that local and regional recurrence was determined independently by pathologic T (pT) stage, tumour localization, radiation status and pN stages (p < 0.05). The distant metastasis rate significantly depended on N stage and tumour localization (p < 0.05) and the rate of formation of multiple primary tumours was significantly affected by the patient's age and radiation status (p < 0.05). In conclusion irradiation of laryngeal cancer patients independently increases the risk of local and regional recurrence, and also increases the risk of multiple primary tumours while not significantly influencing the risk of distant metastasis. The risk of distant metastasis is affected by determinants of advanced lesions and tumour localization.     

Carcinoma of the nasal vestibule: prognostic factors in relation to lymph node metastasis

In this retrospective study 127 patients with a squamous cell carcinoma of the nasal vestibule were evaluated. Though treated with curative intent, 23 patients eventually died with or because of tumour. Lymph node metastases were of the utmost importance and were detected in 31 patients, in two-thirds of whom the treatment was unsuccessful. Since elective treatment of possible lymph node metastases is a possibility to improve prognosis we have established a high-risk group in which metastases are to be expected and elective treatment of the neck should be considered. These patients are those with a large lesion on presentation and those with a poorly differentiated tumour.     

Squamous cell carcinoma in the area of the parotid gland. Metastasis or primary tumor?

A total of 61 patients with a histological diagnosis of squamous cell carcinoma of the parotid gland were studied. The patients were classified into three categories. There were 34 patients with a metastasis to the parotid gland from a squamous cell carcinoma elsewhere within the head and neck who presented on average 2.1 years (range 3 months to 7 years) after diagnosis of the primary tumour; in one case a salivary gland tumor presented 32 years after irradiation of a squamous cell carcinoma of the temple. Six patients had histological evidence of a metastasis within the parotid gland, but no evidence of a primary tumour. Twenty-one patients presented with a primary epidermoid carcinoma of the parotid gland. Two patients showed a primary squamous cell carcinoma of the parotid arising in myoepithelial sialadenitis.     

Multicentricity in papillary thyroid carcinoma: analysis of predictive factors.

OBJECTIVES: Multicentricity has been cited as a rationale for total thyroidectomy in patients with papillary thyroid carcinoma (PTC) confined to one lobe. The purpose of this study was to examine the incidence of multicentricity of PTC in a cohort of 165 patients with PTC confined to one lobe and to examine clinical and pathologic features that may help predict for the presence of contralateral disease. DESIGN: Retrospective review. SETTING: Tertiary care hospital. METHOD: A retrospective review of 165 patients with PTC confined to one lobe treated at the Toronto General Hospital from 1992 to 1997 was performed. MAIN OUTCOME MEASURE: The predictive factors affecting the presence of multicentricity of PTC were analyzed. RESULTS: The incidence of PTC present in the contralateral lobe was 56.3%. We were unable to find any correlation of multicentricity with age, sex, tumour size, extrathyroidal spread, thyroiditis, or tall cell variant of PTC. There were trends toward higher incidence of contralateral disease in those patients with a prior history of irradiation and those with lymphatic metastases, but these trends did not reach statistical significance. CONCLUSIONS: The incidence of contralateral disease in papillary thyroid cancer treated at the Toronto Hospital was 56.3%. There was a higher incidence of contralaterality in those patients with a previous history of irradiation and in those with lymphatogenous metastases, but this did not reach statistical significance.     

Seventeen year's experience in the treatment of carcinoma of the mobile tongue

Two hundred and forty-two patients with squamous cell carcinoma of the mobile tongue were reviewed. Most of them were initially treated by irradiation and then treated surgically for salvage. Cervical node metastases were frequently developed during or after the initial therapy. The patients in the advanced stage showed poor prognosis due to uncontrolled cervical node metastases and/or local recurrence. In the patients with no initial cervical node involvement, better local control and less frequent incidence of subsequently developed cervical node metastases were observed in the group treated by surgery than in those treated by irradiation. In the patients with initial cervical node involvement, no significant difference was noted in the survival yielded by either treatment modality. In advanced carcinoma, combined treatment with radiotherapy and surgical therapy seemed to give better results than with either radiotherapy or surgical therapy alone in this study.     

Small cell carcinoma of the larynx: results of therapy

Primary small cell carcinoma of the larynx is a rare malignancy with a dismal prognosis. A survey of the long-term follow-up from reported cases of small cell carcinoma of the larynx and a review of the recent experience with this tumor at the University of Michigan Hospitals was undertaken to determine if newer treatment approaches incorporating adjuvant chemotherapy were associated with prolonged survival. Median survival for those patients receiving adjuvant chemotherapy was 19 months compared to 11 months for patients treated with surgery and/or radiation therapy alone. Among patients treated initially with primary radiation therapy and adjuvant chemotherapy median survival was 55 months, which was significantly longer than any other treatment regimen (P = 0.02). Systemic chemotherapy and therapeutic irradiation appears to offer the least disabling and most efficacious form of current therapy.     

Radiation Therapy for Early Stage (T1-T2) Sarcomatoid Carcinoma of True Vocal Cords: Outcomes and Patterns of Failure

Sarcomatoid carcinoma of head and neck mucosal sites is a rare high-grade malignancy that may cause diagnostic and therapeutic controversies. A characteristic of this entity consistently reported but not entirely validated is its relative radioresistance and the general belief is that surgery is the treatment of choice. The objective of this retrospective study was to determine if patients treated with radiation for early glottic sarcomatoid carcinoma had worse outcomes than those achieved with irradiation for the more typical squamous cell carcinoma. Twenty-eight cases of early stage (T1-T2) sarcomatoid carcinoma of the larynx treated with definitive doses of megavoltage irradiation between 1969 and 1995 at The University of Texas M. D. Anderson Cancer Center form the cohort for this analysis. All pathologic material was reviewed to confirm the diagnosis. All tumors manifested spindle cell features with marked cytomorphologic abnormalities characteristic of this entity. Sixteen tumors (57%) had the more typical polypoid gross morphology of sarcomatoid carcinoma. Twenty-one patients (75%) were staged T1 and seven patients (25%) had stage T2 disease. All patients were treated with small laryngeal fields, median size 20 cm², and to a median dose of 65 Gy. Follow-up ranged from 1.5 to 24 years (median, 10 years). Four patients (14%) had local disease recurrence, and all had salvage total laryngectomies and remained free of local disease. The 5-year actuarial local control rates for patients with T1 and T2 lesions were 94% and 54%, respectively. Only one patient developed regional and distant disease. The 10-year actuarial disease-specific and overall survival rates were 92% and 63%, respectively. Patients with early stage sarcomatoid carcinoma of the glottis treated with radiation had similar control rates to irradiated patients with similar volume disease with the more typical squamous cell carcinoma. The authors contend that the histologic diagnosis of sarcomatoid carcinoma by itself should not influence the decision to treat a patient with early stage glottic disease with irradiation.     

Local and distant metastases in patients with surgically treated squamous cell carcinoma of the lip

There were 18 patients (16%) with metastatic squamous cell carcinoma of the lip in a total material of 114 operatively treated patients. There were initially palpable cervical nodes in 14% of the patients, but only 6 (5%) had histologically proved metastases. Two patients (1.8%) had distant metastases. The primary tumour in the metastatic group was classifed as T₁ in 3(17%), T₂ in 4(22%) and T₃ in 11(61%) cases. During 5-year follow-up of 73 of the patients, local recurrences were found in 10 cases (13.5%), 5 of whom developed subsequent metastases. Of the remaining 63 patients without local recurrences only 3 (5%) had metastases. Totally 8 of 73 patients, who had no metastases initially, developed them during 5-year follow-up. Metastases appeared within three years after initial treatment. In the metastatic group only 15.5% of the patients are alive after 5 years, and totally 13.5% of the patients died of the czrcinoma of the lip within 5 years.     

Computed tomographic volumetric analysis as a predictor of local control in laryngeal cancers treated with conventional radiotherapy

BACKGROUND: There is still controversy regarding the appropriate management of large T2 and T3 laryngeal cancers, with some investigators finding little correlation between the current TNM staging system and tumour control following external beam radiotherapy. OBJECTIVE: To establish the utility of computed tomography (CT)-determined tumour volume as a predictor of local control of moderately advanced (T2 and T3) squamous cell carcinoma of the larynx. MATERIALS AND METHODS: A retrospective chart review and CT volumetric analysis were performed on 47 patients who were treated for T2 or T3 laryngeal squamous cell carcinoma with radiotherapy alone at the London Regional Cancer Centre between 1995 and 2000. Of these 47 patients, there were 30 with glottic tumours and 17 with supraglottic tumours. Forty-two males and five females were included in the analysis, with ages ranging from 40 to 84 years. Each patient's CT scan was redigitized, and the tumours were outlined by the chief investigator and by a head and neck radiologist using anatomy modelling software. Patient demographics, tumour characteristics, and tumour stage were analyzed, with local failure rates described and related to the variables through univariate and multivariate analyses. RESULTS: Tumour size ranged from 0.15 to 16.64 cm3, with a mean volume of 3.5 cm3. The local recurrence rate in this group of patients was 40% (19/47). Local control was correlated on multivariate analysis to tumour size for all patients combined (> 3 cm3 vs < 3 cm3; p = .003) and for glottic tumours alone (> 1 cm3 vs < 1 cm3; p = .001). A correlation was also demonstrated on multivariate analysis between local control and overall stage (p = .023), patient age (p = .029), and hypopharyngeal involvement (p = .032). CONCLUSIONS: There is a significant and independent relationship between CT-determined tumour volume and local recurrence in moderately advanced squamous cell carcinoma of the larynx treated with conventional radiotherapy. Based on these results and those of similar studies, CT should therefore become a routine part of the staging system for T2 tumours and above.     

Recurrence of oropharyngeal carcinoma after radiotherapy

Two-hundred-and-twenty-one patients with squamous carcinoma of the oropharynx treated by irradiation are presented. The primary recurrence rate at five years in the previously untreated patients was 27%, but was dictated by neither host factors (age, sex and general condition) nor tumour factors (site, T-stage and histological grade). Pre-operative histological diagnosis had a very high sensitivity but a low specificity, indicating that false positives are common but false negatives unusual. Twenty per cent of patients with a recurrent primary tumour were untreatable. The five year survival after a primary recurrence was 31 per cent. Sixty-eight per cent of patients undergoing major surgery recovered without a major complication, and the hospital mortality rate was three per cent, due entirely to major medical catastrophes. The major complication rate in those undergoing flap repair after major resection was seven per cent. The metastatic rate in lymph nodes was 44 per cent at five years, and again this did not depend on any host or tumour factors. The survival at five years after node recurrence was a mere 19 per cent, and the length of survival was related to the primary site of the original tumour and the presence of extranodal disease. Two-thirds of patients had advanced disease (N2 and N3) when node recurrence was diagnosed and about 15 per cent were unsuitable for surgery.     

颌下区原发性恶性肿瘤

１９５９～１９８９年我院共收治原发于颌下区的恶性肿瘤６５例，其中腺样囊性癌１８例，恶性混合瘤１６例，腺癌１４例，未分化癌１０例，鳞癌７例。总的３年、５年生存率为６０．０％和４２．９％。颌下腺恶性肿瘤有包膜外侵犯与无包膜外侵犯，二者的３年、５年生存率分别为５９．５％、３０．３％和８３．３％、７２．７％。淋巴结阳性者预后差，与无淋巴结转移相比，其３年、５年生存率为４４．０％、１１．１％和８８．５％、７９．２％。Ｔ分期越大预后越不好。死亡原因主要是局部。颈部复发和肺转移。治疗以手术为主。如果肿瘤局限，无包膜外侵犯可做颌下或区域清扫。病变范围广并有颈淋巴结转移者，则需行区域广泛切除及颈清扫。手术切缘不净、术后复发、分化差或病期晚者，宜综合治疗。     

Immunocompetent cell reaction in prognostic evaluation of squamous cell carcinoma of the lip

An intimate interplay between the host factors and the tumour seems to be operative in lip cancer, and is undoubtedly capable of modifying the clinical course of the disease. A series of 70 patients with squamous cell carcinoma of the lip was assessed by light microscopy and using histochemical staining for acid alpha-naphthyl acetate esterase to demonstrate the morphological manifestations of tumour-host reactivity. The factors analysed include stromal reactions; intensity of the immunocompetent cell infiltrate including mast cells, and the subpopulations, i.e. B or T lymphocytes and mononuclear phagocytes (MPS cells). B lymphocytes far outnumbered the T and MPS cells in all the infiltrates studied, the percentages of the latter two cell types being inversely related to the intensity of the infiltrate, however. The cell composition in the infiltrates lacked statistically demonstrable effect on the frequency of metastases and the 5-year survival, as did the stromal mast cell reaction, too.