The dentist as a referral source of first episode head and neck cancer patients.

This analysis was conducted to shed more light on the role of the dentist in the detection and referral of patients with head and neck cancer. No other study of the referral practices of dentists has examined the characteristics of these patients in contrast to those referred by physicians to understand the selection of pathways to care. The findings reported here indicate that: "anatomical provinces" exist for both types of practitioners that are well recognized by the lay community and perhaps reinforced by the health field; advanced stage referrals on the parts of physicians may occur because patients delayed seeking care until symptoms required medical attention; and dentists as a group may b better prepared to detect oral cavity lesions, but not lesions at other head and neck sites. The findings of this study, as well as those of Adams and others and Pogrel, suggest the need for improved educational programs about head and neck cancer directed to the public as well as physicians and dentists. The public should be aware not only of the etiology of head and neck cancers and the associated signs and symptoms, but also of the availability of the dentist, as well as the physician, as a diagnostic resource. Furthermore, educational programs should be developed in dental and medical schools to teach and reinforce detection and diagnostic skill including soft-tissue examination procedures; the use of the indirect mirror for examination of the base of the tongue, larynx, and the lower posterior pharyngeal wall; and biopsy techniques.

Squamous cell carcinoma of the oral cavity in young adults.

The 12 patients less than 35 years of age treated for squamous cell carcinoma of the oral cavity at the American Oncologic Hospital between 1954-1979 are examined. Group A (eight patients) had involvement of the tongue; Group B (4 patients) had carcinoma of other oral sites. Mean "T" stage for Group A and Group B was 1 and 1.5, respectively. Treatment was surgical in the majority of cases. Seventy-one percent of Group A and 25% of Group B developed metastatic disease to the neck. The 2-year survival rate was 57% (A) and 75% (B)--75% combined. The collective results of this and other studies suggest lower control rates than those reported for older patients with similar initial presentations. The implications of this observation are discussed in relation to the management of the younger patient with squamous carcinoma of the oral cavity.

Results in suprahyoid, modified radical, and standard radical neck dissections for metastatic squamous cell carcinoma: recurrence and survival.

Two hundred sixty-one patients who underwent three types of neck dissection for cervical lymphadenopathy in association with squamous cell cancer of the head and neck are analyzed retrospectively. Patients were grouped into those with histologically negative nodes and those with histologically positive nodes. Statistical analyses for neck recurrence and survival rates were made using the sampled permutation method. The results show that suprahyoid neck dissection is associated with an unusually high recurrence rate in the neck in patients with histologically negative nodes. Modified radical neck dissection and standard radical neck dissection are equivalent with regard to recurrences in the neck and five year survival rates when the disease is above the juguloomohyoid lymph node group. The study suggests that simple upper neck dissection is contraindicated in patients with negative or positive nodes and that modified radical neck dissection can be used in selected patients instead of the formal radical neck operation.

Yoshi 864 (1-propanol, 3,3'-iminodi-, dimethanesulfonate [ester], hydrochloride): a phase II study in solid tumors.

Two hundred and eight acceptable patients were treated with Yoshi 864 (2 mg/kg/day by iv push X 5 days repeated once every 6 weeks). Toxicity was minimal. There was an overall response rate of 11%. Cross resistance with other alkylating agents may not be present. Because of its lack of toxicity, Yoshi 864 should be further evaluated in chronic myelocytic leukemia, lymphomas, and carcinomas of the ovary and bladder where significant responses were seen. It should also be evaluated in combinations as a replacement for other alkylating agents which cause more nausea and vomiting.

Oncocytoma of the parotid gland with malignant change.

We report on a patient with preinvasive malignant change in an oncocytoma of the right parotid gland. Histologic transition from benign morphology to malignant cellular atypia, to our knowledge described only once previously in the literature, was present. Satisfactory results from wide surgical resection and postoperative radiotherapy in our patient serve as additional experience in the treatment of this rare malignancy.

Restoration of pharyngoesophageal continuity with a replaceable prosthetic conduit: a new method.

Treatment of carcinomas of the upper aerodigestive tract by high dose radiation and wide surgical resection result in large tissue defects. When the inferior pharyngeal constrictor and the cricopharyngeus muscles are removed, a replaceable prosthetic conduit can be used effectively to reestablish pharyngoesophageal continuity. This prosthesis can be readily fabricated and obviates the need for extensive reconstructive operations in suitable candidates.

Adriamycin, bleomycin, and CCNU as effective induction chemotherapeutic agents in advanced squamous cell carcinoma (COG Protocol 7333).

Twenty-six member institutions of the Central Oncology Group entered 154 patients in this two-armed, phase III study comparing the effects of adriamycin, bleomycin, and CCNU against a variety of squamous cell carcinomas. The combination of adriamycin and bleomycin produced a 43% overall response rate in primary tumors of the head and neck, which included two complete responses. This compares favorably to the results obtained with methotrexate and other agents previously reported. The combination of adriamycin and bleomycin will probably be the most useful for induction chemotherapy because both drugs have cumulative toxicities and the duration of response to this combination is short.

Parapharyngeal growth of parotid tumors: report of two cases.

Two patients with parapharyngeal pleomorphic adenomas of the parotid gland, one malignant and one benign lesion, were successfully treated operatively. Deep lobe parotid tumors may occasionally grow along the stylomandibular tunnel into the parapharyngeal region. Since the opening of the tunnel is narrower and less distensible than the parapharyngeal region, the tumor assumes a dumbbell shape. The patients have an intraoral mass or asymmetry of the palate, with difficulties in swallowing or phonation. The diagnosis is suspected on bimanual examination, and puncture biopsies should be done to establish a histologic diagnosis. Operative removal of the parotid gland with facial nerve preservation is recommended. External, transoral, and combined approaches can be employed. Enlargement of the opening of the stylomandibular tunnel by cutting the styloid process of the mandible is necessary for complete tumor removal. Rupture of the capsule should be avoided. Results are rewarding with proper management.

Adjuvant chemotherapy with 5-fluorouracil after surgical resection of colorectal carcinoma (COG protocol 7041). A preliminary report.

In a prospectively randomized study the effect of adjuvant chemotherapy with 5-FU on survival and recurrence was analyzed in 274 evaluable patients with colorectal carcinoma who either underwent a curative or a palliative resection. In the treatment group, chemotherapy consisted of the intravenous administration of 5-FU 12 mg/kg daily for four consecutive days, then 6 mg/kg/per day on alternate days to the point of toxicity or to a maximum of 5 doses, followed by 12 mg/kg/week for one year. Drug toxicity was rarely severe and consisted of nausea and vomiting, diarrhea, stomatitis, leukopenia, and thrombocytopenia in slightly more than half of all patients. There have been no drug-related deaths. Analysis of the survival curves and disease-free interval curves reveal some evidence of drug benefit in both the curative group of resections and the palliative group of resections. However, this benefit is not significant except in those treated to toxicity. The disease-free interval after curative resection is significantly longer in patients treated with 5-FU to the point of toxicity with a white blood count less than 4,000 cells/mm3. We conclude that a preliminary analysis of the Central Oncology Group data in this trial does not make a convincing case for the use of 5-FU as an adjuvant to the surgical treatment of colorectal carcinoma.

Combination chemotherapy in breast cancer: a randomized study of 4 versus 5 drugs.

A randomized clinical trial, involving approximately 100 patients, that compared two combination therapy regimens (5 FU, methotrexate, vincristine, cyclophosphamide with and without prednisone) in advanced breast cancer showed a significantly higher rate of response for the 5-drug therapy group (62.5 versus 44.2%). However, no significant difference in survival has been observed to date. Some differences in toxicity were observed, e.g. a significantly greater number of cases with mild diarrhea for the 5-drug regimen, and a few more cases of sensory loss (not significant) and significantly more severe leukopenia (p value 0.06) for the 4-drug regimen.