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Role of screening chest CT in patients with advanced head and neck cancer
Otolaryngology Head and Neck Surgery P 108
August 1997
Scientific Sessions- - Tuesday
9:08 AM
9:16 AM
Intraoperative Radiation Therapy of the Tongue Base
Role of Screening Chest CT in Patients With Advanced Head and Neck Cancer
CHRISTOPHER K, SINHA, MD, MAJ MC (presenter), RONALD C. HAMAKER, MD, and PETERGARRET, MD, Washington, D.C., and Indianapolis, Ind.
Objective: Advanced stage and recurrent squamous cell carcinoma of the tongue base poses a difficult therapeutic problem. Intraoperative radiation therapy (IORT) allows additional radiation to be given to an area that will receive postoperative irradiation or that previously received radiation. Surrounding normal tissues can be spared excessive radiation. This study retrospectively examines the oncologic results and associated morbidity of IORT administered to the tongue base in patients at high risk for recurrence. Cost and logistical aspects of IORT will be discussed. Methods: From 1982 to 1993, 34 patients with close or positive margins at the tongue base underwent IORT to the tongue base. The IORT was directed at the resection margins with a dose of 1000 to 2000 cGy of 4 to 7 MeV electrons. Sixty-eight percent of these patients underwent treatment for recurrent disease after previous surgery and radiation or full-course radiation. Results: Overall actuarial control within the port of IORT was 66% at 24 months and 39.1% at 63 months. For recurrent cases, actuarial control was 56.4% at 24 months and 21.2% at 63 months, while that for nonrecurrent cases was 85.7% at 5 years. One patient failed to respond in the primary site, but out of the IORT port. Due to failure to respond in the neck and/or distant sites in 50% of patients, actuarial disease-specific survival was only 29.7% overall at 28 months, while for those with recurrent tumors survival was 19%. IORT was tolerated well. Four patients developed orocutaneous or pharyngocutaneous fistulae, and three patients developed mandibular osteoradionecrosis. The contribution of IORT to these complications is unclear. Conclusion: IORT appears to play a significant role in local control in patients at high risk for recurrence at the tongue base, particularly in patients for whom prior aggressive treatment fails. Morbidity does not appear to be increased over that of combined modality therapy without IORT. In addition, IORT possesses logistical and cost benefits when compared with brachytherapy.
LUKE K. S. TAN, MD (presenter), CHRISTOPHER D. GREENER, HADI SEIKALY,MD, CHRISTOPHER H. RASSEKH,MD, FACS, and KAREN H. CALHOUN, MD, FACS, Galveston, Tex., and Edmonton, Alberta
Objective: Most head and neck surgeons have experienced the distress of performing apparently curative surgery in patients with advanced head and neck cancer, only to detect lung metastases or second primaries within months of the initial treatment. We hypothesized that such pulmonary disease was present at the time of original diagnosis but not detected by the CXR. This study investigates the value of chest CT (CCT) as a more accurate screening for pulmonary malignancy in these patients. Method: New patients with Stage III or IV head and neck squamous cell carcinomas were enrolled in this prospective study. Twenty-five patients underwent CXR and CCT within 2 weeks of diagnosis of the index cancer and had a minimum of 12 months follow-up. Results: In 20 patients neither the CXR nor the CT showed any evidence of pulmonary malignancy. Two patients had suspicious lesions on CXR but had normal CCTs. Two other patients had normal CXRs but possible metastatic lesions on CCT. Neither of these turned out to be metastases: One patient had resolution of the suspicious lesions on repeated CCT 2 weeks later, and the other CCT was eventually read by a consulting radiologist as normal. The final patient had bronchogenic carcinoma that was clearly demonstrated on both CXR and CCT. None of the other 24 patients has developed any evidence of pulmonary metastases or second primaries during a minimum of 12 months of follow-up. Conclusion: In only two of the 25 patients did CCT make a significant contribution to patient management (the two who had possible lesions on CXR but normal CCTs). No changes were made in the treatment plans of the other 23 patients as a result of the CCT. Our findings support the current practice of screening for malignant pulmonary disease with CXR.
Introducing Patient Outcomes Software Stop by the Academy exhibit (Island 1038) to see the new software prototype demonstrated. Enjoy an early preview of this tracking software for patient outcomes management in otitis media and rhinosinusitis before it is launched in the spring of 199&
August 1997
Scientific Sessions- - Tuesday
9:08 AM
9:16 AM
Intraoperative Radiation Therapy of the Tongue Base
Role of Screening Chest CT in Patients With Advanced Head and Neck Cancer
CHRISTOPHER K, SINHA, MD, MAJ MC (presenter), RONALD C. HAMAKER, MD, and PETERGARRET, MD, Washington, D.C., and Indianapolis, Ind.
Objective: Advanced stage and recurrent squamous cell carcinoma of the tongue base poses a difficult therapeutic problem. Intraoperative radiation therapy (IORT) allows additional radiation to be given to an area that will receive postoperative irradiation or that previously received radiation. Surrounding normal tissues can be spared excessive radiation. This study retrospectively examines the oncologic results and associated morbidity of IORT administered to the tongue base in patients at high risk for recurrence. Cost and logistical aspects of IORT will be discussed. Methods: From 1982 to 1993, 34 patients with close or positive margins at the tongue base underwent IORT to the tongue base. The IORT was directed at the resection margins with a dose of 1000 to 2000 cGy of 4 to 7 MeV electrons. Sixty-eight percent of these patients underwent treatment for recurrent disease after previous surgery and radiation or full-course radiation. Results: Overall actuarial control within the port of IORT was 66% at 24 months and 39.1% at 63 months. For recurrent cases, actuarial control was 56.4% at 24 months and 21.2% at 63 months, while that for nonrecurrent cases was 85.7% at 5 years. One patient failed to respond in the primary site, but out of the IORT port. Due to failure to respond in the neck and/or distant sites in 50% of patients, actuarial disease-specific survival was only 29.7% overall at 28 months, while for those with recurrent tumors survival was 19%. IORT was tolerated well. Four patients developed orocutaneous or pharyngocutaneous fistulae, and three patients developed mandibular osteoradionecrosis. The contribution of IORT to these complications is unclear. Conclusion: IORT appears to play a significant role in local control in patients at high risk for recurrence at the tongue base, particularly in patients for whom prior aggressive treatment fails. Morbidity does not appear to be increased over that of combined modality therapy without IORT. In addition, IORT possesses logistical and cost benefits when compared with brachytherapy.
LUKE K. S. TAN, MD (presenter), CHRISTOPHER D. GREENER, HADI SEIKALY,MD, CHRISTOPHER H. RASSEKH,MD, FACS, and KAREN H. CALHOUN, MD, FACS, Galveston, Tex., and Edmonton, Alberta
Objective: Most head and neck surgeons have experienced the distress of performing apparently curative surgery in patients with advanced head and neck cancer, only to detect lung metastases or second primaries within months of the initial treatment. We hypothesized that such pulmonary disease was present at the time of original diagnosis but not detected by the CXR. This study investigates the value of chest CT (CCT) as a more accurate screening for pulmonary malignancy in these patients. Method: New patients with Stage III or IV head and neck squamous cell carcinomas were enrolled in this prospective study. Twenty-five patients underwent CXR and CCT within 2 weeks of diagnosis of the index cancer and had a minimum of 12 months follow-up. Results: In 20 patients neither the CXR nor the CT showed any evidence of pulmonary malignancy. Two patients had suspicious lesions on CXR but had normal CCTs. Two other patients had normal CXRs but possible metastatic lesions on CCT. Neither of these turned out to be metastases: One patient had resolution of the suspicious lesions on repeated CCT 2 weeks later, and the other CCT was eventually read by a consulting radiologist as normal. The final patient had bronchogenic carcinoma that was clearly demonstrated on both CXR and CCT. None of the other 24 patients has developed any evidence of pulmonary metastases or second primaries during a minimum of 12 months of follow-up. Conclusion: In only two of the 25 patients did CCT make a significant contribution to patient management (the two who had possible lesions on CXR but normal CCTs). No changes were made in the treatment plans of the other 23 patients as a result of the CCT. Our findings support the current practice of screening for malignant pulmonary disease with CXR.
Introducing Patient Outcomes Software Stop by the Academy exhibit (Island 1038) to see the new software prototype demonstrated. Enjoy an early preview of this tracking software for patient outcomes management in otitis media and rhinosinusitis before it is launched in the spring of 199&