- Email: [email protected]
The management of carcinoma of the nasal vestibule
Radiation Oncology t Bloiogy
ARS6kd AnnualMeeting 57
??Physics
RECURRENCE PATTERNS BY TREATMENT GROUP IN CARCINOMA OF THE FLOOR OF MOUTH AND MOBILE TONGLE
(6i)
Roger H. Lehman, M. D. James D. Cox, M. D.* Russell S. Yale, M. D. Roger W. Byhardt, M. D. Robert J. Toohill, M. D. Thomas C. Malin, B. S. Departments of Otolaryngology and Radiation Therapy The Medical College of Wisconsin Milwaukee, Wisconsin 53226 Recurrence patterns were examined by stage and treatment group in 138 patients with 140 primary carcinomas of the floor of mouth and mobile tongue, reflecting an 11 year experience at two Medical College of Wisconsin affiliated hospitals. Treatment categories included surgery alone, irradiation alone, and combined treatment. Patients who were without evidence of disease at two years, or at the time of death, were considered cured. Cures were achieved in 90% of the patients in the Stage I disease classification, 83% in Stage II, 40% in Stage III and 34% in Stage IV. Similar good results were achieved by irradiation and surgery alone in controlling early lesions. Combined treatment offered the best chance for cure for patients with advanced disease. Failure to cure was most often associated with failure at the primary site. No patient with advanced disease was salvaged after local failure. One of 51 prophylactically treated necks failed regionally, while 7 of 26 untreated clinically negative necks developed regional metastases. Forty two multiple primary cancers were documented in the 138 patients included in this review.
(62)
THE MANAGEMENT
OF CARCINOMA
OF THE NASAL VESTIBULE
1 2 l*A. R. Kagan, M.D., H. Nussbaum, M.D., D. Rice, M.D., 3J. Miles M.D., 1H. A. Gilbert, M.D., 1A. R. Rao, M.D., ‘1 P. Chan, M.D., and 1B. L. Hintz, M.D. lDepartment of Radiation Therapy, Southern California Permanente Medical Group,LosAngeles, California 90027, 2Department ofSurge_ University of California at Los Angeles, Los Angeles, California, 90024, 3Departmentof Otolaryngology, Southern CaliforniaPermanente Medical Group, Los Angeles, California 90027 40 patients with squamous cell carcinoma of the nasal vestibule from the Southern California Permanente Medical Group and UCLA Medical Center were reviewed.
Patients without bone destruction or lymph node metastas1) es did well with either radiation or surgery. Those with bone destruction or lymph node metastases did poorly in spite ofradical treatment. Early lesions can often be cured with partial rhinectomy 2; or irradiation of each lesion. 3;
Surgical recurrences
4j Radiation with surgery.
recurrence
can be salvaged with irradiation. of early lesion can be salvaged
58 ARS63rdAnnualMeeting
RadiationOncology o Bioiogy e Physics
51 Other primary cancers are not uncommon when followup is extended to the 5-10 year interval. EA,RLY LESIONS - CONFINED TO NASAL CAVITY LATE - NODES OR BONE EARLY
SURG. ONLY
LR
13
0
1 Others
2
2
No. Patients
38
14
No. Patients
38
XRT ONLY 7
5
No. Patients
38
SURG + XRT 17
a
(63)
DOSE RESPONSE ANALYSIS
-DEAD
NED
FOR NASOPHARYNGEAL
il
9
CARCINOMA
J.E. Marks, M.D., J.M. Bedwinek, M.D., F. Lee, M.D., C. A. Perez, M.D. Mallinckrodt
Institute of Radiology,
St. Louis, "0
Dose response analysis was performed for 95 patients with nasopharyngeal carcinoma irradiated before I974 and 23 who were irradiated after 1974. Doses gradually increased from 5500 to 7000 rad during the first time period and were almost uniformly 7000 rad during the second. Control of the primary tumor and lymph nodes was achieved in 40 of 95 patients (42%) irradiated before 1974 and 18 of 23 patients (78%) irradiated after 1974. Minimum follow-up was 2 years. The improvement in tumor control occurred despite more advanced tumors in the recent group; tumor invaded base of skull and/or cranial nerves in 13 (T4) and extended outside the nasopharynx in 5 (T3); 13 patients had lymph nodes and 8 of these were stage N3b. Of the 23 patients treated after 1974, four received 6000 to 6600 rad to the nasopharynx and 19 received a dose of 6800 to 7200 rad; there were 3 failures in the nasopharynx of the low-dose group and none in the high-dose group (p=.OOI). This data, in addition to that previously published for the group of patients treated before 1974, further confirms the presence of a significant dose response for nasopharyngeal carcinoma and emphasizes the importance of accurately defining tumor extent and reproducibly delivering dose to the tumor on a daily basis. (64)
LOCAL TUMOR CONTROL IN ADENOID
CYSTIC CARCINOMAS
Larry E. Kun, M.D. and J. Frank Wilson, M.D.
Medical College of Wisconsin Milwaukee, Wisconsin 53226
Twenty-one patients with adenoid cystic carcinomas arising in the upper aerodigestive tract or salivary glands were treated in the Section of Radiation Therapy, Medical College of Wisconsin Affiliated Hospitals, from I967 to 1979. Primary sites of involvement were parotid gland (6), submaxillary gland (3), maxillary antrum (4), lip (3), palate (2), floor of mouth (11, and
ARS6kd AnnualMeeting 57
??Physics
RECURRENCE PATTERNS BY TREATMENT GROUP IN CARCINOMA OF THE FLOOR OF MOUTH AND MOBILE TONGLE
(6i)
Roger H. Lehman, M. D. James D. Cox, M. D.* Russell S. Yale, M. D. Roger W. Byhardt, M. D. Robert J. Toohill, M. D. Thomas C. Malin, B. S. Departments of Otolaryngology and Radiation Therapy The Medical College of Wisconsin Milwaukee, Wisconsin 53226 Recurrence patterns were examined by stage and treatment group in 138 patients with 140 primary carcinomas of the floor of mouth and mobile tongue, reflecting an 11 year experience at two Medical College of Wisconsin affiliated hospitals. Treatment categories included surgery alone, irradiation alone, and combined treatment. Patients who were without evidence of disease at two years, or at the time of death, were considered cured. Cures were achieved in 90% of the patients in the Stage I disease classification, 83% in Stage II, 40% in Stage III and 34% in Stage IV. Similar good results were achieved by irradiation and surgery alone in controlling early lesions. Combined treatment offered the best chance for cure for patients with advanced disease. Failure to cure was most often associated with failure at the primary site. No patient with advanced disease was salvaged after local failure. One of 51 prophylactically treated necks failed regionally, while 7 of 26 untreated clinically negative necks developed regional metastases. Forty two multiple primary cancers were documented in the 138 patients included in this review.
(62)
THE MANAGEMENT
OF CARCINOMA
OF THE NASAL VESTIBULE
1 2 l*A. R. Kagan, M.D., H. Nussbaum, M.D., D. Rice, M.D., 3J. Miles M.D., 1H. A. Gilbert, M.D., 1A. R. Rao, M.D., ‘1 P. Chan, M.D., and 1B. L. Hintz, M.D. lDepartment of Radiation Therapy, Southern California Permanente Medical Group,LosAngeles, California 90027, 2Department ofSurge_ University of California at Los Angeles, Los Angeles, California, 90024, 3Departmentof Otolaryngology, Southern CaliforniaPermanente Medical Group, Los Angeles, California 90027 40 patients with squamous cell carcinoma of the nasal vestibule from the Southern California Permanente Medical Group and UCLA Medical Center were reviewed.
Patients without bone destruction or lymph node metastas1) es did well with either radiation or surgery. Those with bone destruction or lymph node metastases did poorly in spite ofradical treatment. Early lesions can often be cured with partial rhinectomy 2; or irradiation of each lesion. 3;
Surgical recurrences
4j Radiation with surgery.
recurrence
can be salvaged with irradiation. of early lesion can be salvaged
58 ARS63rdAnnualMeeting
RadiationOncology o Bioiogy e Physics
51 Other primary cancers are not uncommon when followup is extended to the 5-10 year interval. EA,RLY LESIONS - CONFINED TO NASAL CAVITY LATE - NODES OR BONE EARLY
SURG. ONLY
LR
13
0
1 Others
2
2
No. Patients
38
14
No. Patients
38
XRT ONLY 7
5
No. Patients
38
SURG + XRT 17
a
(63)
DOSE RESPONSE ANALYSIS
-DEAD
NED
FOR NASOPHARYNGEAL
il
9
CARCINOMA
J.E. Marks, M.D., J.M. Bedwinek, M.D., F. Lee, M.D., C. A. Perez, M.D. Mallinckrodt
Institute of Radiology,
St. Louis, "0
Dose response analysis was performed for 95 patients with nasopharyngeal carcinoma irradiated before I974 and 23 who were irradiated after 1974. Doses gradually increased from 5500 to 7000 rad during the first time period and were almost uniformly 7000 rad during the second. Control of the primary tumor and lymph nodes was achieved in 40 of 95 patients (42%) irradiated before 1974 and 18 of 23 patients (78%) irradiated after 1974. Minimum follow-up was 2 years. The improvement in tumor control occurred despite more advanced tumors in the recent group; tumor invaded base of skull and/or cranial nerves in 13 (T4) and extended outside the nasopharynx in 5 (T3); 13 patients had lymph nodes and 8 of these were stage N3b. Of the 23 patients treated after 1974, four received 6000 to 6600 rad to the nasopharynx and 19 received a dose of 6800 to 7200 rad; there were 3 failures in the nasopharynx of the low-dose group and none in the high-dose group (p=.OOI). This data, in addition to that previously published for the group of patients treated before 1974, further confirms the presence of a significant dose response for nasopharyngeal carcinoma and emphasizes the importance of accurately defining tumor extent and reproducibly delivering dose to the tumor on a daily basis. (64)
LOCAL TUMOR CONTROL IN ADENOID
CYSTIC CARCINOMAS
Larry E. Kun, M.D. and J. Frank Wilson, M.D.
Medical College of Wisconsin Milwaukee, Wisconsin 53226
Twenty-one patients with adenoid cystic carcinomas arising in the upper aerodigestive tract or salivary glands were treated in the Section of Radiation Therapy, Medical College of Wisconsin Affiliated Hospitals, from I967 to 1979. Primary sites of involvement were parotid gland (6), submaxillary gland (3), maxillary antrum (4), lip (3), palate (2), floor of mouth (11, and