Arthur Weaver

Improved complete response rate and survival in advanced head and neck cancer after three‐course induction therapy with 120‐hour 5‐FU infusion and cisplatin

In a series of three consecutive pilot studies carried out between 1977 and 1981 at Wayne State University, Detroit, Michigan, designed to test the feasibility of multimodality therapy in patients with previously untreated advanced squamous cell carcinoma of the head and neck, patients received three different induction chemotherapy regimens: cisplatin + Oncovin (vincristine) + bleomycin (COB) for two courses; 96‐hour 5‐fluorouracil (5‐FU) infusion and cisplatin for two courses, or 120‐hour 5‐FU infusion + cisplatin for three courses. Over‐all response rates (complete response + partial response) to each of the three induction chemotherapy regimens were high: 80%, 88%, and 93%, respectively. Superior complete response rate in the group receiving three courses of 120‐hour 5‐FU infusion + cisplatin was 54% versus 29% for COB and 19% for two‐course 96‐hour 5‐FU infusion + cisplatin (P = 0.04). Significant survival advantage at 18 months minimum follow‐up for the group receiving three courses of 120‐hour 5‐FU + cisplatin induction therapy was found. Actual T and N stage may influence the clinical complete response rate. Responders to initial chemotherapy have significantly better survival as compared to nonresponders regardless of subsequent surgery and/or radiotherapy. These studies show that a multimodality approach to management of advanced head and neck cancer is feasible. Superior complete response rate and survival in one of the treatment groups suggest that choice of induction chemotherapy regimens and/or number of courses is of prime importance in such multimodality treatment programs.

Correlation between response to cisplatinum‐combination chemotherapy and subsequent radiotherapy in previously untreated patients with advanced squamous cell cancers of the head and neck

Induction chemotherapy, followed by surgery and/or radiotherapy was utilized in patients with advanced squamous cell carcinoma of the head and neck. During these trials, the authors observed that response to chemotherapy predicts further response to subsequent radiotherapy. This study was comprised of 57 patients with 60 separate neoplasms who demonstrated less than complete response (partial or no response) to initial treatment with a combination chemotherapy containing cisplatin. Subsequently radiotherapy, either 5000 rad preoperatively or 6600 rad as definitive therapy, was employed. Forty‐one of the 42 tumors with initial partial response to chemotherapy also responded to radiotherapy (97.6%). Only one of the 18 tumors that initially failed to respond to chemotherapy subsequently responded to radiotherapy (5.5%). This observation suggests that patients with head and neck cancer sensitive to initial chemotherapy share parameters that are also radiation sensitive.

Frozen autogenous mandibular stent-graft for immediate reconstruction in oral cancer surgery

Summary The severe psychologic trauma and functional loss that follow “Andy Gump” type of resection for oral cancer can be prevented by immediate reconstruction. This is a preliminary report on the use of an autogenous frozen mandibular stent-graft in six patients over the past two years. It has been necessary to remove this replaced mandibular segment in two patients. New bone growth replacing the graft preparation was demonstrated in a reresected mandible in a patient with residual tumor. Persistent infection necessitated removal of the other unsuccessfully implanted mandibular segment. The immediate results of this procedure indicate that the frozen autogenous mandible serves as a very satisfactory stent. Evaluation of this preparation as a satisfactory graft and its ultimate value in reconstruction for oral cancer await long-term evaluation.

A multidisciplinary therapeutic approach for advanced previously untreated epidermoid cancer of the head and neck: preliminary report.

Abstract A pilot study was conducted using two courses of cis -diamminedichloroplatinum, vincristine (Oncovin), and bleomycin (COB) every three weeks prior to surgery(s) and/or radiotherapy in 34 patients with advanced previously untreated epidermoid cancer of the head and neck. All patients received at least one course of chemotherapy; 7 are too early for evaluation. Responses to chemotherapy were dramatic and occurred within a few days. Sixteen patients had partial remission (PR) (59.3%), 9 had minimal response (MR) (33.3%) and 2 had stable disease after one course of COB. Twenty-two patients completed a second course of chemotherapy, 6 (27.3%) had complete remission (CR), 13 (59.1%) had PR, 1 had MR and 2 had stable disease. Objective remission correlated with subjective improvement. Drug toxicity were tolerable and acceptable. Eight patients had surgical resection after chemotherapy, followed by post-operative radiation therapy, and one patient had pre-operative radiation therapy before the tumor was considered resectable. Twelve patients underwent radiotherapy, including patients with CR after chemotherapy. Presently there is no evidence of local recurrence with the longest follow-up of 15+ months. In this preliminary report, the effectiveness and feasibility of this combined modality therapy is established; further study is needed to prove its value in prolonging disease-free period and survival.

Cryosurgery for head and neck cancer

Abstract We have used cryosurgical technics in the management of 106 malignant lesions of the head and neck region over the past six years. Morbidity has been minimal and short-term follow-up study indicates satisfactory tumor control. We currently use cryosurgery for the treatment of oral leukoplakia, for multiple small primary carcinomas, for widely spreading but superficially invading tumors, and for malignant lesions adjacent to but not deeply invading bone. For palliation and in patients too ill for resectional therapy, we have also found this modality to be advantageous. We are pleased with the minimal cosmetic defect engendered by the cryosurgical destruction of facial skin cancer.

Index of dysphagia: A tool for identifying deglutition problems

Applications and problems associated with an index of dysphagia are discussed. In addition to its use for establishing prevalence of dysphagia, this index identifies dysphagic patients so that early intervention may be initiated. The principal of the index is a list of 18 items that identify specific problems associated with dysphagia; demographic data are included as well. This tool may be used for clinical, research, and administrative purposes in many types of health care facilities.

Surgical management of severe reflux esophagitis. Eight to seventeen year follow-up study.

Abstract An eight to seventeen year follow-up study of patients treated by vagotomy and subtotal gastric resection with Roux-Y reconstruction of the gastroenterostomy shows this to be a curative procedure for reflux esophagitis. No marginal ulcers have been found in this long-term follow-up study.

Evaluation of osteogenesis following immediate and delayed reimplantation of frozen autogenous mandibular bone

A follow-up study of the feasibility of delayed reimplantation of frozen autogenous mandibles after ablative surgery for oral carcinomas with mandibular involvement was performed. Fifteen young adult mongrel dogs were used and evaluated clinically, bacteriologically, radiographically, histologically, and by radionuclide imaging. The animals were divided into two groups according to whether they underwent immediate or delayed reimplantation. These were subdivided into those who received grafts with and without autogenous marrow augmentation. The results were positive and suggested clinical evaluation. Twelve patients had undergone delayed reimplantation along with marrow augmentation over the past 3 years. Again, the results are most promising and we believe that, with further refinement, this technique will offer a new and acceptable modality for facial reconstruction in the cancer patient.

Synovial sarcoma of the head and neck

Abstract The case reported herein brings the total number of patients with synovial sarcoma of the head and neck to eleven. Among these cases, an asymptomatic mass was the most common clinical manifestation. Dysphagia and hoarseness, however, were also seen. The tumor in our patient demonstrated a tendency to late and repeated recurrences. In two other instances, similar late recurrences were found to have occurred in patients described in previously published reports. This pattern of late recurrences and metastasis appears, therefore, to be rather typical of unusual lesions of the head and neck region. Although the majority of patients previously reported on have been treated by excision alone, optimal treatment is probably a combination of excision and radiotherapy.

Lip and laryngeal flaps for reconstruction of the floor of the mouth following glossectomy.

Following glossectomy, the reconstruction of the floor of the mouth is a major problem facing the head and neck surgeon. We have devised split-lip and laryngeal mucosal flaps for this. In selected patients, they have a significant advantage over distant skin flaps. The initial postoperative deformity, from the lip being drawn into the mouth, is corrected by a secondary operation with split-skin graft reconstruction of the vestibule. These lip and laryngeal flaps do not require a delay procedure prior to the cancer surgery, and the operating time is considerably reduced. The cosmetic and functional results have been satisfactory.