Eduardo M. Diaz

Squamous cell carcinoma of the buccal mucosa: One institution's experience with 119 previously untreated patients

Squamous cell carcinoma (SCC) of the buccal mucosa is a rare, but especially aggressive, form of oral cavity cancer, associated with a high rate of locoregional recurrence and poor survival. We reviewed our institutions experience with 119 consecutive, previously untreated patients with buccal SCC.

Parathyroid carcinoma: A 22-year experience

Because parathyroid carcinoma is rare, clear consensus is not available regarding the optimal management of patients with this condition. Treatment strategies generally derive from clinical and anecdotal experiences. We report our experience with this entity.

OLFACTORY NEUROBLASTOMA: THE 22-YEAR EXPERIENCE AT ONE COMPREHENSIVE CANCER CENTER

Olfactory neuroblastoma (ONB) is a rare tumor arising from the olfactory neuroepithelium. There is no universally accepted staging system, and treatment approaches lack uniformity. We present one institutions experience with this tumor and the results of therapy.

FUNCTIONAL ANALYSIS OF SWALLOWING OUTCOMES AFTER SUPRACRICOID PARTIAL LARYNGECTOMY

In this study, we analyzed swallowing recovery after supracricoid partial laryngectomy (SCPL).

Prognostic factors for survival in malignant melanoma of the eyelid skin.

Purpose This study aimed to determine the prognostic factors for survival and disease-free interval for malignant melanoma of the eyelid skin. Methods This was a retrospective, nonrandomized, clinical review. Twenty-four patients with eyelid skin melanoma were identified through a search of the tumor registry at M. D. Anderson Cancer Center. Patients were treated between 1953 and 1994. The follow-up ranged from 3 to 18 years (mean = 9.6 years). Primary treatment in all cases entailed wide local excision of the tumor. Patients in whom regional lymph node metastasis developed underwent parotidectomy or neck dissection, with or without adjuvant chemotherapy or external beam radiation. Descriptive statistics were used to characterize the patients. Survival analysis in terms of disease-free survival and recurrence-free survival was performed using age, sex, location of tumor (upper lid, lower lid, or both), histologic type of melanoma, Breslow thickness, and Clark’s level as independent variables for survival. Results Age, sex, location, and the histologic type of tumor were not significant prognostic indicators for survival in this cohort. Clark’s level ≥IV by itself was a statistically significant predictor of decreased survival. In addition, tumors with either Clark’s level ≥IV or Breslow thickness ≥1.5 mm were associated with increased mortality. Conclusion Clark’s level ≥IV or Breslow thickness ≥1.5 mm are poor prognostic indicators for malignant melanomas of the eyelid skin. Clinicians should have a high level of suspicion for occult regional lymph node metastasis when treating patients with these tumor features.

Intraarterial cisplatin with intravenous paclitaxel and ifosfamide as an organ-preservation approach in patients with paranasal sinus carcinoma

The objectives of this study were to determine the efficacy, organ‐preservation rate, and safety of intraarterial (IA) cisplatin in combination with intravenous paclitaxel and ifosfamide in patients with locally advanced carcinoma of the paranasal sinuses who required orbital exenteration or major craniofacial resection for complete tumor resection.

The role of interstitial brachytherapy with salvage surgery for the management of recurrent head and neck cancers

The role of interstitial brachytherapy (IBT) in the salvage surgical management of regional lymphatic metastases for head and neck cancer has not been defined to date. To further explore its therapeutic benefit in the management of head and neck squamous cell carcinoma, the authors reviewed their experience utilizing IBT at the M. D. Anderson Cancer Center.

Durable Long-Term Remission With Chemotherapy Alone for Stage II to IV Laryngeal Cancer

PURPOSE For patients with stage II to IV laryngeal cancer, radiation therapy (RT) either alone or with concurrent chemotherapy provides the highest rate of organ preservation but can be associated with functional impairment. Thus, we studied the use of induction chemotherapy with or without conservation laryngeal surgery (CLS). Our objectives were to study the sensitivity of laryngeal cancer to platinum-based chemotherapy alone and to highlight the efficacy of CLS in this setting. PATIENTS AND METHODS Thirty-one previously untreated patients with laryngeal cancer (T2-4, N0-1, M0), who were resectable with CLS, were enrolled. Patients received three to four cycles of paclitaxel, ifosfamide, and cisplatin (TIP) chemotherapy, and response was assessed histologically. Patients with partial response (PR) proceeded to CLS. Patients achieving pathologic complete response (pCR) received an additional three cycles of TIP and no other treatment. RESULTS Thirty patients were assessable for response. With TIP chemotherapy alone, 11 patients (37%) achieved pCR, 10 of whom (33%) remain alive with durable disease remission and no evidence of recurrence over a median follow-up time of 5 years. Nineteen patients (63%) treated with TIP alone achieved PR. The overall laryngeal preservation (LP) rate was 83%, and only five patients (16%) required postoperative RT. No patient required a gastrostomy tube or tracheotomy. CONCLUSION Chemotherapy alone in selected patients with T2-4, N0-1 laryngeal cancer can provide durable disease remission at 5 years. For patients with PR, CLS provides a high rate of LP. This prospective study suggests that chemotherapy alone may cure selected patients with laryngeal cancer, warranting further prospective investigation.

Melanoma metastatic to cervical lymph nodes: Can radiotherapy replace formal dissection after local excision of nodal disease?

Completion cervical lymphadenectomy is usually performed after excisional biopsy of nodal metastases from melanoma. Radiation (XRT) might be effective for some patients in lieu of formal lymph node dissection.

CHEMOTHERAPY FOR SKULL BASE CANCERS

This article focuses on treatment options for select skull base problems that have decreased post-treatment morbidity and, in many cases, improved survival. The select skull base cancers covered include nasopharyngeal carcinoma, squamous cell carcinoma of the paranasal sinuses, sinonasal undifferentiated carcinoma, neuroendocrine carcinoma, esthesioneuroblastoma, and salivary gland carcinoma.