Frank S. H. Wong

Targeted chemoradiation for advanced head and neck cancer: Analysis of 213 patients

To determine the survival results, patterns of relapse, and organ preservation effects of a targeted chemoradiation protocol for patients with advanced (stage III–IV) carcinoma of the head and neck.

Efficacy of targeted supradose cisplatin and concomitant radiation therapy for advanced head and neck cancer: The Memphis experience

PURPOSE/OBJECTIVE To evaluate the feasibility, response rates, and toxicity of a Phase II study using targeted supradose cisplatin and concurrent radiation therapy in unresectable Stage III-IV head and neck squamous cell carcinoma. METHODS AND MATERIALS Sixty patients presenting between 6/93-9/94 were enrolled, 44 (73%) of whom had T4 and/or N2-N3 nodal disease. All patients were treated with rapid targeted superselective intraarterial infusions of cisplatin (150 mg/m2 weekly x 4) and simultaneous sodium thiosulfate intravenously (9 g/m2) for systemic neutralization of cisplatin. Concurrent (day 1) daily radiation therapy was delivered to the primary tumor and overt nodal disease to 66-74 Gy while the uninvolved lower neck received 50 Gy, at 2.0 Gy/fraction. RESULTS Fifty-one (85%) patients completed the full RADPLAT protocol as planned. Fifty-seven of 60 patients were evaluable for response. Histological (n = 50) or clinical (n = 7) assessment of primary site revealed a complete response (CR) in 52 patients, partial response (PR) in 4, and stable disease (SD) in 1. Of the 40 patients presenting with nodal metastases, pathological (n = 31) or clinical (n = 6) assessment revealed a CR in 25, PR in 11, and SD in 1, while 3 were unevaluable. Overall, for both primary site and nodal disease, CR was attained in 44 (75%), PR in 12 (23%), and SD in 1 (2%) of the 57 evaluable patients. Only 2 (4%) of 57 evaluable patients have recurred above the clavicle, 1 in the primary site and 1 in the regional lymph nodes. Twelve patients (23%) have failed in distant sites. Grade III/VI toxicity has included gastrointestinal in 6, hematologic in 6, mucosal in 12, vascular in 4, and neurological in 4 patients. CONCLUSION Concurrent radiation therapy and targeted supradose cisplatin (i.e., RADPLAT) can be safely delivered with high response rates and excellent loco-regional control in advanced Stage III/IV head and neck squamous cell carcinoma.

Concomitant radiation therapy and targeted cisplatin chemotherapy for the treatment of advanced pyriform sinus carcinoma : disease control and preservation of organ function

Squamous cell carcinoma of the pyriform sinus is an unfavorable disease which frequently presents in advanced stages. Despite aggressive “standard treatment” involving debilitating surgery and postoperative radiation therapy treatments, the survival and functional outcome for pyriform sinus carcinoma remains poor. Hence, we reviewed our experience in the management of advanced pyriform sinus carcinoma using “organ preservation” chemoradiation therapy.

Efficacy of Concomitant Chemoradiation and Surgical Salvage for N3 Nodal Disease Associated With Upper Aerodigestive Tract Carcinoma

Objectives/Hypothesis To determine whether an aggressive approach using trimodality therapy would improve the outcome in head and neck cancer patients with advanced (N3) nodal disease.

Assessment of gastric electrical activity and autonomic function among diabetic and nondiabetic patients with symptoms of gastroesophageal reflux.

Gastroesophageal reflux disease (GERD) may present differently in patients with diabetes mellitus (DM) than in nondiabetics (NDM). We compared three tests in two patient groups with GERD symptoms: a DM group (n = 10) and a NDM group (n = 13). The tests were 24-hr esophageal pH, autonomic function testing (AFT), and electrogastrography (EGG). Analysis of the 23 patients revealed the DM group had normal 24-hr pH values (9 of 10 patients, mean pH 3.1 ± 1.7), while NDM displayed abnormal pH values (9 of 13 patients, mean pH 21.2 ± 5.9). AFT results were abnormal in DM (demonstrating cholinergic/adrenergic dysfunction), but normal in NDM. EGG values were abnormal in both groups (mean 3.31 ± 0.1 in each). We conclude that in GERD-symptomatic patients, those with DM frequently have normal 24-hr pH, but abnormal autonomic functioning, in contrast to NDM, who have abnormal 24-hr pH but normal autonomic function. Both groups had identically abnormal mean EGG values.

Isolated mucoepidermoid carcinoma in the neck.

Mucoepidermoid carcinoma is a common type of salivary gland malignancy with metastasis to the cervical lymph nodes occurring in up to 29% of patients. 1 We describe three patients presenting with isolated mucoepidermoid carcinoma in a cervical lymph node without an obvious primary site of origin.

Predictive indicators among cancer patients who complete a clinical trial

Objective: Facial nerve monitor use has become standard in neurotologic dissections, but the effect of electrical stimulation has never been studied in isolation. This study uses an animal model to assess the effects of intradural electrical stimulation. Methods: The intracanalicular facial nerve was exposed and stimulated in 10 rabbits. Five rabbits served as controls. Facial nerve function was observed and graded for 3 days postoperatively. A blink reflex EMG was done on day 3. Results: Stimulation did not cause decremental threshold response in animals exposed to five l-minute intervals at 0.5 mA. These animals exhibited normal facial function postoperatively, and EMG findings did not show weakness. Conclusions: The intradural facial nerve in this rabbit model was able to resist significant functional injury, despite the potential trauma of exposure and electrical stimulation, in 10 of 10 cases. Monitoring the intradural facial nerve should not significantly damage nerve function or cause a decremental threshold response.