Hollon W. Farr

Chordoma. Thirty-five-year study at memorial hospital†

The clinical histories of 46 cases of chordoma seen and treated at Memorial Hospital from 1930 to 1965 are reviewed, including 30 cases of sacral origin, ten cases of vertebral origin, five sphenoidal and one extranotochordal, with an age range from 2 1/2 years to 71 and a male sex predominance of 32 to 14. Only three patients in this series are alive and free of disease 5, 13 and 16 years after diagnosis and treatment and the absolute 5‐year survival rate with freedom from disease is only 8.7%. Complete surgical excision can result in a cure in a few selected sacrococcygeal or sphenoidal cases but incomplete removal or tumor spillage in the wound are certain to lead to recurrence and probable metastasis and death. When radiation therapy is employed, either alone or preoperatively, symptomatic relief can be expected and some regression in the tumor at least for a time. In those tumors that show some radioresponsiveness repeat x‐ray dosages may prove of extended benefit. The authors conclude that distant metastasis and local recurrence are more common than ordinarily considered and therapeutic doses of supervoltage irradiation pre‐ or postoperatively could be of subtantial benefit in the management of this uncommon disease.

Cervical node metastasis from epidermoid carcinoma of the oral cavity and oropharynx: A critical assessment of current staging☆

Abstract The clinical and histologic status of cervical lymph nodes has been correlated with the results of treatment in 1,069 consecutive patients who underwent radical neck dissection as part of the initial treatment of a primary epidermoid carcinoma arising in either the oral cavity or oropharynx. The influence on “cure” rates of size, number, location, and fixation of involved nodes, correlated with the specific site of origin within the oral cavity, was evaluated in determinate patients with proved nodal metastasis. As the extent of lymph node involvement increased from solitary to multiple ipsilateral and to bilateral enlarged nodes, cure rates dropped progressively. Survival was not invariably decreased in those whose involved nodes were large or considered fixed, and there was considerable variance among examiners when size and fixation were evaluated. These data suggest that the N system of staging presently advocated might be improved. Rather than designating contralateral or bilateral node involvement as N 2 , this category might be reserved for those with multiple ipsilateral cervical node metastases. Those with contralateral and bilateral as well as so-called fixed metastases might better be relegated to the N 3 category. The results of treatment were uniformly poor in the latter group of patients, provided the term “fixed” indicated immobility of involved lymph nodes and not merely the presumption that tumor had extended beyond the capsule of the node.

Carcinoma of the oral cavity: Factors affecting treatment failure at the primary site and neck☆

A retrospective review of the clinical records of patients with carcinoma of the oral cavity was undertaken, and several parameters were studied in terms of comparing two groups of patients: those who were controlled at the primary site and neck and others who failed locally or regionally following initial treatment. A comparative statistical analysis of the factors studied revealed that female patients who had a higher T status, a higher N status, and thus a higher stage of disease did poorly in terms of local and regional control of disease. Those patients whose primary tumors manifested deep invasion and those who had positive margins after surgical resection at the primary site had also a significantly high incidence of local/regional failure. Presence of extracapsular extension of disease in cervical lymph nodes and involvement of soft tissues in the neck as well as involvement of multiple lymph nodes at multiple levels also put the patients in a high risk category. We urge that these factors be considered as prognostic criteria and be used to select patients for treatment by additional modalities on an elective basis in hope of achieving better local and regional control of disease and perhaps better cure rates.

Malignant vascular tumors of the head and neck

Summary During a forty year period (1930 through 1969) twenty-seven patients with malignant vascular tumors of the head and neck region were seen at Memorial Cancer Center and twenty-one are now available to determine five and ten year end results. All cases are determinate, having received treatment, and none was lost to follow-up study. The classification of these tumors can be unduly complicated and therefore for the benefit of the clinician is simplified in this presentation: ten angiosarcomas and eleven hemangiopericytomas. The absolute and net five year cure rate was 25 per cent and was achieved by radical surgery alone. Among those having had previous treatment (more than half of our cases) there were no five year cures. The five year survival rate of 67 per cent was surprisingly high and can be explained by the prolonged clinical course of hemangiopericytoma as compared with angiosarcoma, for they represent two separate clinical and pathologic entities.

Prognostic significance of histologic grade in epidermoid carcinoma of the mouth and pharynx

Abstract Data are presented on the influence of histologic grading on prognosis in 946 patients with epidermoid carcinoma of the mouth and pharynx. Relationships are shown between the tumor grade and the site of the primary lesion, the stage of disease, node involvement, and prognosis. Histologic grading of epidermoid carcinoma in this region is a factor to be weighed in planning therapy.

Epidermoid carcinoma of the mouth and pharynx at Memorial Sloan-Kettering Cancer Center, 1965 to 1969.

One thousand thirty-four cases of epidermoid carcinoma of the mouth and pharynx were seen by the Head and Neck Service of Memorial Hospital during a recent 5 year period, 1965 to 1969. The 656 determinate cases previously untreated offer a clear basis for evaluation of the 5 year results of treatment, which as surgical in 90 percent of the cases. Preoperative radiotherapy was used in 130 cases. Preoperative radiotherapy was used in 130 cases, matched with 126 untreated cases. Etiologic factors are discussed. The presence and degree of lymph node metastasis are of paramount significance. Indications for elective treatment of the clinically negative neck are discussed in terms of anatomic, logistic and statistical principles. An analysis of failure point toward a continuing effort at combined therapy in this regional disease.

Primary orbital tumors

Abstract Fifty-six patients with primary extraocular orbital tumors were seen during the years 1944 through 1964 at Memorial Hospital for Cancer and Allied Diseases. Of the malignant lesions, the most common were epithelial tumors of the lacrimal gland, malignant lymphoma, and rhabdomyosarcoma. On the basis of the experience being reported, exenterative surgery in conjunction with radiation therapy is recommended for adenoid cystic, malignant mixed tumors, and epidermoid carcinomas of the lacrimal gland. Radiation therapy is recommended for lymphoma. Early exenteration should be the treatment of choice for rhabdomyosarcoma because locally recurrent or metastatic disease occurring after inadequate primary treatment is resistant to any form of management. 34.1 Per cent of the patients with malignant orbital tumors survived five years, but the absolute cure rate was 20.4 per cent in this series. Early diagnosis, aggressive approach to treatment, and closer cooperation between the ophthalmologist and head and neck surgeon should improve the salvage rate.

Soft part sarcomas of the head and neck

During the 28-yr-period from 1949-1977, 285 patients with sarcoma of the head and neck region were seen and treated at Memorial Cancer Center. Two hundred forty-two cases were determinate, and none was lost to follow-up study. The determinate and absolute 5-yr cure rate was 32%. More than 50% of the cases were seen in children (8 cases were congenital) and were almost universally anaplastic and prone to generalized metastasis with fatal outcome. Combined modalities of radical surgery, postoperative radiotherapy, and chemotherapy over a prolonged period have markedly altered the prognosis of these tumors. Soft part sarcomas are an unusual group of tumors with a common fibrosarcomatous background. The qualified pathologist can identify quite accurately the different histologic entities and their varying grade, a point of great significance as to clinical course and treatment.

Tongue Cancer: Current Results of Treatment

To cite this article: Joseph G. Fortner M.D. , Edward J. Beattie Jr. M.D. , Elliot W. Strong M.D. , Hollon W. Farr M.D. , Julius Smith M.B. , William G. Cahan M.D. , Keith Arthur M.B. , Solomon R. Savdie M.D. & Andrew G. Huvos M.D. (1972) Tongue Cancer, Postgraduate Medicine, 51:2, 247-252, DOI: 10.1080/00325481.1972.11698146 To link to this article: http://dx.doi.org/10.1080/00325481.1972.11698146

The lump in the neck

A “lump in the neck” is usually the first symptom of nasopharyngeal cancer, and any of the lymph chains of the head and neck may be the site of the metastatic spread of a malignant neoplasm arising in the head and neck area. When a patient presents with an asymmetric “lump in the neck,” the examiner should immediately suspect metastatic cancer since only a small proportion of neck cancer is primary in the neck structures. Most probably the primary lesion is in the oral cavity, pharynx, or skin. Occasionally, the primary lesion may be below the clavicle. Asymmetric cervical enlargement in children is less likely to be metastatic than it would be in the adult. A knowledge of these chains and the areas that they drain (Fig. 1) is indispensable to the dentist or physician interested in early detection when he is confronted by a patient with such a node. 1 The most serious error that can be made is an excision biopsy which, although proving the presence of malignant disease, does not indicate the primary lesion and contributes only to a poor prognosis by delaying treatment and by scarring a surgical field where radical dissection may be contemplated. Unless the mass is known to be a cyst, lipoma, or thyroid adenoma, biopsy of the node should be the last resort in a series of diagnostic steps which start. with a meticulous examination of the mouth, tongue, larynx, and pharynx.