Jack L. Gluckman

Prognostic value of histopathologic parameters in squamous cell carcinoma of the oropharynx.

Seventy‐seven patients with squamous cell carcinoma of the oropharynx were treated by preoperative radiation therapy (4000–5000 rad) followed by surgical resection. The original biopsy specimens were evaluated for degree of keratinization, nuclear pleomorphism, frequency of mitoses, inflammatory response, vascular invasion, and pattern of invasion. Multivariant analysis (Cox regression model) and life table survival function were used to determine the relative contributions of the clinical and histologic parameters to patient outcome. The results were as follows: (1) large tumor size, nodal metastases, and male sex were found to be predictive of a poorer survival (P = 0.004, 0.004, 0.0167, and 0.0237, respectively); and (2) an analysis of a combination of clinical and histologic parameters demonstrated that the pattern of invasion was the only histologic factor that was predictive of survival (P = 0.0436). Neoplasms invading as large cohesive aggregates indicated a better prognosis than neoplasms invading as thin, irregular cords or individual cells. Restricting the statistical evaluation to only histologic factors (excluding clinical factors) demonstrated that increased frequency of mitoses also correlated with poor survival (P = 0.0218). Further restriction of the analysis to T2 and T3 neoplasms that have similar survival times indicated that both frequency of mitoses and pattern of invasion were of prognostic value in predicting survival (P = 0.0127 and 0.0168, respectively).

Esthesioneuroblastoma and Sinonasal Undifferentiated Carcinoma: Impact of Histological Grading and Clinical Staging on Survival and Prognosis

Objectives Hyams proposed a histological grading system for esthesioneuroblastoma in which grade I tumors have an excellent prognosis and grade IV tumors are uniformly fatal. The Hyams grading system predated advanced craniofacial techniques, extensive use of immunohistochemistry, and the recognition of sinonasal undifferentiated carcinoma (SNUC) as a distinct entity. Therefore we aimed to determine whether Hyams classification is useful in predicting outcome for esthesioneuroblastoma and SNUC.

Tumor angiogenesis as a prognostic indicator in T2-T4 oral cavity squamous cell carcinoma : A clinical-pathologic correlation

Tumor angiogenesis has been shown to correlate with tumor size, metastatic potential, and prognosis in breast and other cancers. Studies in head and neck cancer have suggested a similar correlation, but results have been inconclusive. This study was performed to determine the correlation between angiogenesis and oral tumor behavior.

Tumor angiogenesis in T1 oral cavity squamous cell carcinoma: Role in predicting tumor aggressiveness

Angiogenesis is necessary for tumor growth and metastasis. In breast and other cancers angiogenesis has been shown to correlate with tumor size, metastatic potential, and prognosis. Some studies of head and neck cancer have shown a similar correlation, although results are inconclusive. This study was performed to determine whether tumor angiogenesis can be used as a prognostic indicator for early oral cancers.

Hematoporphyrin photodynamic therapy: Is there truly a future in head and neck oncology? Reflections on a 5-year experience†

Photodynamic therapy, which consists of the selective destruction of tumors using a combination of a photosensitizer administered systemically (dihe‐matoporphyrin ether) and an argon dye‐pumped laser, has provoked profound interest amongst oncologists and has particularly titillated head and neck oncologists with its potential. Unfortunately, no multi‐institutional trials for head and neck tumors have been introduced, and the literature is replete with anecdotal reports from individual researchers on the management of advanced cancers for palliation, superficial early cancers, and field cancerization of the mucosa (“condemned mucosa”)‐ A personal 5‐year experience with 41 head and neck cancers was reviewed, as was the current literature. An attempt was made to place in perspective the true role and future direction of this technology.

Antibiotic Prophylaxis in High-Risk Head and Neck Surgery: One-Day vs. Five-Day Therapy

Patients who undergo major contaminated surgery of the head and neck benefit from perioperative antibiotic prophylaxis. This study was developed to determine if 5 days of antibiotic administration would be more effective than 1 day. A multi-institutional prospective randomized double-blind study was designed. Patients who were identified as requiring pedicled flap reconstruction were potential candidates for the study. Later, patients were randomly assigned to receive cefoperazone sodium for either 24 hours or 120 hours. In each case, the drug was administered intravenously, beginning 1 to 2 hours preoperatively and continued for the prescribed period. One hundred nine patients were evaluable. Fifty-three patients were assigned to 1 day of perioperative prophylaxis. Wound Infection developed in ten patients (18.9%). Fifty-six patients were assigned to 5 days of perioperative antibiotic prophylaxis. Wound infection developed in 14 (25%) of these patients (P >.05). These data suggest that no beneficial effect from administration of antibiotics for longer than 24 hours postoperatively can be achieved in patients who undergo myocutaneous flap reconstruction.

Operative complications of tracheoesophageal puncture

Tracheoesophageal puncture is not a complex procedure; nevertheless, significant complications are possible. In the last four years we have performed this procedure in 47 patients. Seven of them (15%) sustained significant complications related to the procedure. These included three cases of mediastinitis and sepsis, although surgical drainage was not required. Three other patients developed cellulitis of the trachea and root of the neck, centered around the tract through the party wall; one patient suffered a fracture of the cervical spine. Eight lesser complications also occured.

Effects of hemimandibulectomy on quality of life

Objective: To assess the quality of life and functional status of patients who have undergone hemimandibulectomy based on the type of reconstructive procedure performed. Study Design: Survey, retrospective. Methods: Twenty‐one patients who had undergone hemimandibulectomy and had similar defects were divided into two groups based on the reconstructive technique utilized. Eleven patients were placed in the soft tissue reconstruction group. Ten patients were placed in the mandible reconstruction group. All patients were assessed for: function, utilizing the Performance Status Scale, and quality of life, using a general cancer questionnaire (FACT‐G) and a series of questions specific for head and neck cancer patients. Results: Mandible reconstruction produced a perceived better physical appearance (P = .02), better eating ability (P = .04), and a better overall quality of life (P = .002). The mandible reconstruction cohort consistently outscored the soft tissue cohort on all questionnaires. Conclusion: Restoration of mandibular continuity after hemimandibulectomy leads to improved function and a superior quality of life in appropriately selected patients. Laryngoscope, 108:1574–1577, 1998

Survival, Function, and Quality of Life After Total Glossectomy†

Advanced tongue cancer is associated with poor survival despite aggressive therapy. In an attempt at cure, many patients undergo total glossectomy, which significantly affects function and quality of life (QOL). This study was designed to determine the survival rate and QOL of patients who had undergone total glossectomy. A total of 54 patients underwent total glossectomy, with or without total laryngectomy, for advanced tongue cancer from 1970 to 1996. Patient outcomes were assessed for the following: 1. disease‐free survival, 2. function, utilizing the Performance Status Scale (PSS), and 3. QOL, using two general cancer questionnaires (FACT‐G and EORTC QLQ‐C30) and a series of questions specific for head and neck cancer patients. Corrected actuarial survival was 51% and 41% at 3 and 5 years, respectively. Functional assessment using the PSS demonstrated significant deficits in speech and deglutition. QOL questionnaires revealed problems with eating, speaking, socializing, and shoulder function. However, the over‐all responses demonstrated that these patients have adjusted to their deficits and have a good QOL. It was concluded that total glossectomy, with or without total laryngectomy, can result in meaningful survival and an adequate QOL can be achieved in selected patients.

Temporal bone carcinoma : Contemporary perspectives in the skull base surgical era

Historically, malignant tumors that arose within the temporal bone or that intimately juxtaposed the petrous ridge portended an ominous prognosis. Perusal of the surgical literature from 1950 to 1975 strongly supports the impression that despite heroic surgical efforts many of these patients sustained significant morbidity and a high mortality rate.