Kumao Sako

Metastatic Patterns in Squamous Cell Cancer of the Head and Neck

This retrospective study on 832 head and neck cancer patients who died between 1961 and 1985 was carried out to determine the incidence and sites of distant metastases. All patients were staged prior to definitive treatment and were autopsied. The overall incidence of distant metastases was 47 percent. The hypopharynx had the highest incidence of distant metastases (60 percent), followed by the base of the tongue (53 percent) and the anterior tongue (50 percent). Of the 387 patients with distant metastases, 91 percent died with uncontrolled tumor either at the primary site or in the neck. The lung was the most common site of distant metastases (80 percent), followed by the mediastinal nodes (34 percent), the liver (31 percent), and bone (31 percent). Overall, 6 percent of the patients had stage I disease, 20 percent had stage II disease, 32 percent had stage III disease, and 43 percent had stage IV disease. The highest incidence of distant metastases was found in those patients with stage IV disease (193 of 350 patients, 55 percent). We believe that the initial stage of disease does appear to be related to the ultimate development of the distant metastases.

The periosteum of the mandible and intraoral carcinoma

Abstract 1. 1. Data have been presented indicating that the mandible may be preserved in a higher percentage of patients. 2. 2. Clinical application in a small number of patients has provided good results. 3. 3. Clinical criteria for the selection of patients have been outlined.

Adenoid cystic carcinoma of major and minor salivary glands.

Abstract The records of eighty-one patients with adenoid cystic carcinoma of major and minor salivary glands at Roswell Park Memorial Institute have been reviewed. Survival data on sixty-five patients followed five years or more reveals an average survival of 7.4 years. Sixty-five per cent (forty-two of sixty-five patients) lived for five years, 31 per cent (twenty of sixty-five) for ten years, and 15 per cent (ten of sixty-five) for fifteen years or longer. The patients were divided into four anatomic groups which regionally involve similar problems in treatment and often result in similar cosmetic and functional deformities. Similarities are seen but there are also some notable differences in recurrences and total survival depending on the anatomic location of the primary lesion. Aggressive surgical resection and reconstruction is the preferred method of therapy for both primary and locally recurrent disease whenever possible. Local recurrences and systemic metastases are common, but are often delayed for several years. Locally recurrent tumor can be controlled in many instances by surgical resection or radiotherapy, but careful lifetime follow-up study of the patient is required to discover recurrent disease at its earliest stage.

Results of surgical resection of pulmonary metastases of squamous cell carcinoma of the head and neck

In this retrospective review of 58 patients (12 females and 46 males) with pulmonary metastases of squamous cell carcinoma of the head and neck treated between January 1, 1970, and December 31, 1989, we evaluated their clinical courses and analyzed the outcomes of those who underwent pulmonary resection. For the entire group of patients, factors predictive of survival in those patients with a diagnosis of pulmonary metastases included pulmonary resection of metastases (p = 0.0001), locoregional control of the head and neck primary tumor at the time of diagnosis of pulmonary metastases (p = 0.007), TNM stage of the head and neck primary tumor (p = 0.02), a single nodule seen on the chest radiograph (p = 0.02), and disease-free interval (DFI) from the primary tumor of the head and neck of 2 years or more (p = 0.05). Twenty-four of 58 patients underwent thoracotomy for resection of metastases. Four (17%) were found to have a second primary tumor of the lung. Of the 20 remaining patients who underwent explorative surgery for possible pulmonary resection, 18 (90%) underwent complete resection of all malignant disease with an estimated 5-year survival of 29%. In these patients, a DFI of less than 1 year was associated with a 5-year survival rate of 0%, whereas a DFI of 1 to 2 years was associated with a 5-year survival rate of 43% and a DFI of 2 years or longer had a 5-year survival rate of 33%. The number of malignant pulmonary nodules that were resected ranged from one to five and was not significant in predicting survival (p = 0.19). Of eight patients who underwent the resection of more than one malignant pulmonary nodule, 50% survived 2 years, but none survived 5 years. Resection of a solitary pulmonary metastasis from squamous cell carcinoma of the head and neck resulted in long-term survival in selected patients. Important prognostic factors included locoregional control of the head and neck primary tumor, the number of nodules seen on chest radiograph, the TNM stage of the primary tumor, and the DFI from the head and neck primary tumor. The value of resection in patients with more than one malignant pulmonary nodule remains to be defined for this group of patients.

Periosteal lymphatics of the mandible and intraoral carcinoma

Abstract The periosteal lymphatics of the mandible have long been considered an important route by which metastases from intraoral carcinoma spread to the cervical areas. Serial sections of the mandibular periosteum removed from surgical specimens were studied. The periosteum was involved only in those patients in which the tumor rested against the mandible. In instances in which there were only a few millimeters of normal tissue between the lesion and the mandible, there was no periosteal involvement. No relationship existed between the size of the lesion and the presence of periosteal involvement. There was no relationship between periosteal involvement and the presence or absence of cervical metastases. The distance between the lesion and the mandible appeared to be the decisive factor relative to involvement of the periosteum by tumor. Additional studies are under way.

Cryotherapy of intraoral leukoplakia

Abstract In an investigative study sixty patients with single and multiple areas of leukoplakia were treated by cryotherapy. The acceptability of this modality by patients was excellent. Recurrence developed in twelve patients during a follow-up period which ranged from two and a half to four and a half years. In four patients squamous cell carcinomas developed which were relatively small primary lesions in or adjacent to the area of the treated leukoplakia. Although the incidence of malignancy of 6.6 per cent is well within the reported range of malignant change in intraoral leukoplakia, this finding considerably diminishes our initial enthusiasm regarding this modality as routine treatment for leukoplakia and certainly emphasizes the need for further study before it can be completely acceptable as a routine form of treatment.

Bilateral radical neck dissection

From January 1960 to December 1977, 61 patients had a simultaneous one‐stage bilateral neck dissection with or without excision of the primary lesion, while 63 patients had a therapeutic second (two stage) neck dissection performed by our service. In ten patients, one or both of the internal jugular veins and spinal accessory nerve were preserved. Patients in both groups were staged, using the American Joint Commission 1977 clinical classification. All the pathologic specimens had lymph node clearance done.

Multiple malignancies in patients with head and neck cancer.

Abstract Multiple malignancies occurred in 7.5 per cent of 1,919 patients with head and neck cancer. In 64 per cent of patients the two cancers were diagnosed within twenty-four months of each other. Multiple malignancies occurred most frequently in patients with head and neck skin cancer. The most commonly encountered additional malignancy was another cancer of the head and neck. The three year survival of patients after treatment of a second primary malignancy was 21 per cent and the five year survival 9 per cent.

Chemotherapy for advanced and recurrent squamous cell carcinoma of the head and neck with high and low dose cis-diamminedichloroplatinum.

Cis-diamminedichloroplatinum (cis-DDP) in both a high dose regimen of 120 mg/M2 every three weeks with pretherapy hydration and mannitol diuresis and a low dose regimen of 20 mg/M2 daily for five days and cycled every three weeks have effective antitumor activity in approximately one third of patients. Its toxicity in both regimens appears to limit the number of cycles of administration and the duration of response. Further trials with dose schedules intermediate between the present high and low dose schedules are needed to provide a suitable and effective one day regimen every three to four weeks that can be given on an outpatient basis and on a long-term basis.

Complications after radical head and neck surgery performed through previously irradiated tissues

Abstract 1. 1. Cancericidal doses of x-rays will produce tissue changes which interfere with normal healing of surgical wounds in the neck. 2. 2. Evaluation of tissue changes and judgment in selection of patients for surgery will lessen postoperative complications. 3. 3. The resulting complications, in most instances, can be satisfactorily handled. 4. 4. The most serious complication is wound slough and perforation of the carotid artery, which may result in death.