Lawrence W. Desanto

Angiofibroma: Treatment trends in 150 patients during 40 years

A series of 150 patients with histologically confirmed angiofibroma examined from 1945 through 1983 was studied to contrast treatment methods and surgical approaches. From 1945 to 1955, treatment consisted primarily of radiation. From 1955 through 1971, the primary method of treatment was surgical removal; the lateral rhinotomy approach was used to expose the tumor and its extensions in most cases. From 1971 through 1983, all tumors were removed surgically. Trends in diagnosis, treatment, and adjunctive therapy at a single institution were evaluated. Specifically, the trends considered were operative approaches, blood replacement with and without hypotensive anesthesia, adjunctive measures such as hormonal therapy or tumor embolization, mortality, and morbidity. Lateral rhinotomy provides wide exposure of and access to the nose, nasopharynx, paranasal sinuses, elements of the skull base, temporal fossa, and infratemporal fossa. Surgical treatment, specifically the lateral rhinotomy approach and its extensions, is recommended as the best method of managing angiofibroma in most patients.

Surgical treatment of squamous cell carcinoma of the base of the tongue.

One hundred two patients with squamous cell carcinoma of the base of the tongue were treated by surgery. The grade of the tumor did not influence survival; however, survival was influenced by the stage of the disease and the operation selected. Operations that provided wider access decreased the incidence of local recurrence. Of the 102 patients, 23 percent required either total or partial laryngectomy. The survival curves of the 23 patients suggest that management of the larynx is a key factor in treating larger cancers. Overall, the five‐year survival rate for the 102 patients was 42 percent. Surgery is the treatment of choice in squamous cell carcinoma of the base of the tongue.

Laryngofissure and Cordectomy for Early Cordal Carcinoma: Outcome in 182 Patients

At the Mayo Clinic from 1962 to 1974, 182 patients with early squamous cell cancer of the true vocal cord were treated by laryngofissure and cordectomy. Seven patients (4%) had recurrences: four in the larynx and three in the neck (although the larynx was free of disease). The case histories of these patients are reported. Only three (2%) of the patients died as a consequence of their laryngeal cancer. The data substantiate our belief that the laryngofissure and cordectomy operation, and its minor variations, is an expeditious and highly successful means of eradicating glottic cancers.

Intraluminal involvement of the larynx and trachea by thyroid cancer.

Abstract Involvement of the larynx and trachea by thyroid cancer extensive enough to cause an intraluminal mass is rare. In a sixty year period at the Mayo Clinic, only eighteen patients (of 2,000 with thyroid cancer) had involvement that required surgical intervention. Of these eighteen, fifteen were forty years old or older. Seven patients had follicular carcinoma; six, papillary carcinoma; four, anaplastic carcinoma; and one, medullary carcinoma. Seven patients had tracheostomy; seven, laryngectomy; three, partial removal of the larynx or trachea; and one, bronchoscopy and partial removal of the tumor for biopsy. Of the eighteen patients, two died during tracheostomy, seven lived three months to three years after operation, one lived five and a half years, and seven are still alive nine months to eight years after operation. One of the patients was lost to follow-up study. Of the ten patients who have died, two died of causes unrelated to the thyroid cancer. Of the seven surviving patients, six had laryngectomy, and one had partial laryngectomy.

Verrucous carcinoma of the larynx

Verrucous carcinoma, because of its oftentimes unusual clinical appearance, may be misdiagnosed if there is not good communication between the surgeon and the pathologist. We have reviewed our series of 20 cases of verrucous carcinoma from 1964 through 1974 and have analyzed the results of our therapy. We have concluded that verrucous carcinoma is a slow‐growing, locally invasive lesion that does not metastasize to the cervical lymph nodes. Radiation therapy does not seem to be an effective method of treatment; the recurrence rate is high. Conservative laryngeal surgery is the preferred method of treatment in these patients and should prevent loss of life and spare laryngeal function.

Prognostic Implications of Nuclear DNA Content in Head and Neck Cancer

The nuclear DNA content was measured in formalin-fixed and deparaffined specimens of 296 oral, pharyngeal, and laryngeal squamous cell carcinomas from patients in whom the clinical outcome was known. One hundred ninety (64%) contained cells with abnormal DNA (DNA aneuploid or tetra/polypoid). Only 32% (60 of 190) of the patients with DNA nondiploid cancers survived 5 years, compared with 49% (52 of 106) of the patients with DNA diploid cancers. When the findings were controlled for clinical stage, patients whose tumors were DNA diploid had a survival advantage at each stage. Histologic grading showed less correlation, because only patients with well-differentiated carcinomas had a survival advantage if their tumors were DNA diploid. These data showed that determination of DNA content in cancers of the head and neck can offer prognostic information not provided by other means and enhance the diagnosis of cancer.

Cancer of the supraglottic larynx: a review of 260 patients.

The treatment of supraglottic larynx cancer Is still unsettled. The current concerns are the place of conservation surgery, the use of radiation for cure with surgery for salvage, and the management of neck metastasis. In 1976, we reported our experience with treatment of 221 patients with supraglottic cancer. At that time, the issue was the oncologic safety of the conservation operations. That review affirmed that these operations were safe and effective in properly selected patients. This article Is on the study of an additional 260 patients treated in a subsequent period. The principal issues addressed in this review are (1) the frequency of recurrence at the primary site In all stages of supraglottic cancer treated surgically and (2) radical radiation with surgery for salvage. This study documents the oncologic effectiveness of the treatment of primary disease with surgery alone for stages I and II supraglottic cancer. For all stages of supraglottic cancer, this study further documents that the control of neck metastasis remains an unsolved problem.

Cryosurgery of respiratory structures. I. Cryonecrosis of trachea and bronchus

Although extirpative surgery is the mainstay of treatment of tumors of the trachea and bronchial tree, other methods for cure or palliation of neoplasms in these structures should be explored. The present study was designed to assess, in dogs, 1. the pathophysiologic effects of complete circumferential cryonecrosis of a segment of trachea, and 2. the feasibility of performing cryosurgery within the distal tracheobronchial tree through a bronchoscope.

Positive delphian lymph node: Clinical significance in laryngeal cancer

The significance of metastatic cancer in the Delphian lymph node in patients with laryngeal carcinoma has not been thoroughly discussed. Between 1960 and 1985, we identified 20 cases of histologically proven metastasis to the Delphian node. In 12 of these patients with glottic cancer (T1‐T3), the neck was clinically negative but a positive Delphian node was discovered at partial or total laryngectomy; in 6 patients, ipsilateral neck metastasis developed. Eleven of the 20 patients have died from their laryngeal cancer. The frequency of neck metastasis or death, or both, from cancer is unusually high in patients with a positive Delphian node.

Tumefactive fibroinflammatory lesions of the head and neck

We use the term “tumefactive fibroinflammatory lesion” to describe an unusual