Richard H. Jesse

Treatment of the neck in patients with squamous cell carcinoma of the head and neck.

A retospective study of 702 patients with clinically positive nodes associated with squamous cell carcinoma of the oral cavity, supraglottic larynx, and hypopharynx observed from 1954 to 1968 was done. The policies of treatment for the neck were not standardized during those years. Three hundred eleven patients who survived 24 months with the primary lesion controlled were divided into two groups: 1) those whose neck was treated by surgery alone; and 2) those who had combined radiation therapy and surgery to the neck, to test the efficacy of the two forms of treatment. For the three sites, the recurrence rate in the necks for the surgically treated group was 14% for stage N1, 26% for N2 and 34% N3. Rates for the group receiving combined treatment were 2%, 11% and 25% respectively. Results of the study also showed that elective irradiation, 5,000 rads in five weeks, will prevent metastasis from occurring in the N0 staged neck.

Fast neutron therapy for locally advanced head and neck tumors

Abstract Between October 1972 and April 1979, 187 patients with locally advanced head and neck tumors were treated with 50 MeV d→Be neutrons or with conventional treatment in the M. D. Anderson Hospital-Texas A & M University variable energy cyclotron (MDAH-TAMVEC) program. Of these, 114 patients were treated in pilot studies and 73 in a randomized clinical trial. In the pilot studies, 49 patients were treated with neutrons alone, 25 with mixed-beam irradiation (two neutron and three photon fractions per week), and 40 with conventional treatment (surgery, photons, or combined surgery and photons). There was no appreciable difference among patients in these studies with regard to local tenor control or servival. However, the patients in the conventional-treatment pilot study had less advanced disease than those in either of the other studies. The complication rates in the neutrons-only and conventional-treatment studies were significantly greater than the complication rate observed in the mixed-beam pilot study. In the randomized clinical trial, 41 patients were treated with mixed-beam irradiation and 32 with photon irradiation. The preliminary results of this trial show a slight superiority with mixed-beam irradiation. In the mixed-beam group, 61% had local tumor control, 7% developed major complications, and 4996 were alive at the time of analysis; whereas in the photon group, 47% had local tumor control, 3% developed major complications, and 25% were alive at the time of analysis.

Combination chemotherapy of head and neck cancer.

A total of 77 patients with cancer of the head and neck area were treated with five different drug combination regimens. Five of the 77 patients had lymphoepithelioma; four had adenocystic carcinoma, and 68 had squamous‐cell carcinoma of the head and neck (16 from the skin). Of these 77 patients, 16 had no previous treatment, five had surgery, 11 had radiotherapy, and 45 had surgery and radiotherapy. The first regimen consisted of a four‐day Bleomycin infusion followed after a 24‐hour rest, by cyclophosphamide (Cytoxan), Vincristine (Oncovin), methotrexate and 5‐Fluorouracil (5‐FU) (B‐COMF). The next three regimens consisted of a four‐day Bleomycin course, followed by either Cytoxan and methotrexate (B‐CM), Cytoxan and 5‐FU (B‐CF) or Methotrexate and 5‐FU (B‐MF). The fifth regimen consisted of Bleomycin concomitant with Cytoxan, Methotrexate, and 5‐FU (B‐CMF). Of the 49 patients receiving B‐COMF and B‐CMF, 12 showed a complete response and 12 a partial response. Among the 28 patients receiving Bleomycin, followed by any one of the two drug regimens, only six showed a partial response. The severity of the thrombocytopenia, number of drugs, lymphoepithelioma histology and performance status of the patient influenced the rate of response. Drug toxicity consisted mostly in myelosuppression. The B‐CMF combination is highly effective and can be used as an adjuvant to surgery and/or radiotherapy. Cancer 42:1661–1669, 1978.

Combined Therapeutic Approach to Malignant Lacrimal Gland Tumors

The medical records of 13 patients with primary malignant lesions of the lacrimal gland revealed adenoid cystic carcinoma as the most common malignant tumor. The histologic cell type, neural invasion, and bony destruction were correlated with localized control and ultimate survival. Surgical removal of the lacrimal gland was adequate treatment for low-grade mucoepidermoid carcinoma confined to the gland itself. Combining a radical surgical removal of the area in planned sequence with high voltage radiation therapy offered the only reasonable hope for localized control in the more aggressive cell types or in tumors with neural invasion or bony involvement. A 40%-localized control and survival rate was achieved in the adenoid cystic carcinoma group of patients. Radiation therapy administered for cancer that obviously recurs after surgical resection was generally unsuccessful.

Intravenous hyperalimentation in patients with head and neck cancer.

Intravenous hyperalimentation was utilized to support nutritionally 23 malnourished patients with major head and neck tumors during surgical treatment, radiotherapy, or the convalescent period. Fifteen patients were treated during the perioperative period and 12 survived. Six patients received convalescent nutritional support successfully 4 to 24 months following operation or radiation treatment. Two patients received treatment with hyperalimentation throughout a protracted course of radiation therapy. Weight gain, wound healing, and recovery were achieved in all but 3 patients. Subclavian vein thrombosis occurred in 1 patient, and catheter‐related sepsis occurred in 2 patients. Otherwise, hyperalimentation was safe and efficacious in the debilitated patients. These patients may now become acceptable risks for surgical treatment or radiation therapy by nutritional repletion with intravenous hyperalimentation.

The management of squamous cell carcinoma in cervical lymph nodes in the clinical absence of a primary lesion by combined surgery and irradiation

Sixty‐three patients who had either previously treated primary tumors or unknown primary tumors and developed metastatic cervical adenopathy in their previously untreated necks received the combination of surgery and megavoltage irradiation. Within two years, 12 patients died of intercurrent disease, nine patients died with distant metastastases only, and five patients had disease recur at a primary site. The remaining 37 patients were evaluable for control of neck disease; 26 patients had previous treatment to a primary head and neck cancer that was under control at the time cervical adenopathy was treated; and 11 patients had an unknown primary tumor that was believed to be in the head and neck area. The combination of pre‐ or postoperative irradiation and surgery controlled neck disease in 86% of the evaluable patients. Because of the extent of neck disease, these patients would have been at a high risk of failure in the treated area if only a single modality of treatment were used. Analysis of the data shows an association of extranodal connective tissue involvement with both a decreased rate of control within the treated area and distant metastases.

Rotational skin flaps to cover wound defect in groin.

A technique of a lower relaxing incision and use of a rotational skin flap from the anterolateral thigh to close an extensive defect in the inguinal area is described. Its use is especially applicable for palliation in patients with large fungating metastases in the inguinal region.