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Cancer | 1992

Sarcomas of the head and neck. Prognostic factors and treatment strategies

Luir M. Tran; Rufus J. Mark; Robert Meier; Thomas C. Calcaterra; Robert G. Parker

The authors reviewed 164 cases of head and neck sarcoma from adult patients seen at the University of California, Los Angeles (UCLA), between 1955 and 1988. The median follow‐up was 70 months. Multivariate analysis demonstrated that tumor grade, size, and surgical margin status were the most important independent prognostic factors. Thirty‐one percent (27 of 85) of patients with high‐grade lesions were free of disease versus 81% (44 of 55) with low‐grade lesions at last follow‐up. Sixty‐seven percent (50 of 76) of patients with lesions smaller than 5 cm were free of disease versus; 38% (33 of 88) with lesions larger than 5 cm. In 16 patients, low‐grade lesions, measuring less than 5 cm and with negative margins histologically, were controlled with surgery alone. For the 94 patients whose primary tumors were treated at UCLA, local control was achieved in 52% (26 of 50) of patients treated with surgery alone and 90% (20 of 22) with combined therapy (surgery and radiation therapy [RT] with or without chemotherapy). Seventy‐five percent (6 of 8) of patients with positive surgical margins treated with post‐operative RT achieved local control versus 26% (5 of 19) of patients receiving no additional treatment. In conclusion, surgery alone appears to be adequate treatment for small, low‐grade tumors and negative surgical margins. Patients with incomplete resection or high‐grade tumors should receive aggressive treatment–surgery and RT.


American Journal of Clinical Oncology | 2000

Accuracy and clinical impact of mediastinal lymph node staging with FDG-PET imaging in potentially resectable lung cancer.

Elaine Weng; Luu Tran; Sheila Rege; Afshin Safa; Ahmad Sadeghi; Guy Juillard; Rufus J. Mark; Silverio Santiago; Charles V. Brown; M. Mandelkern

To determine the sensitivity, specificity, and accuracy of staging mediastinal nodal disease in potentially resectable lung cancer using fluorodeoxyglucose-positron emission tomography (FDG-PET), computed tomography (CT), or both and compare these results to surgical staging. We also assessed whether PET scanning results changed clinical management. From 1992 to 1997, 50 patients underwent CT, and PET scanning before or close to the time of surgical staging. Sensitivity, specificity, accuracy, and predictive values were then calculated based on pathology results. A retrospective review of the records was performed to determine how PET results affected clinical treatment decisions. Forty-seven of 50 patients had non-small-cell lung cancer. The prevalence of pathologically confirmed mediastinal and hilar involvement was 38%. The sensitivity, specificity, and accuracy of mediastinal disease staging were as follows: CT alone = 73%, 77%, 76%; PET alone = 73%, 94%, 87%; PET + CT = 82%, 96%, 91%, respectively. PET was more specific and accurate than CT (p = 0.025). The results of PET changed management decisions in 12 of 50 cases (24%). Using FDG-PET in conjunction with CT scanning provides the most accurate staging of mediastinal disease in lung cancer by contributing complementary information. Furthermore, PET can affect clinical decision-making and allow some patients considered unresectable a chance for resection.


International Journal of Radiation Oncology Biology Physics | 1997

Concomitant pilocarpine during head and neck irradiation is associated with decreased posttreatment xerostomia

Robert P. Zimmerman; Rufus J. Mark; Luu M. Tran; Guy Juillard

PURPOSE To retrospectively compare subjective postirradiation xerostomia scores of patients who received concomitant oral pilocarpine during radiotherapy for head and neck cancer and 3 months thereafter with those of similar cohorts who did not receive pilocarpine. METHODS AND MATERIALS Subjective xerostomia was assessed using a visual analog scale xerostomia questionnaire that measured oral dryness, oral comfort, difficulty with sleep, speech, and eating. The concomitant pilocarpine group had both parotid glands in the initial field treated to at least 45 Gy and received 5 mg pilocarpine hydrochloride four times per day (q.i.d.) beginning on the first day of radiotherapy and continuing for 3 months after completion of radiation. The control cohort had also received at least 45 Gy to both parotid glands and had not received pilocarpine at the time of evaluation. Scores on the visual analog scale were averaged and compared using the Students t-test. RESULTS Seventeen patients who received concomitant pilocarpine during head and neck irradiation and 18 patients who had not been treated with pilocarpine were available for follow-up. The mean intervals between completion of radiation and evaluation of xerostomia were 17 months and 16 months, respectively. Only one of the pilocarpine-treated patients was still taking pilocarpine at the time of evaluation. For each of the individual components of xerostomia scored on the visual analog scale, as well as the composite of all components, the group that had received oral pilocarpine during radiation had significantly less xerostomia (p < 0.01 for each). CONCLUSIONS The use of 5 mg oral pilocarpine q.i.d. during radiotherapy for head and neck cancer and 3 months thereafter was associated with significantly less subjective xerostomia than that reported by a similar cohort of patients who had not received pilocarpine. The continued use of pilocarpine does not appear to be necessary to maintain this benefit in most patients.


Laryngoscope | 1992

Nasopharyngeal carcinoma: Treatment results with primary radiation therapy

Jeffrey W. Bailet; Rufus J. Mark; Elliot Abemayor; Steve P. Lee; Liu M. Tran; Guy Juillard; Paul H. Ward

One hundred three patients with nasopharyngeal carcinoma were treated with radiotherapy at UCLA Medical Center from January 1955 to December 1990. Overall survival, disease‐free survival, and local control rates were analyzed. In addition, survival from 1955 to 1978 and from 1979 to 1990 were evaluated. Overall 5‐ and 10‐year actuarial survival rates for all patients were 58% and 47%, respectively. Disease‐free survival rates at 3 and 5 years were 45% and 30%, respectively. Local, persistent, or recurrent disease in the nasopharynx was the primary cause of failure, occurring in 32% of patients and correlating with the initial tumor size (T stage). Twenty‐four percent of patients developed distant metastases, which correlated with nodal status but not with T stage. Seventy‐nine percent of patients failed either locally or distally by 4 years. Sex, race, age, and T and N stage categories were evaluated as prognostic variables in terms of survival. Control of primary disease is important in determining long‐term outcome. Modern imaging techniques have greatly assisted in the evaluation of disease extent and treatment options.


Journal of Neurosurgery | 2009

Gamma knife thalamotomy for treatment of tremor: long-term results

Ronald F. Young; Skip Jacques; Rufus J. Mark; Oleg V. Kopyov; Brian Copcutt; Allen Posewitz; Francisco Li

The purpose of this paper was to note a potential source of error in magnetic resonance (MR) imaging. Magnetic resonance images were acquired for stereotactic planning for GKS of a vestibular schwannoma in a female patient. The images were acquired using three-dimensional sequence, which has been shown to produce minimal distortion effects. The images were transferred to the planning workstation, but the coronal images were rejected. By examination of the raw data and reconstruction of sagittal images through the localizer side plate, it was clearly seen that the image of the square localizer system was grossly distorted. The patient was returned to the MR imager for further studies and a metal clasp on her brassiere was identified as the cause of the distortion.A-60-year-old man with medically intractable left-sided maxillary division trigeminal neuralgia had severe cardiac disease, was dependent on an internal defibrillator and could not undergo magnetic resonance imaging. The patient was successfully treated using computerized tomography (CT) cisternography and gamma knife radiosurgery. The patient was pain free 2 months after GKS. Contrast cisternography with CT scanning is an excellent alternative imaging modality for the treatment of patients with intractable trigeminal neuralgia who are unable to undergo MR imaging.The authors describe acute deterioration in facial and acoustic neuropathies following radiosurgery for acoustic neuromas. In May 1995, a 26-year-old man, who had no evidence of neurofibromatosis Type 2, was treated with gamma knife radiosurgery (GKS; maximum dose 20 Gy and margin dose 14 Gy) for a right-sided intracanalicular acoustic tumor. Two days after the treatment, he developed headache, vomiting, right-sided facial weakness, tinnitus, and right hearing loss. There was a deterioration of facial nerve function and hearing function from pretreatment values. The facial function worsened from House-Brackmann Grade 1 to 3. Hearing deteriorated from Grade 1 to 5. Magnetic resonance (MR) images, obtained at the same time revealed an obvious decrease in contrast enhancement of the tumor without any change in tumor size or peritumoral edema. Facial nerve function improved gradually and increased to House-Brackmann Grade 2 by 8 months post-GKS. The tumor has been unchanged in size for 5 years, and facial nerve function has also been maintained at Grade 2 with unchanged deafness. This is the first detailed report of immediate facial neuropathy after GKS for acoustic neuroma and MR imaging revealing early possibly toxic changes. Potential explanations for this phenomenon are presented.In clinical follow-up studies after radiosurgery, imaging modalities such as computerized tomography (CT) and magnetic resonance (MR) imaging are used. Accurate determination of the residual lesion volume is necessary for realistic assessment of the effects of treatment. Usually, the diameters rather than the volume of the lesion are measured. To determine the lesion volume without using stereotactically defined images, the software program VOLUMESERIES has been developed. VOLUMESERIES is a personal computer-based image analysis tool. Acquired DICOM CT scans and MR image series can be visualized. The region of interest is contoured with the help of the mouse, and then the system calculates the volume of the contoured region and the total volume is given in cubic centimeters. The defined volume is also displayed in reconstructed sagittal and coronal slices. In addition, distance measurements can be performed to measure tumor extent. The accuracy of VOLUMESERIES was checked against stereotactically defined images in the Leksell GammaPlan treatment planning program. A discrepancy in target volumes of approximately 8% was observed between the two methods. This discrepancy is of lesser interest because the method is used to determine the course of the target volume over time, rather than the absolute volume. Moreover, it could be shown that the method was more sensitive than the tumor diameter measurements currently in use. VOLUMESERIES appears to be a valuable tool for assessing residual lesion volume on follow-up images after gamma knife radiosurgery while avoiding the need for stereotactic definition.This study was conducted to evaluate the geometric distortion of angiographic images created from a commonly used digital x-ray imaging system and the performance of a commercially available distortion-correction computer program. A 12 x 12 x 12-cm wood phantom was constructed. Lead shots, 2 mm in diameter, were attached to the surfaces of the phantom. The phantom was then placed inside the angiographic localizer. Cut films (frontal and lateral analog films) of the phantom were obtained. The films were analyzed using GammaPlan target series 4.12. The same procedure was repeated with a digital x-ray imaging system equipped with a computer program to correct the geometric distortion. The distortion of the two sets of digital images was evaluated using the coordinates of the lead shots from the cut films as references. The coordinates of all lead shots obtained from digital images and corrected by the computer program coincided within 0.5 mm of those obtained from cut films. The average difference is 0.28 mm with a standard deviation of 0.01 mm. On the other hand, the coordinates obtained from digital images with and without correction can differ by as much as 3.4 mm. The average difference is 1.53 mm, with a standard deviation of 0.67 mm. The investigated computer program can reduce the geometric distortion of digital images from a commonly used x-ray imaging system to less than 0.5 mm. Therefore, they are suitable for the localization of arteriovenous malformations and other vascular targets in gamma knife radiosurgery.


American Journal of Clinical Oncology | 1998

Radiation tolerance of transverse rectus abdominis myocutaneous-free flaps used in immediate breast reconstruction

Robert P. Zimmerman; Rufus J. Mark; Ann I. Kim; Terrence Walton; David Sayah; Guy Juillard; Mai Nguyen

The authors determine the effects of postoperative radiation therapy on flap and local control outcomes in patients who have undergone immediate transverse rectus abdominis myocutaneous (TRAM)-free flap reconstruction after modified radical mastectomy for locally advanced breast cancer. Details of surgery, chemotherapy, and radiation therapy for 21 patients who had undergone immediate TRAM-free flap reconstruction after modified radical mastectomy were gathered retrospectively. The outcomes examined were flap complications, overall cosmesis, and local recurrence rate. Radiation therapy was indicated for large primary tumors (T3-T4), close or positive margins, or extensive nodal disease. With a mean follow-up interval of 19 months, there have been no flap complications or losses. Cosmesis was rated as excellent by 60% of patients, good by 30%, and fair by the remaining 10%. Three patients thought that radiation had improved cosmesis, one noted worse cosmesis, and the remainder thought it had no effect on cosmesis. The local control rate was 86%. Postreconstruction irradiation of TRAM-free flaps used in immediate reconstruction for locally advanced breast cancer appears safe and cosmetically acceptable.


American Journal of Clinical Oncology | 1993

Chondrosarcoma of the head and neck. The UCLA experience, 1955-1988.

Rufus J. Mark; Luu M. Tran; Joel A. Sercarz; Yao S. Fu; Thomas C. Calcaterra; Robert G. Parker

Chondrosarcoma of the head and neck is a rare tumor. In an attempt to clarify optimal treatment of these lesions, we reviewed the records and pathologic material of 18 consecutive cases of head and neck chondrosarcoma seen at our institution between 1955 and 1988. Follow-up ranged from 3 to 168 months with a median of 72. Absolute 5-year survival was 68% (11/16), with 9/16 (56%) patients surviving disease-free. Grade was the most important prognostic factor. Only one of 7 (14%) patients known to have high grade histology was rendered disease-free, as opposed to 9/10 (90%) with low-grade lesions. Tumor size and completeness of surgical resection were also important prognostic factors. Four of 10 patients managed initially with surgery alone achieved local control with greater than 5-year survival. All four had low-grade lesions. Five patients received surgery and radiation as primary treatment, and three are disease-free with greater than 5-year follow-up. Two of these were irradiated because of positive margins. One patient received radiation alone and has persistent disease. Two patients received combined chemotherapy and surgery because of high-grade lesions, and one is free of disease with greater than 5-year follow-up. Patients with incomplete resections should receive further surgery or postoperative radiation therapy. High-grade lesions should be treated aggressively.


American Journal of Clinical Oncology | 1993

Minor salivary gland tumors of the head and neck : treatment strategies and prognosis

Ahmad Sadeghi; Luu M. Tran; Rufus J. Mark; Jonas Sidrys; Robert G. Parker

Between 1961 and 1985, 117 patients with malignant tumors of the minor salivary glands of the upper aerodigestive tract were treated with curative intent at the University of California, Los Angeles (UCLA). The length of follow-up ranged from 24–225 months, with a median of 38 months. The most common site of origin was the oral cavity (65 cases), and the most common histology was adenoid cystic carcinoma (69 cases). Tumor size, histology, and site were important prognostic factors. For oral cavity lesions, small tumors were well controlled with resection alone (25 of 26) or local excision, followed by irradiation (7 of 7). For advanced tumors arising from the paranasal sinuses and pharynx, the control rates were 43% (15 of 35) and 29% (5 of 17), respectively. Ninety-three percent (27 of 29) of patients with mucoepidermoid carcinoma had no evidence of disease at last follow-up versus 55% (38 of 69) of patients with adenoid cystic carcinoma and 56% (10 of 18) of those with adenocarcinoma. It appears that resection with good margin is adequate treatment for small lesions. Large, poorly differentiated tumors require a combined approach: surgery and radiation therapy.


American Journal of Clinical Oncology | 1996

Postirradiation sarcoma of the gynecologic tract : a report of 13 cases and a discussion of the risk of radiation-induced gynecologic malignancies

Rufus J. Mark; Joseph C. Poen; Luu M. Tran; Yao S. Fu; James Heaps; Robert G. Parker

With improvement in survival after cancer treatment, it is becoming increasingly important to examine treatment-related morbidity and mortality. Sarcomas can develop within the irradiated field after radiation therapy (RT) for gynecologic malignancies. We undertook a study to assess the outcome after treatment of postirradiation sarcoma (PIS) of the gynecologic tract. In reviewing our data and the literature, we compare the absolute risk of PIS and other radiation-associated second malignant neoplasms (SMNs) with the mortality risk of surgery and general anesthesia. Between 1955 and 1987, 114 patients with uterine sarcomas were seen at the University of California, Los Angeles (UCLA), Medical Center. Thirteen had a prior history of RT. Conditions for which these patients received RT included choriocarcinoma (one), menorraghia (four), cervical cancer (six), and ovarian cancer (two). RT doses were known in six cases and ranged from 4,000 to 8,000 cGy. Latency time from RT to the development of PIS ranged from 3 to 30 years, with a median of 17 years. Twelve patients were treated with surgery or additional RT. Two patients remain alive 5 months and 57 months, respectively, following salvage therapy. Five-year disease-specific survival for all patients is 17%. From our data and a review of the literature, we estimate that the absolute risk of PIS with long-term follow-up ranges from 0.03 to 0.8%. Postirradiation sarcoma of the gynecologic tract is a relatively rate event associated with a poor prognosis. Mortality risks of radiation-associated SMN are similar to mortality risks of surgery and general anesthesia. Given the large number of patients with gynecologic malignancies who can be cured or palliated with RT, concern regarding radiation sarcomagenesis should not be a major factor influencing treatment decisions.


Annals of Otology, Rhinology, and Laryngology | 1994

Sarcomas of the nasal cavity and paranasal sinuses.

Joel A. Sercarz; Rufus J. Mark; Ian S. Storper; Luu Tran; Thomas C. Calcaterra

Sarcomas of the nose and paranasal sinuses are rare malignancies. Key issues remain unresolved in the management of these tumors, particularly with regard to the role of radiotherapy. To help clarify these issues, 48 consecutive cases of nasal and paranasal sinus sarcomas treated at the University of California, Los Angeles, between 1958 and 1988 were retrospectively reviewed. Six of 16 patients managed initially with surgery alone were cured. All had negative surgical margins and 5 of the 6 had low-grade tumors. Of 5 patients with high-grade lesions treated with surgery only, 1 was rendered free of disease. Twelve patients with positive surgical margins were treated with adjuvant radiotherapy; 5 were cured with this approach. Grade and surgical margin status were found to be significantly related to outcome for sinonasal sarcoma. There were 14 patients with rhabdomyosarcoma; 3 were cured with modern combined-modality therapy. Patients with positive surgical margins should be treated with adjuvant radiotherapy. Surgical therapy is effective for low-grade lesions that are completely excised.

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Guy Juillard

University of California

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Luu M. Tran

University of California

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R.S. Akins

Wilford Hall Medical Center

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Luu Tran

United States Department of Veterans Affairs

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