T. Boyce Cole

5-Fluorouracil, cyclophosphamide, and vincristine for adenoid cystic carcinoma of the head and neck

Twenty‐one patients with adenoid cystic carcinoma of the head and neck were treated with intravenous boluses of cyclophosphamide and vincristine and 5‐day continuous intravenous infusions of 5‐fluorouracil (CVF) every 4 weeks. Eight patients received CVF as palliation for recurrent or metastatic disease. A sustained complete response (107+ months) was observed in one patient; one partial response and one mixed response each also were observed. In four patients disease stabilized, and in one disease progressed. Thirteen patients received six courses of CVF in the adjuvant setting after surgery and radiation for either primary or locoregional recurrent disease. Recurrences developed in two of seven patients with primary disease and three of six patients with recurrent disease with a median follow‐up 45 months (range, 20–108+). Recurrence rate and time interval to recurrence were comparable to those of well‐matched historical controls. Distant metastases have not developed in patients treated with CVF in the adjuvant setting, whereas distant metastases had developed in historical controls within comparable periods of follow‐up. Serious toxicities were not encountered in any patient. The authors conclude that CVF is a well‐tolerated combination chemotherapy program with activity in adenoid cystic carcinoma of the head and neck. This regimen, however, has not had a major impact in the adjuvant setting in preventing recurrent disease. Cancer 59:887‐890, 1987.

A trial of outpatient chemotherapy for recurrent head and neck tumors

A four‐drug combination chemotherapy (bleomycin‐methotrexate‐vinblastine‐CCNU) had been used in 38 evaluable patients with recurrent squamous cell carcinoma of the head and neck region on an outpatient basis. A large number of these patients had carcinoma of the oral cavity (45% of total). Nineteen patients (50%) responded to this regimen with a ≥50% regression of their measured tumors. The median survival of all patients was 34 weeks. There was one chemotherapy‐related death and the overall toxicity was mild. This convenient regimen can be considered a useful alternative to more aggressive therapy.

Application of posterior neck dissection in treating malignant melanoma of the posterior scalp

Utilization of a posterior neck dissection in the treatment of nine patients with malignant melanoma of the posterior scalp is presented. Seven of nine patients presented with metastatic disease present in the posterior neck after initial treatment elsewhere. Four of the seven patients developed regional disease 4 months to 4 years following initial diagnosis. Variables dictating surgical treatment included the Clarks level, Breslow depth of invasion of original lesion, evidence of metastatic disease, and type of melanoma. The surgical technique of the posterior neck dissection is graphically depicted and the indications outlined. The posterior neck dissection is mandatory to adequately resect the primary lymphatics of the posterior scalp. Controlled studies are urged to determine the efficacy of prophylactic surgical lymphadenectomy in malignant melanoma of the head and neck.

A prospective study of squamous head and neck carcinoma. Immunologic aberrations in patients who develop recurrent disease.

In a prospective study of squamous head and neck cancer, the pretreatment peripheral blood of 125 patients was examined for lymphocyte subclass and in vitro immunologic function. After 4 years of follow‐up, 49 recurrences of disease were observed. Lymphocytes from patients with recurrent disease showed elevated Interleukin‐2 (IL‐2) production and a tendency towards increased response to mitogens in comparison to those without recurrence. When disease‐free survival is analyzed on the basis of IL‐2 levels, patients with high relative IL‐2 synthesis (≤1) had a 40% poorer prognosis than patients with low relative IL‐2 levels (<1). The difference is significant at a P value of 0.02. Since IL‐2 synthesis occurs with antigenic stimulation, it is postulated that patients who have a high IL‐2 synthesis in their pretreatment lymphocytes may have had prior stimulation by circulating tumor antigen. Such immune response by the host may be successful in destroying the antigenic tumor cells but may leave the undifferentiated, less antigenic tumor cells to grow and metastasize. Thus, elevated IL‐2 synthesis in pretreatment lymphocytes predicts a poorer prognosis.

Surgical treatment for malignant exophthalmos of endocrine origin

Endocrine exophthalmos is a poorly understood disease process thought to be related to a dysfunction of the thyroid‐pituitary axis. Initial therapy for symptomatic endocrine exophthalmos is medical. Failure to respond to medical management is heralded by progressive exophthalmos, exposure keratitis, and decreasing visual acuity. The pathophysiologic processes involved and an historical review of the various surgical procedures used are discussed. The results of 28 patients surgically decompressed by a transantral transethmoid approach are presented. Preservation or improvement in visual acuities were observed in all but one patient. Diplopia was generally not improved and may be worsened in some patients.

Nasopharyngeal Carcinoma: 1990

Nasopharyngeal carcinoma (NPC) is a malignancy of considerable interest and importance, not only because of its major impact on specific populations, such as Cantonese Chinese and North Africans, but also because of the accumulating information allowing a better understanding of the relative contribution of environmental and genetic factors in this tumor which is believed to have Epstein-Barr virus (EBV) as a necessary etiologic agent. The greater impact of this disease in developing countries, where application of new clinical and laboratory tools is difficult, has undoubtedly delayed progress in controlling NPC, but the development of multidisciplinary studies on an international basis has led to significant improvements in early detection, treatment, and understanding of disease pathogenesis. In this report, we will summarize some of the recent advances that hopefully will lead to the control of this neoplasm.

Radiographic evaluation of the prevertebral space

The prevertebral space as seen on the lateral soft tissue X‐ray is discussed. Variations of normal in the child and adult are reviewed. Normal anatomy may give a false impression of pathology such as air in the ear canal, lung apices, and cervical esophagus. Overlying shadows of other structures, namely, the ear, styloid, stylohyoid ligament, calcified anterior arch of the atlas in a child, calcification in the cricoid signet and cartilago triticea also may be confusing. Physiological changes with crying or swallowing in the child at times appear as pathology. The primary pathological changes seen on X‐ray are air in the tissue spaces, foreign bodies, tumor formation, erosion or proliferation of bone, fractures, deformities of the spine such as reversal of the normal curvature or slippage of the vertebrae, and displacement of the fat line. It must be kept in mind that X‐rays are only one additional tool for making a diagnosis and cannot be substituted for a thorough history and physical examination.