Z. H. Lieberman

Sentinel lymph node biopsy for melanoma

BACKGROUND The most powerful predictor of survival for patients with melanoma is the status of the regional lymph nodes. Sentinel lymph node biopsy may provide improved staging accuracy without the morbidity of elective lymph node dissection (ELND). METHODS Sixty-eight patients with intermediate thickness melanoma underwent gamma probe guided sentinel node biopsy without ELND and were followed up over a mean of 22 months. RESULTS A sentinel node was found in all patients. Six patients (9%) had positive sentinel nodes; all underwent complete lymphadenectomy. Two patients (3%) with negative sentinel nodes developed nodal recurrence; 1 of these patients was found to have microscopic disease on reexamination of the sentinel node. Two patients (3%) developed systemic disease. CONCLUSION Gamma probe guided sentinel node biopsy can be performed with a high rate of technical success. It provides accurate pathological staging with a low incidence of nodal basin failure.

Surgical management of thyroid cancer invading the airway.

AbstractBackground: Locally advanced thyroid cancer invading the tracheal cartilage represents a difficult treatment dilemma during thyroidectomy. Methods: A retrospective chart review was performed to determine the results of laryngotracheal resection or tracheal cartilage shave with adjuvant radiotherapy in patients with locally advanced thyroid cancer invading the upper airway. Results: Of 597 patients undergoing thyroidectomy for thyroid cancer, 40 were found to have laryngotracheal invasion. Thirty-five patients with superficial invasion underwent cartilage shave procedures with adjuvant radiotherapy; five with full-thickness invasion underwent radical resection, including tracheal sleeve resection (n=3) or total laryngectomy (n=2). Histologic subtypes included papillary (n=32), follicular (n=2), Hurthle cell (n=1), medullary (n=3), and anaplastic (n=2). Of the cartilage shave group, 25 are currently alive with no evidence of disease at a mean follow-up of 81 months (range 1–290). Six developed isolated local/regional recurrence and were managed with total laryngectomy (n=1), tracheal resection (n=1), cervical lymphadenectomy (n=1), or repeat radiotherapy (n=3). All six patients remain free of disease at a mean follow-up of 5 years. Of those who underwent initial laryngotracheal resection, four remain free of disease at a mean follow-up of 5 years. The rates of 10-year disease-free survival and overall survival for all patients were 47.9% (95% confidence interval [CI] 24.8, 71.0) and 83.9% (95% CI 70.3, 97.5), respectively. Conclusions: These data suggest that adequate management of thyroid cancer with laryngotracheal invasion can be achieved with a more conservative surgical approach and adjuvant radiotherapy, reserving more radical resections for extensive primary lesions or locally recurrent disease.

Surgical morbidity, mortality, and long-term survival in patients with peripancreatic cancer following pancreaticoduodenectomy

BACKGROUND Surgical resection of the primary tumor in peripancreatic cancer has been associated with an improved survival and decreased morbidity in the recent literature. The purpose of this review was to analyze the results at a single institution. METHODS Between 1985 and 1995, 88 patients underwent a pancreaticoduodenectomy for adenocarcinoma of the pancreatic head region and had complete long-term follow-up. Patient records were reviewed to determine morbidity, mortality, and survival. RESULTS Tumor histology included pancreatic head adenocarcinoma (n = 46), ampullary adenocarcinoma (n = 28), duodenal adenocarcinoma (n = 8), and cholangiocarcinoma (n = 6). Morbidity occurred in 26 patients (29%). Perioperative mortality was seen in 6 patients (7%). No perioperative mortality was seen over the last 3 years, which included 33 patients. The mean follow-up was 29 months, with a median survival of 19 months. At last follow-up, 24 patients were alive without disease with an average survival of 43 months (1 to 141). There were 54 patients who died with cancer with an average survival of 21 months (1 to 117). Based on Kaplan and Meier statistical analysis the estimated survival was 47% at 2 years and 25% at 5 years. The location of the primary tumor (P = 0.0006) and the presence of positive lymph nodes (P = 0.05) was shown to have a negative impact on survival. CONCLUSION Pancreaticoduodenectomy can be done with acceptable morbidity and mortality. The outlook with this disease remains poor, but long-term survival can be achieved in some patients.

History of the Baylor Charles A. Sammons Cancer Center

The Charles A. Sammons Cancer Center at Baylor University Medical Center (BUMC) in Dallas, Texas, opened in 1976. Unlike freestanding cancer centers, Sammons is an integral part of a large tertiary care hospital whose medical staff is composed of physicians in private practice. Thus, it is “a center within a center.” Multidisciplinary interaction among physicians from different specialties has been the pivotal concept underlying the organization and development of the cancer center. Ongoing cooperative interaction with the hospital and with physicians in various communities is a key objective. The principal goals are to provide patients with personalized, high-quality care and to conduct educational and research programs that advance knowledge in the field. The term cancer refers to more than 100 separate diseases that share the common biologic characteristic of abnormal growth. These malignant cells can, if untreated, spread to other parts of the body and ultimately cause death of the patient. Five percent to 10% of cancers are hereditary; individuals carrying an abnormal gene transmitted in the germline are at very high risk of developing certain malignancies. The vast majority of cancers are not hereditary but develop from mutations in various genes (DNA) due to internal or external agents. Cancer remains a major public health problem in the USA and the most feared diagnosis. In the year 2002, the American Cancer Society estimated that 1,285,000 new cases and 555,500 deaths occurred from these malignant diseases (1). In Texas, 79,700 new cases and 34,500 deaths were anticipated. In other words, 1 in every 4 deaths in the USA is related to cancer; this translates to more than 1500 people dying each day. Nearly one third of cancer deaths are caused by tobacco, especially cigarette smoking. Men have a 1 in 2 lifetime risk of developing cancer, and for women the risk is 1 in 3. The 3 most common cancers in men (prostate, lung, and colon) and women (breast, lung, and colon) account for about 50% of new cases and 50% of cancer deaths. Nearly 80% of all new cancer diagnoses are made in persons aged 55 and older; this figure will increase as our population ages. The overall annual costs for cancer in the USA during 2001 were estimated to be

Immobilization of the mandible in oral cancer therapy

156.7 billion,

Head and Neck Cancer

56.4 billion of which was due to direct medical costs. On the brighter side, over 9 million Americans are alive today who have a history of cancer. Cancer survival was rare in the early part of the 20th century. By the 1990s, more than 40% of cancer patients survived. The mortality rate from cancer in the USA began to decline for the first time during the 1990s and is continuing to fall (2). The 5-year relative survival rate for all cancers is now approximately 62% (1). Better outcomes are due to advances in research and education. Future progress will require ongoing advances in cancer prevention, detection, and treatment.

Patterns of Drainage and Recurrence Following Sentinel Lymph Node Biopsy for Cutaneous Melanoma of the Head and Neck

Abstract After resection of the mandible, wound complications can be minimized and functional and aesthetic disabilities reduced by (1) immobilization of the soft tissue wound by intermaxillary-mandibular immobilization of the remaining mandible, (2) the liberal use of well-vascularized flaps for intraoral wound closure, and (3) the limited use of prostheses except when required to suspend the hyoid bone or prevent displacement of the rami.

Patterns of recurrence after sentinel lymph node biopsy for cutaneous melanoma

Head and Neck Cancer addresses a wide range of topics under the broad heading of head and neck oncology. In the initial section, the authors address therapeutic approaches with chapters on current and future treatments. Coverage is extensive and includes articles on IMRT, combined modality treatments, the use of targeted agents in conjunction with chemotherapy, the use of transoral robotic surgery followed by postoperative radiation therapy, and the use of particle therapy.