Laryngeal or hypopharyngeal squamous cell carcinoma: can follow-up CT after definitive radiation therapy be used to detect local failure earlier than clinical examination alone?

Purpose: To determine if follow-up computed tomography (CT) after definitive radiation therapy for laryngeal or hypopharyngeal (laryngopharyngeal) carcinoma allows the detection of local failure earlier than clinical examination alone.

Materials And Methods: Pre- and post-radiation therapy follow-up CT scans in 66 patients were reviewed retrospectively. All patients underwent definitive hyperfractionated radiation therapy and were followed up clinically for at least 2 years after its completion.

Is radiation therapy a preferred alternative to surgery for squamous cell carcinoma of the base of tongue?

Purpose: To evaluate irradiation alone for treatment of base-of-tongue cancer.

Patients And Methods: Two hundred seventeen patients with squamous cell carcinoma of the base of tongue were treated with radiation alone and had follow-up for >/= 2 years.

Results: Local control rates at 5 years were as follows: T1, 96%; T2, 91%; T3, 81%; and T4, 38%.

The impact of primary tumor volume on local control for oropharyngeal squamous cell carcinoma treated with radiotherapy.

Background: A study was needed to determine the effect of primary tumor volume on local control of oropharyngeal carcinoma treated with radiation therapy, with or without induction chemotherapy.

Methods: Between July 1983 and April 1995, 114 patients with T2-T4 squamous cell carcinoma of the oropharynx were treated for cure with radiation therapy, with or without induction chemotherapy, and had a pretreatment CT scan available for retrospective review. All scans were reviewed by a single radiologist (A.

Salvage treatment for neck recurrence after irradiation alone for head and neck squamous cell carcinoma with clinically positive neck nodes.

Background: To analyze the likelihood of salvage for patients with recurrence in the neck after radiotherapy.

Method: Recurrent disease developed in the neck of 51 patients after primary irradiation for head and neck carcinoma. Salvage was defined as no recurrence of cancer anywhere for at least 1 year after initial salvage treatment and continuously thereafter.

Pre- and post-radiotherapy computed tomography in laryngeal cancer: imaging-based prediction of local failure.

Purpose: To determine if pre-radiotherapy (RT) and/or post-radiotherapy computed tomography (CT) can predict local failure in patients with laryngeal carcinoma treated with definitive RT.

Methods And Materials: The pre- and post-RT CT examinations of 59 patients (T3 glottic carcinoma [n = 30] and T1-T4 supraglottic carcinoma [n = 29]) were reviewed. For each patient, the first post-RT CT study between 1 and 6 months after irradiation was used.

Squamous cell carcinoma of the nasal vestibule.

Background And Methods: Sixty patients were treated with radiation therapy alone (56 patients) or followed by surgery (4 patients) between 1970 and 1995 for squamous cell carcinoma of the nasal vestibule.

Results: Local control rates at five years after irradiation alone in 56 patients were: T1-T2, 94%; T4, 71%; and overall, 85%. Multivariate analysis revealed that tumor size and bone invasion significantly influenced local control.

The midline dose distribution for a three-field radiotherapy technique.

At the University of Florida, head and neck cancer often is irradiated using parallel opposed lateral fields (with inferior borders slanted superiorly) and an anterior low neck field. A common criticism is that overlap may occur at the match-line junction of the three fields, resulting in an increased risk of radiation myelitis. One setup for treatment of the oropharynx and two for the larynx were irradiated in an anthropomorphic head and neck phantom made of tissue-equivalent polyacrylamide gel with a two-dimensional thermoluminescent dosimeter array in its sagittal midplane.

Induction chemotherapy and radiation therapy for T4 oropharyngeal carcinoma.

Between 1964 and 1996, 123 patients were treated for T4 oropharyngeal carcinoma; 93 were treated with radiation therapy alone; 30 were treated with induction chemotherapy and radiation therapy. Patients who received induction chemotherapy and radiation therapy were treated between 1985 and 1996; during this time 39 patients were treated with radiation therapy alone. Five-year local control rates for patients undergoing chemotherapy and radiation therapy, radiation therapy alone (all patients), and radiation therapy alone (patients treated since September 1985) were 63%, 38%, and 48%, respectively.

Recent advances in the treatment and outcome of locally advanced rectal cancer.

Objective: To compare the outcomes of treatment of locally advanced rectal cancer of the early era (1975-1990) with those of the late era (1991-1997).

Background: Preoperative therapy has been used in locally advanced rectal cancer to preserve sphincter function, decrease local recurrence, and improve survival. At the University of Florida, preoperative radiation has been used since 1975, and it was combined with chemotherapy beginning in 1991.

Squamous cell carcinoma of the glottic larynx: a review emphasizing the University of Florida philosophy.

Background: Squamous cell carcinoma of the glottic larynx is strongly related to cigarette smoking and excessive ethanol intake. It is the most common head and neck cancer other than skin cancer.

Methods: We reviewed pertinent literature relative to etiology, epidemiology, and treatment results, with emphasis on the treatment philosophy at the University of Florida.

Preradiotherapy computed tomography as a predictor of local control in supraglottic carcinoma.

Purpose: To determine the utility of pretreatment computed tomography (CT) for predicting primary site control in patients with supraglottic squamous cell carcinoma (SCC) treated with definitive radiotherapy (RT).

Materials And Methods: Pretreatment CT studies in 63 patients were reviewed. Minimum length of follow-up was 2 years.

A comparison of 3-D data correlation methods for fractionated stereotactic radiotherapy.

Purpose: Stereotactic radiosurgery is currently used to treat patients who are not good candidates for conventional neurosurgical procedures. For treatments of nonvascular tumor cells, it appears that fractionation offers a radiobiological advantage between tumor and normal tissues. Therefore, fractionated stereotactic radiotherapy (FSR) is preferred because it minimizes normal tissue complications and maximizes local tumor control probability.

Skin cancer of the head and neck with incidental microscopic perineural invasion.

Purpose: To address outcomes in clinically asymptomatic patients in whom the unexpected finding of microscopic perineural invasion is noted at the time of surgery.

Methods And Materials: The 35 patients included in this study had skin cancers of the head and neck treated with curative intent between January 1965 and April 1995 at the University of Florida. All patients were without clinical or radiographic evidence of perineural invasion but, at the time of biopsy or surgical excision, had the incidental finding of microscopic perineural invasion.

Linear accelerator radiosurgery for nonacoustic schwannomas.

Purpose: To analyze the results of nonacoustic schwannomas treated with linear accelerator stereotactic radiosurgery.

Methods And Materials: Between August 1989 and October 1997, 18 patients with nonacoustic schwannomas underwent stereotactic radiosurgery at the University of Florida. Nine patients had schwannomas located in the jugular foramen region, seven in the trigeminal nerve, and two in the facial nerve.

Linac radiosurgery for benign meningiomas.

Purpose: To review outcomes for patients treated with linac radiosurgery for benign meningiomas.

Methods And Materials: Between January 1989 and July 1997, 70 patients with 76 meningiomas were treated with LINAC-based radiosurgery. In 38 patients, radiosurgery was the initial treatment.

T3-4 squamous cell carcinoma of the larynx treated with radiation therapy alone.

This article reviews the results of radiation therapy alone for T3-4 squamous cell carcinoma of the larynx. Local control after radiation therapy is approximately 65% for patients with T3 glottic and supraglottic carcinoma. The likelihood of local control is inversely related to tumor volume and, for those with glottic cancers, is adversely influenced by cartilage sclerosis on pretreatment computed tomography of the larynx.

Altered fractionation in radiation therapy for squamous-cell carcinoma of the head and neck.

Following is a review of altered fractionation in radiation therapy for head and neck cancer. The goals of altered fractionation are to increase local-regional control and/or reduce the risk of late complications. Altered fractionation schedules can be broadly classified as accelerated fractionation and hyperfractionation.

Carcinoma of the extrahepatic biliary tract: surgery and radiotherapy for curative and palliative intent.

Forty-seven patients were treated for carcinoma of the extrahepatic biliary tract between 1962 and 1993: 17 by surgery alone, 20 by surgery and postoperative radiotherapy, and 10 with radiotherapy alone. Initial operations included gross total resection (17 patients), simple cholecystectomy (6 patients), subtotal resection (11 patients), biopsy (3 patients), and percutaneous decompression (10 patients). External-beam radiotherapy (30-60 Gy) was administered to 30 patients: 10 after gross total resection or simple cholecystectomy, 10 after subtotal resection or surgical biopsy, and 10 after percutaneous decompression.

Merkel cell carcinoma of the skin.

Merkel cell carcinoma is a rare, aggressive neuroendocrine tumor of the skin with a predisposition for local regional and distant spread. Radiotherapy after wide local excision has improved local control, but distant spread continues to be a significant problem. This is an update of our experience in the treatment of Merkel cell carcinoma at the University of Florida.

Preliminary experience with frameless stereotactic radiotherapy.

Purpose: To report initial clinical experience with a novel high-precision stereotactic radiotherapy system.

Methods And Materials: Sixty patients ranging in age from 2 to 82 years received a total of 1426 treatments with the University of Florida frameless stereotactic radiotherapy system. Of the total, 39 (65%) were treated with stereotactic radiotherapy (SRT) alone, and 21 (35%) received SRT as a component of radiotherapy.

Diagnostic evaluation of squamous cell carcinoma metastatic to cervical lymph nodes from an unknown head and neck primary site.

Background: The purpose of this study was to evaluate the efficacy of the modern diagnostic evaluation for squamous cell carcinoma metastatic to cervical lymph nodes from an unknown head and neck primary site.

Methods: One hundred thirty patients were evaluated between June 1983 and June 1997. All underwent head and neck examinations, head and neck computed tomography (CT), and/or magnetic resonance imaging (MRI) scans, panendoscopies, and biopsies of head and neck mucosal sites.

Linac scalpel radiosurgery at the University of Florida.

Optimal implementation of stereotactic radiosurgery requires multidisciplinary input from neurosurgeons, radiation oncologists, and physicists. Clinical processes of most importance to the physics staff include stereotactic imaging, treatment planning, and radiation delivery. Careful attention to each of these details helps to ensure the quality of the overall process.

Radiotherapy in the management of chemodectomas of the carotid body and glomus vagale.

Background: Because only limited data are available pertaining to radiotherapy for chemodectomas of the carotid body and glomus vagale, we reviewed our experience.

Methods: Fifteen patients with 23 chemodectomas of either the carotid body or glomus vagale were treated with radiotherapy at the University of Florida between 1981 and 1995. Eighteen lesions were previously untreated.