No abstract

Chondrosarcoma is a malignancy rarely encountered in the head and neck. In an attempt to define this tumor's characteristics and response to therapy, all cases of chondrosarcoma treated at the University of Michigan over the past 25 years were retrospectively studied. Fourteen cases originating in the nose and paranasal sinuses, mandible, temporal bone, and larynx were reviewed. Aggressive surgical resection was the mainstay of treatment, and resulted in an overall survival of 70%, with an average follow-up of 3.5 years. Survival was highest in primary temporal bone lesions, and lowest in paranasal sinus lesions. Unresectable lesions were not cured by other modalities. This study, therefore, continued to support the crucial role of wide surgical resection in the treatment of head and neck chondrosarcoma, but conservative resection, when needed to preserve important structures, has resulted in long-term survival.

Background One of several causes of tracheoesophageal puncture (TEP) speech failure after total laryngectomy is disturbance in relaxation of the pharyngoesophageal (PE) segment. We introduce the use of chemical denervation of the PE segment through botulinum neurotoxin (Botox®) injection to improve TEP speech. Methods An analysis was performed on eight patients who received Botox® injections for TEP speech problems after total laryngectomy at the University of Iowa between June 4, 1991 and August 8, 1994. Retrospective chart review identified the evolution of pretreatment evaluation and injection technique which became standardized in April 1992. Prospective evaluation of results was recorded by a single speech pathologist who subjectively identified the response to Botox® in all patients and recorded pressure readings at the tracheostoma site during speech in 6 patients. Results Seven of the eight patients were noted to have improved TEP speech following injection. Five of these seven patients experienced substantially improved speech, three of whom had no ability to produce speech prior to the Botox® injection. Conclusion Botox® ingection is a safe and effective method of improving TEP speech in selected patients with disturbed relaxation of pharyngoesophageal segment. © 1997 John Wiley & Sons, Inc. Head Neck 19: 92–97, 1997.

No abstract

No abstract

5519 Background: Survival for most cancers is typically reported as a 5-yr percentage from the time of diagnosis. Surviving patients e.g., desire to know if their likelihood for survival has improved, given that they have lived X-years since diagnosis. Conditional survival (CS) is a calculated probability of survival that demonstrates the changing likelihood of demise during a span of intervals after diagnosis. The specific aim of this study is to assess the CS for patients with head and neck squamous cell carcinoma (HNSCC). Methods: The study population included HNSCC patients from the Surveillance, Epidemiology, and End Results (SEER 11) Program. Cumulative survival rates were calculated using JMP v6 (SAS, Cary, NC) with the product-limit method, and derived on the basis of the subsequent annual survival data. Results were also sub-stratified by site of disease. Results: 90,526 patients with histologically confirmed HNSCC diagnosed from 1973 to 2001 were included. The cumulative HNSCC crude cohort 5-year CS at diagnosis is 33%, and 38% at one-year after diagnosis. 5-year CS is 43% at 2 years post-diagnosis, where it plateaus for the next 8 one-year intervals. Sub-site analysis reveals similar CS trends for all HNSCC sites except the nasopharynx. Nasopharynx cancer CS, in contrast, progressively increases over all intervals. Conclusions: HNSCCC 5-year mortality risk stabilizes within 2–3 years after diagnosis, and with the exception of nasopharyngeal cancers, does not substantially improve thereafter. The SEER data represent the largest pooled dataset for HNSCC, but do not necessarily address all relevant issues contributing to risk for death. These data, however, do provide useful estimates for HNSCC patients with known survival after diagnosis, and may have utility in the design of clinical trials which incorporate survival modeling. [Table: see text] No significant financial relationships to disclose.

No abstract

Context.—Perineural invasion and vascular invasion may be adverse prognostic factors in patients with oral cavity squamous cell carcinoma. However, the incidence of perineural and vascular invasion varies in the literature, and the use of immunohistochemistry to enhance their detection has not been evaluated in oral cavity squamous cell carcinomas. Objective.—To determine if the previously assessed incidence of perineural and vascular invasion in cases of oral cavity squamous cell carcinoma would be increased by re-review of the original routinely hematoxylin-eosin–stained sections as well as review of slides stained immunohistochemically with S100 and CD31 to enhance visualization of nerves and vessels. Design.—Forty cases of oral cavity squamous cell carcinoma in which the status of perineural and vascular invasion had been part of the original pathology report were reviewed. All original routinely stained slides were reviewed as well as S100- and CD31-stained sections of each case's tissue blocks that contained tumor. Results.—Perineural invasion was identified in 30% (12/ 40) of tumors in the original reports, 62% (25/40) of the authors' re-review of the same slides, and 82% (33/40) when cases were stained with S100. Vascular invasion was identified in 30% (12/40) of tumors in the original reports, 35% (14/40) of the authors' re-review of the same slides, and 42% (17/40) when cases were stained with CD31. False-positive and false-negative results were common in the original reports. The number of foci of both types of invasion was related to its discovery in the original reports. Vascular invasion, but not perineural invasion, was significantly associated with death at 5-year follow-up. Conclusions.—Although careful re-review of routinely stained slides will detect a significant number of cases of perineural and vascular invasion, immunohistochemical enhancement further improves the accuracy of the determination.