Prognostic Indicators in Head and Neck Cancer Patients Receiving Combined Therapy

Abstract

\s=b\In 1983 we initiated a prospective nonrandomized study of the value of preoperative chemotherapy in previously untreated patients with stages III and IV squamous cell carcinoma of the head and neck. In 1983 and 1984, 50 patients were entered in the study. Prior to therapy all patients were evaluated by a representative from the Medical Oncology, Radiation Therapy, and Head and Neck Surgery Divisions, University of Utah School of Medicine, Salt Lake City. In addition to the standard preoperative evaluation, pretreatment computed tomographic scans were performed on all patients. Follow-up computed tomographic scans were performed after the second cycle of chemotherapy and at the completion of treatment. Initial therapy in all patients consisted of induction chemotherapy with cisplatin (day 1, 100 mg/m2) and fluorouracil (days 1 through 5, 1000 mg/m2). Several factors were examined for their utility in predicting response to therapy and survival. Factors evaluated included: (1) extent and timing of chemotherapeutic response; (2) computed tomographic quantitated primary tumor size; (3) size of computed tomographic quantitated regional (neck) metastases; (4) performance status; (5) cancer stage; (6) total lymphocyte count; and (7) serum liver function tests. The factor found to be most useful in predicting improved survival was the extent of response to chemotherapy. The remaining factors, performance status, regional lymph node status, serum \g=g\-glutamyltransferase levels, and cancer stage, were also found to correlate with length of survival but were much less important than the response to chemotherapy. Many pretreatment factors havebeen evaluated for their poten¬ tial as prognostic indicators in pa¬ tients presenting with newly diag¬ nosed squamous cell carcinoma of the head and neck. Factors examined thus

Long-term survival data and prognostic factors of a complete response to chemotherapy in patients with head and neck cancer treated with platinum-based induction chemotherapy: A hellenic co-operative oncology group study

“…When the timedependent variable response to chemotherapy was excluded from the analysis, then, age, clinical stage, and tumor grade were selected by the Cox model as independent prognostic variables for OS. Clinical stage is considered by several investigators as a significant factor for survival [34,39,41]. As it was reported by Cognetti et al [34] patients with stage III disease had a double median survival compared to those with stage IV (26 months vs 13 months).…”

“…The achievement of a CR to induction chemotherapy was described as an important prognostic factor for OS in most of the published studies [34,[39][40][41]. It has been repetitively demonstrated that patients who were fortunate to achieve a CR to chemotherapy live significantly longer than the others.…”

SMAS Debulking for Management of the Thick-Skinned Nose

“…Without meticulous aftercare, the benefits of SMAS debulking will be negated 5,6. To minimize cutaneous thickening from subcutaneous fibrosis, prevention of swelling and inflammation is the primary goal of aftercare.…”

“…Ice is reapplied continuously throughout the first night after surgery and daily for several days. Topical nasal steroids are initiated after 2 weeks, and low-dose triamcinolone acetate injections (5-10 mg/mL) are initiated if persistent swelling is evident after 1 month 5,6. Injections are repeated at 4- to 6-week intervals as needed, and dosing is titrated to effect.…”

“…SMAS debulking is also contraindicated in skin less than 3-mm thick because overly aggressive surgical debulking may lead to unsightly prominence of the skeletal topography. However, in the appropriate patient, SMAS debulking can reduce skin envelope thickness by as much as 3.0 mm, with greater reductions common in revision rhinoplasty cases when vascularity permits 6…”