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Burnett N, Dhanireddy B, Ain K, Valentino J, Gal T, Kudrimoti M. External Beam Radiation Therapy in Radioactive Iodine Refractory Thyroid Carcinoma: Long-Term Outcomes and Side Effects. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.1378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abstract
The characteristics of facial nerve electromyography at various levels of neuromuscular blockade are unclear. Partial blockade is well known to facilitate anesthetic safety and management. However, the use of neuromuscular blockage in many skull base procedures is avoided to allow intraoperative facial nerve monitoring.We studied the influence of various levels of neuromuscular blockade on facial nerve stimulation in the New Zealand white rabbit. The facial nerve was exposed in the middle ear of six rabbits. Using electromyographic-type facial nerve monitor, we recorded the facial electromyography signals in these rabbits at increasing levels of vecuronium-induced neuromuscular blockade. All animals demonstrated reliable facial electromyography response at all levels of partial neuromuscular blockade (P < .02). Five of the six animals could be monitored throughout complete blockade. These results clearly demonstrate that rabbit facial electromyography monitoring is possible under neuromuscular blockade. The effect of neuromuscular blockers on facial electromyography monitoring deserves further study, as partial blockade would greatly facilitate the management of anesthesia in otologic, neurotologic, and skull base surgery.
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Kudrimoti MR, Arnold SM, Valentino J, Gal T, Hyland A, Singh A, Rangnekar V, Cummings KM, Marshall JR, Warren GW. The accuracy of tobacco assessment during definitive radiotherapy or chemoradiotherapy in patients with head and neck cancer. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.1556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Kudrimoti MR, Arnold SM, Valentino J, Randall M, Warren GW. Longitudinal self-reported and serum-based assessment of tobacco or nicotine use in head and neck cancer patients during definitive radiotherapy or chemoradiotherapy. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.1594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Warren GW, Arnold SM, Valentino J, Randall M, Kudrimoti MR. A rationale and model for tobacco and nicotine assessment during cancer treatment. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e12034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Kudrimoti M, Arnold S, Valentino J, Rangnekar V, Randall M, Warren G. Assessment of Nicotine Exposure in Head and Neck Cancer Patients during Treatment with Radiotherapy or Chemoradiotherapy. Int J Radiat Oncol Biol Phys 2009. [DOI: 10.1016/j.ijrobp.2009.07.988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Warren G, Rangnekar V, McGarry R, Arnold S, Valentino J, Kudrimoti M. Pathways of Resistance: Potential Effects of Nicotine on Cancer and Treatment Response. Int J Radiat Oncol Biol Phys 2008. [DOI: 10.1016/j.ijrobp.2008.06.552] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Payne G, Warren G, Valentino J, Gal T, Arnold S, Ain K, Kenady D, Sloan D, Kudrimoti M. External Beam Radiotherapy in the Management of Recurrent I-131 Refractory Thyroid Cancer. Int J Radiat Oncol Biol Phys 2008. [DOI: 10.1016/j.ijrobp.2008.06.1286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Payne GA, Warren GW, Valentino J, Gal TJ, Arnold SM, Ain KB, Given CA, Brill YM, Kudrimoti MR. Locoregional control following external beam radiotherapy for recurrent, I-131 refractory thyroid 26061 cancer. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.6061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Warren G, Arnold S, Valentino J, Brill Y, Regine W, Spring P, Given C, Mohiuddin M, Meigooni A, Kudrimoti M. Long Term Results of a Phase II Trial of Hyperfractionated Radiation and Intraarterial Cisplatin (HYPERRADPLAT) on Stage III-IV Head and Neck Cancer With Bulky Primary Tumors. Int J Radiat Oncol Biol Phys 2007. [DOI: 10.1016/j.ijrobp.2007.07.1582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Kudrimoti M, Warren G, Valentino J, Spring P, Brill Y, Given C, St.Clair W, Mohuddin M, Regine W, Arnold S. 2417. Int J Radiat Oncol Biol Phys 2006. [DOI: 10.1016/j.ijrobp.2006.07.827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Arnold SM, Graham WW, Valentino J, Brill Y, Regine W, Spring P, Given C, Mohiuddin M, St Claire W, Kudrimoti M. Results of intraarterial cisplatin and hyperfractionated radiotherapy in locally advanced cancer of the oropharynx and oral cavity. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.5563] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5563 Background: Intraarterial cisplatin and hyperfractionated radiation (HYPERADPLAT) is an accepted therapy for Stage III and IV head and neck cancer. We present long-term follow-up of patients with OP and OC cancer treated with HYPERADPLAT at a single institution. Methods: 44 patients with Stage III-IV squamous cell carcinomas of the OP or OC were treated with the HYPERRADPLAT regimen consisting of external beam radiotherapy (76.8–81.6 Gy) delivered in 1.2 Gy BID fractions with intraarterial cisplatin (150 mg/m2) administered when patients had reached 60 Gy. Tumor response, disease free survival (DFS), overall survival (OS), and toxicity were assessed for all patients according to NCI CCT criteria. Results: Of 44 patients, 21 had tumors of the base of tongue, 14-tonsil, 4-floor of mouth, and 5-other. Eighty eight percent of patients had T4 tumors and 7% had T3 tumors. Complete tumor response was observed in 86% of patients and 14% had a partial response. Lymph node metastases were present in 84% of patients with 78% of node positive patients having a complete nodal response and 19% with a partial response to treatment. Three-year DFS was 55% and OS was 45%. Locoregional recurrence was noted in 30% of patients and 16% had distant failure. Overall recurrence was noted in 47% of patients with a median time to recurrence of 8 months (range 4–55 months). Median weight loss during treatment was 9% of initial body weight and 28 patients required a feeding tube within 6 months of starting treatment. Grade 3 mucositis was noted in 68% of patients and 3 patients developed Grade 4 toxicity (2 mucosal, 1 hematologic). Conclusions: HYPERRADPLAT results in excellent tumor control that is well tolerated with minimal Grade 4 toxicity in patients with advanced poor prognosis cancers of the OP and OC. These results compare favorably with historically reported control rates and response for patients with a significantly high percentage of T4 tumors of the oropharynx and oral cavity. No significant financial relationships to disclose.
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Affiliation(s)
- S. M. Arnold
- University of Kentucky, Lexington, KY; University of Maryland, Baltimore, MD; University of Arkansas, Little Rock, AR; Geisinger Medical System, Wilkes Barre, PA
| | - W. W. Graham
- University of Kentucky, Lexington, KY; University of Maryland, Baltimore, MD; University of Arkansas, Little Rock, AR; Geisinger Medical System, Wilkes Barre, PA
| | - J. Valentino
- University of Kentucky, Lexington, KY; University of Maryland, Baltimore, MD; University of Arkansas, Little Rock, AR; Geisinger Medical System, Wilkes Barre, PA
| | - Y. Brill
- University of Kentucky, Lexington, KY; University of Maryland, Baltimore, MD; University of Arkansas, Little Rock, AR; Geisinger Medical System, Wilkes Barre, PA
| | - W. Regine
- University of Kentucky, Lexington, KY; University of Maryland, Baltimore, MD; University of Arkansas, Little Rock, AR; Geisinger Medical System, Wilkes Barre, PA
| | - P. Spring
- University of Kentucky, Lexington, KY; University of Maryland, Baltimore, MD; University of Arkansas, Little Rock, AR; Geisinger Medical System, Wilkes Barre, PA
| | - C. Given
- University of Kentucky, Lexington, KY; University of Maryland, Baltimore, MD; University of Arkansas, Little Rock, AR; Geisinger Medical System, Wilkes Barre, PA
| | - M. Mohiuddin
- University of Kentucky, Lexington, KY; University of Maryland, Baltimore, MD; University of Arkansas, Little Rock, AR; Geisinger Medical System, Wilkes Barre, PA
| | - W. St Claire
- University of Kentucky, Lexington, KY; University of Maryland, Baltimore, MD; University of Arkansas, Little Rock, AR; Geisinger Medical System, Wilkes Barre, PA
| | - M. Kudrimoti
- University of Kentucky, Lexington, KY; University of Maryland, Baltimore, MD; University of Arkansas, Little Rock, AR; Geisinger Medical System, Wilkes Barre, PA
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Kudrimoti MR, Warren GW, Valentino J, Spring PM, Mohiuddin M, St. Clair WH, Brill Y, Given C, Regine WF, Arnold SM. Results of reduction of treatment intensity based on response to a novel induction therapy in stage III and IV head and neck cancer. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.5561] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5561 Background: Concurrent cisplatinum based chemotherapy and qd radiotherapy (RT) to 70 Gy is standard therapy for stage III-IV head and neck (H/N) SCCA. Presented is a prospective IRB approved study tailoring the definitive therapy based on response to induction therapy. Methods: 25 patients with Stage III-IV H/N SCCA were treated with 2 cycles of induction therapy every 21 days comprised of carboplatin (AUC 6 day 1), paclitaxel (75 mg/m2 days 1, 8, and 15), and low dose RT (0.5 Gy BID days 1, 2, 8, and 15) for chemosensitization. The response rates of this mode of induction therapy have been presented previously (ASCO 2005 #3184). Patients with complete response (CR) to induction were treated with reduced dose RT at the primary site (reduced from 70 to 60–66 Gy) and 2 cycles of IV cisplatin (100 mg/m2) instead of 3. Those with partial response (PR) or stable disease (SD) were treated with surgery and adjuvant therapy or with altered fractionation regimens. The impact of dose reduction on survival (OS and DFS), failure patterns, compliance and toxicity (according to NCI CTCAE) were used as end points for the study. Results: Patients included 9 with tonsil, 5-L, 3-HP, 3-OC, and 5-BOT. There were 4-T1,9-T2,9-T3,and 3-T4 tumors. The nodal involvement was N0–5, N1–3, N2–13, N3–4. Patients presented with Stage III (28%), IVA (52%), and IVB (20%). Sixty percent had a CR, 32% had a PR, and 8% had SD after induction therapy. Two patients with CR were non-compliant after induction therapy and not further evaluated. With a median FU of 20.5 months (range 11–36 mo) the OS and DFS is 100% (13/13) in the dose reduced group (CR) and 60% (6/10) in the PR/SD treated with more aggressive regimens. The incidence of distant failure is 40% (4/10) in the PR vs 0% (0/13) in the CR. No patients in the dose reduced group required feeding tubes; however 30% (3/10) were required in patients with PR. Compliance with chemotherapy was 79% (10/13) in the CR vs 80% (8/10) in the PR. Conclusions: Our early results show that the patients showing a CR to induction chemotherapy are a favorable group of patients and they may be treated with reduced treatment intensity. This report provides strong evidence that RT dose deescalation for head and neck cancers may be feasible following assessment after induction therapy. [Table: see text]
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Affiliation(s)
- M. R. Kudrimoti
- University of Kentucky, Lexington, KY; University of Arkansas, Little Rock, AR; Geisinger Health System, Wilkes Barre, PA; University of Maryland, Baltimore, MD
| | - G. W. Warren
- University of Kentucky, Lexington, KY; University of Arkansas, Little Rock, AR; Geisinger Health System, Wilkes Barre, PA; University of Maryland, Baltimore, MD
| | - J. Valentino
- University of Kentucky, Lexington, KY; University of Arkansas, Little Rock, AR; Geisinger Health System, Wilkes Barre, PA; University of Maryland, Baltimore, MD
| | - P. M. Spring
- University of Kentucky, Lexington, KY; University of Arkansas, Little Rock, AR; Geisinger Health System, Wilkes Barre, PA; University of Maryland, Baltimore, MD
| | - M. Mohiuddin
- University of Kentucky, Lexington, KY; University of Arkansas, Little Rock, AR; Geisinger Health System, Wilkes Barre, PA; University of Maryland, Baltimore, MD
| | - W. H. St. Clair
- University of Kentucky, Lexington, KY; University of Arkansas, Little Rock, AR; Geisinger Health System, Wilkes Barre, PA; University of Maryland, Baltimore, MD
| | - Y. Brill
- University of Kentucky, Lexington, KY; University of Arkansas, Little Rock, AR; Geisinger Health System, Wilkes Barre, PA; University of Maryland, Baltimore, MD
| | - C. Given
- University of Kentucky, Lexington, KY; University of Arkansas, Little Rock, AR; Geisinger Health System, Wilkes Barre, PA; University of Maryland, Baltimore, MD
| | - W. F. Regine
- University of Kentucky, Lexington, KY; University of Arkansas, Little Rock, AR; Geisinger Health System, Wilkes Barre, PA; University of Maryland, Baltimore, MD
| | - S. M. Arnold
- University of Kentucky, Lexington, KY; University of Arkansas, Little Rock, AR; Geisinger Health System, Wilkes Barre, PA; University of Maryland, Baltimore, MD
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Warren GW, Arnold SM, Curtis G, Valentino J, Brill Y, Regine WF, Spring PM, Mohiuddin M, St. Clair WH, Kudrimoti MR. The effect of induction therapy with carboplatin-paclitaxel and low dose radiotherapy followed by hyperfractionated radiotherapy and intraarterial chemotherapy on advanced cancers of the head and neck. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.15517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
15517 Background: The purpose of this study is to evaluate the potential benefits of induction therapy followed by intraarterial cisplatin and hyperfractionated radiation (HYPERRADPLAT) on patients with advanced head and neck tumors. Methods: 20 patients with Stage III-IV squamous cell carcinoma of the head and neck were treated with induction therapy consisting of 2 cycles of carboplatin (AUC 6) and paclitaxel (225 mg/m2) and 0.8 Gy BID on the day of and the day following chemotherapy. Induction therapy was given over 2 cycles separated by 3 weeks (previously described in ASCO 2002 abstract # 921 and 2004 abstract # 5593). Patients were then treated with the HYPERRADPLAT regimen consisting of external beam radiotherapy (74.4–81.6 Gy) delivered in 1.2 Gy BID fractions with intraarterial cisplatin (150 mg/m2) administered when patients had reached 60 Gy. Tumor response, disease free survival, overall survival, and toxicity were assessed for all patients according to NCI CTCAE criteria. Results: Of 20 patients, 9 had tumors of the oropharynx, 9-supralaryngeal, and 2-hypopharyngeal. Fifty percent of patients had T4 tumors and 35% had T3 tumors. Complete tumor response was observed in 80% of patients and 20% had a partial response. Three-year disease free survival was 75% and overall survival was 75%. Locoregional recurrence was noted in 25% of patients and 15% had distant failure. Overall recurrence was noted in 40% of patients with a median time to recurrence of 12 months (range 6–55 months). Median weight loss during treatment was 10% of initial body weight and 13 patients required a feeding tube within 6 months of starting treatment. Grade 3 mucositis was noted in 65% of patients and no patients developed Grade 4 toxicity. Conclusions: Two cycles of carboplatin-paclitaxel induction therapy followed by intraarterial cisplatin and hyperfractionated radiotherapy produces excellent tumor response and reduces distant failure. These results compare favorably with historical controls and produce tolerable toxicity profiles. [Table: see text]
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Affiliation(s)
- G. W. Warren
- University of Kentucky, Lexington, KY; University of Maryland, Baltimore, MD; University of Arkansas, Little Rock, AR; Geisinger Medical System, Wilkes Barre, PA
| | - S. M. Arnold
- University of Kentucky, Lexington, KY; University of Maryland, Baltimore, MD; University of Arkansas, Little Rock, AR; Geisinger Medical System, Wilkes Barre, PA
| | - G. Curtis
- University of Kentucky, Lexington, KY; University of Maryland, Baltimore, MD; University of Arkansas, Little Rock, AR; Geisinger Medical System, Wilkes Barre, PA
| | - J. Valentino
- University of Kentucky, Lexington, KY; University of Maryland, Baltimore, MD; University of Arkansas, Little Rock, AR; Geisinger Medical System, Wilkes Barre, PA
| | - Y. Brill
- University of Kentucky, Lexington, KY; University of Maryland, Baltimore, MD; University of Arkansas, Little Rock, AR; Geisinger Medical System, Wilkes Barre, PA
| | - W. F. Regine
- University of Kentucky, Lexington, KY; University of Maryland, Baltimore, MD; University of Arkansas, Little Rock, AR; Geisinger Medical System, Wilkes Barre, PA
| | - P. M. Spring
- University of Kentucky, Lexington, KY; University of Maryland, Baltimore, MD; University of Arkansas, Little Rock, AR; Geisinger Medical System, Wilkes Barre, PA
| | - M. Mohiuddin
- University of Kentucky, Lexington, KY; University of Maryland, Baltimore, MD; University of Arkansas, Little Rock, AR; Geisinger Medical System, Wilkes Barre, PA
| | - W. H. St. Clair
- University of Kentucky, Lexington, KY; University of Maryland, Baltimore, MD; University of Arkansas, Little Rock, AR; Geisinger Medical System, Wilkes Barre, PA
| | - M. R. Kudrimoti
- University of Kentucky, Lexington, KY; University of Maryland, Baltimore, MD; University of Arkansas, Little Rock, AR; Geisinger Medical System, Wilkes Barre, PA
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Arnold SM, Kudrimoti M, Valentino J, Spring P, Ahmed M, Regine W, Kenady D, Given C, Mohiuddin M. Potentiating the effect of chemotherapy with low-dose fractionated radiation (LDFRT) in locally advanced squamous cell carcinoma of the head and neck (SCCHN). J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.3184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- S. M. Arnold
- Univ of Kentucky, Lexington, KY; Unvinversity of Kentucky, Lexington, KY; Univ of Maryland, Baltimore, MD
| | - M. Kudrimoti
- Univ of Kentucky, Lexington, KY; Unvinversity of Kentucky, Lexington, KY; Univ of Maryland, Baltimore, MD
| | - J. Valentino
- Univ of Kentucky, Lexington, KY; Unvinversity of Kentucky, Lexington, KY; Univ of Maryland, Baltimore, MD
| | - P. Spring
- Univ of Kentucky, Lexington, KY; Unvinversity of Kentucky, Lexington, KY; Univ of Maryland, Baltimore, MD
| | - M. Ahmed
- Univ of Kentucky, Lexington, KY; Unvinversity of Kentucky, Lexington, KY; Univ of Maryland, Baltimore, MD
| | - W. Regine
- Univ of Kentucky, Lexington, KY; Unvinversity of Kentucky, Lexington, KY; Univ of Maryland, Baltimore, MD
| | - D. Kenady
- Univ of Kentucky, Lexington, KY; Unvinversity of Kentucky, Lexington, KY; Univ of Maryland, Baltimore, MD
| | - C. Given
- Univ of Kentucky, Lexington, KY; Unvinversity of Kentucky, Lexington, KY; Univ of Maryland, Baltimore, MD
| | - M. Mohiuddin
- Univ of Kentucky, Lexington, KY; Unvinversity of Kentucky, Lexington, KY; Univ of Maryland, Baltimore, MD
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Arnold S, Kudrimoti M, Valentino J, Spring P, Ahmed M, Regine W, Given C, Kenady D, Mohiuddin M. Low-dose fractionated radiation (LDFRT) as a potentiator of neoadjuvant paclitaxel (P) and carboplatin (C) in locally advanced squamous cell carcinoma of the head and neck (SCCHN). Int J Radiat Oncol Biol Phys 2004. [DOI: 10.1016/j.ijrobp.2004.07.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Arnold SM, Kudrimoti M, Regine W, Valentino J, Spring P, Kenady D, Ahmed M, Mohiuddin M. Low-dose fractionated radiation (LDFRT) plus paclitaxel (P) and carboplatin (CBCDA) as induction therapy for locally advanced squamous cell carcinoma of the head and neck (SCCHN): Two-year follow-up. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.5593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- S. M. Arnold
- University of Kentucky, Lexington, KY; University of Maryland, Baltimore, MD
| | - M. Kudrimoti
- University of Kentucky, Lexington, KY; University of Maryland, Baltimore, MD
| | - W. Regine
- University of Kentucky, Lexington, KY; University of Maryland, Baltimore, MD
| | - J. Valentino
- University of Kentucky, Lexington, KY; University of Maryland, Baltimore, MD
| | - P. Spring
- University of Kentucky, Lexington, KY; University of Maryland, Baltimore, MD
| | - D. Kenady
- University of Kentucky, Lexington, KY; University of Maryland, Baltimore, MD
| | - M. Ahmed
- University of Kentucky, Lexington, KY; University of Maryland, Baltimore, MD
| | - M. Mohiuddin
- University of Kentucky, Lexington, KY; University of Maryland, Baltimore, MD
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Qin H, Valentino J, Manna S, Tripathi PK, Bhattacharya-Chatterjee M, Foon KA, O'Malley BW, Chatterjee SK. Gene therapy for head and neck cancer using vaccinia virus expressing IL-2 in a murine model, with evidence of immune suppression. Mol Ther 2001; 4:551-8. [PMID: 11735339 DOI: 10.1006/mthe.2001.0493] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We evaluated the efficiency of recombinant vaccinia virus expressing interleukin-2 (rvv-IL-2) as a tumor vaccine in an immunocompetent mouse model of head and neck squamous cell carcinoma (SCC VII/SF). Mice with five-day-old tumors in the floor of the mouth were treated with rvv-IL-2 by intratumoral injections. These treated mice survived longer (P <.03) than mice treated with control vaccines. Splenocytes, bone marrow, and lymph node cells from tumor-bearing mice responded poorly to concanavalin A stimulation, suggesting induction of immunosuppression. The rvv-IL-2 virus grew for 7 days in the tumor following intratumoral injection. We did not detect any virus particles in several normal organs following rvv-IL-2 injection. Comparison of expression levels of several potential immune inhibitory mediators between the tumors growing in mice and cultured tumor cells demonstrated higher expression of IL-10, GM-CSF, TGF-beta, and NO synthetase in tumors. These results suggested possible roles for these molecules in immunosuppression. We conclude that rvv-IL-2 has potential as a therapeutic vaccine for head and neck cancer and that it can be more effective provided the immunosuppression is reversed.
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Affiliation(s)
- H Qin
- Department of Internal Medicine and the Barrett Cancer Center, University of Cincinnati, Cincinnati, Ohio 45267, USA
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Regine WF, Valentino J, Arnold SM, Haydon RC, Sloan D, Kenady D, Strottmann J, Pulmano C, Mohiuddin M. High-dose intra-arterial cisplatin boost with hyperfractionated radiation therapy for advanced squamous cell carcinoma of the head and neck. J Clin Oncol 2001; 19:3333-9. [PMID: 11454880 DOI: 10.1200/jco.2001.19.14.3333] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To evaluate the tolerance and efficacy of intra-arterial (IA) cisplatin boost with hyperfractionated radiation therapy (HFX-RT) in patients with advanced squamous cell carcinoma of the head and neck (SCCHN). PATIENTS AND METHODS Forty-two patients with locally advanced primary SCCHN were treated on consecutive phase I/II studies of HFX-RT (receiving a total of 76.8 to 81.6 Gy, given at 1.2 Gy bid) and IA cisplatin (150 mg/m(2) received at the start of and during RT boost treatment). RESULTS Acute grade 3 to 4 toxicities were as follows: grade 4 and grade 3 mucosal toxicity occurred in three (7%) and 31 patients (69%), respectively, and grade 3 hematologic, infectious, and skin events occurred in one patient each. Eight of 24 patients (33%) were unable to receive a second planned dose of IA cisplatin because of general anxiety (n = 5), nausea and/or emesis (n = 2), or asymptomatic occlusion of an external carotid artery (n = 1). Thirty-seven patients (88%) experienced complete response (CR) at primary site. Twenty-nine (85%) of 34 patients presenting with nodal disease experienced CR. The actuarial 2-year rates of locoregional control and disease-specific and overall survival are 73%, 63%, and 57%, respectively, with a median active follow-up of 30 months. CONCLUSION In this highly unfavorable subset of patients, these results seem superior to previously reported chemoradiation regimens in more favorable patients. Use of a second dose of IA cisplatin boost was associated with increased toxicity without obvious therapeutic gain. This novel strategy allows for an incremental increase in the treatment intensity of the HFX-RT regimen recently established as superior to once-a-day RT.
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Affiliation(s)
- W F Regine
- Department of Radiation Medicine, University of Kentucky, Lexington, KY 40536-0293, USA.
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Sharma A, Mani S, Hanna N, Guha C, Vikram B, Weichselbaum RR, Sparano J, Sood B, Lee D, Regine W, Muhodin M, Valentino J, Herman J, Desimone P, Arnold S, Carrico J, Rockich AK, Warner-Carpenter J, Barton-Baxter M. Clinical protocol. An open-label, phase I, dose-escalation study of tumor necrosis factor-alpha (TNFerade Biologic) gene transfer with radiation therapy for locally advanced, recurrent, or metastatic solid tumors. Hum Gene Ther 2001; 12:1109-31. [PMID: 11399232 DOI: 10.1089/104303401750214320] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Valentino J. Utilizing a JCAHO review in the education of clinical pastoral education CPE residents. J Pastoral Care 2001; 54:345-9. [PMID: 11147001 DOI: 10.1177/002234090005400311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Reflects on how a pastoral care department utilized a Joint Commission review in the education of five pastoral care residents enrolled in their third unit of Clinical Pastoral Education in a medical center. Outlines how residents prepared for the review, the learning opportunities for residents and medical staff, the outcomes, and the recommendations.
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Affiliation(s)
- J Valentino
- Hillcrest Medical Center, 1120 South Utica Avenue, Tulsa, OK 74104-4090
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Regine WF, Valentino J, John W, Storey G, Sloan D, Kenady D, Patel P, Pulmano C, Arnold SM, Mohiuddin M. High-dose intra-arterial cisplatin and concurrent hyperfractionated radiation therapy in patients with locally advanced primary squamous cell carcinoma of the head and neck: report of a phase II study. Head Neck 2000; 22:543-9. [PMID: 10941154 DOI: 10.1002/1097-0347(200009)22:6<543::aid-hed1>3.0.co;2-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND This phase II study evaluates the tolerability and efficacy of concurrent hyperfractionated radiation therapy (HFX-RT) and high-dose intra-arterial (IA) cisplatin in patients with locally advanced squamous cell carcinoma of the head and neck (SCCHN). METHODS Between December 1995 and November 1997, 20 patients with locally advanced T4/T3 SCCHN were treated with HFX-RT (76.8-79.2 Gy at 1.2 Gy bid over 6-7 weeks) and high-dose IA cisplatin (150 mg/m(2) given at the start of RT boost treatment [start of week 6]). Seventeen patients (85%) had T4 disease, and 14 (70%) had N2/ N3 disease. RESULTS Grade 3-5 acute toxicity was limited to one grade 4 (5%) and 14 grade 3 (70%) mucosal events. No grade 3/4 hematologic toxicity was observed. Median weight loss during therapy was 9% (range, 2%-16%). Eighteen patients had complete response (90%) at the primary site; 14 were confirmed pathologically. Among 17 patients with positive neck disease, 16 (94%) achieved complete response in the neck, including 12 of 13 patients with N2/N3 disease who underwent planned neck dissection. Active follow-up ranges from 12 to 32 months (median, 20 months) with 11 patients alive without disease, 5 dead of disease, and 4 dead of intercurrent disease. Eighteen patients (90%) remained disease free at the primary site, and the locoregional control rate is 80%. CONCLUSIONS High-dose IA cisplatin and concurrent HFX-RT as used in this study is feasible and warrants further investigation. The high complete response rate and low grade 4 toxicity in this highly unfavorable subset of patients appears better than previously reported chemoradiation regimens for more favorable patients.
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Affiliation(s)
- W F Regine
- Department of Radiation Medicine, University of Kentucky, 800 Rose Street, Lexington, Kentucky 40536-0293, USA.
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Valentino J, Weinstein L, Rosenblum R, Regine W, Weinstein M. Radiation and intra-arterial cisplatin: effects on arteries and free tissue transfer. Arch Otolaryngol Head Neck Surg 2000; 126:215-9. [PMID: 10680874 DOI: 10.1001/archotol.126.2.215] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVES To determine the histopathologic effect of combined intra-arterial cisplatin administration and hyperfractionated external beam radiation treatment (HYPERRADPLAT) on potential recipient arteries in the neck and to analyze the efficacy of free tissue transfer (FTT) in patients undergoing HYPERRADPLAT. DESIGN Cisplatin-perfused and nonperfused artery segments were harvested during planned interval neck dissection performed 6 to 10 weeks after HYPERRADPLAT. These segments were evaluated by light microscopy and transmission electron microscopy. All patients undergoing FTT after HYPERRADPLAT were reviewed retrospectively. SETTING Academic medical center. PATIENTS AND INTERVENTION Eight patients undergoing HYPERRADPLAT for head and neck squamous cell carcinoma and planned interval neck dissection were prospectively studied. All patients had a perfused artery sampled, and 3 also had a nonperfused (control) artery sampled. Five patients undergoing FTT after HYPERRADPLAT were retrospectively analyzed for outcome of FTT. RESULTS No consistent histological or ultrastructural differences were detected between injected and noninjected arteries. Both demonstrated intimal thickening, collagen and elastin deposition in the intimal layer, and, occasionally, intimal smooth muscle proliferation. A smaller fraction of the injected and noninjected arteries demonstrated smooth muscle cell vacuolation, elastic fiber degeneration, and calcific deposits. Four of 5 FTTs in patients undergoing HYPERRADPLAT were successful. CONCLUSIONS The changes seen in the injected and noninjected arteries were characteristic of ionizing radiation. Arteries treated with HYPERRADPLAT had no observable difference from vessels treated with radiation alone. These vessels can be used with caution as recipient vessels for FTT. Further clinical experience is needed to establish the expected results of FTT using these arteries.
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Affiliation(s)
- J Valentino
- Division of Otolaryngology-Head and Neck Surgery, University of Kentucky Chandler Medical Center, Lexington 40536-0084, USA.
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Affiliation(s)
- J Valentino
- Division of Otolaryngology, University of Kentucky Chandler Medical Center, Lexington 40536-0084, USA
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Regine WF, Valentino J, Sloan DA, Patel P, Pittard MQ, Kenady DE, Mohiuddin M. Postoperative radiation therapy for primary vs. recurrent squamous cell carcinoma of the head and neck: results of a comparative analysis. Head Neck 1999; 21:554-9. [PMID: 10449672 DOI: 10.1002/(sici)1097-0347(199909)21:6<554::aid-hed9>3.0.co;2-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND There is little literature comparatively evaluating the results of postoperative radiation therapy (RT) for patients with squamous cell carcinoma (SCC) of the head and neck treated for primary versus recurrent disease. METHODS Between 1981 and 1993, 174 patients with SCC of the head and neck, 143 with primary and 31 with recurrent disease, were treated with standard postoperative RT. RESULTS Patients treated for primary disease had 5-year local-regional control (LRC) and disease-specific survival (DSS) rates of 69% and 54%, respectively, as compared with 46% and 32%, respectively, for patients treated for recurrent disease (P = 0.03 and 0.04, respectively). On multivariate analysis, only tumor type (primary vs recurrent) significantly influenced LRC (P = 0.003) and only primary tumor site (oral cavity vs nonoral cavity) significantly influenced DSS (P = 0.04). Among the patients treated for recurrent disease, site of recurrence (undissected vs dissected tissue) significantly influenced both LRC and DSS (P = 0.008 and 0. 001, respectively). CONCLUSIONS Patients with recurrent SCC of the head and neck do poorly as compared with those with primary disease when treated with standard postoperative RT, particularly when the recurrence is within previously dissected tissue. This patient group should be targeted for alternative treatment strategies.
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Affiliation(s)
- W F Regine
- Department of Radiation Medicine, University of Kentucky and Veterans Administration Medical Center, 800 Rose Street, Lexington, KY 40536-0084, USA
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Affiliation(s)
- J Valentino
- Methodist Health System, Memphis, TN 38104, USA
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Valentino J, Andrykowski MA, Wood TA. Population attitudes toward oncology clinical trials. J Ky Med Assoc 1999; 97:111-7. [PMID: 10189772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
OBJECTIVE We examined the attitudes of the Kentucky adult population toward experimental oncology treatment and randomized clinical oncology trials. DESIGN We conducted a health survey of 654 noninstitutionalized adults randomly selected from Kentucky households. We posed to them a series of questions evaluating demographics, general health, and personality characteristics. We asked specific questions to characterize the subjects' experiences with cancer, their desires for autonomy in medical treatment, their health-related behaviors, and their preconceived opinions about specific cancer screening examinations. We then asked the subjects about their willingness to undergo experimental treatment and their willingness to participate in a randomized clinical oncology trial within the framework of a defined, specific oncology scenario. RESULTS Of our subjects, 73% were willing to consider an experimental form of therapy of indeterminate benefit; however, only 39% were willing to consider a randomized clinical trial of two therapies, given the same oncology scenario. The influences of demographic factors, general health, personality factors, personal experience with cancer, and desire for autonomy in health care were found to be of minimal importance in predicting a willingness to participate. CONCLUSIONS A strong negative bias toward randomized clinical trials appears to exist within this population. Continued public education regarding the value of clinical trials to the individual, as well as their selfless benefit to humanity, is clearly needed.
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Affiliation(s)
- J Valentino
- Division of Otolaryngology, University of Kentucky Chandler Medical Center, Lexington, USA
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Hester TO, Valentino J, Strottmann JM, Blades DA, Robinson MC. Cervicothoracic chordoma presenting as progressive dyspnea and dysphagia. Otolaryngol Head Neck Surg 1999; 120:97-100. [PMID: 9914556 DOI: 10.1016/s0194-5998(99)70376-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- T O Hester
- Division of Otolaryngology-Head and Neck Surgery, University of Kentucky Medical Center, Lexington 40536-0084, USA
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Abstract
Increased endotracheal tube cuff pressure causes mucosal ischemia that can lead to necrosis, infection, and, eventually, tracheomalacia or tracheal stenosis. Endotracheally intubated patients frequently undergo portable chest radiography. In this study we explored the relationship of endotracheal tube cuff pressure and the appearance on the tracheal air columns on the portable chest radiograph. We measured the endotracheal tube cuff pressure of intensive care unit patients 124 times immediately before portable chest radiography. On 64 of these radiographs we measured the width of the tracheal air column below the tip of the endotracheal tube and at the maximal diameter of the endotracheal tube balloon. We then analyzed the relationship of cuff pressure to tracheal dilation. The results of ANOVA of tracheal dilation for three groups (safe, borderline, and unsafe cuff pressures) were significant. Large overlapping ranges existed in each group. Regression analysis confirmed a linear relationship between cuff pressure and tracheal dilation (r = 0.435, p < 0.001). Predicted tracheal expansion at 20 mm Hg was a poor screen for endotracheal tube cuff inflation safety; the sensitivity was only 56% and specificity only 71%. The differences in the capacity for tracheal distension between patients make these findings not unexpected. The portable chest radiograph is a poor screening tool for unsafe endotracheal tube cuff pressure.
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Affiliation(s)
- J Valentino
- Division of Otolaryngology, University of Kentucky Chandler Medical Center, Lexington 40536-0084, USA
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Abstract
OBJECTIVE Neurilemomas are classically described as fusiform tumors that eccentrically displace the undisturbed neural fascicles. The authors seek to clarify the relationship of cervical neurilemomas to their nerve of origin and assess the functional outcome of surgical extirpation. STUDY DESIGN A retrospective review of clinical, intraoperative, and histopathologic data of six patients with cervical extracranial neurilemomas. METHODS Additional histochemical staining of the pathologic specimens was performed to evaluate the tumor for neurites. A comprehensive literature review of cervical neurilemoma cases and meta-analysis of clinical outcomes in these cases were performed. RESULTS In the series of five consecutive cervical neurilemomas, only one was an eccentric mass pushing the undisturbed nerve aside. In the five other cases, excision of the neurilemoma required complete nerve excision. Neural elements traveling through the central portions of the tumor were clearly demonstrated histologically. Collective analysis of the literature on cervical neurilemomas revealed that although some cases allow nerve preservation, preservation of function is frequently poor. CONCLUSIONS This experience and that reported in the literature suggest that it is frequently impossible to preserve the function of the nerve of origin with surgical treatment of cervical neurilemomas.
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Affiliation(s)
- J Valentino
- Department of Surgery, University of Kentucky Chandler Medical Center, Lexington 40536-0084, USA
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Abstract
PURPOSE To measure the agreement among faculty members about the importance of items on a checklist used to grade an objective structured clinical examination (OSCE) station. METHODS Six faculty members rated the importance of 47 items for an OSCE station in which students took the history of a patient with sore throat and hoarseness. RESULTS Of the 47 items, the raters independently identified 15 items as very important. The reliability of each individual rater was fair (averaged value of alpha = .63.) The reliability of the mean rating of the six raters was high (alpha = .91). CONCLUSIONS The results strongly suggest that when a group of faculty members cooperatively identifies the important items to be included in an OSCE checklist, the reliability of the checklist is superior to one created by a single author.
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Affiliation(s)
- J Valentino
- Department of Surgery, University of Kentucky College of Medicine, Lexington, USA.
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Regine WF, Valentino J, Patel P, Sloan DA, Mohiuddin M, Kenady DE. Efficacy of postoperative radiation therapy for recurrent squamous cell carcinoma of the head and neck. Int J Radiat Oncol Biol Phys 1997; 39:297-302. [PMID: 9308931 DOI: 10.1016/s0360-3016(97)00319-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE Postoperative radiation therapy (RT) following surgical resection is often the recommended treatment for recurrent squamous cell carcinoma (SCC) of the head and neck. Despite common use, there are few published series evaluating such a management approach. METHODS AND MATERIALS We evaluated the efficacy of postoperative RT in 31 patients with recurrent SCC of the head and neck treated between 1981 and 1993. None of the patients had prior RT. All had complete resection of recurrent gross disease and no distant metastases. Maximum postoperative RT doses ranged from 59.4-70 Gy (median = 66 Gy). RESULTS The 5-year disease-specific survival (DSS) and local control (LC) rate for all patients were 32 and 46%, respectively. Several prognostic factors were analyzed including site and stage of original primary tumor, disease-free interval, site of recurrence, status of surgical margins, and dose. Only site of recurrence significantly influenced both DSS and LC. Patients whose recurrence was limited to previously undissected tissue had 5-year DSS and local control rates of 60 and 74%, respectively, as compared to 19 and 29%, respectively, for patients whose recurrence was within previously dissected tissue (p = 0.05). CONCLUSIONS Patients with recurrent SCC of the head and neck treated with standard postoperative RT following surgical resection do relatively well if the recurrence is within previously undissected tissue (i.e., nodal only); however, patients whose recurrence is within previously dissected tissue do poorly. Every effort to prevent locoregional disease recurrence at the time of primary therapy should be emphasized.
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Affiliation(s)
- W F Regine
- University of Kentucky Medical Center, Department of Radiation Medicine, Lexington, KY 40536-0084, USA
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Abstract
Thrombosis is the most frequent cause of failure in microvascular free-tissue transfer. The large communicating vein of the cubital fossa connects the deep and superficial venous drainage of the radial forearm free flap (RFFF). This vein allows the surgeon to simultaneously drain both systems by means of the large veins of the cubital fossa. We prospectively collected data on the venous anatomy of the cubital fossa in 40 consecutive RFFFs over a 3-year period. We then retrospectively reviewed available data from the 14 cases preceding the cases in the prospective series. At least 78% of our patients had a communicating vein that facilitated dual venous drainage; 87% of our RFFFs were drained by both the superficial and deep venous systems, and 90% of our RFFFs had two or more venous anastomoses. We had no RFFF failures in our series of 54 flaps. We present our venous anatomy findings in this series of forearms as well as the venous anastomoses of our 54 patients. The surgi- cal-flap harvest, including the communicating vein and its use, may provide an advantage in the dependability and quality of venous outflow.
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Affiliation(s)
- J Valentino
- Division of Otolaryngology, University of Kentucky Chandler Medical Center, Lexington, 40536-0084, USA
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Abstract
The use of autogenous fat for augmentation of the paralyzed vocal fold is a promising substitute for alternate injectable material such as Teflon (polytef paste, polytetrafluoroethylene; Ethicon) and Gelfoam (absorbable gelatin sponge; Upjohn). Long-term histologic evaluation of fat grafts to the larynx has not previously been reported in the literature. We present a case report of autogenous fat augmentation of a paralyzed vocal fold with documentation of persistent fat graft present 5 months after transplant.
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Affiliation(s)
- C A Bauer
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, USA
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Funk GF, Valentino J, McCulloch TM, Graham SM, Hoffman HT. Anomalies of forearm vascular anatomy encountered during elevation of the radial forearm flap. Head Neck 1995; 17:284-92. [PMID: 7672968 DOI: 10.1002/hed.2880170403] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The radial forearm flap has gained considerable popularity over the past 10 years. With the increasing number of forearm flaps being used in head and neck reconstruction, it is likely that anomalous forearm vascular anatomy will be encountered by more head and neck surgeons performing this procedure. METHODS We reviewed our experience with 52 forearm flaps; four different anomalies of forearm vascular anatomy were encountered in four patients. In this article we present each of our cases and discuss the incidence, preoperative diagnosis, and recommended management of these and the more common forearm vascular anomalies. RESULTS The anomalies encountered in our series include: one case of distal takeoff of the radial artery deep to the pronator teres muscle, two cases of a superficial dorsal antebrachial artery, one case of bilateral hypoplastic ulnar arteries, and one case of high takeoff of the radial artery. CONCLUSIONS There are a number of anomalies of forearm vascular anatomy of clinical significance to the surgeon performing these procedures. Most of these anomalies can be identified with a careful preoperative examination. Surgeons performing this procedure should be familiar not only with the normal vascular anatomy of the forearm flap, but also with the more common anatomic variants. Failure to recognize or appropriately manage these anomalies of forearm vascular anatomy may result in a compromised surgical outcome.
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Affiliation(s)
- G F Funk
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa College of Medicine, Iowa, USA
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Funk GF, Laurenzo JF, Valentino J, McCulloch TM, Frodel JL, Hoffman HT. Free-tissue transfer reconstruction of midfacial and cranio-orbito-facial defects. Arch Otolaryngol Head Neck Surg 1995; 121:293-303. [PMID: 7873145 DOI: 10.1001/archotol.1995.01890030033006] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To review our results using free-tissue transfer to reconstruct midfacial and cranio-orbito-facial defects. DESIGN Case series. SETTING The University of Iowa Hospitals and Clinics, Iowa City. PATIENTS Fourteen of 21 patients had defects that resulted from ablative oncologic surgery; six had severe mid-facial trauma; and one had Romberg's disease. INTERVENTIONS Four latissimus dorsi, 11 rectus abdominis, three scapula, and four forearm free-tissue transfer flaps were used. MAIN OUTCOME MEASURES Adequate flap separation of vital structures (intracranial contents and carotid artery) from the sinonasal or oropharyngeal cavities; restoration of palatal competence, oral diet, and speech intelligibility; maxillary dental rehabilitation; aesthetic results; complications; and the patient's return to social activities outside the home after surgery. RESULTS The intracranial contents (six cases) or carotid artery (four cases) were protected from sinonasal or oropharyngeal contamination by the reconstructive flap in all cases in which this was required. Functional closure of the palate with the flap or a prosthesis was possible in 12 of the 13 patients with a palatal defect; seven of these 13 patients have had full maxillary dental rehabilitation. Twenty patients take an oral diet. Sixteen patients have normal or easily understood speech. Fourteen patients engage in social activities outside the home, and eight have returned to full-time employment. No vascular flap failures occurred in this series. CONCLUSIONS The use of free-tissue transfer flaps is a safe and effective technique for repairing large midfacial and cranio-orbito-facial defects resulting from ablative oncologic surgery or trauma.
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Affiliation(s)
- G F Funk
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa College of Medicine, Iowa City
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Abstract
Monocortical miniplate fixation provides biomechanical fixation of mandibular fractures. The ability of this system to adequately fixate fractures clinically has not been fully accepted. We analyzed our use of supplemental maxillomandibular fixation with miniplate osteosynthesis during a 5-year period, in 287 patients with 499 mandible fractures. A retrospective, matched pairing of identical fractures fixated with identical plating schemes was carried out. Sixty-five pairs of patients undergoing intraoral monocortical plating were identified. Patients in group 1 were treated with supplemental maxillomandibular fixation after surgery, whereas patients in group 2 were treated without postoperative maxillomandibular fixation. The rate of major complications was 11% with supplemental maxillomandibular fixation and 9% without supplemental maxillomandibular fixation ( p > 0.05). The total rate of complications was 17% with supplemental maxillomandibular fixation and 20% without supplemental maxillomandibular fixation ( p > 0.05). No statistically significant outcome advantage could be attributed to the use of maxillomandibular fixation.
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Affiliation(s)
- J Valentino
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor
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Abstract
OBJECTIVE Intraoral monocortical miniplate fixation of mandibular fractures provides simultaneous visualization of the fracture and occlusal relation, while almost eliminating external incisions and potential compromise of the marginal mandibular nerve. We sought to analyze the outcome of our patients treated with this technique and compare this with literature standards for mandible fracture repair outcome. DESIGN A retrospective analysis of outcomes for a case series. SETTING All treatment performed in inner city, level 1 or 2 trauma rated, teaching hospitals. PATIENTS During a 5-year period, 287 patients with 499 mandible fractures were treated with intraoral miniplates. Follow-up criteria was available for a retrospective analysis of 246 patients with 432 fractures of the mandible. INTERVENTION Intraoral monocortical plating techniques were used to treat 313 of these 432 mandibular fractures. MAIN OUTCOME MEASURES All complications of bone union, occlusion, wound infection, and dehiscence were graded and tabulated. RESULTS On analysis of the miniplated fractures, 1.2% of the patients had delayed union, 0.4% had non-union, 6.5% had postoperative wound infection develop, and 4.1% had varying degrees of malunion. Complication rates are comparable with most reported studies of bicortical and monocortical plating of mandible fractures. CONCLUSIONS Monocortical miniplate fixation is a reliable method of providing rigid fixation. It offers a reasonable alternative to bicortical plating in most mandible fractures.
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Affiliation(s)
- J Valentino
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis
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Wirtschafter JD, Slovut DP, Stordal L, Valentino J, McLoon LK. Severe but temporary injury to rabbit orbicularis oculi muscle using dihematoporphyrin ether and laser photochemomyectomy. Mov Disord 1992; 7:171-7. [PMID: 1533899 DOI: 10.1002/mds.870070212] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
The use of local dihematoporphyrin ether (DHE) injections, followed by laser light activation, was investigated as a potential permanent myectomy treatment for muscle spasms, in particular blepharospasm and hemifacial spasm. DHE was injected into the eyelids of rabbits, followed by laser activation, as used in photochemotherapy. Four days after treatment, histological examination indicated that doses of greater than or equal to 0.5 mg of DHE and laser treatment with an energy density of at least 100 J/cm2 resulted in an almost total destruction of the orbicularis oculi muscle in the treated eyelid. The amount of muscle injury was dependent on both dose of DHE and energy density levels. Histologically, the tarsal glands and conjunctiva were damaged. Glandular tissue was markedly reduced, and the conjunctival epithelium showed hyperplasia and a loss of mucous cells. Six months after DHE and laser treatment, the majority of the muscle tissue had regenerated, although there was evidence of previous injury. While DHE injections combined with laser light activation were lethal to muscle at the site of treatment, this treatment was not permanent. The orbicularis oculi muscle retained its ability to regenerate. However, photochemomyectomy may be studied further as an adjuvant treatment to temporarily injure and debulk large muscles when botulinum toxin is contraindicated due to the large doses involved or as a permanent treatment when used together with an antimitotic agent such as doxorubicin.
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Affiliation(s)
- J D Wirtschafter
- Department of Ophthalmology, University of Minnesota, Minneapolis 55455
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Marentette LJ, Valentino J. Traumatic anterior fossa cerebrospinal fluid fistulae and craniofacial considerations. Otolaryngol Clin North Am 1991; 24:151-63. [PMID: 2027696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Traumatic cerebrospinal fluid fistulae may present a diagnostic and treatment challenge to the head and neck surgeon. The clinical presentation may be obscured by associated injuries. This article serves as a guide in the understanding, diagnosis, and management of patients with dural fistulae of the anterior cranial fossa.
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Affiliation(s)
- L J Marentette
- Department of Otolaryngology, University of Minnesota, Minneapolis
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