75 results on '"Adelstein, David J."'
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2. Reply to A. Piccardo et al, E. Hindié et al, M.C. Kreissl et al, M. Doss, J. Buscombe, R. Fisher, M. Sollini et al, M. Lichtenstein, and M. Tulchinsky et al.
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Molenaar, Remco J., Sidana, Surbhi, Radivoyevitch, Tomas, Gerds, Aaron T., Carraway, Hetty E., Kalaycio, Matt, Nazha, Aziz, Adelstein, David J., Nasr, Christian, Maciejewski, Jaroslaw P., Majhail, Navneed S., Sekeres, Mikkael A., and Mukherjee, Sudipto
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- 2018
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3. Risk of Hematologic Malignancies After Radioiodine Treatment of Well-Differentiated Thyroid Cancer.
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Molenaar, Remco J., Sidana, Surbhi, Radivoyevitch, Tomas, Advani, Anjali S., Gerds, Aaron T., Carraway, Hetty E., Angelini, Dana, Kalaycio, Matt, Nazha, Aziz, Adelstein, David J., Nasr, Christian, Maciejewski, Jaroslaw P., Majhail, Navneet S., Sekeres, Mikkael A., and Mukherjee, Sudipto
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- 2018
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4. Use of Larynx-Preservation Strategies in the Treatment of Laryngeal Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update.
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Forastiere, Arlene A., Ismaila, Nofisat, Lewin, Jan S., Nathan, Cherie Ann, Adelstein, David J., Eisbruch, Avraham, Fass, Gail, Fisher, Susan G., Laurie, Scott A., Le, Quynh-Thu, O’Malley, Bernard, Mendenhall, William M., Patel, Snehal, Pfister, David G., Provenzano, Anthony F., Weber, Randy, Weinstein, Gregory S., Wolf, Gregory T., and O'Malley, Bernard
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- 2018
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5. Radiation Therapy for Oropharyngeal Squamous Cell Carcinoma: American Society of Clinical Oncology Endorsement of the American Society for Radiation Oncology Evidence-Based Clinical Practice Guideline.
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Quon, Harry, Vapiwala, Neha, Forastiere, Arlene, Kennedy, Erin B., Adelstein, David J., Boykin, Holly, Califano, Joseph A., Holsinger, F. Chris, Nussenbaum, Brian, Rosenthal, David I., Siu, Lillian L., and Waldron, John N.
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- 2017
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6. Primary Thyroid Squamous Cell Carcinoma With Complete Response to Radical Surgery and Concurrent Chemoradiotherapy: Diagnostic Pathologic Workup and Clinical Management
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Elsheikh, Tarik M., Adelstein, David J., and Koyfman, Shlomo A.
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Primary squamous cell carcinoma (SqCC) of the thyroid gland is an extremely rare, highly aggressive malignancy associated with locally advanced disease and frequent metastases to regional lymph nodes and distant sites. There are no standardized guidelines for treating primary thyroid SqCC because of its rarity, but some investigators have recommended staging and treating it as a variant of anaplastic thyroid carcinoma. Prognosis, however, remains poor with minimal response to treatment and an estimated median survival of 6 to 14 months. We report a case of primary SqCC of the thyroid that was successfully treated with aggressive locoregional resection followed by concurrent radical dose radiotherapy and cisplatin-based chemotherapy. The patient remains free of disease more than 4 years after surgery and adjuvant chemoradiation. Because of potential prognostic and management implications, it is crucial to make an accurate pathologic diagnosis of primary SqCC of the thyroid and distinguish it from metastatic squamous carcinoma and other primary thyroid malignancies with squamous features. A thorough clinicopathologic diagnostic workup including immunohistochemistry, computed tomography scan, and endoscopy is mandatory. In this case, treatment similar to the standard management used for patients with locally advanced mucosal head and neck squamous cancer led to a successful outcome.
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- 2019
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7. Radiotherapy plus cetuximab or cisplatin in human papillomavirus-positive oropharyngeal cancer (NRG Oncology RTOG 1016): a randomised, multicentre, non-inferiority trial
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Gillison, Maura L, Trotti, Andy M, Harris, Jonathan, Eisbruch, Avraham, Harari, Paul M, Adelstein, David J, Jordan, Richard C K, Zhao, Weiqiang, Sturgis, Erich M, Burtness, Barbara, Ridge, John A, Ringash, Jolie, Galvin, James, Yao, Min, Koyfman, Shlomo A, Blakaj, Dukagjin M, Razaq, Mohammed A, Colevas, A Dimitrios, Beitler, Jonathan J, Jones, Christopher U, Dunlap, Neal E, Seaward, Samantha A, Spencer, Sharon, Galloway, Thomas J, Phan, Jack, Dignam, James J, and Le, Quynh Thu
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Patients with human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma have high survival when treated with radiotherapy plus cisplatin. Whether replacement of cisplatin with cetuximab—an antibody against the epidermal growth factor receptor—can preserve high survival and reduce treatment toxicity is unknown. We investigated whether cetuximab would maintain a high proportion of patient survival and reduce acute and late toxicity.
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- 2019
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8. Case Report: Primary Orbital Squamous Cell Carcinoma
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Blandford, Alexander D., Bellerive, Claudine, Tom, Martin, Koyfman, Shlomo, Adelstein, David J., Plesec, Thomas P., Perry, Julian D., and Singh, Arun D.
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Squamous cell carcinoma (SCC) of the orbit is almost uniformly the result of local invasion from a cutaneous primary, extension by perineural invasion, or the result of metastasis. This is owed to the lack of native squamous epithelium in the orbit. After review of the literature, to date, only 6 reports of 8 patients with primary orbital SCC exist. Of those cases, only 2 reported non-apical orbital SCC. There are 2 reports of orbital SCC after retina surgery with proposed transplanted conjunctival epithelium and subsequent malignant transformation of a conjunctival cyst. The initial signs and symptoms can be vague and lead to delay in diagnosis. We present a case of primary orbital SCC and discuss the workup, imaging, and multidisciplinary management of this rare condition.
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- 2019
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9. Radiation therapy for oropharyngeal squamous cell carcinoma: Executive summary of an ASTRO Evidence-Based Clinical Practice Guideline.
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Sher, David J., Adelstein, David J., Bajaj, Gopal K., Brizel, David M., Cohen, Ezra E.W., Halthore, Aditya, Harrison, Louis B., Lu, Charles, Moeller, Benjamin J., Quon, Harry, Rocco, James W., Sturgis, Erich M., Tishler, Roy B., Trotti, Andy, Waldron, John, and Eisbruch, Avraham
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Purpose To present evidence-based guidelines for the treatment of oropharyngeal squamous cell carcinoma (OPSCC) with definitive or adjuvant radiation therapy (RT). Methods and materials The American Society for Radiation Oncology convened the OPSCC Guideline Panel to perform a systematic literature review investigating the following key questions: (1) When is it appropriate to add systemic therapy to definitive RT in the treatment of OPSCC? (2) When is it appropriate to deliver postoperative RT with and without systemic therapy following primary surgery for OPSCC? (3) When is it appropriate to use induction chemotherapy in the treatment of OPSCC? (4) What are the appropriate dose, fractionation, and volume regimens with and without systemic therapy in the treatment of OPSCC? Results Patients with stage IV and stage T3 N0-1 OPSCC treated with definitive RT should receive concurrent high-dose intermittent cisplatin. Patients receiving adjuvant RT following surgical resection for positive surgical margins or extracapsular extension should be treated with concurrent high-dose intermittent cisplatin, and individuals with these risk factors who are intolerant of cisplatin should not routinely receive adjuvant concurrent systemic therapy. Induction chemotherapy should not be routinely delivered to patients with OPSCC. For patients with stage IV and stage T3 N0-1 OPSCC ineligible for concurrent chemoradiation therapy, altered fractionation RT should be used. Conclusion The successful management of OPSCC requires the collaboration of radiation, medical, and surgical oncologists. When high-level data are absent for clinical decision-making, treatment recommendations should incorporate patient values and preferences to arrive at the optimal therapeutic approach. [ABSTRACT FROM AUTHOR]
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- 2017
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10. The prognostic value of pretreatment FDG-PET parameters in HPV-associated oropharynx cancer.
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Ward, Matthew C., Shah, Ankeet, Koyfman, Shlomo A., Nwizu, Scharpf, Joseph, Burkey, Brian, Lamarre, Eric, Adelstein, David J., Greskovich, John F., and Ping Xia
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- 2016
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11. Modern Image-Guided Intensity-Modulated Radiotherapy for Oropharynx Cancer and Severe Late Toxic Effects: Implications for Clinical Trial Design
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Ward, Matthew C., Ross, Richard Blake, Koyfman, Shlomo A., Lorenz, Robert, Lamarre, Eric D., Scharpf, Joseph, Burkey, Brian B., Joshi, Nikhil P., Woody, Neil M., Prendes, Brandon, Houston, Narcissa, Reddy, Chandana A., Greskovich, John F., and Adelstein, David J.
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IMPORTANCE: Late toxic effects are common after definitive radiotherapy and chemoradiotherapy for oropharynx cancer and are considered a significant contributor to decreased quality of life for survivors. The incidence of severe late toxic effects may be reduced by modern narrow-margin image-guided intensity-modulated radiotherapy (IG-IMRT), current supportive care improvements, and the changing epidemiology of oropharynx cancer. OBJECTIVE: Assess the incidence of severe late toxic effects after modern definitive non-operative treatment for oropharynx cancer. DESIGN, SETTING, AND PARTICIPANTS: For this single-institution retrospective review, 156 patients with stage I-IVB squamous cell carcinoma of the oropharynx treated between April 2009 and February 2015 at a tertiary-referral academic multidisciplinary head and neck practice were recruited. INTERVENTIONS: Definitive narrow-margin IG-IMRT to a dose of 66 Gy (to convert milligray to rad, multiply by 0.1) or higher with or without concurrent cisplatin. MAIN OUTCOMES AND MEASURES: The primary outcome was the prospectively collected 2-year cumulative incidence of severe late toxic effects (Common Terminology Criteria for Adverse Events grade 3 or higher) occurring 3 months or more after radiotherapy. Toxic effect end points investigated included esophageal stricture requiring dilation, aspiration pneumonia hospitalization, vocal dysfunction, delayed feeding tube insertions, and osteoradionecrosis. Feeding tube dependence at 1 year was also considered a severe late toxic effect. Secondary outcomes collected include physician-reported grade 2 or higher neck fibrosis and xerostomia. The competing risks of recurrence and death were accounted for using the Gray method. RESULTS: One-hundred fifty-six patients (median [range] age, 58 [37-96] years) were identified; 130 patients (83%) were HPV positive. Concurrent cisplatin was delivered in 131 patients (84%) and 5 patients (3%) underwent an adjuvant neck dissection. The median (range) follow-up for survivors was 22 (4-73) months from diagnosis. The projected 2-year locoregional control was 93% (95% CI, 88.4%-97.6%) and overall survival was 88% (95% CI, 82.2%-94.0%). Thirty-eight patients (23%) required a feeding tube during treatment. The cumulative incidence of severe late toxic effects adjusted for competing risks at 2-year posttreatment was 2.3% (95% CI, 0%-5.6%). One patient required free-flap reconstruction for grade 3 osteoradionecrosis at 47 months. At 1 year, 2 patients (1%) experienced grade 2 neck fibrosis and 38 patients (23%) experienced grade 2 xerostomia. CONCLUSIONS AND RELEVANCE: These results suggest that severe late toxic effects after modern definitive IG-IMRT, with or without cisplatin, for oropharynx cancer is likely uncommon. The importance of late toxic effect reduction in current and future investigational strategies, including clinical trials, should be considered.
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- 2016
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12. Strategies for Protecting Normal Tissue in the Treatment of Head and Neck Cancer.
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Markman, Maurie, Adelstein, David J., and Brizel, David M.
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Normal tissue tolerance limits the delivery of both ionizing radiation and cytotoxic chemotherapy for virtually all types of cancer including squamous cell carcinoma of the head and neck (HNSCC). The concept of the therapeutic ratio (TR) is fundamental to the understanding of this issue. The TR can be qualitatively defined as the TCP/NTCP where TCP is the tumor control probability and NTCP is the normal tissue complication probability. Both of these parameters have sigmoid dose-response curves Fig.1. The horizontal separation between these two curves for any given treatment will often determine the efficacy of that treatment. As the curves separate from one another, the likelihood increases that treatment will be effective and not cause an unacceptable level of morbidity. Conversely, the closer together these two curves are, the less the likelihood is that treatment will be effective without causing an unacceptable level of morbidity. [ABSTRACT FROM AUTHOR]
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- 2005
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13. Chemoprevention in Head and Neck Cancer.
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Markman, Maurie, Adelstein, David J., Saba, Nabil F., and Khuri, Fadlo R.
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Head and neck squamous cell carcinoma (HNSCC) is an aggressive epithelial malignancy that is the sixth most common neoplasm worldwide, with close to 5000 new cases diagnosed yearly in the United States (estimated to be 56,520 cases in 2004 [1]) and 600,000 worldwide according to the latest numbers from the International Agency for Research on Cancer, World Health Organization. HNSCC accounts for 2% of all cancer deaths in the United States (2) and is the most common epithelial neoplasm of the upper aerodigestive tract. It constitutes a major health care problem and is clearly associated with well-known risk factors such as tobacco smoking and alcohol use. The management of HNSCC is complex and the morbidity of treatment is life-long. Despite the numerous advances in its treatment, the long-term survival still does not exceed 45% and has only marginally improved over the last decades (3). [ABSTRACT FROM AUTHOR]
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- 2005
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14. Palliation of Head and Neck Cancer.
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Markman, Maurie, Adelstein, David J., and Davis, Mellar P.
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Approximately 5% of all cancers arise from the head and neck region (1,2). Patients with head and neck squamous cell cancers (HNSCC) have unique problems related both to the course of their disease and treatment. Pain from surgery and radiation is a particularly difficult problem and becomes a major problem with recurrence due to the high propensity for local erosive metastases in areas that are richly innervated (3). Pain occurs in 31% of patients at presentation but becomes a progressive problem during therapy. Seventy-four percent will experience pain near the end of treatment, and at least one out of four will have significant chronic pain 2 yr after treatment (4-6). Eating disturbances will peak near the end of treatment related to both the disease and the pain of mucositis. Most patients will lose at least 2 kg during treatment. The incidence of mucositis secondary to treatment is as high as 80%, and over half of those receiving intensive radiation combined with chemotherapy will have a grade 3-4 mucositis. Hospitalization owing to mucositis will occur in 16 to 33% of patients treated with radiation. Despite receiving analgesics and topical anesthetics, over one-third of treatment days will be spent in severe pain (7,8). [ABSTRACT FROM AUTHOR]
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- 2005
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15. Quality of Life Outcomes in Head and Neck Cancer.
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Markman, Maurie, Adelstein, David J., Sherman, Allen C., Hanna, Ehab, and Simonton, Stephanie
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Quality of life (QOL) has commanded growing attention within oncology in recent years. Adverse changes in functional and behavioral outcomes are a special concern in patients with head and neck squamous cell cancer (HNSCC), because these malignancies disrupt basic aspects of daily life such as eating, respiration, and communication. These difficulties are greatly amplified by demanding treatment toxicities. Thus, there is growing recognition that traditional clinical endpoints such as tumor response and disease-free survival need to be supplemented by indices of QOL. This development has been given further impetus lately by patient advocacy and by the introduction of improved QOL measures. In this chapter, we briefly discuss advances in QOL assessment, review research findings regarding acute and long-term QOL outcomes, and consider important determinants of risk and resilience. [ABSTRACT FROM AUTHOR]
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- 2005
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16. Gene Therapy for Patients With Head and Neck Cancer.
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Markman, Maurie, Adelstein, David J., Iskander, Andrew, and Yoo, George H.
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It is generally recognized that the unregulated growth of cancer cells results from sequential acquisition of mutations in genes that control growth and/or differentiation of cells or are involved in protection of the genome. Cancer develops when the accumulation of these alterations allows for a growth advantage over normal surrounding cells (1). The pathogenesis of cancer can be described as follows: Oncogenes are altered normal genes (called protooncogenes) that mediate normal cell growth and differentiation. Gain-of-function (dominant) mutations affect these genes to induce the neoplastic phenotype. Tumor suppressor genes are genes that normally inhibit cellular function. Loss-of-function (recessive) mutations alter their inhibitory properties, leading to unimpeded proliferation. Gene therapy aims to change these genetic alterations so that cancer cell growth can be suppressed. After a gene is transfected into a cell, mRNA is transcribed, and then its protein product is translated. [ABSTRACT FROM AUTHOR]
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- 2005
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17. Postoperative Treatment of Locally Advanced Head and Neck Cancers.
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Markman, Maurie, Adelstein, David J., Bernier, Jacques, and Bentzen, Søren M.
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With about half a million cases diagnosed yearly worldwide (1), head and neck squamous cell cancers (HNSCCs) represent 4 to 5% of all solid malignancies. The prognosis of locally advanced stages, which are found in at least 40% of oral cavity and pharynx carcinomas, remains dismal: in the United States the 5-yr relative survival rates for the period 1989-1995 hardly reached 50%. At the time of diagnosis, distant metastases are found in less than 10% of the cases and until the late 1980s, this disease feature led investigators to focus on local treatment. [ABSTRACT FROM AUTHOR]
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- 2005
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18. Targeted Therapies in Head and Neck Cancer.
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Markman, Maurie, Adelstein, David J., Seiwert, Tanguy Y., and Cohen, Ezra E. W.
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Squamous cell carcinoma of the head and neck (HNSCC) can be treated with various modalities including radiotherapy, chemotherapy, and surgery. These are often employed in combination, with each playing a substantial and complementary role. Using a multidisciplinary approach, investigators have recently been able to achieve improved survival outcomes for patients with locally advanced, nonmetastatic disease—including both increased long-term survival rates (now approaching 70% in recent reports) (1-]3) and organ preservation (4,5). Nevertheless, in approx 50% of high-risk patients tumors will recur (1-3,6), often with distant metastasis, making the cancer incurable and shifting the treatment goal toward palliation. In addition, short- and long-term toxicities of combination therapy are significant, with xerostomia, esophageal strictures, dysphagia, and increased aspiration risk commonly encountered. [ABSTRACT FROM AUTHOR]
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- 2005
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19. T3-T4 Squamous Cell Carcinoma of the Larynx Treated With Radiation Therapy Alone or Combined With Adjuvant Chemotherapy.
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Markman, Maurie, Adelstein, David J., and Mendenhall, William M.
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Depending on the site and extent of disease, treatment alternatives for T3-T4 cancers include partial laryngectomy, total laryngectomy, and radiation therapy (RT) alone or combined with adjuvant chemotherapy. The prevailing treatment philosophy varies significantly from one country to another (1). Patients in the United States and Australia are usually treated surgically, which often necessitates total laryngectomy (1). In contrast, patients in Canada and Great Britain are often treated with RT alone, with surgery reserved as salvage treatment for those who experience recurrent disease. Patients treated with RT in the United States sometimes receive induction chemotherapy before RT (2). The rationale for this strategy is based on the Veterans Affairs Laryngeal Cancer Study Group trial which compared induction chemotherapy and RT (in the subset of patients who responded to chemotherapy) with initial laryngectomy and postoperative RT; survival rates were similar, and patients randomized to the induction chemotherapy arm had a higher rate of laryngeal voice preservation (3). A similar trial conducted by the European Organization for Research and Treatment of Cancer (EORTC) evaluated induction chemotherapy followed by RT for patients who had a complete response to treatment for advanced pyriform sinus and aryepiglottic fold malignancies (4). Patients randomized to receive induction chemotherapy had 5-yr survival rates similar to those for patients randomized to undergo initial surgery. Approximately one-third of patients who received induction chemotherapy retained their larynx. More recently, concomitant chemoradiation has gained popularity because it has been shown to improve survival compared with RT alone for patients with local-regionally advanced head and neck cancer. [ABSTRACT FROM AUTHOR]
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- 2005
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20. Multimodality Management of Nasopharyngeal Carcinoma.
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Markman, Maurie, Adelstein, David J., Tan, Eng-Huat, Leong, Swan-Swan, Tan, Terence, Fong, Kam-Weng, and Wee, Joseph
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Nasopharyngeal carcinoma (NPC) of the endemic type (World Health Organization [WHO] type II and III) is considered separately from head and neck squamous cell cancer (HNSCC) because of certain distinctive features that confer a different biological behavior in terms of treatment responses and disease outcome. The most important feature that probably accounts for this difference is its strong association with the Epstein-Barr virus (EBV) (1-]3). This virus is probably the key etiological agent in the pathogenesis of this cancer, with genetic predisposition and other environmental factors as important cofactors (4-13). This is in line with the peculiar geographic distribution and racial predilection of this disease. [ABSTRACT FROM AUTHOR]
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- 2005
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21. Concurrent Chemoradiotherapy.
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Markman, Maurie and Adelstein, David J.
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Initial efforts to integrate systemic chemotherapy into the definitive management of squamous cell head and neck cancer focused on sequential treatment schedules. Given the impressive response rates seen with multiagent chemotherapy in previously untreated patients, considerable effort went into the study of induction or neoadjuvant treatment schedules (1). Numerous randomized trials have now been completed. Although induction chemotherapy has been generally well tolerated, and appears to decrease the likelihood of distant metastatic disease, no consistent survival benefit has been demonstrated from this treatment approach alone (2). [ABSTRACT FROM AUTHOR]
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- 2005
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22. The Evolution of Induction Chemotherapy in Locally Advanced Squamous Cell Cancer of the Head and Neck.
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Markman, Maurie, Adelstein, David J., Posner, Marshall R., Wirth, Lori, Tishler, Roy B., Norris, Charles M., and Haddad, Robert I.
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Squamous cell carcinoma of the head and neck (HNSCC) represents 5% of newly diagnosed cancers in adult patients seen in the United States. Although HNSCC is a highly curable malignancy when diagnosed at an early stage, many patients present with advanced local-regional disease. Locally advanced disease can be separated into either intermediate (stage III; T3N0M0 or T1-3N1M0) or advanced (stage IV; T4N0-1M0 or T1-4N2-3M0) (1). Stage III patients are generally resectable, and although their prognosis is better a stage IV patients, the prognosis for all these patients, particularly those who are unresectable has remained poor (1-8). The potential for surgical resection, whether surgery is advised or not, defines a better prognosis than the presence of unresectable disease. Thus resectability, site, stage, and performance status are the major prognostic factors for patients with HNSCC. Standard therapy with surgery and/or radiotherapy can be associated with significant morbidity and functional disability, particularly when the tumor arises in the larynx, piriform sinus, or oropharynx (9). In addition, despite aggressive local therapy with surgery or radiotherapy, between 50 and 60% will develop locoregional recurrences, and 20 to 30% will develop distant metastases within 2 yr. Only 20 to 45% will remain disease free and alive at 3 yr. [ABSTRACT FROM AUTHOR]
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- 2005
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23. Induction Chemotherapy in Head and Neck Cancer.
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Markman, Maurie, Adelstein, David J., and Rischin, Danny
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It has been known for more than 20 yr that cisplatin-based combination chemotherapy can achieve overall response rates of 70 to 90%, with complete response rates of 20 to 50% in patients with previously untreated locally advanced head and neck cancer (1,2). The use of chemotherapy prior to radiation or surgery is commonly referred to as induction or neoadjuvant chemotherapy. Investigators hypothesized that the addition of an active induction regimen prior to definitive radiotherapy or surgery would have a significant beneficial impact on the outcome of treatment for patients with locally advanced squamous cell carcinoma of the head and neck. As well as the potential to decrease distant metastases, it was hoped that significant tumor shrinkage could contribute to improved local-regional control, and facilitate organ preservation (3). Early single-arm trials confirmed the activity of platinum-based induction regimens and established that sequential induction chemotherapy and radiation was feasible, without any apparent increase in radiation toxicity (4). [ABSTRACT FROM AUTHOR]
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- 2005
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24. The Role of Tumor Hypoxia in Head and Neck Cancer Radiotherapy.
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Markman, Maurie, Adelstein, David J., Le, Quynh-Thu, Giaccia, Amato J., and Brown, J. Martin
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Tumor hypoxia, or the condition of low tumor oxygenation, has been a focus of considerable debate in radiation therapy for almost 50 yr since the pioneering work of Gray and colleagues (1) demonstrating an oxygen dependency in the radiosensitivity of cells and tissues. During this period, interest among researchers has waxed and waned as promising new directions emerged from the laboratory, only to fail in clinical trials. However, with the emergence of new concepts and the development of new tools, the prospect of targeting tumor hypoxia and identifying patients who would most benefit from this approach appears more tangible clinically. This chapter discusses the significance of tumor hypoxia in head and neck squamous cell carcinomas (HNSCC) as well as past, present, and future strategies for targeting this microenvironmental factor. [ABSTRACT FROM AUTHOR]
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- 2005
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25. Altered Fractionation.
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Markman, Maurie, Adelstein, David J., Ahamad, Anesa, Rosenthal, David I., and Ang, K. Kian
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Fractionation deserves a second look in light of the explosive growth and development of radiation therapy. With the progress we have just seen in the manipulation and delivery of cytotoxic agents in conjunction with radiotherapy, there are now new avenues to explore as the classical dose and fraction size limits may no longer apply. Technological developments in physics, computing, and imaging over the past three decades culminated at the end of the 1990s in the ability to deliver elaborate 3D high-dose volumes to precisely defined targets. The traditional dose limits that are based on the tolerated dose to surrounding normal tissues may no longer be limiting since normal tissues are now avoided to a large extent. Can dose now be safely escalated using altered fractionation? Will the reduced toxicity also permit further exploration of concurrent chemotherapy with altered fractionation? Will molecular image-guided boosts to smaller subvolumes improve tolerance of "hotter" fractionation regimes? Breakthroughs in tumor biology have opened exciting new opportunities to develop specific molecularly targeted strategies to selectively enhance tumor response to radiation. With the nonoverlapping set of toxicities of these agents, can they be safely administered concurrently with more intense radiotherapy fractionation regimes? [ABSTRACT FROM AUTHOR]
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- 2005
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26. Intensity-Modulated Radiation Therapy in the Management of Head and Neck Cancer.
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Markman, Maurie, Adelstein, David J., Hong, Theodore S., Tomé, Wolfgang A., and Harari, Paul M.
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Head and neck cancer represents a complex collection of tumors involving mucosal surfaces of the upper aerodigestive tract. Approximately 43,000 cases are diagnosed each year in the United States, representing 3 to 4% of all cancers (1). Worldwide, head and neck cancer represents a much broader oncology problem (∼500,000 annual cases), with tumor development strongly associated with chronic tobacco and alcohol use. [ABSTRACT FROM AUTHOR]
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- 2005
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27. Role of Brachytherapy in Treatment of Head and Neck Malignancy.
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Markman, Maurie, Adelstein, David J., Shankar, Ravi A., Hu, Kenneth S., and Harrison, Louis B.
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Brachytherapy is an important armament available to the radiation oncologist treating cancers occurring in the head and neck region. It is all the more important in this era of organ preservation and improving quality of life (1,2). There are very few sites in the body where locoregional control is so vital to ultimate quality of life, organ function, and survival as in head and neck cancer. Brachytherapy permits dose intensification specifically to the tumor site while minimizing damage to the surrounding normal tissue and organs (3,4). This leads to an increased therapeutic ratio, while the patient also stands to gain functionally, psychologically, and cosmetically. [ABSTRACT FROM AUTHOR]
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- 2005
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28. Salvage Surgery After Chemoradiation Therapy.
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Markman, Maurie, Adelstein, David J., Lee, Walter T., and Esclamado, Ramon M.
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The past two decades have seen significant advances in the efficacy of combined chemotherapy and radiation in the management of advanced stage squamous cell carcinoma (SCC) of the head and neck. This is especially true for SCC of the oropharynx, hypopharynx, and larynx. Primary surgery for advanced T-stage tumors, despite sophisticated reconstruction of the surgical defect, may result in a significant impact on speech, swallowing, and respiration. Organ preservation protocols using definitive radiation with or without chemotherapy may provide an effective primary treatment while avoiding the functional and cosmetic morbidity associated with surgery. [ABSTRACT FROM AUTHOR]
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- 2005
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29. Laryngeal Preservation Surgery.
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Markman, Maurie, Adelstein, David J., Scharpf, Joseph, and Lorenz, Robert R.
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Patients afflicted with selected laryngeal and hypopharyngeal cancers have garnered benefit from laryngeal preservation procedures for more than a century. Billroth performed the first hemilaryngectomy for malignancy in 1874 (1). Over the ensuing decades numerous procedures evolved to afford patients the maintenance of speech and swallowing without permanent tracheostomy. In 1947, Alonso (2,3) first described the open supraglottic laryngectomy to spare the true vocal cords and arytenoids by resecting the upper portion of the thyroid cartilage with the supraglottic structures. The procedure was popularized in Europe by Bocca and in the United States by Ogura, Som, and Kirchner (4). The boundaries of resection were pushed further by Majer and Reider (5) in 1959 with the introduction of the supracricoid partial laryngectomy, which provided an alternative to total laryngectomy for patients with selected glottic and supraglottic cancers. Critical review has provided refinements in these procedures. Specific indications have been established based on an improved understanding of surgical anatomy and patterns of tumor spread that have allowed for selected ablation of laryngeal components without the need for total laryngectomy and its associated morbidity. [ABSTRACT FROM AUTHOR]
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- 2005
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30. The Evolving Role of Neck Dissection in the Era of Organ Preservation Therapy for Head and Neck Squamous Cell Carcinoma.
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Markman, Maurie, Adelstein, David J., Trang, Tung T., and Lavertu, Pierre
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Chemotherapy in combination with radiation therapy has evolved over the last several decades as an important modality in the treatment of head and neck squamous cell carcinoma. Because of the effectiveness of chemoradiation therapy at controlling disease at the primary site, ablative surgery is generally reserved for surgical salvage if chemoradiation fails to control primary site disease. However, the role of surgery in the treatment of regional neck metastases remains controversial. At the core of this controversy is whether chemoradiation alone is adequate to control neck metastases or whether adjunctive neck dissection should be added for effective control. [ABSTRACT FROM AUTHOR]
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- 2005
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31. Laser Surgery for Head and Neck Cancer.
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Markman, Maurie, Adelstein, David J., Akst, Lee M., and Strome, Marshall
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Lasers have broad applications in otolaryngology. The myriad possible uses result from the combination of many different anatomic subsites, different types of pathology (both benign and malignant), and several different types of available lasers. A comparison of the KTP laser for hemorrhagic hereditary telangectasias of the nasal cavity, for instance, with photodynamic therapy for esophageal lesions reveals the wide range of applications for laser technology in the head and neck region. It is difficult, however, to make generalizations about laser use when one considers such disparate functions, sites, and pathology. This chapter, then, is limited to a discussion of lasers in the management of squamous cell carcinoma of the oral cavity, oropharynx, hypopharynx, and larynx. [ABSTRACT FROM AUTHOR]
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- 2005
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32. Head and Neck Squamous Cell Cancers in the Nonsmoker-Nondrinker.
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Markman, Maurie, Adelstein, David J., D'Souza, Gypsyamber, and Gillison, Maura L.
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The vast majority of patients with head and neck squamous cell carcinoma (HNSCC) report a history of tobacco and alcohol use. The risk of oral cancer increases as a function of both intensity and duration of each exposure, indicating that alcohol and tobacco act synergistically to promote cancer development (1-3). [ABSTRACT FROM AUTHOR]
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- 2005
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33. Oncologic and Functional Outcomes of Surgical and Nonsurgical Treatment of Advanced Squamous Cell Carcinoma of the Supraglottic Larynx
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Elegbede, Adekunle I., Rybicki, Lisa A., Adelstein, David J., Kaltenbach, James A., Lorenz, Robert R., Scharpf, Joseph, and Burkey, Brian B.
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IMPORTANCE: Nonsurgical treatment of advanced supraglottic laryngeal cancer is widely used as part of a larynx preservation protocol. However, recent studies have suggested that nonsurgical treatment may be associated with inferior survival. Furthermore, it is not clear whether preservation of the larynx provides superior voice or swallowing function in the long term. OBJECTIVE: To test the hypothesis that surgical treatment of advanced-stage squamous cell carcinoma of the supraglottic larynx is associated with superior overall survival (OS), freedom from recurrence (FFR), and noninferior voice and swallowing function. DESIGN, SETTING, AND PARTICIPANTS: Retrospective medical record review of patients treated for stage III or IV squamous cell carcinoma of the supraglottic larynx between January 1990 and June 2013 at a tertiary referral center: 97 patients underwent surgical treatment and 138, nonsurgical treatment. Exclusion criteria included prior definitive treatment for laryngeal cancer or evidence of distant metastatic disease at presentation. The median follow-up for all 235 patients was 63 months. INTERVENTIONS: Surgical or nonsurgical therapy. MAIN OUTCOMES AND MEASURES: Freedom from recurrence (FFR), OS, larynx preservation, voice graded from 1 to 5, and swallowing graded from 1 to 6 using our voice and swallowing function scales. RESULTS: Surgical treatment was associated with superior FFR (5-year FFR: 75% vs 55%; P = .006) but not OS (5-year OS: 52% vs 52%; P = .61). The larynx was preserved in 83% of patients in the nonsurgical group vs 42% of patients in the surgical group (P < .001). Voice function was superior in the nonsurgical group at all time points through 5 years after treatment (mean voice score, 3.8 vs 2.6; P < .001). Swallowing function was comparable between surgical and nonsurgical groups. Multivariable analysis revealed that advanced age (hazard ratio [HR], 1.43 per 10-year increment; 95% CI, 1.19-1.72) and clinical N stage (HR, 1.17 per 1-level increment; 95% CI, 1.05-1.30) were associated with worse OS, while treatment with chemotherapy was associated with superior OS (HR, 0.61; 95% CI, 0.41-0.92). CONCLUSIONS AND RELEVANCE: Compared with surgical treatment, nonsurgical treatment as part of a larynx preservation protocol is associated with a higher likelihood of recurrence but has similar OS and should continue to be viewed as a viable alternative for the treatment of advanced supraglottic laryngeal cancer.
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- 2015
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34. Effect of Human Papillomavirus on Patterns of Distant Metastatic Failure in Oropharyngeal Squamous Cell Carcinoma Treated With Chemoradiotherapy
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Trosman, Samuel J., Koyfman, Shlomo A., Ward, Matthew C., Al-Khudari, Samer, Nwizu, Tobenna, Greskovich, John F., Lamarre, Eric D., Scharpf, Joseph, Khan, Mumtaz J., Lorenz, Robert R., Adelstein, David J., and Burkey, Brian B.
- Abstract
IMPORTANCE: Important differences exist in the pattern and timing of distant metastases between human papillomavirus–initiated (HPV+) and HPV− oropharyngeal squamous cell carcinoma (OPSCC). However, our understanding of the natural history of distant metastases in HPV+ OPSCC and its implications for surveillance is limited. OBJECTIVE: To investigate the rate, pattern, and timing of distant metastases in advanced-stage OPSCC treated definitively with concomitant chemoradiotherapy. DESIGN, SETTING, AND PARTICIPANTS: In a retrospective review, we identified 291 patients with pathologically diagnosed stages III to IVB OPSCC and known HPV status from a tumor registry at the Cleveland Clinic. Patients were treated from January 1, 1996, through December 31, 2013. Details of treatment failure and the natural history of the disease were retrieved from the electronic medical records. INTERVENTIONS: All patients were treated with definitive concomitant chemoradiotherapy. MAIN OUTCOMES AND MEASURES: The primary outcome was the rate and timing of distant metastases. Secondary outcomes included the pattern of distant failure and survival after distant metastases. RESULTS: Thirty-seven patients developed distant metastatic disease after definitive treatment, including 28 of 252 patients with HPV+ disease and 9 of 39 patients with HPV− disease. The 3-year projected distant control rate was higher in the HPV+ group (88% vs 74%; P = .01). The median time to develop distant metastases was also longer after the completion of treatment for HPV+ disease compared with HPV− disease (16.4 vs 7.2 months; P = .008). We detected a trend in patients with HPV+ disease for more distant metastatic sites involved than in those with HPV− disease (2.04 vs 1.33 sites; P = .09). Although the lung was the most common distant site involved in HPV+ and HPV− disease (HPV+ group, 23 of 28 patients [82%]; HPV− group, 7 of 9 patients [78%]), the HPV+ group had metastases to several subsets atypical for head and neck squamous cell carcinoma, including the brain, kidney, skin, skeletal muscle, and axillary lymph nodes in 2 patients each and in the intra-abdominal lymph nodes in 3 patients. The rate of 3-year overall survival was higher in the HPV+ group (89.9% vs 62.0%; P < .001), as was the median survival after the occurrence of distant metastases regardless of additional treatment (25.6 vs 11.1 months; P < .001). CONCLUSIONS AND RELEVANCE: This retrospective review suggests that distant metastases in patients with HPV+ OPSCC occurs significantly later after completion of chemoradiotherapy than in patients with HPV− disease. Human papillomavirus–initiated OPSCC also appears to involve a greater number of subsites and metastatic sites infrequently seen in head and neck squamous cell carcinoma. Distant metastatic disease in HPV+ OPSCC has unique characteristics and a natural history that may require alternative surveillance strategies.
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- 2015
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35. Biology and Management of Salivary Gland Cancers.
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Adelstein, David J., Koyfman, Shlomo A., El-Naggar, Adel K., and Hanna, Ehab Y.
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The salivary gland cancers are uncommon neoplasms of the head and neck, which exhibit considerable pathologic, biological, and clinical diversity. Surgical resection, often with postoperative radiation, is the standard therapeutic approach, and the results after treatment vary widely depending on the tumor histology. Chemotherapy has been of only limited palliative benefit in patients with advanced disease, and there has been little exploration of its use in definitive management. Recent investigation has focused on identification of the characteristic molecular signatures and genomic alterations of the specific histologic subtypes. These efforts have suggested the potential for molecularly targeted therapies, and clinical trials exploring this approach are currently underway. [Copyright &y& Elsevier]
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- 2012
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36. Role of positron emission tomography in management of sinonasal neoplasms--a single institution's experience.
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Lamarre ED, Batra PS, Lorenz RR, Citardi MJ, Adelstein DJ, Srinivas SM, Scharpf J, Lamarre, Eric D, Batra, Pete S, Lorenz, Robert R, Citardi, Martin J, Adelstein, David J, Srinivas, Shyam M, and Scharpf, Joseph
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Objective: The objective of the study is to examine the utility of positron emission tomography (PET) for staging and restaging after treatment of paranasal sinus carcinomas.Study Design: Retrospective data review was done.Subjects and Methods: Patients selected underwent PET for sinonasal neoplasms from 2003 to 2008 at a tertiary care referral center.Results: Seventy-seven scans were reviewed from 31 patients. The pathologies included olfactory neuroblastoma (n = 9), squamous cell carcinoma (n = 6), sinonasal undifferentiated carcinoma (n = 6), sinonasal melanoma (n = 6), and minor salivary gland carcinomas (n = 4). The positive predictive value of studies performed for restaging at the primary, neck, and distant sites were 56%, 54%, and 63%; negative predictive values were 93%, 100%, and 98%, respectively. During restaging, 32% of patients were accurately upstaged secondary to neck or distant site involvement.Conclusion: Positron emission tomography serves as a useful adjunct to conventional imaging in the management of sinonasal malignancies. Negative studies are effective in predicting absence of disease as seen in the consistently high-negative predictive values. Positive studies need to be viewed cautiously given the high rate of false-positive studies. When viewed in conjunction with clinical examination, endoscopic assessment, and focused biopsies, they may effectively result in a more accurate assessment of the extent of disease. [ABSTRACT FROM AUTHOR]- Published
- 2012
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37. Role of positron emission tomography in management of sinonasal neoplasms—a single institution's experience.
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Lamarre, Eric D., Batra, Pete S., Lorenz, Robert R., Citardi, Martin J., Adelstein, David J., Srinivas, Shyam M., and Scharpf, Joseph
- Abstract
Abstract: Objective: The objective of the study is to examine the utility of positron emission tomography (PET) for staging and restaging after treatment of paranasal sinus carcinomas. Study design: Retrospective data review was done. Subjects and methods: Patients selected underwent PET for sinonasal neoplasms from 2003 to 2008 at a tertiary care referral center. Results: Seventy-seven scans were reviewed from 31 patients. The pathologies included olfactory neuroblastoma (n = 9), squamous cell carcinoma (n = 6), sinonasal undifferentiated carcinoma (n = 6), sinonasal melanoma (n = 6), and minor salivary gland carcinomas (n = 4). The positive predictive value of studies performed for restaging at the primary, neck, and distant sites were 56%, 54%, and 63%; negative predictive values were 93%, 100%, and 98%, respectively. During restaging, 32% of patients were accurately upstaged secondary to neck or distant site involvement. Conclusion: Positron emission tomography serves as a useful adjunct to conventional imaging in the management of sinonasal malignancies. Negative studies are effective in predicting absence of disease as seen in the consistently high-negative predictive values. Positive studies need to be viewed cautiously given the high rate of false-positive studies. When viewed in conjunction with clinical examination, endoscopic assessment, and focused biopsies, they may effectively result in a more accurate assessment of the extent of disease. [Copyright &y& Elsevier]
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- 2012
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38. Intended single-modality management of T1 and T2 tonsillar carcinomas: retrospective comparison of radical tonsillectomy vs radiation from a single institution.
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Lamarre, Eric D., Seth, Rahul, Lorenz, Robert R., Esclamado, Ramon, Adelstein, David J., Rodriguez, Cristina P., Saxton, Jerrold, and Scharpf, Joseph
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Abstract: Background: T1 and T2 tonsillar squamous cell cancer with limited neck disease can be managed with single-modality radiation or surgery. Over 11 years, 17 patients underwent radical tonsillectomies; and 33 patients underwent radiation-based treatments for T1 and T2 and N0 to N2a tonsil cancer. Patients were intended to receive single-modality treatment based on presentation; however, some ultimately received adjuvant treatments. Methods: A retrospective chart review to compare overall survival (OS), disease-specific survival (DSS), and locoregional control (LRC) between the groups was used. Results: In surgical group, of 17 patients, 11 underwent surgery alone, 3 underwent surgery and radiation, and 3 underwent surgery with concurrent chemoradiation. Five-year OS for the surgical and radiation groups was 93% and 72%, respectively (no significance achieved). Five-year DSS rates (93% and 80%) and LRC (69% and 89%) similarly did not yield any significant difference. Conclusion: Surgery remains a viable option in the management of T1 and T2 tonsillar cancers with comparable LRC, OS, and DSS. [Copyright &y& Elsevier]
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- 2012
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39. T2N0M0 esophageal cancer.
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Rice, Thomas W., Mason, David P., Murthy, Sudish C., Zuccaro, Gregory, Adelstein, David J., Rybicki, Lisa A., and Blackstone, Eugene H.
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ESOPHAGEAL cancer ,CANCER treatment ,CANCER patients ,THERAPEUTICS - Abstract
Objective: The study objective was to develop a treatment algorithm for cT2N0M0 esophageal cancer by determining (1) errors in clinical staging and (2) consequences of overtreatment and undertreatment of incorrectly clinically staged patients. Methods: Of 742 clinically staged patients, 61 (8.2%) had cT2N0M0 cancer; 45 underwent surgery alone; 8 underwent surgery and postoperative adjuvant therapy; and 8 underwent induction therapy, then surgery. As reference, 31 of 666 patients (4.7%) who underwent surgery first had pT2N0M0 cancer and a 5-year survival of 61% ± 9.3%. Referent values were calculated from 445 clinically staged patients who underwent surgery first. Unmatched and matched survival comparisons were made using the log-rank test. Results: Only 7 of 53 cT2N0M0 cancers treated with surgery first were pT2N0M0 (13% positive predictive value). Of incorrectly staged cT2N0M0 cancers (46/53), 29 (63%) were overstaged and 17 (37%) were understaged. Most overstaged cancers were pT1 (11 [38%] T1a and 15 [52%] T1b), and most understaged cancers were pN1 (13 [76%]). Matched overstaged patients treated by surgery alone (25/28) had a 5-year survival similar to that of patients with pTNM (69% ± 9.8% vs 63% ± 13%, P =.8). Understaged patients did better at 5 years than patients with pTNM if they had postoperative adjuvant therapy, not surgery alone (43% ± 22% vs 10% ± 9.5%, P = .17). Induction therapy decreased 5-year survival compared with all other treatment strategies (13% ± 12% vs 52% ± 7.4%, P =.05). Conclusions: Patients with cT2N0M0 cancers should undergo surgery first with lymphadenectomy. Clinically understaged patients should receive postoperative adjuvant therapy. In the unlikely event that patients with cT2N0M0 cancers are found to have an uncommon pT2N0M0 cancer, they will have acceptable survival with surgery alone. [Copyright &y& Elsevier]
- Published
- 2007
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40. Brain Metastases From Esophageal Cancer: A Phenomenon of Adjuvant Therapy?
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Rice, Thomas W., Khuntia, Deepak, Rybicki, Lisa A., Adelstein, David J., Vogelbaum, Michael A., Mason, David P., Murthy, Sudish C., and Blackstone, Eugene H.
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METASTASIS ,CANCER risk factors ,ESOPHAGEAL surgery ,ESOPHAGEAL cancer - Abstract
Background: Brain metastases from esophageal cancers are uncommon, yet our impression was that they occurred more frequently than expected after esophagectomy plus adjuvant therapy. Therefore, we determined (1) incidence and prevalence of, risk factors for, and survival after development of brain metastases following esophagectomy for esophageal cancer, and (2) their association with adjuvant therapy. Methods: From 1985 to 2002, 403 patients (52%) underwent esophagectomy alone and 369 esophagectomy plus adjuvant therapy (118 [15%] preoperative only, 124 [16%] postoperative only, and 127 [16%] both). Hazard-function methodology was used to characterize time-related occurrence of brain metastases and risk factors. Inferences were confirmed by propensity analysis. Results: Twenty-nine patients developed brain metastases, 20 within 1 year; 6 had undergone surgery alone, and 23 had adjuvant therapy. Prevalence was 2.5% 5 years after surgery alone, but 8.4%, 7.0%, and 18.4% after preoperative adjuvant therapy only, postoperative adjuvant therapy only, and both, respectively (p < 0.0001). Greater number of locoregional lymph node metastases was associated with brain metastases after surgery alone (p = 0.04). Distant metastases (p = 0.03) and both preoperative and postoperative adjuvant therapy (p = 0.004) were risk factors. Median survival after diagnosis of brain metastases was 3.5 months. Postesophagectomy propensity-matched survival was shorter after adjuvant therapy than after surgery alone; thus, time available for developing brain metastases after surgery alone was slightly lower. Conclusions: A dose-related increased incidence of brain metastases after adjuvant therapy for esophageal cancer cannot be explained by increased longevity. Adjuvant therapy itself, not just advanced disease, appears to create conditions conducive to developing these rapidly fatal metastases. [Copyright &y& Elsevier]
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- 2006
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41. What is new in the management of salivary gland cancers
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Adelstein, David J and Rodriguez, Cristina P
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Salivary gland malignancies are a rare and heterogeneous group of tumors with considerable variability in their natural history. Historically they have been treated with surgery and radiation therapy. It is only recently that there has been any growth in our understanding of these diseases and their management, and this progress will be reviewed.
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- 2011
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42. Does vocal cord fixation preclude nonsurgical management of laryngeal cancer?
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Solares, C. Arturo, Wood, Benjamin, Rodriguez, Cristina P., Lorenz, Robert R., Scharpf, Joseph, Saxton, Jerrold, Rybicki, Lisa A., Strome, Marshall, Esclamado, Ramon, Lavertu, Pierre, and Adelstein, David J.
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- 2009
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43. Current and Emerging Standards of Concomitant Chemoradiotherapy
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Adelstein, David J. and Rodriguez, Cristina P.
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Several different approaches have been tested in an effort to integrate chemotherapy into definitive non-operative management of squamous cell head and neck cancer. In phase III randomized trials and in meta-analyses, the concomitant use of chemotherapy and radiation has proven to be the most consistently successful, and to produce both locoregional control and survival benefits, when compared to radiation therapy alone. Large, multi-institutional and cooperative group studies have now established high-dose single-agent cisplatin and concurrent radiation therapy as the standard of care for patients with advanced nasopharynx cancer, for patients with unresectable head and neck tumors, and as a postoperative adjuvant for patients with high-risk pathologic features. This same treatment regimen also has been demonstrated to be the most effective multi-modality treatment strategy for larynx preservation. Future investigation will focus on optimizing the concomitant chemotherapy and radiotherapy schedules used, integrating targeted agents into these established treatment schedules, addressing the problem of distant metastases, minimizing both acute and late toxicities, and identifying the most appropriate patient populations for this kind of aggressive treatment.
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- 2008
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44. Ability of Positron Emission Tomography to Detect Residual Neck Node Disease in Patients With Head and Neck Squamous Cell Carcinoma After Definitive Chemoradiotherapy
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Tan, Ann, Adelstein, David J., Rybicki, Lisa A., Saxton, Jerrold P., Esclamado, Ramon M., Wood, Benjamin G., Lorenz, Robert R., Strome, Marshall, and Carroll, Marjorie A.
- Abstract
OBJECTIVE To report our experience using the neck examination, computed tomography (CT), and positron emission tomography (PET) to clinically evaluate node-positive patients with head and neck squamous cell cancer for residual neck node disease after definitive chemoradiotherapy. DESIGN Retrospective review of all Cleveland Clinic patients with head and neck squamous cell cancer and N2 or N3 neck node involvement at presentation who were treated with definitive concurrent chemoradiotherapy and who underwent clinical restaging after treatment using the neck examination, CT, and PET. SETTING Tertiary care referral institution. PATIENTS Forty-eight patients with 72 positive necks at diagnosis were followed up for a median of 20 months. MAIN OUTCOME MEASURES Palpable nodes on examination, nodes larger than 1 cm, nodes with central necrosis on CT, or any hypermetabolic lymph nodes on PET were considered clinical evidence of residual nodal disease. The true rate of pathologic involvement was determined by histologic examination after planned neck dissection or if regional recurrence developed. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated for all 3 clinical assessment tools. RESULTS Planned neck dissection was performed in 33 necks and was positive for residual neck node disease in 5 necks. A delayed neck dissection was performed in 5 necks and was positive in 3 necks. The positive predictive value was low for all 3 clinical assessment tools. The addition of PET did not significantly improve the negative predictive value or positive predictive value of CT and the clinical examination. CONCLUSIONS Residual neck node disease after definitive chemoradiotherapy was infrequent and was not well predicted by PET. A positive PET finding in this setting is of little utility. Although a negative PET finding was highly predictive for control of neck disease after chemoradiotherapy, it added little to the clinical neck examination and CT.Arch Otolaryngol Head Neck Surg. 2007;133:435-440 --
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- 2007
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45. Impact of Induction Concurrent Chemoradiotherapy on Pulmonary Function and Postoperative Acute Respiratory Complications in Esophageal Cancer
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Abou-Jawde, Rony M., Mekhail, Tarek, Adelstein, David J., Rybicki, Lisa A., Mazzone, Peter J., Caroll, Marjorie A., and Rice, Thomas W.
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To evaluate the effects of induction concurrent chemoradiotherapy (cCRT) on pulmonary function and postoperative acute respiratory complications (PARCs).
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- 2005
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46. Systemic chemotherapy for squamous cell head and neck cancer
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Adelstein, David J
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Squamous cell head and neck cancer is a relatively uncommon malignancy in North America. Nonetheless, it has been of considerable interest to medical oncologists because of its remarkable sensitivity to systemic chemotherapy. Even in patients with relapsed or metastatic disease, meaningful tumour shrinkage can be achieved with systemic therapy. This has led to the performance of carefully conducted clinical trials exploring the role of systemic chemotherapy, not only in the palliative setting, but as part of definitive multi-modality treatment. Chemotherapy has been used as the initial (or induction) treatment, as an adjuvant treatment after definitive surgery and/or radiation, and concurrent with both definitive and adjuvant radiation therapy. Evidence-based conclusions have been drawn from these clinical trials and have led to significant changes in the current standards of care for this disease. In this article, the available data supporting the use of systemic chemotherapy as palliative treatment, and as part of the definitive management for this disease will be reviewed.
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- 2003
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47. Who merits a neck dissection after definitive chemoradiotherapy for N2–N3 squamous cell head and neck cancer?
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McHam, Scott A., Adelstein, David J., Rybicki, Lisa A., Lavertu, Pierre, Esclamado, Ramon M., Wood, Benjamin G., Strome, Marshall, and Carroll, Marjorie A.
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- 2003
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48. Who merits a neck dissection after definitive chemoradiotherapy for N2N3 squamous cell head and neck cancer?
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McHam, Scott A., Adelstein, David J., Rybicki, Lisa A., Lavertu, Pierre, Esclamado, Ramon M., Wood, Benjamin G., Strome, Marshall, and Carroll, Marjorie A.
- Abstract
The role of neck dissection (ND) after definitive chemoradiotherapy for squamous cell head and neck cancer is incompletely defined. We retrospectively reviewed 109 patients with N2N3 disease treated with chemoradiotherapy to identify predictors of a clinical complete response in the neck (CCR-neck), pathologic complete response after ND (PCR-neck), and regional failure. All patients were given 4-day continuous infusions of 5-fluorouracil (1000 mg/m2/d) and cisplatin (20 mg/m2/d) during the first and fourth weeks of either once daily (n = 68) or twice daily (n = 41) radiation therapy. ND was considered for all patients after completion of chemoradiotherapy and was performed in 32 of the 65 patients achieving a CCR-neck after chemoradiotherapy and in all 44 patients with residual clinical evidence of neck disease. CCR-neck, PCR-neck, and regional failure were then correlated with potential predictors, including T, N, largest lymph node size (<3 cm, ≥3 cm), primary tumor site, and radiation fractionation schedule. Achievement of a CCR-neck was predicted by N, N2 vs N3 (53 of 80 vs 12 of 29, p = .019) and by largest lymph node size, <3 cm vs ≥3 cm (19 of 25 vs 46 of 84, p = .06). Achievement of a PCR-neck could not be predicted by any clinical parameter. Regional failure occurred both in patients undergoing ND and those not dissected (5 of 76 vs 4 of 33, p = .33) and proved more likely only in the ND patients with residual positive pathology compared with those achieving a PCR-neck (5 of 25 vs 0 of 51, p < .001). Primary site was not a useful predictor of CCR-neck, PCR-neck, or regional failure. Most importantly, CCR-neck (vs <CCR-neck) did not predict either a PCR-neck (24 of 32 vs 27 of 44, p = .21) or regional failure (5 of 65 vs 4 of 44, p = .80). After chemoradiotherapy, clinical parameters do not identify those patients with residual neck node disease or those at risk for regional failure, suggesting that ND be considered for all N2N3 patients. © 2003 Wiley Periodicals, Inc. Head and Neck 25: 791798, 2003
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- 2003
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49. Factors Associated with Improved Survival in Patients with Brain Metastases from Esophageal Cancer: A Retrospective Review
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Khuntia, Deepak, Sajja, Ratna, Chidel, Mark A., Lee, Shih-Yuan, Rice, Thomas W., Adelstein, David J., Carlson, Thomas P., Saxton, Jerrold P., Barnett, Gene H., and Suh, John H.
- Abstract
There are over 200,000 cases of brain metastases (BrM) every year, but very few are from esophageal cancer primaries. In order to determine predictors for outcome of these patients, the authors conducted a retrospective review of twenty-seven patients with BrM from esophageal carcinoma diagnosed at the Cleveland Clinic Foundation between 1991 and 2001. For the entire cohort, median follow-up and median survival was 3.6 months and 3.6 months, respectively. On univariate analysis, patients with Karnofsky Performance Status (KPS) ≥ 70, low recursive partitioning analysis score, single BrM, no systemic disease, and aggressive treatment [surgery, stereotactic radiosurgery (SRS) + whole brain radiation (WBRT), SRS + surgery + WBRT, surgery + WBRT)] had a significantly improved survival. In a multivariate model, patients with higher KPS and aggressive treatment had improved survival. The 1-year survival for the WBRT alone group and the aggressive treatment group was 6%, and 36% respectively. We conclude that based on the data presented here, patients with BrM from esophageal cancer have poor outcome. Aggressive treatment and favorable KPS are associated with longer survival for selected patients. We recommend esophageal cancer patients with BrM be enrolled in clinical trials to better delineate the role of treatment and potentially improve results.
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- 2003
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50. Refining esophageal cancer staging
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Rice, Thomas W., Blackstone, Eugene H., Rybicki, Lisa A., Adelstein, David J., Murthy, Sudish C., DeCamp, Malcolm M., and Goldblum, John R.
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Objective:Cancer staging is dynamic, reflecting accrual of knowledge and experience in treatment. The objectives of this study were to assess current esophageal cancer staging and to determine whether refinements of classification and stage grouping are necessary. Methods:From 1983 through November 2000, 480 patients underwent esophagectomy without induction therapy. Depth of tumor invasion (T), regional lymph node status (N), distant status (M), number of metastatic regional lymph nodes, and histopathologic type and grade were subjected to survival-tree analysis, multivariable Cox and hazard function analysis, and residual misclassification risk analysis. Results:Inhomogenity of survival was found within and lack of distinction was found between current American Joint Committee on Cancer staging groups, supporting the need for refinement. T1 and N1 were redefined on the basis of survival differences. T1a is intramucosal cancer, T1b is submucosal cancer (P= .008), N1 is 1 or 2 metastatic regional lymph nodes, and N2 is 3 or more metastatic regional lymph nodes (P= .01). Current subclassification of M1 is not warranted (P= .9). Histopathologic type (P= .17) and grade (P= .3) minimally refined staging. Reassignment of staging groups constrained by American Joint Committee on Cancer definitions of stages 0 and IV produced less monotonic, distinctive, and homogeneous survival than free assignment of staging groups. Conclusions:Current American Joint Committee on Cancer staging of esophageal cancer is inadequate. Refinement requires redefinition of T1, N1, and M1 classifications. Stage grouping within the constraints of American Joint Committee on Cancer definitions produces less accurate prognosis than free assignment based on survival data.
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- 2003
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