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A letter to the editor is presented in response to the article "Treatment of Advanced Squamous-Cell Carcinoma of the Head and Neck with Alternating Chemotherapy and Radiotherapy," in the October 15, 1992 issue.

Purpose: To review radiation fractionation and chemotherapy trials for patients undergoing organ preservation therapy for locally advanced head and neck squamous cell carcinoma., Methods and Materials: Radiation therapy fractionation and chemotherapy trial results as well as historical evidence are systematically reviewed., Results: Trial results, which involve nearly 30,000 patients, have been interpreted, compared, and presented in a structured manner to demonstrate the changing approaches in treatment over the years from the 1960s to the present. The review includes data from the split-course radiation therapy era, meta-analyses of chemotherapy and radiation therapy fractionation trials, cetuximab trials, "triple-drug trials," and modern trials of induction chemotherapy followed by concomitant chemotherapy and radiation therapy., Conclusions: This summary will be useful to clinicians making treatment decisions today and to investigators designing trials in the future., (Copyright © 2015 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.)

In addition to nutrients, poultry are fed trace elements (e.g., As) for therapeutic purposes. Although a large proportion of the nutrients are assimilated by the birds, nearly all of the As is excreted. Hence, turkey litter constituents can leach into the soil and contaminate shallow ground water when it is stockpiled uncovered on bare soil. This study quantified the leaching of turkey litter constituents from uncovered stockpiles into the underlying soil. Four stockpiles were placed on Orangeburg loamy sand in summer 2004 for 162 d; 14 d after their removal, four stockpiles were created over the same footprints and left over winter for 162 d. Soil samples at depths of 7.6 to 30.5 cm and 30.5 to 61 cm adjacent to and beneath the stockpiles were compared for pH, electrical conductivity, total C, dissolved organic C, N species, P, water-extractable (WE)-P, As, WE-As, Cu, Mn, and Zn. All WE constituents affected the 7.6- to 30.5-cm layer, and some leached deeper; for example, NH(4)(+)-N concentrations were 184 and 62 times higher in the shallow and deep layers, respectively. During winter stockpiling, WE-As concentrations beneath the stockpiles tripled and doubled in the 7.6- to 30.5-cm and 30.5- to 61-cm layers, respectively, with WE-As being primarily as As(V). Heavy dissolved organic C and WE-P leaching likely increased solubilization of soil As, although WE-As concentrations were low due to the Al-rich soil and low-As litter. When used as drinking water, shallow ground water should be monitored on farms with a history of litter stockpiling on bare soil; high litter As; and high soil As, Fe, and Mn concentrations.

Background: The treatment of patients with squamous cell carcinoma (SCC) of the oropharynx remains controversial. No randomized trial has addressed adequately the question of whether surgery (S), radiation therapy (RT), or combined treatment is most effective., Methods: Treatment results from North American academic institutions that used S with or without adjuvant RT (S +/- RT) or used RT alone or followed by neck dissection (RT +/- ND) for patients with SCC of the tonsillar region or the base of tongue were compiled through a MEDLINE search (from 1970 to August, 2000) and from the references cited in each report. Studies were eligible for inclusion if they contained direct, actuarial (life-table), or Kaplan-Meier calculations for the following end points: local control, local-regional control, 5-year absolute survival, 5-year cause specific survival, or severe or fatal treatment complications. Weighted average results, which took into account series size, were calculated for each end point for the purposes of treatment comparison. Results and conclusions were based on data from 51 reported series, representing the treatment of approximately 6400 patients from the United States and Canada., Results: The results for patients with SCC of the base of tongue who underwent S +/- RT versus RT +/- ND, respectively, were as follows: local control, 79% versus 76% (P = 0.087); local-regional control, 60% versus 69% (P = 0.009); 5-year survival, 49% versus 52% (P = 0.2); 5-year cause specific survival, 62% versus 63% (P = 0.4); severe complications, 32% versus 3.8% (P < 0.001); and fatal complications, 3.5% versus 0.4% (P < 0.001). The results for patients with SCC in the tonsillar region who underwent S +/- RT versus RT +/- ND, respectively, were as follows: local control, 70% versus 68% (P = 0.2); local-regional control, 65% versus 69% (P = 0.1); 5-year survival, 47% versus 43% (P = 0.2); 5-year cause specific survival, 57% versus 59% (P = 0.3); severe complications, 23% versus 6% (P < 0.001); and fatal complications, 3.2% versus 0.8% (P < 0.001)., Conclusions: The information in this article provides a useful benchmark for evidence-based counseling of patients with SCC of the oropharynx. The rates of local control, local-regional control, 5-year survival, and 5-year cause specific survival were similar for patients who underwent S +/- RT or RT +/- ND, whereas the rates of severe or fatal complications were significantly greater for the S +/- RT group. Furthermore, available data on the functional consequences of treatment suggest the superiority of RT +/- ND. The authors conclude that RT +/- ND is preferable for the majority of patients with SCC of the oropharynx., (Copyright 2002 American Cancer Society.)