Bio

Clinical Focus


  • Cancer > Head and Neck Cancer
  • Otolaryngology
  • Head and Neck Tumor Surgery
  • Nasopharyngeal Cancer

Honors & Awards


  • Member, UGC Hong Kong Task Force on Vet School (2012-present)
  • Member, University Grants Committee, Hong Kong (2007-2012)

Professional Education


  • Board Certification: Otolaryngology, American Board of Otolaryngology (1974)
  • Residency:UCLA Medical Center (1974) CA
  • Residency:Wadsworth General Hospital - VA (1971) CA
  • Internship:Harbor-UCLA Medical Center (1970) CA
  • Medical Education:University of Colorado School of Medicine (1969) CO

Community and International Work


  • University Grants Committee, Hong Kong, China

    Topic

    Hong Kong Government Committee

    Populations Served

    Hong Kong, China

    Location

    International

    Ongoing Project

    Yes

    Opportunities for Student Involvement

    No

Research & Scholarship

Clinical Trials


  • Identification and Characterization of Novel Proteins and Genes in Head and Neck Cancer Recruiting

    Through this study, we hope to learn more about the mechanisms, which may contribute to development and progression of head and neck cancer. The long-term goal of this study will be to develop new strategies and drugs for the diagnosis and treatment of head and neck cancer.

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  • Cervical Nodal Mets in Squamous Cell Carcinoma of H&N - MRI, FDG-PET, & Histopathologic Correlation Not Recruiting

    The purpose of this study is to determine the value of novel non-invasive medical imaging methods for detecting the spread of head and neck squamous cell carcinoma to the lymph nodes in the neck by comparing their results to findings at the time of surgery.

    Stanford is currently not accepting patients for this trial. For more information, please contact Quynh-Thu Le, (650) 498 - 6184.

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  • Biopsy of Human Tumors for Cancer Stem Cell Characterization: a Feasibility Study Not Recruiting

    To see if a limited sampling of tumor tissue from human subjects is a feasible way to gather adequate tissue for cancer stem cell quantification.

    Stanford is currently not accepting patients for this trial. For more information, please contact Ruth Lira, 650-723-1367.

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  • A Phase 2 Clinical Trial of the Safety and Effects of IRX-2 in Treating Patients With Operable Head and Neck Cancer Not Recruiting

    IRX-2 is designed to activate your own body's immune system so that it can better fight the invasion of head and neck cancer. In pre-clinical studies, IRX-2 has been shown to activate a number of different cells of the immune system. IRX-2 was previously tested in a study of 13 patients with advanced head and neck cancer who had been previously treated and failed chemotherapy and/or radiation therapy. The trials were specifically designed to test the safety of IRX-2. Researchers found that IRX-2 did not appear to have major side effects. Also, the researchers believed that further study in less advanced head and neck cancer patients could be useful in obtaining more data on the safety of IRX-2 as well as data on possible effects on tumors and on patient survival.

    Stanford is currently not accepting patients for this trial. For more information, please contact Ruth Lira, (650) 723 - 1367.

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Teaching

2014-15 Courses


Publications

Journal Articles


  • Salvage Treatment for Locally Recurrent Nasopharyngeal Carcinoma (NPC). American journal of clinical oncology Chen, C., Fee, W., Chen, J., Chan, C., Khong, B., Hara, W., Goffinet, D., Li, D., Le, Q. 2014; 37 (4): 327-331

    Abstract

    BACKGROUND:: It is important to determine the outcomes of retreatment in patients with locally recurrent nasopharyngeal carcinoma. METHODS:: We reviewed the records of patients treated for local recurrence at Stanford and Shantou Universities. The end points were local relapse-free survival (LRFS) and overall survival after retreatment. RESULTS:: Fifty-six patients from Stanford and 98 from Shantou qualified. For the Stanford patients, 33 had surgery alone (S group), 12 had surgery plus radiotherapy±chemotherapy (CMT group), and 22 had radiotherapy±chemotherapy (RT Stanford group). All Shantou patients received radiotherapy±chemotherapy (RT Shantou group). The 5-year LRFS rates were: 57% for S group, 25% for CMT group, 53% for RT Stanford group, and 41% for RT Shantou group (P>0.05) for rT1-2 tumors; they were 29% for S group, 25% for CMT group, 39% for RT Stanford group, and 9% for RT Shantou group for rT3-4 tumors (P>0.05). For RT patients, 5-year overall survival rates were 49% for Stanford and 25% for Shantou patients (P=0.026). CONCLUSIONS:: Similar and durable LRFS rates were attained for both S and RT groups when stratified by rT-stage.

    View details for DOI 10.1097/COC.0b013e318277d804

    View details for PubMedID 23275273

  • Impact of positron emission tomography/computed tomography surveillance at 12 and 24 months for detecting head and neck cancer recurrence CANCER Ho, A. S., Tsao, G. J., Chen, F. W., Shen, T., Kaplan, M. J., Colevas, A. D., Fischbein, N. J., Quon, A., Quynh-Thu Le, Q. T., Pinto, H. A., Fee, W. E., Sunwoo, J. B., Sirjani, D., Hara, W., Yao, M. 2013; 119 (7): 1349-1356

    Abstract

    In head and neck cancer (HNC), 3-month post-treatment positron emission tomography (PET)/computed tomography (CT) reliably identifies persistent/recurrent disease. However, further PET/CT surveillance has unclear benefit. The impact of post-treatment PET/CT surveillance on outcomes is assessed at 12 and 24 months.A 10-year retrospective analysis of HNC patients was carried out with long-term serial imaging. Imaging at 3 months included either PET/CT or magnetic resonance imaging, with all subsequent imaging comprised of PET/CT. PET/CT scans at 12 and 24 months were evaluated only if preceding interval scans were negative. Of 1114 identified patients, 284 had 3-month scans, 175 had 3- and 12-month scans, and 77 had 3-, 12-, and 24-month scans.PET/CT detection rates in clinically occult patients were 9% (15 of 175) at 12 months, and 4% (3 of 77) at 24 months. No difference in outcomes was identified between PET/CT-detected and clinically detected recurrences, with similar 3-year disease-free survival (41% vs 46%, P = .91) and 3-year overall survival (60% vs 54%, P = .70) rates. Compared with 3-month PET/CT, 12-month PET/CT demonstrated fewer equivocal reads (26% vs 10%, P < .001). Of scans deemed equivocal, 6% (5 of 89) were ultimately found to be positive.HNC patients with negative 3-month imaging appear to derive limited benefit from subsequent PET/CT surveillance. No survival differences were observed between PET/CT-detected and clinically detected recurrences, although larger prospective studies are needed for further investigation.

    View details for DOI 10.1002/cncr.27892

    View details for Web of Science ID 000316811900010

  • A Planned Neck Dissection Is Not Necessary in All Patients With N2-3 Head-and-Neck Cancer After Sequential Chemoradiotherapy INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS Soltys, S. G., Choi, C. Y., Fee, W. E., Pinto, H. A., Le, Q. 2012; 83 (3): 994-999

    Abstract

    To assess the role of a planned neck dissection (PND) after sequential chemoradiotherapy for patients with head-and-neck cancer with N2-N3 nodal disease.We reviewed 90 patients with N2-N3 head-and-neck squamous cell carcinoma treated between 1991 and 2001 on two sequential chemoradiotherapy protocols. All patients received induction and concurrent chemotherapy with cisplatin and 5-fluorocuracil, with or without tirapazamine. Patients with less than a clinical complete response (cCR) in the neck proceeded to a PND after chemoradiation. The primary endpoint was nodal response. Clinical outcomes and patterns of failure were analyzed.The median follow-up durations for living and all patients were 8.3 years (range, 1.5-16.3 year) and 5.4 years (range, 0.6-16.3 years), respectively. Of the 48 patients with nodal cCR whose necks were observed, 5 patients had neck failures as a component of their recurrence [neck and primary (n = 2); neck, primary, and distant (n = 1); neck only (n = 1); neck and distant (n = 1)]. Therefore, PND may have benefited only 2 patients (4%) [neck only failure (n = 1); neck and distant failure (n = 1)]. The pathologic complete response (pCR) rate for those with a clinical partial response (cPR) undergoing PND (n = 30) was 53%. The 5-year neck control rates after cCR, cPR?pCR, and cPR?pPR were 90%, 93%, and 78%, respectively (p = 0.36). The 5-year disease-free survival rates for the cCR, cPR?pCR, and cPR?pPR groups were 53%, 75%, and 42%, respectively (p = 0.04).In our series, patients with N2-N3 neck disease achieving a cCR in the neck, PND would have benefited only 4% and, therefore, is not recommended. Patients with a cPR should be treated with PND. Residual tumor in the PND specimens was associated with poor outcomes; therefore, aggressive therapy is recommended. Studies using novel imaging modalities are needed to better assess treatment response.

    View details for DOI 10.1016/j.ijrobp.2011.07.042

    View details for Web of Science ID 000305256000055

    View details for PubMedID 22137026

  • Targeted endoscopic salvage nasopharyngectomy for recurrent nasopharyngeal carcinoma INTERNATIONAL FORUM OF ALLERGY & RHINOLOGY Ho, A. S., Kaplan, M. J., Fee, W. E., Yao, M., Sunwoo, J. B., Hwang, P. H. 2012; 2 (2): 166-173

    Abstract

    Despite modern radiotherapy and open surgical techniques, treatment of recurrent nasopharyngeal carcinoma (NPC) remains challenging, with substantial morbidity involved. Targeted endoscopic nasopharyngectomy was evaluated as a viable oncologic alternative to open nasopharyngectomy or radiation for recurrent NPC.Thirteen patients who underwent endoscopic nasopharyngectomy for recurrent NPC between August 2005 and August 2010 were retrospectively reviewed. Average age at surgery was 55.7 years, with mean follow-up period 24.2 months. Two-year disease-free survival, 2-year overall survival, margin status, and complication rate were measured.Including resections for subsequent recurrences, 19 endoscopic procedures were performed with curative intent. Mean operating room (OR) time was 278 minutes, mean estimated blood loss was 197 mL, and mean length of hospitalization was 1.0 days. Negative margins were obtained in 78.9% of procedures: positive margins involved the parapharyngeal space, oropharynx, fossa of Rosenmuller, and infratemporal fossa. Stereotactic radiation was given postoperatively for localized positive margins. Four patients required repeat endoscopic nasopharyngectomy for re-recurrence, despite having their margins cleared or controlled with adjuvant treatment. Two-year local disease-free and overall survival rates were 69.2% and 100.0%, respectively. The overall minor complication rate was 52.6%, with no major complications.Targeted endoscopic nasopharyngectomy is beneficial in locally recurrent NPC, with favorable morbidity and complication rates. Endoscopic surveillance and serial imaging together facilitate the early identification of re-recurrences, which often may be treated with additional directed resection. Postoperative stereotactic radiation may serve as an appropriate adjunct modality for disease control at positive margins.

    View details for DOI 10.1002/alr.20111

    View details for Web of Science ID 000308926000015

    View details for PubMedID 22170783

  • Nasopharyngeal carcinoma: Salvage of local recurrence Oral Oncology Lee AWM, Fee WE, Ng WT, Chan LK 2012; 48 (9): 768-774
  • NOVEL NEOADJUVANT IMMUNOTHERAPY REGIMEN SAFETY AND SURVIVAL IN HEAD AND NECK SQUAMOUS CELL CANCER HEAD AND NECK-JOURNAL FOR THE SCIENCES AND SPECIALTIES OF THE HEAD AND NECK Wolf, G. T., Fee, W. E., Dolan, R. W., Moyer, J. S., Kaplan, M. J., Spring, P. M., Suen, J., Kenady, D. E., Newman, J. G., Carroll, W. R., Gillespie, M. B., Freeman, S. M., Baltzer, L., Kirkley, T. D., Brandwein, H. J., Hadden, J. W. 2011; 33 (12): 1666-1674

    Abstract

    Cellular immune suppression is observed in head and neck squamous cell cancer (HNSCC) and contributes to poor prognosis. Restoration of immune homeostasis may require primary cell-derived cytokines at physiologic doses. An immunotherapy regimen containing a biologic, with multiple-active cytokine components, and administered with cytoxan, zinc, and indomethacin was developed to modulate cellular immunity.Study methods were designed to determine the safety and efficacy of a 21-day neoadjuvant immunotherapy regimen in a phase 2 trial that enrolled 27 therapy-naïve patients with stage II to IVa HNSCC. Methods included safety, clinical and radiologic tumor response, disease-free survival (DFS), overall survival (OS), and tumor lymphocytic infiltrate (LI) data collection.Acute toxicity was minimal. Patients completed neoadjuvant treatment without surgical delay. By independent radiographic review, 83% had stable disease during treatment. OS was 92%, 73%, and 69% at 12, 24, and 36 months, respectively. Histologic analysis suggested correlation between survival and tumor LI.Immunotherapy regimen was tolerated. Survival results are encouraging.

    View details for DOI 10.1002/hed.21660

    View details for Web of Science ID 000297850400002

    View details for PubMedID 21284052

  • Long-Term Great Auricular Nerve Morbidity After Sacrifice During Parotidectomy LARYNGOSCOPE Ryan, W. R., Fee, W. E. 2009; 119 (6): 1140-1146

    Abstract

    To clarify the extent and patient perspectives of great auricular nerve (GAN) morbidity and recovery after nerve sacrifice during parotidectomy 4 to 5 years after surgery.Prospective series.Twenty-two patients who underwent parotidectomy with GAN sacrifice and were previously studied for GAN sensory outcome during the first postoperative year. We performed light touch sensation tests on each patient to develop an ink map representing anesthesia and paresthesia in the GAN sensory territory; patients also completed an outcomes questionnaire.Nineteen (86%) of 22 patients completed follow-up. One patient completed the questionnaire over the phone. The prevalence and average areas of anesthesia and paresthesia decreased since the first postoperative year according to sensory testing and patient scoring. At 4 to 5 years, 47% (9 of 19) of the patients had anesthesia, 58% (11 of 19) had paresthesia, and 26% (5 of 19) had neither anesthesia nor paresthesia during sensory testing. Patients reported that the GAN dysfunction brought them no to mild inference with their daily activities. At a mean point of 2 years, 70% (14 of 20) patients felt that their sensory symptoms had either completely abated or stabilized.The posterior branch of the GAN should be preserved if it does not compromise tumor resection. If this is not possible, the patient and surgeon should be comforted in that only minor, if any, long-term disability will ensue. Laryngoscope, 2009.

    View details for DOI 10.1002/lary.20246

    View details for Web of Science ID 000266899700017

    View details for PubMedID 19399835

  • Excellent local control with stereotactic radiotherapy boost after external beam radiotherapy in patients with nasopharyngeal carcinoma INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS Hara, W., Loo, B. W., Goffinet, D. R., Chang, S. D., Adler, J. R., Pinto, H. A., Fee, W. E., Kaplan, M. J., Fischbein, N. J., Le, Q. 2008; 71 (2): 393-400

    Abstract

    To determine long-term outcomes in patients receiving stereotactic radiotherapy (SRT) as a boost after external beam radiotherapy (EBRT) for locally advanced nasopharyngeal carcinoma (NPC).Eight-two patients received an SRT boost after EBRT between September 1992 and July 2006. Nine patients had T1, 30 had T2, 12 had T3, and 31 had T4 tumors. Sixteen patients had Stage II, 19 had Stage III, and 47 had Stage IV disease. Patients received 66 Gy of EBRT followed by a single-fraction SRT boost of 7-15 Gy, delivered 2-6 weeks after EBRT. Seventy patients also received cisplatin-based chemotherapy delivered concurrently with and adjuvant to radiotherapy.At a median follow-up of 40.7 months (range, 6.5-144.2 months) for living patients, there was only 1 local failure in a patient with a T4 tumor. At 5 years, the freedom from local relapse rate was 98%, freedom from nodal relapse 83%, freedom from distant metastasis 68%, freedom from any relapse 67%, and overall survival 69%. Late toxicity included radiation-related retinopathy in 3, carotid aneurysm in 1, and radiographic temporal lobe necrosis in 10 patients, of whom 2 patients were symptomatic with seizures. Of 10 patients with temporal lobe necrosis, 9 had T4 tumors.Stereotactic radiotherapy boost after EBRT provides excellent local control for patients with NPC. Improved target delineation and dose homogeneity of radiation delivery for both EBRT and SRT is important to avoid long-term complications. Better systemic therapies for distant control are needed.

    View details for DOI 10.1016/j.ijrobp.2007.10.027

    View details for Web of Science ID 000255971100013

    View details for PubMedID 18164839

  • Evaluation of patterns of failure and subjective salivary function in patients treated with intensity modulated radiotherapy for head and neck squamous cell carcinoma HEAD AND NECK-JOURNAL FOR THE SCIENCES AND SPECIALTIES OF THE HEAD AND NECK Daly, M. E., Lieskovsky, Y., Pawlicki, T., Yau, J., Pinto, H., Kaplan, M., Fee, W. E., Koong, A., Goffinet, D. R., Xing, L., Le, Q. 2007; 29 (3): 211-220

    Abstract

    Our aim was to correlate patterns of failure with target volume delineations in patients with head and neck squamous cell carcinoma (HNSCC) treated with intensity-modulated radiation therapy (IMRT) and to report subjective xerostomia outcomes after IMRT as compared with conventional radiation therapy (CRT).Between January 2000 and April 2005, 69 patients with newly diagnosed nonmetastatic HNSCC underwent curative parotid-sparing IMRT at Stanford University. Sites included were oropharynx (n = 39), oral cavity (n = 8), larynx (n = 8), hypopharynx (n = 8), and unknown primary (n = 6). Forty-six patients received definitive IMRT (66 Gy, 2.2 Gy/fraction), and 23 patients received postoperative IMRT (60.2 Gy, 2.15 Gy/fraction). Fifty-one patients also received concomitant chemotherapy. Posttreatment salivary gland function was evaluated by a validated xerostomia questionnaire in 29 IMRT and 75 matched CRT patients >6 months after completing radiation treatment.At a median follow-up of 25 months for living patients (range, 10-60), 7 locoregional failures were observed, 5 in the gross target or high-risk postoperative volume, 1 in the clinical target volume, and 1 at the junction of the IMRT and supraclavicular fields. The 2-year Kaplan-Meier estimates for locoregional control and overall survival were 92% and 74% for definitive IMRT and 87% and 87% for postoperative IMRT patients, respectively. The mean total xerostomia questionnaire score was significantly better for IMRT than for CRT patients (p = .006).The predominant pattern of failure in IMRT-treated patients is in the gross tumor volume. Parotid sparing with IMRT resulted in less subjective xerostomia and may improve quality of life in irradiated HNSCC patients.

    View details for DOI 10.1002/hed.20505

    View details for Web of Science ID 000244459100002

    View details for PubMedID 17111429

  • Quality of life 17 to 20 years after uvulopalatopharyngoplasty LARYNGOSCOPE Goh, Y. H., Mark, I., Fee, W. E. 2007; 117 (3): 503-506

    Abstract

    To study the long-term quality of life outcomes of a group of unselected patients for the long-term effects of uvulopalatopharyngoplasty (UPPP).Retrospective chart review and telephone survey.Forty-nine patients who underwent UPPP between July 1980 and July 1983 and who had their medical records were reviewed and were asked to grade on a visual analogue scale (VAS) the clinical benefits and complications of UPPP after the surgery.Forty-three (87.8%) males and six (12.2%) female patients were studied. Improvement in snoring, excessive daytime somnolence, and nocturnal arousals were seen after UPPP with decreased effectiveness after time. The most common complication of UPPP was velopharyngeal insufficiency (VPI) (28.5%); however, dry throat and swallowing difficulty tended to be more severe in those patients who had them. No correlation between the snoring and VPI VAS grades was observed. Forty-three patients had a preoperative sleep study and 22 patients a postoperative sleep study. There was lack of correlation between the significant subjective clinical improvement and their postoperative polysomnography.When undertaking UPPP, both subjective and objective benefits should be weighed against the risk of long-term ill effects. Patients should also be warned that the long-term side effects such as VPI, dry throat, and abnormal swallowing sensation might be more common than previously expected.

    View details for DOI 10.1097/MLG.0b013e31802d83bd

    View details for Web of Science ID 000244548000020

    View details for PubMedID 17334312

  • Advanced-staged tonsillar squamous carcinoma: Organ preservation versus surgical management of the primary site HEAD AND NECK-JOURNAL FOR THE SCIENCES AND SPECIALTIES OF THE HEAD AND NECK Shirazi, H. A., Sivanandan, R., Goode, R., Fee, W. E., Kaplan, M. J., Pinto, H. A., Goffinet, D. R., Le, Q. 2006; 28 (7): 587-594

    Abstract

    Our aim was to review our experience in the management of advanced tonsillar squamous cell carcinoma (SCC) and to compare treatment outcomes between patients treated with and without surgery to the primary site.The records of 74 patients with advanced-stage tonsillar SCC were reviewed. The median age at diagnosis was 58 years. Thirty-eight patients received definitive surgery to the primary site, and 36 were treated with an organ-preservation approach (OP) using radiotherapy +/- chemotherapy.No significant difference in overall survival (OS) or freedom from relapse (FFR) by treatment was found. T classification and N status were significant independent predictors on multivariate analysis for OS and FFR. Major late toxicity was noted in 10 patients in the surgical group and nine in the OP group.Patients treated with OP and primary surgery had comparable OS and FFR. T classification and N status were significant independent predictors for tumor relapse and survival. On the basis of these results, we favor organ-preservation therapy for patients with advanced-stage tonsillar SCC.

    View details for DOI 10.1002/hed.20372

    View details for Web of Science ID 000238690100003

    View details for PubMedID 16475199

  • Great auricular nerve morbidity after nerve sacrifice during parotidectomy ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY Ryan, W. R., Fee, W. E. 2006; 132 (6): 642-649

    Abstract

    To clarify the extent, timing, and patient perspectives of great auricular nerve (GAN) morbidity and recovery after nerve sacrifice during parotidectomy during the first postoperative year.Prospective series.Tertiary care academic medical center. Patients Twenty-seven consecutive patients who underwent parotidectomy with GAN sacrifice.Preoperatively and at 3, 6, 9, and 12 months postoperatively, we performed light touch sensation tests on each patient to develop an ink map representing anesthesia and paresthesia in the GAN sensory territory; patients also completed an outcomes questionnaire.Twenty-two (81%) of 27 patients completed follow-up. The prevalence and average area of anesthesia decreased continually during the first year according to sensory testing and patient scoring. Half of the patients had no anesthesia at 12 months. The prevalence and average area of paresthesia increased during the first year according to sensory testing; however, the contiguity and subjective scoring of paresthesia peaked at 6 months and decreased in subsequent follow-up points. Throughout the first year, patients had difficulty using the telephone, shaving, combing their hair, wearing earrings, and sleeping on the operative side because of both anesthesia and paresthesia.The impact of GAN sacrifice morbidity on patient quality of life is tolerable and improves during the first postoperative year. However, we feel that GAN morbidity may be bothersome enough to warrant efforts to preserve the posterior branch of the GAN when possible and appropriate.

    View details for Web of Science ID 000238261300011

    View details for PubMedID 16785410

  • Mature results from a randomized phase II trial of cisplatin plus 5-fluorouracil and radiotherapy with or without tirapazamine in patients with resectable stage IV head and neck squamous cell carcinomas CANCER Le, Q. T., Taira, A. I., Budenz, S., Dorie, M. J., Goffinet, D. R., Fee, W. E., Goode, R., Bloch, D., Koong, A., Brown, J. M., Pinto, H. A. 2006; 106 (9): 1940-1949

    Abstract

    The objective of this article was to report the results from a randomized trial that evaluated the efficacy and toxicity of adding tirapazamine (TPZ) to chemoradiotherapy in the treatment of patients with head and neck squamous cell carcinomas (HNSCC).Sixty-two patients with lymph node-positive, resectable, TNM Stage IV HNSCC were randomized to receive either 2 cycles of induction chemotherapy (TPZ, cisplatin, and 5-fluorouracil [5-FU]) followed by simultaneous chemoradiotherapy (TPZ, cisplatin, and 5-FU) or to receive the same regimen without TPZ. Patients who did not achieve a complete response at 50 Grays underwent surgical treatment. Stratification factors for randomization included tumor site, TNM stage, and median tumor oxygen tension. The primary endpoint was complete lymph node response.The addition of TPZ resulted in increased hematologic toxicity. There was 1 treatment-related death from induction chemotherapy. The complete clinical and pathologic response rate in the lymph nodes was 90% and 74% for the standard treatment arm and the TPZ arm, respectively (P = .08) and 89% and 90% at the primary site in the respective treatment arms (P = .71). The 5-year overall survival rate was 59%, the cause-specific survival rate was 68%, the rate of freedom from recurrence was 69%, and the locoregional control rate was 77% for the entire group. There was no difference with regard to any of the outcome parameters between the 2 treatment arms. The significant long-term toxicity rate also was found to be similar between the 2 arms.The addition of TPZ increased hematologic toxicity but did not improve outcomes in patients with resectable, Stage IV HNSCC using the protocol administered this small randomized study. The combination of induction and simultaneous chemoradiotherapy resulted in excellent survival in these patients.

    View details for DOI 10.1002/cncr.21785

    View details for Web of Science ID 000237187400010

    View details for PubMedID 16532436

  • Cyclin D1 and p16 expression in recurrent nasopharyngeal carcinoma. World journal of surgical oncology Lin, H., Berry, G. J., Sun, Z., Fee, W. E. 2006; 4: 62-?

    Abstract

    Cyclin D1 and p16 are involved in the regulation of G1 checkpoint and may play an important role in the tumorigenesis of nasopharyngeal carcinoma (NPC). Previous studies have examined the level of expression of cyclin D1 and p16 in primary untreated NPC but no such information is available for recurrent NPC. We set out in this study to examine the expression level of cyclin D1 and p16 in recurrent NPC that have failed previous treatment with radiation +/- chemotherapy.A total of 42 patients underwent salvage nasopharyngectomy from 1984 to 2001 for recurrent NPC after treatment failure with radiation +/- chemotherapy. Twenty-seven pathologic specimens were available for immunohistochemical study using antibodies against cyclin D1 and p16.Positive expression of cyclin D1 was observed in 7 of 27 recurrent NPC specimens (26%) while positive p16 expression was seen in only 1 of 27 recurrent NPC (4%).While the level of expression of cyclin D1 in recurrent NPC was similar to that of previously untreated head and neck cancer, the level of p16 expression in recurrent NPC samples was much lower than that reported for previously untreated cancer. The finding that almost all (96%) of the recurrent NPC lack expression of p16 suggested that loss of p16 may confer a survival advantage by making cancer cells more resistant to conventional treatment with radiation +/- chemotherapy. Further research is warranted to investigate the clinical use of p16 both as a prognostic marker and as a potential therapeutic target.

    View details for PubMedID 16953893

  • Positron-emission tomography for surveillance of head and neck cancer LARYNGOSCOPE Ryan, W. R., Fee, W. E., Le, Q. T., Pinto, H. A. 2005; 115 (4): 645-650

    Abstract

    To determine the diagnostic accuracy and the ideal timing of fluoro-fluorodeoxyglucose positron-emission tomography (PET) in the posttreatment surveillance of head and neck mucosal squamous cell carcinoma (HNSCC).Retrospective chart review.Our sample includes 103 adult patients with 118 posttreatment PET scans who had undergone treatment for HNSCC. We correlated PET results with surgical pathology and clinical outcome in the subsequent 6 months.For the detection of locoregional persistent or recurrent HNSCC, PET scans had a sensitivity of 82%, specificity of 92%, positive predictive value (PPV) of 64%, negative predictive value (NPV) of 97%, and overall accuracy of 90%. For the detection of distant metastases, PET scans had a sensitivity of 89%, specificity of 97%, PPV of 85%, NPV of 98%, and overall accuracy of 96%. PET scans of the head and neck region performed greater than 1 month after the completion of radiation compared with scans performed within 1 month had a significantly higher sensitivity of 95% versus 55% (P < .01) and NPV of 99% versus 90% (P < .01).PET is effective in detecting distant metastases in the posttreatment surveillance for HNSCC patients. A negative PET is highly reliable for all sites. However, a positive PET in the head and neck region is unreliable because of a high false-positivity rate. PET of the head and neck region has a statistically significant risk of a false-negative reading when performed within 1 month of radiation.

    View details for DOI 10.1097/01.mlg.0000161345.23128.d4

    View details for Web of Science ID 000228280300016

    View details for PubMedID 15805874

  • Split-thickness skin graft attachment to bone lacking periosteum ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY Tran, L. E., Berry, G. J., Fee, W. E. 2005; 131 (2): 124-128

    Abstract

    To develop an animal model to investigate the survival of split-thickness skin grafts (STSGs) on bone without periosteum, to compare STSG attachment to bone with and without periosteum, and to determine the effect of fibrin glue on STSG attachment to bone.Prospective laboratory study.University laboratory.Sprague-Dawley rats.Percentage of survival of the STSGs at 2 weeks determined independently by the authors and a third, blinded head and neck surgeon.In experiment 1, which included 40 rats, the sutured STSGs showed an average survival rate of 38% when attached to bone with periosteum, 6% when attached to bare bone, and 10% when attached to bare bone using fibrin glue. The poor survival rate was thought to be attributable to the animals scratching at their bolster dressings. In experiment 2, 18 animals underwent a posteriorly based U-shaped flap of skin and subcutaneous tissue. The grafts were placed and isolated from the overlying flap with a biosynthetic wound dressing. The sutured STSG survival rates were as follows: 87% when attached to bone with periosteum, 94% when attached to bare bone, and 74% when attached to bare bone using fibrin glue.The survival of STSGs attached to bare bone was comparable to that of STSGs attached to bone with periosteum when grafts were protected with the skin-subcutaneous flap. The STSGs that were fixed with 0.1 cc of fibrin glue demonstrated poorer survival rates than those attached with sutures and were associated with more seromas.

    View details for Web of Science ID 000226817900006

    View details for PubMedID 15723943

  • Readers' responses to "are 80 hours a week enough to train a surgeon?". MedGenMed : Medscape general medicine Fee, W. E. 2005; 7 (4): 43-?

    View details for PubMedID 16652454

  • Long-term results of 100 consecutive comprehensive neck dissections - Implications for selective neck dissections ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY Sivanandan, R., Kaplan, M. J., Lee, K. J., Lebl, D., PINTO, H., Le, Q. T., Goffinet, D. R., Fee, W. E. 2004; 130 (12): 1369-1373

    Abstract

    The optimal surgical procedure for the neck in patients with squamous head and neck cancers is controversial. Selective neck dissections have replaced modified radical neck dissections as the procedure of choice for the clinically negative (N0) neck and are now being considered for patients with early-stage neck disease. We report the long-term local recurrence rates in 100 consecutive patients undergoing a radical or modified radical neck dissection for clinically positive (N+) and N0 neck disease and review comprehensively the literature reporting and comparing regional control rates for both neck dissection types.The clinical records of 100 consecutive patients who underwent a comprehensive neck dissection (levels I-V) for squamous head and neck cancers with a minimum of a 2-year follow-up were retrospectively reviewed for primary site of disease, clinical and pathologic neck status, histopathologic grade, neck dissection type, and the site and time of recurrence.Complete data were available for 97 patients on whom 99 neck dissections were performed. Three patients died from unknown causes. Seventy-six patients with N+ disease underwent a therapeutic neck dissection, while 24 patients with clinically N0 disease underwent an elective dissection. The overall neck recurrence rate in patients with controlled primary disease was 7%. The neck or regional failure rate for patients completing the recommended adjuvant radiotherapy was 4%. Six (25%) of 24 patients with clinically N0 disease had occult metastases. The recurrence rate for this group was 4%.Further study is needed to determine the optimal surgical management of the N0 and limited N+ neck.

    View details for Web of Science ID 000225606400002

    View details for PubMedID 15611394

  • Laryngeal embryonal rhabdomyosarcoma - A case of cervical metastases 13 years after treatment and a 25-year review of existing literature ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY Sivanandan, R., Kong, C. S., Kaplan, M. J., Fee, W. E., Thu-Le, Q., Goffnet, D. R. 2004; 130 (10): 1217-1222

    Abstract

    Rhabdomyosarcoma is the most common soft tissue sarcoma in childhood, the majority of which are of the embryonal rhabdomyosarcoma (ER) variety. Present day treatment protocols involve a combination of aggressive surgery, chemotherapy, and radiation therapy. Embryonal rhabdomyosarcoma of the larynx is rare and unlike ER of other regions exhibits excellent response to multimodality treatment without the need for extensive surgery. We report a case of cervical metastases in a 29-year-old man 13 years after treatment of his laryngeal ER. To our knowledge, this is the first reported case of late neck metastases in ER of the larynx and the second reported case of delayed presentation of recurrent disease. A 25-year review of all published reports of ER of the larynx was conducted that highlights the move toward organ preservation with the multimodality treatment protocols. Embryonal rhabdomyosarcoma of the larynx is highly responsive to combination chemoradiotherapy, allowing for excellent cure rates without the need for extensive surgery. Late relapses warrant long-term follow-up.

    View details for Web of Science ID 000224353600016

    View details for PubMedID 15492173

  • Identification of tyrosine kinases overexpressed in head and neck cancer ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY Lin, H. S., Berry, G. J., Fee, W. E., Terris, D. J., Sun, Z. J. 2004; 130 (3): 311-316

    Abstract

    To identify protein-tyrosine kinases (PTKs) that may be involved in the development and progression of head and neck squamous cell carcinoma (HNSCC).Messenger RNA from 7 HNSCC specimens was reverse transcribed to complementary DNA, and selective amplification of PTK complementary DNA was achieved using polymerase chain reaction (PCR) with degenerate PTK primers. The resulting PTK PCR products from these 7 HNSCC specimens were then cloned and randomly selected for sequencing. The PTKs that were represented multiple times in these randomly selected clones were selected as candidate PTKs that may be overexpressed in HNSCC. Antibodies against these candidate PTKs were then used for immunohistochemical studies on 8 other HNSCC specimens not used in the original selection of the candidate PTKs.Three known (EphA1, Brk, and Ron) and 2 novel (KIAA0728 and KIAA0279) PTKs were found to be highly expressed in the 7 HNSCC samples studied, based on the technique of reverse transcriptase-PCR with degenerate primers. Immunohistochemical studies with antibodies against the 3 known PTKs in 8 other HNSCC specimens not used in the previous reverse transcriptase-PCR reaction demonstrated overexpression of EphA1, Brk, and Ron in 12.5%, 37.5%, and 75% of these specimens.In this study, we identified 5 PTKs that were overexpressed in HNSCC using a reverse transcriptase-PCR technique and confirmed the overexpression of 3 known PTKs in some of the 8 archival HNSCC specimens studied. Our finding suggests that the signaling pathways mediated through EphA1, Brk, and Ron may be involved in the development and progression of HNSCC.

    View details for Web of Science ID 000220067500008

    View details for PubMedID 15023838

  • Functional outcome after total parotidectomy reconstruction LARYNGOSCOPE Fee, W. E., Tran, L. E. 2004; 114 (2): 223-?

    Abstract

    The objective was to compare and contrast the functional and cosmetic outcomes of patients who underwent total parotidectomy with and without reconstruction using an inferiorly based sternocleidomastoid muscle flap.Retrospective review in the setting of a university medical center.Twenty-four patients underwent a total parotidectomy. Fifteen patients had reconstruction with an inferiorly based sternocleidomastoid muscle flap, and nine patients had no reconstruction. Clinical examination was performed independently by two head and neck surgeons and one aesthetician to evaluate cosmetic outcome, presence of gustatory flushing or sweating, and return of facial nerve and greater auricular nerve function.With the mean follow-up of 22 months, the group having reconstruction showed a better cosmetic outcome compared with the group without reconstruction. Objective testing for Frey syndrome demonstrated gustatory sweating in 20% of the group having reconstruction group versus 22% in the group without reconstruction. There was no difference in length of operation, hospital stay, or facial nerve function. Objective testing of facial sensation revealed that only 40% in the group having reconstruction had normal sensation to light touch compared with 78% in the group without reconstruction.The inferiorly based sternocleidomastoid muscle flap offers improved cosmetic results in patients undergoing total parotidectomy. However, there is a decreased return of greater auricular nerve function, probably attributable to relocation of the nerve stump anteriorly. Benefit was not seen in prevention of Frey syndrome measured objectively; however, the group having reconstruction had fewer clinical symptoms of gustatory sweating or flushing.

    View details for Web of Science ID 000225916300009

    View details for PubMedID 14755194

  • Long-term outcomes after external beam irradiation and brachytherapy boost for base-of-tongue cancers INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS Gibbs, I. C., Le, Q. T., Shah, R. D., Terris, D. J., Fee, W. E., Goffinet, D. R. 2003; 57 (2): 489-494

    Abstract

    To assess long-term efficacy and toxicity associated with external beam irradiation (EBRT) and interstitial (192)Ir implantation for the treatment of squamous carcinoma of the base of tongue.Between April 1975 and December 1993, 41 patients with base-of-tongue carcinomas were treated with (192)Ir interstitial implants after EBRT at Stanford University. One patient had Stage I, 6 had Stage II, 7 had Stage III, and 27 had Stage IV tumors. Twenty-eight patients had cervical lymph node involvement at diagnosis. All received EBRT to a median dose of 50 Gy (range 48.9-68 Gy) to the primary tumor and regional lymph nodes before brachytherapy. Interstitial implant was performed 2-4 weeks after EBRT. Intraoperatively, nylon catheters were placed via steel trocars into the base of tongue, glossotonsillar groove, and pharyngo-epiglottic fold using a catheter looping technique. Twenty-three of 28 node-positive patients also underwent simultaneous neck dissections. Postoperatively, the (192)Ir seeds were inserted and allowed to remain in place for approximately 35 h to achieve a median tumor dose of 26 Gy (range 20-34 Gy) to a median volume of 73 cc. Survival, local control, and complications were assessed.With a median follow-up of 62 months (range 9-215) for all patients and 90 months for alive patients, the 5-year Kaplan-Meier survival estimate was 66%. The 5-year local control rate was 82%, with 7 patients recurring locally, 2 of whom were salvaged with surgery. Nodal control was achieved in 93% of patients with either EBRT alone or in combination with neck dissection. The 5-year freedom from distant metastasis rate was 83%. Acute complications included transient bleeding (5%) and infection (8%). Late complication included soft-tissue necrosis/ulceration (7%), osteoradionecrosis (5%), and xerostomia.Base-of-tongue carcinoma can be effectively treated with EBRT and (192)Ir implant boost. Local control is excellent and complication rates are acceptable.

    View details for DOI 10.1016/S0360-3016(03)00597-2

    View details for Web of Science ID 000185315200023

    View details for PubMedID 12957261

  • Evaluation of a patient with a parotid tumor ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY Fee, W. E., Tran, L. E. 2003; 129 (9): 937-938

    View details for Web of Science ID 000185220400004

    View details for PubMedID 12975264

  • Improved local control with stereotactic radiosurgical boost in patients with nasopharyngeal carcinoma INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS Le, Q. T., Tate, D., Koong, A., Gibbs, I. C., Chang, S. D., Adler, J. R., Pinto, H. A., Terris, D. J., Fee, W. E., Goffinet, D. R. 2003; 56 (4): 1046-1054

    Abstract

    Treatment of nasopharyngeal carcinoma using conventional external beam radiotherapy (EBRT) alone is associated with a significant risk of local recurrence. Stereotactic radiosurgery (STR) was used to boost the tumor site after EBRT to improve local control.Forty-five nasopharyngeal carcinoma patients received a STR boost after EBRT at Stanford University. Seven had T1, 16 had T2, 4 had T3, and 18 had T4 tumors (1997 American Joint Commission on Cancer staging). Ten had Stage II, 8 had Stage III, and 27 had Stage IV neoplasms. Most patients received 66 Gy of EBRT delivered at 2 Gy/fraction. Thirty-six received concurrent cisplatin-based chemotherapy. STR was delivered to the primary site 4-6 weeks after EBRT in one fraction of 7-15 Gy.At a medium follow-up of 31 months, no local failures had occurred. The 3-year local control rate was 100%, the freedom from distant metastasis rate was 69%, the progression-free survival rate was 71%, and the overall survival rate was 75%. Univariate and multivariate analyses revealed N stage (favoring N0-N1, p = 0.02, hazard ratio HR 4.2) and World Health Organization histologic type (favoring type III, p = 0.002, HR 13) as significant factors for freedom from distant metastasis. World Health Organization histologic type (p = 0.004, HR 10.5) and age (p = 0.01, HR 1.07/y) were significant factors for survival. Late toxicity included transient cranial nerve weakness in 4, radiation-related retinopathy in 1, and asymptomatic temporal lobe necrosis in 3 patients who originally had intracranial tumor extension.STR boost after EBRT provided excellent local control in nasopharyngeal carcinoma patients. The incidence of late toxicity was acceptable. More effective systemic treatment is needed to achieve improved survival.

    View details for DOI 10.1016/S0360-3016(03)00117-2

    View details for Web of Science ID 000183937500018

    View details for PubMedID 12829140

  • Airway management after maxillectomy: Routine tracheostomy is unnecessary LARYNGOSCOPE Lin, H. S., Wang, D., Fee, W. E., Goode, R. L., Terris, D. J. 2003; 113 (6): 929-932

    Abstract

    There is a paucity of data to guide the optimal management of the airway in patients after maxillectomy. The decision on whether a concomitant tracheostomy is needed is often dictated by the surgeon's training and experience. We reviewed our experience with maxillectomy to assess the need for tracheostomy in postoperative airway management.Retrospective analysis at a university hospital.We identified 121 patients who underwent 130 maxillectomies between October 1990 and September 2001. Twenty-four of these were total (all six walls removed), 45 were subtotal (two or more walls removed), and 61 were limited (only one wall removed). Reconstruction ranged from none to microvascular free flap, with split-thickness skin graft being the most common reconstructive option.Only 10 tracheostomies (7.7%) were performed at the time of maxillectomy. These included four tracheostomies in patients who underwent bulky flap reconstruction, two tracheostomies in patients who underwent both flap reconstruction and mandibulectomy, one tracheostomy in a patient who underwent mandibulectomy, one tracheostomy in a patient with mucormycosis in anticipation of prolonged ventilatory support postoperatively, and two tracheostomies at the surgeons' discretion because of concern for upper airway edema. Among the 111 patients who underwent 120 maxillectomies without concomitant tracheostomy, 1 patient (0.9%), a 74 year-old man with oxygen-dependent chronic obstructive pulmonary disease, required repeat intubation on day 3 and again on day 10 after the surgery, because of respiratory failure; fiberoptic examination confirmed the absence of upper airway compromise.The routine performance of tracheostomy in patients undergoing maxillectomy is unnecessary. Selective use of tracheostomy may be indicated in situations in which mandibulectomy or bulky flap reconstruction is performed or a concern for postoperative oropharyngeal airway obstruction because of edema or packing exists.

    View details for Web of Science ID 000183391900002

    View details for PubMedID 12782798

  • The efficacy of corticosteroids in postparotidectomy facial nerve paresis LARYNGOSCOPE Lee, K. J., Fee, W. E., Terris, D. J. 2002; 112 (11): 1958-1963

    Abstract

    To determine whether the administration of perioperative corticosteroids is effective in ameliorating facial nerve paresis after parotidectomy.Prospective, randomized, double-blinded, placebo-controlled clinical trial at a university medical center.Patients scheduled for parotidectomy and who met inclusion criteria were invited to enroll in the protocol. They were stratified according to the anticipated surgery (superficial or total parotidectomy) and then received one of two doses of dexamethasone (0.51 or 1.41 mg/kg divided into three doses) or placebo solution immediately preoperatively and then every 8 hours for 16 hours postoperatively. The facial nerve was graded for proportion (percentage) of function at each of the four major regions (frontal, orbital, midface and upper lip, and lower lip). The early postoperative function and rate of return of function were compared among the treatment groups.Forty-nine patients were enrolled and evaluated (18 in the control group, 16 receiving low-dose dexamethasone, and 15 receiving high-dose dexamethasone). No therapeutic advantage of dexamethasone treatment could be appreciated with respect to the degree of early postoperative nerve function (81.3% for control patients vs. 69.5% for dexamethasone-treated patients [ =.239]). Similarly, the median time to recovery of complete facial nerve function was 60 days in the control group and was 150 days in the dexamethasone-treated patients.Dexamethasone administration in patients undergoing parotidectomy is not justified. Despite the relatively modest risk profile of dexamethasone, we were unable to demonstrate any benefit in patients who were treated with either low-dose or high-dose steroids compared with placebo-treated patients in a randomized, controlled trial.

    View details for Web of Science ID 000179193300009

    View details for PubMedID 12439162

  • Nasopharyngectomy after failure of 2 courses of radiation therapy ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY Ibrahim, H. Z., Moir, M. S., Fee, W. W. 2002; 128 (10): 1196-1197

    Abstract

    Recurrence of nasopharyngeal carcinoma after initial therapy has been reported to range between 18% and 54%. As an alternative to surgical salvage, patients with recurrent nasopharyngeal carcinoma are offered a second course of radiation therapy. If this second course fails, patients may be candidates for surgical resection.To identify the effectiveness and morbidity of surgical resection of recurrent nasopharyngeal carcinoma in patients who have received 2 cycles of external beam radiation.Retrospective survey of 6 patients in a university-based practice who underwent resection of recurrent nasopharyngeal carcinoma after 2 courses of radiation therapy.Our study group comprised 4 women and 2 men aged between 35 and 67 years. All patients underwent 2 courses of radiation with a mean total dose of 11 500 rad (115 Gy) (range, 9500-13 200 rad [95-132 Gy]) delivered to the nasopharynx prior to resection. The mean duration between the second course of radiation and resection is 21 months (range, 8-52 months). The mean follow-up period is 7.2 years (range, 4.2-11.5 years).Nasopharyngectomy after failure of 2 courses of radiation therapy.Postoperative clinical outcome and morbidity.Five years after resection, 1 patient died of disease. The remaining 5 patients (83%) are alive with no evidence of disease. Osteomyelitis is the most common complication, affecting 5 patients. Three of the 5 patients with osteomyelitis required operative debridement of the nasopharynx and split-thickness skin grafting. Other complications include oronasal fistula (2 patients), chronic otitis media (2 patients), and nasopharyngeal stenosis (1 patient).Although poor wound healing is evident, the overall 5-year survival of 83% is encouraging.

    View details for Web of Science ID 000178560200011

    View details for PubMedID 12365893

  • Percutaneous endoscopic gastrostomy: Strategies for prevention and management of complications LARYNGOSCOPE Lin, H. S., Ibrahim, H. Z., Kheng, J. W., Fee, W. E., Terris, D. J. 2001; 111 (10): 1847-1852

    Abstract

    The placement of percutaneous endoscopic gastrostomy (PEG) tubes is within the realm of the head and neck surgeon because most are proficient in the use of rigid and flexible esophagoscopes. The ability to provide comprehensive care for the patient with head and neck cancer provides further incentive for the head and neck surgeon to adopt this technique. Although it is a technically simple procedure, the surgeon must be aware of the range of complications that can occur with PEG. We review our experience with PEG focusing on the complications as well as strategies for the prevention and management of these complications.A retrospective review of the records of patients who underwent PEG at Stanford University by the Head and Neck Surgery Service between July 1992 and December 1998 was conducted. A total of 103 patients were identified, of which 84 (82%) were patients with head and neck cancers. Complications associated with PEG were identified. All PEGs were performed using the pull technique.There was no mortality associated with the procedure. Minor complications occurred in 11 cases (10.7%). These included cellulitis (4), ileus (3), tube extrusion (1), clogged lumen (1), and peristomal leakage (2). The only major complication was a single case of PEG site metastasis.The review of our experience with PEG tube placement revealed a low complication rate. Safe PEG placement was achieved by transillumination of the abdominal wall and confirmation by ballottement. In addition, appropriate patient selection, use of perioperative antibiotics, as well as meticulous post-procedure care contributed to the low rate of complications. For the patients with head and neck cancer, a barrier should be placed between the tumor and the instrumentation at the time of tube placement.

    View details for Web of Science ID 000171422900033

    View details for PubMedID 11801956

  • Lymph node metastasis in maxillary sinus carcinoma INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS Le, Q. T., Fu, K. K., Kaplan, M. J., Terris, D. J., Fee, W. E., Goffinet, D. R. 2000; 46 (3): 541-549

    Abstract

    To evaluate the incidence and prognostic significance of lymph node metastasis in maxillary sinus carcinoma.We reviewed the records of 97 patients treated for maxillary sinus carcinoma with radiotherapy at Stanford University and at the University of California, San Francisco between 1959 and 1996. Fifty-eight patients had squamous cell carcinoma (SCC), 4 had adenocarcinoma (ADE), 16 had undifferentiated carcinoma (UC), and 19 had adenoid cystic carcinoma (AC). Eight patients had T2, 36 had T3, and 53 had T4 tumors according to the 1997 AJCC staging system. Eleven patients had nodal involvement at diagnosis: 9 with SCC, 1 with UC, and 1 with AC. The most common sites of nodal involvement were ipsilateral level 1 and 2 lymph nodes. Thirty-six patients were treated with definitive radiotherapy alone, and 61 received a combination of surgical and radiation treatment. Thirty-six patients had neck irradiation, 25 of whom received elective neck irradiation (ENI) for N0 necks. The median follow-up for alive patients was 78 months.The median survival for all patients was 22 months (range: 2.4-356 months). The 5- and 10-year actuarial survivals were 34% and 31%, respectively. Ten patients relapsed in the neck, with a 5-year actuarial risk of nodal relapse of 12%. The 5-year risk of neck relapse was 14% for SCC, 25% for ADE, and 7% for both UC and ACC. The overall risk of nodal involvement at either diagnosis or on follow-up was 28% for SCC, 25% for ADE, 12% for UC, and 10% for AC. All patients with nodal involvement had T3-4, and none had T2 tumors. ENI effectively prevented nodal relapse in patients with SCC and N0 neck; the 5-year actuarial risk of nodal relapse was 20% for patients without ENI and 0% for those with elective neck therapy. There was no correlation between neck relapse and primary tumor control or tumor extension into areas containing a rich lymphatic network. The most common sites of nodal relapse were in the ipsilateral level 1-2 nodal regions (11/13). Patients with nodal relapse had a significantly higher risk of distant metastasis on both univariate (p = 0.02) and multivariate analysis (hazard ratio = 4.5, p = 0.006). The 5-year actuarial risk of distant relapse was 29% for patients with neck control versus 81% for patients with neck failure. There was also a trend for decreased survival with nodal relapse. The 5-year actuarial survival was 37% for patients with neck control and 0% for patients with neck relapse.The overall incidence of lymph node involvement at diagnosis in patients with maxillary sinus carcinoma was 9%. Following treatment, the 5-year risk of nodal relapse was 12%. SCC histology was associated with a high incidence of initial nodal involvement and nodal relapse. None of the patients presenting with SCC histology and N0 necks had nodal relapse after elective neck irradiation. Patients who had nodal relapse had a higher risk of distant metastasis and poorer survival. Therefore, our present policy is to consider elective neck irradiation in patients with T3-4 SCC of the maxillary sinus.

    View details for Web of Science ID 000085412400004

    View details for PubMedID 10701732

  • Surgery in the aging population ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY Fee, W. E. 1999; 125 (12): 1405-1405

    View details for Web of Science ID 000084137200021

    View details for PubMedID 10604427

  • Treatment of maxillary sinus carcinoma - A comparison of the 1997 and 1977 American Joint Committee on Cancer staging systems CANCER Le, Q. T., Fu, K. K., Kaplan, M., Terris, D. J., Fee, W. E., Goffinet, D. R. 1999; 86 (9): 1700-1711

    Abstract

    This study was conducted to assess the effectiveness of the 1997 American Joint Committee on Cancer (AJCC) staging system to predict survival and local control of patients with maxillary sinus carcinoma and to identify significant factors for overall survival, local control, and distant metastases in patients with these tumors.Ninety-seven patients with maxillary sinus carcinoma were treated with radiotherapy at Stanford University and the University of California, San Francisco between 1959-1996. The histologic type of carcinoma among the 97 patients were: 58 squamous cell carcinomas, 4 adenocarcinomas, 16 undifferentiated carcinomas, and 19 adenoid cystic carcinomas. All patients were restaged clinically according to the 1977 and 1997 AJCC staging systems. The T classification of the tumors of the patients was as follows: 8 with T2, 18 with T3, and 71 with T4 according to the 1977 system and 8 with T2, 36 with T3, and 53 with T4 according to the 1997 system. Eleven patients had lymph node involvement at diagnosis. Thirty-six patients were treated with radiotherapy alone and 61 received a combination of surgical and radiation treatments. The median follow-up for surviving patients was 78 months.The 5-year and 10-year actuarial survival rates for all patients were 34% and 31%, respectively. The 5-year survival estimate by the 1977 AJCC system (P = 0.06) was 75% for Stage II, 19% for Stage III, and 34% for Stage IV and by the 1997 AJCC system (P = 0.006) was 75% for Stage II, 37% for Stage III, and 28% for Stage IV. Significant prognostic factors for survival by multivariate analysis included age (favoring younger age, P<0.001), 1997 T classification (favoring T2-3, P = 0. 001), lymph node involvement at diagnosis (favoring N0, P = 0.002), treatment modality of the primary tumor site (favoring surgery and radiotherapy, P = 0.009), and gender (favoring female patients, P = 0.04). The overall radiation time was of borderline significance (favoring shorter time, P = 0.06). The actuarial 5-year local control rate was 43%. By the 1977 AJCC system (P = 0.78) it was 62% with T2, 36% with T3, and 45% with T4 and using the 1997 AJCC system (P = 0.29) it was 62% with T2, 53% with T3, and 36% with T4. The only significant prognostic factor for local control for all patients by multivariate analysis was local therapy, favoring surgery and radiotherapy over radiotherapy alone (P< 0.001). For patients treated with surgery, pathologic margin status correlated with local control (P = 0.007) and for patients treated with radiation alone, higher tumor dose (P = 0.007) and shorter overall treatment time (P = 0.04) were associated with fewer local recurrences. The 5-year estimate of freedom from distant metastases was 66%. The 1997 T classification, N classification, and lymph node recurrence were adverse prognostic factors for distant metastases on multivariate analysis. There were 22 complications in 16 patients, representing a 30% actuarial risk of developing late complications at 10 years.The 1997 AJCC staging system was found to be superior to the 1977 AJCC staging system in predicting both survival and local control in this patient population. Combined surgical and radiation treatment to the primary tumor yielded higher survival and local control than radiotherapy alone. Other significant prognostic factors for survival were patient age, gender, and lymph node (N) classification. Prolonged overall radiation time was associated with poorer survival and local control. Late severe toxicity from the treatment of these tumors was a significant problem in long term survivors. Improved radiotherapy techniques should lead to decreased injury to the surrounding normal tissues. (c) 1999 American Cancer Society.

    View details for Web of Science ID 000083430700011

    View details for PubMedID 10547542

  • Nasopharyngectomy for recurrent high-grade mucoepidermoid carcinoma after radiation failure OTOLARYNGOLOGY-HEAD AND NECK SURGERY Brown, J., Choi, E. C., Fee, W. E. 1999; 120 (4): 564-566

    View details for Web of Science ID 000079594100030

    View details for PubMedID 10187960

  • Management of the clinically positive neck in organ preservation for advanced head and neck cancer AMERICAN JOURNAL OF SURGERY Dagum, P., Pinto, H. A., Newman, J. P., Higgins, J. P., Terris, D. J., Goffinet, D. R., Fee, W. E. 1998; 176 (5): 448-452

    Abstract

    To investigate clinicopathologic predictive criteria for the optimal management of neck metastases in patients with advanced head and neck cancers treated with combined chemoradiotherapy.Prospective study, 48 patients. Mean length follow-up, 23 months.Neck stage predicted neck response to chemoradiotherapy; N3 necks showed more partial responses (P = 0.04), and N1 necks showed more complete responses (P = 0.12). Primary tumor site strongly predicted the pathologic response found on neck dissection in patients with a clinical partial response (cPR) following chemoradiotherapy. There was no difference in survival between patients with a clinical complete response (cCR) after chemoradiotherapy, and patients with a pathologic complete response (pCR) after neck dissection (P = 0.20); however, when grouped together, these patients survived longer than did patients with a pPR at neck dissection (P = 0.06).Clinical response to induction chemotherapy is a poor predictor of ultimate neck control. Induction chemotherapy followed by chemoradiotherapy, and planned neck dissection for patients with persistent cervical lymphadenopathy, provides good regional control.

    View details for Web of Science ID 000077441400013

    View details for PubMedID 9874431

  • Management of the neck in nasopharyngeal carcinoma (NPC) OTOLARYNGOLOGIC CLINICS OF NORTH AMERICA Brown, J. J., Fee, W. E. 1998; 31 (5): 785-?

    Abstract

    Management of cervical nodal metastasis from nasopharyngeal carcinoma (NPC) begins with a thorough assessment of the patient to determine extent of the disease process at the primary site, regionally and systematically. Detailed knowledge of the anatomy of the head and neck will facilitate an accurate diagnosis and subsequent staging of each individual patient. The use of the appropriate diagnostic tools such as imaging, fine-needle aspiration studies, and serology direct the clinician to the appropriate management scheme. This article attempts to cull information from various clinicians who treat the majority of NPC patients, and to raise the issue of the need for more innovative approaches.

    View details for Web of Science ID 000076620700004

    View details for PubMedID 9735107

  • Conservation of resources: Indications for intensive care monitoring after upper airway surgery on patients with obstructive sleep apnea LARYNGOSCOPE Terris, D. J., Fincher, E. F., Hanasono, M. M., Fee, W. E., Adachi, K. 1998; 108 (6): 784-788

    Abstract

    Although significant complications can result after upper airway surgery for obstructive sleep apnea (OSA), there is a lack of consensus regarding the most appropriate level of monitoring in the perioperative period. A retrospective analysis was performed on the operative records of 109 adult patients who underwent 125 surgical procedures from January 1, 1991, to May 31, 1996, with particular emphasis on complications that would have mandated intensive care monitoring and management. Airway complications occurred in one patient (0.8%), who became obstructed immediately after surgery; he responded to naloxone and suctioning. Five other patients (4%) suffered oxygen desaturation to levels below 90% (none fell below 80%, and in only one case was it below the lowest preoperative oxygen saturation level). Cardiac complications, primarily significant hypertension, were the most common adverse events. Four (3.2%) bleeding complications were encountered; all occurred after discharge from the hospital. Routine postoperative intensive care monitoring for all adult patients undergoing upper airway surgery for OSA is unnecessary. Although high-risk patients cannot always be identified preoperatively, significant complications generally emerge within 2 hours after surgery. Therefore a decision regarding the level of postoperative monitoring needed may be made with confidence during the period of time that the patient is in the recovery room.

    View details for Web of Science ID 000074014500002

    View details for PubMedID 9628489

  • Validity of clinic biopsy specimens in classifying histopathologic characteristics of recurrent nasopharyngeal carcinoma ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY Brown, J. J., Berry, G. J., Moretto, J., KEATING, W. F., Fee, W. E. 1997; 123 (9): 950-955

    Abstract

    To evaluate nasopharyngeal carcinoma resection specimens for heterogeneity of histologic patterns to determine if preoperative histologic characteristics of the clinic biopsy specimen are representative of the entire lesion. The null hypothesis is that clinic biopsy specimens are not necessarily representative.Preoperative clinic biopsy specimens were measured to calculate their average size. Resection specimens were then sectioned and evaluated in increments corresponding to this size. Each of these increments was then histologically classified according to the World Health Organization (WHO) criteria. This classification of the preoperative biopsy specimens was compared with that of the resection specimen as a whole.University referral center.Twenty-six consecutive patients with recurrent nasopharyngeal carcinoma who underwent surgical resection. Radiation therapy failed in all patients.The presence or absence of WHO histologic heterogeneity in the nasopharyngectomy specimen was recorded. Disparity between preoperative clinic biopsy and resection specimens was recorded.The mean clinic biopsy specimen size was 13.9 mm2 or less than 1% of the available surface area of the nasopharynx. Of 26 resection specimens classified in 5 increments of this size, 15 (57.7%) were a single WHO type, and 11 (42.3%) were found to be mixtures of WHO types I, II, and III. Of 16 cases with preoperative biopsy specimens available, 4 (25%) were a different WHO classification than their corresponding resection specimen.Most clinic biopsy specimens were representative of their corresponding tumor resection specimens in their entirety; however, tumor heterogeneity is such that some biopsy specimens will not be representative. This finding may interfere with WHO classification data determined on the basis of clinic biopsy specimens and hence confound any meaningful data on treatment outcomes. It is recommended then that multiple nasopharyngeal biopsy specimens be obtained from disparate areas of the lesion and each subjected to independent histopathologic review.

    View details for Web of Science ID A1997XX18900008

    View details for PubMedID 9305245

  • Patterns of care for cancer of the larynx in the United States ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY Shah, J. P., Karnell, L. H., Hoffman, H. T., Ariyan, S., Brown, G. S., Fee, W. E., Glass, A. G., Goepfert, H., Ossoff, R. H., Fremgen, A. 1997; 123 (5): 475-483

    Abstract

    To assess case-mix characteristics, treatment patterns, and outcomes for laryngeal cancer using the largest series of patients to date.Analyses performed on retrospectively collected survey data submitted by hospitals for diagnostic periods 1980 through 1985 and 1990 through 1992 (with a 9-year follow-up for the long-term group).Broad spectrum of US hospitals (N = 769).Consecutively accrued series of patients with laryngeal cancer (N = 16,936), with only squamous cell carcinomas (N = 16,213) analyzed.Surgery, radiation therapy, and chemotherapy.Descriptive analyses of case-mix, diagnostic, and treatment characteristics plus recurrence and 5-year, disease-specific survival outcomes.There was a slight increase across these years in stage IV disease and in radiation therapy (with or without surgery and/or chemotherapy). Overall diversity of management of this disease (by site and stage) was apparent. Five-year survival rates indicated a large difference between modified groupings of the T and N classifications, separating stages III and IV cases into localized disease (87.5% for T1-T2; 76.0% for T3-T4 cases) and regional metastasis (46.2%).Regardless of improvements in entering data in hospital records (most commendably, staging), more rigorous standards are needed. Also, the small increase in advanced-stage patients indicates that efforts toward early detection have not been successful. The rise in radiation therapy perhaps reflected an increased use of nonsurgical treatment for early-stage patients and organ-sparing radiochemotherapy protocols for advanced-stage patients. Regrouping stages III and IV cases into localized disease vs regional metastasis appears to predict survival better. Ongoing refinements of the American Joint Committee on Cancer staging scheme will hopefully improve this cancer's classification.

    View details for Web of Science ID A1997WZ21100002

    View details for PubMedID 9158393

  • Restoration of the G(1) checkpoint and the apoptotic pathway mediated by wild-type p53 sensitizes squamous cell carcinoma of the head and neck to radiotherapy ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY Chang, E. H., Jang, Y. J., Hao, Z. M., Murphy, G., Rait, A., Fee, W. E., Sussman, H. H., Ryan, P., Chiang, Y. W., Pirollo, K. F. 1997; 123 (5): 507-512

    Abstract

    A significant number of squamous cell carcinomas of the head and neck (SCCHN) resist radiation treatment, the most common form of adjuvant therapy for this disease. The presence of a mutant form of the tumor suppressor gene p53 has been correlated with disruption of programmed cell death (apoptosis) and reduced cell cycle arrest, resulting in increased radiation resistance and survival.We introduced by means of an adenoviral vector a functional p53 gene into a radiation-resistant SCCHN cell line that harbors mutant p53. Replacement of wild-type p53 restored the G1 block and apoptosis in these cells in vitro. Moreover, introduction of wild-type p53 sensitized SCCHN-induced mouse xenografts to radiotherapy in vivo.The combination of p53 replacement gene therapy with conventional radiotherapy may treat SCCHN more effectively.

    View details for Web of Science ID A1997WZ21100007

    View details for PubMedID 9158398

  • p53 mediated sensitization of squamous cell carcinoma of the head and neck to radiotherapy ONCOGENE Pirollo, K. F., Hao, Z. M., Rait, A., Jang, Y. J., Fee, W. E., Ryan, P., Chiang, Y. W., Chang, E. H. 1997; 14 (14): 1735-1746

    Abstract

    Radiation resistant squamous cell carcinoma of the head and neck cell line JSQ-3 carries a mutant form of tumor suppressor gene p53. Treatment of these cells with an adenoviral vector containing wild-type p53 (Av1p53) was able to inhibit their growth in vitro and in vivo while having no effect on normal cells. More significantly, introduction of wtp53 also reduced the radiation-resistance level of this cell line in vitro, in a viral dose-dependent manner. Furthermore, this radiosensitization also carried over to the in vivo situation where the response of JSQ-3 cell-induced mouse xenografts to radiotherapy was markedly enhanced after treatment with Av1p53. Complete, long-term regression of the tumors for up to 162 days was observed when a single dose of Av1p53 was administered in combination with ionizing radiation, demonstrating the effectiveness of this combination of gene therapy and conventional radiotherapy. This sensitization of tumors to radiation therapy by replacement of wtp53 could significantly decrease the rate of recurrence after radiation treatment. Since radiation is one of the most prevalent forms of adjunctive therapy for a variety of cancers, these results have great relevance in moving toward an improved cancer therapy.

    View details for Web of Science ID A1997WR89300012

    View details for PubMedID 9135075

  • Baroreflex dysfunction after nasopharyngectomy and bilateral carotid isolation ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY Lee, H. T., Brown, J., Fee, W. E. 1997; 123 (4): 434-437

    Abstract

    Baroreflex dysfunction (BRD) is an uncommon but perplexing clinical entity that occurs after an operation performed in the head and neck. Cases of BRD have occasionally been reported after bilateral carotid endarterectomies and in rare brain-stem tumors. We describe, for the first time to our knowledge, BRD in a patient after nasopharyngectomy and bilateral carotid isolation for recurrent nasopharyngeal carcinoma.

    View details for Web of Science ID A1997WT84900014

    View details for PubMedID 9109794

  • Potential success of near-total laryngectomy despite postoperative radiation therapy LARYNGOSCOPE Terris, D. J., Fee, W. E., Goffinet, D. R. 1996; 106 (9): 1152-1156

    Abstract

    Advanced laryngeal cancers frequently require total laryngectomy (TL). Some of these cancers, however, are suitable for near-total laryngectomy (NTL). We review our experience with NTL over a 14-year period and compare the functional results with those obtained over the same period using TL followed by tracheoesophageal puncture (TEP). One particular interest was the results achieved when surgery was preceded or followed by radiation therapy. From January 1980 through December 1994, 22 patients underwent NTL. The mean age of the 19 men (86.4%) and 3 women (13.6%) was 61.1 +/- 9.9 years. Follow-up ranged from 4 to 109 months, with a mean of 26.5 months. The local control rate was 90.9% (i.e., 20 of the 22 patients). Over the same time period, 11 TEPs were performed in 7 men (63.6%) and 4 women (36.4%) who had a mean age of 60.4 +/- 7.2 years. Compared with the TEP group, the patients in the NTL group had higher mean scores for swallowing, aspiration, and voice quality evaluations, although the differences were not statistically significant. Notably, 21 of 22 patients (95.5%) received preoperative or postoperative radiotherapy. Complications in the NTL group included aspiration, dilated shunt appendix, and inadequate tracheopharyngeal shunt function. Slight modifications of the NTL technique, including routine entrance into the vallecula in uninvolved larynges, the use of contralateral pyriform mucosa flaps, and the performance of an H-flap tracheostomy are described. The NTL is a sound oncologic procedure for tumors causing vocal cord fixation, and it can be successful even when postoperative radiotherapy is administered. The quality of speech, the ease of swallowing, and the incidence of aspiration are similar to those in patients who have had a TEP following TL.

    View details for Web of Science ID A1996VG63300019

    View details for PubMedID 8822722

  • Ciliary neurotrophic factor enhances peripheral nerve regeneration ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY Newman, J. P., Verity, A. N., Hawatmeh, S., Fee, W. E., Terris, D. J. 1996; 122 (4): 399-403

    Abstract

    Adjunctive measures to enhance nerve repair have focused on a variety of trophic factors that alter the physiologic response to nerve injury through Schwann cell-axonal interactions.To evaluate the effects of two trophic factors, ciliary neurotrophic factor and nerve growth factor, on axonal response to injury.A prospective, randomized, blinded animal study with a placebo control using lactated Ringer's solution.Rat sciatic nerves were transected and repaired as a model of injury following which experimental factors were delivered in vivo through an implantable osmotic pump.Functional nerve recovery, muscle mass, and gene expression in the three experimental groups were evaluated.The ciliary neurotrophic factor group (n=6) showed a higher sciatic functional recovery (P=.003) and preservation of affected muscle mass (P=.03) compared with the nerve growth factor (n=8) and control (n=8) groups. Molecular analysis of injured nerves showed no difference in expression of ciliary neurotrophic factor, myelin basic protein, or low-affinity neurotrophin receptor messenger RNA among the three groups.These data suggest that ciliary neurotrophic factor may serve as an important neurocytokine for axonal regrowth during peripheral nerve regeneration.

    View details for Web of Science ID A1996UE21200007

    View details for PubMedID 8600925

  • EFFECT OF ARGININE ON GROWTH OF SQUAMOUS-CELL CARCINOMA IN THE C3H/KM MOUSE ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY Hester, J. E., Fee, W. E. 1995; 121 (2): 193-196

    Abstract

    To determine whether arginine supplementation affects tumor growth or metastases in well-fed and starved mice using a squamous cell carcinoma VII tumor model.Prospective study in a murine model.Simulation of the cachectic state often seen in patients with head and neck cancer, induction of squamous cell carcinoma, and administration of standard and arginine-supplemented diet.Effect of arginine supplementation on tumor growth, metastases, and host weight gain.Tumor weight was significantly decreased in those animals receiving 5% arginine supplementation. The rate of metastases was lower in animals receiving arginine, but this difference did not reach statistical significance. All groups receiving supplemental arginine experienced weight loss, which contradicts the findings that arginine as an anabolic agent may not be present in cancer-bearing hosts.

    View details for Web of Science ID A1995QF83100010

    View details for PubMedID 7840927

  • MODIFIED FACELIFT INCISION FOR PAROTIDECTOMY JOURNAL OF LARYNGOLOGY AND OTOLOGY Terris, D. J., Tuffo, K. M., Fee, W. E. 1994; 108 (7): 574-578

    Abstract

    The most commonly used incision for parotidectomies is the modified Blair incision. We have successfully used an alternative incision which allows good exposure, and leaves no neck scar. Between 1 March 1989 and 1 August 1991, 18 parotidectomies were performed using a modified facelift incision. Fifteen parotidectomies were done for similar indications during the same period using a modified Blair incision. The mean age in both groups of patients was 40.3 years. The pathology and incidence of complications was similar in the two groups. The difference in mean (+/- SD) time of surgery between the two groups was not statistically significant: 3.14 +/- 0.75 hours in patients with a modified facelift incision and 3.25 +/- 1.27 hours in patients with a modified Blair incision (p > 0.1). The modified facelift incision is an alternative approach to parotidectomy for selected patients. It provides adequate exposure, even for a total parotidectomy and mastoidectomy and it results in improved patient satisfaction without additional risk of complications.

    View details for Web of Science ID A1994NZ89000009

    View details for PubMedID 7930893

  • IR-192 INTERSTITIAL IMPLANT AND EXTERNAL-BEAM RADIATION-THERAPY IN THE MANAGEMENT OF SQUAMOUS-CELL CARCINOMAS OF THE TONSIL AND SOFT PALATE INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS BEHAR, R. A., Martin, P. J., Fee, W. E., Goffinet, D. R. 1994; 28 (1): 221-227

    Abstract

    To evaluate the results, techniques, indications and complications of interstitial brachytherapy in the management of squamous cell carcinomas of the tonsil and soft palate, we reviewed the Stanford University Medical School experience with this modality.Between May 1975 and January 1990, 37 patients with squamous cell carcinomas of the Tonsillo-Palatine region were treated with a combination of external beam irradiation and a removable Iridium-192 interstitial implant. The mean age of these patients was 56. Twenty-two were males and 15 were females. The stage distribution included four patients with Stage I, 5 with Stage II, 10 with Stage III, and 18 with Stage IV cancers. Thirty-two percent (12/37) of these patients had T3 or T4 lesions. Forty-nine percent (18/37) had stage N2 or N3 cervical lymphadenopathy. All 37 patients received initial external beam irradiation to the primary, bilateral necks, and supraclavicular region (mean dose: 5400 cGy, range 4000-6600). Eighteen patients (49%) also received neck dissections. All 37 patients received an interstitial Irridium-192 implant using a combination intraoral swage and external looping technique. The mean dose was 2700 cGy (range 2000-4000 cGy) to an average volume of 24 cc (range 5-81).Local control was obtained in 95% (35/37) of the patients. Eighty-seven percent (32/37) of the patients have remained disease-free in the neck. Nine patients have developed second primary lesions, and one developed pulmonary metastasis. Fifteen patients have died (6 succumbed to their cancers, 6 to second primaries, 2 to intercurrent disease, 1 from an unknown cause). The actuarial freedom from relapse is 75%, and overall survival is 64% at 5 years, with a mean follow up of 43 months (range 5-110). Complications were limited to one case of osteoradionecrosis of the mandible and one tonsillar ulcer. Functional and esthetic integrity was preserved in most of these patients.Iridium-192 interstitial implant boost combined with external beam radiation therapy is a safe and effective therapy in the management of locally advanced carcinomas of the tonsil and soft palate.

    View details for Web of Science ID A1994MP35300028

    View details for PubMedID 8270445

  • CURRENT ISSUES IN NERVE REPAIR ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY Terris, D. J., Fee, W. E. 1993; 119 (7): 725-731

    Abstract

    Although accepted surgical techniques for peripheral nerve repair remain largely unchanged over the past three decades, much progress has been made toward understanding the mechanisms involved in nerve regeneration, and consequently toward providing adjunctive measures to enhance this regenerative process. We present a comprehensive review of the significant advances made in several aspects of nerve repair over the past decade, and particularly the past few years, and provide a few examples of facial nerve repair using the standard neurorrhaphy techniques recommended today. Several conclusions were drawn after thorough review of the literature. Early repair of injured nerves is preferred, and there appears to be no benefit to waiting for 3 weeks. Severed nerves should be repaired with monofilament 9-0 nylon suture placed in epineurial fashion. Fibrin glue confers no benefit in reattaching injured nerves. Likewise, theoretical advantages of laser neurorrhaphy have not resulted in improved nerve regeneration. Finally, trophic factors, such as apolipoproteins and nerve growth factor, and tubulization both appear to offer promise for future experimental and clinical progress in nerve repair. However, further work must be done to prove their efficacy.

    View details for Web of Science ID A1993LL82600002

    View details for PubMedID 8318201

  • THE ELECTROPHYSIOLOGIC AND HISTOLOGIC EFFECTS OF THE ARGON BEAM COAGULATOR ON PERIPHERAL-NERVES LARYNGOSCOPE Steiniger, J. R., Fee, W. E., Nowels, K. W., Lusted, H. S., Wilkinson, A. H. 1992; 102 (11): 1263-1267

    Abstract

    The electrophysiologic and histologic effects of the Bard Argon Beam Coagulator (ABC) were investigated in the New Zealand White rabbit. Thirty-four rabbits were divided into three groups. Controls underwent simple femoral exploration and closure. The remaining rabbits' femoral nerves were spot coagulated with either the ABC or standard electrosurgical unit (ESU). Stimulus thresholds were recorded before treatment and again prior to sacrifice at 0, 30, 60, or 120 days. Thresholds were significantly elevated for the ABC and ESU compared to controls (P = .0077 and .0351, respectively). Changes in threshold were greater for the ABC than for the ESU, but were not significant. All ABC- and ESU-treated nerves had significant histologic injury when compared to controls (P < .0002). Although the ABC may be clinically safe, significant injury to rabbit femoral nerves occurs when they are exposed to energy emitted by this instrument.

    View details for Web of Science ID A1992JW25100012

    View details for PubMedID 1405988

  • RADIOSURGERY FOR PALLIATION OF BASE OF SKULL RECURRENCES FROM HEAD AND NECK CANCERS CANCER Kaplan, I. D., Adler, J. R., Hicks, W. L., Fee, W. E., Goffinet, D. R. 1992; 70 (7): 1980-1984

    Abstract

    Seven patients received stereotaxic radiosurgery for 10 lesions at the base of the skull (BOS) from recurrent head and neck malignant neoplasms.A radiation dose of 17.5-35.0 Gy was delivered as a single fraction. Follow-up ranged from 1 to 14 months.Nine lesions were symptomatic, and the symptoms improved in five and stabilized in four lesions. In addition, a significant radiographic response was observed in 4 of 10 recurrences. Cranial nerve signs developed in two patients, and an area of asymptomatic necrosis developed in one patient in the temporal lobe tip.From their brief experience, the authors conclude that stereotaxic radiosurgery may be a promising treatment in locally controlling recurrent head and neck cancers that involve the BOS.

    View details for Web of Science ID A1992JP69200027

    View details for PubMedID 1525775

  • Conservation surgery for laryngeal carcinoma. Annals of the Academy of Medicine, Singapore Roberson, J. B., Fee, W. E. 1991; 20 (5): 656-664

    Abstract

    Partial laryngeal surgery as a treatment for certain laryngeal carcinomas is sound in principle and practice. Knowledge of intralaryngeal barriers to spread is necessary for selection of appropriate patients and for surgical planning. Ten partial laryngeal procedures are discussed including selection criteria and cure rates for each. With meticulously accurate tumour staging and mapping, the practitioner can perform partial laryngeal surgery safely. Results equal or better those achieved by radiation therapy or total laryngectomy while preserving vocal function.

    View details for PubMedID 1781652

  • THYROIDECTOMY UNDER LOCAL-ANESTHESIA ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY Hochman, M., Fee, W. E. 1991; 117 (4): 405-407

    Abstract

    Thyroidectomy for benign and malignant disease is most commonly performed with the patient under general anesthesia, although the literature is sprinkled with reports of series of operations performed using local anesthetic techniques. A retrospective review of 43 sequential thyroidectomies compares 21 performed using local anesthesia with 22 performed using general anesthesia. No significant difference was demonstrated in the incidence of major complications. All patients who required a second operation to remove the remaining hemithyroid after the final pathology reports were reviewed elected local anesthesia for their second procedure, attesting to patient satisfaction. Some hemithyroidectomies performed using local anesthesia were outpatient procedures. The indications, guidelines for patient selection, and operative technique of this effective alternative approach to thyroid surgery are presented.

    View details for Web of Science ID A1991FF34400009

    View details for PubMedID 2007010

  • ESOPHAGOGRAPHY AND ESOPHAGOSCOPY - COMPARISON IN THE EXAMINATION OF PATIENTS WITH HEAD AND NECK-CARCINOMA ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY NINOMURCIA, M., Vincent, M. E., Vaughan, C., Fee, W. E., Goode, R. L., Robbins, A. H., ZBORALSKE, F. F. 1990; 116 (8): 917-919

    Abstract

    We carried out a prospective, double-blind study at three institutions, comparing esophagography with esophagoscopy for the detection of simultaneous cancer of the esophagus in patients with other squamous cell cancers of the head and neck. The goal was to determine whether esophagography and esophagoscopy are necessary for the examination of patients before treatment. One hundred eighty-two patients were studied; both examinations were done in 148 patients. Twenty-one patients could not undergo esophagoscopy; esophagography was inadequate in 9 patients; 4 patients could have neither examination. Concordance was noted between the two procedures in 86.5% of patients. Sixty-five percent were normal, and 21.5% were abnormal. One esophageal cancer was found in this series that was diagnosed by both methods. Our data suggest that esophagoscopy and esophagography may be complementary in evaluating squamous cell carcinoma of the head and neck in patients before treatment. Esophagography alone was useful in patients in whom esophagoscopy could not be performed.

    View details for Web of Science ID A1990DT07500004

    View details for PubMedID 2378717

  • Nasopharyngeal carcinoma. Current opinion in oncology Fee, W. E. 1990; 2 (3): 585-588

    View details for PubMedID 2092778

  • Surgical resection for recurrent nasopharynx cancer. Cancer treatment and research Fee, W. E. 1990; 52: 55-59

    View details for PubMedID 1976375

  • Head and neck squamous cancers. Current problems in cancer Jacobs, C. D., Goffinet, D. R., Fee, W. E. 1990; 14 (1): 1-72

    Abstract

    Head and neck squamous cancers are a heterogeneous group of neoplasms with varying etiologic factors, presenting symptoms, staging, treatment, and expected outcome. In this monograph, we discuss principles of management common to all sites as well as individual differences. The presenting symptoms of disease are reviewed, stressing the importance of early diagnosis. Accurate pathologic diagnosis can be improved on in difficult cases by newer immunohistochemical techniques. Following diagnosis, accurate clinical staging must be performed, and the evaluation of an unknown primary in the neck is described. We review general considerations for planning the treatment of head and neck cancer, and then discuss specific guidelines for individual sites, stressing the optimal integration of surgery and radiation therapy, particularly brachytherapy. Controversial management issues and new, innovative approaches are discussed. The conventional use of chemotherapy in head and neck cancer is for palliation of recurrent disease. In recent years, chemotherapy has been added to the primary treatment program in an induction role, as a radiosensitizer, as an adjunct following standard therapy, and for organ preservation. The current status of these roles is reviewed. This is a cancer for which there are known etiologic agents. Future efforts in this disease should be directed toward early detection and prevention.

    View details for PubMedID 2194750

  • EARLY REEXPLORATION OF THE PAROTID WOUND FOLLOWING PAROTIDECTOMY AMERICAN JOURNAL OF OTOLARYNGOLOGY Chaffoo, R. A., Fee, W. E. 1989; 10 (1): 38-41

    Abstract

    Our experience with reexploration of the parotid wound following parotid gland surgery is presented. There is scant information in the literature to guide the head and neck surgeon in deciding when, and indeed whether, he can safely reexplore the parotid wound following parotidectomy for the removal of residual disease or for determination of neural integrity. The authors treated six patients at Stanford University (Stanford, CA), all of whom underwent reexploration of the parotid wound. Four patients were reexplored to remove residual disease, and two patients were reexplored to evaluate the integrity of the facial nerve after evidence of neural degeneration. Reexploration was undertaken from seven to 23 days after the primary surgical procedure. In all cases, no difficulty was encountered in identification and repair of the facial nerve or removal of residual disease. Five of these patients have fully recovered facial nerve function; one is awaiting recovery after a facial nerve grafting procedure. We recommend early reexploration of the parotid wound following parotidectomy for the removal of residual disease and to assess the integrity of the facial nerve in instances of neural degeneration. Reexploration may be easily and safely accomplished within 3 weeks of initial surgery without significant risk of further neural damage.

    View details for Web of Science ID A1989T130000005

    View details for PubMedID 2929875

  • SURGICAL-MANAGEMENT OF RECURRENT NASOPHARYNGEAL CARCINOMA AFTER RADIATION FAILURE AT THE PRIMARY SITE LARYNGOSCOPE Fee, W. E., GILMER, P. A., Goffinet, D. R. 1988; 98 (11): 1220-1226

    Abstract

    Nine patients have undergone transpalatal resection of recurrent nasopharynx cancer 10 to 56 months following a full course of external beam irradiation. Seven patients were treated for cure, and two were treated palliatively because of nasal airway obstruction, recurrent epistaxis, and severe headaches. Of the patients treated for cure, five are living free of disease 6 to 48 months (mean, 22.2 months) after their surgery. Disease recurred in two patients at 5 and 7 months. Both underwent secondary procedures and are alive with disease at 25 months and 11 months, respectively. The mean hospital stay was 8.7 days (range, 2 to 30 days) for all patients. The average time to swallowing was 2 days (range, 1 to 3 days). Six patients required resection of their soft palate and a soft palate obturator; two patients had intact functioning soft palates without velopharyngeal insufficiency. Of the two patients treated for palliation, one patient died 1 year postoperatively and, although she received some benefit from the resection (diminished headaches), in retrospect, surgery was not worthwhile. The second patient is alive 3 years following her resection and remained symptom-free for 2 years.

    View details for Web of Science ID A1988Q795600013

    View details for PubMedID 2460711

  • POSTIRRADIATION SARCOMA IN RETINOBLASTOMA - INDUCTION OR PREDISPOSITION ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY SCHWARZ, M. B., Burgess, L. P., Fee, W. E., Donaldson, S. S. 1988; 114 (6): 640-644

    Abstract

    An alarmingly high rate of postirradiation sarcomas following treatment for retinoblastoma has been described in the literature. We present four new cases and report 57 others from the English literature. Osteogenic sarcoma was the predominant histologic type (58%), followed by fibrosarcoma (21%) and various other sarcomas (21%). The average latency period between irradiation and development of the second primary (sarcoma) was 12.4 years. Irrespective of irradiation, a genetic linkage between retinoblastoma and osteogenic sarcoma on the 13q14 chromosome is recognized. Through a pleiotropic effect of this same chromosome, a predisposition for other sarcomas may exist as well. Finally, a strong role for radiation induction is proposed for all of these postirradiation sarcomas. This is based on the increased number of sarcomas arising in the field of prior irradiation (sites uncharacteristic of spontaneously occurring primary sarcomas) and the prolonged latency periods.

    View details for Web of Science ID A1988N640200004

    View details for PubMedID 3284548

  • A NEW DESIGN FOR INTRAOPERATIVE FACIAL-NERVE MONITORING OTOLARYNGOLOGY-HEAD AND NECK SURGERY Metson, R., Thornton, A., Nadol, J. B., Fee, W. E. 1988; 98 (3): 258-261

    View details for Web of Science ID A1988M605400015

    View details for PubMedID 3127791

  • REACTIVITY OF MONOCLONAL-ANTIBODY 17.13. WITH HUMAN SQUAMOUS-CELL CARCINOMA AND ITS APPLICATION TO TUMOR-DIAGNOSIS CANCER RESEARCH Ranken, R., White, C. F., GOTTFRIED, T. G., Yonkovich, S. J., BLAZEK, B. E., Moss, M. S., Fee, W. E., LIU, Y. S. 1987; 47 (21): 5684-5690

    Abstract

    Monoclonal antibody 17.13., derived from a fusion of splenocytes of a BALB/c mouse immunized with a surgically resected poorly differentiated human laryngeal recurrent squamous cell carcinoma (SCC) with mouse Sp2/0 cells, is an IgM-K which recognizes a cytoplasmic component of basal cells. Tissue sections of malignant and normal squamous epithelium, tumors of nonsquamous origin, and normal and malignant cytological specimens were tested with an immunoperoxidase assay. Seventy-nine of 81 (98%) SCC of the head and neck, 26 of 26 (100%) SCC of the cervical and female gynecological tract, 29 of 30 (97%) SCC of the lung, 19 of 19 (100%) SCC of the oral cavity, and 17 of 17 (100%) SCC-involved neck lymph nodes reacted strongly. Various carcinomas from breast, colon, ovary, and others were unreactive. In normal squamous epithelial tissues, monoclonal antibody 17.13. reacts only with basal cells but not the cells above the basal layers. Normal tissues from heart, liver, spleen, kidney, bladder, colon, ovary, stomach, pancreas, breast, lung, prostate, thyroid, and lymph nodes were unreactive with the exception of myoepithelial cells. Monoclonal antibody 17.13. may be useful in the diagnosis and management of SCC.

    View details for Web of Science ID A1987K572200031

    View details for PubMedID 3311357

  • CHEMOTHERAPY AS A SUBSTITUTE FOR SURGERY IN THE TREATMENT OF ADVANCED RESECTABLE HEAD AND NECK-CANCER - A REPORT FROM THE NORTHERN-CALIFORNIA-ONCOLOGY-GROUP CANCER Jacobs, C., Goffinet, D. R., Goffinet, L., Kohler, M., Fee, W. E. 1987; 60 (6): 1178-1183

    Abstract

    This trial determines the feasibility for patients with resectable Stages III/IV head and neck cancer who achieved a complete response to induction chemotherapy of eliminating surgery from their treatment program. Thirty patients were treated with three cycles of cisplatin and 5-fluorouracil (5-FU), followed by reendoscopy and biopsy. Twelve patients achieved a complete pathologic response at the primary and received radiation (interstitial and/or external beam) only. The remainder underwent surgical resection and postoperative radiation. At 2 years, the relapse-free survival was 52%, and the survival was 53% for the entire group. For the 12 complete responders who had surgery eliminated, the relapse-free survival was 60%, and the survival was 70%. This pilot study suggests that for patients with resectable disease who achieve a complete pathologic response to induction chemotherapy at their primary, it is feasible to omit surgery and treat with primary radiation without compromise in survival. This approach warrants further study in a randomized trial.

    View details for Web of Science ID A1987J841700003

    View details for PubMedID 3304610

  • UNUSUAL PHARYNGEAL LESION CAUSING DYSPHAGIA ANNALS OF OTOLOGY RHINOLOGY AND LARYNGOLOGY OBANA, K. K., Fee, W. E. 1987; 96 (5): 527-529

    Abstract

    A 58-year-old man was evaluated for a 42-year complaint of a pharyngeal foreign body sensation whenever he ate. Examination revealed normal anatomy at rest but diffuse hypopharyngeal distension with Valsalva's maneuver. His past history was remarkable for an infectious illness, possibly diphtheria. We speculate that this unusual case most likely represents a postdiphtheritic selective pharyngeal paralysis and present his case, radiographic findings, and a discussion of the differential diagnosis.

    View details for Web of Science ID A1987K570500010

    View details for PubMedID 3674649

  • CONRADI-HUNERMAN SYNDROME - CASE-REPORT ANNALS OF OTOLOGY RHINOLOGY AND LARYNGOLOGY Hochman, M., Fee, W. E. 1987; 96 (5): 565-568

    Abstract

    Conradi-Hunerman syndrome, a variant of chondrodysplasia punctata, rarely presents with primary manifestations relevant to the head and neck surgeon. Usually, the disease is evidenced by malformation of the extremities, cataracts, cutaneous lesions, and an unusual facies. We have followed a child with Conradi-Hunerman syndrome for 7 years whose primary manifestation of the disease is respiratory compromise secondary to calcification of the laryngotracheobronchial tree. In addition, he has a conductive hearing loss thought to be secondary to ossicular chain fixation.

    View details for Web of Science ID A1987K570500017

    View details for PubMedID 3674654

  • A MONOCLONAL-ANTIBODY TO SQUAMOUS-CELL CARCINOMA LARYNGOSCOPE Ranken, R., Kaplan, M. J., GOTTFRIED, T. G., Fee, W. E., Boles, R., Silverman, S., White, C., Yonkovich, S., Liu, V. 1987; 97 (6): 657-662

    Abstract

    Monoclonal antibody 17.13.Cl.10 is a murine IgM kappa monoclonal antibody (Mab) that stains frozen section squamous cell carcinoma (SCC) homogeneously and intensely with a sensitivity greater than 98%, including 106/107 SCC specimens from the head and neck. It was produced using a human laryngeal SCC as immunogen and screened using frozen section human tissue. Monoclonal antibody 17.13.Cl.10 faintly stains the basal layer of normal squamous epithelium, does not stain normal organ tissue other than myoepithelial cells, and reacts with few non-SCC tumors. It, therefore, may be a useful adjunct to standard histopathologic criteria for the diagnosis of SCC. It may prove helpful in the investigation of tumor-associated antigens. Despite major technical and immunologic problems, monoclonal antibodies to functional tissue-specific tumor-associated antigens have the potential to play a major role in imaging and in treatment in the future.

    View details for Web of Science ID A1987H644700001

    View details for PubMedID 2438528

  • SAFETY OF I-125 AND IR-192 IMPLANTS TO THE CANINE CAROTID-ARTERY - LONG-TERM RESULTS ACTA OTO-LARYNGOLOGICA Fee, W. E., Goffinet, D. R., Fajardo, L. F., GUTHANER, D., HANDEN, C. 1987; 103 (5-6): 514-518

    Abstract

    Thirty-nine healthy dogs underwent a simulated radical neck dissection followed by implantation of either 125Iodine (125I) or 192Iridium (192Ir) in various dose regimes randomized prospectively from 3,000 to 30,000 rad. Bilateral selective carotid angiography was performed immediately postoperatively and at 6, 12, 18, and 24 months. No significant effects occurred to the animals who received 15,000 rad 125I or 6,000 rad 192Ir. In the higher dosed animals the 125I-treated group fared better than the 192Ir-treated group, probably due to the lower dose rate delivery. Fewer and less serious complications occurred in the 125I-treated group, but this group developed more complications after one year than the Iridium group.

    View details for Web of Science ID A1987H681100028

    View details for PubMedID 3618180

  • MACFEE INCISIONS - DISPELLING THE MYTH OF CERVICAL FLAP VASCULAR INADEQUACY HEAD & NECK SURGERY DANIELL, C. H., Fee, W. E. 1987; 9 (3): 167-171

    Abstract

    MacFee (double horizontal) incisions have often been criticized for transecting the dominant blood supply of the central bipedicled cervical flap. To assess the viability of this flap we reviewed our recent surgical data. Ninety-three patients who underwent 100 radical neck dissections were evaluated retrospectively for cervical skin viability after surgery. MacFee incisions were used in 50 of these; in the remaining 50 a variety of other incisions were used. With MacFee incisions no ischemic tissue loss resulted. By contrast, six patients (12%) in the comparison group experienced partial flap necrosis due to ischemia. Chi-square analysis shows this difference to be statistically significant (P less than 0.01). This study shows the bipedicled cervical flap to be durable, dependable, and sufficiently vascularized to prevent ischemic tissue loss, even when incisions were previously placed in the ipsilateral neck or antecedent radiation therapy was delivered.

    View details for Web of Science ID A1987F361000006

    View details for PubMedID 3623947

  • NEURO-TRACE - A NEW INTRAOPERATIVE NERVE STIMULATOR OTOLARYNGOLOGY-HEAD AND NECK SURGERY Fee, W. E. 1986; 94 (4): 529-531

    View details for Web of Science ID A1986C084000023

    View details for PubMedID 3086818

  • Prevalence of cigarette smoking in Dundee school children in 1964 and 1984. Community medicine FEE, W. M., Briscoe, C., Crombie, I. K., IRVING, J. M., Smith, W. C., Threapleton, L., Tunstall-Pedoe, H. D. 1985; 7 (4): 283-288

    View details for PubMedID 4092423

  • IR-192 PHARYNGOEPIGLOTTIC FOLD INTERSTITIAL IMPLANTS - THE KEY TO SUCCESSFUL TREATMENT OF BASE TONGUE CARCINOMA BY RADIATION-THERAPY CANCER Goffinet, D. R., Fee, W. E., Wells, J., AUSTINSEYMOUR, M., Clarke, D., MARISCAL, J. M., Goode, R. L. 1985; 55 (5): 941-948

    Abstract

    Twenty-eight patients with squamous carcinomas of the base tongue were seen and evaluated in a conjoint Head and Neck Tumor Board at Stanford between 1976 and 1982. Fourteen patients were treated by combined external beam and interstitial irradiation, 11 of whom had Stage III and IV carcinomas (American Joint Committee). An initial dose of 5000 to 5500 rad was first delivered by external beam irradiation in 5 to 5.5 weeks, followed approximately 3 weeks later by an iridium 192 (192Ir) interstitial implant boost by the trocar and loop technique. The key to successful treatment of these neoplasms was found to be the use of a lateral percutaneous cervical technique, which placed horizontal loops through the oropharyngeal wall above and below the hyoid bone; the superior loop included the pharyngoepiglottic fold and the tonsilloglossal groove. Standard multiple loop implants (submentally inserted) of the base tongue from the vallecula anteriorly to the circumvallate papillae were also used routinely. This approach has been successful, since 10 of the 14 patients (71%) remain without evidence of disease (mean follow-up, 32 months). There have been only two local recurrences, both on the pharyngoepiglottic fold in patients who did not receive the now standard pharyngoepiglottic fold/lateral pharyngeal wall implants. No patients have relapsed after 18 months. The other 14 patients were treated prospectively during the same period by combining initial resection, radical neck dissection, and postoperative irradiation. In this group, there were more locoregional failures compared to the group treated with radiation therapy alone (5 tongue recurrences and 7 neck relapses); in addition, more severe complications were noted in these 14 patients who received surgery and postoperative irradiation. The authors believe that combined external beam and interstitial irradiation is effective treatment for base tongue carcinomas, especially when the high-dose distribution includes the adjacent tonsilloglossal groove, pharyngoepiglottic fold, and oropharyngeal wall to and below the level of the hyoid bone, in addition to treating an adequate base tongue volume.

    View details for Web of Science ID A1985ACJ0800004

    View details for PubMedID 3967201

  • SAFETY OF I-125 AND IR-192 IMPLANTS TO THE CANINE CAROTID-ARTERY - PRELIMINARY-REPORT LARYNGOSCOPE Fee, W. E., Goffinet, D. R., Fajardo, L. F., GUTHANER, D., HANDEN, C. 1985; 95 (3): 317-320

    Abstract

    Thirty-nine healthy dogs underwent a simulated radical neck dissection followed by implantation of either 125Iodine (125I) or 192Iridium (192Ir) in various dose regimes randomized prospectively from 3,000 to 30,000 rad. Bilateral selective carotid angiography was performed immediately postoperatively and at six months and one year. No significant effects occurred to the animals who received 15,000 rad 125I or 6,000 rad 192Ir. In the higher dosed animals the 125I treated group fared better than the 192Ir treated group, probably due to the lower dose rate delivery. All surviving animals will be maintained an additional year to determine the late effects of brachytherapy irradiation to the carotid artery.

    View details for Web of Science ID A1985ADK4500015

    View details for PubMedID 3974384

  • I-125 SUTURE IMPLANTS IN THE MANAGEMENT OF ADVANCED TUMORS IN THE NECK ATTACHED TO THE CAROTID-ARTERY JOURNAL OF CLINICAL ONCOLOGY PARYANI, S. B., Goffinet, D. R., Fee, W. E., Goode, R. L., Levine, P., Hopp, M. L. 1985; 3 (6): 809-812

    Abstract

    Between 1975 and 1982, 38 patients with locally advanced head and neck cancer attached to the carotid artery underwent surgical excision followed by iodine 125 vicryl suture implant in the neck. Most patients had neck masses that were greater than 6 cm and stage IV disease without clinically evident distant metastases. Twelve patients had received no previous therapy while 26 underwent an implant for recurrent disease. The local control rate in the implant volume was 79%. The local and regional control rate in all head and neck sites was 53%. The mean survival was 11 months. The overall complication rate was 26%. There was no significant correlation of local control or complications with the minimum total dose, volume implanted, individual 125I seed strength, or total seed strength. In patients with large masses attached to the carotid artery, surgical resection followed by a 125I implant for residual disease is a viable alternative to resection of the carotid artery.

    View details for Web of Science ID A1985AKC5500011

    View details for PubMedID 4009217

  • I125 VICRYL SUTURE IMPLANTS AS A SURGICAL ADJUVANT IN CANCER OF THE HEAD AND NECK INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS Goffinet, D. R., Martinez, A., Fee, W. E. 1985; 11 (2): 399-402

    Abstract

    Sixty-four intraoperative 125I seed implants using absorbable suture (Vicryl) carriers were performed in 53 patients with head and neck cancers at Stanford between 1975 and 1980. In previously untreated patients, local control in the implanted volume or in all head and neck sites was obtained in 79 and 71%, respectively. Five of these patients (40%) remained NED. Of 34 patients with recurrent carcinomas, local control was obtained in the implant volume in 20 (59%), while 38% had no recurrence post-implantation in any head and neck site. The incidence of complications is correlated with 125I radiation doses, total millicuries inserted, seed strength used, and tissue volume implanted for both untreated patients and those with local recurrences. Guidelines for the optimal use of the above 4 parameters are also presented. We conclude that 125I seed Vicryl intraoperative suture implants are an effective surgical adjuvant in the treatment of advanced, previously untreated or recurrent head and neck cancers.

    View details for Web of Science ID A1985ACJ5900024

    View details for PubMedID 3972656

  • Use of intraoperative 125iodine implants for large tumors attached to the carotid artery. Auris, nasus, larynx Fee, W. E., Goffinet, D. R. 1985; 12: S107-11

    Abstract

    Twenty-nine patients with large masses attached to the carotid artery underwent surgical resection with preservation of the artery, and intraoperative 125Iodine implantation via an absorbable suture. Eighteen were treated for recurrent neoplasms, having failed prior surgery and/or irradiation therapy. Eleven were treated primarily. With the minimum follow-up of one year, 76% were disease free in the implant volume and 62% were disease free in the entire neck. Distant metastasis occurred in 45%. Mean survival was 15 months in the primary group (range, 2-50 months) and 12 months in the recurrent group (range, 4-26 months). This technique shows promise in providing local control without necessity for sacrifice of the carotid artery.

    View details for PubMedID 3836628

  • DIAGNOSIS-RELATED GROUPS - ONLY THE LEAD DOG SEES A CHANGE OF SCENERY ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY Fee, W. E. 1984; 110 (10): 631-632

    View details for Web of Science ID A1984TK93000001

    View details for PubMedID 6433865

  • HYPOPHARYNGEAL RECONSTRUCTION ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY Fee, W. E. 1984; 110 (6): 384-385

    View details for Web of Science ID A1984ST77000008

    View details for PubMedID 6372766

  • TRANSDERMAL SCOPOLAMINE IN THE TREATMENT OF ACUTE VERTIGO ANNALS OF OTOLOGY RHINOLOGY AND LARYNGOLOGY BABIN, R. W., Balkany, T. J., Fee, W. E. 1984; 93 (1): 25-27

    Abstract

    A double-blind, parallel investigation was undertaken to evaluate the efficacy of transdermally delivered scopolamine hydrobromide in acute vertigo as compared to meclizine hydrochloride and placebo. Statistical analysis of subjective patient responses and clinical observations suggested that both scopolamine and meclizine are more effective than placebo. Both have significant, but different, side effects.

    View details for Web of Science ID A1984SE27000006

    View details for PubMedID 6703595

  • ONE DAY VS 2 DAYS OF PROPHYLACTIC ANTIBIOTICS IN PATIENTS UNDERGOING MAJOR HEAD AND NECK-SURGERY LARYNGOSCOPE Fee, W. E., Glenn, M., HANDEN, C., Hopp, M. L. 1984; 94 (5): 612-614

    Abstract

    Thirty patients undergoing major head and neck surgery were prospectively randomized to receive moxalactam (30 mg/kg) before surgery and for either 3 or 6 doses total postoperatively. Wound infection criteria were carefully specified and serum drug levels were monitored. Overall infection rate was 3%; the single infection occurred in a patient randomized to the 3 dose protocol. There was no statistically significant difference in infection rates between the two groups. Drug serum levels between the groups did not differ and none of the patients developed significant drug side effects. We conclude that short course prophylaxis is equally effective as more prolonged therapy. Our wound infection rate compares favorably with previous studies and supports the use of moxalactam as a prophylactive antibiotic in major head and neck surgery.

    View details for Web of Science ID A1984SR50500006

    View details for PubMedID 6717216

  • PAROTID-GLAND SURGERY USING THE SHAW HEMOSTATIC SCALPEL ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY Fee, W. E., HANDEN, C. 1984; 110 (11): 739-741

    Abstract

    Twenty-five patients who underwent parotid gland surgery using the Shaw Hemostatic Scalpel (group 1) were compared with 25 patients who had similar surgery using conventional techniques (group 2). Overall, the patients in group 1 had less blood loss and shorter operative times. In patients who underwent superficial parotidectomy, the incidence of temporary partial facial nerve paralysis was 31% in the experimental group v 43% in the conventional group. The mean number of branch paralyses per patient was one in group 1 v 1.9 in group 2, and time to recovery of full function was 50% less in group 1. The Shaw Hemostatic Scalpel is a safe, efficacious instrument for use in parotid gland surgery.

    View details for Web of Science ID A1984TP71100010

    View details for PubMedID 6487125

  • COMBINED SURGERY AND POSTOPERATIVE IRRADIATION IN THE TREATMENT OF CERVICAL LYMPH-NODES ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY Goffinet, D. R., Fee, W. E., Goode, R. L. 1984; 110 (11): 736-738

    Abstract

    One hundred seventy-three patients with squamous carcinomas of the laryngopharynx, oral cavity, and oropharynx received planned, combined resection of the primary neoplasm and radical neck dissection (when N1, N2, or N3 lymphadenopathy was present) followed by megavoltage irradiation to the primary sites and bilateral cervical regions between 1975 and 1982. Radical neck dissections were performed in all patients with N2 and N3 cervical lymphadenopathy, in 90% of those with N1 necks, but in only 4% whose necks were staged NO. Neck failures occurred in 10%, 22%, 19%, and 38% of patients with stages N0, N1, N2, and N3 necks, respectively. The most ominous pathologic feature was soft-tissue extension in the radical neck dissection specimen. Initially clinically benign contralateral lymph nodes became involved in only 9% of these patients.

    View details for Web of Science ID A1984TP71100009

    View details for PubMedID 6487124

  • INTRAOPERATIVE PTERYGO-PALATINE INTERSTITIAL I-125 SEED IMPLANTS INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS Goffinet, D. R., Martinez, A., Pooler, D., Fee, W., Levine, P. A. 1983; 9 (1): 103-106

    View details for Web of Science ID A1983QA63000018

    View details for PubMedID 6841168

  • SQUAMOUS-CELL CARCINOMA OF THE BASE OF THE TONGUE OTOLARYNGOLOGY-HEAD AND NECK SURGERY Riley, R. W., Fee, W. E., Goffinet, D., Cox, R., Goode, R. L. 1983; 91 (2): 143-150

    Abstract

    The squamous cell carcinomas of 119 patients treated between 1958 and 1980 were retrospectively reclassified according to the 1977 American Joint Committee for Cancer Staging-End Results Reporting guidelines. Analysis of the information was performed with an interactive computer program that allows the analysis of a large number of medical factors with numerous variables. The following factors show the statistically significant improved survival rates: well-differentiated histopathologic findings, small T-stage lesions, and clinically negative neck disease. Although the survival curve was similar in the planned combined therapy and radiation therapy groups, local control was statistically superior in the combined therapy group. A similar trend is seen in those patients who receive interstitial implants in addition to external beam therapy. A randomized prospective study is needed to determine the optimum mode of therapy.

    View details for Web of Science ID A1983QM63500006

    View details for PubMedID 6408570

  • ALVEOLAR SOFT PART SARCOMA OF THE TONGUE AMERICAN JOURNAL OF OTOLARYNGOLOGY KING, V. V., Fee, W. E. 1983; 4 (5): 363-366

    Abstract

    Alveolar soft part sarcoma is a rare malignancy. To our knowledge, 13 cases in the head and neck have been reported previously. It occurs more commonly in the extremities, where it is associated with a poor prognosis. Its clinical course resembles that of adenoid cystic adenocarcinoma in that late metastases often cause death in 10 to 15 years. A 5-year-old girl with alveolar soft part sarcoma was successfully treated with partial glossectomy and is free of disease at two-year follow-up.

    View details for Web of Science ID A1983RK85100006

    View details for PubMedID 6638326

  • UPPER AIRWAY-OBSTRUCTION DUE TO LARYNGEAL COCCIDIOIDOMYCOSIS IN A 5-YEAR-OLD CHILD AMERICAN JOURNAL OF OTOLARYNGOLOGY Benitz, W. E., Bradley, J. S., Fee, W. E., LOOMIS, J. C. 1983; 4 (5): 367-370

    Abstract

    Laryngeal coccidioidomycosis with severe upper airway obstruction occurred in a 5-year-old boy. Diagnosis was confirmed by positive serum precipitin and complement fixation titers, pathologic demonstration of typical Coccidioides spherules in biopsy specimens from subglottic tissue and paratracheal lymph nodes, and culture of C. immitis from the subglottic tissue specimen. The child was treated successfully with tracheostomy and intravenously administered amphotericin B (total dose of 60 mg/kg).

    View details for Web of Science ID A1983RK85100007

    View details for PubMedID 6638327

  • INTRAOPERATIVE IODINE 125 IMPLANTS - THEIR USE IN LARGE TUMORS IN THE NECK ATTACHED TO THE CAROTID-ARTERY ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY Fee, W. E., Goffinet, D. R., Paryani, S., Goode, R. L., Levine, P. A., Hopp, M. L. 1983; 109 (11): 727-730

    Abstract

    Twenty-nine patients with large masses attached to the carotid artery underwent surgical resection, preservation of the artery, and intraoperative iodine 125 implantation via an absorbable suture. Eighteen were treated for recurrent neoplasms, having failed prior surgery and/or irradiation therapy. Eleven were treated primarily. With a minimum follow-up of one year, 76% were disease free in the implant volume and 62% were disease free in the entire neck. Distant metastases occurred in 45%. Mean survival was 15 months in the primary group (range, two to 50 months) and 12 months in the recurrent group (range, four to 26 months). This technique shows promise in providing local control without necessity for sacrifice of the carotid artery.

    View details for Web of Science ID A1983RP53700005

    View details for PubMedID 6639439

  • I125 IMPLANTS AS AN ADJUVANT TO SURGERY AND EXTERNAL BEAM RADIOTHERAPY IN THE MANAGEMENT OF LOCALLY ADVANCED HEAD AND NECK-CANCER CANCER Martinez, A., Goffinet, D. R., Fee, W., Goode, R., Cox, R. S. 1983; 51 (6): 973-979

    Abstract

    125Iodine seeds either individually placed or inserted into absorbable Vicryl suture carriers were utilized in conjunction with surgery and external beam radiotherapy in an attempt to increase local control rates in patients with (1) advanced oropharyngeal and laryngopharyngeal cancers (T3-T4, N2-N3), (2) massive cervical lymphadenopathy (N3) and an unknown primary site and (3) locally recurrent head and neck cancers. Forty-eight patients were treated with 55 implants. The carotid artery was implanted in 15 patients, while seven patients had seeds inserted into the base of the skull region, and another three patients had implants near cranial nerves. Eighteen of the 48 patients were treated for cure. The actuarial survival at five years in this subgroup was 50%. The overall local control in the head and neck area was 58%. In this group no patients to date have had a local failure in the implanted volume. Seventeen patients with comparable stage of disease treated prior to 1974 with curative intent without 125I implants were analyzed retrospectively for comparison with the implanted patients. The actuarial survival of these patients was 18% and the overall head and neck control was 21%. These differences are statistically significant at a P value of 0.01 and 0.007, respectively. Seventeen patients received implants for local recurrence. The local control in the head and neck area was 50%; however, the 2.5 year actuarial survival was only 17%. The complication rate was 11% (six of 55 implants). The improved survival, the high local control, and the minimal complication rates in this series makes the intraoperative implantation of 125I seeds and effective adjunctive treatment to surgery and external beam irradiation.

    View details for Web of Science ID A1983QD27000001

    View details for PubMedID 6821872

  • EVALUATION OF FROZEN SECTION IN PAROTID-GLAND SURGERY ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY Hillel, A. D., Fee, W. E. 1983; 109 (4): 230-232

    Abstract

    One hundred eight patients underwent primary parotid gland resections at Stanford University Medical Center between 1977 and 1980. Sixty-nine percent of the patients received intraoperative frozen-section diagnosis. Of these, 81% were benign and 19% were malignant. Four patients who received frozen-section diagnosis benefited by further surgery during the initial procedure. Two of four patients who did not receive frozen-section diagnosis could have benefited by further surgery. False-negative results (a malignant tumor called benign on frozen-section diagnosis) occurred in 5%. False-positive results (a benign lesion called malignant on frozen-section diagnosis) did not occur and no unnecessary surgery was performed.

    View details for Web of Science ID A1983QJ40200004

    View details for PubMedID 6830515

  • PLANNED APPROACH TO THE MANAGEMENT OF MALIGNANT INVASION OF THE CAROTID-ARTERY AMERICAN JOURNAL OF SURGERY Olcott, C., Fee, W. E., Enzmann, D. R., MEHIGAN, J. T. 1981; 142 (1): 123-127

    Abstract

    A planned approach to the evaluation and management of patients with tumor involvement of the cervical carotid artery is presented. Preoperative arteriography and determination of carotid back-pressure permitted a rational approach in these high risk patients. One patient found to have an extremely low carotid back-pressure was advised not to undergo carotid resection. Six patients with satisfactory carotid back-pressure tolerated carotid resection and reconstruction.

    View details for Web of Science ID A1981LX98400023

    View details for PubMedID 7258506

  • USE OF THE SHAW SCALPEL IN HEAD AND NECK-SURGERY OTOLARYNGOLOGY-HEAD AND NECK SURGERY Fee, W. E. 1981; 89 (4): 515-519

    Abstract

    Fifty patients undergoing a variety of head and neck surgical procedures were used to study a new thermally activated scalpel. No electric current passes through the patient and, thus, no ground pad is needed. Subjective equipment evaluation resulted in mean scores of 3.8 (1 = worthless and 5 = excellent) for effectiveness of hemostasis and 4.1 for blade sharpness. The Shaw scalpel system is a worthwhile surgical tool 70% of the time. It is excellent for raising flaps and for use in precise surgery where small capillary bleeding typically obscures visibility (ie, parotid surgery).

    View details for Web of Science ID A1981ME05200001

    View details for PubMedID 6793957

  • INVERTING PAPILLOMA OF THE SPHENOID SINUS OTOLARYNGOLOGY-HEAD AND NECK SURGERY McElveen, J. T., Fee, W. E. 1981; 89 (5): 710-712

    Abstract

    Although inverting papillomas originating from the paranasal sinuses have been reported, inverting papillomas emanating from the sphenoid sinus are exceedingly rare. The following is a case report and one year follow-up of a 57-year-old white man who underwent a radical sphenoidostomy for recurrent inverting papilloma of the sphenoid sinus. The patient, to date, is free of disease.

    View details for Web of Science ID A1981MR46000002

    View details for PubMedID 6799893

  • CLINICAL-APPLICATION OF NON-ACOUSTIC MIDDLE-EAR MUSCLE STIMULATION ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY Fee, W. E. 1981; 107 (4): 224-226

    Abstract

    Several clinical situations exist when only nonacoustic stimuli will provide data necessary for the correct neuro-otologic diagnosis. The tactile stapedius and the orbital air-jet reflexes have been used to aid in detecting the middle ear status in severe hearing losses, retrocochlear hearing losses, ossicular fixation, and facial paralysis. These reflexes also are useful in localization in some cranial nerve disorders. The equipment required to elicit these reflexes is inexpensive, and the test can be performed rapidly. Some pitfalls in interpretation are caused by the lack of precise correlative data. When properly used, performed, and interpreted, nonacoustic reflex response data supply information to the clinician that is otherwise unobtainable.

    View details for Web of Science ID A1981LK47500005

    View details for PubMedID 7213182

  • UNSUSPECTED ESOPHAGEAL FOREIGN-BODIES IN ADULTS WITH UPPER AIRWAY-OBSTRUCTION CHEST Handler, S. D., BEAUGARD, M. E., Canalis, R. F., Fee, W. E. 1981; 80 (2): 234-237

    Abstract

    Esophageal foreign bodies rarely cause respiratory distress in adults. While it is well known that upper airway obstruction can occur with esophageal foreign bodies in children, the otorlaryngologic literature mentions little of this problem in older patients. Two adults with airway obstruction from unsuspected esophageal foreign bodies are described, with emphasis on the problems of diagnosis and management. The possibility of an unsuspected esophageal foreign body should be kept in mind during the evaluation of respiratory distress in an adult, especially in one who is a poor historian or has a history of a psychiatric disorder. Early endoscopic removal in the treatment of choice, although esophagotomy may be required.

    View details for Web of Science ID A1981MB21200029

    View details for PubMedID 7249775

  • Metastasis in head and neck cancer, 1979. Annals of plastic surgery Cochran, J. H., Fee, W. E. 1980; 4 (5): 405-409

    Abstract

    Metastatic spread of head and neck cancer signifies a grave change in prognosis for the patient. The presence or absence of detectable metastasis is valuable knowledge both in planning treatment and in predicting prognosis. Knowledge of the metastatic behavior patterns of such tumors, and of the diagnostic means of detecting metastasis, is essential. The available knowledge on this problem is comprehensively reviewed to present, in a single source, the requisite knowledge for any physician treating head and neck cancer. Metastatic spread is reviewed according to incidence, detection methods, anatomical sites, and correlation with characteristics of the primary tumor. Finally, methods of detecting metastasis are reviewed and a practical approach to patient evaluation recommended.

    View details for PubMedID 7436270

  • Squamous cell proliferative lesion of the nasopharynx in a newborn. Otolaryngology and head and neck surgery STILLWATER, L. B., Fee, W. E. 1980; 88 (3): 240-247

    Abstract

    Nasopharyngeal tumors in the newborn are exceedingly rare. Typically, initial symptoms are breathing or eating difficulties. A case is presented of a patient in whom bleeding began following diagnostic passage of nasopharyngeal catheters. Surgical excision was required on the third day of life, and histologic review revealed a squamous cell proliferative lesion consistent with squamous cell carcinoma. The infant's postoperative course was uneventful. Specimens from a nasopharyngeal biopsy done six weeks later revealed only reactive lymphoid hyperplasia and a 6 months of age, the child's condition was normal. After review of the available literature and this patient's pathologic condition, it is believed that this lesion represents an otherwise unclassifiable squamous cell proliferation previously not described.

    View details for PubMedID 7402665

  • FRONTAL-SINUS SEPTECTOMY FOR CHRONIC UNILATERAL SINUSITIS OTOLARYNGOLOGY-HEAD AND NECK SURGERY Goode, R. L., STRELZOW, V., Fee, W. E. 1980; 88 (1): 18-21

    Abstract

    Frontal sinus trephination with removal of the intersinus septum has been found to be an effective therapy in selected cases of chronic unilateral frontal sinusitis; in addition, it may be combined with unilateral duct reconstruction in the treatment of chronic bilateral sinusitis. It may also be performed as a prophylactic measure when nasofrontal duct injury occurs during unilateral nasal or maxillary sinus surgery. The authors' experience with the procedure in 20 cases is described.

    View details for Web of Science ID A1980JM05200005

    View details for PubMedID 7393597

  • FOLLICULAR LYMPHOID HYPERPLASIA OF THE HARD PALATE SIMULATING LYMPHOMA OTOLARYNGOLOGY-HEAD AND NECK SURGERY HARSANY, D. L., Ross, J., Fee, W. E. 1980; 88 (4): 349-356

    Abstract

    Follicular lymphoid hyperplasia of the hard palate is a slowly growing, soft, nontender swelling that may grow to involve the entire hard palate. The overlying mucosa is normal. This appearance naturally prompts biopsy, and both clinically and microscopically might be confused with lymphoma. Four case histories are presented with histologic description: normal palatal submucosal structures are replaced with benign reactive lymphoid tissue replete with well-developed germinal centers. Surrounding these centers are dense populations of small, regular, bland lymphocytes. Minor salivary glands, except for some atrophied residue, are notably absent; also absent are the epimyoepithelial islands characteristic of the benign lymphoepithelial lesion (Mikulicz's disease). Etiologic factors remain obscure. One of our patients had two recurrences following local excision; in another patient nodules of benign lymphoid hyperplasia developed in the cheek and upper neck. These four patients are alive and free of any malignant process 4, 7, 9, and 12 years after the onset of their palatal swellings. We urge caution in distinguishing these lesions from palatal lymphoma, and recommend local excision as the treatment of choice.

    View details for Web of Science ID A1980KC85300006

    View details for PubMedID 6821414

  • RECONSTRUCTIVE VERSATILITY OF THE PECTORALIS MAJOR MYOCUTANEOUS FLAP OTOLARYNGOLOGY-HEAD AND NECK SURGERY Strelzow, V. V., Finseth, F., Fee, W. E. 1980; 88 (4): 368-372

    Abstract

    The pectoralis major myocutaneous flap is presented in its two basic forms: a muscle flap carrying a skin paddle and the continuous skin-muscle flap technique. The pertinent anatomy of the enveloping fascial planes is reviewed, stressing the increased latitude of safety afforded by elevating the vascular pedicle from the undersurface of the lateral muscle edge. The advantages of a deltopectoral flap outline in approaching the formation of the skin-muscle paddle are introduced. Clinical applications, advantages, and disadvantages are discussed.

    View details for Web of Science ID A1980KC85300009

    View details for PubMedID 6821417

  • AMINOGLYCOSIDE OTOTOXICITY IN THE HUMAN LARYNGOSCOPE Fee, W. E. 1980; 90 (10): 1-18

    Abstract

    One hundred thirty-eight patient courses of tobramycin (tobra) and gentamicin (genta) were prospectively monitored for ototoxicity using weekly audiograms and electronystagmograms. Twice weekly drug serum levels and kidney function tests were determined. A pre, during, and post-therapy history was obtained and the results were analyzed to determine significant parameters of ototoxicity. Statistical analysis of the data was performed using SPSS on an IBM 370/3033 computer. Tobra showed less toxicity than genta but only the difference in vestibular toxicity was statistically significant. Significant associations with toxicity included the patient developing a high temperature, total dose, low hematocrit for tobra, high hematocrit for genta, high creatinine clearance with cochlear toxicity, high creatinine with nephrotoxicity, poor condition or critically ill, and duration of therapy greater than 10 days. Non-significant parameters included dose rate (mg/kg), serum levels, age, prior noise exposure, prior aminoglycosides, prior ear infections, non-aminoglycoside ototoxic drugs, underlying disease, or total number of high risks present. Ototoxicity was independent of nephrotoxicity.

    View details for Web of Science ID A1980KM14700001

    View details for PubMedID 7432055

  • EFFECT OF PROPHYLACTIC ANTIBIOTICS IN RADICAL HEAD AND NECK-SURGERY LARYNGOSCOPE Goode, R. L., Abramson, N., Fee, W. E., Levine, P. 1979; 89 (4): 601-608

    Abstract

    One hundred major head and neck operations performed on 77 patients were evaluated regarding the effectiveness of an aminoglycoside and cephalosporin antibiotic combination given prophylactically to prevent postoperative infection. The postoperative infection incidence was 6%, significantly lower than that reported in similar series where no antibiotics were used. The addition of the aminoglycoside did not appear to provide any additional protection compared with the use of cephalosporin alone.

    View details for Web of Science ID A1979GQ00700009

    View details for PubMedID 431260

  • ANGIOSARCOMA OF THE HEAD AND NECK OTOLARYNGOLOGY-HEAD AND NECK SURGERY Cochran, J. H., Fee, W. E. 1979; 87 (4): 409-416

    Abstract

    Angiosarcomas are uncommon tumors of the skin and soft tissues, but occur in endothelial cells of almost any internal organ. When they occur in the skin, the head and neck are the most common sites of origin. Nothing is pathognomonic about their clinical presentation, and the pathologic diagnosis can only be established by biopsy. The frequent multicentric nature of the tumor and propensity for extensive subcutaneous spread require wide treatment fields, whatever the modality of therapy, and account for the low survival reported. Four cases and their outcome are reported, with only one patient achieving an apparent cure following irradiation therapy. Based on experience and extensive review of the literature, a best therapeutic approach cannot be recommended. Since the outlook for cure is so unfavorable, there appears to be a need for cooperative studies using surgery, irradiation, and perhaps, chemotherapy.

    View details for Web of Science ID A1979HT30800003

    View details for PubMedID 574245

  • SYNOVIAL CHONDROMATOSIS OF THE TEMPOROMANDIBULAR-JOINT OTOLARYNGOLOGY-HEAD AND NECK SURGERY Fee, W. E., WINDHORST, P., Wiggins, R., Pang, L. 1979; 87 (6): 741-748

    Abstract

    Synovial chondromatosis is an uncommon disease of cartilaginous transformation of synovial membrane with formation of loose bodies within the joint space. A case involving the temporomandibular joint (TMJ) is presented. In the TMJ, this disorder occurs more often in females and is usually on the right side. Symptoms include preauricular swelling, pain, and tenderness. Radiographs of the TMJ may be normal, but frequently show multiple, partially calcified loose bodies within the joint. Treatment consists of removal of the loose bodies together with all affected synovium. If the meniscus is excised, reconstruction with a Silastic prosthesis is recommended.

    View details for Web of Science ID A1979JB13200006

    View details for PubMedID 530695

  • EPIGLOTTITIS IN AN IMMUNOSUPPRESSED HOST WESTERN JOURNAL OF MEDICINE Cochran, J. H., Fee, W. E., Maze, A. 1979; 131 (2): 150-152

    View details for Web of Science ID A1979HJ24500021

    View details for PubMedID 516706

  • TRACHEOESOPHAGEAL SPACE ABSCESS LARYNGOSCOPE Fee, W. E., Wilson, G. G. 1979; 89 (3): 377-384

    Abstract

    Two cases of a newly described complication of endotracheal intubation are presented with a discussion of the pathophysiology, clinical symptoms, and treatment evaluation. Treated late, bilateral arytenoid fixation associated with subglottic stenosis is the eventual outcome. Reconstructive efforts in one patient have allowed decannulation two years after onset of his disease following bilateral arytenoidectomy. No reconstructive efforts were attempted in the second patient because of her basic underlying disease process. Early recognition is important and exploratory laryngotracheal-fissure advocated for suspected cases in order to perhaps decrease the devastating consequences of late treatment.

    View details for Web of Science ID A1979GM36400006

    View details for PubMedID 431245

  • RADIOACTIVE SUTURE IN THE TREATMENT OF HEAD AND NECK CANCER LARYNGOSCOPE Goode, R. L., Fee, W., Goffinet, D., Martinez, A. 1979; 89 (3): 349-354

    Abstract

    I-125 seeds in Vicryl suture have been used as a radioactive suture in 24 cases of advanced malignancy of the head and neck. Twelve cases had metastatic carcinoma attached to the internal or common carotid artery. The goal was to excise surgically as much tumor as possible, then implant any residual tumor with this radioactive suture which remains as a permanent implant (half-life of 60 days). This preliminary study shows that use of I-125 impregnated Vicryl suture in this manner appears to produce improved long-term palliation and may increase local cure rates.

    View details for Web of Science ID A1979GM36400001

    View details for PubMedID 431240

  • SQUAMOUS-CELL CARCINOMA OF THE SOFT PALATE ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY Fee, W. E., SCHOEPPEL, S. L., Rubenstein, R., Goffinet, D. R., Goode, R. L., Boles, R., TUSCHMAN, M. 1979; 105 (12): 710-718

    Abstract

    We performed a retrospective study of 106 patients with carcinoma of the soft palate who were treated at two university hospitals. Computer analysis using a new interactive data base program called MING was made to determine Berkson-Gage survival and Gehan tests of statistical significance. Statistically significant associations with an increased survival included the following: smaller lesions, a clinically negative neck examination. well- and moderately well-differentiated histopathologic features, radiation therapy dose of less than or equal to 6,300 rads, absence of a simultaneous primary, and surgical salvage. No statistically significant differences were seen with age, sex, stage, or the number of days during which patients were treated with radiation therapy. There appears to be a need for a prospective, multi-institutional, randomized therapy study to solidify treatment policy. Consideration should be given to combine surgery-radiation vs radiation therapy alone.

    View details for Web of Science ID A1979HX31700006

    View details for PubMedID 508197

  • [Clinical evaluation of the ototoxicity of aminoglycosides. Comparison of tobramycin and gentamycin. Preliminary report]. La Nouvelle presse médicale Fee, W. E. 1978; 7 (42): 3854-3855

    View details for PubMedID 309592

  • Cis-platinum chemotherapy in head and neck cancers. Otolaryngology Jacobs, C., Bertino, J. R., Goffinet, D. R., Fee, W. E., Goode, R. L. 1978; 86 (5): ORL-780 3

    Abstract

    Sixteen patients with advanced head and neck carcinomas were treated with cis-diaminedichloro platinum chemotherapy; seven preoperatively and nine for recurrent disease. Cis-platinum was given by 24-hour infusions of 80 mg/m2 every three weeks. There was 50% regression in 38% (6) of the patients; another 38% (6) had 25% to 50% regression. Toxicity was minimal, with vomiting occurring in 75% (12) of the courses, renal toxicity in 6% (2), leukopenia in 13% (4), thrombocytopenia in 9% (3), and anemia in 31% (10). Of the seven patients who had serial audiograms, only one experienced ototoxicity. Cis-platinum, given by 24-hour infusion, was effective in reducing tumor bulk in 75% (12) of the patients, with advanced head and neck carcinomas, without undue morbidity.

    View details for PubMedID 114948

  • TEMPORAL ARTERIAL LIGATION IN HEAD AND NECK SURGERY WITH ABSORBABLE SUTURES LARYNGOSCOPE Fee, W. E., Okamoto, E., Spellman, M., Ward, P. H. 1978; 88 (4): 619-631

    Abstract

    Temporary arterial ligation is a useful concept in head and neck surgery for situations dealing with potential recurrent hemorrhage or recurrent vascular neoplasms. In this study, several absorbable sutures, including plain gut, chromic gut, and polyglycolic acid were used to ligate the common carotid artery in dogs. Arterial patency was followed by serial selective arteriograms. Only polyglycolic acid sutures proved to be a reliable material to achieve transient arterial occlusion.

    View details for Web of Science ID A1978EU54800008

    View details for PubMedID 642660

  • CLINICAL EVALUATION OF AMINOGLYCOSIDE TOXICITY - TOBRAMYCIN VERSUS GENTAMICIN, A PRELIMINARY-REPORT JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY Fee, W. E., VIERRA, V., Lathrop, G. R. 1978; 4: 31-36

    View details for Web of Science ID A1978FD65100005

    View details for PubMedID 659347

  • CIS-PLATINUM CHEMOTHERAPY IN HEAD AND NECK CANCERS OTOLARYNGOLOGY Jacobs, C., Bertino, J. R., Goffinet, D. R., Fee, W. E., Goode, R. L. 1978; 86 (5): 780-783
  • 24-HOUR INFUSION OF CIS-PLATINUM IN HEAD AND NECK CANCERS CANCER Jacobs, C., Bertino, J. R., Goffinet, D. R., Fee, W. E., Goode, R. L. 1978; 42 (5): 2135-2140

    Abstract

    Eighteen patients with advanced squamous cell cancer of the head and neck were treated with cis-diamminedichloroplatinum in a 24-hour infusion. The most frequent dose used was 80 mg/m2 repeated every three weeks. Six were treated preoperatively for Stage III or IV disease, and twelve were treated for recurrent disease. The overall response rate was 72% with one complete remission, greater than 50% regression in six patients, and 25--50% regression in six patients. Toxicity was minimal: creatinine greater than 2 in 6% of courses, leukopenia in 9%, anemia in 29%, vomiting in 76%, and documented minimal hearing loss in one patient. Plasma and urine platinum levels during infusion are presented. The dosage of 80 mg/m2 administered over 24 hours gives a response rate in head and neck cancers equivalent to that reported with higher doses given by rapid infusion, and toxicity is minimal.

    View details for Web of Science ID A1978FY61800007

    View details for PubMedID 719601

  • THYROID SURGERY - SURGICAL AND METABOLIC CAUSES OF HYPOCALCEMIA ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY Schaefer, S. D., Fee, W. E. 1978; 104 (5): 263-266

    Abstract

    Patients undergoing radical surgical treatment of head and neck neoplasms often are seen with a history of cirrhotic liver disease, electrolyte abnormalities, and other stigma of chronic disease. Despite skillful thyroid surgical technique performed as an isolated procedure or in combination with other procedures such as laryngectomy, hypocalcemia can occur. Common causes of lowered serum calcium levels secondary to removal of parathyroid glands, blood transfusions, hypoalbuminemia, gastrointestinal malabsorption, and renal insufficiency are well known. Less well known is the recently elucidated role of dependence of calcium metabolism on magnesium. Recently, it has been well documented that alcoholism directly lowers serum magnesium levels in both human and animal models without prior liver disease or malabsorption. The fact that three mechanisms are needed to explain calcium homeostasis implies that the magnesium-calcium interdependence is not clearly understood.

    View details for Web of Science ID A1978EY05400006

    View details for PubMedID 646719

  • RECURRENT MIXED TUMORS OF PAROTID-GLAND - RESULTS OF SURGICAL THERAPY LARYNGOSCOPE Fee, W. E., Goffinet, D. R., Calcaterra, T. C. 1978; 88 (2): 265-273

    View details for Web of Science ID A1978EL59200008

    View details for PubMedID 202823

  • Planned carotid artery resection in head and neck surgery. Transactions. Section on Otolaryngology. American Academy of Ophthalmology and Otolaryngology Fee, W. E., STEADMAN, M. G. 1977; 84 (5): ORL814-5

    View details for PubMedID 919151

  • RHOMBOID FLAP ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY Gunter, J. P., CARDER, H. M., Fee, W. E. 1977; 103 (4): 206-211

    Abstract

    The rhomboid flap is a practical and efficient method of repairing small- to moderate-size surface defects of the head and neck. This flap has the advantage of combining the lateral shift and rotational methods of transfer that aid in the closure of the donor site as the flap is transposed. A description of this flap, the principle of its design, its clinical application, and potential pitfalls are presented.

    View details for Web of Science ID A1977DB10600006

    View details for PubMedID 322652

  • SAFETY OF HOSPITAL VS HOME CARE OF INFANT TRACHEOTOMIES TRANSACTIONS AMERICAN ACADEMY OF OPHTHALMOLOGY AND OTOLARYNGOLOGY Okamoto, E., Fee, W. E., Boles, R., Calcaterra, T. C., DOBIE, R. A., STEADMAN, M. G. 1977; 84 (1): 92-99

    View details for Web of Science ID A1977DF27600011

    View details for PubMedID 855095

  • Complications of orbital floor implants. Transactions of the Pacific Coast Oto-Ophthalmological Society annual meeting Canalis, R. F., Handler, S. D., Fee, W. E., Roser, S. M. 1977; 58: 81-88

    View details for PubMedID 354111

  • METHOD OF INTERSTITIAL TONSILLO-PALATINE IMPLANTS INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS Goffinet, D. R., Martinez, A., PALOS, B., Fee, W., Bagshaw, M. A. 1977; 2 (1-2): 155-162

    View details for Web of Science ID A1977DF46400020

    View details for PubMedID 321400

  • COMPOSITE HYOID STERNOHYOID MUSCLE GRAFTS IN HUMANS - ITS USE IN RECONSTRUCTION OF SUBGLOTTIC STENOSIS AND ANTERIOR TRACHEAL WALL ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY Ward, P. H., Canalis, R., Fee, W., Smith, G. 1977; 103 (9): 531-534

    Abstract

    Successful results were achieved in three of four human cases of glottic, subglottic, and tracheal stenosis by using composite hyoid bone-muscle pedicle. A technique is used to create and interposition the grafts to widen the lumen and to provide structural support. The vital composite hyoid bone-muscle graft interposition technique offers a promising method for the solution of difficult cases of glottic, subglottic, and tracheal stenosis. Abandonment of previous long-term dilations is recommended in favor of early surgical restoration of a widened airway.

    View details for Web of Science ID A1977DU59000006

    View details for PubMedID 901279

  • PERMANENT TRACHEOSTOMY - NEW SURGICAL TECHNIQUE ANNALS OF OTOLOGY RHINOLOGY AND LARYNGOLOGY Fee, W. E., Ward, P. H. 1977; 86 (5): 635-638

    Abstract

    A new method of permanent tracheal fenestration is reported, utilizing cervical skin and tracheal flaps. It has been performed on four patients without complications and has the advantage of being a quick, simple, one-stage operation that is reversible should conditions change. The procedure is utilized in patients with posttraumatic or postirradiation fibrosis of the larynx, chronic obstructive pulmonary disease and patients with sleep apnea.

    View details for Web of Science ID A1977DY25300017

    View details for PubMedID 334025

  • Pathologic quiz case 2. Allergic vasculitis. Archives of otolaryngology (Chicago, Ill. : 1960) Schaefer, S., Fee, W. E. 1976; 102 (12): 756-758

    View details for PubMedID 803075

  • Pathologic quiz case 2: neurilemoma. Archives of otolaryngology (Chicago, Ill. : 1960) Smith, G. A., Canalis, R. F., Fee, W. 1976; 102 (10): 640-642

    View details for PubMedID 971139

  • RHOMBOID FLAP PRINCIPLES AND COMMON VARIATIONS LARYNGOSCOPE Fee, W. E., Gunter, J. P., CARDER, H. M. 1976; 86 (11): 1706-1711

    Abstract

    The rhomboid flap was initially popularized by a Russian, Alexander Limberg, and modified by Claude Dufourmentel of Paris. Numerous variations on the flap have been proposed more recently by Webster and Gunter. This flap has found its way into the practice of most surgeons doing head and neck surgery, with its primary advantage being that it is an extremely simple flap operation to learn, with great versatility. The general principles and their clinical application are presented in order to increase proper utilization of the flap.

    View details for Web of Science ID A1976CK50000013

    View details for PubMedID 790060

  • TRIGEMINAL NEURINOMAS LARYNGOSCOPE Fee, W. E., EPSY, C. D., Konrad, H. R. 1975; 85 (2): 371-376

    Abstract

    Trigeminal neurinomas may produce atypical facial pain, loss of facial sensation, facial palsy, hearing loss, nystagmus, or vertigo, and thus may be confused with nasopharyngeal carcinomas or acoustic neurinomas. The diagnosis can be made by the clinical presentation together with radiographic features showing widening of the foramen ovale and/or smooth destruction of the anteromedial portion of the peterous apex. Tomography, pneumoencephalography, angiography, and other diagnostic procedures are sometimes helpful. Treatment is removal by transtemporal craniotomy and offers an excellent prognosis.

    View details for Web of Science ID A1975V729100013

    View details for PubMedID 1113604

  • NONACOUSTIC STIMULATION OF MIDDLE-EAR MUSCLE-REFLEX ANNALS OF OTOLOGY RHINOLOGY AND LARYNGOLOGY Fee, W. E., Dirks, D. D., Morgan, D. E. 1975; 84 (1): 80-87

    Abstract

    The purpose of these experiments was to determine the incidence of the middle ear reflex in response to several nonacoustic (tactile and air jet) stimuli among subjects with normal hearing who had an acoustic reflex and selected patients with severe hearing loss. The results demonstrate that the incidence of response to tactile stimulation increases as the facial area stimulated approaches the auricle. The response to an air jet stimulus directed toward the eye is high; however, the clinical utility of the air jet may be limited because it often results in a startle reaction and head movement, and the response appears to fatigue easily. In normal listeners the response to auricular air jet stimulation probably results from both acoustic and tactile stimulation. The presence of a reflex to tactile stimulation, together with normal tympanometry constitutes strong evidence of a normal middle ear; but the absence of a reflex to acoustic or tactile stimuli still leads to an ambiguous determination of potential stapedial muscle function.

    View details for Web of Science ID A1975V554300011

    View details for PubMedID 1111436

  • BROW-LIFT OPERATION ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY RAFATY, F. M., Goode, R. L., Fee, W. E. 1975; 101 (8): 467-468

    Abstract

    We describe a useful technique for local brow-lift operation. We discuss the results and outline procedural modifications that minimize postoperative scarring. The operation may be performed in conjunction with blepharoplasty or other cosmetic surgery.

    View details for Web of Science ID A1975AL53800004

    View details for PubMedID 1098630

  • LONG-TERM PROGNOSIS OF ASEPTIC MENINGITIS IN CHILDHOOD DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY Fee, W. E., Marks, M. I., KARDASH, S., Reite, M., Seitz, C. 1970; 12 (3): 321-?

    View details for Web of Science ID A1970G719400008

    View details for PubMedID 5464733

Conference Proceedings


  • Treatment results of carcinoma in situ of the glottis - An analysis of 82 cases Le, Q. T., Takamiya, R., Shu, H. K., Smitt, M., Singer, M., Terris, D. J., Fee, W. E., Goffinet, D. R., Fu, K. K. AMER MEDICAL ASSOC. 2000: 1305-1312

    Abstract

    To evaluate the results of different treatment modalities for carcinoma in situ of the glottis, and to identify important prognostic factors for outcome.Review of 82 cases treated definitively for glottic carcinoma in situ between 1958 and 1998. The median follow-up for all patients was 112 months, and 90% had more than 2 years of follow-up.Academic tertiary care referral centers.Fifteen patients were treated with vocal cord stripping (group 1), 13 with more extensive surgery (group 2) including endoscopic laser resection (11 patients) and hemilaryngectomy (2 patients), and 54 with radiotherapy (group 3). Thirty patients had anterior commissure involvement and 9 had bilateral vocal cord involvement. Radiotherapy was delivered via opposed lateral fields at 1.5 to 2.4 Gy per fraction per day (median fraction size, 2 Gy), 5 days per week. The median total dose was 64 Gy, and the median overall time was 47 days.Initial locoregional control (LRC), ultimate LRC, and larynx preservation.The 10-year initial LRC rates were 56% for group 1, 71% for group 2, and 79% for group 3. Of those who failed, the median time to relapse was 11 months for group 1, 17 months for group 2, and 41 months for group 3. Univariate analysis showed that the difference in initial LRC rates between groups 1 and 3 was statistically significant (P =.02), although it was not statistically significant on multivariate analysis (P =.07). Anterior commissure involvement was an important prognostic factor for LRC on both univariate (P =.03) and multivariate (P =.04; hazard ratio, 1.6) analysis, and its influence appeared to be mainly confined to the surgically treated patients (groups 1 and 2). The 10-year larynx preservation rates were 92% for group 1, 70% for group 2, and 85% for group 3. Anterior commissure involvement was the only important prognostic factor for larynx preservation (P =. 01) on univariate analysis. All but 2 patients in whom treatment failed underwent successful salvage surgery. Voice quality was deemed good to excellent in 73% of the patients in group 1, 40% in group 2, and 68% in group 3.Treatment of carcinoma in situ of the glottis with vocal cord stripping or more extensive surgery or radiotherapy provided excellent ultimate LRC and comparable larynx preservation rates. Anterior commissure involvement was associated with poorer initial LRC and larynx preservation, particularly in the surgically treated patients. The choice of initial treatment should be individualized, depending on patient age, reliability, and tumor extent. Pretreatment and posttreatment objective evaluation of voice quality should be helpful in determining the best therapy for these patients.

    View details for Web of Science ID 000165283600001

    View details for PubMedID 11074826

  • Dilatational versus standard tracheostomy: A meta-analysis Cheng, E., Fee, W. E. ANNALS PUBL CO. 2000: 803-807

    Abstract

    The advent of percutaneous dilatational tracheostomy (PDT) was initially viewed by otolaryngologists with great skepticism. The purpose of this study was to compare the complications of PDT with those of standard tracheostomy (ST) by a meta-analysis of randomized studies. We found that ST had a fivefold higher rate of complications than did PDT, and these complications were often more severe. We conclude that PDT is a safer procedure for elective tracheostomy in carefully selected patients, ie, those with normal-sized necks.

    View details for Web of Science ID 000089416100003

    View details for PubMedID 11007080

  • Stereotactic radiosurgical boost following radiotherapy in primary nasopharyngeal carcinoma: Impact on local control Tate, D. J., Adler, J. R., Chang, S. D., Marquez, S., Eulau, S. M., Fee, W. E., PINTO, H., Goffinet, D. R. ELSEVIER SCIENCE INC. 1999: 915-921

    Abstract

    Treatment of patients with nasopharyngeal carcinoma using external beam radiation therapy (EBRT) alone results in significant local recurrence. Although intracavitary brachytherapy can be used as a component of management, it may be inadequate if there is extension of disease to the skull base. To improve local control, stereotactic radiosurgery was used to boost the primary tumor site following fractionated radiotherapy in patients with nasopharyngeal carcinoma.Twenty-three consecutive patients were treated with radiosurgery following radiotherapy for nasopharyngeal carcinoma from 10/92 to 5/98. All patients had biopsy confirmation of disease prior to radiation therapy; Stage III disease (1 patient), Stage IV disease (22 patients). Fifteen patients received cisplatinum-based chemotherapy in addition to radiotherapy. Radiosurgery was delivered using a frame-based LINAC as a boost (range 7 to 15 Gy, median 12 Gy) following fractionated radiation therapy (range 64.8 to 70 Gy, median 66 Gy).All 23 patients (100%) receiving radiosurgery as a boost following fractionated radiation therapy are locally controlled at a mean follow-up of 21 months (range 2 to 64 months). There have been no complications of treatment caused by radiosurgery. However, eight patients (35%) have subsequently developed regional or distant metastases.Stereotactic radiosurgical boost following fractionated EBRT provides excellent local control in advanced stage nasopharynx cancer and should be considered for all patients with this disease. The treatment is safe and effective and may be combined with cisplatinum-based chemotherapy.

    View details for Web of Science ID 000083624000013

    View details for PubMedID 10571198

  • Postoperative irradiation of minor salivary gland malignancies of the head and neck Le, Q. T., Birdwell, S., Terris, D. J., Gabalski, E. C., Varghese, A., Fee, W. E., Goffinet, D. R. ELSEVIER IRELAND LTD. 1999: 165-171

    Abstract

    (1) To review the Stanford experience with postoperative radiotherapy for minor salivary gland carcinomas of the head and neck. (2) To identify patterns of failure and prognostic factors for these tumors.Fifty-four patients with localized tumors were treated with curative intent at Stanford University between 1966 and 1995. The 1992 AJCC staging for squamous cell carcinomas was used to retrospectively stage these patients. Thirteen percent had stage I, 22% stage II, 26% stage III, and 39% stage IV neoplasms. Thirty-two patients (59%) had adenoid cystic carcinoma, 15 (28%) had adenocarcinoma, and seven (13%) had mucoepidermoid carcinoma. Thirty (55%) had positive surgical margins and seven (13%) had cervical lymph node involvement at diagnosis. The median follow-up for alive patients was 7.8 years (range: 25 months-28.9 years).The 5- and 10-year actuarial local control rates were 91 and 88%, respectively. Advanced T-stage (T3-4), involved surgical margins, adenocarcinoma histology, and sinonasal and oropharyngeal primaries were associated with poorer local control. The 5- and 10-year actuarial freedom from distant metastasis were 86 and 81%, respectively. Advanced T-stage (T3-4), lymph node involvement at diagnosis, adenoid cystic and high-grade mucoepidermoid histology were associated with a higher risk of distant metastases. The 10-year cause-specific survival (CSS) and overall survival (OS) were 81 % and 63%, respectively. On multivariate analysis, prognostic factors affecting survival were T-stage (favoring T1-2), and N-stage (favoring NO). When T- and N-stage were combined to form the AJCC stage, the latter became the most significant factor for survival. The 10-year OS was 86% for stage I-II vs. 52% for stage III-IV tumors. Late treatment-related toxicity was low (3/54); most complications were mild and no cranial nerve damage was noted.Surgical resection and carefully planned post-operative radiation therapy for minor salivary gland tumors is well tolerated and effective with high local control rates. AJCC stage was the most significant predictor for survival and should be used for staging minor salivary gland carcinomas.

    View details for Web of Science ID 000082784400010

    View details for PubMedID 10577702

  • Hypopharyngeal cancer patient care evaluation Hoffman, H. T., Karnell, L. H., Shah, J. P., Ariyan, S., Brown, S., Fee, W. E., Glass, A. G., Goepfert, H., Ossoff, R. H., Fremgen, A. M. LIPPINCOTT-RAVEN PUBL. 1997: 1005-1017

    Abstract

    A survey was conducted to identify demographics and standards of care for treatment of hypopharyngeal squamous cell carcinoma in the United States. Data were accrued from voluntary submission of cancer registry and medical chart information from 769 hospitals representing 2939 cases diagnosed from 1980 to 1985 and 1990 to 1992. Clinical findings, diagnostic procedures employed, treatment practices, and outcome are presented. Overall, 5-year disease-specific survival was 33.4%, which segregated to 63.1% (stage I), 57.5% (stage II), 41.8% (stage III), and 22% (stage IV). Survival was best for patients treated with surgery only (50.4%), similar with combined surgery and irradiation (48%), and worse with irradiation only (25.8%). This analysis provides a standard to which current treatment practice and future clinical trials may be compared.

    View details for Web of Science ID A1997XQ52300001

    View details for PubMedID 9260999

  • Radiosurgery for skull base malignancies and nasopharyngeal carcinoma Cmelak, A. J., Cox, R. S., Adler, J. R., Fee, W. E., Goffinet, D. R. ELSEVIER SCIENCE INC. 1997: 997-1003

    Abstract

    Patients with skull base lesions present a challenging management problem because of intractable symptoms and limited therapeutic options. In 1989 we began treating selected patients with skull base lesions using linac stereotactic radiosurgery. In this study the efficacy and toxicity of this therapeutic modality is investigated.Forty-seven patients with 59 malignant skull base lesions were treated with linac radiosurgery between 1989 and 1995. Eleven patients were treated for primary nasopharyngeal carcinoma using radiosurgery as a boost (7 Gy-16 Gy, median: 12 Gy) to the nasopharynx after a course of fractionated radiotherapy (64.8-70 Gy) without chemotherapy. Another 37 patients were treated for 48 skull base metastases or local recurrences from primary head and neck cancers. Eight of these patients had 12 locally recurrent nasopharyngeal carcinoma lesions occuring 6-96 months after standard radiotherapy, including one patient with nasopharyngeal carcinoma who developed a regional relapse after radiotherapy with a stereotactic boost. Lesion volumes by CT or MRI ranged from 0 to 51 cc (median: 8 cc). Radiation doses of 7.0 Gy-35.0 Gy (median: 20.0 Gy) were delivered to recurrent lesions, usually as a single fraction.All 11 patients who received radiosurgery as a nasopharyngeal boost after standard fractionated radiotherapy remain locally controlled (follow-up: 2-34 months, median: 18). However, one patient required a second radiosurgical treatment for regional relapse outside the initial radiosurgery volume. Thirty-three of 48 (69%) recurrent/metastatic lesions have been locally controlled, including 7 of 12 locally recurrent nasopharyngeal lesions. Follow-up for all patients with recurrent lesions ranged from 1 to 60 months (median: 9 months). Local control did not correlate with lesion size (p = 0.80), histology (p = 0.78), or radiosurgical dose (p = 0.44). Major complications developed after 5 of 59 treatments (8.4%), including three cranial nerve palsies, one CSF leak, and one trismus. Complications were not correlated with radiosurgical volume (p = 0.20), prior skull base irradiation (p = 0.90), or radiosurgery dose > 20 Gy (p = 0.49).Stereotactic radiosurgery is a reasonable treatment modality for patients with skull base malignancies, including patients with primary and recurrent nasopharyngeal carcinoma. The dose distribution obtained with stereotactic radiosurgery provides better homogeneity than an intracavitary implant when used as a boost for nasopharyngeal lesions, especially lesions which involve areas distant to the nasopharyngeal mucosa.

    View details for Web of Science ID A1997XB01200004

    View details for PubMedID 9169805

  • Surgical morbidity of neck dissection after chemoradiotherapy in advanced head and neck cancer Newman, J. P., Terris, D. J., Pinto, H. A., Fee, W. E., Goode, R. L., Goffinet, D. R. ANNALS PUBL CO. 1997: 117-122

    Abstract

    The use of chemotherapy and irradiation for organ preservation attempts to eliminate the need for extensive surgery in patients with advanced squamous cell carcinoma of the head and neck (SCCHN). We sought to characterize the morbidity of surgery in patients who needed surgery after treatment with induction chemotherapy followed by simultaneous chemotherapy and radiotherapy (chemoradiotherapy). The surgical morbidity within the first 30 postoperative days of 17 patients treated in an organ preservation approach between July 1991 and December 1994 was compared with a control group of patients undergoing similar surgical procedures during the same period. The organ preservation study patients underwent surgical procedures consisting of 18 neck dissections and 5 resections of the primary site. Six patients in the organ preservation study group experienced 8 surgical complications within the first 30 postoperative days, and most complications were minor. There was no significant difference in the duration of surgery or length of hospitalization between study patients and matched controls. Our surgical complication rate (35.3%) was higher but not statistically different from that of the control group, and compared favorably to reports of surgical morbidity (44% to 61%) in the literature on patients treated with chemoradiotherapy. The lower complication rate seen in this study may be a reflection of early surgical intervention as part of our organ preservation study scheme, the preponderance of neck dissections performed, and the limited number of pharyngeal procedures performed.

    View details for Web of Science ID A1997WH40500005

    View details for PubMedID 9041815

  • LONG-TERM SURVIVAL AFTER SURGICAL RESECTION FOR RECURRENT NASOPHARYNGEAL CANCER AFTER RADIOTHERAPY FAILURE Fee, W. E., Roberson, J. B., Goffinet, D. R. AMER MEDICAL ASSOC. 1991: 1233-1236

    Abstract

    Results are reported of transpalatal, transcervical, and transmaxillary resection in 15 patients with recurrent nasopharyngeal cancer after failure of primary radiotherapy. Seven patients treated for cure have been followed up for more than 3 years (mean, 55 months; range, 40 to 82 months), with three (43%) remaining free of disease. Two patients are living with local disease (59 and 40 months postoperatively), while two have died of their local and regional recurrence (40 and 17 months postoperatively). Two additional patients underwent nasopharyngectomy for palliation. One of these patients died of uncontrolled disease 12 months postoperatively; the other remains alive with disease 70 months after resection. Six patients have been followed up for less than 3 years (mean, 22.3 months; range, 16 to 32 months). Of this group, one (17%) is without evidence of disease, four are living with local disease (13, 16, 17, and 27 months postoperatively), and one has died of disease (13 months postoperatively). Recurrence (10 of 13 patients) has occurred an average of 8 months after surgery (range, 4 to 17 months). Complications include transient marginal mandibular nerve weakness (one), permanent cranial nerve paralysis (two), nasopharyngitis and/or osteomyelitis of the cervical vertebrae or base of skull requiring intravenous antibiotics (two), aspiration pneumonia (two), prolonged nasogastric tube feeding (two), and intraoperative thyroid storm (one). No cerbrospinal fluid leaks or perioperative deaths occurred. The long-term cure rate and disease-free interval of transpalatal nasopharyngectomy lead us to believe that this technique is probably only slightly better than reirradiation in the appropriately selected patient.

    View details for Web of Science ID A1991GN85300006

    View details for PubMedID 1747224

  • COMPARISON OF ESOPHAGOGRAPHY AND ESOPHAGEAL ENDOSCOPY IN DETECTING SYNCHRONOUS ESOPHAGEAL-CARCINOMA IN PATIENTS WITH HEAD AND NECK SQUAMOUS-CELL CARCINOMA NINOMURCIA, M., Vincent, M. E., Vaughan, C., Fee, W. E., Goode, R. L., Robbins, A. H., ZBORALSKE, F. F. LIPPINCOTT-RAVEN PUBL. 1988: S54-S54

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