High Critical Current Density in the Textured Nanofiber Structure in Multifilament MgB2 Wires Made by the Powder-In-Tube (PIT) Technique

We show that the structure of multifilament MgB₂ wires made by the powder-in-tube (PIT) method can be texturized by annealing the structure under high isostatic pressure. Our results show that we obtained continuous fibers with a uniform diameter of 250 nm in all 36 filaments, a small grain size of approximately 50 nm and a high density of the superconducting material. These results contribute to a significant improvement in the critical current density in high magnetic fields, e.g., 100 A/mm² at 14 T and 4.2 K.

Data supporting the results of the characterization of the phases and structures appearing during the synthesis process of Ba0.5Sr1.5Zn2-xNixFe12O22 by auto-combustion

The data presented has to do with identifying the various phases arising during the synthesis of the Y-type hexaferrite series Ba_0.5Sr_1.5Zn_2-xNi_xFe₁₂O₂₂ by auto-combustion that we deem important for their microstructural and magnetic properties. The data and the related analyses support the research paper "Ni-substitution effect on the properties of Ba_0.5Sr_1.5Zn_2-xNi_xFe₁₂O₂₂ powders" [1]. Thus, the parameters are presented of the phases appearing after auto-combustion and after the initial annealing at 800 °C, namely, crystal cell and crystallite size. Also, additional data are provided obtained by EDS concerning the Ba:Sr:Zn:Ni:Fe ratio in Ba_0.5Sr_1.5Zn_2-xNi_xFe₁₂O₂₂ (x = 0.8, 1, 1.5) samples synthesized at 1170 °C for 10 h. The data can be used as a reference in establishing how the phases distinguished during the initial process of auto-combustion affect the Ba_0.5Sr_1.5Zn_2-xNi_xFe₁₂O₂₂ powders, which are candidates for room-temperature multiferroic materials. The data have not been published previously and are made available to permit critical or further analyses.

Structural, Magnetic and Microwave Characterization of Polycrystalline Z-Type Sr3Co2Fe24O41 Hexaferrite

We report results on the structural and microwave properties and magnetic phase transitions in polycrystalline Sr₃Co₂Fe₂₄O₄₁ hexaferrite synthesized by sol-gel auto-combustion and acting as a filler in a composite microwave absorbing material. The zero-field-cooled (ZFC) and field-cooled (FC) magnetization curves revealed a change in the magnetization behavior at 293 K. The reflection losses in the 1-20 GHz range of the Sr₃Co₂Fe₂₄O₄₁ powder dispersed homogeneously in a polymer matrix of silicon rubber were investigated in both the absence and presence of a magnetic field. In the latter case, a dramatic rise in the attenuation was observed. The microwave reflection losses reached the maximum value of 32.63 dB at 17.29 GHz in the Ku-band. The sensitivity of the microwave properties of the composite material to the external magnetic field was manifested by the appearance of new reflection losses maxima. At a fixed thickness t_m of the composite, the attenuation peak frequency can be adjusted to a certain value either by changing the filling density or by applying an external magnetic field.

Study of the Structural and Magnetic Properties of Co-Substituted Ba2Mg2Fe12O22 Hexaferrites Synthesized by Sonochemical Co-Precipitation

Ba₂Mg_0.4Co_1.6Fe₁₂O₂₂ was prepared in powder form by sonochemical co-precipitation and examined by X-ray diffraction, Mössbauer spectroscopy and magnetization measurements. Careful XRD data analyses revealed the Y-type hexaferrite structure as an almost pure phase with a very small amount of CoFe₂O₄ as an impurity phase (about 1.4%). No substantial changes were observed in the unit cell parameters of Ba₂Mg_0.4Co_1.6Fe₁₂O₂₂ in comparison with the unsubstituted compound. The Mössbauer parameters for Ba₂Mg_0.4Co_1.6Fe₁₂O₂₂ were close to those previously found (within the limits of uncertainty) for undoped Ba₂Mg₂Fe₁₂O₂₂. Isomer shifts (0.27-0.38 mm/s) typical for high-spin Fe³⁺ in various environments were evaluated and no ferrous Fe²⁺ form was observed. However, despite the indicated lack of changes in the iron oxidation state, the cationic substitution resulted in a significant increase in the magnetization and in a modification of the thermomagnetic curves. The magnetization values at 50 kOe were 34.5 emu/g at 4.2 K and 30.5 emu/g at 300 K. The zero-field-cooled (ZFC) and field-cooled (FC) magnetization curves were measured in magnetic fields of 50 Oe, 100 Oe, 500 Oe and 1000 Oe, and revealed the presence of two magnetic phase transitions. Both transitions are shifted to higher temperatures compared to the undoped compound, while the ferrimagnetic arrangement at room temperature is transformed to a helical spin order at about 195 K, which is considered to be a prerequisite for the material to exhibit multiferroic properties.

Observation of superconductivity in the intermetallic compound β-IrSn4

Low-temperature dc-magnetization, ac electrical resistivity and specific heat measurements were performed on single crystals of the intermetallic compound β-IrSn4. The compound crystallizes in the tetragonal MoSn4-type structure (space group I41/acd) and exhibits superconductivity below Tc = 0.9 ± 0.05 K. Further, the magnitude of the ratios ΔCp/(γnkBTc) = 1.29, 2Δ/(kBTc) = 3.55 and of the electron-phonon coupling λ[overline](e-ph) = 0.5 imply that superconductivity in β-IrSn4 can be ascribed to a s-wave weak coupling regime. We determined crucial thermodynamic characteristics of the superconducting state. It turned out that depending on the assumption of either a spherical or non-spherical Fermi surface, the superconductivity can be ascribed to either a type-I and type-II/1 or type-II in clean limit, respectively. However, the behavior of the upper critical field and the anisotropic crystalline structure of the studied compound provide strong support to the type-II superconductivity. In the normal state the resistivity exhibits a prominent quadratic temperature dependence, which together with a large Kadowaki-Woods ratio and with the enhanced effective mass indicate that the electrons in β-IrSn4 are strongly correlated.

The role of positron emission tomography in occult primary head and neck cancers

PURPOSE

To evaluate the utility of positron emission tomography (PET) fluorodeoxyglucose (FDG) imaging in the workup of unknown primary head and neck tumors.

METHODS

Fourteen patients with squamous cell carcinoma of cervical lymph node metastasis of unknown primary origin (clinical stage N2-N3) were studied prospectively. The patients underwent conventional workup, including physical examination, computed tomography, and random biopsies of the potentially suspected sites. If no primary site was found, 8 to 13 mCi of FDG was given intravenously, and whole-body scans with standardized uptake values were obtained. The results of FDG-PET imaging were compared with clinical, CT, and histopathologic findings. To eliminate bias, PET scans were reviewed by nuclear medicine physicians who had no previous knowledge of the other findings.

RESULTS

PET identified the location of primary tumor in three patients: lung hilum, base of tongue, and pyriform sinus. These lesions were pathologically confirmed. All these primary sites were not visualized on CT or physical examination, except for a pyriform sinus lesion, which was seen on CT, but initial biopsy result was negative. In one patient, the initial PET did not identify a primary tumor, but a nasopharyngeal carcinoma was identified in post-radiation therapy follow-up PET. In the remaining nine patients, a primary lesion was never found. All cervical lymph nodes detected by CT were identified by PET.

DISCUSSION

A previously unknown primary tumor can be identified with FDG-PET in about 21% of the patients in our prospective series. PET can be of value in guiding endoscopic biopsies for histologic diagnosis and treatment options.

An early comparison between endoscopic ultrasound-guided fine-needle aspiration and mediastinoscopy for diagnosis of mediastinal malignancy

Precise mediastinal lymph node staging is essential in non-small cell lung cancer for proper evaluation and treatment. In addition to CT, mediastinoscopy is routinely used for staging and diagnosis of mediastinal malignancy. Recently, endoscopic ultrasound (EUS) combined with fine-needle aspiration (FNA) biopsy has been used to evaluate mediastinal disease. The purpose of this study was to assess and compare mediastinoscopy with EUS/FNA in the evaluation of mediastinal masses. From August 1995 to July 1997, 21 patients with suspected mediastinal malignancy underwent cervical mediastinoscopy with biopsy. During this same period, seven patients with suspected mediastinal malignancy were evaluated using EUS/FNA. All patients were retrospectively studied. Both mediastinoscopy and EUS/FNA were highly sensitive in diagnosing mediastinal malignancy (100% and 86%, respectively). Specificity and positive predictive value were 100 per cent for both procedures. Mediastinoscopy and EUS/FNA are highly accurate methods of staging mediastinal malignancy. Mediastinoscopy provides better access to the upper and anterior mediastinum, whereas EUS/FNA can safely be used to biopsy subcarinal and posterior mediastinal masses. Mediastinoscopy and EUS/FNA target different areas of the mediastinum and may be complimentary in the evaluation of mediastinal malignancy and staging of bronchogenic carcinoma.

Protection of platelet glycoprotein IIb/IIIa receptor complex preserves platelet function during in vitro ventricular assisted circulation

Platelet dysfunction probably contributes to bleeding associated with ventricular assist devices (VADs). Previous evidence suggests that VAD associated platelet dysfunction may be due to dysfunction of the platelet fibrinogen receptor. The purpose of this investigation was to test the hypothesis that selective protection of platelet fibrinogen receptor preserves platelet aggregating ability during in vitro ventricular assisted circulation. Eight in vitro nonpulsatile centrifugal VAD circuits were simulated for four days using 450 ml of fresh human whole blood. Temperature, activated clotting time, pH, PCO2, PO2, Ca2+, and glucose were maintained at physiologic values. Flow was maintained at a constant 2.0 L/min/m2. We examined whole blood platelet aggregation induced by ristocetin, collagen, and adenosine diphosphate (ADP). We added a highly specific reversible inhibitor (MK-383) of the glycoprotein (GP) IIb/IIIa receptor complex before start of circulation to the final four VAD experiments. ADP induced aggregation decreased within the first hour of circulation. Ristocetin and collagen induced aggregation decreased to negligible levels after 10 hours of circulation. With MK-383, ristocetin induced aggregation was preserved. Addition of MK-383 did not alter the decrease of ADP and collagen induced aggregation. These results suggest platelet aggregating ability is maintained with protection of the platelet fibrinogen receptor during in vitro ventricular assisted circulation.

Concomitant pilocarpine during head and neck irradiation is associated with decreased posttreatment xerostomia

PURPOSE

To retrospectively compare subjective postirradiation xerostomia scores of patients who received concomitant oral pilocarpine during radiotherapy for head and neck cancer and 3 months thereafter with those of similar cohorts who did not receive pilocarpine.

METHODS AND MATERIALS

Subjective xerostomia was assessed using a visual analog scale xerostomia questionnaire that measured oral dryness, oral comfort, difficulty with sleep, speech, and eating. The concomitant pilocarpine group had both parotid glands in the initial field treated to at least 45 Gy and received 5 mg pilocarpine hydrochloride four times per day (q.i.d.) beginning on the first day of radiotherapy and continuing for 3 months after completion of radiation. The control cohort had also received at least 45 Gy to both parotid glands and had not received pilocarpine at the time of evaluation. Scores on the visual analog scale were averaged and compared using the Student's t-test.

RESULTS

Seventeen patients who received concomitant pilocarpine during head and neck irradiation and 18 patients who had not been treated with pilocarpine were available for follow-up. The mean intervals between completion of radiation and evaluation of xerostomia were 17 months and 16 months, respectively. Only one of the pilocarpine-treated patients was still taking pilocarpine at the time of evaluation. For each of the individual components of xerostomia scored on the visual analog scale, as well as the composite of all components, the group that had received oral pilocarpine during radiation had significantly less xerostomia (p < 0.01 for each).

CONCLUSIONS

The use of 5 mg oral pilocarpine q.i.d. during radiotherapy for head and neck cancer and 3 months thereafter was associated with significantly less subjective xerostomia than that reported by a similar cohort of patients who had not received pilocarpine. The continued use of pilocarpine does not appear to be necessary to maintain this benefit in most patients.

Angiosarcoma. A report of 67 patients and a review of the literature

BACKGROUND

Angiosarcomas (AS) are rare, aggressive tumors. Optimal treatment has not been well defined. The authors undertook a retrospective review of patients seen at their institution with the intent of identifying prognostic factors and optimal treatment strategies.

METHODS

Between 1955 and 1990, 67 patients with AS were seen at the University of California, at Los Angeles Medical Center. Follow-up ranged from 1 to 173 months with a median of 30 months.

RESULTS

The overall prognosis was poor. The actuarial 2- and 5-year disease free survivals (DFS) were 44% and 24%, respectively. Of 52 recurrences after primary treatment, 81% (42 of 52) had a component of local failure. Twenty-eight patients had developed distant metastases at last follow-up. Of patients who received surgery (S) and radiation therapy (RT), with or without chemotherapy (CT), 5-year actuarial DFS was 43%, compared with 17% for patients who underwent S +/- CT as initial treatment (P = 0.03). Only 9% of patients (1 of 11) treated with RT +/- CT were rendered free of disease.

CONCLUSIONS

Patients with AS usually present with high grade histology, and with multifocal disease. There is a propensity for both local recurrence and distant metastases. Our results and a review of the literature, suggest that S plus RT offers the best chance for long term control of this aggressive tumor. The role of CT remains undefined.

Postirradiation sarcoma of the gynecologic tract. A report of 13 cases and a discussion of the risk of radiation-induced gynecologic malignancies

With improvement in survival after cancer treatment, it is becoming increasingly important to examine treatment-related morbidity and mortality. Sarcomas can develop within the irradiated field after radiation therapy (RT) for gynecologic malignancies. We undertook a study to assess the outcome after treatment of postirradiation sarcoma (PIS) of the gynecologic tract. In reviewing our data and the literature, we compare the absolute risk of PIS and other radiation-associated second malignant neoplasms (SMNs) with the mortality risk of surgery and general anesthesia. Between 1955 and 1987, 114 patients with uterine sarcomas were seen at the University of California, Los Angeles (UCLA), Medical Center. Thirteen had a prior history of RT. Conditions for which these patients received RT included choriocarcinoma (one), menorraghia (four), cervical cancer (six), and ovarian cancer (two). RT doses were known in six cases and ranged from 4,000 to 8,000 cGy. Latency time from RT to the development of PIS ranged from 3 to 30 years, with a median of 17 years. Twelve patients were treated with surgery or additional RT. Two patients remain alive 5 months and 57 months, respectively, following salvage therapy. Five-year disease-specific survival for all patients is 17%. From our data and a review of the literature, we estimate that the absolute risk of PIS with long-term follow-up ranges from 0.03 to 0.8%. Postirradiation sarcoma of the gynecologic tract is a relatively rate event associated with a poor prognosis. Mortality risks of radiation-associated SMN are similar to mortality risks of surgery and general anesthesia. Given the large number of patients with gynecologic malignancies who can be cured or palliated with RT, concern regarding radiation sarcomagenesis should not be a major factor influencing treatment decisions.

Craniopharyngioma: treatment in the CT and MR imaging era

PURPOSE

To determine optimal treatment in patients with craniopharyngiomas.

MATERIALS AND METHODS

In 1977-1990, 49 patients (age range, 3-67 years; median age, 35 years; 25 female, 24 male) with craniopharyngiomas were examined. Follow-up was 5-17 years (median, 8 years). Fifteen patients were aged younger than 18 years.

RESULTS

All patients underwent surgical resection. Complete resection was achieved in 19. Seven patients underwent additional surgery for recurrent disease. Rate of mortality due to surgical complications was 10% (n = 5). Eight patients had marked perioperative or long-term morbidity. Twenty-five patients judged to have undergone subtotal resection underwent postoperative radiation therapy (RT). RT doses were 4,600-6,287 cGy administered in fractions of 180-200-cGy/d. Actuarial 5-year progression-free survival in patients who underwent complete resection was 63% (12 of 19 patients) versus 96% (24 of 25 patients) in patients who underwent subtotal resection followed by RT (P = .04). No RT dose response was observed. Patient functional status has not been substantially affected by adjuvant RT.

CONCLUSION

RT achieves excellent tumor control after subtotal resection of craniopharyngiomas.

Pediatric sarcomas of the head and neck other than rhabdomyosarcoma

INTRODUCTION

The treatment of children with rhabdomyosarcoma (RMS) has been established in multicenter protocols. There are few data available regarding the treatment of other sarcomas in pediatric patients.

METHODS

From 1955 to 1988, a retrospective review of 33 children with sarcomas other than RMS of the head and neck was performed to identify prognostic factors and to determine optimal treatment. Grade, tumor size, and RMS grouping of the tumors were found to be of prognostic value.

RESULTS

Eighteen of 33 (54%) patients are currently disease free. Only 3 of 16 (19%) patients treated initially with surgery alone were rendered disease free. However, 6 patients were salvaged with an additional surgical procedure, yielding 9 of 16 (56%) patients disease free treated with surgery alone. Of patients receiving surgery plus radiation therapy, with or without chemotherapy, 7 of 14 (50%) have no evidence of disease.

CONCLUSION

After salvage therapy, 5-year disease-free survival was 56% (15 of 27). Unlike rhabdomyosarcoma, complete surgical extirpation is the mainstay of treatment in pediatric sarcomas other than RMS of the head and neck. Adjuvant radiation with or without chemotherapy should be administered when complete resection is not possible.

Pediatric rhabdomyosarcoma of the head and neck

The optimal treatment for most patients with pediatric rhabdomyosarcoma (RMS) of the head and neck has been shown to be a combination of surgery, chemotherapy and radiation therapy. A retrospective review of patients seen at our institution is presented to analyze the impact of multimodality treatment on survival in 32 pediatric RMS patients. Sixty-five percent (21/32) of the patients were disease free at the most recent follow-up. The 5 year disease free survival was 57% (17/30). Combined modality treatment in 25 patients consisting of chemotherapy, radiation therapy and surgical resection (in 5 patients) rendered 18 (72%) patients free of disease. Only 1 of 7 (14%) patients who underwent surgery alone as primary management was cured. Two of these 7 patients were salvaged, both with combined modality treatment. The Intergroup Rhabdomyosarcoma Study (IRS) protocols have resulted in increased survival in pediatric patients with RMS of the head and neck. Our results reflect the significant improvement since the IRS study was completed.

Postirradiation sarcomas. A single-institution study and review of the literature

BACKGROUND

With improvement in survival after cancer treatment, it is becoming increasingly important to examine treatment-related morbidity and mortality. Sarcomas can develop in the irradiated field after radiation therapy (RT). The authors undertook a study to estimate the risk, and compared the risk of postirradiation sarcoma (PIS) with other treatment modalities used against cancer.

METHODS

Since 1987 the authors have reviewed the records of 1089 patients with head and neck, gynecologic, gastrointestinal, and extremity sarcomas. Of these 1089 patients, 37 had a prior history of RT.

RESULTS

Conditions for which these patients received RT included: Hodgkin's disease (2 patients), retinoblastoma (3), non-Hodgkin's lymphoma (2), acne (1), astrocytoma (1), multiple recurrent mixed parotid tumor (1), laryngeal cancer (1), papillary adenocarcinoma of the thyroid (1), bony fibrous dysplasia (1), lymphangioma (1), squamous cell carcinoma of the nasopharynx (1), Ewing's sarcoma (1), choriocarcinoma (1), menorrhagia (4), cervical cancer (6), ovarian cancer (2), breast cancer (7), and hypoplasia (1). RT doses ranged from 3000 to 12,440 cGy. Latency time from RT to the development of PIS averaged 12 years. More than 15,000 patients have received RT for various conditions at our institution since 1955.

CONCLUSIONS

From our data and a review of the literature, we estimate the risk of PIS with long-term follow-up to be 0.03-0.8%. From a review of the literature that compared mortality risks of chemotherapy, general surgery, and anesthesia, the risk of PIS appears no worse. Thus, given the large number of patients who can be cured or receive palliative treatment with RT, concern regarding PIS should not be a major factor influencing treatment decisions in patients with cancer.

Mucosal melanoma of the head and neck: the impact of local control on survival

The management for mucosal melanoma of the head and neck is controversial in view of the poor prognosis. Thirty-five patients seen from 1955 to 1991 were analyzed retrospectively. Almost all (34/35) presented with localized disease. Primary treatments included radical surgery (15), local resection (11), radiation therapy (6), or systemic treatment (2). While the rate of local recurrence was high (27/34), only 5 patients developed distant disease before local relapse. Furthermore, only 5/21 achieved successful local salvage. Patients with their disease controlled locally had significantly longer survival than those with persistent local disease (P = .0001). The 5-year disease-specific survival was 45%. The authors conclude that mucosal melanoma of the head and neck is not necessarily incurable. When local control is achieved, survival rate is significantly improved. Aggressive local treatments should be initiated at presentation of this disease.

Angiosarcoma of the head and neck. The UCLA experience 1955 through 1990

Between 1955 and 1990, 28 patients with angiosarcoma of the head and neck were seen at UCLA Medical Center, Los Angeles, Calif. Half the lesions arose on the scalp; the remainder occurred in the soft tissues of the face and neck. Nine patients presented with multifocal disease. Follow-up ranged from 3 to 159 months, with a median of 32 months. The overall prognosis was poor, with a 5-year disease-free survival of 26% (7/27 patients). Of 21 patients having recurrences after primary treatment, 90% (19/21 patients) had a component of local failure. Distant metastasis had developed in nine patients at last follow-up. Of patients treated initially with surgery alone, 8% (1/12 patients) remain disease free vs 67% (4/6 patients) who received postoperative radiation therapy, with or without chemotherapy. Only one (14%) of seven patients treated primarily with radiation therapy with or without chemotherapy was rendered disease free. Angiosarcoma usually presents with high-grade histologic features and frequently with multifocal disease. There is propensity for both local recurrence and distant metastasis. Our results and a review of the literature suggest that combined modality therapy offers the best chance for long-term control in patients with angiosarcoma of the head and neck.

Postirradiation sarcoma of the head and neck

BACKGROUND

With improvement in survival after cancer treatment, it is becoming increasingly important to study treatment-related morbidity and mortality. Sarcoma can develop in the irradiated field after radiation therapy. The authors performed a study to estimate the risk, and compared the risk of sarcoma after radiation therapy with that of other treatment modalities used against cancer.

METHODS

Between 1955 and 1988, 229 patients with sarcoma of the head and neck were seen at the University of California, Los Angeles (UCLA), Medical Center. Of these, 13 (6%) had a previous history of radiation therapy to the head and neck.

RESULTS

Radiation doses were known in 10 of 13 patients and ranged from 30 to 124.4 Gy. The latency time from radiation therapy to the development of postirradiation sarcoma (PIS) ranged from 3 months to 50 years, with a median of 12 years. More than 2000 patients have received radiation therapy to the head and neck for various conditions at the UCLA Medical Center since 1955.

CONCLUSIONS

The authors conclude that most head and neck sarcomas are not radiation related and that the risk of PIS after head and neck irradiation for other diseases is low. From a review of the literature comparing mortality risks of chemotherapy, general surgery, and anesthesia, the risk of PIS appears no worse. Given the large number of patients who can be cured or receive palliation with radiation therapy, concern about PIS should not be a major factor influencing treatment decisions in patients with cancer.

Postirradiation sarcoma of the head and neck

BACKGROUND

With improvement in survival after cancer treatment, it is becoming increasingly important to study treatment-related morbidity and mortality. Sarcoma can develop in the irradiated field after radiation therapy. The authors performed a study to estimate the risk, and compared the risk of sarcoma after radiation therapy with that of other treatment modalities used against cancer.

METHODS

Between 1955 and 1988, 229 patients with sarcoma of the head and neck were seen at the University of California, Los Angeles (UCLA), Medical Center. Of these, 13 (6%) had a previous history of radiation therapy to the head and neck.

RESULTS

Radiation doses were known in 10 of 13 patients and ranged from 30 to 124.4 Gy. The latency time from radiation therapy to the development of postirradiation sarcoma (PIS) ranged from 3 months to 50 years, with a median of 12 years. More than 2000 patients have received radiation therapy to the head and neck for various conditions at the UCLA Medical Center since 1955.

CONCLUSIONS

The authors conclude that most head and neck sarcomas are not radiation related and that the risk of PIS after head and neck irradiation for other diseases is low. From a review of the literature comparing mortality risks of chemotherapy, general surgery, and anesthesia, the risk of PIS appears no worse. Given the large number of patients who can be cured or receive palliation with radiation therapy, concern about PIS should not be a major factor influencing treatment decisions in patients with cancer.

Dermatofibrosarcoma protuberans of the head and neck. A report of 16 cases

Dermatofibrosarcoma protuberans of the head and neck is a rare neoplasm. Overall, sarcomas account for less than 1% of all head and neck malignancies. Of 229 patients with sarcomas of the head and neck seen at our institution between 1955 and 1988, 14 (7%) were assigned the diagnosis of dermatofibrosarcoma protuberans after pathologic review. Two additional cases have been seen since 1988, bringing the total to 16. All cases were low-grade lesions. Follow-up ranged from 36 to 198 months, with a median of 114 months. Fifteen patients were managed with surgery alone, and nine (60%) developed local recurrence. Eight were salvaged with further surgery. There were no regional lymph node recurrences or distant metastases. One patient was judged to be a poor surgical candidate and received primary radiation therapy. He died disease free 3 years after treatment. At last follow-up, 15 (94%) of 16 patients were ultimately disease free after salvage treatment. The overall 5-year survival rate was 93% (13/14). We conclude from this series, and from a review of the literature, that wide surgical resection achieving good margins offers excellent probability of cure, and that radiation therapy is a reasonable alternative in patients who have unresectable lesions or who are medically inoperable.

Chondrosarcoma of the head and neck. The UCLA experience, 1955-1988

Chondrosarcoma of the head and neck is a rare tumor. In an attempt to clarify optimal treatment of these lesions, we reviewed the records and pathologic material of 18 consecutive cases of head and neck chondrosarcoma seen at our institution between 1955 and 1988. Follow-up ranged from 3 to 168 months with a median of 72. Absolute 5-year survival was 68% (11/16), with 9/16 (56%) patients surviving disease-free. Grade was the most important prognostic factor. Only one of 7 (14%) patients known to have high grade histology was rendered disease-free, as opposed to 9/10 (90%) with low-grade lesions. Tumor size and completeness of surgical resection were also important prognostic factors. Four of 10 patients managed initially with surgery alone achieved local control with greater than 5-year survival. All four had low-grade lesions. Five patients received surgery and radiation as primary treatment, and three are disease-free with greater than 5-year follow-up. Two of these were irradiated because of positive margins. One patient received radiation alone and has persistent disease. Two patients received combined chemotherapy and surgery because of high-grade lesions, and one is free of disease with greater than 5-year follow-up. Patients with incomplete resections should receive further surgery or postoperative radiation therapy. High-grade lesions should be treated aggressively.

Management of oligodendrogliomas

To define optimum treatment and delineate recurrence patterns and prognostic factors in oligodendrogliomas, the authors reviewed the records of 49 patients who received treatment for these rare tumors between 1957 and 1990; 41 patients had at least 5 years follow-up. Age, race, gender, performance of computed tomography (CT), tumor location and grade, histologic findings, calcifications, surgery with or without postoperative radiation therapy, and the doses and fields used in radiation therapy were evaluate for prognostic relevance by means of chi 2 and Wilcoxon log-rank tests. Metaanalysis of relevant literature was also performed. Actuarial survival at 5, 10, and 15 years was 61%, 41%, and 24%, respectively. The pattern of recurrence was predominantly local alone (30 of 31 patients [97%] with recurrence). Age younger than 40 years, low-grade tumor, calcifications, and performance of CT were statistically significant prognostic factors. A trend existed toward improved 5-year survival in patients who underwent postoperative radiation therapy (P = .067); at stratification for subtotal resection, this improvement became significant (74% vs 25%, P = .019). Metaanalysis demonstrated a survival advantage for surgery with radiation therapy versus surgery only (56% vs 42%, P < .01).

Minor salivary gland tumors of the head and neck: treatment strategies and prognosis

Between 1961 and 1985, 117 patients with malignant tumors of the minor salivary glands of the upper aerodigestive tract were treated with curative intent at the University of California, Los Angeles (UCLA). The length of follow-up ranged from 24-225 months, with a median of 38 months. The most common site of origin was the oral cavity (65 cases), and the most common histology was adenoid cystic carcinoma (69 cases). Tumor size, histology, and site were important prognostic factors. For oral cavity lesions, small tumors were well controlled with resection alone (25 of 26) or local excision, followed by irradiation (7 of 7). For advanced tumors arising from the paranasal sinuses and pharynx, the control rates were 43% (15 of 35) and 29% (5 of 17), respectively. Ninety-three percent (27 of 29) of patients with mucoepidermoid carcinoma had no evidence of disease at last follow-up versus 55% (38 of 69) of patients with adenoid cystic carcinoma and 56% (10 of 18) of those with adenocarcinoma. It appears that resection with good margin is adequate treatment for small lesions. Large, poorly differentiated tumors require a combined approach: surgery and radiation therapy.

Nasopharyngeal carcinoma: treatment results with primary radiation therapy

One hundred three patients with nasopharyngeal carcinoma were treated with radiotherapy at UCLA Medical Center from January 1955 to December 1990. Overall survival, disease-free survival, and local control rates were analyzed. In addition, survival from 1955 to 1978 and from 1979 to 1990 were evaluated. Overall 5- and 10-year actuarial survival rates for all patients were 58% and 47%, respectively. Disease-free survival rates at 3 and 5 years were 45% and 30%, respectively. Local, persistent, or recurrent disease in the nasopharynx was the primary cause of failure, occurring in 32% of patients and correlating with the initial tumor size (T stage). Twenty-four percent of patients developed distant metastases, which correlated with nodal status but not with T stage. Seventy-nine percent of patients failed either locally or distally by 4 years. Sex, race, age, and T and N stage categories were evaluated as prognostic variables in terms of survival. Control of primary disease is important in determining long-term outcome. Modern imaging techniques have greatly assisted in the evaluation of disease extent and treatment options.

Sarcomas of the head and neck. Prognostic factors and treatment strategies

The authors reviewed 164 cases of head and neck sarcoma from adult patients seen at the University of California, Los Angeles (UCLA), between 1955 and 1988. The median follow-up was 70 months. Multivariate analysis demonstrated that tumor grade, size, and surgical margin status were the most important independent prognostic factors. Thirty-one percent (27 of 85) of patients with high-grade lesions were free of disease versus 81% (44 of 55) with low-grade lesions at last follow-up. Sixty-seven percent (50 of 76) of patients with lesions smaller than 5 cm were free of disease versus 38% (33 of 88) with lesions larger than 5 cm. In 16 patients, low-grade lesions, measuring less than 5 cm and with negative margins histologically, were controlled with surgery alone. For the 94 patients whose primary tumors were treated at UCLA, local control was achieved in 52% (26 of 50) of patients treated with surgery alone and 90% (20 of 22) with combined therapy (surgery and radiation therapy [RT] with or without chemotherapy). Seventy-five percent (6 of 8) of patients with positive surgical margins treated with postoperative RT achieved local control versus 26% (5 of 19) of patients receiving no additional treatment. In conclusion, surgery alone appears to be adequate treatment for small, low-grade tumors and negative surgical margins. Patients with incomplete resection or high-grade tumors should receive aggressive treatment--surgery and RT.

Primary non-Hodgkin's lymphomas of the paranasal sinuses and nasal cavity. A report of 18 cases with stage IE disease

During a 26-year period (1961-1987), a total of 18 patients with primary non-Hodgkin's lymphoma (NHL) of the paranasal sinuses and nasal cavity received radiation therapy at (University of California at Los Angeles) UCLA Medical Center. At the time of diagnosis and using the available diagnostic methods, none of these patients had clinically detectable disease beyond the paranasal sinuses. All 18 patients were staged IE by the Ann-Arbor system. When the patients were staged according to the AJC staging system from epithelial tumors, half presented with advanced T3-4 disease. Diffuse histiocytic lymphoma was the most common histology (eight cases) and maxillary sinus, the most common site of origin (11 cases). All nine T1-2 tumors received radiation therapy alone, while radiation and chemotherapy was used in seven of nine advanced T3-4 staged tumors. The mean follow-up was 71 months. At last follow-up, eight of nine T1-2 patients were rendered disease-free. In contrast, only four of nine T3-4 patients had long-term disease-free survival. Seventy-five percent of the failure occurred within 2 years. Radiation therapy alone achieves high local control in small tumors (T1-2), while large tumors (T3-4) require aggressive combined treatment, i.e., radiation and chemotherapy.

Testicular seminoma. A study of 103 cases treated at UCLA

The records of all patients treated at UCLA with stage I through stage III testicular seminoma, diagnosed in 1956-1983, were reviewed. Histologic subtype, therapeutic protocol, survival, and the incidence of subsequent primary malignancies are examined in this presentation. The 10 year cause-specific survival is 93% for stage I and 70% for stage II patients. Of the four patients initially seen with stage III disease, three have achieved long-term disease-free survival after combined irradiation and chemotherapy. Irradiation of the whole pelvis was not associated with improved control for those patients with previous pelvic surgery. Four patients complained of gynecomastia after therapy, and since none of these patients had elevated human chorionic gonadotropin levels, the gynecomastia was attributed to gonadal failure.

The role of radiation therapy in squamous cell carcinoma of the upper aerodigestive tract with positive surgical margins

One hundred four patients with squamous cell carcinoma of the upper aerodigestive tract and with histologically positive surgical margins were evaluated for this historically controlled study to determine the efficacy of postoperative radiation therapy. Positive margins were defined as the presence of one or more of the following: carcinoma in situ, tumor within 0.5 cm from the surgical margins, microscopic disease, or dysplasia. Patients received either surgery alone (44 cases) or surgery plus postoperative radiation therapy (60 cases) and were followed for a minimum of 2 years. Treatment strategies, stage by stage, were similar for all patients. Surgery varied from simple excision in T1 to composite resection and/or laryngopharyngectomy with radical neck dissection in advanced cases. Radiation therapy was given postoperatively with doses ranging from 4,500 to 7,500 cGy. The overall 2-year survival rate with no evidence of disease (NED) was consistently higher in the surgery plus radiation therapy group. Furthermore, when the subgroup of patients who had dysplasia at the surgical margins was excluded from the analysis, the 2-year NED survival rate difference became statistically significant (p = 0.05). This outcome favored combined therapy (36 of 58 patients) over surgery alone (13 of 32 patients). This favorable result was obtained despite the high percentage of T3-T4 stages (79 vs. 21%) and clinically positive lymph nodes (83 vs. 17%) in patients who had received postoperative radiation therapy. The significance of dysplasia at the surgical margins and the impact of radiation therapy on the tumor and nodal control in this group of patients needs further clarification.