The use of planned neck dissection (ND) in patients with advanced nodal disease in head and neck squamous cell carcinoma (HNSCC) after treatment with chemoradiotherapy is controversial. The purpose of this study is to clarify the role for neck dissection in patients treated with combined chemoradiotherapy (CRT) on 2 similar organ preservation protocols at our institution. The records of 90 patients with N2-N3 neck nodes who were treated between 1991 and 2001 at Stanford University on two organ preservation CRT protocols (OSP2 and OSP3) were reviewed. All patients received 2 cycles of cisplatin and 5-Fluorouracil (5-FU) induction chemotherapy, followed by concurrent CRT with similar chemotherapeutic agents. Patients on OSP3 were randomized to receive either CRT alone versus CRT and Tirapazamine for 8 doses. Radiotherapy was delivered at conventional fractionation at 2 Gy/fraction to a total dose of 66–70 Gy to the gross target volume. Patients with persistent neck nodes either clinically or radiographically at a planned evaluation at 50 Gy proceeded to a neck dissection following completion of CRT. Patients treated on the OSP3 protocol (n = 54) also received a single dose of 5 Gy delivered via 9–16 MeV electrons to the largest nodal mass prior to treatment for the comet study. The median follow up was 3.6 years. Overall, 63% (n = 57) of the patients attained a clinical complete response (cCR) in the neck; of these, 8 patients had a ND and all 8 had a pathologic complete response (pCR). Of the remaining 49 cCR patients whose necks were observed, 13 relapsed and 2 had a neck relapse without a recurrence at the primary site (1 with an isolated neck recurrence, 1 with a neck and distant failure). Of the 33 patients (37%) with < cCR in the neck, 2 had progressive disease and died. The remaining 31 patients had NDs with a pCR rate of 52% (n = 16). Outcomes of the 3 groups: (1) cCR, (2) < cCR/pCR and (3) < cCR/< pCR are summarized in table 1. The cCR rates were similar for the 2 OSP protocols (61% and 65%). There was a trend for higher pCR rate patients who underwent ND in OSP3 group (58% vs. 42%, p = 0.3, χ2 Test) Based on our experience, in patients with N2-N3 neck nodes who have achieved a clinical and radiographic cCR in the neck following CRT, planned ND benefited only 4% (2/49) and is therefore not routinely recommended. Patients with a

of the 41st Annual ASTRO Meeting 273 differentiate between benign post therapy fibrosis or recurrence.This study is testing the value of PET scan in early detection of recurrent nasopharyngeal cancer.

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.

Intra-operative 125I seed implants of the pterygo-palatine fossa and/or base skull region were performed in 15 patients at Stanford between 1976 and 1980. Local control was obtained in the implanted volume in 6 of the 10 previously untreated patients and in 4 of 5 of those who were treated with combined resection and seed implantation after local recurrences. The technique of base skull implantation, the low incidence of complications from this procedure and the dosimetric methods are discussed.

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.

The use of absorbable Vicryl sutures containing 125 Iodine seeds intra-operatively as an adjuvant to surgery and external beam radiotherapy is an attractive technique for implanting patients with locally advanced cancer.

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)

A modified after-loading method of interstitial tonsillo-palatine implantation using 192Ir ribbons is described. Removal of the ribbons is simplified by attaching sutures to the metallic clips which maintain the position of the implant. By this safe and apparently effective technique, increased doses of radiation can be delivered to oropharyngeal cancers after external beam radiotherapy. At the same time, radiation injury to the adjacent normal tissues can be minimized, since they receive only a negligible additional dose of radiation from the interstitial implant.