SURGICAL ONCOLOGY

During the past year, clinical activity within the department has increased particularly with more emphasis on the outpatient and same day surgery program. The department continues to work closely with the network hospitals in accruing patients to clinical protocols and providing the interaction necessary to promote state of the art cancer care in the community hospital setting. The concept of the multi-modality management of cancer is now firmly practiced in all the surgical clinics where patients can be evaluated by surgery, radiation therapy, and medical oncology in a single clinical setting.

The department holds outpatient clinics in all aspects of surgical oncology, including gastrointestinal cancers with emphasis on pancreatic and colorectal, breast, gynecologic, genitourinary, thoracic, bone & soft tissue tumors, skin cancers, head and neck cancers, and plastic reconstruction. Active participation in both institutional and cooperative group clinical research has resulted in trials for: 1) locally advanced rectal cancer employing a combination of preoperative infusional chemotherapy and hyperfracted radiation with sphincter sparing surgery, 2) a new neoadjuvant pancreatic cancer protocol employing escalating doses of chemotherapy and radiation prior to surgery, 3) a new intravesical chemotherapeutic agent for the treatment of refractory, high-grade carcinoma in situ of the bladder, 4) a new phase II trial of high dose chemotherapy and stem cell rescue followed by surgery for patients with locally advanced lung cancer, and 5) novel molecular studies of pre-invasive breast cancers with tissue obtained by stereotactic techniques.

We have helped generating national protocols in the treatment of pancreatic, liver and rectal cancer. Current national studies include RTOG 9704, which is a phase III Trial of postresectional Gemcitabine versus continuous infusion of 5-Fluorouracil (5FU), and the Intergroup study of intrahepatic 5-fluoro-2'-deoxyuridine (FUDR) versus systemic 5FU for patients with unresectable liver metastases from colorectal carcinoma.

Lilly protocol JHEM, a Phase I Trial of Preoperative Gemcitabine and Radiotherapy and Postoperative Maintenance Gemcitabine in the Treatment of Pancreatic Cancer, continues to accrue patients as the maximal tolerable dose (MTD) has not yet been reached. This is a collaborative effort with the University of Michigan and Ellis Fischel Cancer Centers. Fox Chase has entered 20 of the 21 patients entered into the trial to date; 15 patients have had resections and one patient is awaiting surgery. The current dose level is 700 mg/m² given over 30 minutes weekly during the radiation therapy (5040 cGy in 180 cGy fractions over 28 days). There are two other aspects of the trial: 1) a correlation of pre and postoperative Ki67 in the biopsy and resected tumors with responses to chemoradiotherapy and survival, and 2) a histologic comparison of the resected tumors with those treated by prior Fox Chase protocols using 5-FU and Mitomycin C. We continue to collaborate with Drs. Cooper and Young to discover histologic correlates of response to chemoradiotherapy in order to compare various treatment programs.

We also continue to register patients with gastric, periampullary, gallbladder, hepatic (both primary and metastatic), recurrent colorectal and low rectal tumors treated by transanal or transcoccygeal excision plus/minus postoperative chemoradiotherapy. Depending on the site and stage of the tumor, patients with primary colorectal cancer are exhorted to enter Eastern Cooperative Oncology Group (ECOG) 9211 (Perioperative Chemotherapy), ECOG 9581(171A vaccine [Panorex]), or the in-house preoperative chemoradiotherapy with hyperfractionation for T3 rectal cancers.

Prostate Cancer. The primary surgical option for patients with clinically localized prostate cancer continues to be nerve sparing, radical, retropubic prostatectomy following negative staging pelvic lymphadenectomy. The patients are apprised of non-surgical alternatives, which include observation and three-dimensional conformal external beam radiation therapy. Experimental options are also reviewed, including cryosurgery and interstitial irradiation (brachytherapy) now being offered at Fox Chase. Permanent interstitial I¹²⁵ brachytherapy has become a standard of therapy for low volume, well to moderately, well-differentiated prostate cancers. Also, we explore neoadjuvant therapy prior to both surgery and radiation therapy as options to improve long term response.

We continue to pursue advances in the management of hormone refractory prostate cancer. With ongoing success, we have extended the use of combined chemotherapy and hormone therapy protocols with radiation therapy for patients who have isolated regional lymph node metastasis at the time of the radical prostatectomy. For patients with locally advanced prostate cancer, neoadjuvant chemotherapeutic protocols are ongoing. These treatments precede definitive 3-dimensional conformal external beam radiation therapy.

Bladder Cancer. We continue to study new agents and combinations of intravesical agents for the treatment of recurrent low grade, low stage papillary bladder cancer as well as non-invasive carcinoma in situ. Radical cystectomy is offered to appropriately selected patients with invasive high grade bladder cancer. The various forms of urinary diversion, including standard ileal conduit, continent urinary diversion, and orthotopic neobladder reconstruction, are reviewed in detail with the patients in deciding the appropriate operative procedure. Recent results from a multi-institutional study appear to show little advantage to neoadjuvant systemic chemotherapy. Patients deemed poor risks based on final histopathology and staging are offered adjuvant chemotherapy. Many new agents with activity against advanced bladder cancer are currently under investigation.

Renal cell carcinoma. Renal cell carcinoma remains primarily a surgical disease. Little additional progress has been made with adjuvant, neoadjuvant, or therapeutic treatment for metastatic renal cell carcinoma. Aggressive surgical management of patients with isolated metastases or local recurrence remains an option in appropriately selected patients. Some genetic abnormalities associated with renal cell carcinoma have been found, and study of these abnormalities is ongoing.

Testicular cancer. Testicular cancer, both seminoma and non-seminomatous disease, continues to be managed in a multi-modal fashion, depending on the clinical stage and histology of the disease. When found early, this malignancy is potentially curable. The main research focus has been to minimize the amount of therapy, both surgery and chemotherapy that effects an adequate cure.

Patients with voiding and/or sexual dysfunction as a consequence of treatment for genitourinary and non-genitourinary malignancies continue to be evaluated and treated on an outpatient basis. Progress continues in the pharmacologic management of these processes with surgical management as a useful adjunct. Quality of life, as well as extension of life, continues to be extremely important in the overall management of patients at Fox Chase.

The Section of Head and Neck Surgery provides multidisciplinary care for patients with malignant and benign tumors of the head and neck, as well as for patients with pre-existing cosmetic and functional problems arising from tumor resection, radiation, or trauma. Skull base resections, partial laryngectomies, sentinel node identification for melanoma and other skin tumors, sarcoma resections, operations for thyroid and parathyroid tumors, and procedures to correct airway problems are frequently performed. Laser techniques and endoscopic surgery are employed when appropriate.

Clinical protocols include those of national cooperative research groups as well as those developed by physicians and surgeons at Fox Chase. Members of the Head and Neck team are recognized as national leaders in clinical trials design. Some studies underway address: combining chemotherapy with radiation for inoperable and otherwise advanced cancers, use of chemotherapy with radiation to treat recurrent cancer after prior radiation, use of radiation and chemotherapy to preserve (rather than operate upon) the larynx, sentinel node mapping in selecting treatment for melanoma, development of new biomaterials for reconstruction, application of novel techniques for bone reconstruction, testing drugs to prevent the development of second primary head and neck cancers, evaluation of drugs to halt progression of premalignant oral lesions to cancer, and testing new methods in drug delivery to tumors.

Laboratory studies include pursuit of the role of angiogenesis and cell cycle regulation in tumor progression from benign to malignant epithelium, evaluation of tumor metabolism through magnetic resonance spectroscopy, and development of new methods to evaluate tumor oxygen levels and to improve drug delivery.

The Craniofacial Tissue Engineering team uses advanced microvascular tissue transfer in reconstruction for patients with head and neck defects resulting from cancer treatment and trauma. Innovative additional approaches include use of other biomaterials, polymers, and allografts in order to limit the morbidity of reconstruction.

Surgical treatment of primary and recurrent skin cancer remains one of the cornerstones of plastic and reconstructive surgery. This involves not only the ablative aspects, but also repair of simple wounds and reconstruction of complex post-resectional defects. These operations epitomize the unique contribution of plastic and reconstructive surgery to a cancer center, effecting the cure of malignant tumors (increasing quantity of life) and, by surgery, restoring normal appearance and function (improving quality of life). In collaboration with other members of the department of surgical oncology, these principles are applied to treating both nonmelanoma skin cancers as well as malignant melanoma.

This collaborative effort extends to the surgical treatment of other cancers in various parts of the body. Post-mastectomy breast reconstruction using autologous tissue, as well as implants, often provides an important stabilizing influence on women affected with breast cancer who face loss of a breast. This operation can be a powerful source of hope and healing by restoring a woman's body image, sense of confidence, and well being. Functional and cosmetic restoration is crucial to the patient having radical surgery for treatment of cancer of the head and neck.

Large and complicated surgical defects of the chest, abdomen, genitalia, and extremities can be reconstructed with the promise of acceptable appearance and good function. This allows other specialists and subspecialists in the department of surgical oncology the latitude to offer their patients radical surgery for cure of primary as well as recurrent cancers with the expectation of good postoperative quality of life. Reflecting these unique activities and contributions, we are actively sharing outcome data with studies sponsored by various national plastic surgical organizations. We feel that this demonstrated benefit to cancer patients speaks for itself, and will ensure the continued recognition of plastic and reconstructive surgery as an integral part of cancer care. In addition, as part of our mission to restore abnormal to normal, we actively participate in the cleft lip and palate team at the Children's Hospital of Philadelphia. We perform operations to repair cleft lip and palates of babies; in addition, we correct secondary deformities resulting from the disturbed growth caused by cleft lip and palate on older children and young adults. We feel that these surgeries also benefit our cancer patients in that they give a unique insight into the development of the normal adult tissues and provide invaluable perspectives on how to approach reconstruction of adult patients having had radical surgery for cancer to restore them to "normal."

The Section of Thoracic Surgical Oncology remains a very vital part of Fox Chase Cancer Center since it services a major share of the four hundred or more initial primary lung cancers that we see in one year. As an affiliate of the Radiation and Therapy Oncology Group (RTOG) and ECOG, we are partially responsible for accrual of patients into numerous studies that involve surgery alone or utilize surgery as an adjuvant to other forms of management. We also have trials that are hospital-based and are institutionally exclusive that involve innovative therapies for some types of cancers of the chest that are otherwise intractable to conventional management.

Conventional therapy for lung cancer, esophageal cancer, mesothelioma, and other types of intrathoracic malignancy are available. We also offer innovative therapies for these diseases, many involving combination chemoradiation therapy and surgery, which allows for a multidisciplinary approach for cancer management. Presently, patients with resected stage IB disease are offered a randomized phase III study of postoperative chemotherapy versus observation alone. Resected stage II and IIIA patients are offered combination chemoradiation therapy on a phase II study. In instances where stage IIIA disease is diagnosed prior to operation, we have two studies in place. One compares chemoradiation therapy alone versus chemoradiation therapy combined with surgery. Another, in those patients with marginal IIIA disease, utilizes high dose chemotherapy and stem cell rescue followed by surgery and radiation therapy. As a result, treatment options on study are available for all of our patients that have had curative resections. In many instances, patients on adjuvant therapy are downstaged, offered surgery, and have prolonged survivals compared to historic controls.

Patients with stage I or II mesothelioma are offered combination chemoimmunotherapy in the form of cisplatinum and interferon, followed by surgery and radiation therapy if a response is identified after the induction therapies. This again offers multimodality therapy, four in this instance, for treatment of an otherwise intractable disease.

The section continues to treat patients with esophageal cancer by induction chemoradiation therapy followed by surgery in patients with locoregional disease. Shortly, a new phase II study will be in place to identify advantages of combination chemoradiation therapy and surgery in patients utilizing Taxol, continuous 5FU, cisplatin and 4500 cGy of radiation therapy based upon a previous study of escalating doses of Taxol and 60 Gy of radiation therapy.

The Section of Gynecologic Oncology continues to provide innovative and comprehensive care for patients with all types of gynecologic cancer. We participate in all gynecologic oncology group trials, as well as institutional trials involving ovarian, endometrial, cervical, and vulvar carcinomas. We also provide care for patients with gestational trophoblastic disease (choriocarcinoma, molar pregnancies). In addition, We have a special interest in pregnant women who develop cancer during their pregnancy.

We have now expanded and offer comprehensive evaluation and care of patients with abnormal Pap smears. As in the past, we continue to investigate the role of minimally invasive surgery (laparoscopy) for gynecologic cancers, and for evaluations of adnexal masses (ovarian cysts). We have recently completed the initial study on reconstructive surgery for patients having pelvic exenteration for advanced gynecologic cancers, and continues to investigate the role of continent urinary diversions, low rectal anastomoses, and rectus abdominus neo-vaginas in this arena.

We work closely with the Department of Medical Oncology to evaluate the role of surgery (radical debulking surgery and minimally invasive surgery) in coordination with high dose chemotherapy and stem cell rescue for patients with advanced ovarian carcinoma. We are also actively evaluating and participating in a prospective randomized trial for patients with early stage endometrial carcinoma evaluating the role of hormone replacement therapy following this type of surgery.

Drs. Boente and Bergman continue to pioneer innovative ideas in the treatment of early stage and advanced stage cervical carcinoma. Particularly, the role of staging laparotomy, radiosensitizing chemotherapy, and extended field radiotherapy are currently being investigated. Finally, we have recently begun to evaluate the role of fenretinide in the prevention of ovarian cancer, and continue to perform minimally invasive surgery for the prophylactic removal of ovaries in high risk families that are enrolled in the Margaret Dyson Family Risk Assessment Program for ovarian cancer.

A multidisciplinary approach is taken with most patients evaluated in this clinic. An RTOG study employing an interdigitated combined chemoradiation therapy followed by surgery for large high-grade soft tissue sarcomas is presently accruing patients. In addition, other novel techniques such as brachytherapy and, in advanced disease, phase I chemotherapy or molecular targeted therapy are utilized in selective patients.

All eligible patients with stage I or II melanoma are candidates for lymphatic mapping with radiolabeled localization. Patients are entered in the Sunbelt Melanoma Trial, which randomizes patients by sentinel lymph node status to further node dissection with or without adjuvant Intron therapy. In addition, RT-PCR technology has enabled us to further evaluate these patients for metastatic regional or systemic disease based on molecular detection criteria.

All newly diagnosed breast cancer patients are evaluated within the multidisciplinary breast evaluation clinic. All aspects of the clinical picture are reviewed, including pertinent x-rays and pathology slides. The Fox Chase Cancer Center Registry breast lymphatic mapping study is underway, and sentinel lymph node biopsy is becoming more commonplace for the breast cancer patients; Dr. Sigurdson is leading this effort in ECOG. In addition, the majority of patients seen in this clinic are considered to be candidates for breast preservation therapy, and many are being diagnosed by stereotactic biopsy techniques. The majority of patients on adjuvant trials are entered into cooperative group trials through the Breast Evaluation Clinic.

BERGMAN, C., BOENTE, M.P. Surgery for gynecologic malignancies. Curr. Opin. Oncol. 10:434-438, 1998.

BOENTE, M.P., CHI, D.S., HOSKINS, W.J. The role of surgery in the management of ovarian cancer: Primary and interval cytoreductive surgery. Semin. Oncol. 25(3):326-334, 1998.

BOENTE, M.P., BERCHUCK, A., WHITAKER, R., KALEN, A., FENG-JI, X., CLARKE-PEARSON, D.L., BELL, R., BAST, R.C. Jr. (Anti-erb B-2 (Her-2/neu). Suppression of diacylglycerol levels by antibodies reactive with the c-erbB-2 (HER-2/new) gene product p185c-erbB-2 in breast and ovarian cancer cell lines. Gynecol. Oncol. 70:49-55, 1998.

BOENTE, M.P., SCHILDER, R.J., OZOLS, R.F. Gynecologic cancers. In Cancer Chemotherapy and Biological Response Modifiers, edited by H.M. Pinedo, D.L. Longo, and B.A. Chabner (in press).

BOENTE, M.P. Ovarian cancer: Surgical aspects of patient care. Dis. Management Digest (in press).

DESAI, D.C., CARP, N.Z., HOFFMAN, J.P. Papillary cystic neoplasm of the pancreas: clinical and pathologic features of an unusual malignancy. Contemp. Surg. 52:87-91, 1998.

FINLAYSON, C., HOFFMAN, J.P., YEUNG, R., KESSLER, H., GUTTMANN, M., SHAER, A., CLAIR, M. Intraoperative ultrasound does not improve detection of liver metastases in resectable pancreatic cancer. Am. J. Surg. 175:99 --101, 1998.

FORASTIERE, A., GOEPFERT, H., GOFFINET, D., HONG, K.W., LARAMORE, G., MITTAL, B., PFISTER, D.G., RIDGE, J., SCHULLER, D., SHAH, J., SPENCER, S., URBA, S., URBA, S., WOLF, G. NCCN practice guidelines for head and neck cancer. NCCN Proceedings Volume 3. Oncology 12(7):39-247, 1998.

FOWBLE, B., HANLON, A.L., PATCHEFSKY, A., FREEDMAN, G., HOFFMAN, J.P., SIGURDSON, E.R., GOLDSTEIN, L.J. The presence of proliferative breast disease with atypia does not significantly influence outcome in early-stage invasive breast cancer treated with conservative surgery and radiation. Int. J. Radiat. Oncol. Biol. Phys. 42:105-115, 1998.

FRANK, A., MONTGOMERY, R.C., GOLDBERG, M., et al. Pleural herniation and incarceration of the gastric graft following trans-hiatal esophagectomy: A case report. Ann. Thor. Surg. (in press).

FREEDMAN, G.M., FOWBLE, B.L., HANLON, A.L., MYINT, M.A., HOFFMAN, J.P., SIGURDSON, E.R., EISENBERG, B.L., GOLDSTEIN, L.J., FEIN, D.A. A close or positive margin after mastectomy is not an indication for chest wall irradiation except in women aged fifty or younger. Int. J. Radiat. Oncol. Biol. Phys. 41(3):599-605, 1998.

FRIEDMAN, C.D., COSTANTINO, P.D., TAKAGI, S., CHOW, L.C. BoneSource® hydroxyapatite cement: a novel biomaterial for craniofacial skeletal tissue engineering and reconstruction. J. Biomed. Mater. Res. (Appl. Biomater.) 43:428-432, 1998.

GOLDBERG, M., MOVSAS, B., LANGER, C. Editors. Controversies and Issues in Lung Cancer. Marcel Dekker, Inc., New York, NY (in press).

HENSKE, E.P., AO, X., SHORT, M.P., GREENBERG, R.E., NEUMANN, H.P.H., KWIATKOWSKI, D.J., RUSSO, I. Frequent progesterone receptor immunoreactivity in tuberous sclerosis-associated renal angiomyolipomas. Mod. Pathol. 11(7):665-668, 1998.

HOFFMAN, J.P., LIPSITZ, S., PISANSKY, T., WEESE, J.L., SOLIN, L., BENSON, A.B. Phase II trial of preoperative radiation therapy and chemotherapy for patients with localized, resectable adenocarcinoma of the pancreas: An Eastern Cooperative Oncology Group Study. J. Clin. Oncol. 16(1):317-323, 1998.

HOFFMAN, J.P., SIGURDSON, E.R., EISENBERG, B.L. Use of saline-filled tissue expanders to protect the small bowel from radiation. Oncology 12:51-62, 1998.

HOFFMAN, J.P., COOPER, H.S., YOUNG, N.A., PENDURTHI, T.K. Preoperative chemotherapy or chemoradiotherapy for the treatment of adenocarcinoma of the pancreas or ampulla of vater. J. Hepatobiliary & Pancreatic Surg. 5:251-254, 1998.

HOFFMAN, J.P., LIPSITZ, S., PISANSKY, T., WEESE, J.L., SOLIN, L., BENSON, A.B. Phase II trial of preoperative radiation therapy and chemotherapy for patients with localized, resectable adenocarcinoma of the pancreas: An Eastern Cooperative Oncology Group Study. J. Clin. Oncol. 16(1):317-323, 1998.

HOFFMAN, J.P., PENDURTHI, T.K., ROSS, E., YEUNG, R.S.W. Preoperative radiation therapy and chemotherapy for adenocarcinoma of the pancreas. Hepato-Gastroenterology 45:634-637, 1998.

HOSKINS, W.J., CHI, D.S., BOENTE, M.P., RUBIN, S.C. State of the art surgical management of ovarian cancer. Cancer Research, Therapy, and Control (in press).

JOHNSON, D.E., HOFFMAN, J.P. Surgical considerations for local excision of rectal cancers. Semin. Radiat. Oncol. 8:39-47, 1998.

JOHNSON, D.E., HOFFMAN, J.P. Management of exocrine cancer of the pancreas. In Cancer Treatment and Research: Gastrointestinal Oncology. Kluver Publications (in press).

KATZ, A., HANLON, A., LANCIANO, R., HOFFMAN, J.P., COIA, L. Prognostic value of CA19-9 levels in patients with carcinoma of the pancreas treated with radiotherapy. Int. J. Radiat. Oncol. Biol. Phys. 41:393-396, 1998.

KUSIAK, J.F. Skin tumors. In Head and Neck and Brain Tumors, edited by J.A. Ridge and D.A. Fein. Chapter 13, Atlas of Clinic Oncology (in press).

LANGER, C.J., SCHAEBLER, D., SAUTER, E., DEMARIA, D., JOHNSON, C., REILLY, D.M., CLARK, J., LEIGHTON, J., AKS, C., LITWIN, S., RIDGE, J.A. Phase II study of n-phasphonacetyl-1-aspartate, recombinant interferon-alpha, and fluorouracil infusion in advanced squamous cell carcinoma of the head and neck. Head Neck 20(5):385-391, 1998.

LYKINS, C.L., FRIEDMAN, C.D., COSTANTINO, P.D., HORIOGLU, R. Hydroxyapatite cement in craniofacial skeletal reconstruction and its effects on the developing craniofacial skeleton. Arch. Otolaryngol. Head Neck Surg. 124:153-159, 1998.

MATIN, T.A., GOLDBERG, M. Surgical staging of lung cancer. Oncology (in press).

MINSKY, B.D., COIA, L., HALLER, D., HOFFMAN, J.P., JOHN, M., LANDRY, J., PISANSKY, T.M., WILLETT, C., MAHON, L., OWEN, J., HANKS, G. Treatment. systems guidelines for primary rectal cancer from the 1996 patterns of care study. Int. J. Radiat. Oncol. Biol. Phys. 41:21-27, 1998.

MINSKY, B.D., COIA, L., HALLER, D., HOFFMAN, J.P., JOHN, M., LANDRY, J., PISANSKY, T. M., WILLETT, C., MAHON, L., OWEN, J., BERKEY, B., KATZ, A., HANKS, G. Radiation therapy for rectosigmoid and rectal cancer: results of the 1992-94 patterns of care process Survey. J. Clin. Oncol. 16:2542-2547, 1998.

MONTGOMERY, R.C., HOFFMAN, J.P., ROSS, E. A., RILEY, L.B., RIDGE, J.A., EISENBERG, B.L. Biliary CA19-9 values correlate with the risk of hepatic metastases in patients with adenocarcinoma of the pancreas. J. Gastrointestinal Surg. 2:28-35, 1998.

MONTGOMERY, R.C., RIDGE, J.A. Radiologic staging of gastrointestinal cancer. Semin. Surg. Oncol. 15:143-150, 1998.

MOVSAS, B., HANLON, A.L., LANCIANO, R., SCHER, R.M., WEINER, L.M., SIGURDSON, E.R., HOFFMAN, J.P., EISENBERG, B.L., COOPER, H.S., PROVINS, S., COIA, L.R. Phase I dose escalating trial of hyperfractionated pre-operative chemoradiation for locally advanced rectal cancer. Int. J. Radiat. Oncol. Biol. Phys. 42:43-50, 1998.

PELTON, J.J., HOFFMAN, J.P., EISENBERG, B.L. Comparison of liver function tests after hepatic lobectomy and hepatic wedge resection. Am. Surg. 64(5):408-414, 1998.

PENDURTHI, T.K., HOFFMAN, J.P., ROSS, E., JOHNSON, D.E., EISENBERG, B.L. Preoperative versus postoperative chemoradiation for patients with resected pancreatic adenocarcinoma. Am. Surg. 64:686-692, 1998.

RHEE, P.H., FRIEDMAN, C.D., RIDGE, J.A., KUSIAK, J. The use of processed allograft dermal matrix for intraoral resurfacing. An alternative to split-thickness skin grafts. Arch. Otolaryngol. Head Neck Surg. 124:1201-1204, 1998.

SIEGELMANN-DANIELI, N., HANLON, A., RIDGE, J.A., PADMORE, R., FEIN, D.A., LANGER, C.J. Oral tongue cancer in patients less than 45 years old: institutional experience and comparison with older patients. J. Clin. Oncol. 16(2):745-753, 1998.

TIERNEY, J., EISENBERG, B.L. Adjuvant chemotherapy for localized resectable soft tissue sarcoma: A meta-analysis of individual patient data. Lancet (in press).

WATSON, J.C., RIDGE, J.A. Surgical management of local and regional recurrent head and neck squamous cell carcinoma. Curr. Opin. Oncol. 10:207-212, 1998.

ALAGIRI, M., COLTON, P., SEIDMAN, E.J., GREENBERG, R.E., HANNO, P.M. The staging pelvic lymphadenectomy: implications as an adjunctive procedure for clinically localized prostate cancer. Br. J. Urol. 80(2):243-246, 1997.

ARBEIT, J., HOHN, D.C., RIDGE, J.A., SPIVAK, S.D. Oncology and cancer chemotherapy. In Current Surgical Diagnosis and treatment. 11th Edition, edited by L. W. Way. Appleton & Lange, Norwalk (in press).

FRIEDMAN, C.D. Reconstruction of the head and neck. In Atlas of Clinical Oncology--Head and Neck, edited by J.A. Ridge, D. Fein. Current Science, Philadelphia, PA (in press).

FRIEDMAN, C.D., STOESSEL, K.M. The sensory organs. In The Patient's Guide to Medical Tests, edited by B.L. Zaret. Houghton Mifflin Company, Boston, MA. pp397-426, 1997.

WEINER, L.M., COLLARUSSO, P., GOLDBERG, M., DRESLER, C., COIA. L.R. Combined-modality therapy for esophageal cancer: phase I trial of escalating does of paclitaxel in combination with cisplatin, 5-fluorouracil, and high-dose radiation before esophagectomy. Semin. Oncol. 6:S19-93--S19-95, 1997.

^§   Fox Chase researcher

^a   C. Dresler: Present address--SmithKline, Beecham, 1500 Littleton Road, Parsippany, NJ 07054

^b   K. Chan: Present address--16422 Pemoak, San Antonio, TX 78240

^c   S. Kjellberg: Present address--Washington Medical Associates, 224 Roseberry St., Philipsburg, NJ 08865

^d   R. Montgomery: Present address--Lexington Clinic, 1221 S. Broadway, Lexington, KY 40504

Illustrations or unpublished data in these reports should not be used without permission of the author.

Fox Chase Cancer Center

Scientific Report 1998