Salvage treatment for recurrent squamous cell carcinoma of the oral cavity.

BACKGROUND: Squamous cell carcinoma (SCCA) of the oral cavity recurs with a frequency of 25%-48%, a fact that usually portends a poor prognosis. Recent studies have reported salvage cure rates as high as 67%. Investigators have also claimed that restaging recurrent tumors provides useful prognostic information, although this has not been demonstrated with tumors of the oral cavity. The purposes of this study were: (1) to report the patterns of recurrent SCCA of the oral cavity; (2) to examine the benefit of restaging oral cavity tumors, and (3) to compare different treatment modalities in the management of recurrent SCCA of the oral cavity. Materials and Methods Thirty-eight patients who developed recurrent SCCA of the oral cavity were reviewed. Salvage treatment consisted of surgery, chemotherapy, radiation therapy, or a combination of these modalities. Survival analysis was based on the stage of the primary and recurrent tumors and the type of salvage treatment received. RESULTS: The overall recurrence rate was 28%. Local recurrence was most common (58%) followed by locoregional (27%) and regional recurrence (16%). Patients who recurred more than 6 months after completion of their primary treatment had improved survival compared with those who recurred within 6 months of initial treatment. Individuals with stage I-II primary tumors had significantly improved salvage time and total survival time compared with those with stage III-IV primary tumors (p < 0.005 and p < 0.001). Conversely, the stage of the recurrent tumor was not predictive of either improved salvage time or total survival time. Patients who underwent salvage surgery had significantly improved salvage time and total survival time compared with those who received chemotherapy and/or radiation therapy (p < 0.001 and p < 0.002). The overall salvage cure rate was 21%. Neither the stage of the primary or recurrent tumors nor the type of salvage treatment received significantly correlated with an improved cure rate. However, the group of patients who underwent salvage surgery approached a statistically significant improvement in cure rate (p = 0.08). CONCLUSIONS: Squamous cell carcinoma of the oral cavity is most likely to recur at the primary site. The stage of the primary tumor is significantly correlated with survival even after recurrence, but the stage of the recurrent tumor is not significantly correlated with survival. Patients most likely to benefit from retreatment are those who (1) have primary tumors stage I-II, (2) recur greater than 6 months after their initial treatment, and (3) develop recurrences that are amenable to salvage surgery.

Evaluation of a motivational smoking cessation intervention for women in public health clinics.

BACKGROUND: A multicomponent motivational smoking cessation intervention was evaluated in 33 prenatal, family planning, and pediatric services in 12 public health clinics. Clinic-based intervention components were implemented by clinic personnel as part of routine medical visits. METHODS: The evaluation design included pre- and postintervention measurements of multiple study outcomes in a baseline (all clinics prior to the start of the intervention) and an experimental period (matchedpair random assignment of clinics to intervention or control conditions). Subjects were 683 (baseline) and 1,064 (experimental) smokers with measurements of smoking outcomes at both times. Mixed-effects regressions analyzed individual outcomes clustered within clinics and services. RESULTS: Control and intervention clinics had similar outcomes in the baseline period. In the experiment, outcomes improved in the intervention but not in the control clinics. Compared to controls, smokers exposed to the intervention were more likely to have quit (14.5 versus 7.7%) or take actions toward quitting and had higher mean action, stage of readiness, and motivation to quit scores. These positive effects persisted when clustering within clinics and services was controlled. CONCLUSIONS: This intervention, implemented by clinic personnel as part of routine medical visits, was effective under these natural conditions across different types of clinic service.