A multivariate analysis was carried out in 492 patients with metastatic neck disease from squamous cell carcinoma to determine the influence of clinical and therapeutic factors on survival, local and regional control, and distant metastases. After radiation treatment with radical intent, recurrence at the primary site was the most frequent site of treatment failure (20% of cases), followed by distant metastases (14% of the cases), whereas isolated neck recurrences occurred in only 7% of the patients. The most significant factors influencing survival were primary tumor site, node fixation, N-stage, T-stage, and number of lymphatic chains. The most significant factors influencing local control were primary site, T-stage, and node fixation. Significant factors influencing regional control were radiation therapy volume, primary tumor site, node fixation, and node location (upper and lower neck). Significant factors influencing distant control were N-stage, number of nodes, and number of involved lymphatic chains. Cancer 1992; 69:1224-1234.In head and neck cancer the presence of clinically involved lymph nodes (Stages I11 and IV) seems to be a major determinant of patient outcome.'-3 Despite the advances of surgery and radiation therapy, tumor control and survival remain disappointing, and a multidisciplinary approach often has been a d~o c a t e d .~,~ Some studies have analyzed the patterns of failure in this group of patients, either considering a specific tumor site6-8 or head and neck tumors in These generally have shown that the recurrence at the primary site is the main cause of tumor failure. In addition, some major prognostic factors have been previously defined mainly based on information from the neck d i s~e c t i o n .~~'~~'~ The effect on prognosis is less clear for other clinical parameters, which might be useful in determining the likelihood of eradicating the cancer with locoregional treatment or might indicate the need for additional systemic therapy. This study attempts to identify, by means of a multivariate analysis, the clinical and treatment factors most significantly associated with survival, local and regional recurrences, and distant metastases in a large series of patients with squamous cell carcinoma of the head and neck (SCCHN) and clinically positive neck nodes.. Patients and Methods PatientsWe have retrospectively reviewed 492 patients with previously untreated SCCHN and clinically positive neck nodes at diagnosis who where treated with radical radiation therapy at the Clinica Puerta de Hierro, Madrid, Spain, between 1965 and. The Department of Radiation Oncology receives patients from the Surgery Department of this hospital and other hospitals in the country with ap indication of radiation therapy. Patients with histology other than squamous cell carcinoma with previous cancer, distant metastases at presentation, those who had primary surgical treatment other than a biopsy, and those who did not finish a radical course of radiation were excluded from the analysis.The median age was 53 ...

The records of 50 cerebellar haemorrhages were reviewed retrospectively. In this series the most important factor for clinical development, management and mortality was the presence of obstructive hydrocephalus (p < 0.01). Slowly progressive (type 1) and abruptly developing (type 2) deterioration of consciousness was significantly related to high mortality; this holds also true for the combination of hydrocephalus with an haematoma diameter > 3 cm. Larger haematomas had a higher mortality but this relation, analyzed alone, did not reach statistical significance (p > 0.05). In cases with hydrocephalus mortality could significantly be reduced by surgical evacuation of the haematoma (p < 0.01). The treatment of cerebellar haemorrhages must be directed at resolving obstructive hydrocephalus.

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We have designed and tested a simple and reliable method by which to quantify neuropathic pain after traumatic brachial plexus injuries. Initial surgical treatment of the paralysis--including nerve, trunk and root reconstruction, and neurolysis--comprises an effective means by which to initially treat neuropathic pain. Ablative or neuromodulative procedures, like dorsal root entry zone, should be reserved for refractory cases.