Language：Japanese   Publisher：JAPAN SOCIETY FOR HEAD AND NECK SURGERY  

We retrospectively analyzed 27 patients with T3 laryngeal carcinoma treated at our department from 2004 to 2008. The patients ranged from 38 to 73 years of age (median: 62) and consisted of 24 men and 3 women. Cases included 21 supraglottic and 6 glottic. Of the 27 patients, 7 were treated by total laryngectomy, 14 by chemoradiotherapy and 6 by radiation alone. The 3-year disease-specific survival rate was 85.7% for operative cases, 77.9% for chemoradiotherapy cases, and 66.7% for radiotherapy cases. In the sixth edition of the UICC staging system, paraglottic space invasion was added as a factor in T3-stage carcinoma. The 3-year disease-specific survival rate was 100% for the cases of paraglottic space invasion, 70.0% for the cases of vocal cord fixation, and 53.6% for the cases of preepiglottic space invasion. These results suggest that the cases of paraglottic space invasion showed a good prognosis, and that laryngeal preservation is indicated.

DOI： 10.5106/jjshns.22.317

CiNii Books

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Language：Japanese   Publisher：Society of Oto-rhino-laryngology Tokyo  

DOI： 10.11453/orltokyo.56.174

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Language：Japanese   Publisher：Society of Oto-rhino-laryngology Tokyo  

Secondary placement of a voice prosthesis is often difficult to perform due to inability in flexing the neck after total laryngectomy and radiation therapy. We report a technique of secondary voice prosthesis placement using a curved rigid esophagoscope. An endotracheal tube and a flexible endoscope are inserted into the esophagus. In creating a tracheoesophageal puncture, a sharp forceps is inserted through the tip of esophagoscope. Then, a guide wire is introduced through the esophagoscope and the voice prosthesis is placed by back-loading method. This method is safe and easy because there is no risk of perforation through the posterior esophageal wall.

DOI： 10.11453/orltokyo.56.334

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Language：Japanese   Publisher：Society of Oto-rhino-laryngology Tokyo  

DOI： 10.11453/orltokyo.56.130

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Language：Japanese  

CiNii Books

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Language：Japanese  

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Language：Japanese   Publisher：The Society of Practical Otolaryngology  

Despite recent advances in surgical technology and chemoradiation regimens, no significant improvement has been seen in the survival rate of head and neck squamous cell carcinoma (HNSCC) in more than 3 decades. Examples of new and remarkable clinical strategies such as epidermal growth factor receptor(EGFR) targeted therapy and the status of human papilloma virus (HPV) infection in oropharyngeal carcinoma have attracted attention over the years. Molecular-targeted therapy has been approved in Europe and the United States as standard treatment for HNSCC and has shown significant effect with conventional chemotherapy and radiotherapy. However, the therapeutic effect is heterogeneous as is the case with other cancers, and problems have also been highlighted such as acquired resistance associated with long-term treatment. Recent studies have shown that a subset of HNSCC, especially in the oropharynx, is caused by HPV infection and that the clinical outcome of patients can be clearly distinguished based on their HPV status. Patients with HPV(+) tumors have a more favorable prognosis compared to HPV(-) patients. The use of the HPV status as a marker for personalized treatment has been anticipated. In this paper, we show our recent data on EGFR-targeted therapy and the clinical outcome of patients depending on their HPV status, and we discuss the future of translational research in HNSCC.

DOI： 10.5631/jibirin.105.183

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Language：Japanese   Publisher：JIBI TO RINSHO KAI  

This retrospective study aimed to assess the role of salvage surgery for local recurrence after concomitant radiotherapy and superselective arterial infusion of cisplatin (RADPLAT) in patients with squamous cell carcinoma cancer of the maxillary sinus as an initial treatment. Forty-one patients were treated by RADPLAT between 1999 and 2009. Local recurrence in the primary site was observed in 12 patients of whom 9 could undergo further salvage surgery. Primary disease control was achieved in 7 of these patients (successful salvage rate, 58.3%). Successful salvage rates for T3, T4a and T4b primary disease were 66.7% (2/3), 66.7% (4/6) and 33.3% (1/3), respectively. The 5-year overall survival rate was 73.6% in all patients. Severe postoperative complication was seen in one patient. Prognosis of patients with locally recurring maxillary sinus squamous cell carcinoma after RADPLAT is relatively good. This is because residual/recurrent tumor was located in anterior portion of the face in most cases. This result should be taken into consideration when the initial treatment plan is decided and the choice of salvage surgery for such recurrent cases should be carefully determined.

DOI： 10.11334/jibi.58.S52

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Language：Japanese   Publisher：Society of Oto-rhino-laryngology Tokyo  

Background: The concept of sentinel node (SN) has been established in oral cancer. This study aimed to investigate distribution of the area where SN was located.Method: Ten patients with T1-2 N0 tongue cancers underwent SN biopsy following partial glossectomy. SNs were detected using gamma camera and gamma probe and were analyzed pathologically.Result: SN was localized in 9 submandibular, 14 upper jugular, 5 middle jugular, 1 lower jugular area in disease side. SN was also localized in 1 upper jugular, and 1 middle jugular area in the opposite side. Occult SN metastasis was observed in 6 of 10 patients (60%).Conclusions: It was concluded that the most likely site where SN was detected was upper jugular area in disease side.

DOI： 10.11453/orltokyo.55.364

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Language：Japanese   Publisher：JAPAN SOCIETY FOR HEAD AND NECK SURGERY  

We retrospectively analyzed 27 patients with T3 laryngeal carcinoma treated at our department from 2004 to 2008. The patients ranged from 38 to 73 years of age (median: 62) and consisted of 24 men and 3 women. Cases included 21 supraglottic and 6 glottic. Of the 27 patients, 7 were treated by total laryngectomy, 14 by chemoradiotherapy and 6 by radiation alone. The 3-year disease-specific survival rate was 85.7% for operative cases, 77.9% for chemoradiotherapy cases, and 66.7% for radiotherapy cases. In the sixth edition of the UICC staging system, paraglottic space invasion was added as a factor in T3-stage carcinoma. The 3-year disease-specific survival rate was 100% for the cases of paraglottic space invasion, 70.0% for the cases of vocal cord fixation, and 53.6% for the cases of preepiglottic space invasion. These results suggest that the cases of paraglottic space invasion showed a good prognosis, and that laryngeal preservation is indicated.

DOI： 10.5106/jjshns.22.317

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Language：Japanese   Publisher：JAPAN SOCIETY FOR HEAD AND NECK SURGERY  

Salivary duct carcinoma histologically resembles an invasive mammary ductal carcinoma and is a malignant tumor with a poor prognosis. The rarity of this carcinoma has resulted in a lack of consensus on its chemotherapy regimen. In recent years, HER2 overexpression has been reported in not only breast cancer but also salivary duct carcinoma, so we performed an immunostaining on the surgical specimens of salivary duct carcinoma and analyzed the relationship between HER2 expression and the clinical background. As a result, 3 cases were found to be HER2-positive. In salivary gland carcinomas, the HER2 positive rate was 60% in salivary duct carcinomas, 0% in adenoid cystic carcinomas, 17% in mucoepidermoid carcinomas, 38% in adenocarcinomas. For the examination of pathological grade in salivary duct carcinoma, all HER2-positive patients belonged in a pathological high-grade group, whereas all HER2-negative cases belonged in a low-grade group. This result suggests a relation between HER2 expression and pathological grade. It is hoped that a new treatment strategy using the anti-HER2 antibody will be developed for HER2-positive salivary duct carcinoma.

DOI： 10.5106/jjshns.21.195

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Language：Japanese  

We performed a retrospective analysis of the association between tumor HPV status and the demographic and clinicopathological parameters of 83 patients with oropharyngeal squamous cell carcinoma at Hokkaido University Hospital, Japan, between 1998 and 2010. The parameters included age, gender, tumor subsite, Tumor-Node-Metastasis (TNM) stage, and overall survival. HPV status was established by multiplex polymerase chain reaction analysis. Of the 83 oropharyngeal cancers, 22 were positive for HPV-16, two for HPV-18, and one for HPV-35 and HPV-58. Kaplan-Meier survival analysis showed improved overall survival rates in patients with HPV-positive tumors (p = 0.0024) compared with HPV-negative tumors. Of the 51 patients who received chemoradiotherapy, HPV-positive patients experienced better overall survival than HPV-negative patients (p = 0.0024). HPV status is a significantly favorable prognostic factor in oropharyngeal cancer in Japan.

DOI： 10.5981/jjhnc.37.394

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Language：Japanese   Publisher：Japan Society for Head and Neck Cancer  

We performed a retrospective analysis of the association between tumor HPV status and the demographic and clinicopathological parameters of 83 patients with oropharyngeal squamous cell carcinoma at Hokkaido University Hospital, Japan, between 1998 and 2010. The parameters included age, gender, tumor subsite, Tumor-Node-Metastasis (TNM) stage, and overall survival. HPV status was established by multiplex polymerase chain reaction analysis. Of the 83 oropharyngeal cancers, 22 were positive for HPV-16, two for HPV-18, and one for HPV-35 and HPV-58. Kaplan-Meier survival analysis showed improved overall survival rates in patients with HPV-positive tumors (p = 0.0024) compared with HPV-negative tumors. Of the 51 patients who received chemoradiotherapy, HPV-positive patients experienced better overall survival than HPV-negative patients (p = 0.0024). HPV status is a significantly favorable prognostic factor in oropharyngeal cancer in Japan.

DOI： 10.5981/jjhnc.37.394

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Language：Japanese  

CiNii Books

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Language：English  

There are many methods of treating laryngeal cancers: definitive irradiation with or without concurrent chemotherapy, endoscopic laser surgery, partial surgery techniques, and total laryngectomy. Few studies have been reported on vocal function and quality of life of patients after the definitive treatment for laryngeal cancer, using single voice related QOL measures. The aim of this study was to examine voice related QOL in patients treated with various modalities using a Voice-Related Quality of Life (V-RQOL) questionnaire as well as Voice Handicap Index-10 (VHI-10) questionnaire. Between August 2006 and May 2007, survey data on voice utilizing the V-RQOL and VHI-10 were obtained from a total of 130 patients who had received definitive treatment for laryngeal cancers with follow-up at the Hokkaido University Hospital, and who were alive with no evidence of malignancy at the time of survey. Mean V-RQOL scores of the patients who received radiation therapy (n=63), chemoradiotherapy (n=29), laser resection (n=14) and total laryngectomy (n=27) as the final treatment for laryngeal cancer were 92.6, 92.9, 85.5, and 68.4, respectively. Mean VHI-10 values were 2.87, 2.34, 5.43, and 11.26. Such measures of quality of life are important endpoints to help judge the overall effectiveness of treatment options for laryngeal cancers. © 2007, Japan Society for Head and Neck Cancer. All rights reserved.

DOI： 10.5981/jjhnc.33.465

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Language：English   Publisher：Japan Society for Head and Neck Cancer  

Background: Management of lymph node metastasis in head and neck cancer is as important as that of the primary site. We analyzed the treatment outcome in the necks of patients with lymph node metastasis treated by rapid superselective intra-arterial infusion of cisplatin and concomitant radiotherapy (RADPLAT). Patients and Methods: Twenty-three patients with positive lymph nodes whose neck disease was followed up for over one year were analyzed. Primary tumor sites were hypopharynx (13 cases), oropharynx (5), paranasal sinus (4), and parotid gland (1). N stages included N1 (2 cases), N2b (10), N2c (8), and N3 (3). All patients received superselective intra-arterial infusion therapy of cisplatin (100-120 mg/m2/week) with simultaneous intravenous infusion of thiosulfate for neutralizing cisplatin toxicity, and conventional extrabeam radiotherapy (65 Gy/26f/6.5 weeks). The most cisplatin was injected to the primary site, but in patients with nodes of more than 3 cm, some of the drug (approximately 20 to 30 mg) was delivered to this region. Neck dissection was indicated in cases where the neck disease was residual or recurring. Results: Among the 23 patients, the neck diseases of 17 (74%) were well controlled by RADPLAT without surgery
2/2 (100%) with N1 disease, 7/10 (70%) with N2b, 7/8 (87.5%) with N2c, and 1/3 (33.3%) with N3. Among the 5 patients with persistent neck disease, 2 patients with N2b and 1 with N2c were treated successfully by salvage neck dissection. As a result, neck disease was successfully controlled in 20 of 23 (87%) with all patients with positive lymph nodes
2/2 (100%) patients with N1, 7/8 (87.5%) with N2b, 8/8 (100%) with N2c, and 1/3 (33.3%) with N3. Conclusions: RADPLAT was effective not only for primary disease but also neck metastasis. We should establish when and how to employ neck dissection for patients treated by chemoradiotherapy. © 2007, Japan Society for Head and Neck Cancer. All rights reserved.

DOI： 10.5981/jjhnc.33.39

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Background: Management of lymph node metastasis in head and neck cancer is as important as that of the primary site. We analyzed the treatment outcome in the necks of patients with lymph node metastasis treated by rapid superselective intra-arterial infusion of cisplatin and concomitant radiotherapy (RADPLAT). Patients and Methods: Twenty-three patients with positive lymph nodes whose neck disease was followed up for over one year were analyzed. Primary tumor sites were hypopharynx (13 cases), oropharynx (5), paranasal sinus (4), and parotid gland (1). N stages included N1 (2 cases), N2b (10), N2c (8), and N3 (3). All patients received superselective intra-arterial infusion therapy of cisplatin (100-120 mg/m2/week) with simultaneous intravenous infusion of thiosulfate for neutralizing cisplatin toxicity, and conventional extrabeam radiotherapy (65 Gy/26f/6.5 weeks). The most cisplatin was injected to the primary site, but in patients with nodes of more than 3 cm, some of the drug (approximately 20 to 30 mg) was delivered to this region. Neck dissection was indicated in cases where the neck disease was residual or recurring. Results: Among the 23 patients, the neck diseases of 17 (74%) were well controlled by RADPLAT without surgery
2/2 (100%) with N1 disease, 7/10 (70%) with N2b, 7/8 (87.5%) with N2c, and 1/3 (33.3%) with N3. Among the 5 patients with persistent neck disease, 2 patients with N2b and 1 with N2c were treated successfully by salvage neck dissection. As a result, neck disease was successfully controlled in 20 of 23 (87%) with all patients with positive lymph nodes
2/2 (100%) patients with N1, 7/8 (87.5%) with N2b, 8/8 (100%) with N2c, and 1/3 (33.3%) with N3. Conclusions: RADPLAT was effective not only for primary disease but also neck metastasis. We should establish when and how to employ neck dissection for patients treated by chemoradiotherapy. © 2007, Japan Society for Head and Neck Cancer. All rights reserved.

DOI： 10.5981/jjhnc.33.39

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Language：English   Publisher：Japan Society for Head and Neck Cancer  

Surgical complication rates of salvage laryngectomy after chemoradiotherapy (CRT) have been reported to be high. Wound complications after salvage laryngectomy following concurrent chemoradiotherapy (CCRT) were analyzed. Eighty-six patients who had undergone total laryngectomy for laryngeal cancer at Hokkaido University Hospital between 1990 and 2006 were divided into three groups according to preoperative treatments received: TL group (n = 35) without radiotherapy (RT) or CCRT, RT-TL group (n = 17) with RT alone, CRT-TL group (n = 34) with low-dose CCRT. Major wound complications were defined as major pharyngocutaneous fistulas which caused inpatient care for more than eight weeks or which were closed by surgery, bleeding that required surgical reintervention, and wound infection or skin necrosis that caused inpatient care for more than eight weeks. Minor complications were self-limited, managed with local wound care, and did not prolong inpatient care for more than eight weeks. We also analyzed wound complications of larynx preservation surgery after CCRT. Overall wound complications, both major and minor, were observed in 26% of the TL group, 35% of the RT-TL group, and 47% of the CRT-TL group. Major wound complications were observed in 11%, 18%, and 29%, respectively. A considerable but not statistically significant increase in the incidence of overall and major wound complications was observed between the TL and CRT-TL groups (p = 0.082 and 0.078, respectively). Pharyngocutaneous fistulas were the most common complication, occurring in 14/86 (16%) of patients. Patients who developed pharyngocutaneous fistulas after CCRT tended to require surgical reintervention and longer periods before the initiation of oral intake. Wound complications were observed in 2/3 (67%) of patients who had undergone larynx preservation surgery. High incidences of wound complications and poor wound recovery in patients undergoing salvage laryngectomy following CCRT should be taken into account before the initiation of CCRT. © 2007, Japan Society for Head and Neck Cancer. All rights reserved.

DOI： 10.5981/jjhnc.33.356

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Surgical complication rates of salvage laryngectomy after chemoradiotherapy (CRT) have been reported to be high. Wound complications after salvage laryngectomy following concurrent chemoradiotherapy (CCRT) were analyzed. Eighty-six patients who had undergone total laryngectomy for laryngeal cancer at Hokkaido University Hospital between 1990 and 2006 were divided into three groups according to preoperative treatments received: TL group (n = 35) without radiotherapy (RT) or CCRT, RT-TL group (n = 17) with RT alone, CRT-TL group (n = 34) with low-dose CCRT. Major wound complications were defined as major pharyngocutaneous fistulas which caused inpatient care for more than eight weeks or which were closed by surgery, bleeding that required surgical reintervention, and wound infection or skin necrosis that caused inpatient care for more than eight weeks. Minor complications were self-limited, managed with local wound care, and did not prolong inpatient care for more than eight weeks. We also analyzed wound complications of larynx preservation surgery after CCRT. Overall wound complications, both major and minor, were observed in 26% of the TL group, 35% of the RT-TL group, and 47% of the CRT-TL group. Major wound complications were observed in 11%, 18%, and 29%, respectively. A considerable but not statistically significant increase in the incidence of overall and major wound complications was observed between the TL and CRT-TL groups (p = 0.082 and 0.078, respectively). Pharyngocutaneous fistulas were the most common complication, occurring in 14/86 (16%) of patients. Patients who developed pharyngocutaneous fistulas after CCRT tended to require surgical reintervention and longer periods before the initiation of oral intake. Wound complications were observed in 2/3 (67%) of patients who had undergone larynx preservation surgery. High incidences of wound complications and poor wound recovery in patients undergoing salvage laryngectomy following CCRT should be taken into account before the initiation of CCRT. © 2007, Japan Society for Head and Neck Cancer. All rights reserved.

DOI： 10.5981/jjhnc.33.356

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Language：English   Publisher：Japan Society for Head and Neck Cancer  

There are many methods of treating laryngeal cancers: definitive irradiation with or without concurrent chemotherapy, endoscopic laser surgery, partial surgery techniques, and total laryngectomy. Few studies have been reported on vocal function and quality of life of patients after the definitive treatment for laryngeal cancer, using single voice related QOL measures. The aim of this study was to examine voice related QOL in patients treated with various modalities using a Voice-Related Quality of Life (V-RQOL) questionnaire as well as Voice Handicap Index-10 (VHI-10) questionnaire. Between August 2006 and May 2007, survey data on voice utilizing the V-RQOL and VHI-10 were obtained from a total of 130 patients who had received definitive treatment for laryngeal cancers with follow-up at the Hokkaido University Hospital, and who were alive with no evidence of malignancy at the time of survey. Mean V-RQOL scores of the patients who received radiation therapy (n=63), chemoradiotherapy (n=29), laser resection (n=14) and total laryngectomy (n=27) as the final treatment for laryngeal cancer were 92.6, 92.9, 85.5, and 68.4, respectively. Mean VHI-10 values were 2.87, 2.34, 5.43, and 11.26. Such measures of quality of life are important endpoints to help judge the overall effectiveness of treatment options for laryngeal cancers. © 2007, Japan Society for Head and Neck Cancer. All rights reserved.

DOI： 10.5981/jjhnc.33.465

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Language：English   Publisher：Japan Society for Head and Neck Cancer  

Seventy patients, who were mainly considered contraindicated for surgery or who rejected radical surgery, received superselective intra-arterial infusion therapy of cisplatin (100-120mg/m2/week) with simultaneous intravenous infusion of thiosulfate to neutralize cisplatin toxicity, and conventional concomitant extrabeam radiotherapy. The five-year progression-free rate of the primary lesion and overall survival were 82.1% and 54.4% for all patients, respectively. Acute toxic effects were considered acceptable
however, severe toxic events occurred in some cases, specifically cranial nerve palsy, MRSA pneumonia, sepsis, and osteoradionecrosis. We confirmed high effectiveness of superselective arterial infusion and concomitant radiotherapy, which can concentrate attacks on locoregional diseases by decadose cisplatin. Moreover, even patients with unresectable diseases can be cured. There are various techniques and protocols for superselective arterial infusion, and they must be standardized. Moreover, indication for this treatment must be established. © 2006, Japan Society for Head and Neck Cancer. All rights reserved.

DOI： 10.5981/jjhnc.32.87

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Language：Japanese  

DOI： 10.5981/jjhnc1974.29.450

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Language：Japanese   Publisher：Japan Society for Head and Neck Cancer  

Superselective arterial infusion for patients with advanced head and neck cancer has increasingly been applied in Japan. We analyzed our experiences and evaluated the efficacy and safety of this treatment. Patients and Methods: Forty-four patients, who were considered contraindicated for surgery or rejected radical surgery, received superselective intra-arterial infusion therapy of cisplatin (100-120mg/m²/week) with simultaneous intravenous infusion of thiosulfate to neutralize cisplatin toxicity, and conventional concomitant extrabeam radiotherapy (65Gy/26f/6.5weeks). Results: During the median follow-up period of 17 months, 2-year progression-free survival rate of primary lesion was 66.9%, and that of patients with T4b diseases 57%. The 2-year overall survival rate was 52.4%. Although acute toxic effects were considered acceptable, severe toxic events occurred in some cases, namely, cranial nerve palsy, MRSA pneumonia, sepsis, and osteoradionecrosis. Conclusions: We confirmed the high effectiveness of superselective arterial infusion and concomitant radiotherapy, which can concentrate the attack of decadose cisplatin on locoregional disease. Moreover, even patients with unresectable disease can be cured. We must clarify the treatment results and late side effects, and establish the indications for this treatment.

DOI： 10.5981/jjhnc1974.29.450

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Language：Japanese   Publisher：Japan Society for Head and Neck Cancer  

Superselective arterial infusion for patients with advanced head and neck cancer has increasingly been applied in Japan. We analyzed our experiences and evaluated the efficacy and safety of this treatment. Patients and Methods: Forty-four patients, who were considered contraindicated for surgery or rejected radical surgery, received superselective intra-arterial infusion therapy of cisplatin (100-120mg/m2/week) with simultaneous intravenous infusion of thiosulfate to neutralize cisplatin toxicity, and conventional concomitant extrabeam radiotherapy (65Gy/26f/6.5weeks). Results: During the median follow-up period of 17 months, 2-year progression-free survival rate of primary lesion was 66.9%, and that of patients with T4b diseases 57%. The 2-year overall survival rate was 52.4%. Although acute toxic effects were considered acceptable, severe toxic events occurred in some cases, namely, cranial nerve palsy, MRSA pneumonia, sepsis, and osteoradionecrosis. Conclusions: We confirmed the high effectiveness of superselective arterial infusion and concomitant radiotherapy, which can concentrate the attack of decadose cisplatin on locoregional disease. Moreover, even patients with unresectable disease can be cured. We must clarify the treatment results and late side effects, and establish the indications for this treatment.

DOI： 10.5981/jjhnc1974.29.450

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Language：Japanese  

DOI： 10.5981/jjhnc1974.28.269

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Language：Japanese   Publisher：Japan Society for Head and Neck Cancer  

We analyzed differential gene expression between cancer tissue and dysplasia and normal nasal tissue obtained from a patient with maxillary carcinoma, using a cDNA microarray consisting of about 1000 genes. Genes whose expression was increased or reduced in cancer tissue were almost the same as genes in dysplasia. Three genes (Humig, Diubiquitin, Stat-1) that showed significant overexpression in the step of carcinogenesis, were identified.

DOI： 10.5981/jjhnc1974.28.269

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