In our department, 109 patients with advanced or recurrent head and neck cancer were treated with chemotherapy alone for the past 11 years. Only 3. 3% of the patients survived for 5 years. It is quite difficult to get 5-year survivors with chemotherapy alone for unresectable hypopharyngeal cancer. However, we can expect a prolongation of life and an improvement in quality of life with chemotherapy.
From clinical experience, we recognized several combinations in which noncross-resistance was observed. They include UFT + BM therapy (bleomycin, mitomycin C), UFT-M therapy (UFT, mitomycin C) + CP therapy (cisplatin, peplomycin), VMB therapy (vincristine, methotrexate, bleomycin) +CP therapy, VMBM therapy (vincristine, methotrexate, bleomycin, mitomycin C) + cisplatin, etc. English and Japanese literature in terms of chemotherapy for hypopharyngeal cancer was also reviewed. At present, we recommend noncross-resistant sequential chemotherapy consisting of VMP therapy (vincristine, methotrexate, peplomycin) or VDMP therapy (vindesine, methotrexate, peplomycin) and cisplatin containing regimen like CP therapy or cisplatin+5-fluorouracil.

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Nineteen patients of hypopharyngeal cancer with fixed cervical metastatic lymphnodes, who had been treated at the Cancer Institute Hospital during the period from 1974 through 1987, were analysed. Sixteen of the 19 cases were of pyriform sinus cancer (PS), 2 cases were of postcricoid cancer (PC) and one was of posterior wall cancer (PW). According to T-classification, 9 cases (47%) were classified as T3, which was the largest group. Three T1 cases were found among the patients with PS. Radiotherapy was performed on all cases, and resectable cases were surgically treated. As a result, 5 of the 19 cases were controlled without any subsequent reccurence of lymphnode metastasis. All of these 5 cases were PS and consisted of 3 cases of Ti and each one case of T2 and T3. In each of the 5 cases, the primary site had shown a low degree of outward invasion, and the lymphnode metastasis was large but solitary. On the contrary, in unresectable cases and cases in which resection was performed with reccurence within one year after the operation, the primary tumor had shown a high degree of outward invasion, and in some cases the primary and metastatic tumor were consecutive forming a single mass. CT examination was useful for judging of resectability of the tumor. The cummulative one-year and two-year survival rate for 19 cases were 32% and 24%, respectively.

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Taking many factors into consideration, indication for surgery of esophageal cancer is rather difficult to establish. It is of importance to assess invasion to the adventitia.
Diagnosis of stage A3, utilizing X-ray, CT and endoscopic ultrasonography, is discussed. It is possible to get an eighty percent correct diagnosis by the X-ray findings such as the depth of ulceration and the characteristics of the surrounding rim of the tumor besides an esophagotracheal fistula and a clear penetration.
Furthermore, it is possible to observe the relationship of the esophagus to the trachea and the aorta by using an endoscopic ultrasonography and a CT scan.
However, since even these examinations have demerits, a doctor's intuition and sensitivity plays an important part.
The treatment of the cases, in which a resection is inadvisable or impossible, is also discussed.

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In general, surgical operation may be considered as the first choice of treatment for patients with esophageal cancer. When primary lesions of the esophagus are already in an advanced state, we usually apply radiation and chemotherapy to them with palliative intention. Consequently, the results of these treatment are far from expectation. We should use these modalities for patients in curable conditions. Up to present day, we have no definitive combined therapy for esophageal cancer using irradiation and anti-cancer drugs. Treatment method should be selected to improve tumor control with reasonable combination of radiation and chemotherapy.

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Nine patients with advanced thyroid carcinoma invading the upper aerodigestive tract and mediastinal tissues have been described. Surgical intervension was performed in seven of nine patients. CT and MRI were useful in evaluating vascular, deep fascial and esophageal invasions.
Reconstruction of the cervical esophagus by the musculocutaneous flap was useful in protecting large vessels and in filling up the dead space in the upper mediastinum.
Generally, when direct invasion to deep fascia, carotid artery and inferior mediastinum occurred, it probably signified advanced carcinoma which was beyond practical surgical approach.
From our experiences, however, we believe that thyroid carcinoma should be completely resected, even if its invasion is observed in the mediastinum, since the cause of death in advanced thyroid carcinoma is mainly in the obstruction of the trachea, esophagus and/or large vessel.

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In this paper, a case of adenoid cystic carcinoma of the trachea is reported. A 28-year old male, who admitted to our hospital had a complaint of severe dyspnea and unconsciousness. Bronchoscopy revealed a tumor in a lower part of the trachea which occupied 80% of the lumen of the trachea. During an operation, we found that the tumor had spread over 10. 5 cm in length along the tracheal wall and left main bronchus. We opend the pars membranacea of the trachea widly, and removed the intra-tracheal tumor with an electric knife and CUSA as far as possible. After the operation, we irradiated 60 Gy with Linac and the tumor diminished markedly. He has been well for the past 2 years since the operation. Bronchoscopy revealed no evidence of tumor recurrence. From our experience, it is suggested that when dealing with advanced cases of adenoid cystic carcinoma of the trachea, a palliative operation and additional irradiation has a beneficial role.

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Seventeen patients with malignant tumors of the trachea or main bronchus have been treated with the Nd-YAG laser under topical anesthesia. Eleven of these patients had bronchogenic carcinomas (5 primary and 6 recurrent) and the rest of them had miscellaneous malignant tumors. Two of the 5 patients with primary bronchogenic carcinomas could be resected after laser treatment and the other 3 cases were treated with irradiation. However, 6 patients with recurrent bronchogenic carcinoma, though opening of the air ways could be achieved, did not survive more than 8 months. One patient with recurrent oesophageal carcinoma survived 2 years and 9 months with laser treatment and chemotherapy repeated 3 times. Laser treatment provides an excellent method for resuscitating patients with life threatening obstruction and enables subsequent management to be carefully planned.

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The mynah birds, having no teeth or lips, possess the excellent ability to imitate almost any kind of sound and human speech that they hear. We began to think of apply the well-structured mynah's vocal organ to laryngectomees and developed the pneumatic“Syrinx-type artificial larynx. ”By using the new apparatus, the degree of clearness of speech sounds was increased as compared with those of the conventional artificial larynx.

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Out of 162 patients with esophageal cancer who underwent esophagectomy, 84 patients (52%) developed recurrent laryngeal nerve paralysis post-operatively. The incidence of paralysis was high in patients whose cervical and upper mediastinal lymphnodes were intensively dissected. In particular, bilateral paralysis often occurred in patients who underwent bilateral cervical lymphnode dissection. Post-operative pulmonary complications were more frequent in patients with recurrent laryngeal nerve paralysis than in those without paralysis. Approximately 10% of the patients with recurrent laryngeal nerve paralysis recovered spontaneously. Laryngeal electromyography was useful for prognostic purposes.

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A 69 year-old male, driving a car, swerved and collided into a tree. He was sent to our hospital because of dyspea with extension of the neck. Although he had no subcutaneous emphysema nor open wound, he showed bilateral pneumothorax. Thoracic drainage was performed and his dyspnea improved. One day after admission his dyspnea recurred without emphysema. We tried tracheostomy because of bilateral recurrent nerve paresis. The cervical trachea was completely separated between the cricoid cartilage and the 1st tracheal ring. Under general anesthesia, tracheostomy was performed at the level of 3 rings distal from the separated part and tracheoplasty was carried out. Ten days after the operation, progressive necrosis occurred in the anterior wall of the trachea between the anastomosis and the tracheostomy. A silicon T-tube was inserted to keep the tracheal lumen open 50 days after the operation. The proximal end of the T-tube did not pass the vocal cord because slight movement of vocal cord appeared. Granulation tissue gradually replaced the necrotic tissue. After the silicon T-tube was removed 78 days after the operation, the T-tube wound was closed, then he was discharged with horseness but without dyspnea.

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A 32-year-old male with primary choriocarcinoma of the anterior mediastinum was reported. He came to our hospital complaining of sputum cruentum and exertional dyspnea. The carcinoma had already metastasized both lung fields at the initial radiological examination. The patient died 25 days after the first examination due to respiratory disorder. An autopsy revealed a solid dark reddish tumor (4*6 cm) in the anterior mediastinum. Syncytiotrophoblasts and cytotrophoblasts were noted in the hemorrhagic necrotic lesions. Staining studies indicated the presence of human chorionic gonadotropin (hCG) and the diagnosis of choriocarcinoma was established. The serum hCG level was elevated to 3, 000 IU/L. There was no evidence of the tumor in the testis.

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