Treatment modality of the nasopharyngeal cancer (NPC) is still controversial. We reviewed 36 patients of NPC who underwent radiotherapy followed by CDDP-based adjuvant chemotherapy during the period from1983 to 1991. The survival rate of this group is better than another 53 patients treated with radiotherapy alone. Distant metastases was seen only 8 cases (22%) in former group as opposed to 21 cases (63%) of the latter. The interval until the detection of distant metastasis was also longer in the patients treated with radiotherapy and chemotherapy. The results suggest that adjuvant chemotherapy contributes to the suppression of distant metastasis and improve the survival rate of the NPC patients.

View full abstract

Nasopharyngeal carcinoma is known to highly involve neck node and distant site. Since early in 1970, chemotherapy has been studied for the treatment of this disease. Numbers of positive results have been reported. Despite such promising results, no randomized trial testing added value of chemotherapy has yet been reported, and it remains to be shown in a randomized trial whether the additions of chemotherapy to conventional treatment could improve patient's outcome. In this paper, the author analyzed the results of chemotherapy for nasopharyngeal carcinoma from the literature. For the neoadjuvant chemotherapy, International Nasopharynx Cancer Study Group reported that there is a significant increase in 3 year disease free survival. Thus neoadjuvant chemotherapy should be indicated for stage III, IV with advanced neck node disease, up to 3 cycles by combination chemotherapy that has some certain magnitude of activity. Simultaneous chemo-radiotherapy has a role in advanced T-stage cases, since main purpose of this treatment modality is local control. Al-Sarrf reported the therapeutic benefit in adjuvant chemotherapy. Adjuvant chemotherapy should be applied for stage III, IV patients with poor prognosis who consider to cause distant metastasis. An outpatient setting chemotherapy regimen that has some certain magnitude of activity is thought to ideal for adjuvant chemotherapy.

View full abstract

Two patients with recurrent squamous cell carcinoma of the nasopharynx and maxillary sinus respectively invading the cavernous internal carotid artery (ICA) underwent radical operation. Cavernous ICA and the contents of the cavernous sinus were excised. Saphenous vein graft reconstruction was performed with direct vein graft technique from the extra cranial ICA to the intracranial supraclinoid ICA to replace the cavernous ICA in the patient with nasopharyngeal cancer. Patch angioplasty was fashioned in the patient of maxillary cancer. We report here the operative procedure, surgical technique, and perioperative management employed in the above two cases. Our experience in the above two operations showed that the prospects of achieving successful middle cranial base resection of medial site of the carotid sulcus and foramen lacerum including the petrous apex of the temporal bone were good, when excision and then reconstruction of the cavernous and petrous ICA was undertaken.

View full abstract

Indication and limitation of the skull base resection for the sinonasal malignancies was discussed in the anatomical and statistical point of view. 1) En bloc resection of the sinonasal primary site and the skull base was necessary for a good surgical result. 2) Orbital apex, optic canal, anterior clinoid process, sphenoid body, anterior border of foramen lacerum, carotid canal and clivus were thought as borderline sites against en bloc complete resection of the skull base. Becase the internal carotid artery had intimate relationship with these sites, respectively. 3) The outer surface of the cavernous sinus (CS) dura could be included in the en bloc resection of the skull base as one of the intracranial tissues. If the tumor invaded deeper and more extensive into the CS, the operative indication was decided whether internal carotid artery could be resected or not. 4) Combined resection of brain parenchyma and the skull base should be a candidate for a new method of en bloc resection of the skull base and sinonasal malignancies. 5) Resectability of the tumor was one of the most influencing factors to the outcome of the skull base surgery for the sinonasal malignancies: Incomplete resection of the tumor did not assure longer than 21-month survival for all the patient after skull base surgery and the resectability of the tumor was more significant for the cumulative 5-year survival rates than factors such as the site involved by the tumor or the histlogic type of the tumor.

View full abstract

1. Vertical Partial Laryngectomy (VPL): Our indications of VPL are in principle T1 and T2 glottic carcinomas. But most of them are considered to be curative by radiation therapy. For that reason the patients treated by VPL initially were only 5% of all T1 and T2 glottic carcinomas. On the other hand VPL for salvage of the radiation failures has been increased, because of the extended indication of irradiation for more advanced glottic carcinomas. Some postoperative complications are atrophy, fibrosis, and loss of the reconstructed soft tissues, which may yield severe hoarseness. The chondritis of the thyroid cartilage was found in two irradiated patients, one of them required total laryngectomy due to necrosis of the cartilage. 2. Horizontal Partial Laryngectomy (HPL): Our indications of HPL are in principle T1 and a part of T2 and T3 supraglottic carcinomas. It is mandatory to evaluate the exact deep invasion with CT scan, and to take into account of the patient's age and systemic conditions. One of the most serious postoperative complications is aspiration. It took a long period for some patients to swallow without aspiration who required wider resection in primary lesions or the combination of neck dissections. Decanulation was retarded for the patients received bilateral neck dissections, because of the persistent edema of the mucosa on arytenoid region.

View full abstract

Various methods of laryngoplasty after partial or total laryngectomy developed in the past 40 years are reviewed. Indications a nd surgical highpoints for near-total laryngectomy developed in our institution are shown in the video. Furthermore, merits and drawbacks of those unique primary laryngoplasties after total laryngectomy, so-called epiglottis saving near-total laryngectomy (Takemiya) and cricoid cartilage saving primary laryngoplasty (Morimitsu), are confirmed. It is need of the times to magnify indications of partial laryngectomy for shorter hospitalization, cost effectiveness, and to avoid long-term hazards after irradiation.

View full abstract

Fifty cases of partial laryngectomy were performed in Gunma Cancer Center from 1972 to 1996. Twenty-seven cases were recurrent after radical irradiation and 23 were performed as initial treatment. After partial laryngectomy one case had local recurrence which placed it in the after radical irradiation group. Partial laryngectomy is indicated for recurrent laryngeal cancer after radical irradiation. I n the case of horizontal partial laryngectomy, preventional neck dissection should be undertaken because in this case cervical metastasis often occurs. Partial laryngectomy falls between radical irradiation and total laryngectomy and it is useful treatment method for laryngeal cancer as this treatment maintains the phonetic function.

View full abstract