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Volume 45, Issue 6Supplement3
Displaying 1-12 of 12 articles from this issue
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Masatoshi HORIUCHI1999 Volume 45 Issue 6Supplement3 Pages 699-705
Published: November 20, 1999
Released on J-STAGE: May 10, 2013
JOURNAL FREE ACCESSThis article reviewed recent developments of clinical studies on cancer chemotherapy in the head and neck and discussed the role of chemotherapy in management of hypopharyngeal cancer. Squamous cell carcinomas developing in lower part of pharynx (hypopharynx) is considered to be most aggressive disease in head and neck. Clearance of loco -regional diseases is not able to improve survival rate in half of patients with advanced hypopharyngeal cancer, because of late appearance of distant metastasis. Patients with hypopharyngeal cancer can be divided in three groups by their resectability of loco-legional lesion and clincal outcome. 1) T2-3N0-1 are usually resectable, and their clinical course may be favorable. 2) T1-3N2 are also resectable diseases, but their outcome are unfavorable. 3) T4N2-3 are usually unresectable, and their survival time are short. Possibility of survival rate of patients with T2-3N0-1 after surgical treatment was reported as 50-60%. Sequential chemo-radiotherapy may be a alternative treatment modality for this favorable stages. Neoadjuvant chemotherapy can preserve laryngeal function after completion of cancer treatment. Outcome of patients with clinical N2 were poor, even their nodes has been resectable. Standard regimen of chemotherapy had limited effect to N2 diseases. Use of neoadjuvant chemotherapy can not improve their prognosis. Advantage of neoadjuvant chemotherapy is considered to be limited. Survival time of patients with unresectable disease was dependent on clinical effect to first treatment. Only patients achieved complete remission had shown relatively favorable outcome as longer median survival time over 24 months. Recent clinical trials of combined chemo-radiotherapy has drawn controversial conclusions. Routine use of neoadjuvant chemotherapy is not recommended for any stage of hypopharyngeal cancer. Role of chemotherapy in management of hypopharyngeal cancer may be different in three clinical categories mention above.View full abstractDownload PDF (15063K) -
Satoshi FUKUDA, Tatsumi NAGAHASHI, Akihiro HONMA, Yukio INUYAMA, Hirok ...1999 Volume 45 Issue 6Supplement3 Pages 706-709
Published: November 20, 1999
Released on J-STAGE: May 10, 2013
JOURNAL FREE ACCESSAccording to current concepts of cancer therapy, the platinum coordination complexes can modulate radiation damage. Past clinical data indicate encouraging preliminary results with concurrent cisplatin and radiotherapy. Carboplatin (CBDCA), a second generation platinum analog has comparable antitumor activity in the head and neck cancer with less toxicity than cisplatin. In order to evaluate the efficacy and safety of concurrent CBDCA and radiotherapy, previously untreated 22 hypopharyngeal carcinomas were treated with weekly CBDCA at 100mg/m2 given simultaneously for the conventional radiotherapy (2.5Gy×4/week) from November 1990. At the dose of 40Gy, patients were evaluated. NC cases underwent planned surgery and PR+CR cases continued this modality up to a dose of 65Gy. Five year disease free survival rate was 34.1%. From the viewpoit of preventive medicine, we consider education regarding not only decreased smoking and alcohol consumption but also chemoprevention to be important.View full abstractDownload PDF (7964K) -
Katsufumi HOKI, Shin-etsu KAMATA, Kazuyoshi KAWABATA, Tomohiko NIGAURI ...1999 Volume 45 Issue 6Supplement3 Pages 710-713
Published: November 20, 1999
Released on J-STAGE: May 10, 2013
JOURNAL FREE ACCESSTwelve hypopharyngeal cancer patients with multiple positive nodes numbered 4 or more were treated with adjuvant chemotherapy. They had resectable tumors and received preoperative radiotherapy and surgery. The drug combination was CDDP/5FU or CDDP/PEP. 2-year survival rate was 58.3%. In contrast, 25 patients with positive nodes numbered 4 or more treated with radiotherapy and surgery had 25.0% 2- year survival rate. The differences are significant. It has been shown that the lymph node status is the most important prognostic factor in head and neck cancer. Number of positive nodes portend poor prognosis, and positive nodes number 4 or more are strongly correlated with poor prognosis and the rate of distant metastasis. In this retrospective study, we recognize that this design is imperfect. However, results of this study suggest that adjuvant chemotherapy may improve survival in patients with advanced head and neck cancer. And in the future, it must be investigated that which status of tumor should be treated with adjuvant chemotherapy.View full abstractDownload PDF (6761K) -
[in Japanese], [in Japanese], [in Japanese], [in Japanese]1999 Volume 45 Issue 6Supplement3 Pages 714-718
Published: November 20, 1999
Released on J-STAGE: May 10, 2013
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Tomohiko NIGAURI, Shin-etsu KAMATA, Kazuyuki KAWABATA, Katsuhumi HOKI, ...1999 Volume 45 Issue 6Supplement3 Pages 719-722
Published: November 20, 1999
Released on J-STAGE: May 10, 2013
JOURNAL FREE ACCESSWe reviewed 240 patients of hypopharyngeal cancers who underwent neck dissection between1978 and 1994 at Cancer Institute Hospital in Tokyo. Radical neck dissection (RND) was performed for 175 sides of the neck and neck failures developed on 7 sides (failure rate; 4%). Modified radical neck dissection (mRND) was performed for 147 sides and neck failure was seen in 3 sides (2.0%). Forty two sides received lateral neck dissection (LND) and neck faileure appeared on one side (2.3%). Totally local recurrences appeared on 11 sides within the dissection field among 364 sides, then overall neck recurrence rate was 3.0%. We did not find definite relationship between the types of neck dissection, number of pathological LN metastases and incidence of neck failure. Because of low recurrence rate of mRND cases, conservative neck dissection may be more widely indicated for hypopharyngeal cancer patients in near future.View full abstractDownload PDF (6782K) -
An assessment of new surgical approach using segmented neck dissectionWataru NISHIJIMA, Syouji TAKOODA, Hiroko KOUDA, Kouki KIMIZUKA1999 Volume 45 Issue 6Supplement3 Pages 723-728
Published: November 20, 1999
Released on J-STAGE: May 10, 2013
JOURNAL FREE ACCESSThis study evaluates a modified neck dissection that has been applied to patients with hypopharyngeal carcinoma who have been treated at Saitama Cancer Institute. The procedure starts with creation of an apron type of flap, making an initial incision in the direction of natural skin crease in the lateral aspect of the neck at the level just above the hyoid bone. Then the incision is continued down to the level just above the sternum along the anterior border of the sternocleidomastoid muscle (SCMM) taking care not to include the SCMM with the flap. An idential incision is made on the opposite side of the neck to form a u- shaped flap. Dissection is carried out laterally at the level deep to the SCMM and posteriorly as far as to the anterior border of the trapezius muscle. Then the entire lateral neck flap is retracted anteriorly and posteriorly as if a book was opened. This action allows an adequate exposure of fat pads, a main target for neck dissection. The fat pads posterior to the internal jugular vein is cleaned separately from those located anterior to the vein as the two compartments. Thus the two copmartments are dissected individually. The posterior copmpartment is occasionally divided further into two subcompartments bordered by the spiral accesory nerve. Each compartment is cleaned in the same fashon. A special care is taken not to disturb the capsular membrane of lymphnodes affected with metastasis. The anterior fat pads dissected are removed in continuity with the hypopharyngeal lesion. The posterior fat pads are cleaned individually as a separate specimen. Twenty six procedures including eight unilateral and 16 bilateral cases have been carried out using the tchnique described here, whereas conventional en bloc dissection has been performed in 68 cases (unilatera1: 22, bilatera1: 46). The analysis shows no significant difference between the two modalities inregard to survival rate. This segmented dissection advocated here seems to be indicated for lesion up to N2b in which positive nodes are not connected each other as a chain like fashion. It is, therefore, suggested that the technique may be employed as safely and effectively as the standard en bloc procedure for selected patients.View full abstractDownload PDF (12171K) -
Ryuichi HAYASHI, Satoshi EBIHARA, Seiji KISHIMOTO1999 Volume 45 Issue 6Supplement3 Pages 729-731
Published: November 20, 1999
Released on J-STAGE: May 10, 2013
JOURNAL FREE ACCESSIt is well known that hypopharyngeal carcinoma frequently associate with the carcinoma of the esophagus. We reviewed the management of the carcinoma of the esophagus in the patients who had undergone operation against hypopharyngeal carcinoma. Between 1988 and 1995, 120 cases had received the operation to hypopharyngeal carcinoma. We recognized the carcinoma of the esophagus simultaneously for 17 patients (14%) out of 120 patients. In nine cases, the presence of carcinoma were found as unstained area by iodine staining. These results suggest the importance of screening preoperative endoscopy of upper digestive tract. The 3-and 5-year overall survival rates of 17 cases were 31.8%, and cause specific 3-and 5-year survival rates of hypopharyngeal carcinoma were 37.4%. Eleven patients died and 9 of 11 patients died of hypopharyngeal carcinoma. The patients with hypopharyngeal carcinoma requiring operation had advanced disease, whereas most of the synchronous esophageal carcinomas were in early stage. We considered that the existence of esophageal carcinoma was not a prognostic factor for the patients who had received operation to hypopharyngeal carcinoma.View full abstractDownload PDF (4593K) -
Takashi YOSHIDUMI, Bunsuke SATAKE, Tetsuya URUMA, Masashi FUKATSU, Hid ...1999 Volume 45 Issue 6Supplement3 Pages 732-736
Published: November 20, 1999
Released on J-STAGE: May 10, 2013
JOURNAL FREE ACCESSThe results of treatment according to surgical procedures in 68 patients with squamous cell carcinoma of the hypopharynx and incidence of double cancer with esopahgeal cancer were analyzed. Surgical procedures for cancer resection were partial pharyngectomy with total laryngectomy (TLP) in 16 patients, total pharyngolaryngocervical esophagectomy (TPLCe) in 18 and total pharyngolaryngoesophagectomy (TPLE) in 33, respectively. Procedures of esophageal reconstruction for patients who had TPLE were gastric pull-up in 3lpatients and pedicled colon in 2 and that for patients who had TPLCe were deltopectoral flap in 3, free tissue tranfer with microsurgical vessel anastomosis in 15 (jejunum in 14, forearm flap in 1). The 5-year survival rate of all patients was 47%. There was no significant differece in survival rate between those patients with TPLE and those with TPLCe or TLP. Among them, intra-thoratic esophageal cancer was detected in 4 patients (6%) and the incidence of skip lesion in cervical esophagus was estimated to be 3-9% (2-6patients). First choice of surgical procedures for hypopharyngeal cancer should be TPLCe, but TPLE would be indicated for about 15% of these patients.View full abstractDownload PDF (9780K) -
[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...1999 Volume 45 Issue 6Supplement3 Pages 737-741
Published: November 20, 1999
Released on J-STAGE: May 10, 2013
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Katsunari YANE, Hirosi MIYAHARA, Ichiro OTA, Hiroaki NAITO, Hirokazu U ...1999 Volume 45 Issue 6Supplement3 Pages 742-748
Published: November 20, 1999
Released on J-STAGE: May 10, 2013
JOURNAL FREE ACCESSTo assess the prognostic value of p53, wafl, Rb, bc1-2, and bax in hypopharyngeal carcinoma, twenty nine hypopharyngeal carcinomas were investigated. Exons 5 through 9 of the p53 gene were screened using single-strand conformation polymorphism analysis of polymerase chain reaction products (PCR- SSCP). The targeted DNA sequences coding for p53 were confirmed by direct DNA sequencing. Expression of p53, wafl, Rb, bc1-2, and bax protein were evaluated by immunohistochemistry. Point mutations of p53 were found in 9 (31%) of the 29 hypopharyngeal carcinomas, including one with a double mutation, and 4-bp deletion was detected in one case. Positive staining of p53, wafl, Rb, bc1-2, and bax were immunohistochemically detected in 48% (14/29), 70% (19/27), 76% (19/25), 27% (7/26), and 77% (20/26), respectively. Although strong staining of Rb was found in 76%, Rb protein was expressed in all tumors evaluated. The 5-year survival rate in hypopharyngeal carcinomas was worse in p53 positive staining compared to p53 negative staining (p<0.05). In contrast, there was no statistical significance in survival with p53 mutation and expression of wafl, Rb, bc1-2, and bax protein. This result suggests that immunohistochemical staining of p53 is more useful for the prognosis of hypopharyngeal carcinomas.View full abstractDownload PDF (15794K) -
Tetuya OGAWA, Yasuhisa HASEGAWA, Hidehiro MATSUURA1999 Volume 45 Issue 6Supplement3 Pages 749-752
Published: November 20, 1999
Released on J-STAGE: May 10, 2013
JOURNAL FREE ACCESSChemotherapy is an important therapy of head and neck carcinomas. The emergence of chemotherapeutic drug resistance is a major clinical problem and the reason for failure in the treatment of patients with head and neck cancer. It is very important to predict the response of chemotherapy of head and neck cancer. We reported two methods of anticancer drug sensitivity test. SDI test is an in vitro test, based on the correlation of succinate dehydrogenase activity using tetrazolium salt as a hydrogen acceptor, with cell viability. This method's good points are as follows: 1: It is very simple and could be able to deal many samples at a time. 2: It takes only short time to do and it has good reappearance. 3: It could be able to elect ineffective drugs. This method's weak points are as follows: 1: It has an aspect loss of interaction of cells because this method uses only malignant cells viabillity. 2: It has low rate of judgment. 3: There are low relationship between this result and clinical course. 4: There are influence of intermediate cells. HDRA method is reported by Freeman and Hoffman at 1986. This method's good points are as follows: 1: Measurement is done by preserving the interaction of cell. 2: Rate of judgment is higher than SDI method. 3: Correlation to clinical course is high. This method's weak points are as follows: 1: Measurement time is long. We reported the relationship between p53 expression and response of chemotherapy. The negative cases of p53 had a tendency of good response of chemotherapy, but positive cases of p53 had a tendency of bad response. We concluded that assessment of p53 protein expression would be able to predict the response of chemotherapy. Then we may be able to elect the effective drugs using HDRA method and inffective drugs using SDI method.View full abstractDownload PDF (6901K) -
[in Japanese], [in Japanese], [in Japanese], [in Japanese]1999 Volume 45 Issue 6Supplement3 Pages 753-759
Published: November 20, 1999
Released on J-STAGE: May 10, 2013
JOURNAL FREE ACCESSDownload PDF (15412K)
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