Objectives: The aim of this study is to review the treatment results for stage IV oropharyngeal cancer at Cancer Institute Hospital of Japanese Foundation for Cancer Research in Tokyo. Patients & Methods: Two hundred and eight cases with stage IV oropharngeal cancer were treated from 1971 to 2003. All cases were irradiated 40Gy followed by surgery when the primary site remained or followed by full dose radiation when it disappeared clinically. Results: Treatment results improved after a microvascular flap was used for head and neck reconstruction. Among 208 cases, 91 cases were radically irradiated and 117 cases underwent surgery. There was no significant difference between local control rates of two modalities. But surgery provided a superior outcome in T 3/4. More than half of the cases with stage IV base of tongue cancer or T 4 had total laryngectomy. Conclusion: Surgery is regarded to be an optimal treatment for stage IV oropharyngeal cancer if the postoperative function is preserved.

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We report the results of superselective intraarterial CDDP infusion and concomitant radiotherapy for 25 patients with stage IV oropharyngeal carcionamas, compared with 52 patients treated before introduction of intraarterial chemoradiation. The 5-year cause-specific survival rates in the intraarterial chemoradiation group were 89% for under T2, 58% for T4 and 72% for total patients, including 2 patients with T3 who are alive within 5 years after treatment. On the other hand, the survival rates in the past group were 75% for T2, 50% for T3, 39% for T4 and 48% in all. The survival rates of the operated patients in the past group were 75% for T2 and T3, 50% for T4, but 31 of 34 patients in this group had extensive resection required reconstruction surgery. However, only 6 patients received partial resection in the intraarteial chemoradiation group. We conclude that intraarterial CDDP infusion combined with radiotherapy is very effective for patients with advanced oropharyngeal carcinomas, because it makes minimizing dysfunction and possibly improving survival.

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Treatment of the temporal bone carcinoma, such like squamous cell carcinoma in the external ear canal, is still formidable challenge. Surgery is the first choice for its treatment. However, because of its complex anatomy, total removal of carcinoma in the temporal bone is difficult task for the surgeon. Inside of the temporal bone is invisible even using an endoscope, imaging study is the key to establish adequate treatment. In this article, we introduce our surgical strategy for the malignant temporal bone tumour. The first line in this strategy is whether to perform lateral temporal resection or whether to perform subtotal temporal bone resection. The second line is area of resection of the soft tissue, such like helix, concha, parotid gland and adjacent muscles. From our experience, the former is best decided by target CT imaging and the latter is best decided by MR imaging.

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Forty patients with external ear canal and/or middle ear cancer were treated at the Department of Otolaryngology-Head and Neck Surgery, Kobe University Hospital during the past 12 years. The tumors were classified according to the staging system proposed by Kishimoto. as follows: 15 lesions as T1 and T2 and 25 lesions as T3 and T4. Either surgery or radiotherapy has led to no local recurrence for early stages (T1 and T2). The 5-year estimated survival rates of the patients with T3 and T4 lesions treated by surgery and by radiotherapy were 64% and 15%, respectively. Particularly, the 2-year estimated survival rates of these patients treated with radiotherapy were 100% (3/3) for T3 and 17% (1/6) for T4, respectively. These results suggest that radiotherapy might be the alternative best treatment option for T3 lesions but for T4 lesions.

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Our rationale and treatment strategy for squamous cell carcinoma of the temporal bone were described. Preoperative chemoradiotherapy was performed in the following cases; i. e., Ti and T2 of which the lesion extended beyond the cartilaginous part, T3, and the anterior lateral type of T4. Most of the cases except the medial type of T4 cases were radically operated. Disease-specific 5-year survival rates of T3 and T4 were 80% and 36%, respectively. Surgical margin free was important factor for good prognosis.

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Nasal NK/T-cell lymphoma is an Epstein-Barr virus (EBV)-related aggressive neoplasm with poor prognosis. To improve the treatment outcome, we are trying arterial infusion chemotherapy from superficial temporal artery in combination with radiotherapy for early stage nasal NK/T-cell lymphoma. New regimen for the arterial infusion consist of fosfamide, carboplatin, methotrexate, peplomycin and etoposide (MPVIC-P). Fosfamide, carboplatin, methotrexate, and peplomycin are independent of multidrug resistance genes common- ly expressed in the lymphoma cells, and etoposide is known to be effective against lymphoma-associated hemophagocytic syndrome (LAHS), which frequently develops in the patients. From 2003, 5 patients with stage I nasal NK/T-cell lymphoma were treated by the arterial infusion of MPVIC-P regimen for 3 cycles and concomitant radiotherapy. Effect of the treatment was evaluated by local findings, CT and MRI findings, and EBV-DNA copy number in serum. All patients achieved complete remission (CR) and the 3-year disease free survival (DFS) rates were 100%. According to these results, arterial infusion chemotherapy from superficial temporal artery in combination with radiotherapy is effective treatment for early stage nasal NK/ T-cell lymphoma.

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Malignant lymphomas arising in the head and neck area include nasal NK-cell lymphoma, paranasal diffuse large B-cell lymphoma (DLBCL), Waldeyer ring DLBCL, and DLBCL and MALT (mucosa-associated lymphoid tissue) lymphoma of the salivary glands and thyroid. In the cervical lymph nodes, various types of lymphomas are found, including DLBCL, follicular lymphoma and Hodgkin lymphoma. Here, I will describe the treatment of early stage and advanced stage lymphomas, with particular emphasis on that of nasal NK- cell lymphoma.

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Combined transoral-transcervical approach has been used for the resection of the most or opharyngeal cancer without invasion to the mandible, medial pterygoid muscle or nasopharygeal space. This approach enables to get better results cosmetically and functionally than the mandibular swing approach. However, in recent years, cisplatin-based concurrent chemoradiotherapy (CCRT) has been widely employed in the treatment of even advanced oropharyngeal cancer with the intent of presenting swallow and speech. After CCRT, more than 70% of the patients with stage III, IV oropharyngeal cancer showed CR at our institute and the CR persisted for more than 18 months in 70% of these patients. Salvage surgery for the remnant tumor also had a good result, however the result was poor for the recurrent tumor after CCRT. We discussed the choice of the surgery approach and of treatment modality.

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