The standard non-surgical treatment for locally advanced head and neck squamous cell carcinoma is concurrent chemoradiotherapy with cisplatin (CDDP) since previous pivotal phase Ⅲ trials and meta-analyses showed the survival benefit of CDDP plus radiation. On the other hand, adding cetuximab to radiation (RT) also showed the survival benefit comparing with RT alone. So, we are now facing the clinical question whether cetuximab plus RT is equivalent to CDDP plus RT or not. At present, we have to wait for the ongoing randomized clinical trials comparing CDDP plus RT with cetuximab plus RT and recommend CDDP + RT to the patient in good general condition with adequate organ function.

The non-surgical treatment strategy for locally advanced head and neck squamous cell carcinoma has been controversial. To assess appropriate therapies including chemoradiotherapy and bioradiotherapy, we conducted a retrospective chart review of 75 patients with squamous cell carcinomas of head and neck who underwent high dose CDDP-concurrent CRT. These cases included 64 males and 11 females, aged from 36 to 79 years (median age : 65 years old). The primary sites included oropharynx in 20 cases, hypopharynx in 18 cases, larynx in 3 cases and oral cavity in 24 cases, respectively. Of total 75 cases, 72 (96.0％) completed the radiotherapy. Only one case ceased radiotherapy because of adverse event (acute renal failure and pneumonia). Two cases discontinued radiotherapy due to recurrent tumor during radiotherapy. As for CDDP total dose, 23 cases (30.7％), 32 cases (42.7％) and 20 cases (26.7％) underwent full dose (300 mg/m²), 200 mg/m² or more and less than 300 mg/m² (200 mg/m² ≦, ＜ 300 mg/m²) and less than 200 mg/m² (＜ 200 mg/m²), respectively. Furthermore, we conclude that aging and the creatinine clearance before treatment were found to portray low feasibility factor for high dose CDDP-concurrent CRT.

Adverse events and supportive care during Chemoradiotherapy (CRT) or Bioradiotherapy (BRT) for head and neck cancer are presented and discussed. Although to varying degrees, mucositis and dermatitis are frequently observed during either CRT or BRT. Infusion reaction and interstitial lung disease are severe adverse events to which we must pay close attention during BRT. Appropriate supportive care is important to achieve high treatment completion rates and good prognosis.

Surgical treatment is often adopted as function-preserving therapy for advanced oral cavity carcinoma. This study investigated the resected area, method of reconstruction, whether deglutition-improving surgery was performed, and nutrition method at the time of discharge intended for advanced tongue cancer patients who received radical resection and reconstruction with free flap. Most patients achieved oral intake without tube feeding at the time of discharge. These facts show that if appropriate reconstruction surgery is undertaken, even in advanced cases, oral intake is possible. Sufficient swallowing function after surgery cannot be achieved in some cases. These cases showed several problems besides surgical treatment, such as poor performance status, or poor motivation in swallowing rehabilitation. Head and neck surgeons cannot solve these problems. Cooperation with swallowing rehabilitation and mental support teams is important to achieve better swallowing function.

The author conducted a review of 19 patients who had undergone resection of lateral wall type oropharyngeal cancer at Okayama University Hospital for between September, 2006 and August, 2014. General diet was eaten in 11 of 12 patients in the T2 cases, but six of seven patients were able to eat only mixer food in the T4a cases. Posterolateral resection was performed in the layer of the internal carotid, all seven cases for eight of 12 T2 cases and all T4 cases. Six of seven T4a cases were able to eat only mixer food, but, as for seven of eight T2 cases, intake of the general diet was possible, and the posterolateral resection along the internal carotid was not a factor for swallowing dysfunction. The resection of the base of tongue was performed in seven T4a all cases. Seven of 11 patients who underwent base of tongue resection were able to eat only mixer food. Resection of the base of tongue seemed to be the factor in for postoperative swallowing dysfunction T4a cases.

An important goal of reconstructive surgery in patients with mesopharyngeal cancer is to restore oropharyngeal function after cancer ablation. Especially, simultaneous resection of three part of mesopharynx - lateral wall, soft palate and tongue base - is closely related to velopharyngeal and swallowing dysfunction. In this report, our surgical procedures of reconstructive surgery for three dimensional defect was introduced.

Epstein-Barr virus (EBV) is involved in carcinogenesis and progression in most cases of nasopharyngeal carcinoma (NPC). Standard treatment in Western countries is concurrent chemoradiotherapy (CCRT) followed by adjuvant chemotherapy (AC). However, the treatment completion rate is only 55%, and a meta-analysis failed to show the advantage of adding AC following CCRT. Now, clinical trials adding AC only to high-risk patients according to high copy numbers of EBV-DNA (BamHI-W fragment) as biomarker are in progress internationally. In recent years, vesicles called exosomes that enclose RNA and/or protein in cells were found to function as intercellular messengers, and they are released into extracellular fluids. Exosomes are released from living cells, and RNAs that are encapsulated in them can be present stably even in blood. Therefore, we examined whether EBV-encoded small RNAs (EBERs) are present in the serum of NPC patients. In addition, we compared this new candidate biomarker and existing markers such as EBV antibody titers and imaging diagnosis, with respect to the response to treatment and prognostic assessment.

The human papillomavirus (HPV) is relevant to the pathogenesis of head and neck cancer, in particular oropharyngeal cancer (OPC). In USA, the population-level incidence of HPV-related OPCs increased by 225% from 1988 to 2004, and incidence for HPV-unrelated OPCs declined by 50%. A large number of papers showed that HPV-related OPCs have better prognosis than HPV-unrelated OPCs. Recently, several clinical trials intended to reduce the intensity of treatment are going on using HPV status or p16 protein expression as biomarker. I present an overview of the current state of HPV as biomarker in head and neck cancer treatment.

A growing body of evidence suggests that microRNA (miRNA) contributes significantly to head and neck squamous cell carcinoma (HNSCC) progression, development and metastasis. Our recent studies of miRNA expression signatures demonstrated that microRNA-29s (miR-29s ; miR-29a/b/c) were significantly downregulated in HNSCC and were putative tumor-suppressive miRNAs in human cancers. The aim of this study was to investigate the functional significance of miR-29s in cancer cells and to identify novel miR-29s-mediated cancer pathways and responsible genes in HNSCC oncogenesis and metastasis. To identify miR-29s-mediated molecular pathways and targets, we utilized gene expression analysis and in silico database analysis. Loss-of-function assays were performed to investigate the functional significance of miR-29s target genes. Restoration of miR-29s in SAS and FaDu cell lines revealed significant inhibition of cancer cell migration and invasion. Gene expression data and in silico analysis demonstrated that miR-29s modulated the focal adhesion pathway. Moreover, laminin γ 2 (LAMC2) and integrin α 6 (ITGA6) genes were candidate targets of the regulation of miR-29s. Luciferase reporter assays showed that miR-29s directly regulated LAMC2 and ITGA6. Silencing of LAMC2 and ITGA6 genes significantly inhibited cell migration and invasion in cancer cells. The miR-29s acted as tumor suppressors and directly targeted laminin-integrin signaling. Recognition of tumor-suppressive miRNA-mediated cancer pathways provides new insights into the potential mechanisms of HNSCC oncogenesis and metastasis and suggests novel therapeutic strategies for the disease.