We discussed superselective intra-arterial cisplatin infusion with concomitant radiation therapy (RADPLAT) for patients with squamous cell carcinoma of the maxillary sinus (SCC-MS). Ninety-two patients with SCC-MS were treated by RADPLAT between 1999 and 2016 in Hokkaido University Hospital. The 5-year local control rate by RADPLAT and overall survival rate were 64.2% and 65.1%, respectively. We are currently undertaking a multi-institutional prospective trial of the superselective intra-arterial infusion of high-dose cisplatin with concomitant radiotherapy for patients with T4aN0M0 or T4bN0M0 locally advanced SCC-MS (JCOG 1212). The results of the dose-finding phase indicated that this therapy is safe and well-tolerated at 7 cycles of cisplatin 100mg/m², which was determined to be the recommended number of cycles for locally advanced SCC-MS. We consider SCC-MS as a suitable indication for RADPLAT. Therefore, we have to confirm the efficacy and safety of RADPLAT for SCC-MS. We expect that RADPLAT will be one of the treatments of choice for SCC-MS.

We report a retrospective study of 28 maxillary sinus squamous cell carcinoma patients treated by total maxillectomy. The survival was same as other reports. However total maxillectomy leaves dysfunction and appearance problem, surgery is also applicable to the patient with renal dysfunction.

An indication of systemic therapy is thought as T4b maxillary sinus cancer cases. In our hospital we have treated 26 T4b maxillary sinus cancer patients；17 males：8 females；median age：60 years old (36-84 years old). We performed surgeries for 19 patients. Surgeries were consisted of multidisciplinary therapy for 18 patients and craniofacial resection for one patient. Three patients were performed definitive radiation consisted of chemoradiation, super-selective-arterial infusion chemoradiation, and proton beam therapy. Palliative radiation was performed for two patients and best supportive care was performed for two patients. In our hospital we have performed surgery combined multidisciplinary therapy for patients who were observed middle skull base involvement without orbital apex invasion. Compared the other reports we performed surgery for more T4b patients. In non-surgical treatment group definitive treatments performed for three patients, and palliative or best supportive care were performed four patients. Among patients who were performed non-surgical definitive therapy, local control was not observed in patient with chemoradiation, patient with super-selective-arterial infusion chemoradiation was not followed. Local control was achieved in a patient who performed proton beam therapy. The patient was observed radionecrosis of brain, which reduced a quality of life. A 5-year over all survival rates of 20 patients who were performed surgery and proton beam therapy were 57%. There are many issues about systemic therapy for maxillary sinus cancers.

The aim of this study was to evaluate the outcomes of video-assisted thyroidectomy in a single institution. Between May 2009 and June 2018, a total of 325 patients with thyroid diseases underwent thyroid surgery by video-assisted neck surgery (VANS) in our hospital. Among these patients, 249 patients underwent VANS for the benign thyroid nodule, 23 patients for Graves' disease, and 53 patients for malignant disease (cT1N0M0). As a surgical technique, we modified VANS method mainly by using originally developed skin-flap retractor. The main incision was made on the diseased side of the chest wall below the clavicle, and then newly developed retractor was inserted under the subplatysmal layer for creating working space. An endoscope was inserted via the 5 mm ports on diseased sides of the neck. The operation was successfully completed endoscopically in all patients. The median value of the maximum diameter of benign thyroid nodules, operating time for hemithyroidectomy, and amount of bleeding was 32 mm, 121minutes, and 17 mℓ, respectively. As the complications of all 325 patients, 23 patients (7.1%) had the transient recurrent laryngeal nerve (RLN) paralysis and 2 patients (0.6%) had the permanent RLN paralysis. No patient needed tracheotomy and another neck scar. We could confirm that VANS method was safety reliable technique for benign nodule, Graves' disease and early stage malignant disease.

Tracheal invasion with thyroid cancer is a common experience in daily clinical practice. Shave resection is performed for superficial tracheal invasion, and window or circular resection is performed when the cancer has invaded the tracheal intraluminal surface. Although end-to-end anastomosis of the trachea is performed in circular resection, postoperative management is difficult. Even in cases where window resection is performed, multiple invasive surgeries are required to close defect of the trachea. Aiming to achieve minimally invasive tracheal reconstruction, an artificial trachea has been developed using various materials, however many complications have limited its acceptability. We aimed to establish an effective and safe tracheal reconstruction method, and have been working on the development of in situ tissue engineering based artificial trachea. Currently, investigator initiated clinical trials are underway to commercialize in situ tissue engineering based artificial trachea as a medical device.

Recently, the standard treatment for head and neck cancer in each stage include various treatment modalities (surgery, radiotherapy and chemotherapy). Complex regimens such as TPF induction chemotherapy followed by cetuximab with radiotherapy or surgery followed by chemoradiotherapy have various adverse reactions and these often cause treatment interruption and multidisciplinary approaches are necessary. It is important that we have common recognition for the same matter in multidisciplinary treatment, however, I think we don't have enough skill to use common terminology criteria yet. As for hematological toxicities, there are objective borders between grade 1,2 and 3,4. On the other hand, most of non-hematological toxicities have subjective borders and this judgement often need global assessment which consist of findings, ADL and patient reported outcome (PRO). To evaluate non-hematological toxicities, discussions with medical staffs are mandatory. Then, we should discuss about how to use 'terminology' in clinical practice.