Nippon Jibiinkoka Gakkai Kaiho
Online ISSN : 1883-0854
Print ISSN : 0030-6622
ISSN-L : 0030-6622
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Volume 113, Issue 12
Displaying 1-6 of 6 articles from this issue
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Review article
Original article
  • Complications and Clinical Outcome of Salvage Surgery after Concurrent Chemoradiotherapy for Advanced Head and Neck Squamous Cell Carcinoma
    Hidenori Inohara, Yoichiro Tomiyama, Tadashi Yoshii, Yoshifumi Yamamot ...
    2010 Volume 113 Issue 12 Pages 889-897
    Published: 2010
    Released on J-STAGE: June 10, 2011
    DOIhttps://doi.org/10.3950/jibiinkoka.113.889
    JOURNAL FREE ACCESS
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    Concurrent chemoradiotherapy (CCRT) is increasingly used in organ preservation for head and neck squamous cell carcinoma (HNSCC), with surgery as second-line treatment for salvaging locoregional failure. The significance of post-CCRT salvage surgery, however, remains to be established. We report complications and clinical outcome in 34 salvage surgeries on 30 subjects with advanced HNSCC treated by docetaxel and cisplatin concurrent with conventional radiotherapy. Postoperative complications occurred in 9 (30%) subjects and 10 (29%) surgeries. There was no significant difference in complication incidence between salvage surgeries for persistent disease (7 of 19 cases, 37%) and those for recurrent disease (3 of 15 cases, 20%). Complication incidence in isolated neck dissection (6 of 21 cases, 29%) did not differ significantly from that in primary site resection (4 of 13 cases, 31%). Most frequent complications were dysphagia and skin flap necrosis, occurring in 5 subjects each. Three with dysphagia underwent percutaneous endoscopic gastrostomy, and two with skin flap necrosis led to pharyngocutaneous fistula, requiring pectoralis major myocutaneous flap repair. No carotid artery rupture or chyle fistula occurred. Overall 3-year survival after salvage surgery was 74% for persistent disease, and 87% for recurrent disease. Although post-CCRT salvage surgery harbors high risk of complication, it renders good survival and is recommendable for all whose disease is operable.
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  • Deep-neck Infection: Clinical Analysis of 299 Cases
    Kanako Noda, Satoru Kodama, Kenji Noda, Tetsuo Watanabe, Masashi Suzuk ...
    2010 Volume 113 Issue 12 Pages 898-906
    Published: 2010
    Released on J-STAGE: June 10, 2011
    DOIhttps://doi.org/10.3950/jibiinkoka.113.898
    JOURNAL FREE ACCESS
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    Deep-neck infection (DNI) remains potentially fatal. We retrospectively analyzed 299 surgically treated DNI cases between January 1997 and October 2007 by reviewing computed tomography (CT) results and discuss treatment and risk factors. Subjects were divided into two groups by abscess-site; peritonsillar abscess (PTA) (n=251) and deep-neck abscess (DNA) (n=48). Age, smoking habits, body mass index (BMI) and bacteriological histories were collected from clinical records and compared by group. DNI and PTA severity parameters were C-reactive protein (CRP) titer and hospitalization length. Median subject age in DNI was 51.0 years and peak incidence in the 50s. Median subject age in PTA was 31.0 years and the peak incidence in the 20s. Smoker prevalence was higher in both groups than in normal healthy subjects. The DNI group had higher BMI and diabetes mellitus. Factors potentially most affecting illness were complications such as obesity and diabetes mellitus in DNI and age in PTA.
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  • Clinical Analysis of Mandibular Osteoradionecrosis
    Mioko Matsuo, Fumihide Rikimaru, Yuichiro Higaki, Kichinobu Tomita
    2010 Volume 113 Issue 12 Pages 907-913
    Published: 2010
    Released on J-STAGE: June 10, 2011
    DOIhttps://doi.org/10.3950/jibiinkoka.113.907
    JOURNAL FREE ACCESS
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    Radiotherapy thought vital in treating head and neck cancer, occasionally causes seriously local complications such as mandibular osteoradionecrosis (ORN). An analysis of mandibular ORN cases showed 16 in 638 subjects treated by radiotherapy, for an ORN rate of 2.5%. This rate was highest in subjects with oral cancer excluding the tongue, administered 81 Gy radiation dose, using X-ray plus electronic beams. 8 cases of ORN occurred within 1 year following radiation, and the 8 others within 5 years. Preservation treatment was successful in 44% of ORN cases, including surgery, for which the rate of final cure was 63%. With case of cancer recurrence, the rate was 25%. In 2 subjects dying of aspiration pneumonia, the cause should be a particular point for reflection. Radiotherapy involving mandibular bone should include special consideration related to the radiation source, radiation dose. Once ORN occurred, we should take care of the mixed cancer and dysphagia in the treatment.
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Educational lecture
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