Surgical removal is the basic treatment for thyroid cancer. Radioactive iodine therapy and thyroid hormone suppression have also long been used as standard adjuvant therapies. The recent rapid advances in molecular-targeted drugs have led to the development of tyrosine kinase inhibitors (TKIs), which have also been found to be effective against thyroid cancer. The TKIs sorafenib and lenvatinib have been used for the treatment of unresectable differentiated thyroid cancers, and the two drugs came to be covered by insurance in 2014 and 2015, respectively.
We evaluated the treatment outcomes of 13 patients treated with TKIs at our clinic between November 2014 and January 2017. The patients consisted of nine with differentiated thyroid carcinoma and 4 with anaplastic thyroid carcinoma. Eight of the 9 patients with differentiated thyroid carcinoma received sorafenib and 1 received lenvatinib as the 1st line chemotherapy. Four of the 8 patients treated with sorafenib went on to receive lenvatinib as the 2nd line chemotherapy. All of the patients with anaplastic thyroid carcinoma received lenvatinib. Partial response was achieved in two patients treated with sorafenib and 8 patients treated with lenvatinib. None of the 13 patients achieved complete response. Adverse events of all grades associated with sorafenib included hypertension in 4 patients, hand foot syndrome in 3 patients, fatigue in 3 patients, diarrhea in 3 patients, and alopecia in 3 patients. Adverse events of all grades associated with lenvatinib included hypertension in 6 patients, hand foot syndrome in 5 patients, proteinuria in 4 patients, and fatigue in 3 patients.
In Japan, clinical training program for junior residents was started in 2004 and has been administered for over 10 year now. Otolaryngology is an optional subject in the program, and most junior residents generally complete the training program without recerving any experience in dealing with diseases and symptoms in the field of otolaryngology.
We have introduced an otolaryngology outpatient examination training program for all our junior residents to improve the quality of the clinical training at our hospital. A survey using a questonnaire developed by the Ministry of Health, Labour and Welfare was conducted in trainees who had completed the clinical training objectives of the program, to evaluate the impact of the training program and assess the experience of trainees in handling referred clinical cases.
Overall, 163 junior residents who were registered at our hospital from 2012 to 2014, participated in the survey. Results of the survey before and after the introduction of the otolaryngology outpatient examination training program were compared. At a result of the training, the experience rate of common diseases such as dizziness were improved and the ability of the residents to manage common diseases, such as dizziness, improved, and their ability to manage otolaryngology-specific conditions, such as nasal bleeding and hoarseness of the voice, also improved.
A resident of the program commented that his first impression of otolaryngology was narrow field, but the training revealed to how diverse the clinical field actually is. Another resident commented that the training program enhanced interest in the field of otolaryngology.
We consider that the otolaryngology outpatient examination training program at our hospital is valuable for residents familiarize themselves with the subject of otolaryngology. Comments in the open questonaire suggest that hat the training program provides better clarity to the residents about diseases in the field of otolaryngology than before.
Due to the current clinical training program, the relationship between junior residents and otolaryngologists has also become easier. The otolaryngology outpatient examination training program for junior residents has great potential for improving the clinical skills of the residents, as well as for stimulating their interest in the clinical field of otolaryngology.
Giant cell tumor of the bone (GCTB) is a rare osteolytic tumor accounting for 3-5% of all bone tumors and is characterized by aggressive growth, local recurrence, and lung metastasis, although it is classified as a benign tumor. Here, we report a 15-year-old male with GCTB of the sphenoidal bone. No symptoms were apparent at the time of the discovery of the GCTB. However, abducens nerve palsy was subsequently observed. After the first operation, a broad tumor reccured, so anti-RANKL (denosumab) was administered after the second surgery. As a result, the tumor was decreased in size, and the abducens nerve palsy disappeared. This outcome suggests that denosumab treatment might be effective for controlling GCTB in the head and neck region.
Herein, we report a relatively rare case of spindle cell carcinoma of the oropharynx. A 59-year-old man visited our hospital with a one-month history of a foreign-body sensation in his throat. Examination revealed a pedunculated tumor at the base of the tongue on the left side. The tumor was diagnosed by biopsy as being either a spindle cell carcinoma or a solitary fibrous tumor. It was removed by microscopic laryngeal surgery under general anesthesia. The histopathologic findings of the resected tumor were consistent with spindle cell carcinoma. Because atypical epithelium was observed at the surgical margins, the patient received adjuvant radiation therapy and chemotherapy. Until now, more than 5 years since the treatment, the patient has shown no evidence of relapse. High-risk human papillomavirus was not considered to be related to the carcinogenesis in this case, since immunostaining for p16 overexpression yielded a negative result.