In cases of suspected perilymphatic fistula (PLF) as the cause of dizziness and/or acute sensorineural hearing loss, we instruct patients to rest for several days with the head raised. Thereafter, if the symptoms do not improve, surgery is performed. Between January 2016 and December 2019, we treated 28 cases of PLF by surgery at Kurume University Hospital, and examined the triggers and symptoms at onset, nystagmus pattern, surgical findings, and treatment outcomes. In most cases, there were no triggers for the symptom onset. Vestibular symptoms were observed in 92.9% of cases. Sensorineural hearing loss was observed in 82.1% of cases. Vestibular function tests showed positional nystagmus in 82.1% of cases. During surgery, fistulas were confirmed in 14.3% of cases and perilymphatic fluid leakage in 64.3% of cases. The hearing loss improved after the surgery in 26.1% of cases. The improvement rate of hearing loss was 80.0% for patients who underwent surgical treatment within 2 weeks of onset. The overall improvement rate of vestibular symptoms was 88.5%. Even in cases treated a long time after the disease onset, the rate of improvement of vestibular symptoms was good. Surgical treatment should be considered for cases of suspected PLF.

In this study, we examined the data of 136 patients with pars flaccida cholesteatoma and 62 patients with pars tensa cholesteatoma who had undergone initial surgical treatment at Kurume University Hospital between January 2010 and August 2015.

Canal wall up tympanoplasty (CWU) had been selected as the basic procedure, and the defect in the posterior wall of the ear canal was reconstructed with cartilage. Staged surgery was performed in patients with suspected residual presence of cholesteatoma or severe inflammation.

The selected surgical method, the postoperative hearing improvement rate, and the rate of recurrence were examined retrospectively.

Among the patients with pars flaccida cholesteatoma, transcanal atticotomy (TCA) was performed in 10.3%, CWU in 72.8%, and canal wall down tympanoplasty (CWD) in 16.8% of patients.

Among the patients with pars tensa cholesteatoma, TCA was performed in 57.3%, CWU in 29.5%, and CWD in 13.1% of patients.

In the patients with pars flaccida cholesteatoma, the overall hearing improvement rate was 61.5%.

In the patients with pars tensa cholesteatoma, the overall hearing improvement rate was 63.6%.

In the group with pars flaccida cholesteatoma, residual cholesteatoma was observed in 9.6% and relapse/reformation in 7.4% of patients. In the group with pars tensa cholesteatoma, residue was observed in 11.4% and relapse/reformation in 13.1% of patients.

The rates of recurrence were higher than in previous reports, and we believe that staged surgery should have been performed for more cases.

We conducted a retrospective review of 53 cases of sinonasal papillomatosis treated between November 2000 and October 2018. The most frequent symptom was nasal obstruction (66%). The patient distribution according to the Krouse classification was as follows: T1, 7 cases; T2, 24 cases; T3, 15 cases; T4, 7 cases. The papillomatous lesions were surgically removed by an endoscopic (40 cases) or external (13 cases) approach. Postoperative histopathological examination revealed squamous cell carcinoma components in the papillomatous lesions in 4 cases. Postoperative recurrence occurred in 8 cases (15.1%), including a case of recurrence developing 94 months after the endoscopic surgery. Although endoscopic techniques have advanced in recent years, endoscopic resection of sinonasal inverted papillomas remains challenging, especially in advanced cases. To determine the appropriate surgical approach, careful evaluation in individual cases is necessary.

Adenotonsillectomy is the standard surgical treatment for pediatric obstructive sleep apnea syndrome (OSAS). Overnight polysomnography (PSG) is recognized as the gold standard for the diagnosis of pediatric OSAS.

We reviewed the data of 44 cases of pediatric OSAS treated by surgery (adenotonsillectomy).

Significant improvements were obtained in the apnea-hypopnea index, obstructive apnea index, minimum SpO₂, snoring index, and arousal index after the surgery. On the other hand, no significant changes in the central apnea index, sleep efficiency, deep sleep (Stage N3 sleep) or Stage REM sleep were observed postoperatively.

Improvement of the clinical symptoms was noted in all cases after surgical treatment, and all the parents were satisfied with the efficacy of the surgical treatment.

PSG provides useful pathophysiological information in pediatric OSAS patients. However, to select the most suitable surgical intervention, not only preoperative PSG, but also evaluation of the symptoms and upper airway tract in individual cases are of utmost importance.

Preventive surgery to combat aspiration by completely separating the airway from the gastrointestinal tract results in the loss of vocal function and does not necessarily guarantee postoperative oral intake. We conducted a retrospective evaluation of the patient background, surgical procedures, complications, pre- and postoperative nutritional management, and pre- and postoperative airway management in 33 patients who had undergone preventive surgery to combat aspiration at our department between January 2000 and December 2020. The most common underlying diseases were cerebrovascular disease in younger patients, and cerebrovascular disease and post-pharyngeal cancer in elderly patients. The surgical procedures performed were laryngotracheal separation in 10 cases, tracheoesophageal diversion in 12 cases, total laryngectomy in 7 cases, and glottal closure in 4 cases. Laryngotracheal separation tended to be selected for younger patients and patients with lower levels of independence. The complication rates did not differ depending on the surgical technique. Postoperative oral intake was associated with the degree of independence and presence of preoperative oral intake. Patients who required respiratory management, frequent aspiration of the sputum, and abnormal neck morphology, such as short neck, strained neck, cervical contracture, or stenosis of the tracheal stoma often required tracheal cannulation after the surgery. Good wound healing and postoperative freedom from cannulation or neck rests are important to avoid postoperative complications. Postoperative oral intake depends on the patient’s preoperative condition and state of progression of the underlying disease. When selecting the most appropriate procedure, the patient’s condition and the degree of invasiveness of the surgery should be considered, and the advantages and disadvantages of the surgery must be fully explained and understood by the patient and his/her family.

Objective: The aim of this study was to investigate the effect of surgical treatment for Reinke’s edema on the voice quality and vocal fold vibrations.

Method: We reviewed the data of 40 cases of Reinke’s edema who were treated surgically at our hospital between 2001 and 2019. Reinke’s edema was classified into three types, Type I, Type II and Type III, according to the classification proposed by Yonekawa. Results of psychoacoustic evaluation using the GRBAS scale, preoperative laryngeal findings, surgical procedure selected, perioperative findings, and results of pre- and postoperative phonatory function examinations (aerodynamic study and acoustic voice analysis) were investigated retrospectively.

Results: Of the 40 cases, 6 were classified as Type I, 18 as Type II and 16 as Type III. The condition was multilocular in 6 cases. In all cases, the results of psychoacoustic evaluation and phonatory function improved significantly after the surgery. Furthermore, the degree of improvement was greater in Type II and Type III cases. Type III cases, and cases with multilocular swelling, mucosal lesions and/or subepithelial adhesions showed poor vocal fold vibrations after the surgery.

Conclusion: We consider that surgical treatment is the most appropriate for Type II and Type III cases, and in Type III cases, multilocular swelling, and presence of mucosal lesions and subepithelial adhesions might be risk factors for vocal fold insufficiency after the surgery.

Introduction: Unilateral vocal fold paralysis (UVFP) is a major voice disorder, caused in most cases by recurrent laryngeal nerve palsy. Several surgical methods have been described for the treatment of UVFP, including arytenoid adduction (AA), thyroplasty type I (TP1), and fat injection laryngoplasty (FIL). This study was aimed at clarifying the efficacy of the phonosurgery performed at our institution.

Method: We analyzed 272 cases of unilateral vocal fold analysis treated by TP1, AA or FIL at our institution between 1996 to 2019. The patient demographics, number of selected surgical procedures with or without glottal level difference and posterior glottal gap during phonation, and the phonatory outcomes were analyzed using a voice examination profile. The maximum phonation time (MPT), mean flow rate (MFR), fundamental frequency (F0), sound pressure level (SPL), pitch perturbation quotient (PPQ), and amplitude perturbation quotient (APQ) were used for the analysis. For each surgical method, the postoperative voice examination data between 3 and 6 months after the surgery were statistically compared with the preoperative examination using a paired t-test.

Results: The distribution of the patients according to the surgical procedure adopted was as follows: TP1: 74 (27%) cases; AA: 22 (8%) cases; TP1 + AA: 47 (17%) cases; FIL: 129 (47%) cases. Mainly TP1 and FIL were performed for the cases without glottal level difference, and mainly AA and TP1 + AA were performed for the cases with a gap on each side of the vocal process (posterior gap) or with glottal level difference. The MPTs were longer, MFRs smaller, SPLs higher, and PPQs and APQs were found to be lower after the surgeries as compared with the preoperative values.

Conclusion: The postoperative voice function improved, irrespective of the surgical procedure adopted. Selection of the appropriate surgical procedure should be made based on evaluation of the glottal level difference and posterior gap. AA surgery is suitable for cases with a glottal level difference or large posterior gap, since TP1 and FIL can fundamentally improve the glottal gap of the membranous portion of the vocal folds.

Objective: External laryngeal trauma is a rare event. Otolaryngologists need to be well informed about the characteristics and mechanisms, so as to avoid a persistent voice problem. In the present retrospective study, we reviewed the data of 32 patients of laryngeal trauma who were treated at our department between 2000 and 2021 to investigate the clinical characteristics and voice outcomes.

Methods: Details of several patient characteristics (age, symptom, cause of trauma, classification, treatment, voice condition) were collected from the patients’ records. In addition, we statistically compared the voice conditions of the patients before and after treatment.

Results: The patients ranged in age from 13 to 81 years (median: 39 years). The presenting symptoms in the total of 32 cases were hoarseness (84%), neck pain (16%), dysphasia (6%), dyspnea (6%), and odynophagia (3%). Laryngeal trauma was caused by sports accident (38%), traffic accident, violence, fall (16% each), and suicide attempt (3%). According to the Umeno classification, 23 patients were classified into Group 3, 8 into Group 1, and 1 into Group 4. Surgical treatments were provided for 14 patients (44%). Reduction of thyroid and cricoid cartilage was performed in 11 (34%) and 2 cases (6%), respectively. Thyroplasty was performed in 2 cases (6%), injection laryngoplasty in 1 case, and mucosal treatment with laryngofissure in 1 case. In regard to voice evaluation, significant improvement was observed in maximum phonation time and amplitude perturbation quotient. Especially in the surgery group, the highest fundamental frequency showed a remarkable tendency to increase, leading to a significantly expanded voice range.

Conclusion: We examined 32 cases of laryngeal trauma and demonstrated desirable voice outcomes. Voice examination seems to be useful to evaluate the treatment outcomes in patients with laryngeal trauma.

We conducted a retrospective review of the clinical findings of 98 patients with acute epiglottitis who were hospitalized and treated between 2008 and 2019. There were 66 men and 32 women, ranging in age from 18 to 88 years (median: 49). The most frequent season of occurrence was the spring season, and the most frequent symptom was sore throat. When classified according to Tanaka’s classification, 67 patients had mild disease (score 1–3) and 31 had severe disease (score 4 or 5). All cases recovered with antibiotic and/or glucocorticoid treatment. Additional airway management, which involved tracheostomy in all cases, was needed in 11 patients. Statistical analysis identified high scores on Tanaka’s classification (scores of 4 or 5) and high white blood cell counts (≥17000 counts/μL) as being significantly correlated with the possibility of airway management.

Surgical resection is the standard treatment for tongue cancer. We conducted a retrospective investigation of the clinical outcomes of 202 patients with tongue cancer who were treated surgically at our institution.

The 5-year overall survival (OS), disease-free survival (DFS), and disease-specific survival (DSS) rates in the overall subject population (n = 202) were 72%, 54%, and 78%, respectively.

The 5-year OS rates were 90%, 75%, 61%, and 46% in patients with T1, T2, T3, and T4 tumors, respectively. The 5-year DFS rates were 72%, 47%, 52%, and 41% in patients with T1, T2, T3, and T4 tumors, respectively. The 5-year DSS rates were 93%, 84%, 68%, and 49% in patients with T1, T2, T3, and T4 tumors, respectively.

The 5-year OS rates were 90%, 72%, 71%, and 53% in the patients classified as having Stage I, Stage II, Stage III, and Stage IV disease, respectively. The 5-year DFS rates were 71%, 45%, 63%, and 45% in the patients classified as having Stage I, Stage II, Stage III, and Stage IV disease, respectively. The 5-year DSS rates were 93%, 82%, 71%, and 61% in the patients classified as having Stage I, Stage II, Stage III, and Stage IV disease, respectively.

In patients with locally advanced disease (high T stage), the treatment outcomes were unsatisfactory. Therefore, further prospective analyses are recommended to improve the prognosis in patients with tongue cancer treated by surgery.

Chemotherapy (CT) and radiotherapy (RT) are the main curative treatments for nasopharyngeal cancer, because it is difficult to achieve complete resection. At our institution, the curative treatment for nasopharyngeal cancer has changed from neoadjuvant chemotherapy followed by radiotherapy (NAC + RT) to alternating chemoradiotherapy (ALCRT) or concurrent chemoradiotherapy followed by adjuvant chemotherapy (CCRT + AC). We investigated the outcomes in 57 patients with nasopharyngeal cancer who received NAC + RT (n = 14), ALCRT (n = 34), or CCRT + AC (n = 9) at our department between October 1999 and December 2018. The 5-year local control (LC), progression-free survival (PFS), and overall survival (OS) rates of the overall subject population (n = 57) were 79.4%, 58.1%, and 64.7%, respectively. The 5-year LC, PFS, and OS rates according to the clinical disease stage (St) were 94.4%, 84.4%, and 88.7% in patients with St I/II disease; 58.3%, 30.1%, and 41.8% in patients with St III disease; and 87.1%, 62.5%, and 64.2% in patients with St IV disease, respectively. The 5-year LC, PFS, and OS rates in the three treatment groups were as follows: 69.8%, 50%, and 56.3% in the NAC + RT group; 80.8%, 57.3%, and 65.7% in the ALCRT group; and 88.9%, 76.2%, and 77.8% in the CCRT + AC group. The CCRT + AC group exhibited favorable LC and survival rates, although the differences among the three groups were not significant. In the future, it is necessary to increase the frequency of CCRT + AC treatment and to additionally investigate the adverse events associated with these treatments.

We investigated the treatment outcomes of 371 patients with oropharyngeal squamous cell carcinoma who had received radical treatment at our institution between 1989 and 2018. The analyses were conducted by dividing the cases into three treatment periods: Period A: 1989–1999; Period B: 2000–2010 (when induction chemotherapy and chemoradiotherapy (CRT) were actively introduced); and Period C: 2011–2018 (when the human papillomavirus (HPV) status was actively investigated). The 5-year overall survival (OS) rates were 42.8% in Period A, 62.4% in Period B, and 72.4% in Period C (P < 0.0001). The 5-year OS by the HPV status was 85.4% in patients with HPV-positive cancer and 52.1% in patients with HPV-negative cancer (P = 0.0003). These treatment outcomes were comparable to those reported previously. With the increase in the number of cases of HPV-positive cancer and advancements in treatment techniques, the number of patients needing treatment by extended resection has decreased, and treatments such as CRT and minimally invasive surgery for preserving function are the mainstays of the currently used treatments.

We have been treating patients with hypopharyngeal squamous cell carcinoma at our department for several years. There have been two major treatment transitions in the last few decades: introduction of reconstruction using free jejunal flaps after total pharyngo-laryngectomy in 1989, and introduction of neoadjuvant chemotherapy or chemoradiation therapy for larynx preservation in 2000. We investigated the treatment outcomes by classifying the treatment period into three terms: 1971–1988 (Period A); 1989–1999 (Period B); and 2000–2018 (Period C). The 5-year overall survival (OS) and disease-specific survival (DSS) rates in Period A, Period B, and Period C were 27.1%, 33.8%, and 58.6% (P < 0.001) and 38.5%, 57.7%, and 69.8% (P < 0.001), respectively. In addition, the 5-year laryngectomy-free survival (LFS) rates in Period A, Period B, and Period C were 5.8%, 8.9%, and 36.7% (P < 0.001), respectively. Among the patients treated during the three periods, patients treated in Period C showed significantly improved and more favorable OS, DSS, and LFS rates. It is considered that the increase in the adoption rate of transoral surgery for early-stage cancer because of advancements in endoscopic techniques and introduction of induction chemotherapy and definitive chemoradiation therapy for advanced cancer contributed greatly to improvement of the survival and laryngeal preservation rates in the patients treated in Period C.

Introduction: Laryngeal cancer is the second most commonly encountered head and neck cancer in clinical practice. The survival prognosis of patients with laryngeal cancer is relatively favorable as compared with that of those with other aerodigestive epithelial malignancies, but loss of laryngeal function with laryngectomy is inevitable, especially in patients with advanced disease. To validate our treatment strategy, we conducted a retrospective analysis of the outcomes of laryngeal cancer patients treated at our institution.

Methods: Data of a total of 548 cases of laryngeal cancer were analyzed. Under our fundamental treatment strategy, we treat the patients as follows: transoral laser microsurgery or radiation therapy for T1 and early T2 stage tumors, radiation with systemic chemotherapy or selective intraarterial infusion of cisplatin (RADPLAT) for T2-3 tumors; partial or subtotal laryngectomy for T1-3 tumors in whom chemoradiation is contraindicated; total laryngectomy for T3-4 tumors. The 5-year overall survival (OS), disease specific survival (DFS) and laryngeal preservation rate (LPR) in patients with tumors at each of the laryngeal subsites were analyzed by the Kaplan-Meier method.

Results: The 5-year OS/DSS rates were 83.2%/93.9% for patients with cancer of the glottis (glottic cancer), 71.9%/80.9% for patients with cancer of the supraglottis (supraglottic cancer), and 83.3%/83.3% for patients with cancer in the subglottis (subglottic cancer). In the patients with glottic cancer, the 5-year OS/DSS rates were: 90.0%/100% for T1a tumors, 87.7%/100% for T1b tumors, 89.3%/96.3% for T2 tumors, 68.1%/84.9% for T3 tumors, and 44.8%/54.7% for T4 tumors. The OS/DSS rates in patients with supraglottic cancer were: 68.4%/87.8% for T1 tumors, 89.3%/87.9% for T2 tumors, 67.8%/79.3% for T3 tumors, and 62.0%/68.2% for T4 tumors. The overall 5-year LPR was 80.7% for patients with glottic cancer, 54.9% for patients with supraglottic cancer, and 75.0% for patients with subglottic cancer. Stratified by the T stage, the LPR in cases of glottic cancer were 96.4%/93.9%/90.1%/48.2%/7.1% for T1a/1b/2/3/4 tumors, and those in cases of supraglottic cancer were 80.7%/79.0%/46.8%/13.1% for T1/2/3/4 disease.

Discussion: The results showed almost the same and satisfying survival and laryngeal preservation outcomes as compared with previous reports. The higher LPR in our T3 cases than in previous reports could be attributable to the use of RADPLAT, which is indicated for T3 cases to avoid total laryngectomy. In conclusion, our treatment strategy appears to be acceptable. In cases of laryngeal cancer, the appropriate treatment for individual patients should be selected to not only manage survival, but also the laryngeal function.

At our department, we performed a modified trimodal treatment (MTT) in patients with locally advanced squamous cell carcinoma of the maxillary sinus for improving the rates of preservation of the palate and eyeball between 1991 and 1997. This modified treatment, first reported by Sato, et al., is performed as a preoperative treatment and the residual tumor is removed subsequently. Furthermore, superselective cisplatin intraarterial infusion chemoradiotherapy (RADPLAT), proposed by Robbins et al., has been performed for further improving the rates of preservation of organs and functions since 1998. The 5-year palate-preserved survival rates in patients who received MTT (MTT group: n = 32) and RADPLAT (RADPLAT group: n = 68) were 22.8% and 42.4%, respectively. The 5-year eyeball-preserved survival rates in the patients who received MTT and RADPLAT were 31.9% and 54.1% (P = 0.006), respectively. Furthermore, the 5-year palate-preserved survival rates in patients with T4 tumors treated by MTT and RADPLAT were 17.3% and 28.0% (P = 0.003), respectively, and the eyeball-preserved survival rates were 24.6% and 40.9%, (P = 0.006) respectively. Organ and functional preservation were improved following introduction of RADPLAT, but the 5-year local control rates in the MTT group and RADPLAT group were 70.2% and 64.7% (P = 0.412), respectively, and the 5-year overall survival rates were 48.4% and 61.4% (P = 0.470), respectively, neither of which differed significantly between the MTT and RADPLAT groups. Modalities to achieve favorable local control and prolong overall survival while preserving organs and functions remain to be investigated in future studies.

At our department, we often treat patients with squamous cell carcinoma of the external auditory canal. One of the treatment transitions in the last two decades was the introduction of intra-arterial cisplatin and concurrent radiation therapy (RADPLAT) for organ preservation in 2003. We investigated the treatment outcomes according to the treatment period classified into two terms: 1975–2002 (previous period) and 2003–2018 (late period), and according to the treatment method adopted. The 5-year local control (LC), disease free survival (DFS), and overall survival (OS) rates were 59.1%, 51.8%, and 51.8% in the patients treated in the previous period, and 58.8%, 50.2%, and 64.0% in the patients treated in the late period, respectively. In addition, the 5-yr LC, DFS, and OS rates were 54.2%, 51.6%, and 51.0%, respectively, in the patients treated by surgery, and 51.5%, 44.6%, and 62.1%, respectively, in the patients who received RADPLAT. In patients with local early-stage disease (T1/T2), the 5-yr LC, DFS, and OS rates were 100%, 88.9%, and 88.9%, respectively, in the surgery group, and 66.7%, 66.7%, and 83.3%, respectively, in the RADPLAT group. In patients with locally advanced disease (T3/T4), the 5-yr LC, DFS, and OS rates were 25.0%, 25.0%, and 25.0%, respectively, in the surgery group, and 41.2%, 29.4%, and 47.1%, respectively, in the RADPLAT group. The group treated in the late period showed a more favorable OS rate than the group treated in the previous period, although the difference was not statistically significant. RADPLAT might be a more useful treatment modality for patients with locally advanced tumors as compared to surgery. However, for patients with local early-stage tumors, selection between surgical treatment and RADPLAT should be discussed.

We investigated the data of 24 patients with carcinoma of the submandibular gland who were treated by radical surgery. The histological grade was low in 1 case (4%), intermediate in 13 cases (54%), and high in 10 cases (42%). Adenoid cystic carcinoma was the most common subtype (11 cases, 46%). The 5-year overall survival (OS) rates according to the c (clinical) T classification were: cT1, 100%; cT2: 48.6%; cT3, 52.0%; and cT4, 0% (3 years) (P = 0.049). The 5-year OS rates according to the cN classification were: N(–), 88.9%; and N(+), 23.1% (P = 0.005). The 5-year OS rates according to the histological grade were: low grade, 100% (2 years); intermediate grade, 83.1%; and high grade, 13.3% (P = 0.010). cN(+) and high malignancy grade were predictive of an unfavorable prognosis. These treatment outcomes in our study are slightly inferior to those reported previously. In addition, in all of the patients who died of the primary disease, the death was caused by distant metastases.

We reviewed the data of 66 patients with parotid gland cancer who were treated by radical surgery. The 5-year overall survival (OS) rates according to the T classification were: T1: 100%; T2: 92.4%; T3: 56.1%; and T4: 68.1% (P = 0.082). The 5-year OS rates according to the disease Stage (St) classification were: St I: 100%; St II: 95.5%; St III: 88.9%; and St IV: 55.4% (P = 0.002). The 5-year OS rates according to the histological malignancy grade were: low grade: 100%; intermediate grade: 83.3%; and high grade: 53.2% (P < 0.001). St IV and high malignancy grade were predictive of an unfavorable prognosis. The treatment results of this study are mostly consistent with those reported previously.

Objective: Sorafenib and lenvatinib have been used for treating cases of unresectable differentiated thyroid gland cancer (DTC). However, their use is not common, because DTCs are slow growing tumors, even in the advanced stages. In this study, we investigated the outcomes of these treatments for DTC at our department.

Methods: Between 2015 and 2020, sorafenib therapy was started in 6 patients, and lenvatinib therapy in 24 patients with unresectable DTC. The objective response rate (ORR) and disease control rate (DCR) for each of the treatments were calculated in accordance with RECIST version 1.1. The overall survival (OS) and progression-free survival (PFS) were determined. Adverse events occurring during the treatments were investigated in accordance with CTCAE version 5.

Results: Although the tumor size decreased in 3 out of 6 patients after sorafenib therapy, the rate of reduction did not satisfy the criteria for PR or CR (ORR: 0%). The best response was rated as SD in 5 out of 6 patients, and as PD in the remaining one patient (DCR: 83%). On the other hand, the response of lenvatinib therapy appeared to be remarkable. The ORR in the patients treated with lenvatinib therapy was 63%, including one case of CR, and the DCR was 96%. Both the 2-year OS and PFS rates were 54.5%, and median PFS duration was 16.5 months. All of the patients who received sorafenib therapy experienced hand-foot syndrome, and two patients (33%) developed grade 3/4 serious adverse effects. Among the patients who received lenvatinib therapy, proteinuria and hypertension were the most common adverse effects. Fifteen patients (63%) developed serious grade 3/4 adverse effects, including cerebral infarction in one case that led to death.

Conclusion: Sorafenib and lenvatinib appear to be effective agents for the treatment of patients with unresectable DTC. Especially, lenvatinib appeared to exert remarkable effect, although careful management of adverse effects was required.