In reconstructive surgery for head and neck cancer, it is most important to perform the operation with cooperative teamwork between the resection side and reconstruction side. On the resection side, the operator should carefully preserve a good blood supply and healthy tissue of the surgical cut end and carefully manage the vessels for microanastomosis. On the reconstruction side, the operator should prepare the best flap with a good blood supply and suitable volume, and perform reconstruction to produce the best post-operative function with some devices to avoid complications. To achieve excellent head and neck reconstructive surgery seamlessly, it is essential that the operators know each other's intentions in detail and cooperate with each other.

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Although surgical treatment is the primary choice of treatment for tongue cancer, concurrent chemoradiotherapy is performed for advanced cancer in our Department in order to coserve organs and functions. Moreover, patients with even relatively small lesions that are difficult to resect depending on the site of tumor development are also treated similarly in our Department. In the present study, we report the results of an investigation of 32 patients with tongue cancer treated at our Department between April 2002 and October 2008. The results showed that the cause-specific survival rate was 100% in stage I, 88.9% in stage II, 75.0% in stage III, and 66.7% in stage IV. CR rate for concurrent chemoradiotherapy was 60.0%.

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To evaluate the association of the extranodal spread (ENS) of subsequent cervical lymph node metastasis and prognosis in stage I and II squamous cell carcinoma of the tongue, 58 patients showing subsequent cervical node metastases, initially treated by glossectomy alone, between 1987 and 2003, were reviewed. Of those, 34 cases had uneventful prognosis (G), ipsilateral neck failure (N) in 14 and distant metastases (M) in 10. Eight patients had intranodal spread (INS). Fifty cases with ENS were divided into two groups, perinodal fatty tissue invasion + or -, moreover, each group was classified into subgroups: desmoplastic pattern response around cancer nests outside of nodes +, ± or -. The distribution of G, N and M of each subgroup was as follows: INS, 7:1:0, ENS-/+, 3:0:0, ENS-/±, 5:0:0, ENS-/-, 7:2:1, ENS+/+, 5:5:4, ENS+/±, 3:6:5, ENS+/-, 4:0:0. ENS with both perinodal fatty tissue invasion and desmoplastic pattern response indicated poor prognosis.
Therefore, for stage I and II tongue carcinomas revealing subsequent metastases with high-risk features mentioned above, postoperative treatments should be considered to prevent both neck failure and distant metastases.

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We report the clinical results of continuous superselective intra-arterial infusion chemotherapy through the superficial temporal artery with concomitant radiotherapy in 8 patients with carcinoma of base of the tongue. The T-stage distribution was T2: 3, T3: 2, and T4a: 3. A catheter was fluoroscopically inserted through the superficial temporal artery into the target artery using a catheter exchange method. The regimen consisted of continuous intra-arterial infusion of 20 mg/body docetaxel (day 1-5) and 10 mg/body pepleomycin (day 6-10), intra-arterial infusion of 20 mg/body docetaxel (day 3) and 20 mg/body cisplatin (day 4 and 5), and oral administration of 40 mg/body TS-1 (day 1-14) as one course. The second course was performed 4 weeks after completion of the first course. Concurrent external-beam radiotherapy was performed at a dose of 60 Gy in all patients except for one patient who received 40 Gy. Clinically complete response was observed in all 8 patients. Grade 3 toxicities included mucositis (5 cases), pain (4 cases), and leukocytopenia (3 cases). Neither grade 4 toxicities nor cerebrovascular disorder were observed. The treatment results indicated that our present therapeutic approach was favorable and tolerable in patients with carcinoma of base of the tongue.

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The oropharynx is an anatomically and physiologically complicated organ, and the challenging problems regarding postoperative function of speech and swallowing remain in reconstructive surgery after wide resection of the lateral and superior wall of the oropharynx. We evaluated the swallowing function after surgical treatment of oropharyngeal cancer. Between 2000 and 2008, 17 patients underwent wide resection and reconstruction of oropharyngeal cancer at Tokai University Hospital. The surgical defect was reconstructed by Gehanno's method. Functional outcome of speech and swallowing was assessed by a subjective scale and videoendoscopic examination of swallowing for 10 patients. The swallowing function was highly influenced by the extent of the resection. The duration of the whiteout time might reflect the subjective swallowing function.

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We reviewed oropharyngeal carcinoma of the anterior, posterior, and superior walls. Clinical features of 34 cases with anterior, posterior, and superior oropharyngeal carcinoma among 93 patients of oropharyngeal carcinoma that we treated in our hospital from January 1997 to October 2005 were analyzed. We treated oropharyngeal carcinoma with concurrent chemoradiotherapy by intra-arterial CBDCA continuous infusion after 1997. In cases of anterior, posterior, and superior wall carcinoma, the disease-specific 3-year survival rates were 55%, 83%, and 100%, and all the cases that successfully received primary radical treatment obtained loco-regional control. On the other hand, two cases died due to postoperative swallowing dysfunction, suggesting that improvement is required. In addition, multiple primary cancers were detected in 48% of the 34 patients. These results suggest that concurrent chemoradiotherapy by intra-arterial continuous infusion for oropharyngeal carcinoma is an effective method.

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The incidence of metastatic cardiac tumors, which are seldom detected during the lifetime of a person, is considered to be low. Furthermore, it is highly unusual for a head and neck tumor to be the primary tumor of this disease. In the present study, we report a case of pleomorphic adenoma of the submandibular gland that was left untreated for many years, became cancerous, and metastasized to the right atrium of the heart. A 64-year-old female, who had undergone extirpation of pleomorphic adenoma of the right submandibular gland, was diagnosed with cancer at another clinic. During postoperative radiation and chemotherapy, multiple metastases were detected in the right atrium of the heart, brain, neck, and lung. Metastasis to the right atrium of the heart was detected by CT and not by clinical symptoms. Currently, there is no cure for metastatic cardiac tumors. In the present case, based on clinical experience, a combination therapy of irradiation and docetaxel was initiated; however, there was no shrinkage of the tumor. Pleomorphic adenoma may turn cancerous and cause multiple metastases, and so it is considered important to institute medical care that includes treatment of the symptoms of the primary disease and cardiac metastases, which can easily go out of control.

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We clinically investigated 14 cases of cervical lymph node metastases of carcinoma from unknown primary sites in the last three years, with respect to the N stage of cervical lymph nodes, the histopathological types, the region occupied by the largest metastatic lymph node, the therapeutic strategy, and the detection of primary sites. The 14 cases were 13 males and 1 female, and the mean age was 59.6 years old. In the histological diagnosis of metastatic lymph nodes, FNAB (fine needle aspiration biopsy) was conducted in 11 cases and open biopsy in 3. The N stage was N2 in all cases, and the histopathological types were squamous cell carcinoma in 13 cases and adenocarcinoma in 1. The largest metastatic lymph nodes were located in the upper deep cervical region in 8 cases. PET-CT was routinely conducted in all cases, and in 3 of the 7 cases in whom primary sites were detected, the lesions revealed that the uptake of FDG corresponded to the primary site. Blind biopsy (sites were epipharynx, hypopharynx and root of tongue) and tonsillectomy were performed in 12 cases.
We could detect the primary sites in 7 cases, 6 of whom were as follows: palatine tonsil in 4 and hypopharynx in 2. It is important to pay attention to the mesopharynx and hypopharynx in particular as primary sites. Ten cases were treated with neck dissection, and all of them also underwent postoperative radiotherapy or chemoradiotherapy. The control of metastatic lymph nodes is very important for therapy, and combination therapy consisting of neck dissection and chemoradiotherapy is advisable.

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Extra thyroidal extension (ETE) of thyroid papillary carcinoma (PAC) is known as a risk factor of poor prognosis. The ATA Guideline recommends total thyroidectomy (TT) with radioiodine ablation for patients of PACs with ETE and we have been following this strategy for cases of PACs with ETE. In this paper, we retrospectively examined the patients of PACs with ETE in terms of the following two issues: 1) Does ¹³¹I total body scan (¹³¹I-TBS) after TT enable us to detect subclinical distant metastases of PACs? and 2) Can ¹³¹I ablation eliminate microscopic remnants of PACs after TT?
The subjects consisted of 68 patients who had PACs with ETE and underwent ¹³¹I-TBS and/or ¹³¹I ablation after TT in our hospital in the past 20 years. TNM classifications of the patients were pT3: pT4=12: 56, pN0: pN1a: pN1b=13: 15: 40, M0: M1=62: 6. Twenty-two cases underwent only ¹³¹I-TBS and 46 cases underwent ¹³¹I-ablation. Fourteen cases diagnosed as M0 preoperatively had distant focus detected using ¹³¹I-TBS (1). Including M1 cases, 20 out of 68 cases (29%) turned out to have clinical or subclinical distant lesions in our study. ¹³¹I ablation eliminated thyroid bed in 18 out of 22 cases, and distant foci in 5 out of 13 cases (2). However, the distant lesions which had been apparent before operation (M1 cases) did not reach CR by ¹³¹I ablation. In 22 out of those 23 cases successfully treated with the ablation, serum-thyroglobulin level was almost undetected after therapy. The overall 10-year survival rate was 82% and the cause-specific survival rate was 91%.

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