Toukeibu Gan
Online ISSN : 1881-8382
Print ISSN : 1349-5747
ISSN-L : 1349-5747
Volume 44, Issue 3
Displaying 1-15 of 15 articles from this issue
  • Katsunari Yane
    2018Volume 44Issue 3 Pages 253-257
    Published: 2018
    Released on J-STAGE: December 11, 2018
    JOURNAL FREE ACCESS
    In the revised TNM classification (AJCC/UICC 8th) of 2017, HPV-related oropharyngeal carcinoma (OPC) is defined separately from conventional head and neck cancers. Immunohistochemistry for p16 overexpression has emerged as a surrogate biomarker for HPV-related OPC. All oropharyngeal carcinomas should be tested for p16 immunohistochemistry. Oropharyngeal carcinomas without p16 testing are staged using the p16-negative staging system. Patients classified as N1-N2b using the 7th edition are classified as N1 in p16-positive OPC in the 8th edition. Categories T4a and T4b are defined as T4 without distinction. The classifications cN and pN are different for N classifications. Primary unknown p16 positive squamous cell carcinoma is classified as T0 for HPV-related OPC. The applicability of the new TNM classification for HPV-related OPC is unclear. Future analysis to validate the applicability of the new TNM classification is warranted.
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  • Susumu Okano
    2018Volume 44Issue 3 Pages 258-262
    Published: 2018
    Released on J-STAGE: December 11, 2018
    JOURNAL FREE ACCESS
    Although chemotherapy and molecular targeted therapy have long been used for head and neck cancer, it became possible to use immunotherapy for it last year. Many clinical trials for not only recurrent or metastatic cancer but also locally advanced cancer are currently underway.
    In locally advanced cancer, preexisting treatment is insufficient to improve local and distant control. Much work has been done on the early development of induction therapy or neoadjuvant therapy, concurrent therapy, adjuvant therapy or maintenance therapy. In particular, phase 3 trials of concurrent therapy have been conducted and new therapies are expected to emerge, considering the status of preceding development of non-small-cell lung cancer and melanoma.
    Drug therapy is becoming increasingly important in the development of immunotherapy for locally advanced cancer. The results of future clinical trials are awaited.
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  • Taku Yamashita, Shunsuke Miyamoto, Yutomo Seino, Tabito Okamoto, Takas ...
    2018Volume 44Issue 3 Pages 263-268
    Published: 2018
    Released on J-STAGE: December 11, 2018
    JOURNAL FREE ACCESS
    The treatment policy for oropharyngeal squamous cell carcinoma is currently controversial in the context of the association between human papilloma virus (HPV) and the introduction of transoral surgeries, such as transoral robotic, laser, and videolaryngoscopic surgeries. Transoral surgeries are rapidly spreading worldwide, as they have advantages in treatment and functional outcomes compared to those of concurrent chemoradiotherapy (CCRT) in selected cases. However, postoperative radiation and chemoradiation adversely affect good swallowing function, which is a merit of transoral surgery. Therefore, absolute proper indications of transoral surgery for oropharyngeal carcinoma would be T1-2N0-1 cases in terms of both locoregional control and functional outcomes. In addition, a meta-analysis suggested the superiority of transoral surgery for HPV-negative oropharyngeal carcinoma regarding survival and locoregional control. As for T3-4 or N2-3 cases, some reports show equivalent or favorable survival and locoregional control of transoral surgery compared to those of CCRT. However, we must wait for future developments in research regarding whether transoral surgery for advanced cases is also useful for functional preservation. Some studies have demonstrated that the intervention of transoral surgery for cases with cervical lymph node metastasis from an unknown primary site, which is transoral palatal and lingual tonsillectomy, leads to the identification of the primary lesion, safe dose reduction and limitation of the irradiation field of postoperative radiation therapy, and improvement of survival and cost benefits. Transoral surgery for appropriately selected oropharyngeal carcinoma is relatively safe; however, severe operative hemorrhage can result in life-threatening complications. Therefore, meticulous hemostasis during surgery and careful postoperative management are also important.
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  • Yu Koizumi, Toru Sasaki, Hiroyuki Yonekawa, Hirofumi Fukushima, Wataru ...
    2018Volume 44Issue 3 Pages 269-275
    Published: 2018
    Released on J-STAGE: December 11, 2018
    JOURNAL FREE ACCESS
    Recently, the importance of supportive care in the perioperative period of head and neck cancer surgery has been widely recognized. Although improvement of treatment outcomes is important in cancer treatment, functional recovery and acquisition of a high quality of life are also essential. The main feature of head and neck cancers is that they occur in the area directly involved in eating. It is impossible to avoid physical and functional impairments due to the treatment of these cancers.
    Therefore, in our hospital, a multidisciplinary team for swallowing therapy was formed in April 2014. As members of this team, head and neck surgeons actively conduct swallowing evaluations and postoperative eating and swallowing rehabilitation.
    In cases of head and neck cancer surgery at our hospital, head and neck surgeons perform not only primary resection, but also flap harvesting, free flap reconstruction, and microvascular anastomosis. The findings from postoperative swallowing evaluations can be applied immediately to other similar surgical cases. In addition, it is possible to devise new surgical techniques.
    In this study, changes in the clinical course of oral cancer patients who underwent reconstruction by free flap were examined before and after support by multidisciplinary teams. The time taken for swallowing rehabilitation was shortened by the involvement of a multidisciplinary team.
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  • Sadamoto Zenda
    2018Volume 44Issue 3 Pages 276-279
    Published: 2018
    Released on J-STAGE: December 11, 2018
    JOURNAL FREE ACCESS
    The methodology of clinical research in supportive and palliative care is different from that in the field of medical oncology in terms of the style of multidisciplinary approaches, study design, and endpoints. In Japan there are serious problems in the system of clinical research especially in supportive and palliative care. Although several small study groups in Japan try to conduct prospective studies in the field of supportive and palliative care, it is difficult to develop their exploratory researches to multi-center confirmatory studies.
    To provide a useful system for researchers, the Japan Supportive, Palliative and Psychosocial Oncology Group (J-SUPPORT) was established in 2016. J-SUPPORT is a multicenter collaborative clinical research group from the National Cancer Center Hospital. Its missions are called ABCD missions:
    A: all Japan; beyond an existing organization, mobilize all Japan’s resources
    B: bridging and optimization; optimized by bridging small studies at an early stage
    C: cooperation; cooperation with existing research groups as a hub
    D: dialogue and diversity; respect differences in communities, groups, and facilities; dialogue between the parties; and strive to develop supportive care
    As of April 2018, 5 confirmatory trials (3 supportive care for anti-cancer treatment, 1 palliative care, 1 psychosocial oncology) are underway in J-SUPPORT. We seek to cooperate with not only study groups in Japan, but also study groups in the EU, USA and Australia. In the future, we hope that new evidence based on J-SUPPORT trials will emerge and change clinical practices.
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  • Hiroyuki Maeda, Sen Matayoshi, Shinya Agena, Jin Uezato, Hidetoshi Kin ...
    2018Volume 44Issue 3 Pages 280-284
    Published: 2018
    Released on J-STAGE: December 11, 2018
    JOURNAL FREE ACCESS
    We experienced a case of leiomyosarcoma occurring from the nasal cavity. The patient was a 60-year-old woman. Her chief complaint at the time of first contact was right chronic nasal obstruction and unexpected nasal bleeding. Upon initial examination, her right nasal cavity was found to be occupied by a solid red-white oval mass with smooth surface. Because of hemorrhagic tumor, incisional biopsy was not performed at pre-treatment. However, endoscopic and image findings suggested that the tumor was malignant. Therefore, an extensive Denker’s operation, with which we could secure an adequate incisional safety margin during operation, was performed. As a result, the final diagnosis was determined to be leiomyosarcoma by immunohistopathological examinations. Because sarcoma cells were not found at the incisional margin microscopically, we considered that we had achieved perfect resection of the tumor. Moreover, full-dose irradiation (70Gy) and seven courses of chemotherapy (vincristine 1.5mg/m2, cyclophosphamide 1,200mg/m2, actinomycin-D 1.35mg/m2) were performed for adjuvant therapy. Local recurrence and distant metastasis have not appeared at present, which is about five years after treatment. Moreover, both a sufficient cure and acceptable appearance were achieved.
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  • Tsuyoshi Takemoto, Hiroshi Orita, Yoshihiro Okazaki, Ryuichi Murakami, ...
    2018Volume 44Issue 3 Pages 285-288
    Published: 2018
    Released on J-STAGE: December 11, 2018
    JOURNAL FREE ACCESS
    We report a case of huge squamous cell carcinoma derived from cheek skin. A 57-year-old man visited our hospital because of a huge tumor on the right face. His right face, including his right eyeball, was replaced by a huge tumor. CT scan revealed that the tumor invaded his paranasal sinuses and skull base bone. We resected the tumor including facial skin, right eyeball and skull base bone. After resection, we reconstructed his face with two free flaps and two free bones.
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  • Taiki Matsui, Takashi Shigeta, Noboru Akazawa
    2018Volume 44Issue 3 Pages 289-294
    Published: 2018
    Released on J-STAGE: December 11, 2018
    JOURNAL FREE ACCESS
    Malignant melanoma rarely occurs in the head and neck region. Among malignant melanoma cases, amelanotic malignant melanoma of the tongue is especially rare. We report a case of amelanotic malignant melanoma that occurred in the tongue. A 47-year-old man presented at our hospital with a tumor in the tongue. A slightly white tumor with a normal surface was found on the left dorsum of the tongue. An induration was palpable in the tumor. No cervical lymph node swelling was found on the neck. T1-weighted MRI revealed contrast enhancement at the tumor. Tumor biopsy revealed that it was a malignant tumor derived from melanocytes and thus was diagnosed as a malignant melanoma. No cervical lymph node metastasis or distant metastasis was detected on CT, MRI, PET, and US. The tongue tumor was then surgically excised under general anesthesia. Pathological diagnosis of the resected tumor confirmed that it was an amelanotic malignant melanoma. No sign of recurrence was noted for 32 months after the operation.
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  • Yoshimasa Yamaguchi, Reona Aijima, Yoshio Yamashita
    2018Volume 44Issue 3 Pages 295-299
    Published: 2018
    Released on J-STAGE: December 11, 2018
    JOURNAL FREE ACCESS
    Bone reconstruction should be performed to restore the postoperative masticatory function and facial appearance of patients who have undergone segmental mandibulectomy. In some cases, however, rigid reconstruction is unable to be performed for various reasons. Occlusal positions in such cases are often unstable, and marked excursion during jaw movement is consistently present. Postoperative prosthetic treatment is thus difficult under such poor conditions, and it is particularly hard to achieve denture stability for edentulous elderly patients. We report our prosthetic management for a patient without mandibular reconstruction following segmental mandibulectomy. Subjective and objective data showed improvement of masticatory function with application of our fabricated denture.
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  • Hiroyuki Iuchi, Keiichi Miyashita, Junichiro Ohori, Yuichi Kurono
    2018Volume 44Issue 3 Pages 300-304
    Published: 2018
    Released on J-STAGE: December 11, 2018
    JOURNAL FREE ACCESS
    Small cell carcinoma is rarely seen in the head and neck area and high-grade malignant neoplasm is characterized by highly active proliferation of neuroendocrine tumor cells. There are no established therapies for this disease. The patient was a 63-year-old man, who visited our clinic complaining of sore throat on the left side. The presence of tumor was confirmed by CT imaging on which a mass limited to the left oropharynx was observed. The pathological diagnosis of a biopsy specimen taken from the oropharynx was small cell carcinoma. Immunohistochemical studies showed positive staining for CD56 and synaptophysin, and partial positivity for chromogranin. The patient received concurrent chemoradiotherapy using cisplatin and irinotecan. There has been no clinical evidence of recurrence or metastasis 5 years after treatment.
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  • ―focused on second injection of cisplatin―
    Hiroyuki Iuchi, Kotoko Ito, Hayato Matsumoto, Yutaka Hanamure, Tsutomu ...
    2018Volume 44Issue 3 Pages 305-309
    Published: 2018
    Released on J-STAGE: December 11, 2018
    JOURNAL FREE ACCESS
    A retrospective review of 43 patients who received high-dose cisplatin(CDDP)(100mg/m2; 100% dose)with concurrent chemoradiotherapy(CCRT)from May 2016 to May 2018 was performed. We divided the patients into two groups: in the second CDDP(+)group it was possible to administer the second CDDP(100mg/m2; 100% dose)3 weeks later, whereas in the second CDDP(−)group such administration was not possible. In the second CDDP(−)group, incidence of leukopenia was 96% and renal dysfunction was 11%. Compared to the second CDDP(+)group, in the second CDDP(−)group, albumin(Alb)was significantly lower before the first administration of CDDP, and the modified Glasgow Prognostic Score(mGPS)was higher. Furthermore, comparing dietary intake, the second CDDP(+)group had higher average meal intake per day. Nutritional management during high-dose CDDP(100mg/m2; 100% dose)is an important factor for the continuation of treatment.
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  • Moriyasu Yamauchi, Kanako Kawasaki, Eriko Shimazaki, Akimichi Minesaki ...
    2018Volume 44Issue 3 Pages 310-315
    Published: 2018
    Released on J-STAGE: December 11, 2018
    JOURNAL FREE ACCESS
    We retrospectively reviewed the acute toxicity and efficacy of locally advanced head and neck cancer patients treated with radiotherapy plus cetuximab. Forty patients with head and neck cancer comprising 3 nasopharynx, 13 oropharynx, 21 hypopharynx and 3 larynx were analyzed. Clinical stages at diagnosis were Ⅲ in 8, ⅣA in 30 and ⅣB in 2 cases. The treatment completion rate was 92.5%. Grade 1 or 2 infusion reactions were observed in 2 patients. Three patients developed grade 2 interstitial lung disease. Grade 3 or higher adverse events were as follows: radiation dermatitis in 15, oral/pharyngeal mucositis in 14, aspiration pneumonia in 2, and laryngeal edema in 1 case. Response rates were 100% in nasopharynx, 92.3% in oropharynx, 83.3% in hypopharynx, 100% in larynx, and 89.2% in total. These findings of toxicity and efficacy are similar to those of recent publications.
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  • Masaru Ogawa, Satoshi Yokoo, Yu Takayama, Takaya Makiguchi, Jun Kuriha ...
    2018Volume 44Issue 3 Pages 316-320
    Published: 2018
    Released on J-STAGE: December 11, 2018
    JOURNAL FREE ACCESS
    Neck dissection is the first choice of treatment for cervical lymph node metastasis or recurrence of oral squamous cell carcinoma (OSCC). However, many patients are inoperable due to their general condition, age, and lesions that are not indicatable or are unresectable due to their progression. We report a case of an inoperative patient with cervical lymph node recurrence of OSCC, and who underwent bio-radiation therapy and subsequent surgery (neck dissection).
    An 86-year-old female with contralateral cervical lymph node recurrence of OSCC of left buccal mucosa, and who was not indicated for neck dissection, underwent treatment with cetuximab plus radiation. Following the completion of external-beam radiation therapy (40Gy/20Fr), computed tomography was carried out, revealing a reduction in size of the recurrent lymph node. The lesion was then indicated for neck dissection, which was carried out as conversion surgery.
    New drug therapies with cetuximab and nivolumab (an immune check-point inhibitor) have been recently approved as additional treatment options for OSCC, and are expected to increase the number of cases converted to a resectable condition for locally advanced OSCC. Therefore, unresectable or non-indicated surgical resection of OSCC should be appropriately evaluated with imaging during the course of treatment of cetuximab plus radiation to consider the possibility of subsequent surgery (conversion surgery).
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  • Hiroki Morimoto, Akihito Arai, Shota Kinoshita, Kanako Yoshimura, Juni ...
    2018Volume 44Issue 3 Pages 321-325
    Published: 2018
    Released on J-STAGE: December 11, 2018
    JOURNAL FREE ACCESS
    It has been reported that long-term intubation of a nasogastric tube (NGT) might cause laryngeal necrosis. We report a case of laryngeal radionecrosis caused by NGT during chemoradiotherapy for hypopharyngeal carcinoma. A 71-year-old male received chemoradiotherapy for hypopharyngeal and esophageal carcinoma, and NGT insertion became necessary due to severe mucositis. Thereafter, the mucositis remained, resulting in hypopharyngeal mucosal ulcer along the run of the NGT. The tube was removed and the ulcer showed a tendency to recover, but bilateral vocal cord fixation was confirmed, resulting in the diagnosis of laryngeal necrosis. Total laryngo-pharyngectomy was performed, and the permanent specimen showed no evidence of malignancy but only necrosis. It was thought that severe mucositis and long-term intubation of NGT induced the onset of necrosis. We consider that percutaneous gastrostomy should be performed before radiation of the head and neck in cases of extensive irradiation range because such patients will need nutrition support due to poor oral intake.
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  • Atsumori Hamahata, Takeshi Beppu, Ayataka Ishikawa, Tsutomu Kasimura, ...
    2018Volume 44Issue 3 Pages 326-330
    Published: 2018
    Released on J-STAGE: December 11, 2018
    JOURNAL FREE ACCESS
    Free jejunal flaps are now commonly used for reconstruction after resection of hypopharyngeal cancer and cervical esophageal cancer. Although other skin flaps are found to be well revascularized from surrounding tissue, the jejunal flap is poorly revascularized. We report on one patient who presented with ischemic stenosis of a transferred free jejunum after resection of a mesenteric lymph node. A 67-year-old man developed advanced hypopharyngeal carcinoma and underwent pharyngolaryngectomy, neck dissection on both sides, and free jejunal transfer at our hospital. After two years, mesenteric lymph node metastasis was discovered via FDG-PET scan and the metastatic lymph node was resected. However, after the operation, the transferred free jejunum developed ischemic stenosis, and the stenosis became so severe that, after five years, the patient could not eat any food. The previously transferred free jejunum was resected and replaced with a new jejunal flap. The resection had a full circumferential stenosis in part of the free jejunal flap. The pathological findings indicated that the mucosa had atrophied and been lost, while the submucosal tissue had fibrous tissue growth. The muscular layer, however, was found to have less fibrous tissue.
    Unlike skin flaps, the jejunal flap is considered to be less tolerant to ischemic conditions, i.e., the ischemic time is shorter in jejunal flaps than in skin flaps. In several experimental animal studies, it has been reported that fibrous tissue easily grows in mucosal and submucosal tissue of the jejunum under ischemic conditions. The mesenteric vessels are terminal vessels near the jejunum and no communications are sent between vessels. In this case study, the susceptibility of the combination of mucosal and submucosal tissues to ischemia and the mesenteric vessels’ decreased network may have contributed to the full circumferential stenosis of the free jejunal flap.
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