To clarify the problem of the new T classification in tongue carcinoma, we reviewed the records of 427 previously untreated tongue cancer patients between 2006 and 2015. In the 7^th edition, there were 224 patients in T1, 152 in T2, 42 in T3, and 9 in T4a. In the 8^th edition, there were 204 patients in T1, 149 in T2, and 74 in T3. The T classification was unchanged in 87.9％, upstaged in 10.0％, and downstaged in 2.1％. According to the 7^th edition, 5-year disease-specific survival was 96.4％ in T1, 93.5％ in T2, 79.2％ in T3, and 46.9％ in T4a. In the 8^th edition, 5-year disease-specific survival was 96.7％ in T1, 94.3％ in T2, and 78.8％ in T3. In addition, the mean shrinkage rate of tissue width during preparation of histopathological specimens was 6.8％. Compared with the clinical DOI, the histopathological DOI corrected 6.8％ of the shrinkage rate of the specimen. Clinical DOI was measured by MRI and US. As a result, the DOI measured by MRI before the biopsy was the closest to the histopathological DOI.

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　Quality of life （QOL） after cancer treatment, namely “quality of survival”, is important for patients who have overcome cancer. We introduce an evaluation of swallowing and shoulder rehabilitation exercises as supportive care for cases of head and neck cancer surgery performed in our hospital. 　In head and neck reconstructive surgery, not only head and neck surgeons but also co-medical staff such as certified nurses assess the patient’s swallowing function and arrange the type of diet. By introducing a standard care system for perioperative swallowing and eating function, we were able to shorten the period to oral intake and arrange the type of diet in stages. 　We defined the method and strength of shoulder exercises in accordance with post-operative function or operation type to reduce the shoulder syndrome of neck dissection. In cases of elective neck dissection, we improved the shoulder function and QOL by omitting Level Ⅱb neck dissection.

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 We have adopted transoral videolaryngoscopic surgery （TOVS） for hypopharyngeal cancer as a minimally invasive surgical technique that was developed in Japan. The indications are T1-2 and N0-N2a. The practical surgical techniques, including pharyngeal exposure and surgical devices, are described. Among them, exposure of the operative field is the most important factor for successful and safe operation. Ten cases of T concerning successful operation are described. Pre-operative assessment of swallowing function is very important for evaluating the functional outcome.

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　Carbon-ion radiotherapy provides highly concentrated dose distributions and offers high biological effectiveness. Therefore, carbon-ion radiotherapy offers excellent local control for head and neck non-squamous cell carcinoma （SCC）, mucosal malignant melanoma, and bone and soft tissue tumor, which are generally resistant to X-ray therapy. In Japan, there are five carbon-ion facilities, which play a leading role in the development of the treatments. The Japan Carbon-Ion Radiation Oncology Study Group （J-CROS） has been conducting multi-institutional studies to show the effectiveness and safety of carbon-ion radiotherapy for head and neck tumors. Based on the results, head and neck tumors excluding oral and oropharyngeal SCC have been covered by medical insurance since 2018. In this review, we describe an overview, clinical outcomes, and future prospects of carbon-ion radiotherapy for head and neck tumors.

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There have been rare cases of papillary thyroid carcinoma in which tumor focus in the thyroid gland could not be identified with preoperative examinations. Foci may be absent or very small in the thyroid gland, making identification impossible. Between 2010 and 2017, there were 5 cases in which tumor focus in the thyroid gland could not be identified with preoperative examination, but in which lateral lymph node metastases were noted. These cases underwent thyroid lobectomy and D2b dissection for definitive treatment. One case showed absence of tumor focus in the thyroid gland, whereas the other three cases were identified as multifocal papillary thyroid carcinoma. 　Thyroid lobectomy involves an appropriate extent of resection for cases with papillary thyroid carcinoma, with unidentified focus in the thyroid gland by preoperative examination, for balanced radical cure and functional preservation.

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　There are only a few reports on the terminal clinical course of patients who received palliative care alone. We retrospectively analyzed the clinical records of 130 patients with head and neck cancer who accepted a policy of palliative care alone at our institute between March 2008 and February 2018. 　Median overall survival （OS） was 3.6 months. Patients’ age, histological type, primary site, palliative treatment or use of opioids did not influence OS. On the other hand, OS was significantly shorter in patients with distant metastasis （p＝0.004）, those who had received second-line chemotherapy （p＝0.033）, intervention by the palliative care team （p＝0.023）, those with steroid use （p＝0.005）, and those who spent their terminal period in our hospital （p＝0.005）. A significant correlation was found between the palliative treatment period and the total period of terminal care （r＝0.631, p＜0.0001）. 　These results suggest that longer palliative treatment may extend the entire course of the terminal period. Since the survival period of patients with head and neck cancers under palliative care alone is generally short, patients’ quality of life is the most important issue to be addressed in this period.

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Nivolumab has shown efficacy in patients with recurrent/metastatic head and neck squamous cell carcinoma（RM-HNSCC）. Recent data suggest increased response rate to salvage chemotherapy after exposure to immune checkpoint inhibitors in advanced non-small cell lung carcinoma. We evaluated responses to salvage chemotherapy in RM-HNSCC patients who have progressed on nivolumab. A retrospective study was conducted at Kagoshima City Hospital. From May 2017 to February 2018, 12 patients were treated with nivolumab for RM-HNSCC and 5 patients whose diseases have progressed on nivolumab were received salvage chemotherapy. The overall response rate to nivolumab was 16.7％ and the disease control rate was 33.3％. Salvage chemotherapy included taxane-based regimen （60％） and platinum-based regimen （40％）. The overall response rate to salvage chemotherapy was 40％ and the disease control rate was 80％. This suggests that nivolumab could make tumor more vulnerable to subsequent chemotherapy in RM-HNSCC patients.

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In CheckMate 141, a randomized, phase 3 trial, nivolumab demonstrated superior overall survival（OS）in patients with recurrent or metastatic squamous cell carcinoma of the head and neck compared with the investigator’s treatment of choice. However, patients with non-squamous cell carcinoma or nasopharyngeal cancer were excluded from this trial. This retrospective study evaluated 28 patients with head and neck cancer who received nivolumab at the Osaka International Cancer Institute. In this retrospective analysis, nine had nasopharyngeal cancer and two had non-squamous cell carcinoma. Median progression-free survival （PFS） was 4.3 months （95％ CI: 1.9-5.2） and median OS was not reached （95％ CI: 7.8-NA）. Of the 24 patients who had one or more target lesions, the response rate was 16.7％, and the disease control rate was 54.2％. The incidence of immune-related adverse events （irAE） was 46.4％ （13 patients） for all grades, and 7.1％ （2 patients） for grade 3. The PFS among patients with irAE was longer than that among patients without irAE. Although this retrospective study included patients with non-squamous cell carcinoma or nasopharyngeal cancer, nivolumab monotherapy demonstrated a comparable efficacy with the results of CheckMate 141.

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 In this study we statistically analyzed the efficacy of concurrent chemoradiotherapy （CCRT） on a total of 54 cases with hypopharyngeal and laryngeal squamous cell cancers that had been primarily treated from 2006 at our hospital. 　The results were as follows: with hypopharyngeal cancer/laryngeal cancer the 2-year overall survival rates （OS） were 70％/83％, the 2-year disease-specific survival rates （DSS） were 73％/92％, and the 2-year disease-free survival rates （DFS） were 68％/71％. In regard to the stage of hypopharyngeal cancer/laryngeal can­cer 100％/100％ had stageⅢ, 75％/88％ had stageⅣA, and 0％/100％ had stageⅣB respectively. There was a significant difference in the statistical analysis between the 2-year DSSs with 62％ for the group receiving one course of chemotherapy during CCRT and with 90％ for another group receiving two or three courses. The 2-year laryngeal preservation rate （LPR） was 89％ in all cases and in regard to T-stage 100％ had T2, 91％ had T3, and 81％ had T4. As to severe long-term adverse events, there was only one case, who required insertion of a gastric tube for more than one year. 　To conclude, our therapeutic approach of using CCRT for hypopharyngeal and laryngeal cancers showed successful improvements of the survival rates and the LPRs especially in patients with higher T-stages. Furthermore, the occurrence rates of severe long-term adverse events in our approach were smaller than those found in other reports.

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　Mucosal malignant melanoma （MMM） is a rare disease with poor prognosis, and standard therapies have not been established. In recent years, the effects of carbon ion radiotherapy, molecularly targeted drugs, and immune checkpoint inhibitors have been verified. In this study, we present one case of oropharyngeal MMM, with central airway constriction, in which some foregoing treatments have been successful. A 55-year-old man complaining of swallowing pain and dyspnea was diagnosed with StageⅢ （T3N0M0） （AJCC/UICC, 7th edition）oropharyngeal MMM. There was no surgical indication, so he was sequentially treated with carbon ion radiotherapy, chemotherapy （DAV therapy）, and immunotherapy with ipilimumab （an anti-CTLA-4 antibody）. During the treatment period, the tumor size decreased, and we were able to continue and complete treatment without airway obstruction by using steroids. Good local control has continued for 3 years. Our conclusion is that a combination of carbon ion radiotherapy and drug therapy may be useful for MMM, and that steroids are helpful in preventing airway obstruction due to radiation therapy.

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It is important to evaluate multiple primary cancers when treating head and neck cancers. If double cancer is found, the treatment strategy must be determined considering not only lesions but also the background and general condition of the patient. Herein, we report a case of laryngeal cancer accompanying esophageal cancer treated with combined surgery. 　The patient was a 72-year-old male who was diagnosed with spinocerebellar degeneration. He was referred to our hospital with a suspected tumor of the left vocal cord. We made a diagnosis of laryngeal cancer （cT3N2cM0） based on histology and image examination. Furthermore, upper gastrointestinal endoscopy revealed thoracic esophageal cancer （Mt, Pw, 0-Ⅱc, T1b-SM）. We planned total pharyngolaryngoesophagectomy and reconstruction using the gastric tube at first, but this would have been a burden to this patient because he had obstructive pulmonary disease and neurodegenerative disease, so we performed laryngectomy and transhiatal esophagectomy. 　At first, right-side neck dissection and laryngectomy were performed keeping as much pharyngeal mucosa as possible. After the pharyngeal mucosa was closed, the cervical esophagus was amputated and the thoracic esophagus was removed. Then, the gastric tube was elevated and anastomosed to preserve the cervical esophagus. In order to avoid sutural leakage, we put the thyroid on the pharyngeal suture. Blood flow in the preserved pharyngeal mucosa and elevated gastric tube was good and microvascular anastomosis was not needed. Ingestion was started 13 days after the surgery, and sutural leakage did not occur. He has no recurrence or metastasis after treatment.

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Acinic cell carcinoma is a relatively rare malignancy of ductal cell origin that accounts for 1-6％ of salivary gland neoplasms, and often occurs in the parotid gland. Acinic cell carcinoma of the parotid gland in children is extremely rare. A 10-year-old boy was referred to our hospital because of left parotid tumor. Magnetic resonance imaging T1 examination revealed a low signal and T2 examination revealed an iso-high signal. The formation of cysts was observed inside, and many of them had hemorrhagic change. There was no characteristic finding in the preoperative imaging diagnosis, and schwannoma was considered. The maxillary branch of the facial nerve was involved in the tumor, and the facial nerve was resected. 　There has been no clinical evidence of recurrence or metastasis for 3 years since the surgery.

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　Surgical therapy is the main strategy for medullary thyroid cancer, but there is no effective therapy for resectable advanced cases. Vandetanib is a once-daily oral inhibitor of RET kinase, vascular endothelial growth factor receptor, and epidermal growth factor receptor signaling. We experienced a case medicated by Vandetanib for medullary thyroid cancer. A 55-year-old female was diagnosed with medullary thyroid cancer by aspiration cytology of a thyroid tumor and needle biopsy histology. Since FDG-PET showed multiple bone metastases, she was treated with Vandetanib. Serum calcitonin and carcinoembryonic antigen decreased after withdrawal of the medication, and US showed decreased size of the thyroid tumor and cervical lymph nodes similarly. Since PET-CT showed decreased accumulation into these nodules, she was judged to have responded to the treatment. Though Vandetanib is a first-line TKI for unresectable medullary thyroid cancer, the purpose of this therapy is to control progression of the cancer.

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 CASTLE is a rare entity distinct from squamous cell carcinoma of the thyroid, due to the better prognosis and immune-pathological positive results for CD5, bcl-2, etc. Three cases of CASTLE are presented in this paper. Though invasion of surrounding organs was observed, radical resection could be completed. Postoperative radiotherapy was added, and all three cases remain alive without recurrence. Reinnervation of the recurrent laryngeal nerve was performed in two of the three cases, and hoarseness and aspiration were improved in two cases postoperatively. Though the prognosis of CASTLE is better compared to thyroid squamous cell carcinoma, cases of recurrence and death have been reported. To improve the prognosis of CASTLE, a combined strategy is required. The efficacy and significance of radiotherapy for CASTLE are still controversial.

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