Induction chemotherapy （ICT） of DTX＋CDDP＋5-FU （TPF） has been reported to be useful as pretreatment preceding standard CDDP combination chemoradiotherapy （CCRT） for head and neck cancer. However, ICT causes many adverse events, and its effectiveness is still controversial. We conducted a study on ICT followed by CCRT in 30 cases of advanced laryngeal and hypopharyngeal cancer with a desire for laryngeal preservation. We examined completion rates, success rates based on primary tumor （T） and neck lymph node （N） metastasis, prognosis, and laryngeal preservation. Nine cases had laryngeal cancer （Stage Ⅲ：4 cases, Stage Ⅳ：5 cases） and 21 cases had hypopharyngeal cancer （Stage Ⅲ：3 cases, Stage Ⅳ：18 cases）. The completion rate of ICT （TPF 2 courses） was 93％, and the completion rate of ICT＋CCRT was 82％. The success rate of ICT was T100％, N80％, and the success rate of ICT＋CCRT was T97％, N92％. The two-year overall survival rate was 75％, and the two-year laryngeal preservation survival rate was 67％, indicating good results. From this study, it is considered that good completion and effects can be achieved with TPF-based ICT and CCRT by selecting cases and addressing adverse events.

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Reconstruction with microvascular free tissue transfer is useful for wound healing and preservation of appearance and function after head and neck cancer resection. In our department, all reconstructive procedures, including flap harvesting and suturing, and microvascular anastomosis are performed by head and neck surgeons. Here, we retrospectively evaluated this practice in 104 patients （106 flaps） undergoing treatment, focusing mainly on microsurgical complications. The majority of reconstruction sites were the oral cavity and hypopharynx. In about half of the cases an anterolateral thigh flap （ALT） was used for reconstruction. The recipient vessels of choice were the superior thyroid artery and internal jugular vein in most patients. Intraoperative free flap complications occurred in 14 patients （13％）, eight of which were thrombosed arterial anastomosis. Postoperative free flap complications occurred in six patients （6％）, four of which required flap removal （4％）. While anastomotic thrombosis did not occur postoperatively, ALT perforator complications occurred in as many as four patients. Intraoperative complications were more common in salvage surgery （P＝0.059）, whereas postoperative complications were significantly correlated with postoperative infection （P＝0.016）. Although these surgical outcomes were not inferior to those of previous large-scale reports, certain improvements were considered necessary, particularly in the handling of ALT perforators.

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Cervical esophageal cancer is a rare disease that accounts for approximately 5% of all esophageal cancers. Since laryngectomy is necessary in cases of head-side extension and cervical lymph node metastasis is common due to the anatomical site, cooperation between head and neck surgery and esophageal surgery is essential. In our hospital, head and neck surgery is in charge of neck operations when laryngectomy and neck dissection are required. We performed a retrospective study of 25 cases of cervical esophageal cancer operated on at Nagoya City University Hospital from 2017 to 2022, of which 15 cases were operated jointly with our department. The median age was 69 years; 12 were male and 3 were female. All patients had squamous cell carcinoma, and the clinical stage was stage Ⅰ in 2 cases, stage Ⅱ in 5 cases, stage Ⅲ in 7 cases, and stage Ⅳa in 1 case. In seven of the 15 cases removal of the cancer was possible only by neck surgery. Among all cases, the two-year overall survival rate was 33.3%, and the two-year disease-free survival rate was also 33.3%. Local recurrence was observed in 7 patients and distant metastasis in 3. Postoperative complications were observed in 9 patients, including tracheal necrosis in one patient, which required treatment. Cooperation between esophageal and head and neck surgery is important in the treatment of cervical esophageal cancer.

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We report a case of a hypopharyngeal tumor that was suspected to be malignant on preoperative endoscopic findings, but was diagnosed as glycogenic acanthosis on pathological examination. The patient was a 72-year-old man. During follow-up after radiotherapy for right glottic cancer, a small lesion of the right piriform sinus was found. The lesion enlarged and increased in thickness, and atypical vessels on its surface became evident, so transoral resection was performed. Intraoperative magnifying endoscopy showed abnormal vessels like type B1 vessels on its surface, suggesting early-stage cancer, but intraoperative Lugol staining showed the lesion to be dark brown with a pink color sign-negative non-staining zone adjacent to it. Pathological examination of the excised specimen confirmed the diagnosis of glycogenic acanthosis with dysplasia of the adjacent zone. In superficial lesions of the hypopharynx, glycogenic acanthosis, which is difficult to distinguish from cancer, should be included in the differential diagnosis, and the diagnosis and treatment should be made after comprehensive evaluation of the lesion using magnifying endoscopy and Lugol staining.

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Primary lymphoepithelial carcinoma of the salivary gland is a rare tumor that accounts for less than 1% of all salivary gland cancers and has been implicated in Epstein-Barr virus （EBV）. In this study, we experienced a rare case of EBV-unrelated lymphoepithelial carcinoma of the parotid gland. The case was a 69-year-old male patient who underwent superficial parotidectomy at the Department of Otorhinolaryngology at another general hospital, and was diagnosed with lymphoepithelial carcinoma of the parotid gland. He was referred to our clinic for additional treatment. Postoperative imaging showed cervical lymph node metastasis, so left total neck dissection was performed. Multiple cervical lymph node metastases with extranodal invasion were found, so postoperative radiation therapy was administered. He remains free of locoregional recurrence and distant metastasis in the three years after treatment. Lymphoepithelial carcinoma is known to be radiosensitive, and postoperative radiotherapy can improve the prognosis.

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A 76-year-old male was treated with pembrolizumab for postoperative neck and pulmonary metastases from laryngeal cancer. Two days after the first administration, CTCAE Grade 2 arthritis was observed. It was diagnosed as an immune-related adverse event （irAE）. Prednisolone （20mg/kg/day） was started, and his symptoms and abnormal blood test findings rapidly improved. He could continue pembrolizumab therapy with no recurrence of irAE with tapering prednisolone, and his metastatic lesions remain in partial response. Although the frequency of reported irAEs with arthritis is not high, Grade 2 or higher arthritis decreases the patient’s activities of daily living, and immune checkpoint inhibitors （ICI） may have to be interrupted or discontinued. There are reports that the development of irAEs is associated with a better prognosis for ICI therapy. Therefore, we believe that continuing pembrolizumab therapy while controlling irAE could contribute to patients’ long-term survival.

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