Chemoradiotherapy （CRT） with cisplatin is a standard treatment for head and neck cancer.　However, it is known that administration of platinum agents （such as cisplatin and carboplatin） causes hearing impairment. In this study, pure tone audiometry was performed for 33 head and neck cancer patients who underwent CRT with cisplatin. Hearing tests were performed before the first dose of cisplatin, and at 3 months, 6 months, and 1 year after the first dose. As a result, 76% of the patients had hearing loss after 1 year. We also analyzed how the total cisplatin dose, age, sex, and smoking history were related to hearing impairment and found that there was no significant difference.
Long-term follow-up revealed that many patients have hearing impairment after cancer treatment. Medical involvement including supportive care is required for a long period after CRT for head and neck cancer patients.

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We examined 82 cases of upper gingival and hard palate cancer that underwent surgery at our institution from January 2013 to November 2022. In the investigation of contralateral cervical lymph node metastasis, we categorized the primary tumor sites into four types: 1） lateral type, 2） anterior type, 3） contralateral medial type surpassing midline, and 4） ipsilateral medial type not surpassing midline.
The combined rate of occult cervical lymph node metastasis, including those identified through elective neck dissection and subsequent metastasis, was 14.3％. The contralateral medial type surpassing midline showed a significantly higher proportion of contralateral cervical lymph node metastasis at 21.1％. No evident correlation was observed between pathological depth of invasion （DOI） and cervical lymph node metastasis in our study. However, the subgroup with pathological DOI under 5mm demonstrated significantly better relapse-free survival compared to the subgroup with DOI exceeding 5mm.
This primary tumor site categorization is thought to provide valuable insights when considering the applicability of contralateral elective neck dissection. The lack of an evident correlation between pathological DOI and cervical lymph node metastasis may have been related to the fact that the lesions in this study were lesions with a bony lining.

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Hypopharyngeal cancer is the second most common type of head and neck cancer in Japan, and its prognosis is poor. Although there have been many studies on inflammation and nutritional parameters for the prognosis of head and neck cancer, there is no consensus on the clinical application of the results. This study clarified the prognosis of hypopharyngeal cancer in our hospital and evaluated the reproducibility and usefulness of these inflammatory and nutritional parameters in our hypopharyngeal cancer cohort. We conducted a retrospective study of 83 cases of hypopharyngeal cancer treated radically at The Jikei University Kashiwa Hospital from January 2015 to December 2020 based on medical record information. Five-year survival rate was 59.3% （95% confidence interval: 46.8-69.8%）, and inflammation and nutrition parameters were prognostic factors. The reproducibility of inflammatory and nutritional parameters as predictors of prognosis was confirmed. Among them, Geriatric nutritional risk index and Glasgow prognostic score were versatile parameters in terms of equalization of inter-institutional disparities in clinical application because of their predefined cutoff values.

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In cases of T4 parotid carcinoma requiring extended resection, sacrificing the facial nerve can reduce quality of life. In this study, we examined 25 patients with pT4 parotid carcinoma who underwent radical surgery at our department. The cohort comprised 17 men and 8 women, with patients’ age ranging from 8 to 81 years, and the median observation period being 8.6 years. Overall, 16 patients had high-grade disease. Of the 14 patients without preoperative facial nerve palsy, 6 had high-grade disease, and facial nerve preservation was achieved in 2 of them. The 5-year locoregional control rate was 74.4%, 5-year distant metastasis rate was 45.4%, and overall 5-year survival rate was 59.5%. Univariate analysis showed that only the pathological grade was a prognostic factor for locoregional control, distant metastasis, and overall survival. For patients with T4 parotid carcinoma without preoperative facial nerve palsy, our results suggest that sacrificing the facial nerve does not improve outcomes, although it is common in high-grade cases.

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Mandibular reconstruction using a mandibular reconstruction plate （MRP） combined with a free flap remains controversial. Between 2016 and 2022, we investigated 43 cases in our department in which reconstruction was performed using MRP and free flap after segmental mandibulectomy. Complications in which the MRP was exposed to the oral cavity or on the skin were observed in 9 cases; of these, all four cases in which the MRP was exposed on the skin side required removal or replacement of the MRP. Five cases with exposure on the mucosal side underwent additional surgery or conservative treatment, but no cases required removal of the MRP.
To protect the MRP from exposure to oral saliva, we developed an easier method that was comparable with the previously reported “no-touch method.” After tumor ablation, the MRP was temporarily fixed to the mandible, and after the skin flap was sutured to the oral defect, we removed and disinfected the MRP during microvascular anastomosis. This “plate detachment and disinfection method” was not inferior to the no-touch method. We believe that with strict application and careful handling, MRP will continue to be useful as an option for rigid reconstruction for segmental mandibular resection.

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Elderly patients are often under polypharmacy conditions and are at risk of suffering from adverse events. We report a case of erythema multiforme after radiation therapy for oropharyngeal cancer. A 75-year-old male with chronic renal failure under polypharmacy conditions was diagnosed with p16-positive oropharyngeal cancer and underwent radiation therapy. After completion of radiation therapy, he developed a fever, deterioration of mucositis, and a rash. Considering the possibility of severe drug eruption based on the clinical course, prednisolone was administered and the symptoms diminished. He was diagnosed with erythema multiforme via skin biopsy. Acetaminophen was the suspected cause of this rash; however, the drug-induced lymphocyte stimulation test was negative. For elderly patients, the risk of adverse drug events such as severe drug eruptions associated with polypharmacy should be considered, and radiation-induced mucositis should be differentiated from severe drug eruptions.

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