It is difficult for clinicians to allocate sufficient time to both daily clinical practice and research activities. Our hospital uses a customized database tool, Access®. This is effective in improving the efficiency of clinical research and facilitating case selection. Furthermore, it is used in the malignant tumor registry of the Japanese Head and Neck Cancer Society. The process of extraction from the database allows searches by treatment period, age, and type of treatment, and the usefulness of this is demonstrated by presenting an actual search screen. We discuss the evolution of head and neck cancer treatment, the need for database management, and the advantages and disadvantages of Access®. Access® is excellent at database registration and extraction, and is useful for building a system could help reduce the burden on clinicians. It can also handle updates in head and neck cancer treatment in the future. We believe that the introduction of Access® at other medical institutions would assist further medical treatment and clinical research.

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We examined retrospectively the effect of postoperative radiotherapy for salivary gland cancer performed at our hospital. There were 104 eligible patients, of whom 75 （72％） received postoperative radiotherapy. For all patients, the 3-year locoregional control （LRC） rate was 90.3％ （95％ CI 82.8-97.9％） in the group with postoperative radiotherapy and 71.2％ （95％ CI 52.9-89.5％） in the group without postoperative radiotherapy, and was thus significantly better in the group with postoperative radiotherapy （p＝0.02）. For the patients with parotid gland cancers, the 3-year local control （LC） rate was 93.0％ （95％ CI 86.4-99.7％） in the group with postoperative radiotherapy and 66.6％ （95％ CI 42.4-90.9％） in the group without postoperative radiotherapy （p＜0.01）. Multivariate analysis showed that postoperative radiotherapy was the only independent risk factor in LRC for all patients, and in the analysis of parotid gland cancers, high grade malignancy and postoperative radiotherapy were independent risk factors in LC.

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We retrospectively studied patients with recurrent or metastatic head and neck cancer who started pembrolizumab monotherapy or combination therapy between 2019 and 2021 in our institution to evaluate the efficacy and safety of the treatment. This study included 39 patients, of which 8 （21％） were 80 years or older. Of the participants enrolled, 21 had CPS≥20, 13 had CPS 1-19, and 5 had CPS＜1. The BOR for monotherapy was CR 14％, PR 23％, SD 23％, and PD 41％ with a response rate of 36％, and the response rate by CPS was 36％ for CPS≥20, 50％ for CPS 1-19, and 0％ for CPS＜1. The BOR for combination therapy was CR 29％, PR 24％, SD 24％, and PD 24％ with a response rate of 53％, and the response rate by CPS was 71％ for CPS≥20, 43％ for CPS 1-19, and 33％ for CPS＜1. The 1-/2-year survival rates were 66/40％ for overall, 63/48％ for monotherapy, and 71/32％ for combination therapy. The median overall survival was 17.2 months in all groups. The median overall survival by CPS was 25.4 months in CPS≥20, 15.5 months in CPS 1-19, and 14.9 months in CPS＜1. Thirteen patients had irAE （grade 4 in 1, and grade 3 in 1）. Patients with irAE had a better response rate （67 vs. 33％） and survival rate （83 vs. 59％ at 2 years） than those without irAE. In patients aged 80 years or older, both the median duration of treatment and the median overall survival were longer than those of the overall population, suggesting that the treatment was well tolerated.

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Although nasopharyngeal carcinoma can cause cranial nerve （CN） involvement by skull base extension, it is not easy to diagnose the occurrence mechanism due to the complexity of the anatomy of the skull base. We report a rare case of nasopharyngeal carcinoma in which the involvement of nine CNs, including inner ear dysfunction, developed within one month from the onset of symptoms and investigated the route of skull base extension. A 21-year-old man was referred to our hospital with chief complaints of hoarseness and dysphagia for 3 days. He showed swelling of the nasopharynx and bilateral cervical lymph nodes in the first medical examination and was diagnosed with nasopharyngeal carcinoma （right posterosuperior wall type, cT4N2M0, stage ⅣA）. The involvement of all CNs other than CN Ⅰ, Ⅱ, and Ⅶ was observed between the first medical examination and the start of chemoradiotherapy 29 days later. Based on MRI findings in this case, it was assumed that the right foramen lacerum was the critical site of the tumor extension to CN. The involvement of CN Ⅸ-Ⅻ certainly developed due to caudal extension from that site to the jugular foramen and the hypoglossal canal via the prevertebral space. The involvement of CN Ⅲ-Ⅵ also certainly developed due to cranial extension to the cavernous sinus via the carotid canal. In addition, the involvement of CN Ⅷ presumably developed due to the spread of meningitis that occurred at the site of tumor invasion to the internal auditory canal. MRI was useful for the detailed evaluation of the route of skull base extension and CN involvement.

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We report a case of a schwannoma that underwent malignant transformation into an angiosarcoma. The patient was a 46-year-old male who visited our hospital for enlargement of a left cervical tumor and headache. CT imaging revealed a lesion, approximately 80mm in size, with well-defined margins, pronounced peripheral contrast enhancement, and suspected extensive hypovascular areas indicating potential bleeding or necrosis. While fine needle aspiration （FNA） detected malignancy, a detailed histological diagnosis was not reached. Tumor resection was performed for both diagnostic and therapeutic purposes, and because of the coexistence of schwannoma and angiosarcoma, the diagnosis of malignant transformation from schwannoma to angiosarcoma was confirmed. After surgery, bleeding from the early recurrent tumor persisted, making hemostasis challenging, but hemostasis was achieved through radiotherapy combined with paclitaxel. Subsequent administration of pazopanib resulted in a partial response （PR）, and the patient has been progression-free for 13 months. For schwannomas, when symptoms such as growth trends or pain are observed, resection is more strongly recommended, bearing in mind the possibility of malignant transformation.

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Among cases of primary hyperparathyroidism, familial hyperparathyroidism accounts for 2-5%, and diseases with CDC73 gene mutation include hyperparathyroid jaw tumor syndrome and familial isolated primary hyperparathyroidism. In this report, we describe a case of parathyroid carcinoma with CDC73 gene mutation who was referred for surgery due to primary hyperparathyroidism. The patient, a 19-year-old woman, presented to our department with suspected primary hyperparathyroidism following a femoral neck fracture. Blood tests showed elevated calcium and intact-PTH levels, and imaging studies revealed a left lower parathyroid tumor and systematic fibrous osteitis. Genetic testing revealed a CDC73 gene mutation, and combined resection of the left lower parathyroid gland and left lobe of the thyroid gland was performed. Postoperatively, hypercalcemia and fibrous osteitis improved, and pathological examination confirmed the diagnosis of parathyroid carcinoma. We will continue to follow up the patient with attention to recurrent metastasis of parathyroid carcinoma and systematic complications associated with CDC73 gene mutation.

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