Patients with head and neck cancer face various problems, including physical problems （such as pain caused by the tumor, dysphagia, and respiratory dysfunction）, aesthetic problems due to changes in appearance, mental problems such as anxiety and depression, financial problems such as medical expenses and living expenses, and employment problems.
The support required differs depending on the time of diagnosis, the time when radical treatment such as surgery or chemotherapy is required, the time of palliative chemotherapy for distant metastasis or recurrence, and the time when palliative care is required. The patient backgrounds are also becoming more complex, and there is an increase in cases of elderly people living alone, elderly people caring for elderly people, and people caring for people with illnesses.
We discuss the patient support that is considered necessary in the treatment of head and neck cancer.

View full abstract

Postoperative bleeding in head and neck surgery can lead to airway obstruction due to venous return insufficiency if not addressed promptly. Therefore, it is essential to establish a comprehensive safety management system after neck surgery. However, cases of death or severe complications related to postoperative bleeding in the head and neck region continue to be reported, indicating that some facilities still have inadequate safety management protocols for postoperative care.
In March 2022, the Japan Medical Safety Research Organization published an analysis titled “Analysis of Death Cases Related to Airway Obstruction Caused by Cervical Surgery,” which proposed various measures to avoid airway obstruction after postoperative bleeding. Based on these recommendations, our department has revised and unified the guidelines for postoperative management, ensuring that physicians and nurses are prepared to respond effectively and without confusion when encountering cases of postoperative bleeding.
Specifically, we have clarified the necessary preparations （such as tracheostomy sets and cannulas）, the intervals for measuring neck circumference, reporting criteria to physicians, and the findings that should be communicated to physicians based on the aforementioned recommendations. This framework allows even less experienced nurses to report without hesitation and enables less experienced physicians to perform promptly when necessary.
As a result, we believe we have established an effective safety management system. We hope this report serves as a foundation for developing specific postoperative management protocols in other facilities.

View full abstract

This study compared FDG-PET/CT and DWIBS （Diffusion-Weighted Whole Body Imaging with Background Suppression） for the detection of distant metastasis in hypopharyngeal cancer. The study included four cases of hypopharyngeal cancer, in which both FDG-PET and DWIBS were performed before treatment between November 2017 and January 2018, and DWIBS was used for surveillance after treatment. The pretreatment FDG-PET and DWIBS showed similar results in three patients, while the results showed a discrepancy in the evaluation of mediastinal lymph nodes in one case, suggesting that FDG-PET accumulation could be physiological. DWIBS offers advantages such as being cost-effective, quick, and free from radiation exposure. Using FDG-PET only when recurrence is suspected could reduce healthcare costs and radiation exposure. However, the use of DWIBS in head and neck cancer remains limited, and further cases need to be accumulated to better establish its utility.

View full abstract

Transnasal endoscopic surgery for sinonasal mucosal melanoma is considered to be minimally invasive and has outcomes comparable to those of open surgery. We performed transnasal endoscopic surgery for salvage in two patients with suspected residual tumor after initial treatment with immunoradiotherapy. In both cases, postoperative pathology showed no tumor and nivolumab was continued postoperatively. Case 1 remained recurrence-free after nivolumab was discontinued one year later, but Case 2 developed a recurrence in clivus and was treated palliatively. The presence of pigmentation or a mass does not always indicate residual tumor, and in some cases it is difficult to determine residual tumor after immunoradiotherapy. Although there have been no reports on transnasal endoscopic surgery after immunoradiotherapy, salvage surgery is one of the few options for additional treatment in BRAF mutation-negative cases. Pathological response after neoadjuvant ICI therapy is considered an important prognostic indicator, and the indication for salvage surgery should be determined after considering its significance and risks.

View full abstract

HPV-associated p16-positive oropharyngeal squamous cell carcinoma （OPSCC） generally has a favorable prognosis. However, few reports have investigated long-term outcomes, including causes of death and treatment approaches for recurrent or metastatic disease. We retrospectively analyzed 106 patients with OPSCC who were diagnosed and treated at our institution. We compared p16-positive （n＝61） and p16-negative groups （n＝45）, with a particular focus on causes of death and outcomes after recurrence or metastasis. The 5-year overall survival, recurrence-free survival, and disease-specific survival rates in the p16-positive group were 71.6％, 71.1％, and 85.8％, respectively, whereas those in the p16-negative group were 42.9％ （p＝0.02）, 31.8％ （p＜0.01）, and 73.6％ （p＝0.03）, respectively, showing significantly better prognosis in the p16-positive group. Although not statistically significant （p＝0.15）, the rate of deaths from other causes was higher in the p16-negative group （19.5％） than the p16-positive group （9.2％）. Patients who received local treatment for recurrence or metastasis, including salvage surgery and radiotherapy, had significantly favorable outcomes regardless of p16 status. These findings suggest that aggressive local therapy should be considered for selected patients with recurrent or metastatic OPSCC, independent of HPV status.

View full abstract

Biphenotypic sinonasal sarcoma （BSNS） is a rare primary nasal sinus sarcoma first reported in 2012. In this report, we present a case of BSNS with skull base involvement in a 76-year-old male who underwent craniofacial surgery using a combination of craniotomy and nasal endoscopy for treatment. The tumor had extensively involved the right ethmoid sinus, and a pathological diagnosis of BSNS was made. The tumor was surgically excised in a single lump, and postoperative radiation therapy was administered. One year after surgery, no recurrent metastasis was observed. Although BSNS has a high local recurrence rate, distant metastasis has not been reported, and complete resection is crucial for disease control. For BSNS with skull base involvement, complete resection by skull base surgery combined with craniotomy and nasal endoscopy, as in this case, may be an effective option.

View full abstract

Intrathyroid thymic carcinoma is a rare malignant tumor that originates from residual thymic tissue within the thyroid. We report a case of unresectable intrathyroid thymic carcinoma treated with definitive radiation therapy. The patient was an 88-year-old female. Physical examination revealed a mass caudal to the inferior pole of the right thyroid lobe, and endoscopic examination observed right vocal cord paralysis. CT and MRI indicated a tumor lesion in the right upper mediastinum infiltrated into the right lobe of the thyroid gland, common carotid artery and trachea. For diagnostic purposes, a biopsy was performed under general anesthesia resulting in a diagnosis of poorly differentiated squamous cell carcinoma. Pathologically, the boundary between the normal thyroid tissue and the tumor was unclear, leading to the conclusion that the tumor originated from thyroid gland and it was diagnosed as intrathyroid thymic carcinoma. As the tumor was unresectable, definitive radiation therapy was performed. Five years after treatment, the tumor has shrunk without regrowth. Intrathyroid thymic carcinoma is highly sensitive to radiation. Although there is no established treatment for unresectable cases, definitive radiation therapy may be considered as an option of treatment.

View full abstract