Two cases of parotid tumors extending to the parapharyngeal space are reported. A 74-year-old male complained of the left shoulder stiffness and was pointed out swelling of the left postauricular region. Another patient, 34-year-old male complained of swelling of the left side of the soft palate and the left infraauricular region. CT-sialography (case 1) and MRI (both cases) revealed that the tumors arose from the deep lobes of the left parotid glands and that they extended to the parapharyngeal spaces. Both cases were operated on by an external approach. The lateral lobe of the parotid gland was elevated temporarily and the facial nerve was isolated and dissected from the tissues of the deep lobe of the parotid. Then the tumor was successfully removed with no sugical complications except subtle weakness of the lower lip in case 1. Histologic examinations revealed pleomorphic adenoma in case 1 and carcinoma in pleomorphic adenoma in case 2. Postoperative irradiation was given to case 2.
The surgical approaches to the parapharyngeal space include 3 routes; an intraoral route, an external route, and a combined route (both external and intraoral). Of the 31 cases reported in the recent Japanese references, 6 cases were operated on by an intraoral approach, 20 by an external and 5 by a combined. The external approach is recommended because of the advantages of wide exposure of surgical field, ease to identify the 7th and 9-12th cranial nerves, no risk of infection from oral cavity, and satisfactory control of bleeding.

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Nineteen patients with primary non-Hodgkin's lymphoma of the thyroid were reviewed. Thirteen patiens had stage I E disease and five had II E and one had III E. All cases received radiotherapy over 40Gy combined with chemotherapy; either CHOP or modified one. The overall 5-year survival rate for the patients was 100% and disease free 5-year survival rate was 86.2%. Two of ten cases who were treated with involoed field irradiation relapsed on the margin of the field. So, extended field is recommended even in the case with intense chemotherapy. Relapse within a year or under the diaphragma was not experienced. This regimen was well tolerable and led good results, but eight cases (42.1%) showed hypothyroidism from 6 months to 4 year after radiotherapy. Continuous reevaluation of thyroid function including serum TSH is nescessary for the patients undergoing neck irradiation for treatment of lymphoma of the thyroid.

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Thirteen patients with advanced oral cavity and pharyngeal cancer were treated with three-drug regimen consisting of cisplatin, etoposide and mitomycin-C (PEM regimen) as a induction setting. Of 12 patients evaluable for response, 4 complete and 7 partial response were achieved, with an overall response rate of 92%, Myelosuppression was major side effect and thrombocytopenia was dose limiting toxicity. This study demonstrates that the PEM regimen achieved response rate comparable to the other cisplatin-containing regimen including CDDP plus 5-fluorouracil or CDDP plus bleomycin plus methotrexate with lesser mucosal toxicity. This regimen produced beneficial effect in patients with cancer in oral cavity.

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Six patients, 2 children (ages under 20) and 4 adults, wjth rhabdomyosarcoma involving parameningeal area (ethmoid sinus and pterygoid fossa) were operated on between 1985-1991 in the Tokai University Hospital. In 5 cases tumor was incompletely resected and in 1 case tumor was biopsied with gross residual disese. Histopathologic examination revealed alveolar type rhabdomyosarcoma in 5 cases and embryonal type in one child case. The children patients were postoperatively treated by radiotherapy plus chemotheraph with a combination of vincristine, actinomycine-D and cyclophosphamide (VAC) administered for 20 cures within 2 years. The children stay in remission for 4 years and 9 months, and 3 years and 7 months, respectively, since the completion of radiotherapy and first cure of chemotherapy. Adult cases were post-operatively treated in various modalities. First case was treated by radiotherapy and the primary tumor has disappeared. This patient has, however, immediately developed bone marrow metastasis and received 1 cure of CHOP (cyclophosphamide, adriamycin, vincristine and prednisolone) and 2 cures of VAC, but died because of disseminated intravascular coagulation. Two adult patients were subjected to radiotherapy plus chemotherapy with 3 cures of CHO, and the tumor has disappeared. Both patients, however, showed local recurrence 4 months later and died with distant bone and lung metastasis. One adult patient was given 2 cures of CHO and then radiotherapy and stayed in remission for 6 months. This patient has then showed local recurrence and was operated on through a craniofacial approach, and 3 cures of VAC was post-operatively. administered. The patient died because of intracranial invasion. The clinical records of the above patients suggest that radiotherapy plus chemotherapy is effective in the treatment of the rhabdomyosarcoma in children, but various combinations of radiotherapy and chemotherapy remain ineffective in the control of local and metastatic invasion in the adult disease.

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A retrospective analysis was performed for 92 patients with nasopharyngeal carcinoma treated with definitive radiation from 1959 to 1990 at the Department of Radiology, Gunma University Hospital. Of these patients, 74 had poorly differentiated epidermoid carcinoma histologically. There were 6 (8%), 5 (7%), 6 (8%) and 57 (77%) patients with stage I, II, III, and IV diseases, respectively. The cause specific survival rates at 5 years for stage I, II, III, and IV diseases were 100%, 80%, 80% and 39%, respectively. Except for the patients with VII-XII cranial nerve involvement, primary lesions were controlled easily following radiation therapy.
Twenty-three patients developed loco-regional recurrence within five years. Local recurrence was associated with wide invasion to the skull base or geographic errors. There was not a significant difference between the survival rates for patients with recurrent lesions and for patients without recurrent lesions, because the recurrent tumors were controlled with second course of radiation therapy. Twenty-one out of 57 patients with stage IV disease developed distant bone metastases. The 5-year cause specific survival rates for the patients with distant bone metastases and for those without distant bone metastases were 5% and 61%, respectively. There was a significant difference between the survival rates for the patients with distant bone metastases and for the patients without distant bone metastases (p<0.001). Therefore, the distant bone metastasis was found to be a significant factor affecting prognosis in the patients with poorly differentiated epidermoid carcinoma of the nasopharynx.
On the other hand, other histological types of nasopharyngeal carcinoma were not controlled with radiation therapy alone even if the primary lesions did not advanced.

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Five hundreds and ninety-two patients with squamous cell carcinoma of the maxillary sinus were treated by radiation therapy alone (136 patients) or in combination with chemotherapy (456 patients), at the Department of Radiology, Osaka Uuniversity Hospital between 1967 and 1984. After a median follow-up of 12 years (range 6-24), actuarial 5-year and 10-year survival rates were 34% and 24%, respectively. The 5-year and 10-year survival rates according to T stage were as follows: T2 (n=107 patients): 51% and 37%, T3 (n=318): 37% and 27%, and T4 (n=158): 22% and 18%, respectively. The mean dose (TDF) of radiation was 123 (range 59-184) for radiotherapy alone (RT) group, and 92 (range 49-141) for radiotherapy combined with intraarterial infusion of 5-fluorouracil (RT+FU) group. Recurrence-free and actuarial survival rates at 5-years were 11% and 20% for RT group, and 42% and 57% for RT+FU group, respectively.
It was concluded that radiation therapy (50Gy/25f/35d) combined with 5-FU (2.5gr/10f/35d) is an acceptable treatment strategy for maxillarr sinus carcinoma: it yielded a high rate of disease control and functional eye and maxilla preservation.

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A retrospective analysis was made of 103 patients (pts.) with carcinoma of the floor of the mouth (16 pts. with stage I, 33 st. II, 40 st. III and 14 st. IV after UICC-TNM '78) treated with radiotherapy, solely or in combination, from 1980 through 1988. In 13 pts. with st. I, permanent implant of ¹⁹⁸Au grains was applied, to a median permanent dose of 89Gy (range 65-150Gy). In 24 pts. with st. II, a concomitant combination of external radiotherapy (ERT) of a dose of 30Gy/3 weeks and intravenous infusion of either Bleomycin (BLM), 90mg/3w, or Peplomycin (PEP), a derivative of BLM, 60mg/3w before applying boost brachytherapy or radical surgery. In pts. with st. I, perfect local control (13/13) was achieved when applied with ¹⁹⁸An grains. In all pts. with st. II, ultimate local control rate of 93% (31/33) was obtained. In 24 pts. treated with combination of ERT+BLM/PEP, results differed according to whether lower gum was involved or not. Clinical complete remission (CR) before brachytherapy or surgery was obtained in 8 of 12 pts. with tumor not extended to the gum, which led to ultimate local control in all pts. and preservation of mandible in 8. In contrast, of 12 pts. with tumor extended to the gum, only 4 pts. achieved CR, and ultimate preservation of mandible was obtained in only 6 out of 12. Mandible was preserved in all with st. I (16/16) and in some st. II who were treated with ERT+BLM/PEP with brachytherapy (14/24). Overall cause-specific 5-year survival by stage was, 94% for st. I, 70% st. II, 49% st. III and 43% st. IV, respectively.

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Flow cytometric DNA analysis was performed on 86 samples of head and neck tumors. These patients were treated in National Kyushu Cancer Center during the period from May, 1989 through April, 1991. In the experiments, solid specimens were cut into three pieces and examined for routine histological examination, chemosensitivity tsl ting or flow cytometric analysis of cellular DNA content.
DNA aneuploidy tended to be predominant in advanced (60% of T3, T4) tumors as compared to early stage (25% of T1, T2) tumors. Aneuploid pattern of DNA was also detected more frequently in tissues from patient with lymphnodes metastasis than in patients without.
Statistically significant difference of servival rate was noted between patients with DNA aneuploidy and patients with DNA diploidy.
We conclude from this study that analysis of DNA ploidy as well as chemosensitivity of head and neck tumors will aid not only selecting effective antitumor agents but also predict the patients' clinical status during the course of disease.

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Thirty seven patients with carcinomas in head and neck underwent thoracotomies for pulmonary metastases. The pathological types of the 37 patients were as follows: thirty two were squamous cell carcinomas, four were adenoid cystic carcinomas and one was mucoepidermoid carcinoma. A five-year survival rate of all the patients was 28%, and that of the patients with squamous cell carcinomas was up to 32%. For a patient with squamous cell carcinoma in the head and neck, surgical treament of the metastases to the lung is justified when he satisfies the following criterias: (1) primary site is controlled, (2) there is no extrapulmonary metastatic site. (3) the patient is able to tolerate the operation, and (4) metastasic tumors are confined in one lobe of the lung. Neither the desease-free interval from the time of primary treatment to the first appearance of pulmonary metasatasis nor the number of the metastatic tumors is a consideration. We should pay attention to the chests of the patients with head and neck cancers to detect the pulmonary metastases as early as we can, because we may have a chance to salvage them by surgery.

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Recently, Quality of Life (QOL) is looked important for the cancer treatment.
QOL of 28 laryngectomized cases were inquired the postoperative conditions.
1) Their general conditions were mostly good.
2) Fourteen cases among 18 had the same jobs of the preoperative ones.
3) Twenty-two cases communicated with esophagolalia.
4) About 60 percent cases felt the impairment of their conversation.
5) The majority of laryngectomized cases lost the sense of smell. However, the influence for the gustatory sense was very small. And the better esophageal speakers had better smell.
6) They had little tendency to catch cold and to defecate more hardly in postoperative period than in the preoperative one.
QOL of laryngectomized patients are better than our general imagination, though many of them felt difficulty of the communication.

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Using three kinds of antibodies against P-glycoprotein (mdr (Ab-1), C219, MRK-16), we examined immunohistochemically the tissues from 25 patients with malignant tumors of the head and neck for the presence of the multidrug-resistance gene products (P-glycoprotein; P-gp). In one case of two malignant fibrous histiocytomas, P-gp expression was demonstrated after chemotherapy. In four cases of 5 adenoid cystic carcinomas, which are known to be resistant to chemotherapy, P-gp was detected before chemotherapy. Eight cases of malignant lymphoma which had a well response to chemotherapy and had no relapse, P-gp was not detected before or after chemotherapy. From these results, we suggested that the expression of P-gp would be related to sensitivity to chemotherapy in some malignant tumors of the head and neck.

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Cytotoxic activities of IL-2-stimulated effector cells from peripheral blood mononuclear cells (PBMC-LAK), and those from the lymph node cells without tumor cell invasion (LN(-)-LAK) in patients with head and neck cancer were examined by use of 4-hour⁵¹Cr release assay. LN(-)-LAK showed a significantly higher cytotoxicity against Daudi cell than PBMC-LAK from the same patients. Cytotoxic activities against K562 cell and autologous tumor cells mediated by LN(-)-LAK were not significantly different from those by PBMC-LAK. However, autologous tumor cell lysis by LN(-)-LAK from lymph node showing follicular lymphoid hyperplasia, was higher than that by PBMC-LAK. The effector cells of autologous tumor cell lysis were characterized CD56⁺ cells and CD8⁺ cells (CD8⁺ CD11b^- cells) by surface phenotypical analysis and negative selection assay using immunomagnetic isolation technique. These data indicated that regional lymph node cells (no tumor cell invasion) could be useful as effector cells for adoptive immunotherapy.

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Clinical and immunological effect of local immunochemotherapy combining cisplatin (CDDP) and recombinant Interleukin-2 (rIL-2) for head and neck cancer was studied. CDDP was administered by balloon occuluded arterial infusion (BOAI) through superficial temporal artery and subsequently, rIL-2 was administered by peritumoral injection or arterial infusion. Of twelve cases including oral cancers, mesopharyngeal cancers and maxillary cancers, five complete response (CR) and four partial response (PR) was achived. Effective rate was 75% and no sev ere toxicity was encounted.
Histological study revealed that marked lymphocytes infiltration was observed in tumor tissues of effective cases. Phenotypic analysis of peripheral blood lymphocytes exhibited an increase of CD4⁺ CD45R^- cells and CD 25⁺ cells in these cases.
It will be documented that induction immunochemotherapy combining CDDP and rIL-2 could be one of beneficial treatments in a multidisciplinary treatment for these cancers.

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It has been experienced that the modified grading of mode of invasion (Yamamoto & Kohama) at the tumor-host borderline in oral squamous-cell carcinoma was closely correlated with effect of cancer-chemotherapy and survival rate of patients who had underwent surgery. The more tumor cells wers invasive, the more hyposensitive to anti-cancer agents these cases were and poor prognoses of patients were observed. According to these results, type-oriented induction chemotherapy consisted of two regimens has been applied in our Department from 1988. Regimen I (R-I) is OK432+BLM as mild chemotherapy for less-invasive cases of modes 1 and 2 of cancer invasion. On the other hand, Regimen II (R-II) is CDDP+PEP as strong one for more invasive cases of modes 3, 4 C and 4D of it. These regimens were applied for 21 cases of previously untreated oral cancer. Results were as follows: objective response rate in each regimen was 5/10 (50%) in R-I and 7/11 (63.6%) in R-II. Among five complete response cases, four were observed in less-invasive cases of M-1, 2 by mild chemotherapy of R-I. It was suggested from these results that sensitivity to anti-cancer agents of each case would be predicted and optimal chemotherapy regimen could be chosen at the time of pretreatment.

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In order to increase the survival rate of the pectoral major musclocutaneous (PMMC) flap reported by Ariyan in 1979, the survival rate of our 35 cases of PMMC flap was analyzed according to the distance between the donor and rechpient site, size and place deviled by the nipple. Furthermore, the vascular anatomy of the thoracoacromial artery was studied using 10 sides of 5 cadavers with special reference to the relationship between the site of the nipple and it. As a result, the site for taking PMMC flap was found to be desirable to include the nipple, more central than the original internal site. According to the abowe result, a new design to make PMMC flap was proposed as a clinical application. A radial incision at the lowest distance of the flap measured from the middle point ofthe clavicle is at first made to watch the vascular route of the thoracoacromial artery.

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The significance of desmoplastic response after chemotherapy was studied in 20 patients with oral squamous cell carcinoma. According to the Oboshi and Shimosato's criteria, the histological effects were rated as Gr. IV in 5 cases, Gr. III in 1 case, Gr. II b in 1 case, Gr. II a in 8 cases and Gr. I in 5 cases. Desmoplastic response around cancer nests was observed in 17 out of the 20 cases (85.0%). There were no obvious correlation between the degree of desmoplastic response and the histological effect. In some cases the whole of viable cancer cell nests was circumscribed by desmoplastic response. In another cases without desmoplastic response cancer cells invaded diffusely into the deepest portion of the tumor. These results suggest that desmoplastic response dose not necessarily occur for repair of the destruction of parenchymal tissue and may act as a defense against cancer invasion. Since tumor localization caused by desmoplastic response is beneficial to the following operation, the mechanism of desmoplastic response after chemotherapy should be further investigated.

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In 37 cases of supraglottic cancer, we quantifi ed DNA and analyzed the relationship between DNA ploidyand T. classification. In some of these cases (16 T₁ or T₂ cases treated by radiotherapy alone), the relationship of DNA ploidy to local tumor controllabilityafter irradi ation was also examined.
Nuclear DNA was quantified by determining fluorescence from DAPI-stained cells (isolated from formalin-fixed and paraffin-embedded tissue block) under a microscope. DNA ploidy was classified as diploid or aneuploid. of all cases, 9 (24%) were diploid and 28 (76%) were aneploid. Of the diploid cases, 89% were T₁ or T₂ cases. As the clinical stage of the disease advanced, diploid cases tended to decrease and aneoploid cases tended to increase. Analysis of local tumor controllability with radiotherapy disclosed a higher incidence of recurrence in aneuploid cases (6/11) than in diploid cases (0/5). These results indicate the necessity of more aggressive treatment in aneuploid cases of supraglottic cancer.

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Carotid body tumors are of special interest to surgeons bacause of the technical challenges presented by extreme vascularity and difficulties encountered in removal. This papar discribes our experience with a case of bilateral carotid body tumors using recent concepts consisted of preoperative angiography with balloon occulution test and selective embolization, preparation of shunt, hypothermic general anesthesia and dissection in the capsular-adventitial plane with use of bipolar coagulation technique and microscope magnification. The patient was a 39-year-old man with a 4-year history of asymptomatic neck masses. CT and DSA demonstrated a 4×3cm vascular mass on the right and a 4×2cm on the left at the carotid biufrcation. After angiography and selective embolization, excision of each tumor was performed separately by recent surgical approach. The common and internal carotid artery on the both sides were preserved. Operating blood loss was 550ml on the right side and 170ml on the left. Temporary dysfunction of right hypoglossal nerve was seen as a postoperative complication. Selective embolization and our device in surgical techniques lessened the risk of surgical excition and decreased the blood loss.

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Over a peried of 15 years, the authors treated with intraarterial injection therapy for 22 cases of other than cancer of the nose and paranasal sinuses occurring on the head and neck. The following results were obtained.
(1) The patients, in which 11 cases of oral cancer and 8 cases of oropharyngeal cancer, etc., predominantly male, ranged in age from 38 to 82 years.
(2) Thirteen of the 22 patients were treated with a cisplatin combination therapy and 12 cases were treated with neo-adjuvant chemotherapy.
(3) At the time of 60th month, the accumulated survival rate as judged by the Kaplan-Meier method of 55% and 86% for oral cancer and oropharyngeal cancer, respectively, was found.
(4) At the same period, this rate of 85% and 26% for cisplatin combination therapy and other drugs therapy, respectively, was found.
(5) This rate among the 12 neo-adjuvant chemotherapy was 92% at the time of 56th month.
(6) It is suggested that neo-adjuvant chemotherapy combined with cisplatin should be the therapy of choice for head and neck cancer.

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Nuclear DNA was measured by microphotometry in 15 cases of thyroid cancer. Samples were prepared from paraffin embedding material, and DAPI-staining was performed. The comparative review was made with follicular carcinoma and papillary carcinoma as studied previously. There was no particular relation between the proliferative index (PI) and existence of vascular or capsular infiltration. The irregularity of the nucleus and fine needle aspiration (FNA) before surgery were related to the proliferative index.
The metastasis of lymph node showed a aneuploidal tendency.
The PI-value was 14.2±7.9 on follicular carcinoma, 5.0±3.3 on adenoma, and 16.0±6.4 on papillary carcinoma. The value with follicular carcinoma was low, because it might be due to the inclusion of 6 cases of follicular carcinoma with minimal invasion.

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Following intraarterial infusion of THP which was given simultaneously with radiotherapy, THP concentration in tumor tissues was measured to eliminate the efficancy of treatment.
THP concentration in tumor tissues continued to elevate up to a dose 10Gy of radiotherapy, and then decreased. However, more than 3ng/mg of THP concentration in tumor tissues were maintained.
In the cases treated with intraarterial infusion as well as those treated with radiotherapy combined with intravenous injection, the drug concentration in tumor tissues remained low.
As a conclusion, combined use of radiotherapy could temporarily elevate THP concentration in tumor tissues following its intraarterial infusion.

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Two cases with recurrent cancer in pterygo palatine fossa or parapharyngeal space were treated with intraarterial chemoimmunotherapy through the ligated external carotid artery. Anti-cancer drugs (CDDP, 5-FU) were injected intraarterially through the external carotid artery, previously ligated at bifercation, followed by killer cells which were induced by mixed lymphocyte and allogeneic tumor cell culture with subsequent recombinant interleukin 2 culture. The therapy was significantly effective in the reduction of tumor mass. We consider the effect was caused by two important factors. One is the ligitation of external carotid artery prior to the intraarterial infusion, which made it possible to provide the infused materials into the most of all branches of the external carotid artery, as indicated by DSA examination. Another factor is an application of the combined therapy of anti-cancer drugs with adoptively given killer cells, which has been reported as highly effective therapy for head and neck cancer.

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Neck dissection is often necessary for the operation of head and neck malignancies. It is difficult to dissect the metastatic lymph nodes adhered to the surrounding structures of the high carotid lesions.
Transient anterior shift of the mandible was tried to obtain a better view of this area and the result was successful. This method has following advantages.
1. Easy and not time-consuming
2. Not harmful because the position of the shift is within the range of motions of the temporo-mandibular joint
3. Good exposure of high carotid lesions is available

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We investigated the characteristics and target cell recognition of CD3·LAK induced by anti-CD3 monoclonal antibody (mAb) and interleukin 2 (IL-2) from peripheral blood lymphocytes (PBL) on the patients with oral squamous cell carcinoma.
‹Materials and Methods› CD3·LAK were induced by 10μg/ml of anti-CD3mAb (solid phase) and 700JRU/ml of IL-2 (S6820). Surface marker of CD3·LAK were detected by flow cytometry. A 4-h⁵¹Cr release assay was used to detect cytotoxic activity. Cultured tumor cell lines, which are Ca9-22 (established from squamous cell carcinoma of the lower gingiva: case 1), NA (established from squamous cell carcinoma of the tongue) and K562, were used as target cells. The expression of HLA antigen on the surface of the cultured tumor cell lines were detected by flow cytometry prior to 4-h ⁵¹Cr releas eassay detection. In order to investigate the target cell recognition of CD3·LAK, inhibition assay with mAb were done.
‹Results› On day 19, CD3·LAK population mainly consisted of TCR α/β positive T cell (CD3+) and NK cell (CD3-NKH-1+), and remaining portion was TCR γ/δ positive T cell (CD3+). The CD3·LAK showed the cytotoxic activities against autologous and allogeneic cultured tumor cell lines, and these activities were inhibited by anti-CD3 monoclonal antibody. Ho wever the cytotoxic activities against K562 were not inhibited by anti-CD3 monoclonal antibody. These results indicate that the target cell recognition of CD3·LAK does not need MHC-restriction. CD3·LAK maybe concerned with two different types of target cell recognition which can either be through TCR/CD3 complex or none at all.

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In the present study we have investigated the effect of oxidative treatment on human natural killer (NK) and lymphokine-activated killer (LAK) cell activity. When peripheral blood lymphocytes (PBL) were treated with 1mM sodium periodate (PI) for 15min at 4°C, their NK activity against K562 myelogeneous leukemia cells and the generation of LAK activity against HTC/C3 thyroid cancer cells were significantly enhanced compared to non-treated controls. When the mechanism of the augmentative effect of PI was examined, both conjugate formation and cellular ATP levels of effector cells were significantly increased. Thus, PI-treatment enhanced the binding capacity and also activated the post-binding cytolytic functions of effector cells. Taken together, our results suggest that PI-treatment of effector cells might be a potentially useful strategy for the immunotherapy of head and neck cancers.

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We studied the antitumor effect of TNF and IFN-γ on a laryngeal tumor cell line (HEp-2) in vitro, and we analysed the influence of these cytokines on cell cycle using flow cytometory (FCM).
The in vitro study showed dose-dependent cytostatic activity of both TNF and IFN-γ on HEp-2. The combined use of the two cytokines resulted in additive in hibitory effect on HEp-2, while cell cycle analys showed the elevation of S phase of tumor cells. These results suggested S phase block in treatment with TNF and IFN-γ.

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We developed subrenal capsule assay (SRCA) which was evaluated by measuring the specific activity of succinate dehydrogenase (SD).
Effect of temperature and oxaloacetate which was a competitive inhibitor of SD to the specific activity of SD was measured and it showed that the specific activity of SD was measured correctly in this assay.
Comparison between SRCA and nude mouse assay was carried out with squamous cell carcinomas in head and neck region which were serially transplanted in nude mice. There was higher correlation between the method which was evaluated by measuring specific activity of SD (SSDI method) and nude mouse assay than that between the method which was evaluated by measuring the tumor size (TGIR method).
Futhermore, SRCA was carried out with 30 cases of malignant tumors in head and neck region which were resected in our department. SSDI method showed high evaluability rate (90%). In every patient, total positive rate by SSDI method was 42.9% and TGIR method was 21.4%. In every drug, total positive rate by SSDI method was 28.0% and by TGIR method was 12.8%. SSDI method showed higher positive response rate than TGIR method in PEP and CDDP. These positive response rate evaluated by SSDI method was closer to the clinical response rate of each anticancer agent for head and neck malignant tumors. Therefore, SSDI method could be a useful method to evaluate the chemsensitivity in SRCA.

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For the purpose of achieving individually effective chemothererapy against head and neck cancers, the chemosensitivity was determined by using the cellular ATP analysis. Nine tumors derived from surgical specimens of head and neck cancer, HTC/C3 cell line, thyroid benign tumor and KB cell line were examinedby ATP assay.
As a result, the evaluable rate of ATP assay was 88.9% (8/9). The positive evaluation of this assay was defined as more than 50% decrease of the cellularATP contents, compared with the non-treatment tumors. The positive rates of ATP assay were CDDP 55.6%, CBDCA 33.3%, 5-FU 25.0%, PEP 55.6%, ADM 50.0%, MMC 66.6%, ACR 100.0%, and Act-D 50.0%, respectively. Two patients, postoperative recurrent cases, were treated according to the results of ATP test. One was true positive and the other was true negative. Clinical corelation rate was 100% so far. As the number of cases is small in this investigation, continuous study should be performed.

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In the past various methods to measure the chemosensitivity of malignant neoplasm cells have been reported for the clinical use. However, to achieve successful chemotherapy, sensitive anticancer drugs should be selected for individual patients with cancer. In general, these methods required a long period of time and complex procedures to date. In our study, we applied an assay using crystal violet to test for anticancer drug sensitivity. In brief, after a short-term incubation in a microplate, surviving cells were fixed with methanol and stained with crystal violet. After washing out the dead cells, the remaining cells attached to the plastic plate were dissolved in ethanol and the intensity of absorbance was measured at 570nm by a spectrophotometer.
We investigated the relationship between the number of tumor cells and the intensity of absorbance and found that the intensity appeared to be in direct proportion to the number of surviving cells.
The reliability of the crystal violet assay was confirmed by the results of a ³H-thymidine uptake assay. Our study demonstrated that the crystal violet assay is a simple, rapid (48hrs) and reproducible method for the evaluation of anticancer drug sensitivity. Furthermore, it requires only a small amount of cells (5×10³-1×10⁴).

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The effects of cobination therapy with cisdichlorodiammineplatinum (II) (CDDP) and 5-fluorouracil (5-FU) on the mesopharyngeal squamous cell carcinoma cell line were examined by flow cytometric bromodeoxyuridine (BrdU)/DNA. analysis, in two cases either 5-FU or CDDP was given preceedingly. CDDP caused an accumulation of tumor cells in the G₂+M phase, but in case which 5-FU was given precedingly, a little difference was observed, comparing with non-treated control, 5-FU caused a large accumulation in the G₀/G₁ phase, and the accumulation kept on enlarging after the following treatment with CDDP. These findings suggest that the pre-treatment with 5-FU enforces the cytocidal effect CDDP that influences the cancer cells in the G₁ plase mainly.

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Twenty-three patients with head and neck tumor invading the skull base and/or intracranial space were reviewed in referring to the findings of MRI, CT and polytomography (PT). The invading patterns were briefly divided into two types; (1) destructing bony structures (16 cases) and (2) intruding through the foramina (7 cases). These changes were estimated by operation or follow-up studies. Even subtle bone destruction seen in type 1 or 2 was easily recognized by CT, especially on high resolution scanning. However, in both types, the tumor location and extent in relation to the nerves or vessels were precisely evaluated by MRI because of high contrast resolution in soft tissues. The other diagnostic benefits of MRI included the multi-direction imagings: axial, coronal and sagittal. The overall diagnostic sensitivity of MRI to intracranial invasion showed 91%, while that of CT and PT remained at 70%, Cranial nerve symptoms were described in 18 patients, whose referred lesions were all identified by MRI, but not necessarily by CT or PT. These symptoms should be signified in cases of foraminal or perineural invasion (type 2) esuecially in the early stage. We consider that MRI is the most promissing modality, if available, to assess the intracranial and/or skull base involvement. High resolution CT may be an important adjunct in evaluating bone destruction in question.

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The metastatic lymph nodes of the pharyngeal carcinoma were examined with ultrasonic tomography, and the following conclusions were obtained.
1. The metastases were more frequently detected in the upper and middle internal cervical profound lymph nodes. Also they were detected in the accessory nerve lymph nodes, in the cases with naso-and mesopharyngeal carcinoma.
2. According to the size of the metastatic lymph nodes, the vast majority of cases was as follows, respectively. In nasophaygeal carcinoma, 112 to 2499mm³, and in mesopharyngeal carcinoma, 112 to 2499mm³. However in the hypopharyngeal carcinoma, it was 1000 to 4999mm³, and had a tendency with larger size.
3. To estimate the pathological finding of the metastatic lymph nodes in the cases with the pharyngeal carcinoma, the findings with ultra-sound-tomography are useful. It is indispensable to understand the findings of the lymph nodes, in putting together their locations and sizes.

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It is difficult to diagnose the postoperative complications (especially recurrent tumor and infection) of patients who have undergone the surgery for the skull base tumor, because the lesion is located deep in the face and skull and the postoperative site is completely covered with the bone, soft tissue or transplanted materials. For this assessment, imaging modalities are most important.
In this article, 4 cases who had undergone the surgery for the skull base tumor and had complications of the recurrent tumor or infection were presented with long-term periodical assessment using several imaging modalities.
For detection of the recurrent tumor or other complications, gadolinium-DTPA (Gd)-enhanced MRI was most helpful. However, anatomical changes due to the surgery, transplanted material, postsurgical fibrosis make an accurate assessment of the recurrent tumor or other complications difficult. Therefore, periodical examinations using Gd-enhanced MRI is also important.

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A retrospective analysis of 65 patients with extracranial tumors of the head and neck was conducted on findings from computed tomography (CT), magnetic resonance imaging (MRI) and clinical records.
MRI was equal or superior to CT in all cases except five. MRI easily surpassed CT in its ability to differentiate subtle differences in soft tissue boundaries and tumor invasion in the head and neck. MRI also hasa number of advantages to the patients: no ionizing irradiation hazards and no need for any intravenous contrast. MRI can depict cross-sectional anatomy in orthgonal planes without requiring patient manipulation. The beem hardening artifacts are also not on CT images from dental amalgam. Replacing normal bone marrow with tissve of a high water content produced lower signeals on T1W images and higher signals on T₂W images. Since this signal pattern is most frequently seen with focal metastatic tumors, MRI may be helpful in detecting bone marrow invasion as well.
There are, however, some limitations in using MRI in the head and neck. Large tumors may inhibit imaging due to motion artifacts from repeated swallowing. MRI is inferior to CT in its representation of micro-calcifications in cases with thyroid cancer. Despite these drawbacks, however, MRI should serve as a premiere imaging modality for most head and neck disease because of its far greater soft tissue contrast potential.

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