Multidisciplinary skull base surgery should be set up for multiple operative fields that include the head, face, neck, body, and extremities. The patient is usually placed in a head-up position by 15 to 30 degrees, to reduce intracranial pressure and venous bleeding. The head is positioned in order to perform cranial, face, and neck procedures, and fixed in a frame for microneurosurgery.
The skin is incised preserving the galea, the periosteum, or temporal muscle. The superficial temporal artery is important for anastomosis with the middle cerebral artery to overcome brain ischemia. A craniotomy should be just adequate in size. A low-positioned craniotomy helps to reduce brain retraction, and a high-positioned craniotomy may produce excess brain retraction. Dura is separated from the inner surface of the skull before making a craniotomy. Dural sinuses must be carefully separated when making a craniotomy beyond the dural sinuses.
During intradural procedures, the brain must be protected with cottonoids and be kept wet. Brain retraction should be gentle and intermittent. Cortical surface veins or bridging veins should be preserved. Damage of veins without collateral flow induces venous infarction and hemorrhaging.
After resection of the tumor, the dura is closed in a watertight fashion. The dural defect is patched with a fascial graft. To eliminate the extradural dead space, the dura is meticulously sutured to the bony edges. The skull base defect is covered with either a galeal flap or a free musculocutaneous flap.
In 12 years, we performed 108 multidisciplinary surgeries in our institute. In multidisciplinary surgery, a preoperative conference is most important. We have a monthly conference. In the conference, we decide the extent of resection, the patient's position, skin incision, surgical procedures, reconstruction method, estimated surgical time, and required instruments.

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The complete removal of tumors involving the anterior skull base has been a very challenging problem due to the severe complications. Recent advances in the technique of craniofacial resection and reconstruction have provided more predictable, functional, and aesthetic results for this challenging surgery, with much lower morbidity rates. Now, anterior skull base surgery is well established and is routinely practiced in neurosurgical and otolrayngological centers in the world. However, postoperative complications remain the most serious issue in craniofacial surgery. Although there has been a trend toward fewer complications, the sequelae are still devastating. In this paper, we described our surgical technique of anterior skull base surgery, which has been performed at University of Tokyo Hospital. The principles of the operation, preoperative preparation, operative technique, after-care and postoperative complications were discussed.

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Subtotal temporal bone resection is employed for malignant tumors of the temporal bone in our department. Cancer extending into the middle ear is an indication for subtotal temporal bone resection. However, palliative or conservative therapy is preferable for poor-prognosis cases. These include tumors extending to the pyramidal apex along the internal carotid artery, dural invasion, or with metastasis. The extent of tumor is determined by both CT and MRI images. Surrounding tissue must be contained to a resected specimen. Transmastoid resection starts from the posterior portion of mastoid cells and goes toward the vestibule, internal auditory canal, cochlea, jugular bulb, and the internal carotid canal. After a middle craniotomy, bone resection from the upper is performed, with care regarding great vessels. Soft tissues around the mandibular joint and jugular foramen, where massive hemorrhaging can occur, are treated at the end of the procedure, under clear vision.

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Surgical procedure of Median labiomandibular glossotomy for en-bloc resection of nasopharyngeal carcinoma is described.
The lower lip is split in the midline and the incision is then carried vertically downward across the chin. The mandible is divided, after holes have been drilled in each bone end, to put in the titanium plate after the resection is completed. Then the whole tongue and floor of the mouth are split down the midline to the level of the hyoid bone. The two halves of the mandible and tongue are spread apart, giving excellent exposure of the nasopharynx and posterior wall of the oropharynx. After removal of the tumor, the whole defect is reconstructed by a radial forearm flap, to protect the carotid artery.
Median labiomandibular glossotomy is a unique approach to expose the nasopharynx, where obtaining wide surgical access is difficult. The advantages of this approach are minimal bleeding, avoidance of nerve injury, and excellent functional and cosmetic results.

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Conservative neck dissection is now considered to be a modified radical neck dissection (MRND). The MRND preserves one or more non-lymphatic structures routinely removed in a radical neck dissection. All of the lymph node groups (level I-V) are comprehensively removed. Preservation of the internal jugular vein, spinal accessory nerve, and sternocleidomastoid muscle improves the cosmetic result and usually maintains function.
When selecting a MRND as treatment, we must be very careful to adhere strictly to proper indications. The MRND type I, in which the spinal accessory nerve is preserved, is indicated in patients without fixed nodes in level II and V nodes; the MRND type II, in which the spinal accessory nerve and internal jugular vein are preserved, is indicated in patients without adhesive nodes in levels II, III, IV, and V; and the MRND type III, in which the spinal accessory nerve, internal jugular vein, and sternocleidomastoid muscle are preserved, is indicated in patients with high malignancy and only level I disease.
Between 1991 and 2000, 259 patients with oral squamous cell carcinoma, whose primary lesion had been controlled, underwent various types of neck dissections. A MRND was performed on 159 sides of the neck (MRND type I, 117 sides; MRND type II, 38 sides; MRND type III, 4 sides). The recurrence rate in the neck with MRND type I was 3.4%, with MRND type II it was 5.3%, and with MRND type III it was 0%.
A MRND requires careful selection of patients, additional operative time, and skill. Although preservation of those anatomical structures does not necessarily guarantee complete preservation of function, the benefits of the MRND make it a reasonable treatment choice when possible.
In this paper, the surgical technique for the MRND type III is described in detail.

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Supraomohyoid neck dissection (SOHND) is a partial (regional) neck dissection that removes the contents of the submental, submandibular, and upper-mid internal jugular region (level I, II, III), where lymph node metastasis is most likely to develop in patients with oral cancer. As the sternocleidomastoid muscle, the internal jugular vein, and the spinal accessory nerve are preserved in a limited surgical field, great skill is required of both the operator and assistant. This type of neck dissection is generally performed in N0 cases, as prophylaxis, while it may be indicated in a patient with single-node metastasis in the submandibular triangle. Metastasis to the node in upper-mid internal jugular region, extra-nodal spread, and multiple metastases are contraindications.
In this paper, we describe the surgical technique to perform SOHND as a radical en bloc operation, and discuss the indication for oral cancer.

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For cases of head and neck carcinoma with lymph node metastasis invading a unilateral common carotid artery, it is possible to reconstruct the circulation to the brain, by performing a contralateral external carotid-external carotid artery bypass, if the distal portion from the carotid bifurcation can be preserved. This operation can also be indicated for common carotid artery rupture during radical neck dissection, in which urgent vascular reconstruction is inevitable.
The operative method consists of directly anastomosing the right and left main trunks of the external carotid artery to each other on the middle of the neck. It can only be carried out combined with a total laryngectomy, because of the limitation of blood vessel length. Disirably, that the external carotid arteries should be long. After the anastomosis is completed, the common carotid artery is resected at the proximal portion of the carotid artery bifurcation. Blood flows from the external carotid artery of the non-affected side to the distal portion of the external carotid artery of the affected side, and regurgitates into the internal carotid artery via the bifurcation. We performed this operation in a 55-year-old male with rupture of the common carotid artery during radical neck dissection. Good postoperative bypass flow, and no neurological complications, were confirmed in this case.

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We reinvestigated the conventional surgical resection for advanced tongue carcinoma, and studied on the suitable surgical method based on the effectiveness of our preoperative therapy and the possibility of organ/function preservation. Forty-three patients with advanced but potentially resectable squamous cell carcinoma of the tongue were included in this study. All of the patients were treated with preoperative concurrent chemoradiotherapy followed by conventional surgical resection.
Concerning the relationship between histological effects and the regression rate to preoperative therapy, a regression rate of 85% and above was needed to obtain a histological effect of Grade II b and above, according to the grading system of Shimosato. In the investigation of residual tumors, both the horizontal and vertical residual rates were low, and cancer cells tended to be limited to the superficial layer of the central area of the primary tumor, in patients who showed a regression rate of 85% and above.
These findings suggest that in such patients, less invasive surgery should be considered to be applicable even in advanced cases, and this policy will produce oral organ/function preservation after surgery.

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We treated 148 patients with primary oropharyngeal cancer from 1990 to 1999. Eighty-five of these cases received surgery and preoperative irradiation, 43 patients had carcinoma of the lateral wall, 11 of the superior wall, 26 of the anterior wall, and 5 of the posterior wall. The local control rate of 85 patients received surgery was 75.3% (the anterior wall, 61.5%; the lateral wall, 88.4%; the superior wall, 72.7%; the posterior wall, 40%). Speech and swallowing function after oropharyngeal resection with free flap reconstruction was examined, using the blowing ratio and water-swallowing test. Patients who had a surgical defect of one-half of the soft palate combined the lateral wall or two-thirds of the tongue base, kept their speech and swallowing function satisfactorily. In advanced cases resected the posterior wall and the tongue base widely, one word speech and swallowing function was very poor, and some cases were performed with total laryngectomy.

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A total of 123 patients with oropharyngeal cancer, who were treated with definitive radiotherapy at National Sapporo Hospital from 1980 to 1999, were reviewed retrospectively. Sixty-four patients out of 123 (52%) were treated with radiotherapy alone, and brachytherapy was added to 37 of these, as a supplement. Thirty-three patients (27%) received chemoradiotherapy. CDDP was selected as a chemotherapeutic agent for 82% of these 33 cases. Twenty-six patients (21%) received preoperative radiotherapy. Second primary cancers were experienced in 36.5% of all cases.
The five-year accumulated survival rate and cause-specific survival (CSS) rate were 47% and 65%, respectively, and the five-year CSS rates by stage were stage 1, 100%; stage 2, 85%; stage 3, 63%, and stage 4, 53%.
For patients with advanced disease that receeved CDDP-based chemoradiotherapy, the five-year CSS rate was 70%.

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To improve the results of radiotherapy for laryngeal cancers, (1) altered fractionation schedules, such as hyperfractionation or accelerated hyperfractionation, and (2) combined chemotherapy, have recently been used.
In our institution, a hyperfractionated and accelerated radiotherapy without a split was performed, to improve the local control probability for early glottic carcinomas. The accelerated fractionation program (AF) consisted of 1.72Gy per fraction, two fractions per day, 5 days a week, for a total of 55 or 58Gy. The conventional fractionation program (CF) consisted of five daily fractions of 2Gy per week, for a total of 64Gy. The 5-year local control probability for T1 tumors was 80% with CF treatment, whereas with AF it was 87%. For T2 tumors it was 63% with CF, whereas it was 75% with AF.
According to combined chemotherapy, concomitant chemoradiotherapy is recently used, and increased preservation rates of the larynx have been reported.
Good communication and thorough discussion between otolaryngologists and radiation oncologists are important to select the appropriate modality of treatments and improve preservation of the natural voice.

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Mutations in p53, tumor suppressor gene, have recently been shown to have an impact on the clinical course of several human tumors, including head and neck cancers. The genetic status of the p53 gene has been focused on as the most important candidate among various cancer-related genes for prognosis-predictive assays of cancer therapy. We examined the restoration of radiation-or cisplatin (CDDP)-induced p53-dependent apoptosis in human lingual cancer cells. The results suggest that glycerol is effective in inducing a conformational change of p53 and restoring normal function of mutant p53, leading to enhanced radiosensitivity or chemosensitivity through the induction of apoptosis. We have also represented the same results in vivo as in vitro. Thus, this novel tool for enhancement of radiosensitivity or chemosensitivity in cancer cells bearing m p53 may be applicable for p53-targeted cancer therapy.

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Dysplasia and squamous cell carcinoma exhibited higher G-CSFR expression than normal and hyperplastic epithelium. There was a significant association between G-CSFR expression on cancer cells and a poor prognosis in patients with oral and oropharyngeal squamous cell carcinoma (SCC), suggesting that the expression of G-CSFR in oral and oropharyngeal SCC may be a independent prognostic factor. Reconbinant G-CSF (rG-CSF) enhanced the invasive potentiality of head and neck cell lines. The binding of rG-CSF to G-CFSR induced phosphrylation of JAK and enhancedtype IV collagenase activity. The experiment of in vitro G-CSFR gene transfection also showed that rG-CSF significantly augmented their invasive potential in cancer cells. It was sugested that rG-CSF may activate p38 MAP kinase and increse nulear trascriptional factor in cancer cells, by DNA microarray analysis. No unusual isoforms were found in head and neck cancer cel lines. Dominant negative transfection using mutated G-CSFR decresed the enhancement of MT-MMP expression induced by G-CSF.

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We examined the significance of TLR4 gene expression in anti-tumor immunity induced by OK-432 and OK-PSA that is the major effective molecule of OK-432. The results of the current study indicated that cytokine production and anti-cancer effects of OK-PSA are mediated by TLR4, and that IFN-γ induction in oral cancer patients given OK-432 peritumorally was correlated with expression of TLR4 and MD2, a co-factor for TLR4 signaling. In addition, Taxol and Taxotere, anti-cancer agents, activated NFκB, a transcription factor, mediated by TLR4 and MD2. These findings strongly suggest that TLR4/MD2 signaling is involved in anti-cancer immunity induced by bacteria-derived immunotherapeutic agents, and that some chemotherapeutic agents may activate NFκB mediated by TLR4/MD2 signaling.

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MMP-2 plays a crucial role in invasion and metastasis of malignant tumors. MT1-MMP was originally identified as an activator of MMP-2. TIMP-2 was identified as an inhibitor of MMP-2 and MT1-MMP. However, TIMP-2 was reported to be essential for cell-mediated activation of MMP-2, and thus the contribution of TIMP-2 to tumor invasion has remained controversial. This study was designed to analyze the role of TIMP-2 for activation of MMP-2, and its prognostic value in tongue SCC. Expression of MMP-2, MT1-MMP, and TIMP-2 was significantly correlated with local and distant metastasic tumor recurrence and poor prognosis. Activation of MMP-2 was remarkably associated with expression of MMP-2, MT1-MMP, and TIMP-2. Increased expression of TIMP-2, as well as MMP-2 and MT1-MMP, was an important prognostic factor in patients with tongue SCC.
Administration of Marimastat (150mg/kg/day), an MMP inhibitor, inhibited lymphatic metastasis of OSC-19 tongue cancer cells in a nude mice model. These results suggest that Marimastat may be useful for improving the prognosis in tongue cancer patients.

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Between 1994 and 2000, 28 patients with T3/T4 squamus cell carcinoma of the maxillary region (maxillary sinus, 22; maxillary gingiva, 4; maxillary bone, 1; buccal mucosa, 1) had accelerated hyperfractionated radiotherapy combined with simultaneous CBDCA chemotherapy preoperatively, at Chiba Cancer Center Hospital.
The protocol consisted of combined therapy with accelerated hyperfractionated irradiation of 1.6Gy, twice a day, to a total dose of 32.0-51.2Gy and concurrent intra-arterial or intravenous infusion of CBDCA 20-30mg/body/day for a cumulative total dose of 270-480mg. After completion of the preoperative combined therapy, the clinical CR rate was 17.9%, and the good PR·CR rate was 32.1%.
According to the initial findings and response to the combined therapy, all patients had maxillectomy (subtotal, 3; total, 16; extended, 9) 4 weeks after completion of the preoperative combined therapy. Postoperatively, the complete pathologic response (Ohboshi and Shimozato's classification, grade III and IV) rate was 28.6%. And the actuarial local control rate was 85.7%, with a mean follow-up of 46.2 months.
Based on these results, we believe this preoperative therapy with CBDCA chemotherapy and accelerated hyperfractionated radiation is a significant choice as treatment for squamous cell cancer of the maxillary region.

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Postoperative swallowing and articulatory functions were investigated by intraluminal manometry, and the 100 Japanese monosyllable speech intelligibility test, in patients who had undergone surgical resection for oral and oropharyngeal cancer. Swallowing pressure at the soft palate region showed a mild decrease following hard palate resection, but it returned to normal with wearing of an obturator prosthesis. Resection of the oropharyngeal lateral wall resulted in lower pressure than normal at the soft palate and oropharynx. In patients with tongue cancer who had received hemiglossectomy and subtotal glossectomy, the swallowing pressure generally appeared normal in an early period after surgery. However, it showed a decrease with the postoperative atrophic change of the reconstructed tongue. Simultaneous elevation of pressures in the oropharynx and hypopharynx was observed. Also, multiple small movements of the tongue were identified prior to the pharyngeal swallowing reflex. These anomalous findings tended to fade away during follow-up months. Postoperative articulatory function was severely deteriorated following hard palate resection, with favorable improvement by the use of a prosthesis. Velars sound was mildly confused in patients with a resection of the lateral wall of the oropharynx. Hemiglossectomy caused slight worsening of the articulation, whereas subtotal glossectomy resulted in marked impairment of it in all sounds, except for glottal sound.

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The prognosis was evaluated in 41 patients who had undergone immediate reconstruction with a free flap for maxillary defects, at the National Cancer Center Hospital and the National Cancer Center Hospital East. Tumors were classified as T3 in 3 cases, and T4 in 13 cases, and 25 cases had recurred after initial treatment. The mean follow-up period was 26.8 months. Local recurrence was recognized in 30 patients, at from 1 to 36 months (mean, 5.2 months) after reconstruction. Twenty-five patients died due to recurrent tumor, 2 patients died due to other disease, five patients were surviving with recurrent tumor, and 9 patients were surviving disease-free. Our results indicate that the prognosis of patients with large maxillary defects, which require immediate reconstruction, is poor. Therefore, comparison with complicated reconstruction, which requires several flaps, prolonged operative time, and repositioning, simple reconstruction such as those that use the single flap and titanium mesh, is concerned and appropriate. For edentulous patients, it is very difficult to wear a denture if the palatal defect is completely closed. To resolve this problem, we developed a slit-type maxillary reconstruction to treat eight edentulous patients who underwent total or extended maxillectomy. Both the medial side of the nasal cavity and palatal defects were reconstructed by a single cutaneous portion of the free flap. In this procedure, a small nasal fistula (slit) was left at the medial site of the palate. Postoperatively, the maxillary prosthesis, with a process that was inserted into the reconstructed nasal fistula, was fabricated by the dental division. In seven of the eight patients, the postoperative speech, mastication, and deglutition ability was evaluated. Satisfactory functional results were obtained in all seven patients. Although long-term follow-up is necessary to confirm the stability of the maxillary prosthesis, this reconstructive method is simple and useful for edentulous patients after maxillectomy.

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When a palatal defect after maxillary cancer ablative surgery is closed by a soft tissue free flap only, we assume that it will be difficult to wear a denture, because gravity causes the palatal flap to sag. On the other hand, we recognize that a reconstructed palate prevents liquid from flowing into the nasal cavity and also relieves the mental stress that comes with using a huge dental prosthesis.
In ten patients who underwent maxillary cancer ablative surgery, a conventional soft tissue free flap with a three-dimensional titanium mesh plate, was transferred to close the palatal defect and prevent the transferred free flap from sagging. In another eight patients, an alveolar bone reconstruction and palatal defect closure was performed using a fibula osteocutaneous free flap with or without osseointegrated implants. With the former method, four of ten cases (40%) were able to wear a dental prosthesis, and with the latter method, four of eight cases (50%) were able to. These results were better than those of a soft tissue free flap transfer only (16.7%).
The soft tissue free flap with a three-dimensional titanium mesh plate is thought to be a useful procedure for enabling patients to wear a denture. The fibula osteocutaneous flap is also thought to be a useful alternative as a procedure that results in excellent masticatory function.

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Resection of a cancer lesion causes serious impairment of articulation, mastication, and swallowing. However, treatment of these functional disturbances and satisfactory restoration of oral functions have become possible by recent improvement in reconstructive surgery, and its combination with techniques of maxillofacial prosthetics.
In maxillary defects, as the masticatory mucosae of the hard palate and gingiva are not mobile, so that functional replacement by tissue grafting is impossible, it is most appropriate for the defects to be repaired using a maxillary prosthesis. If defects extend to soft tissues, such as the soft palate, reconstructive surgery must be considered. In our department, between 1978 and 1999, 209 patients were treated with a maxillofacial prosthesis and or reconstructive surgery.
Results: In the cases with only a hard palate defect with replaced maxillofacial prothesis, they were almost satisfactorily recovered, however, in the cases with the defect extended to the soft palate, even if it is reconstructed with free flap and replaced maxillofacial prothesis, the cases could not keep soft palate continuosly, and serious impairment of swallowing remained.

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Maxillofacial prosthetics is well known to have great ability to functionally rehabilitate the postoperative defect in the maxillo-palatal and soft palate area. We experienced 484 cases of such defects in the last 19.5 years. According to the ratio of defect area to its entire region of the hard palate-alveolar area, 1/6 defect was 67 cases, 2/6 96, 3/6 233, 4/6 59, 6/6 10 cases. Those in soft palate was 1/4 118 cases, 2/4 23, 3/4 10, 4/4 18 cases.
For most of these cases, we started prosthetic work within 1 postoperative week in 3 cases, within 2 weeks in 63 cases, 3 weeks in 155 cases comprising 43% of all cases. The time to fabricate them was 2 days in 238 cases, and 3 days in 73 cases comprising 86% of all cases.
These prosthesis are always used and recognizd useful by patients themselves subscribing its ability to ameliorate the crippling.
From these experiences, we are confident that one of the best ways to rehabilitate immediate postoperative functional disturbance in the maxillo-alveolar area is prosthetic work, occasionally followed by reconstructive surgery and or installing dental implants. As for the defect in the soft palate area, the prosthetics can dedicate patients as the first choise.

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Metastasis to cervical lymph nodes is frequently seen in malignancies of the head and neck. Computed tomography is now widely used for diagnosis and staging. To evaluate cervical lymph nodes, knowledge of the lymphatic pathway from the primary tumor is important. Various diagnostic criteria of metastatic lymph nodes on CT have been reported; however, central lucency, and the ratio of longitudinal and axial diameters, are useful characteristics. Recently developed helical or multidetector-row CT technology has made higher spacial resolution possible. Images produced by volume rendering and maximum intensity projection techniques are useful for localization of lymph nodes and measuring the long and short axis of lymph nodes.

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The extracapsular spread (ECS) in lymph node metastasis from head and neck cancer is a very important prognostic factor.
However, diagnostic imagings of ECS in lymph node metastasis are rarely mentioned.
We examined the characteristic findings of ECS in lymph node metastasis, using MRI. We studied 96 lymph nodes in 46 patients proven to have metastasis histopathlogically. Fifty-one lymph nodes out of 96 were proven to be ECS histopathlogically, and 45 other lymph nodes were non-ECS metastasis. We evaluated maximal longitudinal nodal length, the incidence of perinodal high intensity area (PNHIA) on STIR sequence and central necrosis with every ECS group and non ECS group. There were statistically significant differences between the ECS group and the non-ECS group in maximal longitudinal nodal length. It was suggested that maximal longitudinal nodal length may be a criterion of ECS. As the calculated maximum standard of non-ECS was 31.1mm, we felt that this size may serve as a criterion of ECS.
ECS smaller than our criteria was often found, histologically, in fact. Therefore, we proposed the importance of the PNHIA on STIR sequence. The incidence of this finding in the ECS group was higher than in the non-ECS group, with statistically significant differences. We felt that the presence of PNHIA on the STIR sequence may be a criterion of ECS. The incidence of central necrosis in the ECS group was higher than in the non-ECS group, with statistically significant differences. But, the incidence of this finding in the non-ECS group was also relatively high. It was suggested that this findings is not important criteria.

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In patients with cancer of the head and neck in whom no definite findings of cervical lymph node metastasis were obtained by diagnostic ultrasonography, the necessity for prophylactic treatment in the neck was evaluated. During the past nine-year period, cervical metastasis has been examined by ultrasonography in our department. In principle, we have not performed prophylactic treatment in bilateral neck areas in patients with N0 diagnosed by ultrasonography, or in the neck area on the side without metastasis in patients with unilateral cervical metastasis. The clinical course and outcome were evaluated in detail in patients with laryngeal cancer, tongue and/or oral floor cancer, and hypopharyngeal cancer. No patient died due to poor control of lymph node metastasis in the neck not prophylactically treated. In the patients with tongue cancer and hypopharyngeal cancer, late cervical lymph node metastasis developed. However, patients who developed lymph node metastasis only in the neck could be cured by diagnosing recurrence early by ultrasonography. These results suggest that prophylactic treatment in necks without definite metastasis is not always necessary if there is close observation of the course.

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The purpose of this study was to evaluate the usefulness of power Doppler ultrasonography (PD-US) for detecting cervical lymph node metastasis.
Materials and Methods: PD-US and B mode ultrasonography images (B-US) of 126 metastatic lymph nodes, and 249 benign nodes, in 79 patients with oral squamous cell carcinoma, were evaluated, retrospectively.
Sensitivity and specificity on B-US-alone reading were compared with those on combined B-US and PD-US reading.
Results: As the short-axis diameter of lymph nodes increased, the sensitivity of B-US-alone reading, and B mode US and PD-US combined reading, increased, together. In lymph nodes with a short-axis diameter of 5 to 7mm, the sensitivity for B-US-alone reading was 54.2%, and that of B-US and PD-US combined reading was 79.2%. The difference in sensitivity was significant. In lymph nodes with a short-axis diameter of 8mm and more, the sensitivity for B-US-alone reading was 83.3%, and that of B-US and PD-US combined reading was 95.3%. The difference in sensitivity was also significant. On the other hand, no differences in specificity were significant for any lymph node size.
Conclusion: Our results suggest that PD-US improves the detection of cervical lymph node metastasis.

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One aim of radiotherapy for hypopharyngeal cancer is to expand the indication for radical radiotherapy, and to verify the role of preoperative treatment for laryngeal preservation. Through several articles on clinical results of radiotherapy for hypopharyngeal cancer, a consensus was obtained that T1-T2 hypopharyngeal cancer could be controlled with radical radiotherapy. Based on the good results of T1-T2, patients with T1-T2 primary tumor and neck nodal metastasis are treated with neck dissection and following radiotherapy.
Because results of preoperative radiotherapy were much worse than postoperative radiotherapy, the latter is preferred for the combined therapy. To avoid surgery and preserve organ functions, preoperative chemoradiotherapy and induction chemotherapy were tried, and they achieved substantial clinical results.

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