As the aging society is advancing in Japan, the opportunity to treat oral squamous cell carcinoma in elderly patients is expected to increase. The aim of this study was to study the clinical features for patients over 75 years old with oral squamous cell carcinoma who underwent radical surgery. We performed radical surgery for 187 patients （86 males and 101 females） over 75 years old with oral squamous cell carcinoma who were treated in our department from 2005 to 2015. The most frequent site of the primary tumor was the gingiva （81 cases: 43.3％）, followed by the tongue （67 cases: 35.8％）. By classification of clinical stage, 61 cases were stage Ⅰ（32.6％）, 61 were stage Ⅱ（32.6％）, 28 were stageⅢ （15.0％）, and 37 were stage Ⅳa （19.8％）. One hundred and sixty-eight patients （88.8％） had systemic disease. We performed vascularized free flap transfer in 53 cases （28.3％）; the most used flap was the forearm flap （24 cases）, followed by the rectus abdominis flap （21 cases）. Total flap necrosis developed in one case with a rectus abdominis flap. The 5-year overall survival rate was 77.5％, and the 5-year disease-specific survival rate was 89.1％. In this study, we obtained good treatment outcomes by radical surgery. Considering that the possibility of postoperative complications and sequelae is small, we believe that radical surgery should be performed for elderly patients.

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As Japan enters the super-aging society, the number of patients with oral cancer is tending to increase in the late-elderly population over the age of 75. Accordingly, our hospital encounters more cases of late-elderly for whom aggressive therapy is indicated. However, to determine the appropriate therapeutic modality, many factors such as social status, tumor character, physical state, psychological state, and the will of the patient and/or family members should be considered. In the present study, we summarized the therapeutic modalities conducted in our hospital and analyzed the recent trends. Future prospects for treating late-elderly patients with oral cancer are discussed.

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Elderly patients have comorbidity, such as hypertension, diabetes mellitus, liver, kidney or lung dysfunction. The selection of treatment, including surgery, radiotherapy with or without chemotherapy, for elderly patient with oral cancer is made by a multidisciplinary team, which considers key factors such as the primary tumor site, disease extent, and individual patient factors including age, comorbidity and preferences regarding treatment type. Surgical treatment improves survival in oral cancer patients, but extended surgery for locally advanced oral cancer patients causes severe oral dysfunction including swallowing and speech difficulties, which affects the patient’s quality of life. Curative nonsurgical treatments including definitive radiotherapy or concurrent chemoradiotherpy are sometimes selected for elderly patients with locally advanced oral cancer due to comorbidities or age. Elderly patients with oral cancer have a tendency to have acute adverse events during treatment compared with younger patients.
This review was conducted to evaluate the clinical outcomes of radiotherapy and daily concurrent retrograde superselective intra-arterial chemotherapy for elderly patients with oral cancer.

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CyberKnife （CK） treatment for elderly patients with oral cancer （75 or older） was analyzed. The subjects were 26 patients （10 males and 16 females; age range 75-98, median 84）, who were followed up for more than one year. The range of tumor volume was 3.5-223.3ml （median 47.4ml）, which were treated with 21.0-35.0 Gy by 3-7 fractions. Median overall survival and progression-free survival after CK treatment were 24 months and 12 months, respectively. CK treatment appears to be feasible for elderly patients with oral cancer.

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Elderly patients with head and neck cancer are increasing in Japan. Although the indications for chemotherapy are judged by doctors, it is a remarkably difficult decision to make. There are many problems, such as the pros and cons of classification of chronological age, geriatric syndrome, and specific physical features, and the decision is made based on age, performance status, experience and so on. Recently, some tools for pre-treatment evaluation for one of the criteria for selecting chemotherapy have been developed.
The value of chemotherapy has been proven through many clinical trials but its effect on the survival of elderly patients is not clear because these trials have had a low percentage of elderly patients or an upper limit on age. There are no data in sub-group analysis suggesting the effectiveness of chemotherapy for older patients. The purpose of therapy is not always prolonging survival: relief of symptoms and maintenance of QOL are just as important. If the objective is clear and whether a drug therapy is safe and effective can be determined, then the therapy may prove useful.
New clinical trials for elderly patients are ongoing, especially for major cancers such as lung cancer, colon cancer and breast cancer. However, there are still very few trials for head and neck cancer, which is a challenge that needs to be solved. We should pay attention to not only head and neck cancer trials, but also other cancers.

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The number of elderly patients with oral cancer is increasing. Oral oncologists are concerned about their treatment and management because the patients often compromised with physical, biological, psychological, and sociological problems. Previously, we retrospectively analyzed healthy life expectancy （self-reliance survival times）, which is a summary measure of population health that takes into account the mortality and morbidity, of oral squamous cell carcinoma （OSCC） patients. The results suggested that most patients with early-stage cancer underwent curative treatments and showed a good health expectancy as well as overall survival. On the other hand, in patients with advanced cancer, health expectancy was good if radical treatments were performed in patients aged 75-79 years. From the results of these studies, it is suggested that, in the treatment of elderly patients, healthy life expectancy may be a useful measure of treatment outcome and that comprehensive geriatric assessment is necessary in deciding the treatment and management strategy. It is also suggested that there is an immediate need to develop a treatment protocol for “vulnerable” or “passive” patients who do not or will not undergo radical treatment of their oral cancer.

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The purpose of this study was to investigate the feasibility of postoperative concomitant chemoradiotherapy （CRT） with cisplatin （CDDP）, and to compare the prognosis in three groups: without postoperative therapy （S-only）, with radiotherapy （RT） alone （S＋RT）, and with CRT （S＋CRT）, in oral squamous cell carcinoma （OSCC） patients at high risk of recurrence （Extranodal Extension （ENE） （n＝116））.
There were 39 patients （84.8%） in the S＋CRT group who were administered a cumulative cisplatin dose of more than 200mg/㎡ The 3-year cumulative LRC rates for the S-only, S＋RT, and S＋CRT groups were 35.4%, 53.6%, and 68.9%, respectively. The 3-year cumulative OS rates for the S-only, S＋RT, and S＋CRT groups were 25.1%, 59.2%, and 43.8%, respectively. These results suggest that the addition of concomitant cisplatin to postoperative RT improved LRC in OSCC patients. There may be no benefit from the addition of concomitant CDDP to postoperative RT for DM and OS rates in OSCC patients.
We discuss the indication of surgery, the selection of neck dissection, and postoperative chemoradiotherapy in view of lymph node metastasis.

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We conducted a clinical study on malignant tumors other than squamous cell carcinomas developing from the oral and maxillofacial region. We examined a total of 93 patients who visited our hospital for treatment over a 10-year period （2006-2015）, and who had been diagnosed with salivary gland cancer （81 patients）, osteosarcoma （four patients）, soft tissue sarcoma （four patients）, and/or primary mucosal malignant melanoma （four patients）. This patient cohort comprised 5.3％ of the 1,753 patients who visited our hospital for treatment of malignant tumors during this period, apart from 68 patients who were diagnosed with malignant lymphoma. In cases of salivary gland cancers, the accurate assignment of safety margins, with respect to the observed histologic malignancy, is important; the disease-specific 10-year cumulative survival rate of patients who underwent pathological stump resections decreased to 69.1％. In cases of bone and soft tissue tumors, administration of pre – and postoperative chemotherapy, and resection using wider margins decreased mortality rates （except for one patient）, and improved favorable results. In patients with primary mucosal malignant melanomas, it was necessary to perform an extensive resection and neck dissection within the appropriate range and administer postoperative adjuvant chemotherapy. One patient experienced tumor-bearing survival without death due to the disease, and follow-up was continued for six years postoperatively. Patient survival time is expected to improve further through the application of immunotherapy, which has rapidly progressed in recent years. The disease-specific 5-year and 10-year cumulative overall survival rates of the 93 patients were 93.7％ and 81.4％, respectively. In patients with tumors of specialized tissue types, favorable resection results can be obtained by using the appropriate resection range and relevant adjuvant therapy.

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Several factors are crucial in the selection of surgical treatment for oral cancer. These include the patient’s age and healthy life expectancy, general medical condition, tolerance of treatment, patient acceptance of surgery and socioeconomic considerations. In general, older age is not a primary consideration for surgical risk. However, advancement of intercurrent disease and aggravation of general medical condition increase the risk of complications after extensive surgical treatment. In the present study, we analyzed risk factors related to complications after radical surgery for oral cancer. A total of 196 patients underwent radical surgery for oral cancer in our hospital from 2011 to 2015. We excluded 83 patients with primary tumor resection alone and analyzed the remaining 113 patients who underwent neck dissection. Data on these patients were retrospectively collected and the incidence of complications within 30 days after surgery was assessed. We defined postoperative complications according to the Clavien-Dindo classification. Prognostic factors associated with major complications were analyzed by Fisher exact tests and logistic regression analysis. Most of the complications were surgical site infection. Multivariate analysis identified ASA （≥ 3） and NLR （≥ 3.00） as significant risk factors for the development of postoperative complications. Further study is needed to explore alternative perioperative managements to decrease postoperative complications in patients with oral cancer.

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Acute respiratory distress syndrome （ARDS） is the most serious type of respiratory failure, carrying a high mortality rate. We report a case of ARDS occurring postoperatively in a 76-year-old man treated for oral cancer. The patient underwent radical surgery for buccal mucosal cancer. Fibular flap necrosis ensued postoperatively, the site became infected, and ARDS developed. Diffuse bilateral alveolar infiltration was seen on chest radiography. The PaO2/FiO2 ratio fell to 99.1mmHg, even with an oxygen flow of 8l/min delivered by tracheal cannula. He underwent treatment with a ventilator, surgical debridement, and pharmacotherapy. Lung oxygenation raised the PaO2/FiO2 ratio to 203mmHg, and he was weaned from NIPPV 10 days after the onset of symptoms.

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Superior mesenteric artery occlusion （SMAO） is associated with a poor prognosis as it rapidly progresses to intestinal ischemia and necrosis. The clinical manifestations of SMAO have no specific symptoms during the early phase of the disease and diagnosis is difficult. We describe a case of SMAO in a patient with cancer of the oral floor.
A 73-year-old woman who had been treated with warfarin for atrial fibrillation presented with a chief complaint of intractable ulcer of the oral floor, which we diagnosed as squamous cell carcinoma. Antithrombotic therapy was provided with a heparin bridge for the perioperative period, and the patient underwent resection of the cancer of the oral floor. Two days later, the patient complained of a stomachache. Computed tomography findings revealed SMAO three hours after the stomachache worsened. The patient was treated by interventional radiology （IVR）, thrombus aspiration and urokinase. These measures consequently reduced the stomachache within three hours and restored blood flow.
Elderly persons with heart disorders who develop acute abdominal pain are at high risk of SMAO, and it is important to recognize this. The present findings indicated that contrast-enhanced CT, IVR and D-dimer monitoring can be useful for an early diagnosis of SMAO.

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Plasmablastic lymphoma （PBL） is an aggressive non-Hodgkin lymphoma commonly associated with HIV infection. We present here a case of AIDS-related PBL of the maxillary gingiva with a review of the literature. A 61-year-old Japanese man was referred due to gingival swelling around the left maxillary second molar. The lesion was diagnosed as PBL by histological and immunohistochemical analyses of the biopsy specimen. Blood examination revealed that HIV antigen and antibody were positive and HIV-1 quantitative RT-PCR score and CD4 positive cell count were 51,000 copies/ml and 105 cells/μl, respectively. After antiretroviral therapy was started by a hemato-oncologist, the maxillary gingival mass rapidly disappeared without receiving chemotherapy for PBL. Two years after the start of antiretroviral therapy, HIV infection is controlled and there is no recurrence of PBL.

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