Journal of Japanese Society of Oral Oncology
Online ISSN : 1884-4995
Print ISSN : 0915-5988
ISSN-L : 0915-5988
Volume 32, Issue 4
Displaying 1-18 of 18 articles from this issue
The 38th Annual Meeting of Japanese Society of Oral Oncology
Symposium 1: Current and future prospects of precision medicine
  • Narikazu UZAWA, Yoshitaka HONMA
    2020 Volume 32 Issue 4 Pages 129
    Published: 2020
    Released on J-STAGE: December 22, 2020
    JOURNAL FREE ACCESS
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  • Yoshitaka Honma
    2020 Volume 32 Issue 4 Pages 130-133
    Published: 2020
    Released on J-STAGE: December 22, 2020
    JOURNAL FREE ACCESS
    Head and neck cancer is a general term for tumors that have multiple origins and various histological types. The chemotherapy regimen varies depending on the histological type, and a different treatment strategy is sometimes required by site of occurrence even if the histological type is the same. This paper discusses the transition and future perspective of treatment development for various head and neck cancers, including the utility and problems of comprehensive gene analysis.
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  • Kazufumi Honda
    2020 Volume 32 Issue 4 Pages 134-143
    Published: 2020
    Released on J-STAGE: December 22, 2020
    JOURNAL FREE ACCESS
    Adjuvant chemotherapy is performed with the aim of preventing late metastasis; however, if the primary tumor is completely resected initially, the development of late metastases most likely depends on the characteristic metastatic activity of the tumor. In other words, it may be that the best strategies for adjuvant chemotherapy could be established if the molecular biological profiles of primary tumor characteristics are determined.
    We isolated the actin-bundling molecule alpha-actinin-4 (ACTN4) from gene amplification in highly metastatic breast cancer, colorectal cancer, ovarian cancer, pancreatic cancer, lung cancer, salivary gland cancer, and tongue cancer. High expression of the ACTN4 protein induces the formation of cell processes that are involved in cancer metastasis. In a transcriptome subgroup analysis of a randomized controlled study of adjuvant chemotherapy for non-small cell lung cancer conducted in Canada, an additional effect from adjuvant chemotherapy was demonstrated only in a group with high ACTN4 expression. We developed a FISH probe that detects gene amplification of ACTN4 and began the clinical development of biomarkers that predict the metastatic activity of stage I lung adenocarcinoma and contribute to providing appropriate adjuvant chemotherapy.
    Non-small cell lung cancer is not the only cancer in which late metastasis can be predicted from gene amplification. For oral cancer as well, it may be possible to provide appropriate therapeutic strategies by identifying high-risk groups for late metastasis. Here, we discuss the clinical significance of these biomarkers.
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  • Chie Kudo-Saito
    2020 Volume 32 Issue 4 Pages 144-152
    Published: 2020
    Released on J-STAGE: December 22, 2020
    JOURNAL FREE ACCESS
    Immunotherapy, especially targeting immune inhibitory checkpoint pathways, has recently attracted much attention as a promising strategy in the treatment of cancer, since the anti-tumor efficacy induced by specific inhibitors called “immune checkpoint inhibitors (ICIs)” has been demonstrated even in patients with advanced metastatic cancer. However, the clinical outcome is extremely limited to some patients, and adverse events such as serious autoimmunity and hyperprogression have emerged. Many studies have been conducted worldwide to identify the genomic, molecular, microenvironmental and immunological mechanisms underlying ICI resistance, and numerous clinical trials have been conducted globally using newly generated antibodies targeting other IC molecules such as LAG3 and TIGIT in combination with other agents. Despite the enthusiasm, however, there has been little practical progress in clinical settings. There are two possible reasons: one is evolutional transformation of both tumor cells and host environment through the interplay between them, and the other is a loss of immune functions caused by tumor progression and metastasis. Thus, we need to better understand both tumor cells and host immunity together in order to disrupt the vicious spiral that leads to treatment resistance. This review highlights the current advances in immunotherapy and oncoimmune determinants driving the deterioration of tumor immunity for developing precision immunotherapy.
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  • Tsuyoshi Sugiura
    2020 Volume 32 Issue 4 Pages 153-158
    Published: 2020
    Released on J-STAGE: December 22, 2020
    JOURNAL FREE ACCESS
    To date, “precision medicine” in cancer treatment has involved stratifying patients by genetic characterization and providing proper drugs. In Japan, oncopanel gene analysis is covered by medical insurance, however, the driver genes are usually not amenable to drugs. Thus, it is difficult to apply the benefits of precision medicine to the public’s health. Another problem is “cancer plasticity” in which the genetic profile of cancer cells continuously changes over time during treatment such as surgery and chemoradiation. This means that real-time diagnosis and sampling should be established.
    We have focused on real-time sampling, diagnosis and monitoring according to the time of cancer and have developed a non-invasive precision diagnosis for oral cancer. This review outlines the precision diagnosis methods for 1) super-early detection of oral potentially malignant diseases (OPMDs) and SCC, 2) diagnosis of existence of oral cancer and metastasis using serum micro RNA and 3) isolation of circulation tumor cells (CTCs) and possibility of their utilization in precision diagnosis and treatment.
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Symposium 2: Utilization of AI for the future of oral cancer medicine ~fusion of medicine, dentistry and industry
  • Shin-ichiro Hiraoka
    2020 Volume 32 Issue 4 Pages 159-170
    Published: 2020
    Released on J-STAGE: December 22, 2020
    JOURNAL FREE ACCESS
    The application of artificial intelligence (AI) technology in healthcare is spreading rapidly thanks to the construction of a medical “big data” database as well as the development of graphics processing units (GPUs) that can process data at high speed. A further major reason is the development of deep learning technology. This review introduces practical applications of AI in clinical and pathological diagnosis and the concept of data-driven science. For the future of oral cancer treatment, it is important to train the next generation of medical professionals who can make full use of AI technology.
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  • —Possibility of diagnostic imaging support of oral cancer—
    Yoshiko Ariji, Eiichiro Ariji
    2020 Volume 32 Issue 4 Pages 171-178
    Published: 2020
    Released on J-STAGE: December 22, 2020
    JOURNAL FREE ACCESS
    With the development of deep learning technology, research on diagnostic imaging in the dental field has progressed, and its application to the diagnosis of oral cancers and jaw bone cysts/tumors has been reported.
    This paper introduces deep learning technologies, including classification, object detection, segmentation, and super-resolution processing, and their application.
    In the future, clinical application will develop further through multi-center joint research and academic society-based research.
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Symposium 3: Treatment indications for elderly oral cancer patients: What indicators follow age and PS?
  • Kazuo TAMURA, Michihiro UEDA
    2020 Volume 32 Issue 4 Pages 179
    Published: 2020
    Released on J-STAGE: December 22, 2020
    JOURNAL FREE ACCESS
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  • Shin-ichi Yamada, Hiroshi Kurita
    2020 Volume 32 Issue 4 Pages 180-185
    Published: 2020
    Released on J-STAGE: December 22, 2020
    JOURNAL FREE ACCESS
    In Japan, 60% of patients aged 70 years or older are newly diagnosed with cancer. Since the aging process is generally heterogeneous, there are difficulties in evaluating elderly patients based only on age. Therefore, new treatment outcomes and general assessment tools for selecting treatment strategies in older patients with oral squamous cell carcinoma (OSCC) will need to be established. In this study, the clinical significance of healthy life expectancy and the G8 screening tool were investigated in elderly OSCC patients. It seems that in patients with advanced cancers, healthy life expectancy was poor (less than 1 year), except among patients aged 75-79 years who received standard treatments. In elderly patients, healthy life expectancy (self-reliance survival time) may be one of the measures for patient prognosis as well as overall survival time. A lower G8 score was associated with poorer self-reliance survival. The clinical significance of the G8 score for elderly OSCC patients was demonstrated and its combination with ECOG-PS may be useful for assessing their prognoses.
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  • Masahiro Takahashi
    2020 Volume 32 Issue 4 Pages 186-192
    Published: 2020
    Released on J-STAGE: December 22, 2020
    JOURNAL FREE ACCESS
    The number of older patients with head and neck cancer is increasing. Cetuximab, nivolumab, and pembrolizumab were approved for head and neck cancer in recent years based on the results of clinical studies. Physicians should choose appropriate treatments for older patients according to not only subgroup analyses by age of clinical studies but also physical status, comorbidities, nutritional status, and patients’ preferences. The combination of chronological age and performance status alone does not reflect heterogeneity of the older cancer population. Geriatric assessment rather than routine oncology evaluations may better assist in taking treatment decisions in older cancer patients because it more accurately identify their vulnerabilities, chemotherapy-related toxicities, and prognoses.
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Symposium 4: Pathology of oral superficial cancer
  • Hisao YAGISHITA, Hitoshi NAGATSUKA
    2020 Volume 32 Issue 4 Pages 193-194
    Published: 2020
    Released on J-STAGE: December 22, 2020
    JOURNAL FREE ACCESS
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  • —From the standpoint of oral surgeon—
    Toru Sato
    2020 Volume 32 Issue 4 Pages 195-206
    Published: 2020
    Released on J-STAGE: December 22, 2020
    JOURNAL FREE ACCESS
    High-grade dysplasia and carcinoma without muscle invasion are temporarily defined as oral superficial carcinoma of the tongue. It is sometimes difficult to distinguish such lesions from many kinds of inflammatory and reactive lesions; the iodine staining method is a useful aid for the detection. Imaging devices, such as the narrow-band imaging endoscope, VELscope and IllumiScan have been developed as adjunctive tools. VELscope and IllumiScan show high sensitivity but low specificity. The excised mucosal margin should be free of high-grade dysplasia. Regarding the width of the deep margin, definitive criteria have not been established. The surgical wound is treated by primary closure, skin graft, or coverage with artificial materials. All these methods have both advantages and disadvantages. The surgical margin is evaluated intraoperatively by immediate histopathological examination. A novel technique using gamma glutamyltranspeptidase as a fluorescent tracer is a promising approach in this field. While the degree of epithelial dysplasia has been categorized into three grades, a binary system is advocated by the WHO. However, the criteria set by the WHO, the Japanese Society of Oral Tumor, and the Japanese Society of Head and Neck Cancer appear to have some differences. When histopathological DOI measurement is attempted based on the established horizon by AJCC, the measured values are sometimes negative under the condition in which dysplastic mucosa, “a not intact mucosa,” is widely distributed adjacent to the invasive carcinoma. It is necessary to revise these unsuitable and criterial differences, and to establish better common rules for oral surgeons, head and neck surgeons and pathologists.
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  • Naomi Yada, Kou Matsuo
    2020 Volume 32 Issue 4 Pages 207-217
    Published: 2020
    Released on J-STAGE: December 22, 2020
    JOURNAL FREE ACCESS
    Oral cancer is increasing in Japan and advanced oral cancer affects the quality of life. The first treatment for advanced oral cancer is usually surgical resection, and early detection that allows early treatment is important. The demand for oral exfoliative cytology is increasing. It is a quick, simple, and economical procedure based on a relatively atraumatic semi-invasive technique. The procedure for cell extraction and cytopreparation influences the timing of cytological diagnosis. Cytology has many advantages; however, it is necessary to understand the limits of screening and performing the tests. Recently, the development of liquid-based cytology (LBC) has increased the cell amounts retrieved and reduced the artifacts due to hemorrhage and saliva. This article provides an outline of oral exfoliative cytology from the perspective of cytological diagnosis. Moreover, a comparison with cytological diagnosis at Kyushu Dental University was conducted and we report the utility and limitations of oral cytology.
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  • Ayataka Ishikawa, Kazuhiro Yagihara
    2020 Volume 32 Issue 4 Pages 218-228
    Published: 2020
    Released on J-STAGE: December 22, 2020
    JOURNAL FREE ACCESS
    Early detection and diagnosis of oral epithelial dysplasia (OED) and carcinoma in situ (CIS) improve treatment outcomes and prognosis in oral cancer. Hyperplasia, regenerative changes, and reactive atypical epithelium as a result of stimulation and inflammation are often observed in the oral region.
    Staining with hematoxylin and eosin (H&E) to diagnose OED and CIS in biopsy specimens is often difficult. Hence, immunostaining with CK13, CK17, CK19, p53, Ki-67, and p40 can assist pathologists in diagnosing oral cancer in its early stages.
    However, immunostaining alone may produce false positives or false negatives. Therefore, confirmation of immunostaining with H&E is imperative. Furthermore, the results should also be correlated with the clinician’s judgment and the patient’s clinical course.
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Case Report
  • Tamaki Sekiguchi (Yamada), Kanchu Tei, Yoichi Ohiro, Kazuyo Kuribayash ...
    2020 Volume 32 Issue 4 Pages 229-236
    Published: 2020
    Released on J-STAGE: December 22, 2020
    JOURNAL FREE ACCESS
    We report a case of radiation-induced sarcoma that developed shortly after postoperative radiation therapy for squamous cell carcinoma of the maxillary gingiva. A 55-year-old man with a right maxillary gingival tumor was referred to our hospital. We performed partial maxillectomy to remove the tumor. The stump of the resected tumor was close to the surgical margin. Later, we performed postoperative radiation therapy. After 4 years, the patient experienced pain in the right buccal region of the irradiated area. Contrast computed tomography revealed the recurrence of tumor in the right maxilla. The pathology of the tumor was undifferentiated pleomorphic sarcoma, which was different from that of the first cancer. Although various chemotherapies were performed, the tumor remained unaffected and the volume of the tumor gradually increased. The patient died 8 months after chemotherapy.
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  • Miri Fujita, Takamasa Shirozu, Fumitaka Terasawa, Yusuke Kondo, Hiroak ...
    2020 Volume 32 Issue 4 Pages 237-241
    Published: 2020
    Released on J-STAGE: December 22, 2020
    JOURNAL FREE ACCESS
    A 76-year-old woman with Down syndrome visited a clinic because of swelling of her lower lip. A biopsy revealed squamous cell carcinoma, so she was admitted to our hospital and was diagnosed as cT1N0M0 stage Ⅰ lip cancer. A lipectomy was performed. She has survived without recurrence after the operation. Post-operative function and esthetic form were also satisfactory.
    Patients with Down syndrome have a greater risk of leukemia than the general population, but lower risk of solid tumors.
    We report this case of lip cancer with Down syndrome.
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  • Ryota Kobayashi, Ritsuo Takagi, Yutaka Nikkuni, Satoshi Maruyama, Mana ...
    2020 Volume 32 Issue 4 Pages 243-250
    Published: 2020
    Released on J-STAGE: December 22, 2020
    JOURNAL FREE ACCESS
    We report a case of primary intraosseous carcinoma (PIOC) of the jaw thought to be related to the crown of an impacted mandibular third molar in a 74-year-old man that was detected during a routine checkup at his family dental clinic. He was referred to our department with paresthesia affecting the right lower lip and occlusal pain in the right mandibular molar region. The right lower second molar was elongated with grade 2 mobility and the buccal gingiva was mildly swollen. There was no purulent discharge. Panoramic radiographs showed an ill-defined radiolucent lesion measuring 35×25 mm with irregular margins that was continuous with the crown of an inverted and impacted right mandibular third molar. A biopsy specimen was obtained. The histopathological diagnosis was squamous cell carcinoma (with suspicion of PIOC). The patient underwent submandibular dissection, segmental resection of the mandible, and reconstruction of the jaw with a metal plate. PIOC is generally associated with malignant transformation of a cystic lesion. However, there were no abnormal findings on panoramic radiographs taken at his family dental clinic 8 months earlier in this case. Therefore, it is probable that the malignancy had developed without cystic changes and had increased rapidly in size. Although asymptomatic impacted mandibular third molars and periodontitis are common, dentists should keep various lesions including PIOC in mind in elderly patients despite the low risk of developmental cysts.
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  • Takehito Kobayashi, Kenichiro Kitabatake, Nobuyuki Sasahara, Kaoru Eda ...
    2020 Volume 32 Issue 4 Pages 251-257
    Published: 2020
    Released on J-STAGE: December 22, 2020
    JOURNAL FREE ACCESS
    Congenital epulis is a rare benign localized mass in newborns’ gingiva, many of which are solitary. We experienced an extremely rare case of a girl with congenital epulis lesions in both the maxillary and mandibular gingiva.
    The maxillary mass was located in a socket of the anterior region, pedunculated and with a maximum diameter of 25 mm. This mass was the cause of a suckling disorder and there was also the concern of choking if it was shed. Therefore, it was resected under local anesthesia on the day of birth. The mandibular mass shrank and disappeared spontaneously during 10 months of follow-up.
    The resected maxillary lesion showed solid growth of cells with low N/C ratio and abundant PAS-positive cytoplasmic granules in the mucosal epithelium, accompanied by background vascular growth. Immunologically, the lesion was positive for vimentin and negative for S-100 protein, CD68, and CD163. Based on these findings, congenital granular cell tumor was diagnosed.
    There have been no reports of recurrence of congenital epulis following excision, and there have been cases of spontaneous disappearance. Thus, taking into account invasiveness to the body of the newborn baby, it was considered best to examine the response to each mass separately in accordance with its size, shape, location, and growth tendency.
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