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ABSTRACT: OBJECTIVE: This study was conducted to assess local recurrence and clinical prognosis in patients diagnosed as having a positive margin in the epithelial layer after a partial glossectomy treated by close observation. METHODS: A total of 365 cases of squamous cell carcinoma of the tongue diagnosed as clinical Stage I or II, treated by partial glossectomy in the National Cancer Center Hospital East between 1992 and 2006, were studied retrospectively. RESULTS: Pathological findings showed that 13 cases had positive margins in the epithelial layer, 4 (30.8%) of whom showed up with local recurrence in 4.4 years (3.0-5.0) on average. Lymph node recurrence was not observed and the 5-year overall survival rate was 76.2% in those 13 cases. The treatment for the recurrent cases was an additional partial glossectomy without neck dissection, which resulted in no recurrence and a survival rate of 100% after an average follow-up of 6.7 years. CONCLUSIONS: We suggest careful observation as one option for cases diagnosed with epithelial positive margin.
Japanese Journal of Clinical Oncology 02/2013; · 1.78 Impact Factor
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ABSTRACT: OBJECTIVE: Early-stage oral or oropharyngeal carcinomas are often treated with surgical resection. Resulting wounds that are too large for primary closure can be covered with skin grafts or patches made from various biomaterials. Recently, polyglycolic acid sheets have been used for this purpose. METHODS: We treated six patients with large wounds resulting from the resection of oral or oropharyngeal squamous cell carcinoma by grafting polyglycolic acid sheet patches. All patients were initially treated at the National Cancer Center East Hospital from March 2010 through July 2012. After mucosal resection, the wounds were covered with polyglycolic acid sheet patches attached with fibrin glue. Oral intake was started 4 days after surgery. RESULTS: Mucosal resection was the initial treatment in seven patients (five with oral squamous cell carcinoma and two with oropharyngeal squamous cell carcinoma). The polyglycolic acid sheet patches became detached in two patients (on the day of surgery and on postoperative day 6), who then required large doses of analgesics. A patient who underwent tooth extraction also required large doses of analgesics. The other four patients required only small doses of analgesics. One patient had bleeding at the surgical site. No adverse effects were caused by the polyglycolic acid sheet patch or by fibrin glue. CONCLUSIONS: Our study has shown that grafting of a polyglycolic acid sheet patch is effective and provides good pain control for patients with large, open wounds after mucosal resection of oral or oropharyngeal squamous cell carcinoma. We plan to evaluate tissue contraction and oral intake after polyglycolic acid patch grafting.
Japanese Journal of Clinical Oncology 12/2012; · 1.78 Impact Factor
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ABSTRACT: Examinations used to search for unknown primary tumors of squamous cell carcinomas of the neck include CT, MRI, laryngoscopy, gastrointestinal endoscopy, and positron-emission tomography (PET). Narrow band imaging (NBI) endoscopy in which an optical color-separation filter is used to narrow the bandwidth of spectral transmittance is also used.
Twenty-eight patients in whom primary squamous cell carcinomas could not be detected with conventional white light laryngoscopy underwent NBI endoscopy and PET.
Primary lesions were detected with NBI endoscopy in 3 patients, but no primary lesions were detected with PET. However, PET was used to detect a lower gingival cancer and a palatine tonsillar cancer.
Both PET and NBI endoscopy is effective for detecting unknown primary tumors of squamous cell carcinomas of the neck.
Head & Neck 08/2011; 34(6):826-9. · 2.40 Impact Factor
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ABSTRACT: In cases of differentiated thyroid carcinoma, the presence or absence of invasion into the circumferential organs is an important prognostic factor. Surgical procedures include circular resection of the trachea with end-to-end anastomosis and window resection with secondary closure. We have used window resection with secondary closure since 1993, and herein retrospectively analyze the treatment outcomes for this surgical procedure in order to determine the indications for procedure selection.
Subjects comprised 41 cases of invasion by differentiated thyroid carcinoma into the trachea, for which surgery was performed at the Department of Head and Neck Surgery of the National Cancer Center Hospital East from 1993 to 2007. The mean age was 65.7±7.9 years, and the median length of the observation period was 43 months. There were 17 cases (41.4%) cases of secondary relapse.
The 5-year and 10-year overall survival rates for this surgical procedure were 78.9% and 74.5%, respectively, while the 5-year and 10-year local control rates were 92.4% and 73.4%, respectively. The pathological resection stump was positive in 27 cases (65.8%), but no significant differences in treatment outcome were observed between the stump-positive group and the stump-negative group. There were 26 cases in which closure of the tracheal fistula was performed by the time of observation. When the tracheal defect had a diameter equivalent to 7 rings of the trachea or less and a circumference half that of the tracheal cartilage or smaller, including partial cricoid cartilage, it was possible to perform closure with only a local flap. For larger defects, reconstruction was performed using hard tissues or materials, such as hydroxyapatite, titanium mesh, and costal cartilage. There were 2 cases that required re-window because of dyspnea after closure.
The treatment outcomes for this surgical procedure for invasive cases of differentiated thyroid carcinoma into the trachea resulted in a low rate of local recurrence and similar survival rates as described in other reports. Even for cases of resection exceeding half the circumference of the trachea, closure of the tracheal fistula can be performed using hard tissues or materials; however, in such cases, we believe that closure should be attempted progressively in a two-stage reconstruction.
Auris, nasus, larynx 04/2011; 38(2):271-5. · 0.58 Impact Factor
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ABSTRACT: Operative mortality is the most important index for assessing operative results, which has rarely been examined in reconstructive surgery. The aims of this study were to establish a representative index of operative mortality after head and neck reconstruction and to consider measures to improve operative results.
We reviewed cases of head and neck reconstruction by means of free tissue transfer performed from July 1992 through December 2005 at the National Cancer Center Hospital East, Chiba, Japan. The subjects were 1249 patients with a mean age of 62 years. Operative mortality was evaluated on the basis of the 30-day post-operative mortality rate and the in-hospital mortality rate. Statistical analysis was performed with the Cochran-Armitage test.
The 30-day post-operative mortality rate was 0.88% (11 of 1249 patients), and the in-hospital mortality rate was 1.84% (23 of 1249 patients). The 30-day post-operative mortality was significantly correlated with age (P = 0.002), but the in-hospital mortality was not (P = 0.148). Among patients older than 80 years, the 30-day post-operative mortality rate was 8.57%. The most common cause of 30-day post-operative death was cerebral infarction. Of the 23 in-hospital deaths, 13 were due to cancer recurrence.
These results indicate that head and neck reconstruction with free flaps is reliable. However, the high 30-day post-operative mortality rate among patients 80 years or older should be considered when deciding whether to operate. To decrease the operative mortality rate, careful perioperative management is needed to prevent complications and shorten the hospital stay.
Japanese Journal of Clinical Oncology 04/2011; 41(6):758-63. · 1.78 Impact Factor
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Hiroyuki Daiko,
Ryuichi Hayashi,
Minoru Sakuraba, Mitsuru Ebihara,
Masakazu Miyazaki,
Takeshi Shinozaki,
Masahisa Saikawa,
Sadatomo Zenda,
Mitsuhiko Kawashima,
Makoto Tahara,
Toshihiko Doi,
Atsushi Ohtsu
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ABSTRACT: After complete resection of carcinomas of the head and neck, including carcinoma of the cervical esophagus, the pattern of first failure is more often locoregional than distant metastasis. We retrospectively evaluated the safety and efficacy of the combination of post-operative radiation and concurrent chemotherapy with low-dose cisplatin for high-risk squamous cell carcinoma of the cervical esophagus.
From 2005 through 2008, 34 patients with previously untreated squamous cell carcinoma of the cervical esophagus underwent cervical esophagectomy with or without laryngectomy. Of these 34 patients, 11 with disease-positive lymph nodes in the upper mediastinum (M1 lymph/Stage IV) confirmed by pathologic examination were enrolled. Patients received radiotherapy (66 Gy in 33 fractions) and concurrent low-dose cisplatin.
Nine patients completed the planned radiotherapy and two or more courses of chemotherapy. Grade 3 toxicities during chemoradiotherapy were leukopenia (36% of patients), neutropenia (18%) and mucositis (9%). At a median follow-up time of 39.5 months, the overall 1- and 3-year survival rates were 91 and 71%, respectively.
The combination of post-operative radiation and concurrent chemotherapy with low-dose cisplatin is well tolerated and has the potential to improve the rates of locoregional control and overall survival in patients with high-risk advanced squamous cell carcinoma of the esophagus.
Japanese Journal of Clinical Oncology 02/2011; 41(4):508-13. · 1.78 Impact Factor
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ABSTRACT: To examine postoperative complications and swallowing function associated with free jejunal patch graft transfer after partial hypopharyngectomy with laryngeal preservation.
Retrospective medical record review.
Academic research.
A consecutive series of 43 patients who underwent free jejunal patch graft transfer after partial hypopharyngectomy with laryngeal preservation composed the study sample. They represented the following 3 groups based on the type of hypopharyngeal defect: 13 patients with defects of the posterior wall (PW group), 28 patients with defects extending to the unilateral piriform sinus (PS-PW group), and 2 patients with defects extending to the bilateral piriform sinuses (PS-PS group).
Postoperative complications and oral intake ability were compared among the groups.
Except for 1 patient, all the patients in the PW and PS-PS groups resumed oral intake within 2 weeks after surgery. Four patients in the PS-PW group had severe dysphagia, 2 of whom could not discontinue tube feeding.
Free jejunal patch graft transfer after partial hypopharyngectomy allows satisfactory swallowing function, with a low complication rate. Postoperative dysphagia was slightly more common in the PS-PW group than in the PW group.
Archives of otolaryngology--head & neck surgery 02/2011; 137(2):181-6. · 1.92 Impact Factor
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Hiroyuki Daiko,
Kanji Nagai,
Junji Yoshida,
Mitsuyo Nishimura,
Tomoyuki Hishida, Mitsuru Ebihara,
Masakazu Miyazaki,
Takeshi Shinozaki,
Shinpei Miyamoto,
Minoru Sakuraba,
Masahisa Saikawa,
Ryuichi Hayashi
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ABSTRACT: The purpose of this study was to determine the role of surgical treatment and to identify factors affecting the survival of patients undergoing pulmonary resection for tumors metastatic from head and neck carcinomas.
Thirty-three patients who had undergone resection of pulmonary tumors metastatic from head and neck carcinomas, other than thyroid cancers and sarcomas of the head and neck, were reviewed.
The operative morbidity rate was only 6%, no patients died within 30 days after resection and complete resection was achieved in 94% of patients. The overall 1- and 3-year survival rates were 76% and 43%, respectively, and the median survival time was 21 months. The factors found on univariate analysis to significantly affect survival were a disease-free interval of < or =2 years, tongue carcinoma and squamous cell carcinoma. The factor found, on multivariate analysis, to most strongly affect survival was tongue carcinoma. The most frequent pattern of initial recurrence after pulmonary resection was distant metastasis (64%).
The safety and effectiveness of surgical treatment for pulmonary tumors metastatic from head and neck carcinomas in adaptive criteria for resection are well demonstrated. The poor survival after surgical resection of pulmonary tumors metastatic from cancers of the tongue should be noted.
Japanese Journal of Clinical Oncology 03/2010; 40(7):639-44. · 1.78 Impact Factor
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ABSTRACT: We performed a multicenter longitudinal study using our neck dissection questionnaire (NDQ) and arm abduction test (AAT) to assess the impact of rehabilitation and surgical modification on postoperative quality of life (QOL).
Patients who had undergone neck dissection for the treatment of head and neck cancer answered the NDQ and completed the AAT 1, 3, 6, and 12 months after surgery. All patients enrolled in this study underwent a rehabilitation program designed for neck dissection. The obtained data were statistically analyzed according to the types of neck dissection and compared with the data of patients who had undergone neck dissection but not rehabilitation.
A total of 224 patients were enrolled in this study. Our findings revealed that resection of the sternocleidomastoid muscle (SCM) and spinal accessory nerve (SAN) resulted in shoulder drop. Lowering the dissection level and preservation of the SAN and SCM significantly reduced various sensory symptoms of the neck, such as stiffness, pain, numbness, and constriction, and improved shoulder function. Postoperative rehabilitation had a significant effect on arm abduction ability, particularly when the SCM and SAN were resected.
The study demonstrated that rehabilitation, in addition to modifications to radical neck dissection, contributed to the improvement of postoperative QOL after neck dissection.
International Journal of Clinical Oncology 02/2010; 15(1):33-8. · 1.41 Impact Factor
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PhD Kimihide Kusafuka DDS,
Koji Muramatsu PA,
Tsugumi Yabuzaki PA,
Hiroto Ishiki MD,
Rie Asano MD,
Tomoyuki Kamijo MD,
Yoshiyuki Iida MD,
Mitsuru Ebihara MD,
Testuro Onitsuka MD,
PhD Toru Kameya MD,
Kimihide Kusafuka,
Koji Muramatsu,
Tsugumi Yabuzaki,
Hiroto Ishiki,
Rie Asano,
Tomoyuki Kamijo,
Yoshiyuki Iida, Mitsuru Ebihara,
Testuro Onitsuka,
Toru Kameya
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ABSTRACT: Background
Alveolar soft part sarcoma (ASPS) is a rare mesenchymal neoplasm of uncertain origin. In this article, we report a case of ASPS occurring in the larynx, an extremely rare location for this rather unusual tumor.Methods and ResultsThe patient was a 34-year-old Japanese woman who requested an examination for hoarseness. The tumor showed a proliferation of large polygonal cells with periodic-acid-Schiff–positive diastase-resistant intracytoplasmic granules, arranged in an alveolar growth pattern. The cytoplasm of the tumor cells was eosinophilic. Tumor cells were positive for vimentin and titin. Nuclear immunoreactivity for TFE3 was observed, and the Ki-67 labeling index was 14.7%. Ultrastructurally, electron-dense rod-shaped crystals were infrequently observed in the cytoplasm. This case was finally diagnosed as ASPS of the larynx.Conclusion
We discuss the histogenesis and differential diagnosis of ASPS with immunohistochemical and ultrastructural findings. TFE3 immunohistochemistry was found to be a very useful marker for the diagnosis of ASPS. © 2008 Wiley Periodicals, Inc. Head Neck, 2008
Head & Neck 08/2008; 30(9):1257 - 1263. · 2.40 Impact Factor
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Kimihide Kusafuka,
Yoshinori Takizawa,
Takao Ueno,
Hiroto Ishiki,
Rie Asano,
Tomoyuki Kamijo,
Yoshiyuki Iida, Mitsuru Ebihara,
Yojiro Ota,
Tetsuro Onitsuka,
Toru Kameya
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ABSTRACT: Dedifferentiation of salivary gland neoplasms is a rare event, unlike bone and soft part sarcomas, which was first described by Stanley et al. in 1988. An additional case of dedifferentiated epithelial-myoepithelial carcinoma (EMC) is reported here. The patient was a 70-year-old Japanese man who requested examination of the rapid growth of a mass in the right parotid region, which he had first noticed 25 years previously. Clinical examination showed an ill-circumscribed, 6.8 x 4.7 x 7.0-cm lesion. Histologically, most parts of the lesion were high-grade carcinoma (HGC) with sheetlike and nestlike growth of markedly atypical cells and comedonecrosis, whereas the minor part consisted of typical EMC. The outer clear cells of EMC were positive for alpha-smooth muscle actin (ASMA), p63, cytokeratin (CK) 14, and vimentin, and the inner ductal cells of EMC were positive for CKs and epithelial membrane antigen. HGC was negative for ASMA, CK14, and vimentin, but diffusely positive for p53 protein and cyclin D1. The Ki-67 labeling index of EMC was 11.5%, whereas that of HGC was 67.1%. These findings and a review of literature indicate that HGC arose from preexisting EMC, and this phenomenon is the dedifferentiation of EMC. Dedifferentiated EMC is extremely rare.
Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics 08/2008; 106(1):85-91. · 1.50 Impact Factor
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ABSTRACT: Alveolar soft part sarcoma (ASPS) is a rare mesenchymal neoplasm of uncertain origin. In this article, we report a case of ASPS occurring in the larynx, an extremely rare location for this rather unusual tumor.
The patient was a 34-year-old Japanese woman who requested an examination for hoarseness. The tumor showed a proliferation of large polygonal cells with periodic-acid-Schiff-positive diastase-resistant intracytoplasmic granules, arranged in an alveolar growth pattern. The cytoplasm of the tumor cells was eosinophilic. Tumor cells were positive for vimentin and titin. Nuclear immunoreactivity for TFE3 was observed, and the Ki-67 labeling index was 14.7%. Ultrastructurally, electron-dense rod-shaped crystals were infrequently observed in the cytoplasm. This case was finally diagnosed as ASPS of the larynx.
We discuss the histogenesis and differential diagnosis of ASPS with immunohistochemical and ultrastructural findings. TFE3 immunohistochemistry was found to be a very useful marker for the diagnosis of ASPS.
Head & Neck 03/2008; 30(9):1257-63. · 2.40 Impact Factor
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ABSTRACT: The objective of this retrospective study was to investigate the efficacy and tolerability of single-agent docetaxel in patients with platinum-refractory squamous cell carcinoma of the head and neck (SCCHN).
Platinum-refractory disease was defined as cancer with documented tumor progression during platinum-based treatment or recurrence within 6 months after platinum-based chemoradiotherapy. Patients fulfilling the following criteria were enrolled: histologically confirmed SCCHN, excluding nasopharyngeal cancer; measurable metastatic lesions as assessed by the Response Evaluation Criteria in Solid Tumors (RECIST); and platinum-refractory disease. Docetaxel (60 mg/m2) was administered every 3-4 weeks and continued unless there was evidence of disease progression or unacceptable toxicity.
Twenty patients were recruited. Overall response rate was 10% (2/20) and tumor control rate was 25% (5/20). Median progression-free and median overall survival times were 1.7 and 4.6 months, respectively. The most common hematological toxicities were leucopenia (grade 4: 35%) and neutropenia (grade 4: 30%). Grade 3 febrile neutropenia and grade 3 mucositis (functional/symptomatic) each occurred in two patients (10%). One fatal bleeding occurred during this treatment, however, the relation between this event and docetaxel was unlikely. Median inpatient period during treatment was 5.4 days (range, 0-50 days).
A single-agent docetaxel regimen appeared to offer an acceptable clinical profile in patients with platinum-refractory SCCHN.
Japanese Journal of Clinical Oncology 08/2007; 37(7):477-81. · 1.78 Impact Factor
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ABSTRACT: Mucoepidermoid carcinoma is a common neoplasm of the salivary glands. Salivary gland-type neoplasms are very rare in the nasopharynx, and there are only few reports on mucoepidermoid carcinoma of the nasopharynx. Two additional cases of mucoepidermoid carcinoma arising from the nasopharynx are reported here. Case 1: the patient was a 57-year-old Japanese woman who had bloody sputum. Case 2: the patient was a 51-year-old Japanese woman who underwent resection of a nasopharyngeal tumor. Histologically, both tumors were also low-grade mucoepidermoid carcinomas with clear cells. Histochemically, the gland-like nests and mucous cells were positive for mucin staining. Immunohistochemically, the lesions were positive for cytokeratins (CKs), p63, and MUC1, but negative for alpha-smooth muscle actin and EBER mRNA. The Ki-67 labeling indices of the two tumors were 10.4% and 4.3%, respectively. The two present cases and a review of the English literature indicate that salivary gland-type neoplasms arising from the nasopahrynx are extremely rare. The prognosis of salivary gland-type carcinomas of the nasopharynx is still unknown.
Archiv für Pathologische Anatomie und Physiologie und für Klinische Medicin 04/2007; 450(3):343-8. · 2.49 Impact Factor
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ABSTRACT: The objective was to compare electrophysiologic investigations of the upper trapezius muscle (UT) after different selective neck dissections (SND) and analyze the differences between types of SND and the preservation and excision of the cervical nerves (the C2-4 rami of the cervical plexus).
Retrospective study of 54 patients (average age, 65.1 +/- 9.6 yr, 45 males) with 70 SND.
Patients underwent needle electromyography (EMG) of the UT by 4 months after surgery. The findings were rated according to the 5 point EMG scale system from 1 (total denervation: positive sharp wave or fibrillation potential at rest and electrical silence at voluntary contraction) to 5 (normal pattern).
The average EMG scale was 1.7 +/- 1.1, 58.6% for score 1 and only 5.7% for score 5. There was not a significant difference in the EMG scale between the types of SND, whereas the group in which the cervical nerves were excised was significantly lower than in that in which it was preserved. The average EMG scales in the former and latter were 1.5 +/- 0.8 and 2.0 +/- 1.3, 68.8%.
The study data confirm that complete or incomplete denervation of the UT was caused by axonal injury of the spinal accessory nerve, even though it was spared, because of traction of the nerve during neck dissection. Second, the excision of the C2 to 4 rami of the cervical plexus caused worse damage of the UT. It is suggested that it is important to preserve the cervical nerves to avoid denervation of the UT.
The Laryngoscope 03/2007; 117(2):319-22. · 1.75 Impact Factor
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ABSTRACT: Adenoid squamous cell carcinoma (ASCC) is an uncommon but well-recognized variant of squamous cell carcinoma that was first described by Lever in 1947. ASCC has been reported to originate in the sun-exposed skin of the head and neck and in other sites. An additional case of ASCC is reported here. The patient was a 64-year-old Japanese woman who requested examination of a reddish lesion on the left floor of the mouth. The biopsy material was diagnosed as squamous cell carcinoma. Clinical examination showed a well-circumscribed, 20 x 10 mm-sized lesion, which was categorized as cT2cN0cm 0. Tumor resection was therefore performed. Histologically, most parts of the lesion were conventional squamous cell carcinoma in situ, but the invasive part consisted of ASCC with gland-like or reticular appearance. The latter part was negative for mucin staining. Immunohistochemically, this lesion was positive for pancytokeratin, high-molecular-weight keratin, cytokeratin (CK) 7/8, CK19, E-cadherin and p53, but negative for vimentin, CK20, and S-100 protein. The Ki-67 labeling index was 50.3% in the ASCC part and 34.5% in the carcinoma in situ part. These findings and a review of the literature indicate that a gland-like feature of ASCC is associated with the loss of cell adhesion in the center of the cancer nests, and it can be confirmed simply by mucin staining to be neither an adenosquamous carcinoma nor ductal involvement of conventional squamous cell carcinoma.
Pathology International 03/2006; 56(2):78-83. · 1.62 Impact Factor
