[Show abstract][Hide abstract] ABSTRACT: Background:
Prospective trials of non-surgical observation have shown progression rates of only 5-10 % in patients with asymptomatic papillary microcarcinoma (PMC). This study investigated time-dependent changes in calcification patterns and tumor vascularity on ultrasonography (US) to clarify the natural course of PMC.
We examined calcification patterns and tumor vascularity for 480 lesions in 384 patients. Calcification patterns were classified as: (A) none; (B) micro; (C) macro; or (D) rim. Tumor vascularity was classified as rich or poor via color Doppler US.
After a mean of 6.8 years of observation, 29 lesions (6.0 %) had increased in size. Mean age for initial calcification pattern was 52.1 years for A (n = 135), 54.2 years for B (n = 235), 56.3 years for C (n = 96), and 60.1 years for D (n = 14), and the incidence rates of tumor enlargement were 9.6, 5.5, 3.2, and 0 %, respectively. The cumulative rate of upgrade in calcification pattern was 51.8 % at 10 years. Lesions with initially rich vascularity (n = 70) had significantly higher rate of tumor enlargement than those with poor vascularity (n = 410); however, the majority of tumor (61.4 %) with initially rich vascularity had decreased their blood supply during the follow-up. Multivariate analysis showed that strong calcification (C or D) and poor vascularity at last examination correlated significantly with non-progressive disease.
PMCs in older patients showed significantly stronger calcification patterns and poorer vascularity. Both consolidation of calcification and loss of vascularity occurred in a time-dependent manner during observation and were significant indicators for non-progressive disease.
No preview · Article · Nov 2015 · World Journal of Surgery
[Show abstract][Hide abstract] ABSTRACT: The necessity of transoral surgery for head and neck carcinoma is increasing, but its indications for the treatment of superficial head and neck carcinomas have not yet been established. This study was intended to help establish the standard indications for transoral surgery and additional therapy in patients with superficial head and neck carcinoma.
Sixty-two patients with 83 superficial head and neck carcinoma underwent transoral tumor resection at the Cancer Institute Hospital between June 2006 and September 2011. We measured the tumor size and thickness, examined the gross appearance, permeation of vessels, and droplet infiltration, and analyzed the correlations between each parameter.
Sessile type of tumor on gross appearance showed a significantly higher incidence of thickness ≥1000 µm than the other types. Tumor thickness ≥1000 µm was associated with higher incidences of permeation of vessels, droplet infiltration, and cervical lymph node metastasis.
In superficial head and neck carcinoma, if the endoscopic gross appearance is the sessile type, tumor thickness is likely to be ≥1000 µm and risk of cervical lymph node metastasis is increased.
[Show abstract][Hide abstract] ABSTRACT: We report herein on 29 patients with advanced oropharyngeal and tongue squamous-cell carcinoma who underwent a total glossolaryngectomy at the Cancer Institute Hospital of the JFCR between July 2005 and June 2013. In this study, we tried to evaluate associations between several variables of the primary tumor and prognosis in these 29 patients. The cause-specific 5-year survival rate with the Kaplan-Meier method was 45% in all patients. Tumor recurrence occurred in 15 patients. Four patients had recurrence in the primary site, 11 patients in neck lymph nodes or in the lungs or bone. The multivariate analysis revealed that the number of neck lymph node metastases, age and alcohol drinking were poor prognostic markers for patients undergoing a total glossolaryngectomy. Cause-specific survival was compared between patients with salvage surgery and initial surgery using Kaplan-Meier survival curves with log-rank tests. There was no significant association with survival (log-rank test: p = 0.13). The overall local control rate was 69% in all patients. Regarding salvage surgery, 9 of 16 patients had no recurrence in the primary site or neck lymph nodes. The limitations of this study include the small number of patients especially regarding the prognosis study and may have included a selection bias regarding undergoing a total glossolaryngectomy.
[Show abstract][Hide abstract] ABSTRACT: We conducted a phase III study to evaluate S-1 as compared with UFT as control in patients after curative therapy for stage III, IVA, or IVB squamous-cell carcinoma of the head and neck (SCCHN).
Patients were randomly assigned to the UFT group (300 or 400 mg day-1 for 1 year) or the S-1 group (80, 100, or 120 mg day-1 for 1 year). The primary end point was disease-free survival (DFS). Secondary end points were relapse-free survival, overall survival (OS), and safety.
A total of 526 patients were enrolled, and 505 were eligible for analysis. The 3-year DFS rate was 60.0% in the UFT group and 64.1% in the S-1 group (HR, 0.87; 95%CI, 0.66-1.16; p = 0.34). The 3-year OS rate was 75.8% and 82.9%, respectively (HR, 0.64; 95% CI, 0.44-0.94; p = 0.022). Among grade 3 or higher adverse events, the incidences of leukopenia (5.2%), neutropenia (3.6%), thrombocytopenia (2.0%), and mucositis/stomatitis (2.4%) were significantly higher in the S-1 group.
Although DFS did not differ significantly between the groups, OS was significantly better in the S-1 group than in the UFT group. S-1 is considered a treatment option after curative therapy for stage III, IVA, IVB SCCHN.
ClinicalTrials.gov NCT00336947 http://clinicaltrials.gov/show/NCT00336947.
[Show abstract][Hide abstract] ABSTRACT: Preservation of laryngeal function is almost as important as curability in the treatment of hypopharyngeal cancer. Radiotherapy is the gold-standard therapy in laryngeal function-preserving therapy for early hypopharyngeal cancer. In our institute, 62 of 97 cases (63.9%) of T1 or T2 hypopharyngeal cancers received radiotherapy (RT) or chemoradiotherapy (CRT) between 2005 and 2009.In the past, transoral surgery for hypopharyngeal cancer was not common. Transoral surgery such as transoral robotic surgery (TORS), endoscopic mucosal resection (EMR) and transoral videolaryngoscopic surgery (TOVS) for early hypopharyngeal cancers developed with improvements in endoscope technology and the recent advent of surgical robots. Transoral surgery has now become common in function-preserving surgery for early hypopharyngeal cancers.As mentioned above, CRT or transoral surgery is frequently chosen as function-preserving therapy for early hypopharyngeal cancer. The role of conservative partial pharyngolaryngectomy by the open method is to preserve laryngeal function with reconstruction surgeries and deglutition improvement surgeries for cases in which laryngeal function cannot be preserved in transoral surgery.To provide better function-preserving treatment, it is important to understand all of the advantages and disadvantages of radiation, transoral surgery, and open-method partial pharyngolaryngectomy, in order to select an optimal treatment for each specific case.
No preview · Article · Jan 2015 · Japanese Journal of Head and Neck Cancer
[Show abstract][Hide abstract] ABSTRACT: Background
We analyzed the effects of local extension sites on survival in patients with locally advanced maxillary sinus cancer. Methods
The criteria for inclusion in this study were as follows: (1) previously untreated maxillary sinus cancer; (2) squamous cell carcinoma; (3) T4 disease; and (4) curative-intent treatment. The data for 118 patients were obtained from 28 institutions across Japan and analyzed for overall survival and local control rates by local extension site. ResultsSites with a poor prognosis included the cribriform plate, dura, nasopharynx, middle cranial fossa, and cranial nerves other than V2. There was a significant correlation among these sites, except for the cranial nerves. Additionally, the hard palate was the only site that correlated with nodal involvement and showed a poor treatment outcome. Conclusion
Even in cases presenting with similar T4 maxillary sinus cancer, treatment should be performed in consideration of the local extension site. (c) 2013 Wiley Periodicals, Inc. Head Neck 36: 1567-1572, 2014
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to evaluate the depth of muscle invasion and keratinization as predictive factors for the incidence of subsequent cervical lymph node metastasis and prognosis. 210 patients with stage I-II squamous cell carcinoma of the oral tongue who underwent partial glossectomy alone at the Division of Head and Neck, Ganken Cancer Institute Hospital, from 1987 to 2009, were analyzed. The depth of muscular invasion was measured (≥ 5 mm, < 5 mm). Focusing on the most deeply invading area in the muscle layer, keratiniza- tion was evaluated as follows: cancer pearls were remarkable (cancer pearl type: 62 cases), cancer pearls were not remarkable, but tumor nests were well-to moderately keratinized (dyskeratotic type: 98 cases), or tumor nests were very weakly or not keratinized (nonkeratotic type: 50 cases). With regard to muscular invasion ≥ 5 mm, the metastasis rate was 69% (20/29) in the cancer pearl type, 73% (22/30) in the dyskeratotic type, and 89% (8/9) in the nonkeratotic type. Therefore, muscular invasion ≥ 5 mm may be a strong predictor for subsequent lymph node metastasis. The prognoses of 76 of these 210 cases who underwent ipsilateral neck dissection without postoperative adjuvant therapy were analyzed. In the cancer pearl type, all eight patients with muscular invasion ≤ 5 mm had good prognoses. Among the patients with muscular invasion ≥ 5 mm, 47% (7/15) died of neck failures, and 7% (1/15) died from distant metastasis. In the dyskeratotic and nonkeratotic types, among patients with muscular invasion < 3 mm and poor prognosis, 83% (5/6) and 100% (2/2) died of neck failures, respectively. Among patients with muscular invasion ≥ 3 mm and poor prognosis, 64% (7/11) and 57% (4/7) died from distant metastasis, respectively. Therefore, both the depth of muscular invasion and keratinization were associated with prognosis of subsequent metastasis.
No preview · Article · Oct 2014 · Japanese Journal of Head and Neck Cancer
[Show abstract][Hide abstract] ABSTRACT: Background:
Papillary thyroid carcinoma (PTC) often metastasizes to the central and lateral neck lymph nodes, but rarely affects retropharyngeal nodes (RPN).
We retrospectively reviewed 12 patients (three men, nine women) with PTC who underwent dissection of RPN metastases between 1994 and 2012. Mean age at dissection was 65 years (range 23-77).
Dissection was performed with the initial surgery for PTC in eight patients, while the remaining four patients underwent dissection as secondary surgery. RPN metastases arose from an ipsilateral primary in nine patients, bilateral in two, and contralateral in one, with primaries located at the superior pole of the thyroid lobe in nine patients. All patients showed simultaneous or previous lymph node metastases in the upper jugular chain. A transcervical approach was applied for RPN dissection in 11 patients, while a transcervical-transparotid approach was applied in the remaining patient. No patients needed mandibulotomy or showed severe complications. Median duration of follow-up after RPN dissection was 48 months (range 3-206). No recurrences in the retropharyngeal space were identified. Two patients died of the disease, one died from other carcinoma, and five survived with distant metastases from PTC. The remaining four patients remain free of the disease as at the time of writing.
If lymph node metastases are identified in the upper jugular chain, the possibility of RPN metastases should be checked. Most RPN metastases from PTC can be dissected safely without mandibulotomy. In particular, low-risk patients can expect favorable outcomes.
No preview · Article · Aug 2014 · World Journal of Surgery
[Show abstract][Hide abstract] ABSTRACT: The current study sought to assess the role of initial neck dissection (ND) for patients with node-positive oropharyngeal squamous cell carcinomas (OPSCC).
The data for 202 patients with previously untreated node-positive OPSCC were gathered from 12 institutions belonging to the Head and Neck Cancer Study Group in the Japan Clinical Oncology Group. These patients were categorized into two groups, consisting of the initial ND group and the wait-and-see group, according to treatment policy.
Regional recurrence was observed in 17 of 93 patients undergoing initial ND, whereas, recurrent or persistent diseases were observed in 40 of 109 patients who did not undergo initial ND. The 4-year overall survival rates (OS) for the wait-and-see group and initial ND groups were 74.0% and 78.7%, respectively, and the 4-year regional control rates (RC) for each group were 77.6% and 84.9%. There were no significant differences in either OS or RC (p=0.3440 and p=0.2382, respectively). However, for patients with N3 disease, the 4-year OS of the initial ND group (100%) was favorable. For patients with N2a disease, the 4-year RC of the initial ND group was higher than that of the wait-and-see group statistically (100% vs 62.5%, p=0.0156).
The role of initial ND was limited in patients with node-positive OPSCC. The treatment strategy not involving initial ND is considered feasible and acceptable when nodal evaluation after definitive radiotherapy or chemoradiotherapy is applied adequately. However, it is possible that initial ND improves outcomes in patients with resectable large-volume nodal disease.
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to evaluate the incidence of lymph node metastasis among patients with T4 maxillary sinus squamous cell carcinoma (MS-SCC) as well as the delayed metastasis rate and the treatment outcome for untreated N0 neck in patients with T4 MS-SCC.
Consecutive series of all patients (n = 128) with previously untreated T4 maxillary sinus SCC between 2006 and 2007 were obtained from 28 institutions belonging to or cooperating in the Head and Neck Cancer Study Group of the Japan Clinical Oncology Group.
Of the 128 patients, 28 (21.9 %) had lymph node metastasis, and six patients (4.7 %) had distant metastasis at diagnosis. Among the 111 patients who were treated with curative intent, 98 had clinically N0 neck disease and did not receive prophylactic neck irradiation. A total of 11 patients (11.2 %) subsequently developed evidence of lymph node metastasis, of whom eight were among the 83 patients with an N0 neck and had not received elective neck treatment. There were 15 patients who received an elective neck dissection as part of the initial treatment, of whom three had pathologically positive for lymph node metastases. Of 11 patients, six patients with nonlateral retropharyngeal lymph node metastasis without primary or distant disease were successfully salvaged.
This study identified the incidence of lymph node metastasis among patients with T4 MS-SCC as well as the delayed metastasis rate and the treatment outcome for untreated N0 neck in patients with T4 MS-SCC. These results will be of assistance in selecting treatment strategy for T4 MS-SCC in the future.
No preview · Article · Feb 2014 · Annals of Surgical Oncology
[Show abstract][Hide abstract] ABSTRACT: Evaluating metastases to cervical lymph nodes is important and requires accurate diagnostic methods. The present study investigated the diagnosis of metastases to cervical lymph nodes by ultrasonography. We reviewed 88 neck dissections in 62 patients who underwent neck dissection between January and December 2012. This review resulted in 61% sensitivity, 97% specificity, and 90% accuracy. Ultrasonographic evaluation involving internal echo patterns of the lymph nodes provided more accurate diagnoses than thickness alone. The sensitivity, specificity, and overall accuracy of this diagnostic method allowed easier diagnosis of lymph node metastases in oral carcinomas than in pharyngeal carcinomas. Pathological features of false-negative results were small amounts of keratin and necrosis, a metastatic focus within a lymph node aside from the hilum of the lymph node and diffuse cellular infiltration. Diagnosis of metastases to cervical lymph nodes by ultrasonography alone has limitations, so the use of other modalities like computed tomography, magnetic resonance imaging, and positron emission tomography is important, and fine-needle aspiration during ultrasonography can improve diagnosis.
No preview · Article · Jan 2014 · Japanese Journal of Head and Neck Cancer
[Show abstract][Hide abstract] ABSTRACT: Background: Submandibular gland carcinoma is rare, but compared with parotid gland tumors, submandibular gland tumors show a high rate of malignancy. In this report, a series of 76 cases is analyzed, all treated at the Cancer Institute Hospital, Tokyo, Japan during a 32-year period. Methods: All cases of submandibular gland carcinoma treated at our institute between 1979 and 2012 were analyzed through a medical chart review. Radical surgical resections were performed as initial treatment in 58 cases. In these cases, prognostic factors, including histological type, clinical stage, T-stage, N-status, and whether malignant diagnosis was completed before surgery, were analyzed. In cases involving unresectable subman dibular gland carcinoma, palliative chemotherapy was administered. At our institute, the present regimen of palliative chemotherapy for salivary gland carcinoma is paclitaxel (200 mg/m2 on day 1) plus carboplatin (AUC= 6 on day 1) every three weeks. Seven patients received this combination chemotherapy in the current study, and their results were analyzed. Results: Five- and 10-year overall survival rates were 51.0% and 48.0%, respectively. Both N-status and clinical stage were shown to be significant predictors for survival, the former being more significant. Combination chemotherapy with paclitaxel and carboplatin was shown to be effective for unresectable submandibular gland carcinoma. Conclusions: N-status is the primary predictor of survival outcomes, and paclitaxel plus carboplatin is an effective chemotherapy regimen for palliative cases. More effective adjuvant chemotherapies are urgently needed to improve prognosis for submandibular gland carcinoma.
No preview · Article · Oct 2013 · Japanese Journal of Head and Neck Cancer
[Show abstract][Hide abstract] ABSTRACT: Purpose To assess the current status in Japan of the treatment for squamous cell carcinoma of the T4 maxillary sinus (MS-SCC)and its use to plan clinical trials in the future. Patients The data for 128 patients with previously untreated MS-SCC were obtained from 28 institutions from 2006 to 2007. Of the 128 patients, 118 patients with curative intent were included in an analysis of the treatment and its results. Results Of the 118 patients, 73 patients had T4a disease, and 45 with T4b. Thirty-nine patients (33.1%)were treated with total maxillectomy, 25 (21.2%)with partial maxillectomy, 22 patients (18.6%)with RAD-PLAT, 19 patients (16.1%)with IV-CRT, and 13 patients (11.0%)with others. The 5-year overall survival rate and local control rate for 118 patients were 49.8% and 48.9%, respectively. The 5-year overall survival rates for patients with T4aN0M0 and T4bN0M0 were 67.5% and 29.8%, respectively. Conclusion This study was retrospective, but we could understand the tendency of treatment choice and treatment results. It will be useful information to plan clinical trials in the future.
No preview · Article · Oct 2013 · Japanese Journal of Head and Neck Cancer
[Show abstract][Hide abstract] ABSTRACT: Anaplastic thyroid carcinoma has a dismal prognosis and lacks an established therapeutic strategy. We have recently conducted chemotherapy with docetaxel and cisplatin as part of multimodal treatment for eight patients with anaplastic thyroid carcinoma. Docetaxel (75 mg/m²) and cisplatin (75 mg/m²) were administered on day 1 every 4 weeks for six courses. This chemotherapy was used as induction therapy in one patient, as therapy for distant metastases in five patients and as postoperative adjuvant therapy in two patients. Three patients showed partial responses and three patients showed stable disease. After excluding the two patients receiving the treatment as adjuvant therapy the response rate was 50 %. Grade 3 or 4 leukocytopenia occurred in seven patients (88 %), but these adverse events were tolerable. Chemotherapy with docetaxel and cisplatin may thus be feasible for anaplastic thyroid carcinoma.
[Show abstract][Hide abstract] ABSTRACT: Objective:
The current study aimed to compare the therapeutic outcomes of surgery with those of chemoradiation for patients with advanced oropharyngeal cancer (OPC).
The data for 523 patients with previously untreated OPC were obtained from 12 institutions belonging to the Head and Neck Cancer Study Group in the Japan Clinical Oncology Group from April 2005 to March 2007. In this study, we matched a group of patients who underwent surgery with a second group treated with chemoradiation according to age, gender, subsite, and T and N classification, and analyzed the overall survival, progression-free survival, local control and swallowing function.
The final matched-pair analysis included 186 patients. The 5-year overall survival, progression-free survival and local control rates were 69.8 and 71.4% (p = 0.762), 51.0 and 54.4% (p = 0.531), and 75.2 and 80.3% (p = 0.399), respectively, in patients treated with surgery and those treated with chemoradiation. Swallowing function in patients treated with chemoradiation was significantly better than that in patients treated with surgery (p = 0.015).
Although this study was not randomized, this matched-pair analysis of patients treated with surgery or chemoradiation showed that chemoradiation is as effective as surgery in the treatment of OPC.