We evaluated the treatment outcome of 32 cases with hypopharyngeal cancer who underwent larynx preserved partial pharyngectomy with reconstruction using a free flap in our department between 1990 and 2009. Though only the short-term results have been reported for this surgery so far, we also evaluated the long-term results. Of the 32 cases, 30 received normal food, and the tracheal stoma was closed in 28 cases. Thirteen cases survived over five years, and 3 cases over ten years. In most of the cases with long-term survival, the larynx was preserved. Five cases suffered from pneumonia, which suggests the effects of swallowing dysfunction by aging or comorbidity. While this surgery is a superior treatment for laryngeal preservation, it should be chosen after careful consideration and requires long-term follow-up.

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The recent increase in incidence of oropharyngeal cancer in the USA and northern Europe has been attributed to human papillomavirus (HPV) infection. HPV causes an epidemiologically and clinically distinct form of oropharyngeal squamous cell carcinoma (OPSCC). The prevalence of HPV in Japanese patients with OPSCC is not clear. The Japanese Cooperative Study Group for Basic Research in Head and Neck Cancer (JCSG-BRHNC) performed a prospective study to clarify the prevalence and genotype distribution of HPV in OPSCC in Japan. Patients without prior treatments were registered from May 2009 to March 2011 and tissue samples were collected from 20 institutes. OPSCC tissue samples from 158 patients were tested using polymerase chain reaction (PCR) and Hybrid Capture II (HC2). Non-cancerous tissues from 54 patients with chronic tonsillitis or tonsil hypertrophy were also examined as controls. Results: HPV was detected in 79 (50.3%) of 157 patients and 1 of 112 control patients by PCR. HPV genotype distributions revealed HPV16 in 70 cases (88.6%). In histological features, cases with low differentiation type were dominant in HPV-positive OPSCC (p = 0.0175). The sub-sites of tumor were lateral wall (tonsil) in 73(92.4%) for HPV-positive patients and 44 (56.4%) for HPV-negative patients (p < 0.0001). The ratio of stage IV was larger in the HPV-positive patients than in the HPV-negative patients. The ratios of non-smoker and non-drinker OPSCC patients were also was larger in the HPV-positive patients than in the HPV-negative patients. Overall survival was better in HPV-positive than HPV-negative patients with stage III or IV OPSCC treated with CRT or surgery. HPV detection using HC2 using oral brushing samples revealed that sensitivity and specificity were 93.7% and 96.2%, respectively. We clarified the prevalence of HPV of OPSCC in Japanese. The clinical features and prognosis were similar to the data reported in the USA.

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It is widely accepted that the most common risk factors for head and neck squamous cell carcinoma (HNC) are tobacco smoking and heavy alcohol consumption. Recent studies showed that an etiologic role of infection with human papillomavirus (HPV) has been implicated in the development of a subset of HNC. HPV-related HNC is associated with sexual behavior but not with tobacco smoking and alcohol drinking, and has a better prognosis with increased sensitivity to both radiation therapy and chemotherapy than HPV-unrelated HNC. Regarding molecular characteristics, immunohistochemical overexpression of p16 is observed in tumor cells with HPV-related HNC, therefore it is currently regarded as a reliable surrogate marker for HPV-related HNC. HPV-related HNC is a clinical entity entirely distinct from HPV-unrelated HNC. This report presents an overview of the impact of HPV infection as a biomarker for head and neck carcinoma.

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In the area of head and neck oncology as well as other oncology areas, molecular targeting agents are actively being developed and introduced. For example, Bonner et al. reported that adding cetuximab to radiation therapy showed a significant survival benefit for cases with locally advanced squamous cell carcinoma of the head and neck (SCCHN). Moreover, Vermorken et al. reported that adding cetuximab to chemotherapy with platinum plus fluorouracil showed a significant survival benefit for recurrent or metastatic SCCHN. These results have brought big advances in head and neck oncology. However, according to the results from RTOG0522, adding cetuximab to chemoradiothearpy (CRT) did not show superiority to CRT. Furthermore, life-threatening bleeding events were observed in 10% of the patients receiving sunitinib in the phase 2 trial for recurrent or metastatic SCCHN. These results have confirmed that molecular targeting agents do not always bring clinical benefits.
Molecular targeting agents will soon be available in Japan; we must be careful when using and managing these agents.

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However, when the flap is thick with fat tissue, the prosthetic appliance is unstable, resulting in the need for defatting of the flap.
A 73-year-old woman underwent resection of the maxilla and reconstruction using a fibular osteocutaneous flap. Although the flap was successfully transferred, the oral vestibule could not be created due to the bulkiness of the flap. The dental prosthesis was, therefore, unstable, requiring vestibuloplasty, which was performed 11 months after the reconstruction. In the usual setting, the flap is thinned from the lip side. However, the fibula was fixed with plates on the labial side. Thus, the flap was elevated from the posterior side and debulked to avoid exposure of the plates. The oral vestibule was formed sufficiently deep without infection postoperatively.

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Angiosarcoma is a rare malignant endothelial cell tumor and accounts for about 1-2% of soft tissue sarcomas. Chronic lymphedema, after irradiation, such as trauma or chronic physical stimuli has been an incentive. Primary angiosarcoma typically occurs in the head and facial skin; angiosarcoma in the mandible such as this case is extremely rare. The rate of local recurrence or distant metastases is high. The 5-year survival rate is about 10-35% and the prognosis is poor. Complete resection is essential for local control, but it is important to consider postoperative functional preservation if the mandible has been involved in feeding, articulation and swallowing, which are directly linked to decreased quality of life. Here, we report on a case who underwent a complete resection for angiosarcoma that had extensively progressed in the primary lower jaw. We were able to achieve both local control and postoperative functional preservation by performing a rigid reconstruction in a one-stage repair and by using a mandible skin flap.

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We retrospectively analyzed 53 previously-untreated patients of lateral wall oropharyngeal carcinoma treated at our department. Our treatment strategy for the primary lesion in T1, T2 carcinomas was transoral oropharyngectomy, and in T3, T4 carcinomas was extended resection and reconstructive surgery. Regarding neck lesions, elective neck dissection was done aggressively. Those patients with a margin-positive primary lesion and with extra-capsular invasion in neck lymph node metastases underwent postoperative irradiation. The overall 5-year survival rate in our treatment strategy was 74.3%. The cause of death was as follows: multiple primary cancer in 7 patients, primary recurrence 3, and distant metastases 1. It is important to control multiple primary cancer and primary lesion in order to achieve a higher salvage rate.

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We report on 38 patients with hypopharyngeal squamous-cell carcinoma who underwent hypopharynx-larynx partial resection at the Department of Otorhinolaryngology, Jikei University Hospital between July 2005 and December 2011. In this study, we tried to evaluate associations between the clinicopathological variables of the primary tumor and prognosis in these 38 patients. The cause-specific 3-year survival rate by Kaplan-Meier was 72% in all patients (100% in stage I, 75% in stage II, 65% in stage III and 79% in stage IV). Tumor recurrence occurred in 17 patients. Four patients had a recurrence in the primary site, 10 patients in a neck lymph node, 1 patient in both (primary site and neck lymph node) and 2 patients in the lungs or skin. The lymphatic invasion and tumor differentiation were associated with poor prognosis. Regarding these pathologic factors, 6 of 7 patients with lymphatic invasion and poor tumor differentiation showed earlier recurrence than the other patients. With postoperative surgery or chemoradiotherapy, 4 of 6 patients with recurrence could survive during the study period. Our evidence suggests that those patients with lymphatic invasion and poor tumor differentiation may be classified into poor prognosis and need closer observation.

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The subjects were 293 patients with untreated tongue carcinoma in our hospital between 1997 and 2007. We examined appropriate choices for elective neck dissection in patients with stage I/II, and appropriate areas of neck dissection in N+ cases. The incidence of cervical metastasis after surgery for stage I/II was 35% for patients with tumor thickness ≧ 4 mm and 10% for patients with tumor thickness < 4 mm. The occult metastasis rate was 10% for the patients with tumor thickness ≧4 mm and 0% for patients with tumor thickness < 4 mm. In patients with tumor thickness ≧ 4 mm, there was no significant difference in disease-specific survival rates between patients who underwent elective neck dissection and those did not. Posterior neck metastasis was never observed in patients with stage I/II or N1, suggesting that posterior neck dissection may be omitted.

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Purpose: In this study, the usefulness of sentinel lymph node biopsy (SNB) of oral squamous cell carcinoma (OSCC) was evaluated.
Patients and Methods: A total of 50 OSCC patients with clinically diagnosed N0 neck underwent SNB at our department between March 2003 and January 2009. Of these, 25 patients (group I) underwent SNB and neck dissection combined with ablation of the primary tumor. The remaining 25 patients (group II) underwent SNB combined with ablation of the primary tumor. The follow-up period was 11-108 months (median, 80 months). The SN was sampled after identification using a hand-held gamma probe, and then the sampled SN was immediately bisected. One-half of the SN was examined for metastasis by using hematoxylin-eosin (HE) staining and cytokeratin AE1/AE3 (AE1/AE3) immunohistochemical staining. The other half was examined for molecular metastasis by using reverse transcription polymerase chain reaction (RT-PCR) to detect expression levels of cytokeratin 17 (CK17).
Results: HE and AE1/AE3 stainings revealed SN metastasis in 9 patients in group I, whereas no SN metastasis was detected in group II. During the follow-up period, neck recurrence was detected in one patient in group I. The accuracy was 98.0%, sensitivity was 90.0%, specificity was 100% and negative predictive value was 97.6%. RT-PCR revealed CK17 expression in 5 patients, although HE and AE1/AE3 stainings revealed no metastasis in these patients. The N stage of these 5 patients was considered to be pN0 (mol+). Despite no additional treatment, 2 patients in group II showed no evidence of neck recurrence during the follow-up period.
Conclusion: The results suggest that SNB is useful for the diagnosis of neck metastasis in patients with OSCC. Further studies should examine the need for additional treatment in pN0 (mol+) patients.

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A novel protocol incorporating falecalcitriol for management after total thyroidectomy with parathyroid autotransplantation was performed in 20 cases. Sixteen cases (80%) succeeded with the protocol, but four cases (20%) dropped out because of clinical symptoms of hypocalcemia and additional calcium injections were administered to prevent tetany. All 20 cases showed good control of serum calcium level up to 7 days after the operation. Falecalcitriol has a stronger effect in increasing serum calcium level than existing vitamin D3, and makes it easy to maintain the level of serum calcium after total thyroidectomy. The function of the parathyroid was finally preserved in all 17 cases in whom it was possible to transplant two or more glands. A falecalcitriol dose of 0.3μg/day had little influence on the suppression of parathyroid hormone. The success rate of preserving parathyroid function in three cases in whom only one gland was transplanted was 33.3%.

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Intensity modulated radiation therapy (IMRT) is useful in the treatment of head and neck cancer. IMRT planning requires outline setup of the target in CT images and CT value for calculating the distribution of radiation dose. However, dental metal artifacts often interfere with correct CT images and CT values. In this paper, we report a case series of patients who underwent removal of dental metal prior to IMRT.
Five patients with head and neck cancer were referred to our department for removal of all of their dental metal. Primary lesions were the oropharynx in two cases, the tongue in one, the larynx in one, and the hypopharynx in one. CT images of their head and neck showed metal artifacts in the tongue, parotid grand, oropharynx and upper neck. They had 12 to 19 teeth that had dental metal that needed to be removed. The removal required 6 to 13 days (2 to 5 visits per patient). All dental metal was replaced by acrylic resin crowns or resin fillings. After the procedures, metal artifacts disappeared and normal CT values appeared in the IMRT planning CT images. None of the patients had any problem with their chewing ability. Thus, it is better to remove dental metal prior to IMRT.

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Objectives: Total laryngectomy is still the standard treatment for locally advanced laryngeal cancer, particularly T4, although chemoradiotherapy has been developed for advanced head and neck cancers for organ preservation. At the Comprehensive Cancer Center of Kyoto University, both a head and neck surgeon and a radiation oncologist discuss the possibility of larynx preservation treatment even for locally advanced laryngeal cancers. The current preliminary study reports on the potential of larynx preservation treatment using induction chemotherapy for locally advanced laryngeal cancer.
Materials and Methods: The Comprehensive Cancer Center of Kyoto University was established in 2008, and 52 new cases with laryngeal cancer including seven cases with T3 or T4 cancer have been treated between 2008 and 2011. A retrospective chart review was performed to examine the efficacy of larynx preservation treatment in the T3/4 cases.
Results: Six cases were treated by larynx preservation regimen, while a supraglottic T4 case was treated by total laryngectomy because of comorbidity. Of the six cases, a glottis T3 case was treated with hyperfractionated radiotherapy, and the five other cases were treated by induction chemotherapy of TPF. Induction chemotherapy led to CR in one case and PR in three cases. Grade 5 toxicity occurred in one case. Chemoradiotherapy following induction chemotherapy was applied in two cases, while larynx preservation surgery was performed in two cases. All cases that completed larynx preservation treatment have demonstrated preservation of the larynx without recurrence during the follow-up period of 1 to 3 years (mean 2 years).
Conclusion: Although the number of patients and follow-up period are not sufficient, the current preliminary data suggest the possibility of larynx preservation treatment for locally advanced laryngeal cancers using induction chemotherapy followed by concurrent chemoradiotherapy (IMRT) or laryngeal preservation surgery.

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