From 1954 to 2001 the author Shimizu, M. worked for oral tumor and cancer researches in clinical and basic fields at Tokyo Medical & Dental University till 1981, afterwards at Oita Medical University till 1996, now at the Hospital in Saiki. At first he studied the clinical research under three Professors, Adachi at Dept. of Radiology, Nakamura and Ueno at Dept. of Oral Surgery. On the article, Shimizu wrote his severe clinical experiences during 15 years at first where he was taught by his teachers. The treating possibility for oral cancer was strictly limitted at that time, but it was changed by passing of the historical years. Therefore, he encountered some unusual and sad cases, which would be not believable from the present situation. For example, the age limitaion for tumor operation like as mandiblectomy of the lower gum cancer was set under 60 years old. The first trial of the general anesthesia failed in an operation for a female patient with cancer of the mouth floor, because of a total lack of preparation. In 1954 otherwise, he could observe the first lucky male case with cancer of the maxillary sinus, which was firstly decided as inoperable but secondary cured by radiotherapy alone radically over 14 years. The article ended at the year of 1970, where he was a still young trainee for oral surgerv. If a chance for the next article were given to him, he could report the chronicle till 2001.

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A multivariate analysis using Cox's proportional hazards model was carried out on 73 patients with carcinoma of the lower alveolus and gingiva treated by surgery, to identify prognostic indicators for survival. Disease-specific survival was adversely affected by the type of mandibular absorption on X-ray (p=0.0055) and pathologically proven cervical lymph node metastasis (p=0.0277) . Disease-specific five-year cumulative survival rates according to the type of mandibular absorption were 93.5% for patients with no change, 92.9% for patients with erosive type, and 53.6% for patients with invasive type. Radiological findings of mandibular absorption can represent various characteristics and behaviors of carcinoma of the lower alveolus and gingiva. Disease-specific survival rates according to the cervical lymph node metastasis were 91.8% for patients without metastasis, and 54.1% for patients with metastasis. The invasive type of mandibular absorption on X-ray and pathologically proven lymph node metastasis was strongly associated with a poor prognosis for carcinoma of the lower alveolus and gingiva.

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For the past several decades, low-dose-rate (LDR) interstitial brachytherapy has been an accepted method of treatment for patients with early tongue cancer, in consideration of a high local control rate and preservation of shape and function of the tongue. However, LDR caused some problems, e.g. radiation exposure to medical staff, and the necessity of isolating patients. Recently, high-dose-rate (HDR) brachytherapy, which is free from these problems, has been developed and applied to various malignant tumors. The aim of this study was to evaluate the usefulness of HDR for stage I-II tongue cancer.
Twenty-five patients with stage I-II tongue cancer underwent HDR between 1995 and 1999. The status of local control and late neck metastasis, the survival rate, and the frequency of bone necrosis of these patients were examined in comparison with a historical control, composed of 71 patients who underwent LDR between 1980 and 1995. The following results were obtained.
1) The local control rate in the HDR group was 75% in stage I and 54% in stage II patients, while that in the LDR group was 91% in stage I and 84% in stage II.
2) There were no apparent differences in the frequency of late neck metastasis between the two groups.
3) The survival rate in the HDR group was 64% in stage I and 38% in stage II patients, while that in the LDR group was 85% in stage I and 71% in stage II.
4) Osteonecrosis occurred earlier and more frequently in the HDR group.
5) These results showed that great caution is necessary in performing HDR therapy, until further studies are done using many institutions.

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Clinical investigation was conducted on reconstruction cases after resection of oral malignant tumors during the 20-year period between 1978 and 1997. Reconstruction by artificial materials, such as Terdermis^® and Duo-Active^®, accounted for 34.0% ; reconstruction by a local flap, such as a tongue flap and a buccal mucosal flap, accounted for 18.9%, and reconstruction by a sternocleido mastoid myocutaneous (SMMC) flap accounted for 14.7%. The number of extended reconstructions, such as a free flap and a pectoralis major myocutaneous flap, was small.
Primary lesions of cases for which a SMMC flap was used were as follows : 9 tongues, 19 mouth floors, 24 mandibular gingivas, 3 buccal mucosas, and 7 oropharynxes. Their T stages were 2T1, 20T2, 11T3, and 29T4. Primary lesions of the cases for which a platysma myocutaneous (PLMMC) flap was used were as follows : 4 mouth floors, 1 mandibular gingiva, and 1 buccal mucosa. Their T stages were 1T1, 3T2, 1T3, and 1T4.
SMMC flaps and PLMMC flaps do not require extended operating time as compared with free flaps by microsurgery, and when supraomohyoid neck dissection and functional neck dissection are adequately performed, the indication of these flaps might be extended.

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