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Cancer immunotherapy is designed to activate and up-regulate the host immune responses against tumor cells and is currently in use or under investigation for cancer treatments. Although tumor cells can use a variety of mechanisms to create an immunosuppressive environment, many agents and strategies to reduce or eliminate tumor-induced immune suppression are either being developed or already in clinical trials. This review deals with recent advances in cancer immunotherapy, focusing on new strategies to enhance antitumor immunity. Numerous approaches have been tested for the development of therapeutic cancer vaccines. Recently, several promising reports suggest that clinical benefit has been shown in randomized phase III trials for vaccines against prostate cancer, follicular lymphoma, and melanoma. Moreover, in 2010, the first patient-specific immunotherapy (sipuleucel-T) was approved by the FDA for the treatment of prostate cancer. On the other hand, some chemotherapeutic agents such as cyclophosphamide and docetaxel, have direct effects on the immune system that is likely to contribute to an improved antitumor immunity. Therefore, cancer immunotherapy combined with chemotherapy may represent one approach for breaking tumor-induced immune suppression. To date, a number of monoclonal antibodies are in use or under evaluation. Among these antibodies, blocking negative immunoregulatory receptors, CTLA-4 and PD-1, also represent a new strategy to induce antitumor immunity by manipulation of the immune system. In clinical trials, these antibodies could increase anti-tumor T-cell immunity and result in objective tumor regression in some patients. Thus, accumulating data from recent cancer vaccine trials, the manipulation of immune suppression using chemotherapeutic agents, and the use of immune-stimulatory antibodies raise the hope that immunotherapy could become the fourth modality of cancer treatment. Based on these new findings, in our hospital, a clinical trial using dendritic cells combined with low dose cyclophosphamide and docetaxel in patients with relapsed and refractory head and neck squamous cell carcinoma is under way (UMIN000003725, ClinicalTrials.gov identifier, NCT01149902). In the near future, various immunotherapeutic modalities will most probably be applied as novel approaches in the treatment of head and neck cancer.

Although the main symptom of facial nerve neurinoma is facial paralysis, it has been reported that about 30% of patients with facial nerve tumor do not demonstrate symptoms of facial paralysis at the initial diagnosis. Although facial nerve neurinoma is a benign tumor that can be completely treated by surgical extraction, irreversible facial paralysis is almost unavoidable. Therefore, one method is to wait until facial paralysis has clearly developed before performing surgery. However, enlargement of the tumor may cause destruction of adjacent organs and serious complications. Therefore, we must carefully consider the surgical timing as well as how we explain the risk of complications to the patient.In this case, there was an interval of six years from the initial diagnosis of neurinoma until the patient consented to surgery. The tumor had extended from the horizontal portion of the facial nerve to the parotid gland, and destroyed not only the facial canal but also the structures of the middle ear and the posterior wall of the external auditory meatus, causing conductive hearing loss. Severe facial paralysis and moderate conductive hearing loss was present at the time of surgery. Postoperative functional loss was minimized by performing tympanoplasty type III and facial nerve reconstruction by interposition to the hypoglossal nerve.

We reported four cases demonstrating severe visual disturbance due to mucoceles of the posterior paranasal sinuses. Two of the four patients also complained of headache and blepharoptosis or retroorbital pain. All patients were referred to our out-patient clinic by a neurosurgeon or ophthalmologist. They underwent emergency drainage surgery. We found a bony defect of the optic nerve canal in all patients. Three patients reported remarkable improvement of visual acuity postoperatively, although the optic disc in one patient appeared pale preoperatively. The remaining patient did not recover visual acuity. In that case, the optic disc was preoperatively edematous and hyperemic, and become atrophic postoperatively. There was bacteria growth found on culture of the contents of mucoceles. All patients had consulted either a local physician or ophthalmologist within two days of symptom onset. However, patients were referred to us five to 11 days (average: five days) after they initially consulted their hospital. Early diagnosis and prompt surgical management are indispensable in the treatment of severe visual disturbance due to mucoceles of the posterior paranasal sinuses.