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Objective Although neck dissection is an essential technique in the surgical treatment of head and neck carcinoma, arm abduction disorders occurring after neck dissection reduce the patient’s quality of life. Methods We prospectively evaluated the rate of lymph node metastasis in Levels IIB and V in head and neck cancer patients who underwent neck dissection at eight centres in Japan. In addition, post-operative arm abduction disability was classified according to functional assessment values at 1 month post-operatively, and the rate of maintained function at 6 and 12 months was evaluated. Results Lymph node metastasis occurred in Level IIB in 12 of 242 cases (4.9%) and in Level V in 5 cases (2.1%) during the 12-month post-operative course. In patients with preservation of the ipsilateral accessory nerve, arm abduction function was maintained in 142 of 209 patients (67.9%) at 12 months after surgery. Post-operative radiotherapy and Level V dissection had no statistically significant effect on the recovery of arm abduction function. Level V dissection caused a temporary loss of abduction function post-operatively. A higher arm abduction test score at 1 month post-operatively was associated with a higher rate of subsequent ability to maintain arm abduction function. Conclusions In patients classified as cN0, metastatic rate at Levels IIB and V was low. In this cohort, omitting Level V dissection may be an option in strategies aimed at maintaining arm abduction function.

MYB-NFIB and MYBL1-NFIB have been reported in ~60% of adenoid cystic carcinoma cases, but driver alterations in the remaining ~40% of adenoid cystic carcinoma remain unclear. We examined 100 adenoid cystic carcinoma cases for MYB and MYBL1 locus rearrangements by fluorescence in situ hybridization (FISH) with originally designed probe sets using formalin-fixed paraffin-embedded materials. Approximately one-third of samples were also analyzed by fusion transcript-specific RT-PCR and capture RNA sequencing. In the 27 cases with frozen materials, MYB-NFIB and MYBL1-NFIB fusion transcripts were detected in 9 (33%) and 6 cases (22%) by RT-PCR, respectively. Meanwhile, high expression of MYB (18 cases, 67%) or MYBL1 (9 cases, 33%) was detected in all 27 cases in a mutually exclusive manner, regardless of its form (full-length, truncation, or fusion transcript). Interestingly, genomic rearrangements around the corresponding highly-expressed gene were observed in all 27 cases by FISH, suggesting a causative relationship between genomic rearrangements and gene expression. Among the 100 cases, including additional 73 cases, 97 harbored genomic rearrangements in the MYB (73 cases) or MYBL1 locus (24 cases) including 10 cases with atypical FISH patterns undetectable through ordinary split FISH approaches: breakpoints far distant from MYB (5 cases) and a small NFIB locus insertion into the MYB (3 cases) or MYBL1 locus (2 cases). In clinicopathological analyses, histological grade, primary tumor size, and lymph node metastasis were identified as prognostic factors, whereas MYB/MYBL1 rearrangements were not, but were associated with histological grade. In the present study, MYB or MYBL1 locus rearrangement was detected in nearly all adenoid cystic carcinoma cases, and therefore it would be a good diagnostic marker for adenoid cystic carcinoma. However, fusion transcript-specific RT-PCR for MYB-NFIB and MYBL1-NFIB and ordinary split FISH assays for MYB and MYBL1 were less sensitive, and thus detection methods should be judiciously designed because of the diversity of rearrangement modes in adenoid cystic carcinoma.

Salivary duct carcinoma (SDC) constitutes one of the most aggressive cancers in the salivary gland and is associated with a poor prognosis; however, no established systemic therapy options are available. SDC exhibits biological similarity to prostate and breast cancers, therefore anti-hormone therapy and molecular target therapies are available, however with limited beneficial effects. Galanin and galanin receptors (GALRs) are well established as molecular biomarkers to predict the survival rate and risk of recurrence of head and neck squamous cell carcinoma. The present study investigated the clinicopathological features of patients with SDC and the methylation status of their galanin and GALR genes to demonstrate the prognostic value for this disease. The median overall survival (OS) was 37.2 months. T-stage, N-stage, disease stage, tumor size, and preoperative facial paralysis were significantly associated with OS, whereas human epidermal growth factor receptor 2 (HER2) overexpression was not. GALR1 and GALR2 methylation rates in tumor tissues were significantly increased compared with normal tissues with 9.85- and 4.49-fold increase, respectively. p27kip1 and p57kip2 expression significantly inversely correlated with the methylation rate of GALR1 and GALR2. In addition, the observed GALR1 and/or GALR2 methylation rates were significantly correlated with a decrease in OS. These results suggest that GALR1 and GALR2 may serve as potential prognostic factors and therapeutic targets in SDC.

Objectives Total pharyngolaryngectomy with free jejunal reconstruction is often performed in patients with hypopharyngeal carcinoma. However, postoperative speechlessness significantly decreases patient quality of life. We investigated whether Provox® insertion could preserve speech after total pharyngolaryngectomy with free jejunal reconstruction. Study Design Retrospective chart review. Methods A total of 130 cases of secondary Provox® insertions after total pharyngolaryngectomy with free jejunal reconstruction were analyzed. Communication outcomes were compared using the Head and Neck Cancer Understandability of Speech Subscale. Outcomes and complications associated with insertion site (jejunal insertion vs. esophageal insertion) and adjuvant irradiation therapy were also evaluated. Results Provox® insertion had favorable communication outcomes in 102 cases (78.4%). Neither the insertion site nor irradiation affected the communication outcome. Complications were observed in 20 cases (15.4%). Local infection was the most common complication. Free jejunal insertion, in which the resection range was enlarged, had a lower complication rate than did esophageal insertion, and its complication rate was unaffected by previous irradiation. For all patients, the hospitalization duration and duration of speechlessness were 13.4 days and 14.6 months, respectively. Patients receiving jejunal insertions had a significantly shorter hospitalization duration than did those receiving esophageal insertions. Unlike Provox®2, Provox®Vega significantly reduced the complication rate to zero. Conclusion For jejunal inserson of a Provox® prosthetic, a sufficient margin can be maintained during total pharyngolaryngectomy and irradiation can be performed, and satisfactory communication outcomes were observed. Provox® insertion after total pharyngolaryngectomy with free jejunal reconstruction should be considered the standard therapy for voice restoration. Level of Evidence 4.

Background Renal function influences decisions regarding treatment for patients with oropharyngeal squamous cell carcinoma (SCC). However, the importance of renal function in oropharyngeal SCC has not yet been reported. Methods Four hundred sixty patients with oropharyngeal SCC treated with curative intent between April 2005 and March 2007 in 12 institutions in Japan were analyzed retrospectively. Results Four hundred three patients (87.6%) showed a creatinine clearance (CrCl) ≥50 mL/min and 57 (12.4%) with a CrCl

Objective We aimed to clarify the suitable surgical management around the paratracheal area of patients who undergo total pharyngolaryngectomy based on the pathological results of hypopharyngeal cancer. Methods The study was conducted under a multicenter, retrospective observational design in Japan. We analyzed histopathological paratracheal lymph node metastasis and thyroid invasion, and recurrence around the paratracheal area for 184 patients who underwent initial surgery among 280 participants. Results There were significant differences in the frequency of metastasis to paratracheal lymph nodes as cN advances (P = 0.0344) and cT advances (P = 0.00028). By subsite, the paratracheal lymph node metastasis ratio was 22/130 patients (16.9%) in piriform sinus (PS), 8/32 (25.0%) in PW, 5/22 (22.7%) in PC and 10/17 (58.8%) in cervical esophagus (Ce+). The ratio of cases with bilateral paratracheal metastasis tended to be higher in cN2c, posterior wall (PW) and postcricoid (PC). Invasion to the thyroid was histopathologically confirmed in 16/184 patients (8.7%). Invasion from the primary lesion was in 15 patients. Conclusion This study indicates that it is better for patients with advanced hypopharyngeal cancer at minimum undergo ipsilateral paratracheal lymph node dissection. Tumor subsite of PW, PC or cN2c disease or disease extending to the Ce+ should be treated with bilateral paratracheal neck dissection. In order to more reliably perform paratracheal dissection, there is also an option to resect the thyroid lobe in the range of dissection. Preservation of the thyroid gland can be considered if invasion into the thyroid gland has been clearly ruled out.

Background: The current study sought to assess the role of initial neck dissection (ND) for patients with node-positive oropharyngeal squamous cell carcinomas (OPSCC). Methods: 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. Results: 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). Conclusions: 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. (C) 2014 Elsevier Ltd. All rights reserved.

Background The purpose of this retrospective analysis was to evaluate ocular function and survival rates among treatment modalities in patients with maxillary sinus cancer with orbital invasion. Methods Eighty-seven patients were classified according to the main treatment modality. Ocular function preservation rates and survival rates were evaluated for each therapeutic modality. Results The 5-year overall survival rate for the en bloc resection, conservative surgery, superselective intra-arterial chemotherapy, and radiotherapy (RADPLAT), intravenous chemoradiotherapy (IV-CRT) was 70%, 35%, 49%, and 31%, respectively. The ocular function preservation rate for each group was 15%, 27%, 30%, and 17%, respectively. In the en bloc resection group, there was no significant difference in the 5-year overall survival rate between patients with orbital exenteration and those without orbital exenteration (72% vs 71%; p = .9321). Conclusion The en bloc resection group showed a favorable survival rate but a low preservation rate. Preservation of orbital contents did not reduce the survival rate. © 2014 Wiley Periodicals, Inc. Head Neck 37: 537–542, 2015

While the biological behavior of follicular thyroid carcinoma (FTC) has been studied in great detail using clinical experience, few studies have investigated pre- or intraoperative factors related to the risk of distant metastasis (DM) among patients with FTC. The aim of this study was to analyze the characteristics of FTC with DM.This study retrospectively investigated 102 patients with FTC who underwent surgery between 1988 and 2013. We compared clinicopathological characteristics between FTC with and without DM.Univariate analysis revealed nodal metastasis (p=0.045), serum thyroglobulin (Tg) at initial operation (≥1000ng/ml; p0.0001), widely invasive appearance according to macroscopic findings (p0.0001), thick tumor capsule (≥1mm; p0.0001), vascular invasion (p=0.0003), extrathyroidal invasion (p=0.047), and venous tumor embolism (p=0.045) as significant risk factors for DM. Multivariate analysis conducted using pre- and intraoperative factors identified thick tumor capsule (≥1mm), serum Tg at initial operation (≥1000ng/ml), and macroscopically widely invasive appearance as risk factors independently associated with development of DM.Patients with these risk factors should undergo total thyroidectomy and radioactive iodine ablation.

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.

Ectopic hamartomatous thymoma (EHT) is an extremely rare benign tumor. EHTs are difficult to differentiate from sarcomas, especially synovial sarcomas. We encountered two cases of EHT that were referred from other hospitals because sarcoma was suspected. In these cases, fusion gene detection via polymerase chain reaction or fluorescence in situ hybridization was useful for differentiating EHT from synovial sarcoma. EHT requires accurate diagnosis before surgery to avoid excessive treatment. Both tumor location and the presence of fat inside the tumor are important imaging findings for EHT, and confirmation of spindle cells, epithelial cells, and mature adipose cells in the tumor is an important pathological finding. It is important to exclude synovial sarcoma from the differential diagnosis via fusion gene analysis.

Anaplastic thyroid cancer is a fatal disease for which no effective therapeutic strategies exist. Lenvatinib, a tyrosine-kinase inhibitor that targets vascular endothelial growth factor receptor, has recently been approved in Japan for the treatment of patients with unresectable thyroid cancer including anaplastic thyroid cancer. Although lenvatinib, like the other tyrosine-kinase inhibitors, sunitinib and sorafenib, might also confer a risk of bleeding, fatal bleeding as a result of lenvatinib treatment for anaplastic thyroid cancer has not been described. A 61-year-old woman presented with a 7-cm mass in the right lobe of the thyroid, lymph node metastases to the neck and multiple lung metastases. Fine needle aspiration revealed that the tumor was anaplastic thyroid cancer. The TNM classification was T4aN1bM1, stage IVC. Shortly after local curative surgery, a tumor recurred in her neck that was treated with lenvatinib (24 mg/day). Nineteen days later, the common carotid artery ruptured and the lenvatinib was stopped. She received the best possible supportive care but died 40 days after stopping the lenvatinib. Autopsy findings showed that the tumor had invaded the adventitia of the common carotid artery at the region of the neck surgery, and an aneurysm had developed. However, the adventitia of the common carotid artery was preserved at the non-dissected area. Lenvatinib might confer risk for fatal bleeding in patients with recurrent anaplastic thyroid cancer after neck surgery, particularly with dissection around the common carotid artery.

1980年1月から2010年12月までの30年間にがん研病院頭頸科で一次治療として手術を行った頭頸部原発粘膜悪性黒色腫40例の治療成績を検討した。男女比1：1，年齢は24～79歳（中央値62歳），観察期間は5～174ヶ月（中央値23ヶ月）であった。原発臓器は鼻副鼻腔：28例，口腔：9例，咽頭：3例。TNM分類（AJCC/UICC第7版）ではT3：8例，T4a：23例，T4b：9例でN0：36例，N1：4例，stage III：6例，stage IVA：25例，stage IVB：9例であった。Kaplan-Meier法による5年局所制御率，粗生存率，無再発生存率は70%，43%，29%であった。TNM分類は臨床的な予後とよく相関し，T4b，N1は予後不良であった。原発後方再発の制御が課題と考えられた。後発頸部リンパ節転移も高率にみとめ，頸部郭清が治療成績の維持に一定の効果を認めた。

The carcinogenetic role of human papillomavirus (HPV) in mobile tongue cancer remains unclear because of conflicting results reported in the literature. This disparity is likely to be due to variations in the samples and methods used. Furthermore, despite a tendency for increased prevalence of mobile tongue cancer in young adults, only a few reports specifically in young patients have been published. In the present study on 32 patients, including six in their 20s, we genotyped the prevalence of HPV using a highly sensitive detection tool in fresh-frozen samples from surgical specimens and a novel detection device with electrochemical DNA chip and loop-mediated isothermal amplification. In addition, we confirmed HPV prevalence by in situ hybridization and immunohistochemistry for the p16(INK4a) protein, regarded as a biomarker of HPV-associated cancers. The frequency of 13 genotypes of high-risk HPV was 0/32 (0%), which was further confirmed by in situ hybridization. Overexpression of p16(INK4a) protein was observed in six of the 32 patients (19%), with four (67%) also overexpressing p53. Because there is usually a lack of p53 overexpression in HPV-associated cancer, it is unlikely that p16(INK4a) protein overexpression is correlated with HPV infection. Consequently, it is unlikely that HPV infection plays an important role in mobile tongue carcinogenesis, in particular in young adults. In addition, our data suggest that the overexpression of p16(INK4a) protein is not an appropriate biomarker for HPV association in mobile tongue carcinogenesis.

The aim of this study was to evaluate the efficacy of surgical resection of oral tongue cancer (OTC) pulmonary metastases. Between 1977 and 2003, 23 OTC patients who developed 1-3 pulmonary metastases underwent metastasectomy. There were 14 men and nine women with a median age at the time of first metastasectomy of 56 years. All patients had advanced squamous cell OTC with synchronous or metachronous regional lymph node metastases. The median tumor-free interval after the last OTC treatment was 12 months. Five patients underwent pneumonectomy, three bilobectomy, 13 lobectomy, and two wedge resection. Two patients underwent a second pulmonary metastasectomy. One patient continues to survive, without recurrence 19 years after metastasectomy. Another patient was alive with disease at 24 months after metastasectomy but was lost to follow-up. Twenty-two out of 23 patients developed systemic metastases. The median interval to systemic recurrence after lung resection was 4.1 months, and 21 out of 23 patients died of OTC (median, 9.5 months) after metastasectomy. Most patients who underwent pulmonary metastasectomy died of the disease within two years of metastasectomy. Even for patients with a solitary metastasis, surgical metastasectomy is not a recommended treatment option.

Introduction Thyroid hemangioma is very rare, and only a few cases have previously been reported. We encountered a patient with thyroid hemangioma diagnosed after surgery. Case Report A 71-year-old woman visited our hospital with a mass in the left thyroid region. A 5-cm, elastic mass of the thyroid was palpable in the left anterior neck. On cytology by fine-needle aspiration (FNA), the specimen mainly contained blood components without apparent atypical cells. A tumor with abundant blood flow was suspected based on Doppler ultrasonography. Adenomatous goiter was suspected, and subtotal thyroidectomy was performed. A blood clot was present in the tumor, and hemangioma was diagnosed on postoperative histopathological examination. Discussion Preoperative diagnosis of thyroid hemangioma is difficult. However, Doppler ultrasonography and FNA are useful for diagnosis. A differential diagnosis of hemangioma should be considered when blood flow is abundant and only blood components are collected.

Narrow-band imaging (NBI) is a novel optical technique that uses narrow bandwidth filters in a video endoscope system to improve the diagnostic capability of endoscopes in characterizing tissues. It is well known that early identification of neoplasia in the gastrointestinal tract using this technique might make it possible to reduce the suffering of patients caused by loss of function or severe complications after radical surgery. Several reports have introduced this system as a preoperative examination to evaluate the lateral spread of the neoplastic lesions in the oropharynx or hypopharynx. We experienced a case with hypopharyngeal cancer in which we were able to avoid underestimating cancer lesions following insufficient resection using the NBI system. A 62-year-old female underwent partial hypopharyngectomy with the margin estimated by an NBI view coupled with reconstruction of the hypopharynx while preserving the larynx. The resected specimen was cut into serial sections for a detailed pathology examination. The surgical margin seemed to be wide enough and it could be assumed that if possible we should observe these cancers with conventional electroendoscopy and NBI before treatment.

Background: Evaluating recurrent laryngeal nerve function before and after thyroid surgery is important. Although laryngeal electroendoscope is the most reliable tool for evaluating vocal fold (VF) mobility, ultrasonography (US) may offer a non-invasive alternative. The aim of this study is to evaluate the validity and limitation of US evaluation for the assessment of VF mobility. Methods: This was a study for diagnostic testing of US in a single center. One hundred and one patients who underwent thyroid surgery between February 2011 and August 2011 were enrolled to this study. Observation of the VF mobility using a B-mode US scanner was performed before and after thyroid surgery, through the thyrohyoid membrane, thyroid notch, and cricothyroid membrane. The results of US were compared with those of electroendoscopic examination which was performed on the same day but after the US. Results: First we excluded one case that could not be observed by electroendoscopic examination before surgery. After excluding the cases which the VF mobility was invisible by US, we analyzed 89 out of the 100 patients before thyroid surgery and 89 out of the 101 patients after surgery. The sensitivity and specificity of US were 87.5%, 100% for before and 94.4%, 100% for after surgery, respectively. It was significantly more difficult to assess the VF mobility by US among patients who were men (odds ratio [OR] 24.7, 95% confidence interval [CI] 4.9-124.2), 65 years old or more (OR 3.5, 95% CI 1.0-11.9), and have past history of thyroid surgery (OR 7.9, 95% CI 2.1-29.2). Being obese was also a significant factor (OR 10.5, 95% CI 1.7-64.8) among younger patients (less than 65 years). Conclusion: US evaluation can be used for the assessment of recurrent laryngeal nerve function before and after thyroid surgery. This is a safe and non-invasive diagnostic tool which may be performed as a first-line method.

Although high-dose cisplatin is the standard regimen of concurrent chemoradiotherapy (CCRT) for locally advanced head and neck squamous cell carcinoma (HNSCC), varying levels of patient tolerance towards cisplatin have been reported, and the predictive factors of cisplatin tolerance remain to be elucidated. The present study retrospectively reviewed newly diagnosed HNSCC patients who received CCRT. Cisplatin (80 mg/m2) was administered every 3 weeks. The proportion of high-dose cisplatin-tolerant patients (cumulative cisplatin dose, ≥200 mg/m2) was determined, and the predictive factors of cisplatin tolerance were analyzed in a logistic regression analysis. Between June 2006 and March 2013, a total of 159 patients were treated with CCRT. The median follow-up time was 36.7 months. A total of 73 patients (46%) tolerated a cumulative cisplatin dose ≥200 mg/m2; male gender [odds ratio (OR), 25.00; P=0.005] and high body surface area (BSA) (>1.80 m2; OR, 2.21; P=0.032) were significantly predictive of high-dose cisplatin tolerance. The high-dose cisplatin-tolerant patients had a significantly higher complete response (CR) rate (82 vs. 67%, P=0.045); however, there were no significant between-group differences in the 3-year OS (79.5 vs. 81.2%, P=0.59) or PFS (70.4 vs. 44.6%, P=0.076) by cisplatin tolerance. In clinical practice, approximately one-half of the patients tolerated high-dose cisplatin in CCRT. Male gender and high BSA could be predictive of cisplatin tolerance.

Although in recent years there have been a tendency to choose partial hypopharyngectomy with laryngeal preservation in some cases of early stage hypopharyngeal cancer, the standard operation for advanced stage is still considered to consist primarily of total pharyngolaryngectomy. In this article, we report a case of an advanced T3 hypopharyngeal cancer with laryngeal preservation. The field of resection ranged from most of the piriform sinus to the epiglottis, aryepiglottic fold, paraglottic space, false vocal cord, and a part of the arytenoids. Although the resected area encompassed such a large area as described above, we succeeded in the reconstruction with several devices and attained good swallowing function by making the bulky rectus abdominal myocutaneous flap over-hang the supraglottic space and occupying the piriform sinus of the affected side with it. In conclusion, we believe that there is a possibility to perform partial hypopharyngectomy with laryngeal preservation even in T3 cases when movement of bilateral arytenoids and vocal cords are both intact.

1985年から1999年までに当科で根治治療を行った上歯肉，硬口蓋原発扁平上皮癌51例を対象として原発巣制御の治療成績を検討した。この時期における全体の原発巣制御率は70.6%であったが，治療法別では，手術のみ73.3%，根治照射71.4%，術前照射＋手術68%，T分類別ではT1：85.7%，T2：60%，T3：77.8%，T4：80%，術式別では上顎部切69.2%，上顎全摘80%であった。腫瘍の存在部位と原発巣制御の関係をみてみると，口腔前方に腫瘍が存在する場合，制御は良好であったが，後側方や正中に存在する場合で制御が不良であり，再発部位として側頭下窩深部や翼口蓋窩への再発が比較的多く認められた。このような例では救済手術が不可能で，直接的な死因となることが多いため，手術手技上，後方側方への深い浸潤がある例では，できるだけ良好な視野が得られるようなアプローチを充分計画することが大切と思われた。

1979年11月から2000年2月までに当科で根治手術を施行した原発性顎下腺癌，舌下腺癌新鮮例33例を対象として治療成績ならびに臨床像について検討した。33例の内訳は腺様嚢胞癌16例，腺癌7例，粘表皮癌6例，その他4例であった。TNM分類，病期分類ではT1：2例，T2：14例，T3：15例，T4：2例，N0：25例，N（+）：8例，I期：13例，II期：11例，III期：1例，IV期：8例であった。全症例の原発巣制御率は5年で75.5%，10年で61.8%，疾患特異的累積生存率は5年で52.2%，10年では47.5%であった。原発巣制御では充分な安全域を取った一塊切除を行うことが重要であると考えられた。一方，生存率に強く影響を与える因子として頸部リンパ節転移の有無があげられた。また，再発例の治療では遠隔転移に対する制御が重要と考えられた。

近年の頸部郭清の術式はより機能温存的な方向に向かっている。N0症例には様々なSNDが考案され普及したが，N+症例にも周囲組織の保存や郭清野の縮小が可能か否か検討した。1985年から2000年までの舌癌でリンパ節転移陽性の頸部137側と，1995年から2001年までの下咽頭癌でリンパ節転移陽性の頸部83側を対象としたところ，舌癌ではRNDの頸部制御率が80%に対しmRNDは91%，下咽頭癌ではRNDが79%で，mRNDが92%であった。また後頸部への転移症例は舌癌で3%，下咽頭癌で8%あったが，そのほとんどは胸鎖乳突筋後縁のすぐ後方にあった。当科で最近行っている前方からのアプローチによる頸部郭清の術式を示し，今後はN+症例であっても場合によりこのような郭清で周囲組織の保存と後頸部の郭清野の縮小を行っても問題のない可能性を示した。

We evaluated the usefulness and limitations in ultrasonography (US) for diagnosing neck lymph node metastases in patients with hypopharyngeal cancer by comparing the results of preoperative US examinations with postoperative pathological findings following neck dissection. Seventy-five previously untreated patients with hypopharyngeal squamous cell carcinoma underwent a curative procedure that included neck dissection. Preoperatively, all patients were examined by palpation, computed tomography (CT), and US. Postoperatively, all dissected neck lymph nodes were submitted for pathological examination. Results of pre-and postoperative examinations were then compared. US accuracy for each lymph node was 93.9%, while sensitivity was 78.0%, since hypopharyngeal cancer metastasizes early and easily to the neck lymph nodes, and it is difficult to detect small, pathologically positive nodes. Nine of 75 cases showed latent neck recurrence, and two of these were underestimated by US. The major cause for neck recurrence was considered to be the high rate of metastases in such cases, rather than a reduced dissection field. It is not rare to find very small, pathologically positive lymph nodes that US cannot detect in hypopharyngeal cancer. Efforts must therefore be expanded to improve the accuracy of US diagnosis. Care must also be taken when selecting cases for no or limited neck dissection.

遠隔転移 (M) は甲状腺乳頭癌 (PTC) において最大の予後不良因子であるが, PTCのMには長期間進行しない例も少なくなく, その予後予測は容易でない。当科におけるPTC 604例 (1976～98年, 微小癌は除く) 中, 初回治療時Mを認めたものは32例 (5.3%), 術後経過観察中にMを認めたものは26例 (4.3%) であった。全M症例58例中28例 (48.3%) が原病死していたが, うち5例は局所の原因による死亡であった。一方, 7例は治療によりMが消失していた。5年以上の経過観察でMが進行していない24例とMが急速に進行した24例を比較すると, 前者には若年者, Mが小さいもの, 肺のみに遠隔転移したもの, 原発巣の病理組織像が高分化成分主体のものが有意に多かった。Mに対しては131Iによる内照射治療や切除手術を適宜行うが, 特に進行の遅いことが予測されるM症例では, 局所の制御も重要であると考えられた。

The indication and preferred dissection field for prophylactic neck dissection for submandibular gland cancer are controversial and have not been standardized. We reviewed 27 patients who underwent a definitive operation for previously untreated submandibular gland cancer. The 27 patients consisted of 13 patients with adenoid cystic carcinoma, 6 patients with mucoepidermoid carcinoma, 6 patients with adenocarcinoma, and 2 patients with squamous cell carcinoma. The diagnostic accuracies of malignancy and histology with fine needle aspiration cytology were 86% and 56%, respectively. In sixteen out of 21 cases without neck lymph node metastasis, a prophylactic neck dissection was performed and pathological neck lymph node metastases were detected in five cases. On the other hand, in five cases that did not receive a prophylactic neck dissection, latent neck lymph node metastasis was observed in 2 cases. In both cases of neck lymph node metastasis, pathological positive lymph nodes were observed in only level 2 or level 3. The rates of occult neck lymph node metastasis according to the T stage were 0% in TI, 33.3% in T2, 57.1% in T3 and 100% in T4. The rates of occult neck lymph node metastasis according to the histopathology were 46.2% in adenoid cystic carcinoma, 50% in mucoepidermoid carcinoma. 50% in adenocarcinoma, and 50% in squamous cell carcinoma. In conclusion, we believe that supraomohyoid neck dissection is suitable fur NO cases of submandibular gland cancer because of four reasons : 1) rate of occult neck lymph node metastasis in submandibular gland cancer is high, 2) pathological neck lymph node metastasis in No cases and latent neck lymph node metastasis were observed in level 2 and level 3, 3) the prognosis of cases with neck lymph node metastasis was poor, and 4) same skin incision can be used not only for the primary resection but also for the neck dissection.

1990年1月から1999年12月までの頭頸部管腔癌患者 (扁平上皮癌) 計2297例のうち, 頭頸部癌の治療時および治療後2000年12月までに重複癌を認めたものは258例 (11.2%) あった。重複部位は多いものから順に, 食道, 頭頸部, 胃, 肺であった。同時重複食道癌は81例あったが, 下咽頭癌の13.7%に初診時食道癌を合併していた。そのなかで20例が治療として喉頭全摘を含む同時手術が施行されていたが, 開胸して縦隔を郭清したものは気管断端の壊死が生じる頻度がやや高くなり, それを防ぐために甲状腺を気管に付着させたままで保存する術式や, 敢えて異時手術とする場合を紹介した。

近年, 頭頸部癌の早期診断と治療法の進歩により, 初発癌の制御が向上し, 続発癌に遭遇する機会が増加する傾向にある。そのため時に, 口腔内に限局して多発し, 診断, 加療に苦慮させられる症例に直面することが少なくない。そこで今回われわれは, 口腔内多重癌に着目し, 主にその治療法について検討を加えた。対象は1960年1月から1998年12月まで39年間に当科を受診した口唇癌を含む口腔扁平上皮癌2169例中, 口腔内多重癌1次症例30例であった。その内訳は, 同時性癌7例, 異時性癌23例であった。初発癌に対する第1次治療としては, 同時性癌では7例中5例で外科的切除が施行されていた。一方, 異時性癌では23例中12例が放射線治療単独であった。外科的切除を施行した18例中14例が制御可能であった。これらのことから, 口腔内多重癌の治療法としては外科的切除が有効であると考えられた。

先に, 甲状腺乳頭癌において3cm以上の大きなリンパ節転移 (CN3) は, 特に50歳以上の患者で重要な予後不良因子となることを報告した。今回, 乳頭癌604例を対象に, そのリンパ節転移の意義に関してさらに詳細に検討した。CN3の disease specific survival に対する risk 比は年齢50歳以上で5.3と有意に高く, CN3ありの60例中20例が原病死していた。遠隔転移死が12例, リンパ節再発の繰り返しによる死亡が4例であった。一方, 病理組織学的リンパ節転移5個以上 (PN5) の症例では disease free survival に対する risk 比が年齢50歳未満で3.5と有意に高かった。50歳未満でPN5ありの115例中18例16%でリンパ節再発がみられた。リンパ節転移の大きさは特に高齢者で, 遠隔転移や局所再発の繰り返しに伴う低分化化による癌死危険度と関連し, リンパ節転移の数は特に若年者で, リンパ管侵襲の程度を反映しリンパ節再発率と関連することがわかった。

低侵襲な治療が望まれる近年の流れの中で, 当科の手術治療における工夫や注意点を挙げた。また今後の低侵襲手術の適応を考えるために, 遊離皮弁再建症例の合併症率や, 切除や再建を縮小せざるを得なかった高齢者の手術治療結果を検討した。その結果当科での2001年12月までの遊離皮弁再建症例全1,843例中, 全体の合併症率は24.3%, さらにその中で皮弁の全壊死率は2.7%であった。また80歳以上の高齢者で手術治療を中心に行ったものは85例あり, その中で遊離皮弁再建症例は15例あったが全例皮弁は生着した。高齢者は術後に重篤な合併症を起こす危険性があるが, 必要以上に再建手術を縮小すると創部の合併症や機能低下をきたすこともあることが示唆された。

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.

頭頸部腫瘍術後嚥下障害に対する頸部聴診法の判定精度を明らかとするため, 頭頸部腫瘍患者の頸部より検査条件を規格化して検出した嚥下時産生音を対象として, 嚥下障害の有無について音響特性の臨界値による判定および聴覚による判定の精度を検討し, 以下の結果を得た。1. 嚥下音 (159音) の持続時間の臨界値 (0.79秒) による判定とVF所見との判定一致率は77.3%であった。2. 嚥下後呼気音 (194音) における0～250Hz帯域の補正音圧レベルの臨界値 (25.3dB) による判定とVF所見との判定一致率は77.3%であった。3. 嚥下前の呼気音・嚥下音・嚥下後の呼気音からなる44サンプルについて, 6名の検者による聴覚的判定とVF所見との判定一致率は83.5%であった。

両側転移を伴う主な頭頸部癌の, 手術主体の治療を行う際の対応を考察するため, 10年間の病理学的両側転移症例の治療成績を検討した。喉頭癌 (16例, 全症例の4.3%, 以下同様) の5年粗生存率は31%であり, 他の癌と比較すると予後良好で, 根治を目指せる症例が多かった。下咽頭癌 (32例, 19%) の5年粗生存率は19%で, 総転移個数が6個以上の症例と, 5個以下の症例では, 生存率に有意差を認めた。また従来の adluvant chemotherapy は無効と思われ, 新たな方法の開発が必要と考えられた。中咽頭癌 (16例, 13%) は, 他癌と比較すると予後不良 (5年粗生存率13%) であったが, 臨床的両側転移症例で, 術前治療奏効群の中に, 根治治療を目指せる症例があった。舌癌 (16例, 4.3%) の5年粗生存率は19%であり, 臨床的・病理学的に明らかな両側転移症例では, 2年以内の生存しか得られず, 手術適応には熟考を要した。また健側の最低位転移レベルがIII以下の症例でも長期生存はなかった。

This study evaluates the use of ultrasonography (USG) to diagnose metastatic cervical lymph nodes. Three-hundred and one lymph nodes were removed from 58 patients with squamous cell carcinomas of the head and neck. None of the patients had received any preoperative treatments for cancer. The lymph nodes were then histopathologically examined: 139 metastatic lymph nodes and 162 non-metastatic nodes were found. USG was then used to evaluate the size, internal echo, and margin of each lymph node. Size was found to be the best criteria for distinguishing metastatic lymph nodes from non-metastatic lymph nodes in all cervical regions (78% accuracy). Superior internal jugular lymph nodes and submandibular lymph nodes larger than 7 mm and mid and inferior internal jugular lymph nodes larger than 6 mm were regarded as metastatic. Internal echoes were classified into five patterns: homogeneous hypoechoic, homogeneous hyperechoic, heterogeneous, eccentric hyperechoic, and centric hyperechoic. Homogeneous hyperechoic and heterogeneous patterns were characteristic of metastatic nodes, while eccentric hyperechoic patterns were characteristic of non-metastatic nodes. Homogeneous hypoechoic patterns were observed in both metastatic and non-metastatic nodes. Regular margins were found in 81% of the metastatic nodes. Of the 22 lymph nodes with irregular margins, however, 91% were metastatic. Evaluations using a combination of USG and clinical feature criteria were compared with evaluations using only thickness as a criterium. Although thickness is the single most important factor in diagnosing metastatic nodes, the combination of USG and clinical feature criteria improved the accuracy of diagnosis to 83%. Thus, diagnostic methods involving a combination of several criteria are more accurate than methods involving only a single criterium.