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Pembrolizumab and chemotherapy (chemoimmunotherapy) were administered to 2 head and neck squamous cell carcinoma (HNSCC) patients with extremely advanced local tumors and distant metastases with palliative intent. However, they demonstrated strikingly good responses and achieved remission. Expanded application of induction chemoimmunotherapy may be useful for locally advanced HNSCC.

Human papillomavirus (HPV)-related oropharyngeal small-cell carcinoma (OPSmCC) is a rare malignancy with aggressive behavior, whereas HPV-related oropharyngeal squamous-cell carcinoma (OPSqCC) displays a favorable prognosis. Notably, these two malignancies occasionally arise in an identical tumor. In this case study, we explored the molecular characteristics that distinguishes these two carcinomas using a rare case of HPV-related oropharyngeal carcinoma (OPC) with the combined histology of SmCC and SqCC. Immunohistochemical analysis and HPV-RNA in situ hybridization (ISH) suggested that both SmCC and SqCC were HPV-related malignancies. Targeted exome sequencing revealed that SmCC and SqCC had no significant difference in mutations of known driver genes. In contrast, RNA sequencing followed by bioinformatic analyses suggested that aberrant transcriptional programs may be responsible for the neuroendocrine differentiation of HPV-related OPC. Compared to SqCC, genes up-regulated in SmCC were functionally enriched in inflammatory and immune responses (e.g., arachidonic acid metabolism). We then developed a SmCC-like gene module (top 10 up-regulated genes) and found that OPC patients with high module activity showed poor prognosis in The Cancer Genome Atlas (TCGA) and GSE65858 cohort. Gene set enrichment analysis of the SmCC-like gene module suggested its link to MYC proto-oncogene in the TCGA data set. Taken together, these findings suggest that the SmCC-like gene module may contribute to acquisition of aggressive phenotypes and tumor heterogeneity of HPV-related OPC. The present case study is the first report of genetic and transcriptomic aberrations in HPV-related OPSmCC combined with SqCC.

Spindle cell carcinoma of the head and neck is a rare neoplasm. We at Kyushu Cancer Center experienced 6 cases of spindle cell carcinoma which accounted for 0.9% of all cases of head and neck squamous cell carcinoma. These cases presented with the characteristic clinical presentation, such as a particular form (polypoid and exophytic) and difficulty of pathological diagnosis. For treatment, surgery was performed in the main, but in one case of hypopharyngeal cancer chemoradiotherapy was undertaken. Spindle cell carcinoma exhibits a poor prognosis, compared with the other squamous cell carcinomas. However for the moment, 4 of 6 cases are surviving, and disease free. We will require long-term monitoring of these cases.

Definitive concomitant chemoradiotherapy (CRT) with high-dose cis-platinum (CDDP) is a current standard protocol for advanced laryngeal and hypopharyngeal cancer sparing surgery for salvage. However, this modality is associated with limited feasibility and frequent sever toxicities. In the present study, a ‘chemoradioselection’ protocol with minimal toxicity was developed using initial response to CRT as a biomarker for patient selection. Between 2000, March and 2012, September 123 patients with stage III (44), IV (79) laryngeal (64) and hypopharyngeal carcinoma (59) excluding T4 cases were enrolled to this protocol. Two cycles of split (15 mg/m2 ×5 days, 2000–2008) or bolus (80 mg/m2, 2009-present) CDDP was concurrently administered. Tumor responses were evaluated after 40 Gy of CRT and 64 responders (chemoradioselected, CRS) received further CRT up to 70 Gy, while radical surgery was recommended for the 59 non-responders (N-CRS), and 34 underwent surgery (N-CRS-ope). The remaining 25 patients who refused surgery (N-CRS-refu) were treated with continuous CRT. The 5-year overall survival (OS) and disease-specific survival (DSS) were 67, and 77%, respectively. The CRS demonstrated favorable 5-year OS (73%) and laryngo-esophageal dysfunction-free survival (LEDFS, 69%) rates. In contrast, the N-CRS-refu showed significantly lower 5-year OS (47%) compared with CRS (73%) and N-CRS-ope (70%) (P=0.0193), and significantly lower 5-year LEDFS (20%) compared with the CRS (69%) (P

Background: When a head and neck tumor invades the upper lateral mediastinum, the transmanubrial approach (TMA), in which the sternoclavicular joint is temporary mobilized and replaced back to the physiological position, appears to be an excellent method. However, there have been only a few reports about the application of this approach to head and neck tumors. Materials and Methods: We recently adopted this technique for the removal of 2 head and neck tumors that required handling of the subclavian and innominate veins around the venus angle. Results: We could safely remove the tumors under good surgical view and obtained excellent cosmetic and functional results. Conclusions: TMA is a useful technique for the removal of head and neck tumors, which invade the upper lateral mediastinum. More frequent applications of this method are encouraged in combination with head and neck tumor surgery.

Basal cell nevus syndrome is an autosomal dominant disorder characterized by the developmental malformations and its carcinogenic nature. This syndrome shows various symptoms of multiple cutaneous basal cell carcinoma, ketatocystic odontogenic tumors, and inborn abnormalities in the bone and skin. Although basal cell nevus syndrome itself is a rare disorder, we experienced a very rare case in which squamous cell carcinoma of the oral cavity developed, and not cutaneous basal cell carcinoma. Only 4 similar cases have been reported in the English literature. The patient was a 33-year-old woman. She was diagnosed as having squamous cell carcinoma of the hard palate, and basal cell nevus syndrome in our hospital. The patient underwent surgery for squamous cell carcinoma of the hard palate, with postoperative chemoradiothetrapy. Since patients with this syndrome tend to form basal cell carcinoma when exposed to X-ray radiation, we perform radiotherapy with care.

Aims In this study, we aimed to investigate the molecular mechanisms underlying the development of mucoepidermoid carcinoma (MEC). Methods and results In 31 cases, we examined the MAML2 fusion status using reverse transcriptase–polymerase chain reaction, and HER2 and EGFR status using immunohistochemistry and chromogenic in-situ hybridization. MAML2 fusions were detected in 15 (57.7%) of 26 MECs analysed, including 11 of 16 (68.8%) low-grade, two of four (50%) intermediate-grade and two of six (33.3%) high-grade MECs. HER2 gene amplification and an increased EGFR gene copy number (with balanced chromosome 7 high-polysomy) were each detected in four of 28 (14.3%) MECs analysed. Irrespective of MAML2 fusion status, all seven high-grade MECs had an increased gene copy number of either HER2 or EGFR, in a mutually exclusive manner, whereas such abnormalities were extremely rare in low- and intermediate-grade MEC. Conclusions These results suggest that HER2 or EGFR gene abnormality could play an important role in the development of high-grade MEC, and also in the progression from MAML2 fusion-positive low-/intermediate-grade to high-grade in a subset of MEC. Furthermore, we suggest that high-grade MEC comprises a heterogeneous group of tumours in terms of molecular pathogenesis, in particular MAML2 fusion status.

Background Advanced head and neck squamous cell carcinomas frequently develop distant metastases to limited organs, including the lungs, bone, mediastinal lymph nodes, brain, and liver. Peritoneal carcinomatosis as an initial distant metastasis from hypopharyngeal squamous cell carcinoma is quite rare. Case presentation A 75-year-old man diagnosed with hypopharyngeal squamous cell carcinoma and his clinical stage was determined as T2N2cM0. Notably, the right retropharyngeal lymph node surrounded more than half of the right internal carotid artery. Concomitant conformal radiation therapy was administered for the primary hypopharyngeal lesion, and the whole neck and tumor response was evaluated at this point according to our algorithm-based chemoradioselection protocol. As the tumor responses at both the primary and lymph nodes were poor, with the right retropharyngeal lymph node in particular demonstrating mild enlargement, we performed a radical surgery: pharyngolaryngectomy, bilateral neck dissection, and reconstruction of the cervical esophagus with a free jejunal flap. Then, postoperative CRT was performed. During these therapies, the patient developed a fever and mild abdominal pain, which was associated with an increased C-reactive protein level. Contrast-enhanced computed tomography from the neck to the pelvis demonstrated mild peritoneal hypertrophy and ascites with no evidence of recurrent and/or metastatic tumor formation. We initially diagnosed acute abdomen symptoms as postoperative ileus. However, cytological examination of the refractory ascites resulted in a diagnosis of peritoneal carcinomatosis. Owing to rapid disease progress, the patient died 1.5 months after abdominal symptom onset. Conclusions The present case is the second reported case of head and neck squamous cell carcinoma with peritoneal carcinomatosis as an incipient distant metastasis. Therefore, peritoneal carcinomatosis should be considered a differential diagnosis when acute abdomen is noted during treatment for head and neck cancers.

当科では上顎洞扁平上皮癌に上顎試験開洞減量術と浅側頭動脈経由の動注化学放射線治療および根治手術をあわせた集学的治療を施行している。今回この治療の有効性を検証するために1997年1月から2007年12月までの上顎洞扁平上皮癌37症例につき，死因特異的3年生存率，再発率を検討した。生存率はT3症例で89%，T4a症例で66%，T4b症例で29%であった。動注化学放射線治療を施行し一次根治を得られた28例の原発巣再発率はT3症例は0%で，T4a症例は44%，T4b症例は67%であった。原発巣再発後の制御率はT4a症例で43%，T4bは0%であり，T4症例における原発巣再発をさらに減じうる集学的治療の確立が重要であると考えた。

同一の切除範囲や同一の再建皮弁における構音機能を検討するために，舌可動部半切術，大胸筋皮弁による再建術を行った症例で術後6ヵ月以上経過している9例を対象とし，皮弁の形状分類と，舌の可動性の評価を行い，これらと発語明瞭度との関連を検討した．その結果，発語明瞭度は隆起型71.6％，平坦型84.4％，陥凹型34.1％であり，陥凹型は低い傾向を示した．舌の可動性は，前方可動性，側方可動性ともに，隆起型では発語明瞭度と相関する傾向を認めたが，陥凹型では相関しなかった．皮弁の形状が舌の可動性よりも発語明瞭度に与える影響が大きい可能性があり，皮弁の形状は平坦型以上の隆起が必要と考えられた．

進行舌扁平上皮癌の治療成績向上を目的とし，1997年以降当科では術前動注化学放射線治療および根治手術をあわせた集学的治療を施行している。今回その治療法の有効性を検証するために1997年1月から2005年12月までの進行舌扁平上皮癌症例につき，治療法の違いによる死因特異的生存率，再発率を検討した。生存率は集学的治療例の病期IIIは86%，病期IVでは68%であり，それ以外の治療が行われた症例はそれぞれ80%，50%であり，有意差は認めなかったが，集学的治療症例のほうが良い傾向であった。また一次根治症例の原発巣，頸部再発では集学的治療例は22%であったが，それ以外の治療が行われた症例では55%であり，両者に有意差はないものの集学的治療例のほうが少ない傾向にあった。また集学的治療で一次根治できた病期III症例は術後治療の有無に関係なく原発巣，頸部再発は認めなかったが，集学的治療で一次根治できた病期IV症例は術後治療を行っていても原発巣，頸部再発を30%に認め，術後治療内容の変更を考慮すべきであると考えた。

A retrospective review of 145 previously untreated patients with squamous cell carcinoma (SCC) of the tongue was performed. All these cases were with no regional and distant metastasis. They were treated in the Kyushu Cancer Center between March 1972 and July 1998, and received interstitial irradiation, an operation, or an operation or interstitial irradiation after arterial infusion chemotherapy via superficial temporal artery combination external irradiation as initial treatment for primary lesion (tongue). The scope of external irradiation included the submandibular nodes and the upper jugular nodes. They did not receive prophyiactic neck dissection except the cases requiring reconstruction of the tongue and floor of the mouth. The five-year survival rate (5YSR) calculated by the Kaplan-Meier method was 82%. Recurrence occurred in 59 patients, of which 21 cases were local, 37 cases were regional and one case was distant recurrence. The 5YSR of local recurrence cases was 61%, that of regional recurrence cases was 56%, and that of distant recurrence cases was 0%. Neck dissection was performed for 35 patients of 37 regional recurrence cases, of which 31 patients were salvaged and 4 patients were uncontrollable. The regional control rate by neck dissection after regional recurrence was 89%. The N stage of the uncontrollable 4 patients was more than N2b. These results suggest that the early detection of regional recurrenceis important.

Background At our institute, a chemoradioselection strategy has been used to select patients for organ preservation on the basis of response to an initial 30–40 Gy concurrent chemoradiotherapy (CCRT). Patients with a favorable response (i.e., chemoradioselected; CRS) have demonstrated better outcomes than those with an unfavorable response (i.e., nonchemoradioselected; N-CRS). Successful targeting of molecules that attenuate the efficacy of chmoradioselection may improve results. Thus, the aim of this study was to evaluate the association of a novel cancer stem cell (CSC) marker, CD44 variant 9 (CD44v9), with cellular refractoriness to chemoradioselection in advanced head and neck squamous cell carcinoma (HNSCC). Materials and Methods Through a medical chart search, 102 patients with advanced HNSCC treated with chemoradioselection from 1997 to 2008 were enrolled. According to our algorithm, 30 patients were CRC following induction CCRT and 72 patients were N-CRS. Using the conventional immunohistochemical technique, biopsy specimens and surgically removed tumor specimens were immunostained with the anti-CD44v9 specific antibodies. Results The intrinsic expression levels of CD44v9 in the biopsy specimens did not correlate with the chemoradioselection and patient survival. However, in N-CRS patients, the CD44v9-positive group demonstrated significantly (P = 0.008) worse prognosis, than the CD44v9-negative group. Multivariate analyses demonstrated that among four candidate factors (T, N, response to CCRT, and CD44v9), CD44v9 positivity (HR: 3.145, 95% CI: 1.235–8.008, P = 0.0163) was significantly correlated with the poor prognosis, along with advanced N stage (HR: 3.525, 95% CI: 1.054–9.060, P = 0.0228). Furthermore, the survival rate of the CD44v9-induced group was significantly (P = 0.04) worse than the CD44v9-non-induced group. Conclusions CCRT-induced CD44v9-expressing CSCs appear to be a major hurdle to chemoradioselection. CD44v9-targeting seems to be a promising strategy to enhance the efficacy of chemoradioselection and consequent organ preservation and survival.

Background: Definitive concomitant chemoradiotherapy (CRT) with high-dose cis-platinum (CDDP) is a current standard protocol for advanced laryngeal and hypopharyngeal cancer sparing surgery for salvage. However, this modality is associated with limited feasibility and frequent sever toxicities. We have developed a “chemoradioselection” protocol with minimal toxicity using initial response to CRT as a biomarker for patient selection. Materials and Methods: From 2000 to 2012, 123 patients with stage III (44), IV (79) laryngeal (64) and hypopharyngeal carcinoma (59) excluding T4 cases were enrolled to this protocol. Two cycles of split (15 mg/m2 x 5 days, 2000-2008) or bolus (80 mg/m2, 2009-present) CDDP was concurrently administered. Results: Tumor responses were evaluated after 40 Gy of CRT and 64 responders (i.e., chemoradioselected, CRS) received further CRT up to 70 Gy, while radical surgery was recommended for the 59 non-responders (N-CRS), and 34 underwent surgery (N-CRS-ope). The remaining 25 patients who refused surgery (N-CRS-refu) were treated with continuous CRT. The 5-yr overall survival (OS) and disease-specific survival (DSS) were 67% and 77%, respectively. The CRS demonstrated quite favorable 5-yr OS (73%) and 5-yr laryngo-esophageal dysfunction-free survival (LEDFS, 69%). In contrast, the N-CRS-refu showed significantly (P = 0.0193) lower 5-yr OS (47%) than CRS (73%) and N-CRS-ope (70%), and significantly (P < 0.0001) lower 5-yr LEDFS (20%) than the CRS (69%). On multivariate analyses including T, N, primary site, and planned treatment (CRS + N-CRS-ope) or not (N-CRS-refu), unplanned treatment alone showed a significant correlation with poor OS (Hazard ratio [HR]: 2.584, 95% CI: 1.313–4.354, P = 0.007). Conclusions: Chemoradioselection reflects the biological aggressiveness of each tumor, and can segregate patients for functional laryngeal preservation with moderate intensity CRT (150-160 mg/m2 of CDDP) from those who would be better treated with surgery. This strategy may be useful for the optimization of the therapeutic intensity. Citation Format: Muneyuki Masuda, Satoshi Toh, Hidefumi Rikimaru, Naonobu Kunitake, Yuichiro Higaki. Utility of chemoradioselection for the optimization of treatment intensity in advanced hypopharyngeal and laryngeal carcinoma [abstract]. In: Proceedings of the AACR-AHNS Head and Neck Cancer Conference: Optimizing Survival and Quality of Life through Basic, Clinical, and Translational Research; April 23-25, 2017; San Diego, CA. Philadelphia (PA): AACR; Clin Cancer Res 2017;23(23_Suppl):Abstract nr 15.

Subjects were 16 patients--5 men and 11 women aged 46-82 years (mean: 61 years)--with malignant melanoma of the head and neck treated at our clinic from 1972 to 1988. Histologically, 1 subjects was amelanotic and 15 melanotic type. Primary lesions were 10 involving the nasal cavity, 2 the paranasal sinus, 2 the gingiva, 1 the lip, and 1 primary unknown. They were treated with or without multimodal surgery, radiation, chemotherapy, and immunotherapy. Of 12 treated using local surgery, local recurrence was seen in 6 in 7 areas. Two-year survival was 44% and 5-year survival 22%. The prognosis of malignant head and neck melanoma is poor but has gradually improved due to preoperative decisions on disease spread and the introduction of multimodal therapy.

唾液腺腫瘍における穿刺吸引細胞診, 術中迅速組織検査の成績について検討を行った。対象は1980年から1998年までに国立病院九州がんセンターにて手術を行い, 永久組織診断の確定した唾液腺腫瘍症例51例である。術中迅速組織検査はこのうちの33例に対して行った。穿刺吸引細胞診の悪性に関する感受性は70%, 特異性は93%, 正診率は82%であり, 組織型の正診率は43%であった。術中迅速組織検査も施行した33例において, 悪性に関する感受性, 特異性, 正診率, 組織型の正診率は, いずれも穿刺吸引細胞診 (62%, 90%, 79%, 48%) に比べて術中迅速組織検査 (77%, 100%, 91%, 85%) の方が優れていた。術中迅速組織検査においても, 粘表皮癌低悪性型, 腺房細胞癌の組織型推定は困難であったが, その他の腫瘍に対する術式決定には有用な検査法と考えられた。

A clinical study was performed on 42 patients with parotid cancers initially treated in our hospital from 1972 to 1997. The five-year cumulative survival rate was 69% in the whole group and 72% in the radical surgical treatment group (n = 40). The five-year survival rates according to stage were as follows: stage I, 95% (21); stage II, 75% (4); stage III, 0% (1); and stage IV, 37% (16). The factors influencing prognosis were cases of T3 and T4 (p < 0.05), stage III and IV (p < 0.01), and cervical lymph node metastasis (p < 0.01). Regarding treatment modalities, a partial parotidectomy appeared to be a curable surgical procedure for T1 cases. However, a lobectomy is recommended for T2 cases. Furthermore our study proposed that prophylactic supraomohyoid neck dissection should be necessary for mucoepidermoid carcinoma (high-grade malignancy) and undifferentiated carcinoma of T4N0 cases.

This study sought to investigate the clinical outcome and the role of postoperative radiotherapy for patients with salivary duct carcinoma (SDC) who had undergone surgery and postoperative radiotherapy. We performed a retrospective analysis of 25 SDC patients treated between 1998 and 2011 with surgery and postoperative radiotherapy. The median prescribed dose was 60 Gy (range, 49.5–61.4 Gy). The clinical target volume (CTV) was defined as the tumor bed in four patients, the tumor bed and ipsilateral neck in 14 patients, and the tumor bed and bilateral neck in six patients. Local control (LC), disease-free survival (DFS) and overall survival (OS) were estimated using the Kaplan-Meier method, and prognostic variables were analyzed with the log-rank test. The 5-year LC, DFS and OS were 67%, 45% and 47%, respectively. Disease recurrence was found in 12 patients: seven as local, four as regional and eight as distant failure. Perineural and lymphovascular invasion was a significant prognostic factor for LC (P = 0.03). Local failure was common, and the presence of local recurrence significantly affected the OS (P < 0.05). We conclude that surgery and postoperative radiotherapy is expected to decrease the risk of local failure and contribute to good prognoses for patients with SDC. It might be advisable to have the CTV include the cranial nerves involved and the corresponding parts of the skull base in cases of pathologically positive perineural invasion.

We reviewed 72 cases treated in our hospital for adenoid cystic carcinoma of the head and neck during the 37 years between 1972 and 2009. The disease-specific survival rate at 3, 5, 10, 15, and 20 years was 76%, 70%, 46%, 33%, and 33%, respectively so survival rate had decreased gradually to 15 years. There was no significant difference in the survival rate of primary site, but T3 & T4 disease indicated a worse prognosis, and patients with lymph node positive findings tended to have a worse prognosis. The loco-regional control rate was 65% at 5 years, but after that, it continued to decrease, and the loco-regional control rate at 15 years was 31%. In addition, the median of the period for loco-regional recurrence was 93 months, with the longest time being 168 months. The relatively long lapse was traced to recurrence. The rate of absence of distant metastasis was 54% at 5 years, but after that, it continued to decrease, with the rate at 20 years was being 22%. The median time of survival after patients tested positive for distant metastasis was 25 months, with longest recognized period being 216 months. The long-term prognosis of adenoid cystic carcinoma is generally poor, so a long-term follow-up is necessary.

Radiotherapy thought vital in treating head and neck cancer, occasionally causes seriously local complications such as mandibular osteoradionecrosis (ORN). An analysis of mandibular ORN cases showed 16 in 638 subjects treated by radiotherapy, for an ORN rate of 2.5%. This rate was highest in subjects with oral cancer excluding the tongue, administered 81 Gy radiation dose, using X-ray plus electronic beams. 8 cases of ORN occurred within 1 year following radiation, and the 8 others within 5 years. Preservation treatment was successful in 44% of ORN cases, including surgery, for which the rate of final cure was 63%. With case of cancer recurrence, the rate was 25%. In 2 subjects dying of aspiration pneumonia, the cause should be a particular point for reflection. Radiotherapy involving mandibular bone should include special consideration related to the radiation source, radiation dose. Once ORN occurred, we should take care of the mixed cancer and dysphagia in the treatment.

Aim: At our institute, a chemoradioselection strategy has been used to select patients for organ preservation on the basis of response to an initial 30-40 Gy concurrent chemoradiotherapy (CCRT). Patients with a favorable response (i.e., chemoradioselected; CRS) have demonstrated better outcomes than those with an unfavorable response (i.e., nonchemoradioselected; N-CRS). Successful targeting of molecules that attenuate the efficacy of chemoradioselection may improve results. Thus, the aim of this study was to evaluate the association of a novel cancer stem cell (CSC) marker, CD44 variant 9 (CD44v9), with cellular refractoriness to chemoradioselection in advanced head and neck squamous cell carcinoma (HNSCC). Methods: Through a medical chart search, 102 patients with advanced HNSCC treated with chemoradioselection from 1997 to 2008 were enrolled. According to our algorithm, 30 patients were CRC following induction CCRT and 72 patients were N-CRS. Using the conventional immunohistochemical technique, biopsy specimens and surgically removed tumor specimens were immunostained with the anti-CD44v9 specific antibodies. Results: The intrinsic expression levels of CD44v9 in the biopsy specimens did not correlate with the chemoradioselection and patient survival. However, in N-CRS patients, the CD44v9-positive group demonstrated significantly (p = 0.008) worse prognosis, than the CD44v9-negative group. Multivariate analyses demonstrated that among 5 candidate factors (T, N, stage, response to CCRT, and CD44v9), CD44v9 positivity alone was significantly correlated with the poor prognosis (HR: 3.140, 95% CI: 1.230-8.017, p = 0.0167). Furthermore, the survival rate of the CD44v9-induced group was significantly (p = 0.04) worse than the CD44v9-non-induced group. Conclusions: CRT-induced CD44v9-expressing CSCs appear to be a major hurdle to chemoradioselection. The addition of an xCT (a coupling molecule of CD44v9) inhibitor (e.g., sulfasalazine) to chemoradioselection may provide a new approach for clinically feasible CSC-targeted therapy in HNSCC, improving the efficacy of chemoradioselection and consequent organ preservation and survival. Disclosure: All authors have declared no conflicts of interest.

Highlights • Our patient had hypopharyngeal perforation and pyogenic spondylitis post-CRT. • Our patient survived after receiving surgical and long-term antibiotic treatment. • No previous report has described a similar case., Introduction Chemoradiotherapy plays an important role in preserving function and morphology in head and neck cancer. However, in a few cases, chemoradiotherapy has been shown to result in late complications, such as hypopharyngeal perforation, which is very rare. Presentation of case A 65-year-old man, who had undergone chemoradiotherapy for hypopharyngeal cancer 30 months previously, presented with high fever and neck pain. He subsequently developed hypopharyngeal stenosis, hypopharyngeal perforation, and a retropharyngeal abscess followed by pyogenic spondylitis. He underwent surgical treatment (resection with reconstruction) and was administered an antibacterial agent and steroids for an extended period. This treatment regimen was successful, and the patient has survived disease-free without symptoms. Discussion Chemoradiotherapy-induced hypopharyngeal perforation is an extremely rare condition. In the present case, the perforation was large (2 cm), and the hypopharyngeal cavity was originally constricted. Pharyngeal reconstruction with a jejunal autograft was therefore necessary. Through the present case, we reconfirmed that although the primary purpose of chemoradiotherapy is organ preservation, it can also lead to organ destruction and fatal complications. It is important that physicians be aware of the possibility of hypopharyngeal perforation so as to avoid delayed diagnosis and treatment of similar rare cases. Conclusion Hypopharyngeal perforation can sometimes be fatal because it can lead to pyogenic spondylitis. Suitable surgical techniques and appropriate doses of antibacterial agents for long-term use were appropriate treatments for the patient in this case.