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This paper presents a case of non-Hodgkin's lymphoma (NHL) of the larynx. The patient was an 86-year-old man who complained of foreign-body sensation and dysphagia. Laryngoendoscopic examination revealed a large pedunculated mass arising from the left aryepiglottic fold. A diffuse, large, B-cell-type NHL was diagnosed histopathologically. The patient was treated with combination chemotherapy, resulting in complete clinical remission. The clinicopathological features of this case have been described and compared with previously reported cases.

A rare case of lymphoepithelial cyst formed in the piriform sinus of the hypopharynx is reported. Histopathological examination revealed a lymphoepithelial cyst. It was removed by laryngomicrosurgical technique using a side-opened direct laryngoscope. Because this cyst was wide-based on the antero-medial region in the right piriform sinus of the hypopharynx, the mucous membrane around the cyst was incised electrosurgically and then detached to facilitate removal. In this paper, we describe our surgical procedure for removing the cyst in this case and discuss the possible causes of the disease.

We performed endoscopic phonosurgery in a patient with a laryngeal lesion using a prototype of the therapeutic rhino-larynx electronic endoscope connected to a video processor (Asahi Optical Co., Ltd.). This therapeutic electronic endoscope differs from the fiberoptic endoscope, because it contains an instrument channel and a miniature television camera attached to the tip of the endoscope, consisting of a small light-sensitive CCD chip. The dynamic image provided by this system is superior in resolution to that obtained by conventional flexible laryngofiberscopes. Using this therapeutic electronic endoscope and flexible forceps, we succeeded in removing a vocal fold polyp. This endoscope can be passed through the nasal passage into the laryngeal cavity. The therapeutic electronic endoscope is introduced and a clinical case is presented.

A 34-year-old male was found to have a tumor in the posterior auricular region. Malignancy was strongly suggested by a preoperative fine needle aspiration biopsy and CT scan. Complete enbloc resection of the tumor was carried out.Histopathological diagnosis revealed hyaline-vascular type of Castleman's lymphoma.Until now 74 cases of Castleman's lymphoma in the head and neck region have been reported in Japan, but none in posterior auricular region.The pathogenesis and differential diagnosis are discussed, and the literature is reviewed.

With the aim of improving survival rate in advanced head and neck cancer, we scheduled 26 patients to receive PEM regimen. This regimen consisted of cisplatin (CDDP)(P), etoposide (VP-16)(E), and mitomycin-C (MMC)(M) (CDDP 60 mg/m 2 /2 hr infusion on day 1; VP-16 40 Mg/m 2 /1 hr infusion on days 1–3; MMC 7 mg/m 2 iv bolus on day 1). Of 25 patients evaluable for response, 8 complete response (CR), 14 partial response (PR) were achieved, with an overall response rate (RR) of 88%. Myelosuppression was major side effect and thrombocytopenia (23% greater than WHO grade) was dose limiting toxicity. Other adverse reactions including mucositis were all mild and transient. Since limited mucosal toxicity, full course of following treatment including radiotherapy and/or surgery could be done satisfactorily. We concluded that this regimen produced beneficial effect as the adjuvant setting in patients with cancer in pharynx and oral cavity because of limited mucosal toxicity.

Warthin's tumor in the deep lobe of the parotid gland is comparatively rare. We treated four male patients with Warthin's tumor in the deep lobe.The histogenesis of Warthin's tumors is discussed.Heterotopic ductal epithelial tissue probably invades lymphnodes, which are numerous in the pre- and supratragal areas, but scarce in the deep lobe. Therefore, Warthin's tumor rarely arises from the deep lobe.Scintigraphic studies were performed in case 1 and case 2: 99 mTcO4-pertechnetate scintigraphy showed a cold spot in case 1 and a normal image in case 2; 67 Ga-citrate scintigraphy showed hot areas in both patients. We consider that these findings were due to abscess formation.

In recent years, many authors have reported that bisphosphonate-related osteonecrosis of the jaw(BRONJ)is a side effect of bisphosphonate therapy. However, clinicians have been confused by these reports, as no definitive criteria or treatment guidelines for BRONJ exist. In this paper, we report a patient who had BRONJ(stage 0)after dental extraction. She was successfully treated with sitafloxacin(STFX). A 73-year-old female had been taking 35 mg of alendronate per week for 24 months for the treatment of osteoporosis. She had a 1-month history of pain, suppuration, and a mandibular socket that would not heal after a left molar tooth extraction, despite the administration of antibiotics. A diagnosis of BRONJ(stage 0)was made without exposed bone, and she started 200 mg of STFX per day for 2 weeks, which was reduced to 100 mg per day for a week thereafter. After 3 weeks of STFX treatment, the mandibular wound healed. Furthermore, antimicrobial susceptibility testing against all of the organisms isolated from the pus indicated that STFX exhibited the most potent antimicrobial activity of all the agents. The results of these data suggested that STFX may be an effective antibiotic for BRONJ.

Concurrent chemoradiotherapy (CCRT) improves survival and organ preservation in patients with head and neck squamous cell carcinoma (HNSCC), compared with radiotherapy. However, such regimens are not always feasible because of substantial toxicities. Therefore, we evaluated the feasibility of S-1, administered on alternate days, and concurrent radiotherapy among elderly patients with HNSCC.Nineteen eligible patients were treated with CCRT. S-1 was administered at a dose of 80 mg/day on alternate days with the intention to reduce the toxicity.With a median follow-up period of 19.2 months, the two-year overall survival rates were 62.5% for patients with stage III disease and 50.0% for those with stage IV. The Complete Response (CR) rates were 100% for stage II and 66.7% for stage III/IV disease. Grade 3 mucositis occurred in three patients. Grade 3 or 4 hematological toxicities were not observed.CCRT with S-1 administered on alternate days was effective and well-tolerated among elderly patients with HNSCC.

Many squamous cell carcinoma (SCC) of the head and neck presents with locally advanced disiease. In such cases, a combination chemotherapy of docetaxel, cisplatin, and 5FU, followed by radiation improved their survival (Posner et al. 2007; Vermorken et al. 2007). That is, addition of docetaxel to the combination of cisplatin and fluorouracil improves survival in head and neck squamous cell carcinoma. In a recent work to elucidate the possible mechanism, we investigated the effect of docetaxel on cell movement using head and neck cancer cell lines Hep2 and Ca9-22. Docetaxel treatment suppressed migration and invasiveness of head and neck cancer cells in vitro. We investigated the downstream effectors that control invasiveness after docetaxel administration in the present work.

Conventional intraoperative pathological examination for Sentinel node navigation surgery (SNNS) has been controversial. We evaluated the efficacy of one-step nucleic acid amplification (OSNA) assay for intraoperative diagnosis of cervical lymph node (CLN) metastasis compared with histopathological examination in patients with head and neck squamous cell carcinoma (HNSCC). A total of 175 CLNs dissected from 56 patients with HNSCC who underwent surgery at Aichi Cancer Center, Kyorin University, Gunma University or Fukushima Medical University, between April 2008 and December 2011 were enrolled. CLN samples were sectioned into four equal pieces, with two of each used for OSNA assay and other histopathological examinations. The diagnostic value of OSNA assay in HNSCC patients in predicting the results of histopathological diagnosis was evaluated using the area under the receiver operating characteristic (AUROC) curve. OSNA assay showed acceptable efficacy in the detection of pathological CLN metastasis (AUROC 0.918, 95 % confidence interval [CI] 0.852–0.984). Regarding the CK19mRNA cutoff value, the optimum cutoff point in HNSCC patients was 131 copies/μl (sensitivity: 82.4, 95 % CI 65.5–93.2; specificity: 99.3, 95 % CI 96.1–100.0; positive likelihood ratio 116.1; negative likelihood ratio 0.2]. We demonstrated that OSNA assay is useful in intraoperative diagnosis for CLN metastasis in patients with HNSCC. OSNA assay could be applied for SNNS in HNSCC patients.

Purpose: The basic idea of combination chemotherapy is to eradicate tumor cells through potent therapy before the appearance of resistant cells or an elevation in the number of the resistant cells. This article explores the use of combination chemotherapy in the treatment of solid tumors in head and neck. Method: The efficacy of chemotherapy for head and neck tumors is specifically reviewed. Results: Several hypotheses are generally well known and accepted as basic theories in cancer chemotherapy, and researchers have developed effective combination chemotherapy regimens based on these theories. Chemoradiotherapy was initially developed to regulate the local tumor through radiation and control distant metastases through chemotherapy. The purpose of adjuvant chemotherapy is to treat latent tumor cells that cannot be seen macroscopically after completion of first-line therapy. Continuous administration of a small dosage is a new concept that has recently been proposed to replace the conventional concept of total cell-killing. Conclusion: This article examines the use of combination chemotherapy in the treatment of solid tumors and reviews the efficacy of chemotherapy, which should be understood by head and neck surgeons.

We have experienced observed diseases of the larynx using a new type of rhino-larynx electronic endoscope PENTAX PVE VNL-1530 connected to a video processor PENTAX PVE EPM-3300 (Asahi Optical Co., Ltd.). The electronic endoscope differs from the fiberoptic endoscope in that it contains a small, light-sensitive CCD chip which is attached to the tip of the endoscope. This electronic endoscope has a small CCD camera in its tip portion, which is 5.1mm in diameter, and can thus be passed through the nasal passage into the laryngeal cavity. The dynamic image provided by this system is superior to that obtained by a flexible laryngofiberscope in terms of resolution of detail. Several clinical cases were presented using data from this system.

A case of intractable aspiration in a patient with spinocerebellar degeneration was reported. The patient was a 54-year-old woman suffering from spinocerebellar degeneration for about five years. She developed dysphagia, aphonia and dyspnea with the breakdown of the normal protective function of the larynx. She was admitted in our hospital where tracheostomy was performed ;the tracheal separation and tracheoesophageal diversion were successful. We then discussed these surgical procedures for intractable aspiration in patients with progressive neurologic disease, such as spinocerebellar degeneration, from the viewpoint of quality of life.

AimsSentinel node navigation surgery (SNNS) is currently considered to provide better staging of regional metastasis. For rapid and accurate sentinel lymph node analysis, one-step nucleic acid amplification using cytokeratin 19 (CK19) has been applied, particularly in breast cancer. On the other hand, additional quantitative reverse transcription PCR targets containing cytokeratins have been reported recently in head and neck cancer. In this report, CK19 and p63 were immunohistochemically examined in primary tumours for use as molecular markers and were compared with cytokeratin 903 (CK903), cytokeratin 8/18 (CK8/18) and cytokeratin (AE1/AE3), which are used in diagnostic immunohistochemistry for head and neck squamous cell carcinoma.MethodsThe study reviewed 17 patients with T1/T2, N0 (UICC) oral squamous cell carcinoma of the tongue who were treated surgically at Kyorin University Hospital between 2002 and 2009. The intensity and proportion of tumour cells stained for CK19, CK903, p63, CK8/18 and AE1/AE3 were evaluated.ResultsCK19 and CK8/18 staining in cytoplasm was patchy among carcinoma cells, indicating weak expression. Staining proportion for p63, CK903 and AE1/AE3 was greater than for CK19 and CK8/18, although staining intensity for CK903 was weaker than for p63 and AE1/AE3. The difference in total score between CK19 and CK8/18 staining and p63, CK903 and AE1/AE3 staining was statistically significant (pConclusionsThis suggests that p63 is of clinical utility in SNNS and that CK19 is unsuitable for early tongue carcinoma. Further studies are needed before clinical application of these markers.

The sentinel lymph node (SLN) concept is accepted for several types of cancers. Current methods for sentinel node detection involve radioisotopes and blue dye. They have shown good results, but some drawbacks remain. Indocyanine green (ICG) fluorescence using the HyperEye Medical System (HEMS) was evaluated as a new method. This was a prospective, nonrandomized, experimental study in four Japanese white rabbits and six Yorkshire pigs. ICG and indigo carmine were injected into the tongue, larynx, or hypopharynx, and ICG fluorescence detection was evaluated using both transcutaneous visualization of lymphatic vessels and intraoperative identification of SLNs. The SLNs appeared as shining fluorescent spots with HEMS transcutaneously in rabbits, but no SLNs were detected transcutaneously in pigs. Eleven procedures identified SLNs, but one did not due to a technical problem. HEMS could become useful for predicting lymph node metastasis during surgery for head and neck cancer.

We report a very rare case of hearing improvement after removal of the intracranial part of a jugular foramen schwannoma (JFS) presenting with chronic and severe progressive sensorineural hearing loss (SNHL). The patient presented with progressive hearing impairment in his right ear, lasting 2 years. The patient's pure tone audiogram revealed severe SNHL. His speech discrimination score (SDS) was 0%. Auditory-evoked brain responses (ABRs) comprised only I waves following 30–100 dB stimulation, although distortion-product otoacoustic emissions (DPOAEs) had good responses. These test results indicated that his hearing impairment was retrocochlear SNHL. Magnetic resonance imaging revealed within the right jugular foramen a large intracranial–extracranial tumor that compressed the brainstem. The intracranial part of the tumor was resected through retrosigmoidal craniotomy, and the tumor was pathologically diagnosed as a schwannoma. Several months after the operation, the patient's auditory thresholds improved to a level consistent with mild SNHL, ABR V waves emerged following 60–90 dB stimulation, and SDS improved significantly to 95%. This case demonstrates that hearing improvement can be achieved after surgery for JFS presenting with severe and chronic progressive SNHL, and that good DPOAE responses and the presence of ABR I waves may be predictors of postoperative hearing recovery in JFS.

Background: Cisplatin plus fluorouracil is widely used for the treatment of head and neck cancer. However, the cisplatin plus fluorouracil regimen necessitates hospitalization. Therefore, we planned to develop a new regimen that can be administered on an outpatient basis and performed a phase I study of S-1 + nedaplatin. Methods: S-1 was given orally at a fixed dose for 14 days, and nedaplatin was administered intravenously on day 8 of S-1 administration. The dose of nedaplatin was increased in 10-mg/m2 steps to find the maximum tolerated dose, depending on the appearance of dose-limiting toxicities. Results: A total of 14 patients were registered. The maximum tolerated dose of nedaplatin was determined to be 90 mg/m2. The main toxicities were neutropenia and thrombocytopenia. The response rate was 57.1%. Conclusion: The recommended dose of nedaplatin for a phase II study was determined to be 80 mg/m2. We concluded that our regimen was well tolerated and that the response rate was acceptable.

The combination of docetaxel, cisplatin, and fluorouracil significantly enhances the survival of head and neck cancer patients compared to cisplatin and fluorouracil. We hypothesized that docetaxel may affect invasiveness of the head and neck cancer cells in addition to its tumor-killing effect. Two different head and neck cancer cell lines (HEp-2 and Ca9-22) were treated with docetaxel at IC(10) and IC(50) concentrations. Cell migration and invasive growth was evaluated by wound healing assay and three-dimensional (3D) culture of multicellular tumor spheroids, respectively. Expression levels of possible downstream effectors for cell migration/invasiveness were measured by immunoblotting in conditions with or without docetaxel. Docetaxel, but not cisplatin, suppressed filopodia formation compared with no treatment (control) condition. Consistent with this, docetaxel suppressed two-dimensional (2D) cell migration and 3D cell invasion compared with control or cisplatin. Only docetaxel treated cells exhibited thick tubulin bundle and had lower activity of Cdc42, a member of the Rho family of small GTPases. In conclusion, Docetaxel treatment suppressed migration and invasiveness of head and neck cancer cells in vitro, which is likely to be mediated by regulating Cdc42 activity.

Dermatomyositis is well known to be associated with several types of malignancy and patients with dermatomyositis have higher rates of mortality from cancer. Although rare in Japan, head and neck cancer, especially nasopharyngeal cancer, is the predominant type of cancer associated with dermatomyositis in several areas in Asia, including Hong Kong and Singapore. Here we report two cases of head and neck cancer with dermatomyositis as well as a literature review. Both cases were treated with chemotherapy and radiotherapy. Although the patients were immunosuppressed due to dermatomyositis treatment, no grade 3 or 4 adverse events occurred.

A 46-year-old woman presented with short history of dyspnea. Five months before the onset of symptom, the patient had a mild wheezing. She had no history of smoking. Physical examination suggested primary tracheal tumor. The patient underwent a V-shaped resection of 3.5 cm of the trachea followed by reconstraction with the trough method. Histological examination revealed adenoid cystic carcinoma. Adjuvant chemotherapy was indicated with 50 mg of adriamycin postoperatively. The patient has done well for 8.5 years with no further treatment.

Some diseases in which persons show vertigo or dizziness may be life-threatening, regardless of symptom severity, and require careful attention. These include diseases of the inner ear, central nervous system, and cardiovascular manifestation. In May 2006, a group in charge of primary emergency consultation began work enabling physicians to treat vertigo patients more efficiently and safely, as detailed in this report. Of the 173 persons with vertigo hospitalized from January 2004 to March 2008, six had cerebrovascular manifestations clarified only after hospitalization, underscoring the importance of careful examination, especially of those 75 years of age older, having continuous headache, having severe trunk ataxia despite apparently mild eye nystagmus, or reporting a history of high blood pressure, diabetes mellitus, hyperlipidemia, or ischemic heart disease.

Preservation of the larynx is the most critical factor influencing quality of life in the treatment of head and neck cancer. This clinical study focuses on laryngeal function-preserving chemoradiotherapy for locally advanced hypopharyngeal and laryngeal cancer. Thirty-two resectable cases with histologically proven squamous cell carcinoma undergoing function-preserving therapy were examined. Induction chemotherapy comprised cisplatin and 5-fluorouracil, and another cycle of chemotherapy was performed for responders. Chemoradiotherapy comprised conventional irradiation and weekly chemotherapy (nedaplatin plus docetaxel). Non-responder patients were excluded from further chemotherapy and were changed to other surgical treatment. Three patients were non-responders for induction chemotherapy, and 29 patients were treated with chemoradiotherapy. Thus, 21 out of 29 patients obtained preserved laryngeal function. Initial larynx preservation rate with these treatment strategies was 93.8%. This study provides a new concept for laryngeal function-preserving treatment that should be considered for locally advanced laryngeal and hypopharyngeal cancer.

We encountered 6 rare cases of acute-onset unilateral psychogenic hearing loss in adults. All were women in their 20s and 30s. Three cases had severe hearing impairment characterized by hearing loss at every frequency; 2 cases had profound hearing impairment, and 1 case had low-frequency hearing impairment. Of the 6 cases, 3 had a history of hearing loss, and 1 had a history of psychogenic visual disturbance. All 6 cases were initially diagnosed as having idiopathic sudden sensorineural hearing loss; all subsequently received steroid therapy. Three cases were not diagnosed as being psychogenic in origin until otoacoustic emissions and auditory brain responses were performed. Although the presence of distinctive clinical features (age, gender, and past history) is important for suspecting psychogenic hearing loss, objective audiological tests such as otoacoustic emissions are essential for diagnosing some cases. Compared to the existing reports of similar cases, our cases had a poorer prognosis (only 2 cases were cured).

Eighty patients with Stage III and IV head and neck cancer were treated with a four-drug regimen consisting of bleomycin, vincristine, methotrexate, and mitomycin-C (BOMM regimen). Of 69 patients evaluable for response, 7 complete and 40 partial responses were achieved, with an overall response rate of 68%. The median duration of response was 13 weeks (range 3-41 weeks). Anorexia, lassitude, febrile reactions, and myelosuppression were major side effects. The BOMM regimen produced a response rate significantly better than VCR, BLM, and MTx combination (VBM) which we previously reported with improved response duration. This study demonstrates that the BOMM regimen, which can be administered on an outpatient basis, achieved a response rate comparable to cisplatin-containing regimens. The BOMM regimen may be benejcial to patients with poor general condition and/or marginal renal dysfunction who are in high risk of toxicity-associated cisplatin-containing regimens.

A 59-year-old man complained of swelling of the cheek, nasal obstruction and nasal bleeding. Radiographic examination showed massive bone destruction of the left maxillary sinus. The tentative diagnosis was malignant tumor of the maxillary sinus. The patient was treated with maxillotomy. Histopathological examination revealed no evidence of malignancy, but hematoma and necrotic tissue with pseudostratified columnar ciliated epithelium.Blood boil is a clinical term and the etiology is indefinite. It is possible for several causative factors to exist. It is difficult to distinguish such a lesion from malignant tumor and careful examination with long term follow-up is necessary.

非特異性喉頭肉芽腫の5例に対して副腎皮質ステロイド薬の吸入療法を主体とした保存的治療を行った.3例が挿管性, 他の2例が特発性の肉芽腫であった.挿管性肉芽腫の1例はネブライザーを用いて, dexamethasoneの吸入を行ったところ, 約6ヵ月間で治癒した.他の4例はbeclomethasone dipropionate inhaler (BDI) を用いて外来通院で治療したところ, 約1ヵ月ないし3ヵ月半で治癒した.なお, 全例とも不要な咳払いや大声を避けるように指導した.非特異性喉頭肉芽腫の発生原因として, 声門後部の微細な損傷と咳嗽や咳払いによる同部の強い閉鎖に起因する悪循環が考えられた.副腎皮質ステロイド薬の吸入療法では抗炎症作用による直接作用とともに, 間接作用としてこの悪循環を断ち切ることも効果発現に関与していることが考えられた.このうち, BDIの吸入療法は外来でも簡便に行うことができ, 治療法のひとつとして有用と思われた.

A case of epiglottic cyst with pendulous appearance is reported. A 53-year-old man suffered from abnormal sensation of the throat and visited our clinic. At the initial examination, a pale yellow cystic lesion was observed on the left side of the lingual surface of the epiglottis. At the next examination, a cystic lesion was observed on the right aryepiglottic fold, and the location of the cystic lesion was different on all subsequent visits. Laryngomicrosurgery through a direct laryngoscope was performed to remove the cystic lesion. The excised lesion had a long stalk and a pendulous appearance. The histopathological diagnosis was epidermoid cyst. The histopathological findings of the stalk were similar to those seen in the stalk portion of pendulous tonsils, suggesting a common etiology of this lesion and pendulous tonsil.

Taxanes are a highly active anti-cancer drug for squamous cell carcinoma of the head and neck (SCCHN). When used as a single agent, the overall response rates were between 20-40%. In Japan, the phase I study revealed that the maximum tolerated dose of the docetaxel was 70-90 mg/m2 and the recommended dose was 60 mg/m2. The main toxicity was neutropenia. Docetaxel administered in combination with cisplatin has demonstrated promising response rates ranging from 40-70% for recurrent or metastatic SCCHN. Its effect is similar to that of a cisplatin plus 5-fluorouracil regimen. A three-drug combination with docetaxel, cisplatin and 5-fluorouracil has been tested. The preliminary results with three drugs in combination seems superior to a two-drug combination. However, the final conclusions regarding theses drug combinations will be given by the results of an ongoing EORTC #249 71 study. Weekly docetaxel with concurrent chemoradiotherapy is feasible and active for locally unresectable SCCHN. Cisplatin plus 5-fluorouracil based concurrent chemoradiation regimens have demonstrated improved survival compared with conventional radiotherapy. Docetaxel including regimens showed efficacy with mucositis as the major acute toxicity and a swallowing problem as the chronic toxicity. Thus, the three-drug combination as the chemoradiation setting seems to be toxic for Japanese patients. A new intensive supporting care approach focused on mucositis is warranted.

The precise diagnosis for bovine spongiform encephalopathy (BSE) is crucial for preventing new transmission to humans. Several testing procedures are reported for determining protease-resistant prion protein in various tissues as a major hallmark of prion diseases such as BSE, scrapie, and Creutzfeldt–Jakob disease. However, contamination of materials from tissues or degradation of the specimens sometimes disturbs the accuracy of the assay. Here, we have developed a novel method for solid-phase immunoassay of the disease-specific conformational isoform, PrP Sc , using filtration blotting of protein in the presence of sodium dodecyl sulfate (SDS) followed by a filtration-based immunoassay with a single anti-prion protein antibody, together with the improved fractionation procedure involving high concentrations of surfactant/detergent. The SDS/heat treatment renders unfolded PrP Sc quantitative retention on a polyvinylidene difluoride filter and allows enhancement of the analyte signal with immunodetection; thus, all of the tested specimens are determined with 100% accuracy. In addition, the immunoassay is completed in approximately 1 h, indicating its usefulness not only for the screening of BSE specimens but probably also for the postmortem BSE diagnosis of fallen stock as the antibody recognizes the core part of PrP Sc . The solid-phase immunoassay method, including the filtration blotting with SDS, would be applicable to determining even more sensitively proteins other than PrP Sc , especially those having rigid conformations.

We assessd the feasibility and problems associated with sentinel lymph node (SLN) study in 13 cases of oral and pharyngeal squamous cell carcinoma (SCC) that were neck-node-negative clinically. The primary sites were the tongue (n = 10), other sites in the oral cavity (n = 2), and the mesopharynx (n = 1). The day before surgery, tracer was injected into the submucosa around the tumor, and scintigraphic images were acquired 2 hours later. The SLN was identified intraoperatively with a handheld gamma probe, and neck dissection, including the SLNs, was performed. Radioactivity within the nodes was confirmed with a well type scintillation counter, and all resected lymph nodes were histologically examined for metastasis. The SLN was identified in every case. There were regional lymphnode metastases in 4 cases, and metastasis to the SLNs was present in all of 4 cases. Thus, the SLN concept was valid for head and neck SCC, sentinel node navigation surgery (SNNS) was thought to be applied in stage NO SCC of the head and neck. If SNNS is performed, about 70% of patients do not require neck dissection. SNNS is feasible and cost-effective in these cases. We used two different tracers: phytate and tin colloid, and found that phytate was more useful. To avoid the effects of the shine-through phenomenon, it was thought that some directions of lymphoscintigram should be taken. For intraoperative identification of the SLNs, care should be taken to the angle of gamma probe. SLN study leads to clarify each patient's lymphoid flow mapping, and it is also useful to determine the dissection area of selective neck dissection.

A phase I/II trial of concurrent docetaxel and radiation for head and neck cancer was conducted to estimate the recommended dose schedule of docetaxel, and then to evaluate the therapeutic benefit.Patients received radiation in 2.0-Gy single daily fractions to a total dose of 60 Gy. Docetaxel was administered weekly for 6 consecutive weeks.Docetaxel 15 mg/m(2) was considered the maximum tolerated dose (MTD). The recommended dose was decided as 10 mg/m(2). The phase II study was conducted using docetaxel at 10 mg/m(2). Thirty-nine patients were enrolled. The overall response rate was 96.9%. The prognosis of the complete response (CR) patients was significantly better than that of the partial response (PR) patients. Grade 3 or 4 adverse events consisted of lymphopenia, stomatitis, and anorexia. Thirty-two of the 35 eligible patients showed high compliance, of over 90%, and their toxicities were manageable.Even low-dose docetaxel shows a strong effect in combination with radiation, with a high survival rate in CR patients. The effect on survival will be assessed by further follow-up.A phase I/II trial of concurrent docetaxel and radiation for head and neck cancer was conducted to estimate the recommended dose schedule of docetaxel, and then to evaluate the therapeutic benefit.

Objectives To present electronic videoendoscopy of the larynx with digital image processing and to discuss this endoscopic technique from the standpoint of diagnostic usefulness of laryngeal lesions. Study Design Electronic videoendoscopic evaluation of laryngeal lesions with digital image processing. Methods Seventy patients underwent electronic videoendoscopy without digital image processing and, subsequently, with the digital image processing function. Of these, 15 patients with white lesion of the vocal fold and laryngeal neoplasms were assessed in the study. Clinical assessments made before enhancement of digital image processing function were compared with those after enhancement in 15 patients. Results Of the 15 patients observed, the clinical diagnoses of two patients were changed after enhancement. Both patients underwent endolaryngeal microsurgery with histopathological examination of the removed lesions, which confirmed the definitive diagnosis. The clinical diagnoses of both patients after enhancement were compatible with histopathological diagnoses. Conclusions The enhanced color images provided by this system are superior in both quality and resolution to those obtained by conventional flexible fiberoptic endoscopy with a video camera. This system should be a valuable tool for the diagnosis of laryngeal lesions.

Objectives To assess the clinical use of intralaryngeal ultrasonography. Study Design A retrospective study was conducted of 16 patients with laryngeal lesions treated by laryngomicrosurgery. Methods An intraluminal ultrasonic tomography apparatus was connected to a radial scanning 30-MHz miniaturized probe. Under general anesthesia, ultrasonic images were obtained using the filling method. Results In cases of benign disease, such as vocal cord nodules or polyps, the layers of the mucosa could be identified. Characteristic internal echoes were noted in cases of hemorrhagic polyps, vocal cord cysts, and vocal cord cancer. In case of hemorrhagic polyps, hyperechoic regions were noted within the lesions. In cases of vocal cord cysts, internal echoes were absent, and posterior echoes were mildly enhanced. In cases of vocal cord cancer, infiltration beyond the mucosa could be visualized. Conclusions Laryngeal lesions can be diagnosed by intralaryngeal ultrasonography using the filling method. Although it does not replace the combination of conventional endoscopy and a critical evaluation of the clinical symptoms of the individual disease, it can profitably complement them. Intralaryngeal ultrasonography can help in determining the extent of tumor involvement during microscopic laser surgery performed under general anesthesia. Confirmation of the results of this pilot study with a larger series of patients is desirable.

We examined the reliability of the use of lymphoscintigraphy (LS) and a hand-held gamma probe (GP) to identify the sentinel lymph node (SLN), and sequentially determined the feasibility of SLN radiolocalization in clinical neck node-negative oral squamous cell carcinoma (SCC) patients. A radiolabel with the unfiltered 99mTc tin colloid was injected submucosally around the primary site followed by LS at 2-hour intervals. Preoperative localization was performed with GP. After en bloc removal of the regional lymphatics, histopathologic results for the nodes were compared with the SLN radiolocalization. The LS and GP counts were well correlated, and there was concordance between SLN and neck node status in 7 of 8 cases (87.5%). We thus considered that our concept in this study was valid in determining the necessity for neck dissection for those node-negative oral SCC patients.

Stage III, IVの口腔, 咽頭扁平上皮癌に対しシスプラチン, エトポシド, マイトマイシン-Cの3剤による術前化学療法を行った。施行例は13例であり, このうち評価可能例12例中CR4例PR7例で奏効率は92%であった。骨髄抑制が投薬量を制限する副作用であり, 特に血小板減少に注意する必要があった。従来のシスプラチンを含むレジメンに比べて, はるかに粘膜毒性が少なく, 加えて同等か, それ以上の効果を認め, 後続する治療を障害せず, この意味で特に口腔癌に有効と思われた。

In patients with locally unresectable head and neck cancer with large nodal involvement, the expected five-year survival is as low as 1-2%. To improve the prognosis of these patients, we studied the usefulness of concurrent chemoradiotherapy in a phase II trial. Between September 1996 and May 1999, thirty-five patients with locally unresectable head and neck cancer were administered concurrent chemoradiotherapy consisting of low-dose and long-term treatment with cisplatin (CDDP) plus 5-fluorouracil (5FU), or (L-CF); the L-CF regimen consisted of CDDP, 3 mg/m2 on 5 days of the week and 5FU, 150 mg/m2 as a 24-hour infusion on 5 days of the week. Concurrently, conventional radiotherapy was given up to total dose of around 60 Gy. In the 33 patients evaluable for response, 17 complete and 9 partial responses were noted, with an overall response rate of 79%. Oral mucostis and myelosuppression were the major side effects and mucositis was a dose limiting toxicity. This study demonstrates increase in survival among the responders (complete + partial) in the concurrent chemoradiotherapy setting. However 8 local relapses were eventually noted in the 17 complete responders. We concluded that this treatment strategy was beneficial in patients with locally unresectable head and neck cancer.

Background: For locally unresectable recurrent squamous cellcarcinoma of the head and neck, we investigated two salvage chemotherapy regimens as second-line chemotherapy. In our preliminary study, we observed that both regimens wereactive. In the present studywe analyzed the prognosis of these patients. Methods:Twenty-sixpatients with recurrent advanced head and neckcancer, were treated with one of two new regimens as second-line chemotherapy. The PEM regimen consisted of cisplatin 60 mg/m 2 on day 1, etoposide 40 mg/m 2 on days 1, 2 and 3 andmitomycin-C 7 mg/m 2 on day 1. The long CF regimen consisted of cisplatin 8 mg/m 2 on days 1-5, 8-12, 15-19 and 22-26 and 5-fluorouracil 300 mg/m 2 as a 24 h infusion or oral administration of tegaful-uracil (UFT-E) 400 mg/m 2 on days 1-28. Survival curves were calculated using the Kaplan-Meier method and compared by the log rank test. Results: Of 24 patients evaluable for response, threecomplete responses (CR)andsevenpartial responses (PR) were achieved, with an overall response rateof 42%. Myelosuppression wasthe major side effect. One year survival was 100% for CR, 0% for PR and20% for minor response (MR). All patients whofailed to achieve a CR died within 12months, exceptone patientwith MR. Conclusion: Our data suggest that with these salvage regimens survival benefit was demonstrated only in CR patients.

Microscopic direct laryngoscopy (microlaryngoscopy) under general anaesthesia is the optimal method of observing the larynx. However, as microlaryngoscopy does not allow precise observations of the ventricle, inferior surface of the vocal fold and subglottis, multidirectional observations of the larynx using transurethral rigid endoscopes were performed during direct laryngoscopy. This endoscopic technique has been shown to be clinically useful in the diagnosis and treatment of laryngeal lesions. The equipment and methods are introduced herein, and a representative case is presented.

Patients with laryngeal lesions were observed and the lesions were recorded with an electronic videoendoscope system using the PENTAX EPM-3300 video processor and the PENTAX VNL-1330 endoscope portion. The electronic videoendoscope system differs from the conventional fiberoptic endoscope connected to a video camera in that a small monochrome charge-coupled device (CCD) chip is built in the tip of the endoscope portion. The PENTAX VNL-1330 rhinolarynx endoscope portion has a tip and insertion tube of approximately 4mm in outer diameter to allow its introduction through the nasal passages into the larynx. The dynamic color images provided by this system were superior to those obtained by a conventional rhinolarynx flexible fiberscope connected to a video camera in both quality and resolution of detail. This system should be useful in diagnosing laryngeal lesions.

6004 Background: To establish the efficacy of adjuvant chemotherapy with S-1 (tegafur gimeracil oteracil potassium) after curative treatment in patients with advanced squamous cell carcinoma of the head and neck (SCCHN), we conducted a randomized phase III study to investigate whether S-1 is superior to UFT (uracil/tegafur). Methods: Patients with SCCHN who had received curative treatment and were confirmed to be tumor-free were randomly assigned to receive UFT (300 or 400 mg/day for 1 year) or S-1 (80, 100, or 120 mg/day for 1 year). The primary end point was disease-free survival (DFS). Secondary end points were overall survival (OS), relapse-free survival (RFS), and safety. We estimated that 500 patients were needed to establish the primary end point. Results: From April 2006 through November 2008, a total of 526 patients (262 assigned to UFT; 264 assigned to S-1) were enrolled. The 3-year DFS rate was 66.0% in the UFT group and 64.1% in the S-1 group (hazard ratio [HR], 0.87; 95% confidence interval [CI], 0.66 to 1.16; [log-rank], P = .34). The 3-year OS rate was 75% in the UFT group and 82.9% in the S-1 group (HR, 0.64; 95% CI, 0.44 to 0.94; [log-rank], P = .022). The 3-year RFS rate was 63.6% in the UFT group and 68.2% in the S-1 group (HR, 0.81; 95% CI, 0.60 to 1.09; [log-rank], P = .16). There were no significant differences in 3-year DFS or RFS; however, the 3-year OS was significantly better in the S-1 group. The incidence of the following grade 3 or 4 events was significantly higher in the S-1 group: oral mucositis/stomatitis (2.4%), leukopenia (5.2%), neutropenia (3.6%), and thrombocytopenia (5.0%). Conclusions: S-1 was not demonstrated to be superior to UFT in terms of 3-year DFS; however, 3-year OS was significantly better with S-1 than with UFT. Clinical trial information: NCT00336947.

A patient was encountered with verrucous carcinoma of the larynx that presented as a hairy whitish tumor. There was a recurrence because simple excision with forceps by endolaryngeal microsurgery was performed in the first operation. However, in the second operation endolaryngeal microscopic laser surgery using a direct laryngoscope was performed and followed by adjuvant chemotherapy with oral UFT, a combination of uracil and tegafur in a molar ratio of 4:1. The patient’s course has been favorable to date. The case is reported in this paper and discussed from the viewpoint of diagnosis and treatment of this neoplasm.

Malignant tumors arising from trachea are not common. This paper presents an example of primary tracheal adenoid cystic carcinoma treated by surgical resection with good prognosis. A 46-year-old woman presented with a short history of dyspnea. Five months before the onset of dyspnea, the patient had mild wheezing. She had no history of smoking. Physical examination suggested primary tracheal tumor. The patient underwent a V-shaped resection of 3.5 cm of trachea followed by reconstruction with the trough method. Histological examination revealed adenoid cystic carcinoma. Adjuvant chemotherapy was indicated with 50 mg of adriamycin postoperatively. The patient has done well for 12 years with no further treatment. The tumor was an adenoid cystic carcinoma that was slow-growing, infiltration of mucus membrane was few and growth fraction (mitotic index was less than 1%) was low. Those were considered the reason for good prognosis.