Akihiro Homma

Superselective high-dose cisplatin infusion with concomitant radiotherapy in patients with advanced cancer of the nasal cavity and paranasal sinuses: a single institution experience.

The current study aimed to evaluate the efficacy of superselective high‐dose cisplatin infusion with concomitant radiotherapy (RADPLAT) for previously untreated patients with advanced cancer of the nasal cavity and paranasal sinuses.

Surgical complications of salvage total laryngectomy following concurrent chemoradiotherapy

BackgroundSurgical complication rates of total laryngectomy vary according to the preoperative treatments performed and patient factors. Wound complications after salvage laryngectomy following concurrent chemoradiotherapy (CCRT) were analyzed.MethodsEighty-six patients who had undergone total laryngectomy for laryngeal cancer at Hokkaido University Hospital, Japan, between 1990 and 2006 were divided into three groups according to preoperative treatments received: group I (n = 35) without radiotherapy (RT) or CCRT, group II (n = 17) RT alone, and group III (n = 34) low-dose CCRT. Salvage total laryngectomy was performed as a consequence of residual or recurrent disease after completion of the treatments. Wound complications such as pharyngocutaneous fistulas, bleeding, infections, and skin necrosis were retrospectively analyzed in each group.ResultsA considerable (not statistically significant) difference in the incidence of major wound complications was observed between groups I and III (11.4% vs 29.4%, P = 0.078), but not between groups II and III. In stage III/IV patients, a significant increase in the incidence of wound complications was observed in group III compared to group I. Pharyngocutaneous fistulas were the most common complication, occurring in 8/34 (23.5%) of the group III patients. Additional pharyngeal reconstruction surgery was performed in 5 of the 8 (62.5%) group III patients with pha ryngocutaneous fistulas, while no such patients (0/3) in group I required reconstruction surgery.ConclusionThere was an increased risk of wound complications in patients undergoing salvage laryngectomy following CCRT. Patients who developed pharyngocutaneous fistulas after CCRT tended to require surgical reintervention for repair. These findings should be taken into account before the initiation of CCRT and salvage surgery.

Voice-Related Quality of Life After Treatment of Laryngeal Cancer

OBJECTIVE To determine patient-perceived voice-related quality of life in patients treated with various methods based on the results of Voice-Related Quality of Life (VRQOL) and Voice Handicap Index-10 (VHI-10) questionnaires. DESIGN The VRQOL and VHI-10 questionnaires. SETTING University hospital. PATIENTS One hundred thirty-seven patients who had received definitive treatment of laryngeal cancer were followed-up at Hokkaido University Hospital, Sapporo, Japan, and were alive with no evidence of malignancy at the time of the survey. MAIN OUTCOME MEASURE Patient-perceived voice-related quality of life based on the results of the VRQOL and VHI-10 questionnaires. RESULTS The mean VRQOL scores for patients who had undergone radiotherapy (n = 63), chemoradiotherapy (n = 29), laser surgery (n = 14), or total laryngectomy (n = 27) as final treatment of laryngeal cancer were 92.6, 92.9, 85.5, and 68.4, respectively; the mean VHI-10 scores were 2.87, 2.34, 5.43, and 11.26, respectively. CONCLUSION The VRQOL and VHI-10 questionnaires are important in judging the overall effectiveness of treatment options for laryngeal cancer.

Concomitant Weekly Cisplatin and Radiotherapy for Head and Neck Cancer

OBJECTIVE The most common chemoradiotherapy regimen is high-dose (100 mg/m(2)) three-weekly cisplatin with concomitant radiotherapy; however, this protocol is associated with acute and late toxicities. Here, we reviewed the dose intensity and toxicity for concomitant weekly cisplatin and radiotherapy in patients with head and neck cancer. METHODS Fifty-three patients with untreated head and neck cancer were enrolled and evaluated at our institution from April 2006 to April 2010. Weekly cisplatin (40 mg/m(2)) was given on weeks 1, 2, 3, 5, 6 and 7 with radiotherapy, which comprised a standard dose of 70 Gy delivered in 35 daily fractions over 7 weeks. RESULTS Fifty-one patients (96.2%) received the full dose of radiotherapy, while the course was disrupted by adverse events in two. Over the course of the chemotherapy, 31 patients (58.5%) received more than 200 mg/m(2) cisplatin. The toxicity was manageable in all except one patient, who died of sepsis after completing treatment. The 2-year overall survival rate and local progression-free rate for all patients were 93.7% and 88.0%, respectively. The primary site showed a complete response in 52 patients (98.1%) and a partial response in 1 patient (1.9%). The primary disease was well controlled by chemoradiotherapy in 47 patients (88.7%). CONCLUSIONS Weekly cisplatin could be easier to manage than three-weekly cisplatin, because patients can be monitored more regularly for toxicity allowing the schedule to be altered if required. This regimen appears to be a suitable alternative to three-weekly high-dose cisplatin with concomitant radiotherapy.

Preoperative Staging of Sinonasal Inverted Papilloma by Magnetic Resonance Imaging

Objectives/Hypothesis: Sinonasal inverted papilloma is a rare but locally aggressive benign tumor. Inverted papilloma tends to recur after surgical resection and is occasionally associated with squamous cell carcinoma. Radical en bloc resection by lateral rhinotomy and medial maxillectomy has been recommended for initial management; however, endoscopic sinus surgery is effective in selected cases. To determine adequate surgical approaches, a staging system for inverted papilloma based on extent and location of the tumor has been advocated. The study investigated whether preoperative assessment by magnetic resonance imaging (MRI) accurately predicts the extent of inverted papilloma. Study Design: Magnetic resonance imaging was retrospectively reviewed in 21 cases of inverted papilloma without knowledge of the surgical and pathological findings. Methods: Patients were categorized into stages based on MRI findings, according to the staging system proposed by Krouse. The involvement of inverted papilloma in each sinus was also assessed. Results: Stages graded by MRI were coincident with postoperative staging verified by surgical and pathological findings in 18 of the 21 cases (86%), which included 1 case of stage T1, 3 cases of stage T2, and 14 cases of stage T3. Two cases of stage T2 were judged as T3, and one case of T3 was judged as T2 by MRI. Positive predictive value of MRI diagnosis for tumor involvement was 68% to 89% in each sinus, and negative predictive value was more than 93%. Conclusion: In most cases, MRI assessment of inverted papilloma can accurately predict the extent of tumor involvement. Preoperative staging of inverted papilloma by MRI may be useful for planning an appropriate surgical approach.

Rapid superselective high-dose cisplatin infusion with concomitant radiotherapy for advanced head and neck cancer

The purpose of this study was to evaluate the efficacy of rapid superselective high‐dose cisplatin infusion with concomitant radiotherapy for previously untreated patients with advanced head and neck cancer.

Randomized phase II trial of concomitant chemoradiotherapy using weekly carboplatin or daily low-dose cisplatin for squamous cell carcinoma of the head and neck

PURPOSEThis randomized, phase II study aimed to compare concomitant Chemoradiotherapy using weekly carboplatin or daily low-dose cisplatin as a treatment for squamous cell carcinoma of the head and neck. PATIENTS AND METHODSOne hundred nineteen patients with moderate-to advanced-stage disease were eligible for the study. Fifty-three patients had stage II disease, 28 had stage III, and the remaining 38 had stage IV disease. Primary tumor sites included the larynx (N = 63), oropharynx (N = 30), hypopharynx (N = 23), and oral cavity (N = 3). Each patient received either a weekly carboplatin dose (100 mg/m2) in one arm or daily cisplatin (4 mg/m2) in the other arm for the initial 4 weeks of radiotherapy. The radiotherapy dose of 65 Gy was given in 26 fractions over 45 days, dependent on a good tumor response at 40 Gy. Forty-nine (81.7%) of 60 patients treated with carboplatin and 41 (69.5%) of 59 patients treated with cisplatin received the full dose of radiotherapy. Surgical resection was optionally used for the remaining patients. RESULTSThe median follow-up time was 63 months. The local control rate at 5 years was 56.2% for the carboplatin-treated arm and 35.5% for the cisplatin-treated arm, respectively. The 5-year overall survival rate did not significantly differ between treatments: 71.4% for carboplatin and 66.0% for cisplatin. Hematologic toxicity was more frequent in the carboplatin-treated arm. No difference was observed in surgical complications or in radiation-related adverse effects. DISCUSSIONThese findings suggest that weekly carboplatin treatment is preferable to daily low-dose cisplatin. This could be because the total dose of cisplatin was too low to be effective.

Clinical study of adenoid cystic carcinoma of the head and neck.

OBJECTIVE We examined prognostic factors and outcome of the primary treatment in patients with adenoid cystic carcinoma (ACC) of the head and neck. METHODS Twenty patients with ACC of the head and neck who had been treated in our institution from 1985 to 1998 were enrolled in this study. Disease-specific survival rate was analyzed by the Kaplan-Mejer method, and the log-rank test was applied to compare the survival rates. RESULTS The overall 5- and 10-year survival rates determined by Kaplan-Meier analysis were 81 and 57%, respectively. Patients with major salivary gland ACC obtained the best 10-year survival rate (83%), while those with paranasal sinus ACC had the worst survival rate (33%). Predominance of the solid component on pathological examination might indicate a worse prognosis. Our study revealed that postoperative radiotherapy could yield better control of the lesion focus. Chemotherapy failed in some patients and was not dramatically effective by itself. CONCLUSIONS The long-term prognosis of ACC was poor. Long-term follow-up is necessary for better prognosis of patients treated with radical treatment regimens.

Platinum-based Chemotherapy Plus Cetuximab for the First-line Treatment of Japanese Patients with Recurrent and/or Metastatic Squamous Cell Carcinoma of the Head and Neck: Results of a Phase II Trial

Objective To assess the efficacy and safety of cetuximab in combination with cisplatin and 5-fluorouracil for first-line treatment of Japanese patients with recurrent and/or metastatic squamous cell carcinoma of the head and neck. Methods In this open-label, single-arm, multicenter, Phase II study conducted in Japan, patients with confirmed recurrent and/or metastatic squamous cell carcinoma of the head and neck received weekly cetuximab (week 1, 400 mg/m2; subsequent weeks, 250 mg/m2) plus a maximum of six three-weekly cycles of cisplatin (100 mg/m2, day 1) and 5-fluorouracil (1000 mg/m2/day, 24-h infusion, days 1–4). The primary endpoint was the best overall response assessed by an independent review committee according to the modified World Health Organization criteria. Results In total, 33 patients received treatment. The most frequent primary tumor site was the hypopharynx (42%), and most patients had metastatic disease (85%). The best overall response rate as assessed by the independent review committee was 36% (95% confidence interval: 20, 55) and was significantly greater (P = 0.002) than the protocol-specified threshold of 15% at the one-sided 5% level. The disease control rate was 88%. The median progression-free survival and overall survival were 4.1 and 14.1 months, respectively. There were no unexpected safety concerns. Grade 3 or 4 adverse events were experienced by nearly all patients (32, 97%). No adverse events were fatal. Conclusions The demonstrated efficacy and safety of cetuximab in combination with cisplatin and 5-fluorouracil for the first-line treatment of Japanese patients with recurrent and/or metastatic squamous cell carcinoma of the head and neck justify the further use of this combination treatment in this patient population (ClinicalTrials.gov number, NCT00971932).

Salvage surgery for local recurrence after chemoradiotherapy or radiotherapy in hypopharyngeal cancer patients.

This retrospective study aimed to assess the role of salvage surgery for local recurrence in hypopharyngeal cancer (HPC) patients who had received radiotherapy (RT) or concomitant chemoradiotherapy (CRT) as an initial treatment. The local recurrence rate, salvage rate after local recurrence and overall survival rate were investigated in 104 HPC patients who received treatment between 1991 and 2005. Local recurrence in the primary site was observed in 41 patients (rate, 39.4%) of whom only 12 could undergo further salvage surgery. Disease control was achieved in seven of these patients (successful salvage rate, 17.1%). The 5-year overall survival rate was 40.6% in the RT/CRT patient group and successful salvage rates for T1, T2, T3 and T4 primary disease were 33.3% (1/3), 20.0% (4/20), 16.7% (2/12) and 0% (0/6), respectively. Severe postoperative complications such as pharyngo-cutaneous fistula were seen in six patients (50.0%). Prognosis of patients with locally recurring HPC after RT/CRT is poor at any primary T-stage and the incidence of postoperative complication is relatively high. This should be taken into consideration when the initial treatment plan is decided and the choice of salvage surgery for such recurrent cases should be carefully determined.