Hidenobu Iida

Clinical Assessment of Squamous Cell Carcinoma of the Nasal Cavity Proper

The subjects were 14 patients with squamous cell carcinoma or undifferentiated carcinoma of the nasal cavity treated at Nihon University Hospital between October 1984 and November 1991, who were followed for at least 3 years. The site of the tumor origin within the nasal cavity was the lateral wall in 8 patients, the nasal septum in three patients, and unknown in three patients. Histologically, there were 13 squamous cell carcinomas in (3 well differentiated, 7 moderately differentiated, and 3 poorly differentiated) and 1 undifferentiated carcinoma. Treatment was by a combination of radiotherapy, chemotherapy, and surgery in 8 cases, a combination of radiotherapy and surgery in 5 cases, and surgery alone in 1 case. The 3-year and 5-year Kaplan-Meier survival rates were 86 and 69%, respectively. A total of 6 patients suffered a recurrence, with local recurrence occurring in 4 patients and pulmonary metastasis in 2 patients. Tumor control was achieved in 3 of the 4 cases of local recurrence by reoperation, and by surgery in 1 of the 2 cases of pulmonary metastasis. The duration of the recurrence-free interval in the patients who developed local recurrences, 18 to 46 months after the completion of the initial course of therapy, was of considerable interest.

COMBINATION CHEMOTHERAPY WITH CDDP AND 5-FU IN HEAD AND NECK CANCER .

Combination chemotherapy with CDDP and 5-FU was performed in 19 patients with evaluable head and neck cancer and 2 CR patients and 7 PR patients were obtained; thus the response rate was 47.4%. Histologically, the present therapy is considered to be especially effective against well differentiated squamous cell carcinoma (83.3%). The present therapy is considered to be useful as a neo-adjuvant chemotherapy (75.0%), but it is desirable to perform at least 2 courses of treatment. The side effects observed were nausea, vomiting, anemia, leukocytopenia and alopecia, etc., and most of them were reversible. However, there were 2 patients in which the continuation of chemotherapy was impossible due to renal disorders.

Cap Therapy for Advanced, Recurrent and/or Metastatic Malignant Tumors of the Head and Neck

One-day CAP therapy utilizing CPM, THP-ADM and CDDP was performed on 33 patients with malignant tumors in the head and neck region which were able to be evaluated. As a result, CR was obtained in 6 patients and PR in 11 patients; thus the overall response rate was 51.5%. The present therapy is worthwhile as a neo-adjuvant chemotherapy and it was effective in patients with relatively severe systemic condition or those with lung metastasis. When the tissues were classified histologically, the present therapy was effective against anaplastic carcinoma and adenocarcinoma. Since agents significantly effective against adenocarcinoma have not been available so far, the present therapy is considered to be a useful method especially for the treatment of adenocarcinoma. Moreover, because irreversible side effects scarcely appeared and because the period for 1 course of treatment is short enough, the present therapy is considered to be a method with little burden on patients.

T-LYMPHOCYTE SUBSETS IN PATIENTS WITH SQUAMOUS CELL CARCINOMA OF THE HEAD AND NECK

T-lymphocyte subsets in the peripheral blood of patients previously untreated for squamous cell carcinoma of the head and neck were investigated using monoclonal antibodies under flow cytometry before starting treatment. T-lymphocyte subsets in the peripheral blood of patients with squamous cell carcinoma did not significantly differ from those in the peripheral blood of healthy subjects, patients with benign tumors of the head and neck, patients with chronic sinusitis and patients with benign otolaryngological diseases. The necessity to investigate the function of T-lymphocyte subsets was suggested. It was furthermore suggested that T-lymphocyte subsets in cancerous tissues should be investigated.

A Report of Two Cases with Nasal Tuberculosis.

We treated two patients with nasal tuberculosis. One was a 58-year-old female who visited our clinic because of right nasal obstruction and bleeding. Mild swelling of the inferior turbinate and a bloody nasal discharge were observed. Mycobacterium tuberculosis was cultured from the nasal discharge. Biopsy of the mucous membrane of the inferior turbinate showed a granuloma with epithelioid cells. The other was a 59-year-old female who visited us with complaints of right nasal obstruction, purulent nasal discharge, and frontal headache. Granulation, bleeding and crust attachment were observed on the right concha nasalis inferior and the nasal septum. Mycobacterium tuberculosis was cultured from the nasal discharge. Both patients had strongly positive Mantoux tests. Chest X-ray films showed evidence of old tuberulosis but no active pulmonary tuberculosis. Both patients were treated mainly with streptomycin and other anti-tuberculous drugs with satisfactory results.

Posterior paranasal sinus cysts with opthalmological symptoms.

Thirty-eight cases of posterior paranasal sinus cysts with opthalmological symptoms, treated at Nihon Univcrsity School of Medicine between 1977 and 1987 were reviewed.Location of cysts, predominance of sex and age, existence of pasthistory of sinus operation were the same as reported by many other otolaryngologists.Operation was carried out to drain the cysts. Good results were obtained in the cases of 1) good visual acuity preoperatively 2) operation carried out promptly after the devclopment of eye symptoms and 3) gradual onset of eye symptoms.Drainageoperation was satisfactory in patients with visualacuity of more than 0.01. When the visual acuity is below 0.01, more advanced opcration such as pecling off affected mucosa, decompression of optic nerve is preferable.

Cyclophosphamide, Tetrahydropyranyl-Adriamycin, and CIS-Platinum in the Treatment of Head and Neck Adenocarcinoma

Twelve patients with advanced or relapsed head and neck adenocarcinoma received a combination chemotherapy regimen of either cyclophosphamide (C), tetrahydropyranyl-adriamycin (T), and cis-platinum (P) (CTP) or cyclophosphamide, adriamycin (A), and cis-platinum (CAP). Cyclophosphamide (300 mg/sq m), either etrahydropyranyl-adriamycin (30 mg/sq m) or adriamycin (30 mg/sq m), and cis-platinum (50 mg/sq m) were administered intravenously in a single day. Nine patients received the CTP regimen, and three patients, the CAP regimen. Prior to chemotherapy, five patients had received surgery or radiation therapy, and the other seven patients received no special treatment. A response rate 75% was achieved (9/12); there were 7 complete responses, whose duration was a mean 6.8 months, ranging from 2 to 18 months, and 2 partial responses, whose duration was 2 months. Virtually all patients experienced nausea and vomiting. Alopecia developed in 7 patients; however, the patients with the CTP regimen experienced less alopecia, if any. Leucopenia and anemia of either a slight or moderate degree were observed, but there was no patient for whom it was necessary to discontinue the treatment. Both CTP and CAP regimens appear to be of significant value in controlling head and neck adenocarcinoma.