Hisaya Yukawa

A Phase I Study of Concurrent Chemoradiotherapy with S-1 for T2N0 Glottic Carcinoma

Objective: Chemoradiation based on S-1, a novel oral antitumor agent of fluorinated pyrimidines, is the treatment for T2N0 glottic carcinoma; however, the optimal scheduling and dosing have still not been established. A phase I study was conducted to determine the maximum tolerated dose of S-1 with radiotherapy of 2 Gy/day for 5 days a week to a total dose of 60 Gy. Endpoints of this study were to examine the toxicity profile of this regimen and to determine the recommended dose of S-1. Methods: Concomitant administration with the above-mentioned radiotherapy of S-1 once a day for 2 weeks, beginning on the day therapy was started, followed by 2 weeks off the drug and 2 weeks on the drug with the dose escalating from S-1 60 mg/body (level 1) to 80 mg/body/day (level 2), and then to 100 mg/body/day (level 3). Results: Twenty-one patients were valid for safety. Eighteen patients were enrolled in the dose-escalation phase. In all patients, S-1 was administered. The maximum tolerated dose was determined to be 100 mg/body/day and the dose-limiting toxicity was indicated by the onset of grade 3 chemoradiation dermatitis. Therefore, the determined recommended dose of S-1 was 80 mg/body/day. Objective response according to Response Evaluation Criteria in Solid Tumors were observed in 20 of 21 patients who had measurable disease (95.2%). Conclusion: Concurrent S-1 and radiotherapy was feasible and well tolerated, and was suggested to produce a worthwhile response in T2N0 glottic carcinoma. These results warrant further investigation, and a phase II has already been started.

Secondary Shunt Procedure for Alaryngeal Patients in an Outpatient Clinic

The shunt procedure used for laryngectomized patients undergoing secondary tracheo-esophageal (T-E) puncture is inconvenient and causes stress to the patient. In order to overcome these problems we developed a novel surgical T-E shunt technique using the Groningen voice prosthesis that does not require esophagoscopy or general anesthesia and can be performed in an outpatient clinic. In this procedure, a shunt is created using a pair of nasal forceps with the patient seated. An endoscope with biopsy forceps is used to insert the Groningen voice prosthesis. The procedure is usually completed within 20 min after inducing local anesthesia. Neither the technique itself nor the time taken to complete the procedure differed for T-E and tracheo-neoesophageal (reconstructed with flap) shunting. We believe that this procedure is suitable for patients who are afraid of esophagoscopy and/or are not considered suitable candidates for esophagoscopy and repeated general anesthesia. The procedure is also beneficial for both patients and surgeons with regard to its duration and the cost-effectiveness of treatment.

Evaluation of postoperative function in patients undergoing reconstruction following resection of superior and lateral oropharyngeal cancer: long-term outcomes of reconstruction with the Gehanno method

Resection of the superior or lateral wall of the cancer-affected oropharynx can often lead to disturbed nasal breathing, dysphagia, and dysarthria. The authors used the Gehanno method to reconstruct these surgical defects and achieved favourable functional recovery soon after surgery. The present study was undertaken to analyze the long-term outcome and usefulness of this method. Reconstruction was carried out using the Gehanno method in 36 patients during the 10-year period between 1997 and 2007. Both short-term and long-term evaluations of the postoperative function were performed in 12 of the 36 cases. The postoperative function was favourably maintained in all 12 cases, but gradual deterioration was noted in some cases in which the forearm flap had been used for reconstruction. Conventionally, the forearm flap is considered suitable for the reconstruction of complex structures such as the oropharynx because of its excellent flexibility. The results suggest that if the forearm flap is used for reconstruction using the Gehanno method, the surrounding tissue is likely to undergo change over time. The rectus abdominis myocutaneous flap should be considered as the first-choice flap for reconstruction using the Gehanno method.

A case of deep vein thrombosis after surgery for mesopharyngeal cancer

We report a case of deep vein thrombosis after surgery for mesopharyngeal cancer (T4N3M0). The patient showed swelling of the thigh on the right side and was diagnosed as deep vein thrombosis using RI venoscintigraphy. Heparin as an anticoagulant was effective for the disease. The number of cases of the disease may increase in the field of otorhinolaryngology and head and neck surgery. We emphasize the importance of selection of high risk patients and preventive treatment for these patients as well as early detection and therapy for deep vein thrombosis.

Effective Treatment at Early Stage for Anaplastic Carcinoma of the Thyroid : A Case Report

Generally, the prognosis of thyroid anaplastic carcinoma is extremely unsatisfactory. We report here excellent results due to early treatment in a patient with anaplastic carcinoma. The patient was a 74-year-old female, who presented with an enlarged frontal neck tumor, together with cervix and throat pain, and undifferentiated carcinoma was strongly suspected based on aspiration biopsy cytology. The patient was admitted and six days after the first examination, total thyroidectomy was performed, and a diagnosis of anaplastic thyroid carcinoma was made based on the permanent pathological specimen. Postoperatively, EAP (Etoposide, Adriamycin, and Cisplatin) treatment and radiotherapy (56 Gy) were performed, with a subsequent second chemotherapy course. At two years no recurrence or metastasis has been noted and the patient has returned to her normal daily life. In conclusion, if radical dissection of the tumor is possible in the early stages, we consider that in patients with anaplastic thyroid carcinoma immediate operation and radiation and chemotherapy treatment should result in a positive prognosis.