Ichiro Ogura

TRIMODAL COMBINATION THERAPY FOR MAXILLARY SINUS CARCINOMA

PURPOSE This study was conducted to evaluate the effectiveness of trimodal combination therapy (radiotherapy, intra-arterial chemotherapy, antrotomy) for the treatment of primary maxillary sinus carcinoma. METHODS AND MATERIALS Between 1977 and 1996, 110 patients with maxillary squamous cell carcinoma were treated with trimodal combination therapy at Tokyo Medical and Dental University Hospital. All tumors were classified according to the 1997 UICC TNM staging system. Eighty percent of patients had T3 or T4 tumors. The T3 and T4 tumors were also classified into three groups according to their location, as visualized using computed tomography: the posterior-lateral (P) group, the medial (M) group, and the upper (U) group. Eight patients received additional radiotherapy, and 37 patients underwent a second surgical procedure, in addition to the trimodal combination therapy. RESULTS The 5-year cause-specific survival and local control rates were 71% and 65%, respectively. The 5-year local control rate was 80% for the T1+2 tumors, 64% for the T3 tumors, and 52% for the T4 tumors (p = 0.06). Patients in the P+M group who received a 5-fluorouracil (5-FU) dosage of more than 3500 mg had a better 5-year local control rate than patients who received a 5-FU dosage of less than 3500 mg (p = 0.01). No improvement in the local control rate after a second surgical procedure or additional irradiation treatment was observed in any of the groups. CONCLUSION Trimodal combination therapy provides good local control, with the final outcome depending on the T stage of the tumor and the dosage of 5-FU.

Correlation between tumor consistency and cervical metastasis in tongue carcinoma

The purpose of this study was to assess the correlation between the tumor consistency and cervical lymph node metastasis in tongue carcinoma.

Clinicopathological study of carcinomas of the lip and the mucosa of the upper and lower lips

AbstractBackground. Lip carcinomas are rare oral tumors, and there have been few reports of lip carcinoma in Japan. Methods. Of 914 patients with oral carcinomas treated between January 1980 and December 1998, 12 (1.3%) had lip carcinoma and 5 (0.5%) had lip mucosal carcinoma. We investigated the clinicopathological features of these 17 patients. Results. Of the 12 patients with carcinoma of the lip, 10 had squamous cell carcinomas (9, external lower lip; 1 commissures) and 2 had mucoepidermoid carcinomas (external upper lip). Of the 5 patients with lip mucosal carcinoma, 3 had squamous cell carcinomas (2, mucosa of the lower lip; 1, mucosa of the upper lip), 1 had mucoepidermoid carcinoma (mucosa of the lower lip), and 1 had acinic cell carcinoma (mucosa of the lower lip). Of the 12 patients with lip carcinoma, 9 were classified as stage I, 2 as stage II, and 1 as stage III; all 5 of the patients with lip mucosal carcinoma were stage I. Five patients with lip carcinoma were treated by resection, 5 by a combination of resection and reconstruction, and 2 by radiotherapy alone. All patients with lip mucosal carcinoma were treated by resection. After the initial therapy, 3 patients without neck dissection had regional recurrences and received delayed neck dissection, and 2 died with neck regional recurrence after dissection. The 5-year cumulative survival rates of the patients with lip carcinoma and those with lip mucosal carcinoma were 82.5% and 80.0%, respectively. Conclusion. We suggest that early-stage carcinomas of the lip and of the mucosa of the upper and lower lips are frequent, and we found that the outcome of these patients was excellent. However, an aggressive therapeutic approach to the lip carcinoma patient with cervical metastasis appears warranted, in an attempt to improve locoregional control and ultimate survival.

Quantitative evaluation of consistency of normal mucosa, leukoplakia and squamous cell carcinoma of the tongue

The quantitative differences in consistency of normal mucosa, leukoplakia and squamous cell carcinoma of the tongue were studied. Forty-five patients with squamous cell carcinoma of the tongue, 26 with leukoplakia and 80 with normal tongues were examined using an instrument capable of measuring consistency as a function of the load (in grams) needed to displace tongue mucosa by 2.0 mm using a probe 2.0 mm in diameter. The mean value for consistency in tongue carcinoma, leukoplakia and normal tongue was 22.1 +/- 8.0 g, 8.3 +/- 2.0 g and 4.8 +/- 0.7 g, respectively. Differences in consistency among these entities were significant (P < 0.001). Furthermore, consistency in tongue carcinoma was significantly correlated to tumour thickness (r = 0.954, P < 0.001). It was concluded that the consistency in tongue lesions was objectively and quantitatively evaluated by this method, and this technique could measure the thickness of the tumorous lesions preoperatively.

CT findings of cervical lymph node metastasis from intraoral mucoepidermoid carcinoma: Histopathological correlation

ObjectivesTo evaluate CT findings of metastatic cervical nodes from intraoral mucoepidermoid carcinoma and to correlate them with histopathological findings.MethodsFive metastatic cervical lymph nodes in four patients with intraoral mucoepidermoid carcinoma were included in this study. The primary sites of the tumors were the palate (n=2), the lower gingiva (n=1) and the tongue (n=1). The findings for these nodes on contrast-enhanced CT images were retrospectively evaluated and compared with the histopathological findings.ResultsAmong the five metastatic nodes, the minimal axial diameter ranged from 12 mm to 19 mm. They all contained low-density areas on CT, suspicious for nodal necrosis, and showed heterogeneous or rim enhancement. Histopathologically, they all had intranodal cysts, which were consistent with the low-density areas detected on CT.ConclusionThe CT findings of cervical metastases from intraoral mucoepidermoid carcinoma were characterized by the presence of low-density areas within the nodes. Although these findings suggested nodal necrosis typically seen in squamous cell carcinoma, they were histopathologically confirmed to reflect intranodal cyst formation.To evaluate CT findings of metastatic cervical nodes from intraoral mucoepidermoid carcinoma and to correlate them with histopathological findings. Five metastatic cervical lymph nodes in four patients with intraoral mucoepidermoid carcinoma were included in this study. The primary sites of the tumors were the palate (n=2), the lower gingiva (n=1) and the tongue (n=1). The findings for these nodes on contrast-enhanced CT images were retrospectively evaluated and compared with the histopathological findings. Among the five metastatic nodes, the minimal axial diameter ranged from 12 mm to 19 mm. They all contained low-density areas on CT, suspicious for nodal necrosis, and showed heterogeneous or rim enhancement. Histopathologically, they all had intranodal cysts, which were consistent with the low-density areas detected on CT. The CT findings of cervical metastases from intraoral mucoepidermoid carcinoma were characterized by the presence of low-density areas within the nodes. Although these findings suggested nodal necrosis typically seen in squamous cell carcinoma, they were histopathologically confirmed to reflect intranodal cyst formation.

Preoperative computed tomography for determining nodal status combined with histologic grading as a prognostic factor for patients with tongue carcinoma

ObjectivesTo evaluate the predictive value of preoperative neck computed tomography (CT) in combination with histologic grading as a prognostic factor for patients with tongue carcinoma.MethodsFifty-five patients with squamous cell carcinoma of the tongue were examined by CT prior to radical neck dissection. The locoregional failure and survival rates of these patients were analyzed in relation to their clinical characteristics, histologic grading (World Health Organization, WHO) based on tongue biopsy, and imaging diagnoses prior to surgery.ResultsLogistic multivariate regression analysis showed that both histologic grading and number of metastic lymph nodes on CT were significant and independent prognostic factors in locoregional failure (p=0.009 and p=0.009, respectively). When the number of metastatic lymph nodes detected on preoperative neck CT were combined with the histologic grading for the evaluation, the five-year overall survival rates of A group (0 node with any Grade, or 1 node with GradeI–II) and B group (1 node with GradeIII, or 2 or more nodes with any Grade) were 74.5% and 37.5%, respectively (p=0.001). The difference was more significant than histologic grading alone or the number of metastatic lymph nodes seen on CT alone.ConclusionsThe combination of preoperative neck CT with histologic grading of the primary tumor is useful as a prognostic indicator for patients with tongue carcinoma.To evaluate the predictive value of preoperative neck computed tomography (CT) in combination with histologic grading as a prognostic factor for patients with tongue carcinoma. Fifty-five patients with squamous cell carcinoma of the tongue were examined by CT prior to radical neck dissection. The locoregional failure and survival rates of these patients were analyzed in relation to their clinical characteristics, histologic grading (World Health Organization, WHO) based on tongue biopsy, and imaging diagnoses prior to surgery. Logistic multivariate regression analysis showed that both histologic grading and number of metastic lymph nodes on CT were significant and independent prognostic factors in locoregional failure (p=0.009 and p=0.009, respectively). When the number of metastatic lymph nodes detected on preoperative neck CT were combined with the histologic grading for the evaluation, the five-year overall survival rates of A group (0 node with any Grade, or 1 node with GradeI–II) and B group (1 node with GradeIII, or 2 or more nodes with any Grade) were 74.5% and 37.5%, respectively (p=0.001). The difference was more significant than histologic grading alone or the number of metastatic lymph nodes seen on CT alone. The combination of preoperative neck CT with histologic grading of the primary tumor is useful as a prognostic indicator for patients with tongue carcinoma.