Ikuyo Kanai

Stereotactic Radiosurgery in Combination With Chemotherapy as Primary Treatment for Head and Neck Cancer

PURPOSE The purpose of this study was to investigate the effect of stereotactic radiosurgery on local control and organ preservation in cases of primary head and neck cancer. PATIENTS AND METHODS In this retrospective study, 14 patients with a mean age of 73 years were treated between March 2006 and September 2007 with stereotactic radiosurgery for the management of primary head and neck cancer. The patients had biopsy confirmation of disease before treatment and all patients were confirmed with squamous cell carcinoma. The staging consisted of T2 (5 cases), T3 (3 cases), T4 (6 cases), N0 (13 cases), and N1 (1 case). Marginal doses were 3,500 to 4,200 cGy in 3 or 5 fractions. The outcome was assessed according to Response Evaluation Criteria in Solid Tumors criteria based on magnetic resonance imaging and positron emission tomography/computed tomography. RESULTS Significant tumor reduction was noted at the third month of follow-up with 5 complete responses and 9 partial responses. At a mean follow-up of 36 months (range, 14-40 mo) the local control and overall survival rates were 71.4% (10/14) and 78.6% (11/14), respectively. CONCLUSIONS These results show the feasibility of using stereotactic radiosurgery for primary head and neck cancer and its potential benefit in local control and organ preservation.

The assessment of surgical and non-surgical treatment of stage II medication-related osteonecrosis of the jaw

Background Non-surgical treatment has generally been recommended for stage II medication-related osteonecrosis of the jaw (MRONJ) in preference to surgery. However, non-surgical treatment is not empirically effective. The aim of this study was to evaluate whether surgical or non-surgical treatment leads to better outcomes for stage II MRONJ. Material and Methods In this retrospective study, surgery was performed in a total of 28 patients while 24 patients underwent non-surgical treatment. The outcomes of both treatment approaches after 6 months were evaluated and statistically compared. In addition, risk factors for surgical and non-surgical treatments were assessed for each. Results Surgical treatment in 25 patients (89.3%) resulted in success, with failure in 3 patients (10.7%). Non-surgical treatment was successful for 8 patients (33.3%) and failed in 16 patients (66.7%). There was therefore a significant difference between surgical and non-surgical treatment outcomes (P<0.01). Regarding risk factors, in non-surgical treatment primary diseases, medications, and drug holiday had a significant effect on outcomes (P<0.01). Risk factors for surgical treatment could not be clarified. Conclusions Surgical treatment is more effective than non-surgical treatment for stage II MRONJ, and drug holiday, primary disease, and medication constitute risk factors in non-surgical treatment. Key words:Bisphosphonate, bisphosphonate-related osteonecrosis of the jaw, denosumab, management, medication-related osteonecrosis of the jaw.

Intraoperative real-time assessment of blood flow using indocyanine green angiography after anastomoses in free-flap reconstructions

w t c I e e d s i i v i A ndocyanine green (ICG) is a cyanine dye generally used n liver function tests. It emits near-infrared fluorescence, nd can be detected in the body by specific charged-coupled evice cameras.1 This technique, called ICG angiography, llows real-time imaging of the bloodstream. In reconstrucive surgery ICG angiography can confirm the presence of enetrating vessel branches, particularly in flaps for breast econstruction, and evaluation of the bloodstream during kidey transplantation.2,3 However, we know of only one report f its use in free flaps in head and neck surgery.4 We have sed ICG angiography to evaluate the quality of the bloodtream at the anastomotic site in three cases of reconstruction ith free flaps after resections for oral cancer. Between July 2015 and December 2016 we operated on hree patients with advanced oral cancer (Table 1). Cases and 2 had hemiglossectomy and neck dissection on the ffected side. Case 3 had resection of a tumour of the buccal ucosa and neck dissection on the affected side. All patients ad reconstructions with radial forearm free flaps. Each arteial anastomosis was made end-to-end with 9/0 nylon, and wo veins in each case had end-to-side or end-to-end anas-

A diffuse traumatic neuroma in the palate: a case report.

BackgroundA traumatic neuroma is not a true neoplasm but a reactive proliferation of neural tissue that commonly occurs after the transection or damage of a nerve bundle. Traumatic neuromas are rare in the oral region and usually occur as a solitary nodule of the mental foramen, lower lip, or tongue. This is the first report of a diffuse traumatic neuroma of the palate.Case presentationA 30-year-old Japanese man was referred to our clinic complaining of painful swelling of the left side of his palate. The swelling was diffuse and his pain increased with palpation of his palate. He had no noteworthy medical or family history, and was not aware of any history of trauma or inflammation in his head or neck area. We administered antibiotics and non-steroidal anti-inflammatory drugs because we suspected that his symptoms were the result of inflammation caused by an infection. However, his symptoms did not change. An incisional biopsy was performed, and histopathologic examination indicated that the lesion was a traumatic neuroma. Under general anesthesia the lesion was resected with a 5-mm margin using an electric scalpel because of the diffuse expansion and indistinct borders of the mass. Some tumor cells were observed within the surgical margins of the resected specimen, but there has been no recurrence of either the pain or mass in the 3 years since the surgery.ConclusionsThe location and diffuse nature of this traumatic neuroma are both very rare. While we were initially unsure about the diagnosis and treatment of this mass, the treatment outcome has been good. However, a postoperative recurrence can occur at any time following the excision of a traumatic neuroma, and close long-term follow-up will continue.