Kazuyoshi Kawabata

Partial laryngectomy in the treatment of radiation-failure of early glottic carcinoma

This study was undertaken to analyze the functional results, complications, local control rates, and survival in patients undergoing conservation surgery for squamous cell carcinoma (SCC) of the larynx as a salvage procedure for recurrent tumors after previous radiotherapy.

Prognostic factors and the therapeutic strategy for patients with bone metastasis from differentiated thyroid carcinoma.

BACKGROUND The treatment of bone metastasis in association with thyroid cancer represents a difficult challenge. Given the paucity of patients with bone metastasis and the difficulty of treating this disease, few studies have investigated the clinical features and prognostic factors of bone metastasis from differentiated thyroid cancer. METHODS During the 31-year-period from 1976 to 2006, a total of 1,398 patients underwent initial thyroidectomy at Cancer Institute Hospital for differentiated thyroid carcinomas, including standard papillary thyroid carcinoma, papillary microcarcinoma (primary tumor diameter < or =1.0 cm), and follicular thyroid carcinoma. Among these, 25 (2%) patients displayed bone metastasis at initial presentation (synchronous) and 27 patients showed bone metastasis during follow-up (metachronous). The records for these 52 patients were reviewed retrospectively to identify prognostic factors and analyze treatment strategies. RESULTS Univariate analysis for disease-specific survival indicated metachronous bone metastasis and the presence of distant metastasis at sites other than bone as indicators of significantly worse prognosis. The type of cancer (papillary thyroid carcinoma versus follicular thyroid carcinoma) was not a significant indicator of prognosis; however, patients with papillary microcarcinoma showed significantly worse survival than patients with standard papillary and follicular thyroid carcinoma. A significant survival advantage was observed among patients who underwent radioactive iodine therapy, and better prognosis seemed to be obtained with greater doses of radioactive iodine. Operative resection of metastatic bone lesions also seemed to be associated with better prognosis. A multivariate analysis for disease-specific survival identified the coexistence of distant metastasis at sites other than bone as the only independent variable indicative of poor prognosis. CONCLUSION In the absence of definitive, effective treatments for this disease, radioactive iodine therapy combined with resection of bone metastasis, wherever possible, seems to represent the most potent therapy available. Although bone metastasis is a strong sign of poor prognosis, early detection and administration of appropriate therapy using radioactive iodine seems likely to improve the survival rate and quality of life in patients with bone metastasis from differentiated thyroid carcinoma.

Surgical treatment for pulmonary metastases of squamous cell carcinoma of the head and neck

PURPOSE As locoregional control of head and neck cancer has improved, distant metastases have become increasingly common problems. PATIENTS AND METHODS To determine the role of surgical treatment, we reviewed 32 patients with squamous cell carcinoma (SCC) of the head and neck who underwent thoracotomy for pulmonary metastases. RESULTS The overall 5-year survival rate was 32%. The 5-year survival rate of the patients with SCC of the oral cavity was significantly poorer than that of the patients with other primary site (15.4% v 45.2%; P = .01). In the patients with single nodule, extent of the tumor was a significant prognostic factor (P = .007). Mediastinal lymph node involvement (P = .004) and pleural invasion (P = .04) also correlated with survival. CONCLUSION TNM classification of the primary tumor did not have an impact on survival in this study. Further studies of a large series should be performed to determine the indications and modalities of the surgical treatment for pulmonary metastases of the SCC of head and neck.

Combination chemotherapy (cyclophosphamide, doxorubicin, and vincristine with continuous‐infusion cisplatin and etoposide) and radiotherapy with stem cell support can be beneficial for adolescents and adults with estheisoneuroblastoma

Adolescent‐onset and adult‐onset esthesioneuroblastoma is a rare disease and is considered incurable. In many patients, local resection and radiation are chosen as clinical therapy with or without chemotherapy. It was reported previously that local resection and radiotherapy led to temporary remission and, in many patients, recurrent disease. Although combination with chemotherapy has been regarded as promising, an effective regimen has not been established. In the current study, the authors investigated the effect and tolerability of the combination of chemotherapy, radiotherapy, and peripheral blood stem cell transplantation (PBSCT).

Prevalence of human papillomavirus in mobile tongue cancer with particular reference to young patients

The carcinogenetic role of human papillomavirus (HPV) in mobile tongue cancer remains unclear because of conflicting results reported in the literature. This disparity is likely to be due to variations in the samples and methods used. Furthermore, despite a tendency for increased prevalence of mobile tongue cancer in young adults, only a few reports specifically in young patients have been published. In the present study on 32 patients, including six in their 20s, we genotyped the prevalence of HPV using a highly sensitive detection tool in fresh‐frozen samples from surgical specimens and a novel detection device with electrochemical DNA chip and loop‐mediated isothermal amplification. In addition, we confirmed HPV prevalence by in situ hybridization and immunohistochemistry for the p16INK4a protein, regarded as a biomarker of HPV‐associated cancers. The frequency of 13 genotypes of high‐risk HPV was 0/32 (0%), which was further confirmed by in situ hybridization. Overexpression of p16INK4a protein was observed in six of the 32 patients (19%), with four (67%) also overexpressing p53. Because there is usually a lack of p53 overexpression in HPV‐associated cancer, it is unlikely that p16INK4a protein overexpression is correlated with HPV infection. Consequently, it is unlikely that HPV infection plays an important role in mobile tongue carcinogenesis, in particular in young adults. In addition, our data suggest that the overexpression of p16INK4a protein is not an appropriate biomarker for HPV association in mobile tongue carcinogenesis. (Cancer Sci 2012; 103: 161–168)

Surgical management of tracheal shaving for papillary thyroid carcinoma with tracheal invasion

Conclusion: Patients showed improved quality of life following tracheal shaving and the carcinoma was well controlled locally, as long as invasion had not progressed to the mucosal surface of the trachea. However, compared with papillary thyroid carcinoma (PTC) with no tracheal invasion, metastasis was common and invasion of organs other than the trachea was frequent, putting many patients into the high-risk group. The clinical course for such patients thus requires careful monitoring, with particular attention to metastasis to other locations. Tracheal shaving can be recommended for patients with PTC with tracheal invasion. Objectives: Macroscopically, in cases where invasion into the trachea has not reached the tracheal mucosa surface, we perform tracheal surface resection (tracheal shaving). We retrospectively investigated rates of local control, metastasis and survival in patients who had undergone tracheal shaving. Patients and methods: Subjects comprised 22 patients with PTC who underwent tracheal shaving between January 1994 and December 2005. Results: Local control was achieved in 21 patients (95%), and metastasis was seen in 6 patients (27%). With two patients dying from causes other than cancer, 5- and 10-year survival rates were 93% and 41%, respectively. The two surviving patients are still cancer-bearing.

Randomized Phase III Trial of Adjuvant Chemotherapy with S-1 after Curative Treatment in Patients with Squamous-Cell Carcinoma of the Head and Neck (ACTS-HNC)

Background We conducted a phase III study to evaluate S-1 as compared with UFT as control in patients after curative therapy for stage III, IVA, or IVB squamous-cell carcinoma of the head and neck (SCCHN). Patients and Methods Patients were randomly assigned to the UFT group (300 or 400 mg day-1 for 1 year) or the S-1 group (80, 100, or 120 mg day-1 for 1 year). The primary end point was disease-free survival (DFS). Secondary end points were relapse-free survival, overall survival (OS), and safety. Results A total of 526 patients were enrolled, and 505 were eligible for analysis. The 3-year DFS rate was 60.0% in the UFT group and 64.1% in the S-1 group (HR, 0.87; 95%CI, 0.66-1.16; p = 0.34). The 3-year OS rate was 75.8% and 82.9%, respectively (HR, 0.64; 95% CI, 0.44-0.94; p = 0.022). Among grade 3 or higher adverse events, the incidences of leukopenia (5.2%), neutropenia (3.6%), thrombocytopenia (2.0%), and mucositis/stomatitis (2.4%) were significantly higher in the S-1 group. Conclusions Although DFS did not differ significantly between the groups, OS was significantly better in the S-1 group than in the UFT group. S-1 is considered a treatment option after curative therapy for stage III, IVA, IVB SCCHN. Trial Registration ClinicalTrials.gov NCT00336947 http://clinicaltrials.gov/show/NCT00336947

Indications for thyroid cancer surgery in elderly patients.

PurposeTo define the indications for thyroid cancer surgery in elderly patients.MethodsWe compared the clinical characteristics of thyroid cancers in 85 elderly patients, defined as those aged ≥75 years, with those of 37 young patients, defined as those aged <30 years. The elderly group included patients who underwent surgery and/or reoperation and those managed nonoperatively. All patients were treated during an 11-year period from 1994 to 2004 at the Cancer Institute Hospital.ResultsThe elderly patients with papillary thyroid carcinoma had a significantly worse cumulative 5-year survival rate than the young patients with papillary thyroid carcinoma (92% vs 100%: P = 0.03). However, there was no significant difference in the survival of patients with low-risk tumors between the two age groups. The cumulative 2-year survival rate of elderly patients with a high-risk tumor was significantly lower in patients not treated with surgery than in those treated surgically (80% vs 100%: P = 0.02). Quality of life (QOL) was severely impaired in 67% and 6% of the nonoperated and operated patients, respectively.ConclusionsThese results suggest that surgery for thyroid cancer increases the survival rate and promotes the QOL of elderly patients if they are well enough to tolerate the procedure.

Analysis of 59 cases with free flap thrombosis after reconstructive surgery for head and neck cancer

OBJECTIVE There have been few reports addressing methods of dealing with free flap thrombosis after reconstructive surgery for head and neck cancer. The present study, through a detailed analysis of the subsequent course of patients who developed postoperative flap thrombosis, aims to clarify possible methods of salvage surgery in the event of vascular occlusion despite rigorous postoperative follow-up. METHODS We analyzed 59 cases of postoperative thrombosis in 1031 patients who underwent free flap transfer and considered the most appropriate salvage surgery in the event of total flap necrosis. RESULTS The flap salvage rate through vascular reanastomosis was highest for radial forearm flaps, with salvage of jejunal flaps being problematic if postoperative thrombosis occurred. For cases of postoperative thrombosis among patients who underwent reconstruction using a jejunal flap, the period of hospitalization was significantly extended for those patients in whom a second jejunal flap grafting was impossible. For cases of postoperative thrombosis among patients who underwent reconstruction using a radial forearm flap (FA), rectus abdominis flap (RA), or anterior lateral thigh flap (ALT), no significant difference was observed between those undergoing re-grafting with a free flap and those with a pedicled flap. CONCLUSION We concluded that, among patients who undergo reconstruction using a jejunal flap, thrombosis should be discovered at an early stage to enable another jejunal flap re-grafting. For patients who undergo reconstruction using a FA, RA, or ALT, if thrombosis can be discovered at an early stage, there is a possibility of salvaging the flap by means of vascular reanastomosis. If it should prove impossible to salvage the flap, however, primary suture of the defect or reconstruction with a pedicled flap may also be considered.

Factors involved in free flap thrombosis after reconstructive surgery for head and neck cancer.

OBJECTIVE Reconstructive surgery in which a free flap is used following extended resection for head and neck cancer has been popular for more than a quarter of a century. However, postoperative total flap necrosis has not been completely resolved, and few studies have analyzed the specific risk factors for this complication. METHODS Over a three-year period from 2005 to 2007, 388 flaps were used for reconstructive surgery on 384 patients at Department of Head and Neck of the Cancer Institute Hospital of Japanese Foundation for Cancer Research, and the results for 22 flaps with thrombosis were analyzed. RESULTS The only statistically significant risk factor for free flap thrombosis was the history of radical concurrent chemoradiotherapy. CONCLUSIONS It will be necessary to keep this observation in mind when performing salvage surgery following chemoradiotherapy, which is expected to be performed more often in the future.