Keisuke Yamazaki

Clinicopathological features of mucoepidermoid carcinoma

OBJECTIVE We aimed to examine the clinical usefulness of a new World Health Organization classification scheme for salivary gland mucoepidermoid carcinoma, and to identify the factors most strongly associated with prognosis and outcome. METHODS The clinicopathological features of 45 patients who received treatment for mucoepidermoid carcinoma between 1986 and 2010 were retrospectively investigated. RESULTS The overall disease-specific 5-year survival rate was 81.8 per cent. The rate for patients with low-grade tumours (92.5 per cent) was significantly higher than that for patients with intermediate or high-grade tumours (52.2 per cent). Univariate analysis revealed that five factors were significantly associated with five-year survival: age, tumour stage classification, lymph node status, histological grade and treatment method. Four factors were significant in multivariate analysis: age, sex, tumour stage classification and lymph node status. CONCLUSION The new World Health Organization classification was useful in predicting disease progression in patients with mucoepidermoid carcinoma. Patients with high-grade tumours or other prognostic factors positively associated with disease progression should be carefully evaluated and monitored.

Small cell carcinoma of the head and neck: report of three cases.

OBJECTIVE Small cell carcinoma of the head and neck is rare and has unique histopathological characteristics that make it difficult to diagnose and treat. In this report, the Japanese Lung Cancer Treatment Guidelines were adapted to treat three patients with small cell carcinoma of the head and neck, and outcomes evaluated. METHODS There was one case each of stage I small cell carcinoma of the nasal cavity, stage IV-B small cell carcinoma of the ethmoid sinus, and stage IV-A small cell carcinoma of the submandibular gland. All patients underwent chemoradiotherapy and achieved a partial response. RESULTS Only case one underwent surgery after chemoradiotherapy; 31 months after treatment, this patient had suffered no recurrence. Case two died three months after treatment due to bone marrow metastasis. Case three had experienced no progression after 12 months of follow up. CONCLUSION In this small patient series, short-term results were equivalent to or better than usual treatment outcomes for small cell carcinoma of the lung.

Multicenter phase I/II study of chemoradiotherapy with high-dose CDDP for head and neck squamous cell carcinoma in Japan

OBJECTIVE Recent data indicated that concurrent chemoradiotherapy (CCRT) using high dose cisplatin (CDDP) is the most useful treatment for advanced head and neck squamous cell carcinoma (SCC). Regarding the dose of CDDP, 100mg/m2 is most recommended in Western countries. However, in terms of a balance of efficacy and adverse events, appropriate dose of cytotoxic drugs such as CDDP may be different among the different ethnic groups. In this multicenter phase I/II study, we aimed to identify the optimal dose of CDDP in CCRT for patients with advanced head and neck SCC in the Japanese. METHODS Patients were eligible for inclusion if they had head and neck SCC that was treated with radical CCRT comprising whole-neck irradiation of the primary lesion and level II-IV lymph nodes on both sides. For the phase I study, a CDDP dose was 70mg/m2 for level 0, 80mg/m2 for level 1, and 100mg/m2 for level 2. Maximum tolerated dose (MTD) and dose-limiting toxicity (DLT) were examined by phase I trial, by which CDDP dose for phase II was determined. The primary endpoint for the phase II was CCRT completion rate, and the secondary endpoint was full-dose-CCRT completion rate, the percentage of patients receiving a total CDDP dose of ≥200mg/m2, response rate, and incidences of adverse events. RESULTS A CDDP dose of 100mg/m2 was the MTD for phase I, and the recommended dose for phase II was 80 mg/m2. Forty-seven patients were evaluated in the phase II trial. CCRT completion rate, full-dose-CCRT rate, and the percentage of patients receiving a total CDDP dose of ≥200mg/m2, were 93.6%, 78.7%, and 93.6%, respectively. One patient (2.1%) developed grade 2 renal dysfunction, and no patient developed febrile neutropenia or a grade 4 adverse event. CONCLUSION The present phase I study indicated that a CDDP dose of 80mg/m2 is the optimal dose in terms of safety. The phase II study revealed that CCRT completion rate, response rate, and rates of adverse events were not inferior for a CDDP dose of 80mg/m2 as compared with a dose of 100mg/m2, and a dose of 80mg/m2 is therefore recommended in CCRT for the Japanese. This study was registered with the University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR; identification No. UMIN000010369).

Successful transoral surgical closure of a hypopharyngeal pyriform sinus fistula: a case report

Abstract We describe a case of recurrent hypopharyngeal pyriform sinus fistula after an open neck surgery, which was successfully treated with transoral surgical closure. The patient was a 7-year-old boy who had previously undergone neck surgery for removal of a fistula. The fistula recurred one month later, and transoral closure was selected as a treatment. Under general anesthesia, the fistula was identified in the left pyriform sinus, and cotton balls soaked with trichloroacetic acid were inserted in the fistula opening, after which an electrocautery scalpel was used to close the fistula. At 18 months postoperatively, there has been no recurrence or complications. This is the first report to describe a transoral surgical closure of a recurrent fistula. Transoral surgical closure was successful and resulted in no complications; it thus appears to be an effective treatment option, even for patients who have previously undergone open neck surgery.