Motoki Nagata

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.

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.

Diagnostic Problems in a Case of the Mucoepidermoid Carcinoma in the Maxillary Sinus.

Mucoepidermoid carcinoma of the maxillary sinus is a rare neoplasm. We describe diagnostic difficulties in a case of low grade mucoepidermoid carcinoma of a cystic pattern in a 72-year-old man. The patient complained of double vision and nasal bleeding. CT findings indicated a shadow in the unilateral maxillary sinus as well as bony destruction of the maxilla on the same side. Although biopsies and maxillary operations were repeatedly performed over a period of 7 years, the histopathological diagnoses were chronic sinusitis with necrotic characteristics or squamous cell carcinoma.Several cases of mucoepidermoid carcinoma have been similarly misdiagnosed as squamous cell carcinoma because mucoepidermoid carcinomas contain epidermoid cell components similar to squamous cell carcinomas. Tumor necrosis in our case were extensive and the mucous discharge secreted by mucous cell components in this type of carcinoma may increase pressure inside the cystic tumor causing tumor necrosis. The significance of a differential diagnosis between mucoepidermoid carcinoma and chronic inflammation or squamous cell carcinoma in the maxillary sinus should be emphasized.