Shin-etsu Kamata

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.

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.

Surgical results of skull base surgery for the treatment of head and neck malignancies involving skull base: multi-institutional studies on 143 cases in Japan

We analyzed 143 cases of skull base surgery collected from the eight institutions of the Study Group supported by the Grant-in-Aid for Cancer Research from the Ministry of Health and Welfare of Japan. Histologically, the most common type was squamous cell carcinoma (n = 78), which was followed by olfactory neuroblastoma (n = 16) and adenoid cystic carcinoma (n = 16). The most frequent surgical approach was frontal craniotomy (n = 66), followed by front-temporal craniotomy (n = 54) and infratemporal fossa approach (n = 8). For repair of dura matter, fascia lata was used in 37 cases. galeopericranial flap in 35 and temporal muscle fascia in 16. The 5-year survival rate by Kaplan-Meier method of nose and paranasal sinus carcinoma (n = 119) was 48%. As for histological classification, the survival rates were both 65%) in adenoid cystic carcinoma (n = 12) and bone soft tissue malignancy (n = 10), 62% in olfactory neuroblastoma (n = 16), 46% in squamous cell carcinoma (n = 62) and 33% in adenocarcinoma (n = 11). All the three cases of malignant melanoma died within 1 year, so we considered skull base surgery to be contraindicated for this disease. Complications were observed in 62 out of the 143 cases (43%); local infection was most frequent in 29 cases. liquorrhea in 18, abscess in 16, necrosis of the flap and meningitis in ten cases, DIC in four, rupture of the internal carotid artery in two and cerebral thrombosis in one. Death caused directly by surgery was in ten cases (7%). It is important that a multi-center registry be maintained to have a large enough database for comparison of results, and prognosis for each histological entity and further define the role of multidisciplinary treatment.

Clinical Role of p53 and p21WAF1/CIP1 in Squamous Cell Carcinoma of the Pyriform Sinus

To investigate the clinical significance of p53 and p21WAF1/CIP1 in the advanced squamous cell carcinoma (SCC) of the pyriform sinus, we performed immunohistochemical staining of p53 and p21WAF1/CIP1 on the biopsy specimens from patients with stage III or stage IV SCC of the pyriform sinus. The results were compared with clinico-pathological features, including age, histological grade, TNM classification, number of neck lymph node metastases on histopathological examination (pLN) and prognosis. Specific staining for p53 and p21WAF1/CIP1 was detected in 36% and 32% of the specimens, respectively. Positive staining of p21WAF1/CIP1 was observed not only in the p53-negative specimens but also in the p53-positive specimens. Age (p < 0.05) and pLN (p < 0.001) were regarded as the significant prognostic factors. The 5-year survival rate of the p53-positive patients (55%) was significantly higher than that of the p53-negative patients (26.5%: p < 0.03). However, there is no significant difference between the p53 groups after controlling pLN. Although it was not statistically significant, the 5-year survival rate of the p21WAF1/CIP1-positive patients (58.8%) was higher than that of the p21WAF1/CIP1-negative patients (26.9%). These results suggest that expressions of p53 and p21WAF1/CIP1 are independent genetic alterations that may play different roles in the SCC of the pyriform sinus. Expression of p53 could not be regarded as an independent prognostic factor at this point. Further studies including the molecular biological analysis should be performed in order to determine the clinical role of p21WAF1/CIP1.

En bloc temporal bone resection using a diamond threadwire saw for malignant tumors.

The purpose of this study is to describe a new technique for en bloc temporal bone resection using a diamond threadwire saw (T-saw) as an alternative to cutting the temporal bone with an osteotome. This technique has been performed in 10 patients with external auditory canal and middle ear cancers without any injury to the internal carotid artery or jugular vein. The authors conclude that the use of a diamond threadwire saw after transposing the internal carotid artery anteriorly is a safe, simple, and reliable technique for en bloc temporal bone resection.

New classification of stage IV squamous cell carcinoma of the oropharynx

OBJECTIVE The recent progress in reconstructive surgery for the treatment of head and neck carcinomas has made it possible to radically resect cancers. However. the choice of treatment for oropharyngeal carcinoma is rather difficult. Radical treatment sometimes results in severe complications, suggesting that some modes of treatment might reduce the quality of life. The 5-year survival rate of patients with stage IV oropharyngeal carcinoma is still very poor. It is necessary to re-classify stage IV squamous cell carcinoma of the oropharynx in relation to the prognosis. Foote et al. (Base of tongue carcinoma: patterns of failure and predictors of recurrence after surgery alone. Head Neck 1993:15:300-307) demonstrated the two subgroups of stage IV oropharyngeal squamous cell carcinoma, as favorable stage IV and unfavorable stage IV. In this study, we have re-examined the validity of these subsets and we have demonstrated the new subsets of stage IV squamous cell carcinoma of the oropharynx. METHODS We have examined 221 cases of oropharyngeal squamous cell carcinoma at the Cancer Institute Hospital in Tokyo between 1971 and 1994. A total of 107 cases of stage IV were included. We analyzed these cases retrospectively. RESULTS Based on the subsets demonstrated by Foote et al., there were no significant differences between the two groups in our cases, suggesting that these subsets were not useful for the choice of the treatment. In order to make a new classification in view of better choice of treatment, either radical treatment or palliative therapy, these cases were divided into two new groups of stage IV. one group with relatively good results (T1-3 N2 M0 and T4 NO-1 M0; new favorable stage IV), and the other with very poor results (any-T any-N M1 and any-T N3 M0 and T4 N2 M0; new unfavorable stage IV). Patients with the new favorable stage IV have a 5-year survival rate of 30.4%, and those with the new unfavorable stage IV had a survival rate of 0%. CONCLUSION These new subsets of stage IV can be directly related to the prognosis, and are therefore useful in the choice of treatment.

PROGNOSTIC FACTORS OF LATERAL WALL OROPHARYNGEAL SQUAMOUS CELL CARCINOMA

We reviewed 79 patients with squamous cell carcinoma of the lateral wall of the oropharynx who received treatment at the Cancer Institute Hospital. Tokyo, between 1971 and 1990. There were 67 men and 12 women, aged 31 to 81 years (average 59.2 years). The tumors could be staged by TNM classification (UICC 1987) as follows: Stage 10 Stage II 12, Stage III 27, Stage IV 40. It must be noted that more than 50% of the tumors were classified as stage IV. As the initial treatment, 50 patients underwent radical radiotherapy, and the remaining 29 were treated mainly by surgery after pre-operative radiation. Some patients underwent adjuvant chemotherapy, but the role of chemotherapy was not considered in this study. The purpose of the present study was to determine the prognostic factors and to determine the survival rate after each treatment modality. The results were as follows: i) Patients with either T4, over N2b or a stage IV tumor had a significantly poor prognosis. ii) Cox multivariate analysis revealed that age, local extension (base of tongue, anterior pillar, soft palate and mid-line), pathological findings (poorly, moderately or well differentiated), tumor type (exophytic or endophytic) were not useful prognostic factors. iii) Radiosensitivity was not reflected in the survival rate judging from the high recurrence rate (44%) after radical radiotherapy. On the other hand, local recurrence after radical resection was seen in 18% of the patients. iv) Analysis of the data supported the recommendation of surgery after preoperative radiation as the treatment for stage III patients. It seems difficult to find the best treatment modality for stage IV patients in order to improve the survival rate, and this is an issue that still remains to be resolved. v) From the study of the surgical specimens, we are unable to demonstrate a significant survival advantage of the patients with a high grade radiation effect, or patients with no vessel involvement.

PROGNOSTIC VALUE OF THE CALCITONIN-TO-CEA RATIO IN MEDULLARY THYROID CARCINOMA

甲状腺髄様癌では血清calcitonin, CEA値が腫瘍マーカーとして有用であり, calcitonin分泌に比べCEA分泌が優位のものは予後不良であるといわれている。髄様癌におけるcalcitonin/CEA比の予後因子としての有用性について検討した。当科にて経験した髄様癌初取扱い20例 (1986～2004年, 散発性13例, 家族性3家系7例) の5年無再発生存率は80% (再発5例 ; 縦隔4, 頸部3, 肝2), 疾患特異的5年生存率は88% (肝転移の2例が原病死) であった。無再発生存率に影響する予後不良因子として, 術前calcitonin (pg/ml)/CEA (ng/ml) 比10以下, リンパ節転移10個以上が有意であった。術後calcitonin, CEAが正常化した13例には再発を認めなかったが, calcitonin/CEA比が10を超える症例と術後腫瘍マーカー正常化症例とは同一症例であった。calcitonin/CEA比により, 髄様癌の予後を予測することができるものと思われた。

Hypofractionated Stereotactic Radiotherapy for Auditory Canal or Middle Ear Cancer.

BACKGROUND Stereotactic radiotherapy (SRT) may represent a new treatment option for individuals with auditory canal or middle ear cancer. METHODS Study participants with pathologically proven ear cancer were treated with SRT (35 Gy for 3 fractions or 40 Gy for 5 fractions) as first-line therapy. When local tumor recurrence developed following SRT, subtotal temporal bone resection and postoperative chemoradiotherapy were performed as salvage treatment. Boluses were used for the initial 14 study patients. RESULTS Twenty-nine study participants were enrolled and staged with T1 (n = 3), T2 (n = 7), T3 (n = 14), or T4 disease (n = 5). Three-year overall survival rates were 69% for T1/2 disease, 79% for T3 disease, and 0% for T4 disease. Three-year local control rates were 70% for T1/2 disease, 50% for T3 disease, and 20% for T4 disease. Grade 2 or higher dermatitis or soft-tissue necrosis occurred more frequently in study patients treated with boluses (8/14 vs 2/15; P = .02). Salvage treatment was safely performed for 12 recurrent cases. CONCLUSIONS These results suggest that SRT outcomes are promising for patients with ear cancer (? T3 disease). The rate of toxicity was acceptable in the study patients treated without boluses. Outcomes of salvage surgery and postoperative radiotherapy following SRT were also encouraging.