Shuji Sawaki

Tumours metastasizing to the head and neck--a report of seven cases.

Metastatic tumours involving the head and neck region are rare. Over the past 18 years, seven such cases were treated at our clinic. Of those, four were in one of the paranasal sinuses, three had arisen from a primary hepatocellular carcinoma and one from an osteogenic fibrosarcoma of the leg. In the remaining three cases, metastases to the larynx, the tonsil, and the parotid gland arose from a primary renal cell carcinoma, a thyroid carcinoma, and a breast carcinoma, respectively. In metastatic tumours, the primary site can often be identified by the histopathological features. Accordingly, when malignant head and neck tumours are suspected of being metastatic in character, it is important to search carefully for the primary site.

Chemotherapy for recurrent adeno- and adenoidcystic carcinomas in the head and neck

We have investigated the effectiveness of chemotherapy for patients with recurrent adeno- and adenoidcystic carcinomas in the head and neck. Fourteen cases received a monthly combination chemotherapy regimen of cyclophosphamide, pirarubicin and cisplatin (CAP therapy). A response rate of 36% (5/14) was achieved. There was one complete response and four partial responses. The median duration of response was 37 months in the complete response case and 16 months (range, 6 to 20) in the partial response cases. The toxicity of this chemotherapy was acceptable. The result demonstrates that CAP therapy is an effective regimen for adeno- and adenoidcystic carcinomas. It may also be available as induction or adjuvant chemotherapy for patients with advanced tumors of these cancers.

Suppressed cellular immunity in patients with nasopharyngeal carcinoma

The subsets and functions of lymphocytes were investigated in patients with nasopharyngeal carcinoma (NPC). The patients were divided into two groups comprising tumor-bearing patients and those in remission. There was no difference in the proportion of T cells among tumor-bearing, remission and healthy control groups. The percentages of inducer/helper T cells and natural killer cells were smaller in the tumor-bearing group than in the control group whereas the percentage of suppressor T cells was greater in the tumor-bearing group. Phytohemagglutinin-stimulated blastogenesis was markedly suppressed in the tumor-bearing group. The responsiveness to interleukin-2 of blastogenesis and of natural killer and lymphokine-activated killer activities was lowered in the tumor-bearing group. These parameters in the remission group were intermediate between those of the tumor-bearing and control groups. These results suggest that cellular immunity is suppressed in patients with NPC and that the suppressed condition still remains even in remission. Immunotherapy is considered to be indispensable for the proper treatment of NPC.

Clinical application of recombinant human erythropoietin for treatments in patients with head and neck cancer

SummaryThe therapeutic effects of intravenous recombinant human erythropoietin (r-hEPO) administration on anemia induced by radiation therapy (3 cases), chemotherapy (18 cases) and combined therapies (5 cases) in patients with head and neck malignancies were examined. The effectiveness was evaluated by the changes in the hemoglobin concentration examined before and after the r-hEPO administration. The r-hEPO administration combined with anticancer therapies improved anemia induced by all three treatments. The therapeutic effectiveness of r-hEPO injection was also noted on anemia induced by all of four different chemotherapeutic regimens that have been ordinarily used for head and neck malignancies. Furthermore, the efficacy of the different dose schedules, 3000 IU (12 cases) or 6000 IU (14 cases), three times a week, was compared. Both of the r-hEPO dose schedules were effective for anemia, but the efficacy of 6000 IU was superior to that of 3000 IU. No significant changes were observed in the number of white blood cells and platelets and the results of biochemical examinations after the r-hEPO injection. There were no objective side-effects related to the r-hEPO administration. These results suggest that anemia induced by chemotherapy and/or radiotherapy could be prevented by r-hEPO administration. The addition of r-hEPO to anticancer therapies would make it possible to pursue the planned therapeutic schedules, prevent the decrease of immunity after allogeneic blood transfusion and bring about an improvement in the prognosis of patients with malignancies.

Extramedullary plasmacytoma of the larynx

A case of IgD myeloma in a 54-year-old male with a long-standing history of extramedullary plasmacytoma involving the larynx is reported. The patient was treated with radiation therapy and laryngectomy. Twelve years later, he complained of nasal bleeding. On examination he was found to have large masses in the left nasal cavity and in the left supraclavicular region. Histological examination of both lesions showed plasmacytoma. Serum immunoglobulin studies revealed an IgD monoclonal spike of the lambda type. Bence-Jones protein was present. Using the immunoperoxidase staining technique, cytoplasmic monoclonal IgD was detected.

Sinusitis Associated with Disorders of Visual Acuity

We report a case of sinusitis associated with disorders of visual acuity. The patients vision was dramatically improved by sinus surgery despite the fact that the changes in the ethmoidal cells were slight and had no direct observable relation to the optic nerve canal. Possible mechanisms involved in nasal optic neuritis are discussed.

Immunological Basis and Immunotherapy of Nasopharyngeal Carcinoma

Clinically, the prognosis of nasopharyngeal carcinoma is very poor. It is considered that this depends on three factors. The first is the difficulty of early detection of this disease, because the symptoms of this cancer are latent. The second factor is the specificity of the histological character. The third is most important. This cancer cases fall into the extreme failure category of the immuno-surveillance mechanism. Immuno-responsiveness is extremely depressed. Immunological status has been examined and the clinical evaluation of immunotherapy with OK-432 (streptococcal preparation) and lymphocyte transfer has been made. Results are as follows: 1) Deficiencies of cellular immunity could be recognized through the various immunological parameters, such as subsets of peripheral blood lymphocytes. 2) Immunotherapy is indispensable in this cancer, for the above-mentioned reasons. Better results could be obtained with nonspecific immunotherapy, using OK-432. On the other hand, new immunotherapy, using immunologically enforced lymphocytes with Interleukin-2 prevented micrometastasis, one of the worst characteristics of this cancer. Nasopharyngeal carcinoma is a systemic disease. Therefore immunotherapy is indispensable for the treatment of this cancer.