Tomohiro Makoshi

Treatment Effects in Patients with Squamous Cell Carcinoma of the Oral Cavity

A total of 221 patients (155 males, 66 females; stage I, n ¾ 55; stage II, n ¾ 58; stage III, n ¾ 57; stage IV, n ¾ 51) with squamous cell carcinoma of the oral cavity were studied. Tumor localization was as follows: cancer of the tongue, n ¾ 161; cancer of the oral floor, n =28; cancer of the hard palate, n ¾ 12; cancer of the buccal mucosa, n ¾ 11; and cancer of the gingiva, n ¾ 9. In order to compare the effect of different treatments, three major treatment groups were defined, namely a surgery group, a radiotherapy group and a combination treatment group. Five-year cumulative survival rates showed significant differences between stage classifications (stage I=91%, stage II=73%, stage III=63%, stage IV=47%; p <0.01) but not between tumor sites. The 5-year cumulative survival rate was highest for oral floor cancer (80%). In the early-cancer group, the 5-year cumulative survival rate for the surgery group (92%) was significantly higher ( p <0.05) than those for both the radiation (69%) and combination (71%) groups. In the advanced-cancer group, the 5-year cumulative survival rate for the surgery group (74%) was significantly higher ( p <0.05) than those for both the radiation (37%) and combination (51%) groups. No significant difference in regional control rates was observed between the treatment groups. Five-year regional control rates were 86% for cervical untreated patients with T1N0 tumors and 60% for cervical untreated patients with T2N0 tumors. Fourteen N0 cases were treated with neck dissection. Cervical metastasis was found pathologically in 2/14 (14%) of these cases. The 5-year survival rate for patients with cervical recurrences after primary tumor resection was 70% ( n ¾ 15). In contrast, the 5-year survival rate for patients with both primary tumor resection and neck dissection was 74% ( n ¾ 14) but no significant difference was observed between these 2 groups.rate .

Multiple primary malignancies in the head and neck: a clinical review of 121 patients.

A total of 121 multiple primary malignancies (quadruple, n ¾ 2; triple, n ¾ 11; and double, n ¾ 108) were treated at the Department of Otorhinolaryngology, Kitasato University Hospital between July 1972 and December 1998. Of the 108 patients with double primary malignancies, 18 had synchronous double primary malignancies (SDPM), which were defined as occurrence of the index tumor and second malignancy within 6 months of each other, and 90 had metachronous double primary malignancies (MDPM), which were defined as occurrence of the index tumor and the second malignancy separated by a period of >7 months. MDPM was subdivided into MDPM-F (head and neck malignancy occurred as the first tumor; n ¾ 55) and MDPM-S (head and neck malignancy occurred as the second tumor; n ¾ 35). Of the 55 patients with MDPM-F, 27 (49.1%) of the second malignancies were found in the digestive tract, 12 in the stomach (21.8%), 8 in the esophagus (14.5%) and 7 in lower digestive tract tumors (12.7%). The 3- and 5-year survival rates of MDPM-F were 79.2% and 62.3%, respectively. Differential diagnosis between multiple primary malignancy (MPM) and multicentric tumors is often difficult when the lesions involve the oral cavity, pharynx and esophagus. We suggest that it is beneficial to follow patients for as long as possible in order to facilitate diagnosis of tumor recurrence, metastasis and MPM.

Cemento-ossifying fibroma of maxillary and sphenoid sinuses: case report and literature review.

We report a case of cemento-ossifying fibroma (COF) involving the maxillary and sphenoid sinuses and review the literature in order to study the clinical features, imaging findings and histopathologic characteristics of COF. Special care was taken to distinguish this lesion from cemento-osseous dysplasia (COD). It is almost inevitable that differential diagnosis of COD and COF will be complicated by the fact that some pathologic features are shared by both lesions. A combined study incorporating clinical, radiographic and pathologic findings is important in order to ensure an accurate diagnosis. Postoperative follow-up is essential, especially in cases where incomplete removal of the COF was performed.

Combined Therapy for Hypopharyngeal Cancer

We studied 69 hypopharyngeal cancer patients who were treated between 1979 and 1992. The 5-year cumulative survival rate was 53%. There were five stage I, seven stage II, 20 stage III and 37 stage IV patients; survival rates for stages I, II, III, and IV were 80%, 54%, 61% and 47%, respectively. The 5-year survival rate for the 25 patients who received preoperative radiotherapy (fewer than 40 Gy) followed by total pharyngo-laryngo-esophagectomy was 59%. Forty-four patients received radical radiotherapy as a main treatment. From the standpoint of preserving vocal function, we recommend using the radical radiation as a first-choice treatment. The 5-year survival rate was 48%. There were 16 radiation failure patients after radical radiotherapy and two of them refused to have surgery. Fourteen patients (36%) received a salvage operation and the survival rate was 36%. The survival rate for the 30 patients who did not receive surgery was 61%; the patients who received surgery as a palliative purpose and the patients who refused to undergo surgery were included in this group. Both treatment regimens of the present study showed higher survival rates compared to the results of previous studies. We concluded that the improved results were due to the proper selection of the treatment, especially the attention given to the patients immune response and the minimum death as a result of neck node metastasis.

Limited surgery for cancer of the larynx and hypopharynx: Options and consequences

We reviewed surgical options for laryngeal preservation (limited surgery) in laryngeal and hypopharyngeal cancers and the consequences of the options. Of 44 patients with laryngeal cancer, 11 (25%) received limited surgery and 33 (75%) received total laryngectomy. The survival rates were 91% for the limited surgery group and 73% for the total (radical) surgery group. Of 31 patients with hypopharyngeal cancer, 7 (23%) received limited surgery and 24 (77%) received total laryngopharyngectomy. The survival rates were 53% for the limited surgery group and 40% for the total (radical) surgery group. The survival rates associated with limited surgery were thus better than those for total (radical) surgery for cancers of both the larynx and hypopharynx. This was attributed to the limited surgery group comprising well-selected patients with confined lesions. Organ preservation surgery should be technically simple, reliable in terms of its functional impact and, above all, should not jeopardize the patients survival. Supracricoid subtotal laryngectomy with cricohyoidoepiglottopexy or cricohyoido-pexy has great potential for laryngeal preservation and will become the major limited surgery modality for treating cancer of the larynx. Limited surgery, however, needs to be performed with great care and is indicated only for very well-selected patients with cancer of the hypopharynx.

Three-dimensional Computer-reconstructed Image for Studying Cancer Extension Within the Hypopharynx

Hypopharyngeal cancer is one of the head and neck cancers with poor prognosis. This is due to the unpredictable extension of the local disease and the high ratio of distant metastasis. To verify the morphological behavior of hypopharyngeal cancer, whole-mount horizontal serial sections were developed using the larynges obtained from total pharyngolaryngoesophagotomy. The technique of processing high-resolution three-dimensional (3D) images of the larynges using Nikon Cosmozone 2SA software is presented. Two representative surgical specimens were used and 3D images reconstructed. In these two particular cases, the cancer infiltrated superiorly through submucosal lymphatic ducts and formed separate daughter nests under the intact mucosal epithelium far above the main tumor. 3D images enhanced the morphological features of these cases. These cases also suggested the difficulty of defining the upper resecting limit in the operation of hypopharyngeal cancer. 3D reconstruction is and will be a crucial modality for studying the morphological behavior of hypopharyngeal cancer.

Clinical Review of Wegener's Granulomatosis

The prognosis of Wegeners granulomatosis (WG) improved following the introduction of immunosuppressant agents. We, however, still experience some difficult cases that are resistant to treatment. Early diagnosis and treatment may improve the prognosis of WG. We reviewed patients with WG attending the Department of Otorhinolaryngology, Kitasato University Hospital. Of the 13 patients reviewed, 5 are still alive. A definite diagnosis was difficult to make without the presence of certain characteristic features. Recently, cytoplasmic antineutrophil cytoplasmic antibody (c-ANCA) has gained importance in the diagnosis of WG and five of our patients were positive for c-ANCA. Close long-term follow-up of WG is recommended: remission was observed in two of our patients and side-effects of the treatment were identified in four.

Clinical Review of Thyroid Malignant Tumor

We reviewed the files of 120 patients with thyroid malignant tumor treated in our department between July 1971 and December 1996. Clinical features, pathological diagnosis, radiographic findings, treatment and prognosis were studied. The number of patients treated gradually increased over time in both the otorhinolaryngology and surgery departments. Papillary carcinoma ( n ¾ 101) was the most common pathology, followed by follicular carcinoma ( n ¾ 16). Both 5- and 10-year survival rates were 92.7% for the entire group, 93.8% for cases of follicular carcinoma and 92.1% for cases of papillary carcinoma. Although thyroid tumor is undoubtedly one of the malignant head and neck tumors associated with an excellent prognosis, some patients remain resistant to cure in the long term. Some tumors are highly malignant and are difficult to control. The management of these patients is an important subject of future research.

Treatment of Maxillary Sinus Carcinoma: Clinical Results Using the Kitasato Modality

The conventional therapeutic regimen for maxillary sinus carcinoma consists of dissection of the maxilla, full-dose irradiation and extensive chemotherapy. However, the results obtained with this treatment are often poor. Even when patients recover, their quality of life is significantly reduced as a result of deformity of facial structures and swallowing and articulation dysfunctions. A retrospective analysis of 68 patients with maxillary sinus carcinoma treated with the Kitasato modality between 1975 and 1999 was conducted. All patients underwent pergingival maxillary sinus surgery combined with pre- and postoperative irradiation therapy with standardized total doses of 16 Gy; the postoperative irradiation was given in combination with regional intra-arterial infusion chemotherapy administered via the superficial temporal artery. All visible tumor lesions were removed where possible in order to preserve or facilitate cellular immunity after surgery. The cumulative 5-year survival rates were 85.7% for Stage II patients, 88.1% for Stage III, 76.6% for Stage IVA and 75.0% for Stage IVB.

Combined Chemotherapy and Radiation Therapy in Head and Neck Cancer

A combination chemotherapy (PT treatment) with cisplatin and tetrahydropyranyl-adriamycin (THP-ADM) was performed in 17 patients with head and neck squamous cell carcinoma. Chemotherapy treatment began with an intravenous dose of 50 mg/body cisplatin and an intravenous dose of 20 mg/body THP-ADM. Administration of THP-adriamycin was performed on the first day only, while cisplatin treatment was repeated once a day until the third day. Five of the 17 cases achieved complete response (29.4%) and seven achieved partial response. Response rate was 70.6%. Toxicity was mild and controlled with symptomatic treatment. Leukopenia was observed in 71.4% thrombocytopenia 14.3% (due to myelosuppression), appetite loss 38.1%, general fatigue 28.6% and nausea and vomiting 23.8%. No electrocardiographic abnormality was noted.