Wataru Shimbashi

Combination chemotherapy of carboplatin and paclitaxel for advanced/metastatic salivary gland carcinoma patients: differences in responses by different pathological diagnoses

Abstract Background: A standard chemotherapy for recurrent/metastatic salivary gland cancers has not been established. Combination chemotherapy of carboplatin and paclitaxel should be evaluated as a treatment option. Methods: This study retrospectively reviewed salivary gland cancer patients who received combination chemotherapy of carboplatin and paclitaxel. The differences in objective responses and in the prognoses according to the different pathological diagnoses were evaluated. Results: A total of 38 patients were enrolled in the study; of them, 18 had salivary duct carcinomas (SDCs), nine had adenoid cystic carcinomas (ACCs), and 11 had other pathological diagnoses. Objective responses were observed in 15 (39%) patients. The median progression-free survival (PFS) was 6.5 months, and the median overall survival (OS) was 26.5 months. ACC patients had relatively low response rates (9%), but there were no significant differences in PFS or OS compared to other sub-types. The treatment was well tolerated, with few adverse events. Conclusion: Salivary gland cancer patients showed a moderate clinical response to the combination chemotherapy of carboplatin and paclitaxel. The objective response rates differed according to the pathological diagnoses, but there were no significant differences in prognoses.

A Clinical Study of Pharyngolaryngectomy with Total Esophagectomy: Postoperative Complications, Countermeasures, and Prognoses.

Objective Patients with advanced hypopharyngeal or cervical esophageal cancer have a comparatively high risk of also developing thoracic esophageal cancer. Pharyngolaryngectomy with total esophagectomy is highly invasive, and few reports about it exist. We examined the postoperative complications and respective countermeasures and prognoses of patients who underwent pharyngolaryngectomy with total esophagectomy. Study Design Case series with chart review. Setting Department of Head and Neck Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Japan. Subjects and Methods We examined the postoperative complications and respective countermeasures and prognoses of 40 patients who underwent pharyngolaryngectomy with total esophagectomy in our hospital. Results Postoperative complications were observed in 23 patients (57.5%) and consisted of 8 groups: tracheal region necrosis in 5 patients; neck abscess formation/wound infection in 5; fistula in 4; tracheostomy suture leakage in 2; ileus in 2; lymphorrhea in 2; pulmonary complications in 2; and other complications, including hemothorax, tracheoinnominate artery fistula, temporary cardiac arrest due to intraoperative mediastinum operation, methicillin-resistant Staphylococcus aureus enteritis, and sepsis, in 1 patient each. A lethal complication—brachiocephalic vein hemorrhage due to tracheostomy suture leakage and hemorrhagic shock due to tracheoinnominate artery fistula—occurred in 2 (5%) patients. The crude 5-year survival rate was 48.6%. Conclusions Serious postoperative complications were related to tracheostomaplasty. Although pharyngolaryngectomy with total esophagectomy is highly invasive, we believe that our outlined treatment method is the most appropriate for cases of advanced hypopharyngeal or cervical esophageal cancer that also requires concurrent surgery for esophageal cancer.

A comparison of weekly paclitaxel and cetuximab with the EXTREME regimen in the treatment of recurrent/metastatic squamous cell head and neck carcinoma

BACKGROUND The effectiveness of the combination chemotherapy of weekly paclitaxel and cetuximab has not yet been compared to that of the current standard regimen, EXTREME (combination of 5-fluorouracil, cisplatin and cetuximab). METHODS We retrospectively reviewed the clinical records of R/M SCCHN patients who received cetuximab-containing chemotherapy as a first-line therapy; from these, patients receiving a weekly paclitaxel and cetuximab regimen (cohort A) and the EXTREME regimen (cohort B) were extracted. The responses, prognoses and adverse events of these two cohorts were evaluated. RESULTS A total of 86 patients were included (cohort A, 49; cohort B, 36). Patients with histories of platinum-based chemotherapy were more frequently given the cohort A treatment. Though the response rates were similar in the two cohorts (45% in cohort A and 51% in cohort B; p=0.83), the progression-free survival (PFS) was significantly more favorable in cohort A by the log-rank test (6.0monthsvs 5.0months; p=0.027). In the Cox-regression hazard analyses, male gender (hazard ratio [HR]=2.1, p=0.010), older age (≥ 70 yo) (HR=5.0, p=0.018), PS 0 (HR=2.2, p=0.027), no history of platinum chemotherapy (HR=3.2, p=0.003) and the presence of a tracheostomy (HR=2.3, p=0.039) were favorable factors within cohort A. CONCLUSION In selected R/M SCCHN patients, the combination of weekly paclitaxel and cetuximab could be the better treatment option than the EXTREME regimen.

Two Cases of Ectopic Hamartomatous Thymoma Masquerading as Sarcoma

Ectopic hamartomatous thymoma (EHT) is an extremely rare benign tumor. EHTs are difficult to differentiate from sarcomas, especially synovial sarcomas. We encountered two cases of EHT that were referred from other hospitals because sarcoma was suspected. In these cases, fusion gene detection via polymerase chain reaction or fluorescence in situ hybridization was useful for differentiating EHT from synovial sarcoma. EHT requires accurate diagnosis before surgery to avoid excessive treatment. Both tumor location and the presence of fat inside the tumor are important imaging findings for EHT, and confirmation of spindle cells, epithelial cells, and mature adipose cells in the tumor is an important pathological finding. It is important to exclude synovial sarcoma from the differential diagnosis via fusion gene analysis.

Quality of life and functional status of terminally ill head and neck cancer patients: a nation-wide, prospective observational study at tertiary cancer centers in Japan

Background Little is known about quality of life and functional status of patients with terminally ill head and neck cancers. Methods We conducted a multicenter, prospective, observational study to examine quality of life and functional status in terminally ill head and neck cancer patients. Results Of the 100 patients meeting inclusion criteria, 72 were observed until death. There was no significant difference in the quality of life score between baseline and Week 3. Forty patients (54.9%) could speak and 22 patients (30.5%) could have oral intake upon study entry. Fifty-three patients (74.6%) received enteral nutrition. Twenty-six patients (36.6%) required dressing changes for fungating tumors. The route of nutritional intake (nasogastric tube vs. percutaneous gastric tube) might be predictive for the duration of hospital stay (64 vs. 21 days, P = 0.0372). Conclusion There was no significant relationship between quality of life and functional status seen in this study. Feeding tube type could have the most impact on quality of life.

Thick tumor capsule is a valuable risk factor for distant metastasis in follicular thyroid carcinoma.

OBJECTIVE While the biological behavior of follicular thyroid carcinoma (FTC) has been studied in great detail using clinical experience, few studies have investigated pre- or intraoperative factors related to the risk of distant metastasis (DM) among patients with FTC. The aim of this study was to analyze the characteristics of FTC with DM. METHODS This study retrospectively investigated 102 patients with FTC who underwent surgery between 1988 and 2013. We compared clinicopathological characteristics between FTC with and without DM. RESULTS Univariate analysis revealed nodal metastasis (p=0.045), serum thyroglobulin (Tg) at initial operation (≥1000ng/ml; p<0.0001), widely invasive appearance according to macroscopic findings (p<0.0001), thick tumor capsule (≥1mm; p<0.0001), vascular invasion (p=0.0003), extrathyroidal invasion (p=0.047), and venous tumor embolism (p=0.045) as significant risk factors for DM. Multivariate analysis conducted using pre- and intraoperative factors identified thick tumor capsule (≥1mm), serum Tg at initial operation (≥1000ng/ml), and macroscopically widely invasive appearance as risk factors independently associated with development of DM. CONCLUSION Patients with these risk factors should undergo total thyroidectomy and radioactive iodine ablation.

O1-7-5Incidence and risk factors of interstitial lung disease (ILD) of head and neck cancer patients treated with Cetuximab

Yongchel Ahn, Cheon-Soo Park, HyukJai Jang, JiHwan Lee, Mikyong Byun, Byung-Gon Park, Woon-Seob Shin, Yoon-Sun Park, Seokjoon Lee, Daeho Kwon Department of Hematology and Oncology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Korea, Department of Surgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Medical Research Center, Gangneung Asan Hospital, University of Ulsan College of Medicine, Department of Nursing, Korea University College of Nursing, Department of Physiology, Catholic Kwandong University College of Medicine, Department of Pharmacology, Catholic Kwandong University College of Medicine, Department of Microbiology, Catholic Kwandong University College of Medicine

1004PSYMPTOM PREVALENCE AND FUNCTIONAL STATUS AMONG PATIENTS WITH ADVANCED CANCERS OF THE HEAD AND NECK

ABSTRACT Aim: There is no standard medical treatment or method of care for patients with advanced cancers of the head and neck. However, because the treatment received by terminally ill patients with head and neck cancers differ among institutions, evaluations and examinations are not being adequately performed. We aimed to clarify the symptoms in these patients contributing to changes in quality of life (QOL). In the future, we aim to reduce the suffering of these patients as far as possible by establishing a systematic method for care. Methods: This multicenter, prospective, observational study included 100 patients with advanced head and neck cancers in 11 oncology units. We evaluated changes in global QOL (European Organisation for Research and Treatment of Cancer Quality-of-Life Questionnaire–Palliative 15), respiratory tract morphology, tumor site, bleeding, pulmonary metastasis, nutritional course, phonation ability, edema, and respiratory tract secretions. Results: of the 100 patients who met the entry criteria, 71 could be observed until death. Average survival from entry was 33.5 days (range, 0–167 days). Patients with worse performance status were shorter-lived. Questionnaires on QOL were answered by 48 of the 71 patients. There was no significant difference in global QOL between entry and 3 weeks later. 32 patients (45.1%) were breathing with a tracheostoma, and 15 patients needed a cuffed endotracheal tube. 26 patients (36.6%) needed a change of dressing because of bleeding or oozing, and 5 patients had severe bleeding. 17 patients (23.9%) had head and neck edema at entry, and 26 patients (36.6%) had edema at the time of death. 53 patients (74.6%) had received enteral nutrition. Conclusions: With this prospective study we have clarified symptoms in terminally ill patients with head and neck cancers. On the basis of this study, we plan to establish a care system for terminally ill patients with head and neck cancers and prepare further prospective studies. Disclosure: All authors have declared no conflicts of interest.