Yoichiro Hosokawa

Analysis of adenoid cystic carcinoma treated by radiotherapy

The records of 41 patients with adenoid cystic carcinoma of the head and neck region who had been treated with radiotherapy were reviewed. Local control was achieved in 72.3% in the cases with primary lesions at 5 years. The prognosis for tumors that arose in the major salivary glands was better than that for tumors that arose in the minor salivary glands; however, the difference was not statistically significant. In the minor salivary glands, early-stage tumors were well controlled with the use of radiation therapy alone. In spite of the high local control rate, the disease-free survival rate of the patients at 10 years was only 20.8%. Lung metastasis determined the prognosis.

A Phase II Study of Concomitant Chemoradiotherapy for Laryngeal Carcinoma Using Carboplatin

Purpose: We conducted a phase II study of concomitant chemoradiotherapy with carboplatin for laryngeal carcinoma. Materials and Methods: Sixty-four patients with stage II–IV (stage II, 36; III, 19; IV 9) laryngeal carcinoma were treated with concomitant administration of carboplatin (CBDCA) during radiotherapy (CRT group) between 1991 and 1994. There were 36 supraglottic, 25 glottic, and 3 subglottic carcinomas. Patients with stage II and stage III–IV received intravenous CBDCA of 100 mg/m2 and 120 mg/m2 once a week, respectively. Tumor response was assessed at 40 Gy in 16 fractions to select the patients suitable for total laryngectomy or radical radiotherapy of 65 Gy in 26 fractions in 6.5 weeks. The treatment results were compared with the historical control consisting of 56 patients consecutively treated from 1988 to 1990 without chemotherapy (RT group). The two studies were comparable with regard to patient characteristics, including age distribution, gender, tumor location, size, and clinical stage. Results: The actuarial 5-year survival rate was 80.3% for the CRT group and 81.3% for the RT group. A favorable response (complete response or partial response) at 40 Gy was observed in 87.5% of the patients of the CRT group and in 62.5% of the patients of the RT group (χ2 = 7.566, p < 0.01). The actuarial 5-year larynx preservation rate for the CRT group (75%) was significantly higher than that for the RT group (57%) in patients with T2 supraglottic carcinoma (p < 0.05). There was no difference in the larynx preservation rate between the two treatment arms for any T stage of glottic carcinomas. Conclusion: CRT using carboplatin improved the tumor response at 40 Gy and consequently achieved a higher larynx preservation rate for T2 supraglottic carcinoma. A clinical randomized trial is indicated to certify the findings of this phase II study.

Simultaneous carboplatin and radiotherapy for all stages of head and neck squamous cell carcinoma.

The study investigated the toxicity and efficiency of the concomitant administration of radiotherapy and carboplatin to patients with head and neck carcinomas. Sixty-three patients with head and neck squamous cell carcinomas, other than nasopharyngeal cancer and Stage I (UICC) laryngeal cancers, were treated by external radiotherapy and four courses of carboplatin at a dose of 100 mg/m2 per week. In two patients, only three courses were possible due to renal toxicity. In the other 61 patients, toxicities were self-limiting and no patient required interruption of carboplatin administration. No patient required discontinuation of radiotherapy because of acute toxicity. Of 61 evaluable patients, a complete response (CR) was obtained in 11.5% and a partial response (PR) in 60.7% at 40 Gy. In 41 patients treated to 65 Gy (including two patients with maxillary sinus carcinoma, who were treated by debulking surgery), CR was obtained in 76.9% and CR+PR was 100% at the end of treatment. The actuarial survival rate of the 63 patients at 2 years was 69.2%, with a median follow-up period of 24.4 months. One of 12 patients who received salvage surgery after radical radiotherapy has died due to poor wound healing after the surgery. The schedule was safe, providing a weekly check of serum samples was possible. It is likely that the rate of local control and vocal cord preservation in laryngeal tumours might improve if concurrent carboplatin is used. Careful follow-up is required to determine the long-term effect of concomitant carboplatin administration.

Characteristic findings of adenoid cystic carcinoma on MR imaging and differentiation from squamous cell carcinoma

Ten patients with adenoid cystic carcinoma and 49 with squamous cell carcinoma confirmed by aiopsy were evaluated. In these patients, malignant tumors were suspected with clinical progressions and clinical symptoms. The purpose of this study was to analyze and discuss the characteristic findings on MR imaging of adenoid cystic carcinoma in the head and neck, and to examine the usefulness of MR imaging in the differentiation between adenoid cystic carcinoma and squamous cell carcinoma. The characteristics on MR imaging of adenoid cystic carcinoma are a high signal intensity on T2-weighted images, marked enhancement by Gd-DTPA, and a capsular structure. All cases of recurrent adenoid cystic carcinomas also showed upward extension. We consider that the high signal intensity on T2-weighted images, the marked contrast enhancement and the capsular structure in MR imaging can be useful in differentiating adenoid cystic carcinoma and squamous cell carcinoma.

Invasion of the intracranial space by a malignant odontogenic mixed tumor: Report of a case

A case of an odontogenic tumor which invaded the intracranial space from the mandible is reported. Judging from the radiographic images it was similar to a malignant tumor. The patient died 17 years after the first visit. According to the final pathological diagnosis, it was malignant odontogenic mixed tumor of low grade which did not belong to any of the WHO classification.

Unusual CT finding in neck lymph node involved by lymphoma

Squamous cell carcinoma is the most common malignant lesion in the head and neck. Although neck adenopathy is generally thought to be a metastasis from a primary soite. On the other hand, lymphoma is the most common primary malignancy in the extralaryngeal portion of the neck and is the most frequent cause of unilateral neck mass in patients 20-40 years of age. In contrast to squamous ceil carcinoma, lymph nodes involved by lymphoma usually do not show central necrosis before treatment. A 76-year-old woman was referred to our hospital with a chief complaint of pharyngeal pain in January 1992. Physical examination revealed diffuse swelling at the base of the tongue. MRI showed that the suspected tumor mass lesion was located at the left base of the tongue and tonsillar pillar (Fig, 1). Axial CT image showed a clear central necrotic finding at the left upper neck (Fig. 2) which was suggestive of primary squamous cell carcinoma involving the tongue and tonsillar pillar with metastasis to a neck lymph node. However, histopathological examination of a biopsy specimen indicated nonHodgkins lymphoma.

Evaluation of an in vivo labeling method of red blood cells with99mTc-pertechnetate in the head and neck region

Seventeen cases in which red blood cells (RBCs) were labeled with99mTc (99mTc-RBC method) are reviewed to confirm the vascular nature of lesions. This study was undertaken to see whether the99mTc-RBC method is useful in terms of detecting angiomatous lesions, and also to determine the indications for this method. In one case, total removal revealed a good, correlation between the range of uptake and the actual tumor size. MR images definitively demonstrated tumor location and extension. When hemangioma is suspected, MR examination is the preferred modality to determine tumor extension, tumor mass, and invasion into the surrounding tissue. However, when it is suspected that the MR image is poor due to bulky metal artifacts, as in the case of dental prostheses, the99mTc-RBC method should be used because this method is only slightly influenced by metal artificts. In addition, this method should be applied when whole body screening is needed.

An ameloblastoma divided into two parts on MRI

Soft tissue contrast on MRI is primarily provided by the differences in T1 and T2 relaxation times. Recently some authors have reported about the differences in image between T1 and T2 relaxation times in human sinonasal secretion. Here, we are going to present a case of ameloblastoma, in which the image was divided into two parts on MRI. A 73-year-old man was referred to our hospital by his dentist with a main complaint of pain in the lower gingiva. There was a diffuse swelling from right to left bicuspid regions. The panoramic tomogram showed a well-outlined unilocular radiolucency in the anterior region of his mandible (Fig. 1).