Abstract Objective Squamous cell carcinoma (SCC) of the retromolar trigone is uncommon, accounting for 1.4% of all oral cancer cases in Japan. Few studies have examined the optimal treatment for this ...cancer. The aim of this study was to evaluate the outcome of treatment for primary SCC of the retromolar area. Methods We retrospectively analyzed the outcome and prognosis of 45 patients (38 men, 7 women) with SCC of the retromolar trigone who underwent treatment in our department between July 1992 and March 2011. Results Mean age was 62.4 years. Clinical stages were: stage I (n = 4, 8.9%); stage II (n = 10, 22.2%); stage III (n = 5, 11.1%); and stage IVa (n = 26, 57.8%). Surgical resection was performed in all patients and 6 patients also received postoperative radiotherapy. Reconstructive surgery using free flaps was performed in 38 patients; postoperative complications occurred in 5 of these patients. The 3-year local control rate was 80%, and the 3-year over all survival rates for stage I, II, III, and IV disease were 100%, 80%, 40%, and 49.2%, respectively. Cause of death was the original disease in 23 cases and other diseases in 2 cases. The most common cause of death from the original disease was cervical lymph node metastasis. Conclusion The presence of cervical lymph node metastasis was a negative prognostic factor. Marginal mandibulectomy may be selected for patients without distinct bone-marrow infiltration.
One of the most severe side effects of photoimmunotherapy (PIT) for head and neck cancer is pain. As there are presently no detailed reports on pain and pain management in PIT, we conducted a ...retrospective case series study. We conducted a retrospective study of five patients who had received PIT at the National Cancer Center Hospital East between January 2021 and June 2022 using medical chart data. All patients experienced pain, evidenced by an increased numerical rating scale (NRS) after PIT, regardless of the illumination method. The daily change in mean NRS rating shows that the pain was highest on the day of PIT, with ratings of 6.8 and 7.8 for the frontal and cylindrical diffuser methods, respectively; it dropped the following day quickly. Four of the five patients received fentanyl injections for postoperative pain management beginning on postoperative day (POD) 0. All patients who underwent therapy using a cylindrical diffuser required postoperative pain management with opioid drugs. Pain after PIT tended to be most intense immediately after or one hour after illumination and declined the following day, suggesting the need to have a pain relief plan in place in advance.
Enhanced Recovery After Surgery （ERAS） is a package of various evidence-based perioperative management methods that enhance the quality of postoperative recovery. The Japanese version of the Quality ...of Recovery score （QoR-40J） is a clinical outcome which is widely used to evaluate the quality of recovery after surgery under general anesthesia. We evaluated the quality of recovery using the QoR-40J in 10 patients who had been managed according to our ERAS protocol for head and neck surgery followed by free tissue transfer reconstruction. We were able to conduct the ERAS protocol safely and to obtain QoR-40J scores in all patients. The mean overall score of QoR-40J significantly decreased from the day before surgery to postoperative-day （POD） 1, and tended to recover gradually from POD 2 to POD 7. It was suggested that the score trends of QoR-40J reflected the quality of recovery after head and neck surgery followed by free tissue transfer reconstruction. We would like to use the QoR-40J as an indicator to improve perioperative management and to construct a new standard of the ERAS protocol for head and neck surgery.
Background: In the treatment of cancer in the elderly, we experience cases in which the outcomes cannot be followed as planned even if wound healing is good. In recent years, it has been globally ...recommended to carry out a geriatric assessment （GA） to identify risks in advance and perform necessary interventions. Materials and methods: GA was performed from August 2019 to March 2020 for 105 patients aged 65 and over who were scheduled for surgery in our department. We conducted a retrospective study to investigate the relationship between GA and postoperative outcomes, such as complications, delirium, and non-home discharge. Results: Non-home discharge was positive for IADL in all cases and was associated with MOS and reconstructive surgery （p=0.01, 0.01）. All cases had gastrostomy or tracheal stoma. Reconstructive surgery tended to be associated with both complications and delirium （p=0.08, 0.05）. Consideration: Non-home discharge is considered to be highly probable in case of postoperative gastric fistula or tracheal stoma, IADL positive, and MOS positive or reconstructive surgery. Conclusions: GA was performed on elderly patients scheduled for surgery in our department, and a relationship between non-home discharge and GA tools was found.
There have been no reports of long-term follow-up of vertical partial laryngectomy for elderly patients. We investigated the long-term survival rate and laryngeal dysfunction-free survival of such ...patients. Twenty cases aged 70 years or older who underwent surgery from January 1992 to December 2007 were examined retrospectively from their medical records. The median age was 73 years and the median follow-up period was 87 months. The overall survival rate was 73/55％ at 5 years / 10 years, and the laryngeal dysfunction-free survival was 69/44％ at 5 years / 10 years. There were no cases in which laryngeal functions of speaking and eating could not be preserved. No cases required hospitalization for aspiration pneumonia, laryngectomy, or tracheostomy.
Objectives:
Nivolumab, a fully IgG4-programmed death-1 inhibitor antibody, led to improved overall survival compared with single-agent therapy in patients with platinum-refractory recurrent head and ...neck cancers. In general, nivolumab is used in inoperable patients. To the best of our knowledge, there have been no reports of salvage surgery during nivolumab therapy for patients with head and neck cancer. We report the case of a woman treated with salvage reconstructive surgery during nivolumab therapy.
Method:
Case report and literature review.
Results:
The patient underwent nivolumab therapy for recurrent primary and neck disease after induction chemotherapy, followed by concurrent chemoradiation therapy. The neck disease shrunk, whereas the primary disease temporarily shrunk but later progressed again. Recurrent primary disease led to a narrowing of her airway, and she required airway management. We performed total pharyngolaryngectomy with free jejunal reconstruction, and her quality of life improved. The surgery was performed without complications and the postoperative course was uneventful. She was discharged postoperative day 18 with oral intake function and a safer airway.
Conclusion:
As far as we know, this is the first report of salvage surgery during nivolumab therapy for patients with head and neck cancer. The salvage reconstructive surgery in this case proceeded uneventfully.
Early-stage oral or oropharyngeal carcinomas are often treated with surgical resection. Resulting wounds that are too large for primary closure can be covered with skin grafts or patches made from ...various biomaterials. Recently, polyglycolic acid sheets have been used for this purpose.
We treated six patients with large wounds resulting from the resection of oral or oropharyngeal squamous cell carcinoma by grafting polyglycolic acid sheet patches. All patients were initially treated at the National Cancer Center East Hospital from March 2010 through July 2012. After mucosal resection, the wounds were covered with polyglycolic acid sheet patches attached with fibrin glue. Oral intake was started 4 days after surgery.
Mucosal resection was the initial treatment in seven patients (five with oral squamous cell carcinoma and two with oropharyngeal squamous cell carcinoma). The polyglycolic acid sheet patches became detached in two patients (on the day of surgery and on postoperative day 6), who then required large doses of analgesics. A patient who underwent tooth extraction also required large doses of analgesics. The other four patients required only small doses of analgesics. One patient had bleeding at the surgical site. No adverse effects were caused by the polyglycolic acid sheet patch or by fibrin glue.
Our study has shown that grafting of a polyglycolic acid sheet patch is effective and provides good pain control for patients with large, open wounds after mucosal resection of oral or oropharyngeal squamous cell carcinoma. We plan to evaluate tissue contraction and oral intake after polyglycolic acid patch grafting.
Photoimmunotherapy for head and neck cancer Shinozaki, Takeshi
Journal of Immunology, Allergy and Infection in Otorhinolaryngology,
2022, Letnik:
2, Številka:
3
Journal Article
Odprti dostop
The treatment is based on the antibody-photosensitive substance complex AKALUX® and light irradiation. The dye is activated by 690-nm light irradiation 20–28 h after administration of AKALUX®, and it ...is expected to induce a rapid cell-killing effect only to cells to which the complex has bound, where there is selective destruction of cancer cells only. Furthermore, it is expected to minimize damage to normal tissues surrounding tumor cells. In Japan, it has been approved for the treatment of unresectable locally advanced or locally recurrent head and neck cancer and has been covered by the National Health Insurance System since January 1, 2021.Treatment is considered for unresectable locally advanced or locally recurrent head and neck cancer. When standard treatments such as chemoradiotherapy are available, these treatments are given priority.Drugs are administered during the patient’s hospitalization. Light exposure protection is required during and after administration. Premedication should include intravenous corticosteroids and antihistamines followed by intravenous AKALUX® infusion over at least 2 h; 20–28 h after completion of AKALUX® administration, light irradiation is performed for 4–6 min under general anesthesia. Depending on the size of the lesion, multiple sessions may be performed.Light exposure protection should be taken for 4 weeks, postoperatively. Moreover, bleeding, tongue swelling, laryngeal edema, and skin lesions, among others, should be observed. If a complete response is not achieved, the treatment may be repeated up to four times.
As neuroendocrine carcinomas in the head and neck region are extremely rare, their clinicopathological characteristics remain largely unknown. Moreover, the 2005 World Health Organization ...classification criteria for head and neck carcinomas with neuroendocrine features have numerous limitations. Therefore, the clinicopathological features and patient outcomes of these tumors must be clarified.
Between 2007 and 2012, we encountered nine cases of head and neck cancer involving a neuroendocrine carcinoma component. We investigated these tumors according to the 2010 World Health Organization classification criteria for neuroendocrine tumors, and their clinicopathological characteristics and clinical outcomes were examined.
Carcinomas with neuroendocrine features were found to have an aggressive clinical course, which corresponded with the Ki-67 index and mitotic count.
Owing to the difficulty in appropriately diagnosing head and neck carcinomas with neuroendocrine features using the current classification system, a new classification system should be developed for use in these cases.
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