Concurrent chemo-radiotherapy for nasopharyngeal carcinoma.

OBJECTIVE: Because of the low incidence of nasopharyngeal carcinoma (NPC) in Japan, few studies have reported on the use of concurrent chemo-radiotherapy (CCRT) for treatment of this disease. The present study investigated the efficacy and toxicity of CCRT with Carboplatin (CBDCA) and UFT for NPC. PATIENTS AND METHODS: CCRT with injection of CBDCA and oral administration of UFT was given to 21 patients in our institution during 1996-2000. We compared the patients treated with CCRT with those treated with RT alone from 1976 to 1995 or those treated with RT after chemotherapy (Pre-RT chemotherapy) from 1985 to 1995. Overall survival rate (OS), progression free survival rate (PFS) and cause specific survival (CSS) rate were analyzed. RESULTS: The actual 2-year OS, PFS, and CSS of CCRT were 85.7, 66.7 and 90%, respectively. The rates were improved compared to RT alone (37.9, 31.0, and 56.6%) and Pre-RT chemotherapy (58.8, 41.2, and 64.7%). The most frequent and severe acute toxicities were leukopenia (42.9%) and mucositis with grade 3-4 (28.6%), both of which eventually resolved. CONCLUSION: CCRT with CBDCA and UFT is considered to be an effective, convenient, and tolerable treatment, which improves survival rates for NPC patients. Therefore, we recommend this CCRT method for the treatment of NPC.

A case of idiopathic tracheal stenosis.

Idiopathic tracheal stenosis (ITS) is an extremely rare disease. We report the case of a 32-year-old woman with ITS. She had no history of previous surgery, endotracheal intubation, neck trauma, granulomatous disease, or any other severe respiratory tract infections. She presented with progressive dyspnea on effort and had been treated for bronchial asthma for 3 years. Chest radiography and laboratory examinations revealed no abnormalities. Bronchoscopy demonstrated almost circumferential tracheal stenosis extending for 10 mm from about 20 mm below the vocal cords. Luminal diameter was about 4 mm at the narrowest. Bronchoscopic biopsy revealed increased fibrous tissue and chronic inflammatory cell infiltration (nonspecific inflammatory tissue). These finding are compatible with idiopathic stenosis as reported by Grillo et al. After tracheostomy, the patient was treated by tracheal segmental resection (two rings) with end-to-end anastomosis of the cartilaginous trachea. Symptoms of tracheal stenosis were completely relieved and no recurrence has been observed as of 3 years postoperatively.

Clinicopathological study of undifferentiated carcinoma of the parotid gland.

OBJECTIVE: Undifferentiated carcinoma of the salivary gland is a rare malignant tumor, and is difficult to distinguish from other poorly differentiated types of carcinoma or sarcoma. The present study investigated clinical and pathological characteristics for undifferentiated carcinoma of the parotid gland. PATIENTS AND METHODS: Forty-four patients with previously untreated carcinoma of the major salivary glands were treated at our institution between 1986 and 1999. Of these, five patients (two males, three females) were diagnosed with undifferentiated carcinoma of the parotid gland and treated. For histological reinvestigation, multislices of resected specimens were made and diagnosed. RESULTS: Although all patients were treated by radical surgery (more than subtotal parotidectomy), all died of distant metastasis, including two patients with locoregional relapse. Tumors in these two patients included a small portion of poorly differentiated epidermoid or mucoepidermoid carcinoma. The remaining three patients did not show any differentiated portions, and histological findings demonstrated heterogeneous patterns of lymphoepithelial carcinoma, small cell carcinoma and unclassified (a pattern of malignant hemangiopericytoma), respectively. CONCLUSIONS: Investigation using multislice sections is needed to diagnose undifferentiated carcinoma of the salivary glands. Regarding prognosis, carcinoma that is too poorly differentiated but including slightly-differentiated portions should be considered undifferentiated carcinoma. All patients died of distant metastasis despite radical surgery, suggesting that chemotherapy is needed to improve patient outcomes.

Olfactory acuity after total laryngectomy.

The olfactory acuity of 29 patients receiving laryngectomy was prospectively studied. The olfactory acuity was evaluated by Jet Stream Olfactometer (JSO) and Alinamin test preoperatively and at 3, 6 and 12 months postoperatively. The findings of nasal/olfactory mucosae were also observed by rigid endoscope. Based on the results of JSO, the averages of detection/recognition thresholds tended to increase 3 months postoperatively, then the averaged thresholds tended to decrease thereafter. There were significant differences between preoperative values and those 3 months after surgery, but there were no significant differences between preoperative values and these 6/12 months after surgery. Nasal respiratory mucosae observed 12 months after laryngectomy showed atrophic nasal mucosa in 11/14 patients. However, olfactory mucosae appeared normal in all of the patients observed. These results suggested that the function of the olfactory epithelium remained intact after laryngectomy.