ABSTRACT
The operative procedure in the surgical treatment of parathyroid carcinoma differs from that of benign hyperparathyroidism. However, preoperative differentiation is often difficult. This study elucidated how clinicians diagnose parathyroid carcinoma and the relationship between preoperative diagnosis and the operative course. Using a retrospective chart review, twenty cases of parathyroid carcinoma from nine participating centers were examined. In 11 cases with preoperative suspicion of malignancy, at least one of these three features was found: elevated serum calcium level (>14 mg/dL), palpable mass, and irregular margin on ultrasonography. Although an intact parathyroid hormone (iPTH) threshold to suspect malignancy has not been established, six cases showed marked iPTH elevation exceeding 8.0 times the upper limit of normal. One case was excluded from analysis due to hemodialysis. Compared with the four cases that showed calcium elevation, the iPTH threshold might represent better sensitivity. Among 9 cases of benign preoperative diagnosis, six cases were performed with pericapsular resection. In three cases where malignancy was suspected in the middle of the operation, the recommended en bloc resection with ipsilateral thyroid lobectomy was not performed but a parathyroidectomy with surrounding soft tissue. In contrast, 10 preoperatively suspected cases underwent en bloc resection, and one case underwent pericapsular resection followed by supplementary ipsilateral hemithyroidectomy due to the uncertain pre- and intraoperative findings to determine the diagnosis. In conclusion, the surgical procedure for parathyroid carcinoma strongly depends on the preoperative diagnosis. The presence of excessive iPTH levels might contribute to improved preoperative diagnostic sensitivity for parathyroid carcinoma.
Subject(s)
Hyperparathyroidism , Parathyroid Neoplasms , Humans , Parathyroid Neoplasms/diagnosis , Parathyroid Neoplasms/surgery , Parathyroid Neoplasms/pathology , Calcium , Retrospective Studies , Parathyroid HormoneABSTRACT
Background and Objectives: Patients with cervical lymph node metastases from remote primary tumours have poor prognoses because of the advanced stage of their cancer. Owing to recent progress in the nonsurgical management of various cancer types, options for surgical treatment to reduce tumour volume are increasing, and may help improve survival rates. For example, neck dissection may be a good option as a definitive therapy for some patients with resectable cervical metastases. We assessed patients who underwent neck dissection with curative intent and discuss the effectiveness of this approach for cervical metastases from remote malignancies. Material and Methods: We retrospectively reviewed the data of 18 patients (10 males and 8 females in an age range of 30-79 years) who underwent neck dissections for neck lymph node metastases from a remote primary tumour between 2010 and 2019. Patient clinical characteristics, preoperative accuracy of positive node localisation using fluorodeoxyglucose positron emission tomography-computed tomography (FDG/PET-CT), and patient survival rates were estimated. Results: Primary sites included ten lungs, two mammary glands, one thymus, one thoracic oesophagus, one stomach, one uterine cervix, one ovary, and one testis per patient. There were 19 levels with FDG/PET-CT positive nodes in 17 out of 18 patients. Conversely, there were 28 pathological positive levels out of 50 dissected levels. The sensitivity, specificity, positive and negative predictive values, and accuracy of FDG-PET/CT in predicting positive nodes were 69%, 88%, 95%, 47%, and 74%, respectively. The three-year overall survival (OS) rate for all patients was 70%. The three-year OS rate of the group with zero or one pathological positive nodes was 81%, which was significantly higher than that of the group with more than two positive nodes (51%) (p = 0.03). Conclusions: Neck dissection for cervical lymph node metastases from remote primary malignancies may improve prognoses, especially considering anticancer agents and radiotherapy advancements.
Subject(s)
Lymphatic Metastasis/therapy , Neck Dissection/methods , Adult , Aged , Female , Humans , Lymph Nodes/pathology , Lymph Nodes/surgery , Male , Middle Aged , Neck/abnormalities , Neck/diagnostic imaging , Neck/surgery , Positron Emission Tomography Computed Tomography/methods , Prognosis , Retrospective StudiesABSTRACT
OBJECTIVES: In performing an open biopsy of a neck mass, an incisional biopsy may increase the risk of cancer cell seeding and dissemination that, ultimately, worsens a patient's survival. The aim of this study was to compare the impact of incisional and excisional biopsies of cervical lymph node metastases of solid tumors on patients' survival. METHODS: A retrospective review was made of patients with cervical metastases of solid tumors who underwent an open biopsy for a diagnosis between 2005 and 2015. Sixty-four patients met the criteria out of 524 open biopsy cases undertaken during the period. Survival analyses were estimated from 33 cases whose initial symptoms were the presence of a neck mass, using two modes of biopsy: excisional and incisional. RESULTS: The 2-year overall survival rates in incisional and excisional biopsy groups were 65% and 43%, respectively, and 2-year disease-specific survival rates were 74% and 43%, respectively. The differences were not significant. For lung cancer or head and neck cancer subgroups, survival differences between incisional and excisional biopsy groups were also not significant. CONCLUSIONS: A carefully targeted physical examination and performing a fine needle aspiration are essential to establish a diagnosis for the etiology of an unknown neck mass. In performing an open biopsy, the effect of an incisional biopsy on patients' survival was no worse than that of an excisional biopsy, despite the latter being theoretically preferable.
Subject(s)
Cervical Vertebrae/pathology , Lymph Nodes/pathology , Lymphatic Metastasis/pathology , Neoplasms/pathology , Adult , Aged , Aged, 80 and over , Animals , Biopsy , Chick Embryo , Female , Humans , Kaplan-Meier Estimate , Male , Middle Aged , Prognosis , Retrospective Studies , Survival RateABSTRACT
BACKGROUND: Parotid gland carcinoma is a rare malignancy, comprising only 1-4% of head and neck carcinomas; therefore, it is difficult for a single institution to perform meaningful analysis on its clinical characteristics. The aim of this study was to update the clinical knowledge of this rare disease by a multi-center approach. METHODS: The study was conducted by the Kyoto University Hospital and Affiliated Facilities Head and Neck Clinical Oncology Group (Kyoto-HNOG). A total of 195 patients with parotid gland carcinoma who had been surgically treated with curative intent between 2006 and 2015 were retrospectively reviewed. Clinical results including overall survival (OS), disease-free survival (DFS), disease-specific survival (DSS), local control rate (LCR), regional control rate (RCR), and distant metastasis-free survival (DMFS) were estimated. Univariate and multivariate analyses were performed to identify prognostic factors. RESULTS: The median patient age was 63years old (range 9-93years), and the median observation period was 39months. The OS, DFS, DSS, LCR, RCR, and DMFS at 3years were 85%, 74%, 89%, 92%, 88%, and 87%, respectively. Univariate analysis showed age over 74, T4, N+, preoperative facial palsy, high grade histology, perineural invasion, and vascular invasion were associated with poor OS. N+ and high grade histology were independent factors in multivariate analysis. In subgroup analysis, postoperative radiotherapy was associated with better OS in high risk patients. CONCLUSION: Nodal metastases and high grade histology are important negative prognostic factors for OS. Postoperative radiotherapy is recommended in patients with advanced high grade carcinoma.
Subject(s)
Carcinoma, Squamous Cell/mortality , Neoplasm Recurrence, Local/mortality , Parotid Gland/surgery , Parotid Neoplasms/mortality , Adult , Aged , Aged, 80 and over , Analysis of Variance , Carcinoma, Squamous Cell/pathology , Carcinoma, Squamous Cell/surgery , Cohort Studies , Disease-Free Survival , Female , Hospitals, University , Humans , Japan , Male , Middle Aged , Multivariate Analysis , Neoplasm Invasiveness/pathology , Neoplasm Recurrence, Local/pathology , Neoplasm Recurrence, Local/surgery , Neoplasm Staging , Parotid Neoplasms/pathology , Parotid Neoplasms/surgery , Prognosis , Rare Diseases , Retrospective Studies , Risk Assessment , Survival AnalysisABSTRACT
BACKGROUND: In Japan, there has been a lot of reports showing an association between facial flushing after light alcohol consumption and heterozygosity for inactive aldehyde dehydrogenase-2 (ALDH2). Persons with inactive ALDH2 may have a higher risk of alcohol-related oral, pharyngeal and esophageal cancers, compared with those with wild-type ALDH2. The purpose of this study was to examine whether flushers with oral or pharyngeal squamous cell carcinoma have an increased risk of synchronous or metachronous cancer of the upper gastrointestinal (UGI) tract. METHODS: A retrospective study was performed by medical chart review and through a questionnaire sent to 285 patients treated for oral and pharyngeal cancer. Responses were obtained from 150 patients (52.6%), who were classified as flushers or non-flushers, smokers (≥20 pack-year; 1 pack-years = number of cigarettes/20 per day) or non-smokers, and drinkers (≥14 units of alcohol consumption per week; 1 unit = 22 g) or non-drinkers. Relationships of these factors with occurrence of second primary cancers (SPCs) in the UGI tract were investigated. RESULTS: In Kaplan-Meier analysis, there was a significantly higher rate of SPC at 5 years in flushers and drinkers, but no relationship with smoking. In multivariate analyses, a history of flushing was significantly associated with SPC in the UGI tract (HR 2.64, 95% CI 1.25-5.52, P = 0.0109), but not with smoking or alcohol consumption. CONCLUSIONS: A simple interview on history of facial flushing after alcohol intake can be useful for identifying patients at high risk for synchronous or metachronous cancers of the UGI tract.
Subject(s)
Alcohol Drinking/adverse effects , Flushing/etiology , Gastrointestinal Neoplasms/etiology , Neoplasms, Multiple Primary/etiology , Upper Gastrointestinal Tract/pathology , Aged , Female , Humans , Japan/epidemiology , Male , Middle Aged , Multivariate Analysis , Neoplasms, Second Primary , Proportional Hazards Models , Retrospective Studies , Risk Factors , Surveys and QuestionnairesABSTRACT
In cases of thyroid papillary carcinoma, a less aggressive cancer, surgeons may hesitate to perform total thyroidectomy on patients with poor general condition because these may experience longer survival without undergoing surgery. To investigate the influence of general patient condition on the patients' survival who received total thyroidectomy, we utilized the American Society of Anesthesiologists Physical Status (ASA-PS). We retrospectively reviewed all patients undergoing total thyroidectomy under general anesthesia and graded by ASA-PS between 2004 and 2014. Patients with anaplastic carcinoma and metastatic thyroid renal cell carcinoma were excluded. There were 77 (30%), 149 (58%), and 30 (12%) ASA-PS 1, 2, and 3 cases, respectively. Patient age increased significantly with increasing ASA-PS score (median age of 53, 64, and 71 years for ASA-PS 1, 2, and 3). Hospitalization periods extended significantly for patients with ASA-PS 3. Twenty patients died during the study (3.89 median years). Five-year overall survival rates were 100%, 93%, and 79% for ASA-PS 1, 2 and 3, respectively. Patients in the ASA-PS 1 group had significantly better prognosis by log-rank test. Univariate analysis showed an increased risk of death as ASA-PS score increased (hazard ratio: 3.03, 95% confidence interval: 1.55-5.92, p=0.00). In multivariate analysis, including patient age and presence of malignancy, patient age was the only significant predictor of overall survival (hazard ratio: 1.09 by year, 95% confidence interval: 1.03-1.14, p=0.00). We concluded that a high ASA-PS score should not inhibit performance of total thyroidectomy if a patient's age is suitable for the surgery.
Subject(s)
Anesthesia, General/standards , Anesthesiologists/standards , Carcinoma , Health Status Indicators , Thyroid Neoplasms , Thyroidectomy/adverse effects , Thyroidectomy/mortality , Adolescent , Adult , Aged , Aged, 80 and over , Anesthesia, General/mortality , Anesthesiologists/organization & administration , Carcinoma/epidemiology , Carcinoma/mortality , Carcinoma/surgery , Carcinoma, Papillary , Humans , Middle Aged , Morbidity , Prognosis , Retrospective Studies , Societies, Medical/standards , Survival Rate , Thyroid Cancer, Papillary , Thyroid Neoplasms/epidemiology , Thyroid Neoplasms/mortality , Thyroid Neoplasms/surgery , Thyroidectomy/rehabilitation , United States/epidemiology , Young AdultABSTRACT
PURPOSE: Mucosal melanoma of the head and neck (MMHN) is a rare condition. This study aimed to investigate oncological outcomes of surgical intervention in patients with MMHN. MATERIALS AND METHODS: The study included 34 patients with MMHN who underwent surgical resection as initial treatment at 10 institutions in Japan between July 2005 and June 2015. Results: The 5-year overall survival (OS), local control rate (LCR), disease-free survival (DFS), and disease-specific survival (DSS) rates were 48.7%, 53.4%, 32.4%, and 55.1%, respectively. Based on multivariate analysis, no independent prognostic factors for the 5-year OS and DSS were found. Based on univariate analysis, the 5-year LCR was worse in patients with lesions in the nasal cavity and paranasal sinuses than in the oral cavity and pharynx. However, no differences in oncological outcomes were identified in relation to primary sites, and postoperative radiotherapy (PORT) and adjuvant systemic therapy did not contribute to improvements in the 5-year OS. CONCLUSIONS: No independent prognostic factors for the 5-year OS or DSS were identified. Regional or distant recurrences are often identified, regardless of local control with surgical resection. Difficult control of MMHN with conventional therapeutic strategies, such as surgical intervention, PORT, and systemic therapy, has been suggested.
Subject(s)
Head and Neck Neoplasms , Melanoma , Paranasal Sinuses , Humans , Retrospective Studies , Melanoma/surgery , Melanoma/pathology , Japan/epidemiology , Head and Neck Neoplasms/surgery , Paranasal Sinuses/pathology , Survival Rate , Neoplasm Recurrence, Local/epidemiology , Neoplasm Recurrence, Local/pathology , PrognosisABSTRACT
OBJECTIVE: Sinonasal malignant tumors (SNMT) are relatively rare among head and neck malignant tumors. Most are squamous cell carcinomas, and malignant melanomas, olfactory neuroblastomas, adenoid cystic carcinomas, sarcomas, and others also occur. The most common primary site of nasal sinus squamous cell carcinoma is the maxillary sinus. In recent years, a decrease in incidence of maxillary sinus squamous cell carcinoma (MSSCC) has been reported along with a decrease in the incidence of sinusitis. MSSCC is treated with a combination of surgery, radiation, and chemotherapy. Treatment decisions are made according to the progression of the disease, the patient's general condition, and the patient's own wishes. There are variations in treatment policies among facilities due to the specialty of staff and cooperation with other departments at each facility. We conducted a multi-institutional retrospective study to compare outcomes by treatment strategy. METHODS: In this study, 340 patients with SNMT who were treated at 13 Hospitals (Head and Neck Oncology Group (Kyoto-HNOG) ) during the 12-year period from January 2006 to December 2017 were included. There were 220 patients with squamous cell carcinoma, 32 with malignant melanoma, 21 with olfactory neuroblastoma, and 67 with other malignancies. Of the squamous cell carcinomas, 164 were of maxillary sinus origin. One hundred and forty cases of MSSCC that were treated radically were included in the detailed statistical analysis. RESULTS: There were 5 cases of cStage I, 9 cases of cStage II, 36 cases of cStage III, 74 cases of cStage IVa, and 16 cases of cStage IVb. There were 92 cases without clinical lymph node metastasis (cN(-)) and 48 cases with clinical lymph node metastasis(cN(+)). Primary tumors were treated mainly by surgery in 85 cases (Surg) and by radical radiation therapy (with or without chemotherapy) of 6-70 Gy in 55 cases(non-Surg). The 5-year overall/disease-free survival rate (OS/DFS) for MSSCC was 65.1%/51.6%. Old age, renal dysfunction, and clinical T progression were independent risk factors for OS, and renal dysfunction was an independent risk factor for DFS. In cN(-) patients, OS and DFS were significantly better in Surg group than in non-Surg group. In cN(+) patients, there was no significant difference in OS and DFS between Surg and non-Surg groups. CONCLUSION: For patients with MSSCC without lymph node metastasis, aggressive surgery on the primary tumor contributes to improved prognosis.
Subject(s)
Carcinoma, Squamous Cell , Esthesioneuroblastoma, Olfactory , Kidney Diseases , Melanoma , Nose Neoplasms , Paranasal Sinus Neoplasms , Humans , Carcinoma, Squamous Cell/epidemiology , Carcinoma, Squamous Cell/therapy , Esthesioneuroblastoma, Olfactory/therapy , Esthesioneuroblastoma, Olfactory/pathology , Lymphatic Metastasis , Melanoma/pathology , Nasal Cavity/pathology , Nose Neoplasms/epidemiology , Nose Neoplasms/therapy , Nose Neoplasms/pathology , Paranasal Sinus Neoplasms/pathology , Retrospective Studies , Squamous Cell Carcinoma of Head and Neck/therapy , AgedABSTRACT
OBJECTIVE: Transoral surgery is a minimally invasive treatment but may cause severe dysphagia at a lower rate than chemoradiotherapy. METHODS: We compared clinical information, surgical complications, and swallowing function in patients who underwent transoral nonrobotic surgery for laryngo-pharyngeal squamous cell carcinoma between 2015 and 2021 in a multicenter retrospective study. RESULTS: Six hundred and forty patients were included. Postoperative bleeding was observed in 20 cases (3.1%), and the risk factor was advanced T category. Postoperative laryngeal edema was observed in 13 cases (2.0%), and the risk factors were prior radiotherapy, advanced T stage, and concurrent neck dissection in patients with resected HPC. Dysphagia requiring nutritional support was observed in 29 cases (4.5%) at 1 month postoperatively and in 19 cases (3.0%) at 1 year postoperatively, respectively. The risk factors for long-term dysphagia were prior radiotherapy and advanced T category. Short-term risk factors for dysphagia were prior radiotherapy, advanced T category, and concurrent neck dissection, while long-term risk factors for dysphagia were only prior radiotherapy and advanced T category. CONCLUSION: Prior radiotherapy, advanced T stage, and concurrent neck dissection increased the incidence of postoperative laryngeal edema and short-term dysphagia, but concurrent neck dissection did not affect long-term dysphagia. Such features should be considered when considering the indication for transoral surgery and postoperative management.
Subject(s)
Deglutition Disorders , Laryngeal Neoplasms , Neck Dissection , Pharyngeal Neoplasms , Postoperative Complications , Humans , Male , Retrospective Studies , Deglutition Disorders/etiology , Female , Laryngeal Neoplasms/surgery , Middle Aged , Aged , Postoperative Complications/epidemiology , Pharyngeal Neoplasms/surgery , Risk Factors , Squamous Cell Carcinoma of Head and Neck/surgery , Neoplasm Staging , Adult , Laryngeal Edema/etiology , Carcinoma, Squamous Cell/surgery , Postoperative Hemorrhage/epidemiology , Aged, 80 and over , Natural Orifice Endoscopic SurgeryABSTRACT
BACKGROUND: Late laryngopharyngeal cancers after transoral surgery include not only local recurrences but also metachronous multiple cancers. METHODS: We compared clinical information, surgical outcomes, and late laryngopharyngeal cancers in patients who underwent transoral nonrobotic surgery for laryngopharyngeal squamous cell carcinoma without lymph node metastases between 2015 and 2021 in a multicenter retrospective study. RESULTS: Four hundred and fifty-seven patients were included. Positive surgical margins were found in 121 patients (26.5%). Twenty-two patients (4.8%) received additional treatment. Positive horizontal margins of invasive carcinoma (p = 0.003) and positive horizontal margins of carcinoma in situ only (p = 0.032) were independent risk factors for local recurrence, and prior radiotherapy (p = 0.001) for metachronous multiple cancers. Local control was significantly worse without additional treatment (p = 0.049), but there was no significant difference in survival. CONCLUSIONS: Patients with positive margins had an increased frequency of local recurrence, but salvage therapy was effective.
Subject(s)
Carcinoma, Squamous Cell , Head and Neck Neoplasms , Hypopharyngeal Neoplasms , Humans , Squamous Cell Carcinoma of Head and Neck/surgery , Retrospective Studies , Carcinoma, Squamous Cell/surgery , Neoplasm Recurrence, Local/pathologyABSTRACT
BACKGROUND: Hypopharyngeal carcinoma is likely to spread to the lymph nodes, but there is no established strategy for management in transoral surgery. METHODS: We compared oncologic and functional outcomes in a retrospective multicenter study of patients who underwent transoral surgery for hypopharyngeal carcinoma between 2015 and 2021. RESULTS: Two-hundred and thirty-two patients were included. Comparing patients with and without adjuvant radiotherapy, 3-year regional recurrence-free survival (RRFS) was not significantly different in pN2b and pN2c, but was significantly worse in pN3b without adjuvant radiotherapy. In patients without neck dissection, the 3-year RRFS was 85.6%, 76.8%, and 70.0% for T1, T2, and T3 primary lesions, respectively, and was significantly worse for T2 or higher (p = 0.035). CONCLUSIONS: In the absence of extracapsular invasion, regional control did not deteriorate without adjuvant therapy. If prophylactic neck dissection is not performed, careful follow-up is necessary if the primary lesion is T2 or greater.
Subject(s)
Hypopharyngeal Neoplasms , Lymphatic Metastasis , Neck Dissection , Humans , Hypopharyngeal Neoplasms/pathology , Hypopharyngeal Neoplasms/mortality , Hypopharyngeal Neoplasms/surgery , Hypopharyngeal Neoplasms/therapy , Retrospective Studies , Male , Female , Middle Aged , Aged , Adult , Carcinoma, Squamous Cell/pathology , Carcinoma, Squamous Cell/surgery , Carcinoma, Squamous Cell/mortality , Carcinoma, Squamous Cell/therapy , Neoplasm Staging , Aged, 80 and over , Lymph Nodes/pathology , Lymph Nodes/surgery , Radiotherapy, Adjuvant , Disease-Free Survival , Natural Orifice Endoscopic Surgery/methodsABSTRACT
Radiation-induced sarcoma usually develops after an interval of more than 10 years from the completion of radiation therapy to the diagnosis of secondary sarcoma. However, the theory of radiation-induced transformation does not rule out postirradiation sarcomas with a short latency period. We experienced the case of a patient with postirradiation leiomyosarcoma of the tongue, which occurred 19 months after he had received chemoradiotherapy. Besides the short latency period, a pseudotumor stage developed between the time of radiation exposure and the development of leiomyosarcoma. In this article, we also describe an immunohistochemical approach to diagnose leiomyosarcoma and the efficacy of a gemcitabine and docetaxel regimen.
Subject(s)
Granuloma, Plasma Cell/radiotherapy , Neoplasms, Radiation-Induced/etiology , Sarcoma/etiology , Tongue Neoplasms/etiology , Biopsy , Diagnosis, Differential , Granuloma, Plasma Cell/pathology , Humans , Male , Middle Aged , Neoplasms, Radiation-Induced/diagnosis , Sarcoma/diagnosis , Time Factors , Tongue Diseases/pathology , Tongue Diseases/radiotherapy , Tongue Neoplasms/diagnosisABSTRACT
Programmed cell death ligand 1 (PD-L1) expression and tumor-associated immune cell (TAIC) density can be the biomarkers of survival outcome and for predicting the efficacy of immune checkpoint inhibitors in oral squamous cell carcinoma (OSCC), but whether single biopsy accurately reflects the values of these parameters in resected specimens is unclear. To clarify this, we evaluated the concordance of immune marker expression (PD-L1, PD-1, CD3, CD4, CD8, and CD68) between 39 paired biopsied and surgically resected specimens obtained from patients with OSCC at Kobe City Medical Center General Hospital between July 2011 and January 2016. Immune marker expression was assessed using immunohistochemistry. PD-L1 expression was consistent between the biopsied and surgically resected specimens in only 76.9% of cases. TAIC density was significantly lower in biopsied than in surgically resected specimens. There was considerable discordance in immune marker expression between biopsied and surgically resected specimens. We should take into consideration that PD-L1 positivity and TAIC density would be underestimated by single small biopsies compared to the estimations by surgically resected specimens.
ABSTRACT
BACKGROUND: The expression of PD-L1 in tumor cells and infiltration of tumor-associated immune cells (TAICs) might reflect the tumor biology of head and neck cancer. We aimed to characterize their prognostic roles in oral squamous cell carcinomas (OSCCs). METHODS: We enrolled 103 OSCC patients who underwent definitive surgery. Immune expression levels of PD-L1, PD-1, CD3, CD4, CD8, and CD68 were assessed in surgically resected specimens. We evaluated the effects of immune marker expression and localization on survival outcomes. RESULTS: Multivariate analysis results adjusted by the pathological stage, resection margin, and extracapsular extension showed that a high number of PD-1+ TAICs and intratumoral CD68+ TAICs were independent positive and negative prognostic markers (hazard ratio: 0.20 and 4.15, respectively; P = .02 and .01, respectively). CONCLUSION: PD-1+ TAICs in the tumor microenvironment and CD68+ TAICs in the intratumoral area could act as novel biomarkers for predicting overall survival outcomes in OSCC patients.
Subject(s)
Carcinoma, Squamous Cell , Head and Neck Neoplasms , Mouth Neoplasms , B7-H1 Antigen , Biomarkers, Tumor , Carcinoma, Squamous Cell/surgery , Head and Neck Neoplasms/surgery , Humans , Mouth Neoplasms/surgery , Prognosis , Squamous Cell Carcinoma of Head and Neck , Tumor MicroenvironmentABSTRACT
BACKGROUND: Concurrent chemoradiotherapy (CCRT) with tri-weekly high-dose cisplatin (HDC) is considered the standard regimen. However, due to significant toxicity, various weekly low-dose schedules have been increasingly used. We investigated the tolerability and survival of patients with head and neck squamous cell carcinoma (HNSCC) who underwent CCRT with low-dose weekly cisplatin (LDC) for Japanese population. METHODS: A retrospective review was conducted among patients with HNSCC who were treated with CCRT/LDC in our institute. Ninety-five patients who met the criteria were enrolled in this study. We evaluated the cycle and cumulative cisplatin dose, completion rate of radiotherapy, adverse events, and survival outcome. RESULTS: The mean cycles and cumulative cisplatin dose were 4.7 cycles and 187 mg/m2. All patients completed planned dose of radiation without prolonged breaks. Leucopoenia was the most frequent dose-limiting factor and 44% patients developed grade 3 or 4 toxicity. The 2-year overall survival and recurrence-free survival were 93% and 74%, respectively. The significant differences of survival outcomes between the patients with total cisplatin dose (⩾200 mg and <200 mg) or among age distribution (35-55, 56-75, and ⩾76) were not observed. CONCLUSIONS: Concurrent chemoradiotherapy/LDC can be safely administered with acceptable toxicity and survival outcome even if the patients with higher age, lower eGFR, and so on.
ABSTRACT
CONCLUSION: The surgical procedure for the superior prelabyrinthine cell tract approach is described in detail. This approach is a safer and less invasive procedure to totally decompress the facial nerve compared with conventional middle fossa approach. OBJECTIVE: To develop a new approach to the meatal and labyrinthine segments that does not require a craniotomy. BACKGROUND: If performed within 2 weeks after the onset of facial palsy, total decompression of the facial nerve enhances the chance of normal or near-normal facial function recovery in cases with massive nerve degeneration. The transmastoid approach and middle fossa approach are usually combined to totally expose the intratemporal facial nerve. However, the middle fossa approach requires a craniotomy in the temporoparietal area. Because of its invasiveness, patients often hesitate to consent to this operation, and as a result the recovery from facial palsy is incomplete. SURGICAL PROCEDURE: The meatal and labyrinthine segments of the facial nerve are exposed by the superior route via the superior prelabyrinthine cell tracts. Partial resection of the zygoma makes this approach feasible.
Subject(s)
Decompression, Surgical/methods , Facial Nerve/surgery , Facial Paralysis/surgery , Neurosurgical Procedures/methods , Ear, Inner/cytology , Facial Nerve/physiopathology , Humans , Treatment OutcomeABSTRACT
CONCLUSION: Otoacoustic emissions (OAEs) could be detectable as cochlear AC potentials. Spontaneous otoacoustic emissions (SOAEs) were detected either electrically or acoustically, while evoked otoacoustic emissions (EOAEs) could be detected electrically but not acoustically. OBJECTIVE: Many lines of evidence support the hypothesis that SOAEs are produced by spontaneous mechanical oscillation within the cochlea, and perhaps motile properties of the outer hair cells. If this is the case, SOAEs, emitted acoustically in the external auditory meatus, could also be recorded electrically as cochlear AC potential. EOAE is also thought to be produced by vibration of the basilar membrane, generated by the backward-traveling waves. EOAE thus seems to be detectable electrically as cochlear AC potential. In the present study, SOAE and EOAE were recorded both acoustically and electrically in the guinea pigs to examine the correlation between electrically recorded SOAE (ER-SOAE) and acoustically recorded SOAE (AR-SOAE). In addition, a microphonics response (MPR) to tone pip was recorded to analyze the characteristics of the non-linear component and linear component of the AC responses. RESULTS: (1) In 4 out of 20 guinea pigs (20%), SOAE could be detected both acoustically and electrically. (2) Electrical signals of SOAE had a better S/N ratio than acoustical signals. Generally, only some ER-SOAE could be detected acoustically. (3) Almost without exception, the prominent frequencies of multiple ER-SOAEs corresponded to the intermodulation distortion product, or harmonics. (4) ER-SOAEs were suppressed by hypoxia or intense sound exposure and reappeared upon rebreathing or discontinuation of the external tone. During recovery, prominent frequencies showed a transient downward shift in frequency. (5) SOAEs were synchronized in phase with an external tone in the spectral neighborhood of SOAE. The averaged waveform of SOAE synchronized with the external tone was the same with either acoustic or electrical signals. (6) The MPR to tone pip is composed of two components with different frequency characteristics and input/output functions. (7) The non-linear component delayed to cochlear microphonics was markedly saturated at the intensity level of 40 dB peak equivalent SPL. This component was a phase-lock response, not a frequency-locked one. (8) The non-linear component could be separated with Probst's non-linear differential extraction technique. In the MPR to a 4-kHz tone pip, high-cut filtration at 3.5 kHz produced a waveform similar to the non-linear component separated by Probst's method.
Subject(s)
Otoacoustic Emissions, Spontaneous/physiology , Acoustic Stimulation , Animals , Guinea Pigs , Signal Processing, Computer-Assisted , SoftwareABSTRACT
CONCLUSION: Evoked oto-acoustic emission (EOAE), in particular the slow component, is fragile with the inner ear lesions and is apt to disappear in impaired ears. This presence is thought to mean that inner ear is not badly damaged, and that the presence of EOAEs in early stage sudden deafness carries a good prognosis. Narrow-band EOAE analysis would open a potentially promising way to manage sensorineural deafness. OBJECTIVE: The aim of present study was to evaluate the characteristics of EOAEs from pathologic ears by a narrow-band EOAE analysis, which allowed us to investigate amplitude, frequency content and latency of EOAEs simultaneously and also to easily detect weak echoes in cases with inner ear lesions. MATERIALS AND METHODS: EOAEs were analyzed by investigating narrow-band frequency contents of EOAEs, filtered by a 100-Hz step of pass bandwidth in frequency regions from 1.0 to 2.0 kHz, and by 500 Hz of pass bandwidth in the frequency ranges of 0.5-1.0 and 2.0-5.0 kHz. EOAE testing was performed in 40 normal ears and 111 ears with pathologic disorders, including sudden deafness, Ménière's disease and surgically proven acoustic neurinomas. Spontaneous oto-acoustic emission was investigated in some cases. In acoustic neurinoma, especially computed tomography scan and magnetic resonance imaging tests were performed to assess the tumor size. RESULTS: (1) Narrow-band EOAE analysis revealed that EOAEs from normal ears were composed of two main echo trains and several sub-echoes. The main echo trains were divided into a fast component with a short latency of <10 ms and a slow component with a long latency of >10 ms. (2) EOAEs could often be detected from ears with moderate to severe hearing loss >45 dB HL in early stage sudden deafness. The prognosis of sudden deafness was good in cases where both a fast component and slow component were detected in the acute stage within 2 weeks after the deafness onset, and was pessimistic, when either or both of them failed to recover. (3) In Ménière's disease, EOAE was found in 6 (40%) of 15 cases with hearing loss >50 dB, and detected in 54 (90%) of 60 cases with slight to moderate deafness <50 dB HL. Echo duration tended to become shorter, and the slow component decreased in amplitude even in ears with slight deafness <30 dB. The detection threshold of the slow component was also elevated. In ears with more advanced deafness, the slow component disappeared and only the fast component with short latency persisted. Ultimately, the fast component also faded out if the hearing was severely impaired. (4) EOAEs were detectable in 20 (95.2%) of 21 ears with surgically proven acoustic neurinoma, 16 of which had both the slow and fast components. The echo pattern of acoustic neurinoma was basically similar to that of normal ears, but the detection threshold was elevated to a varying degree, although there were some cases with much better detection threshold as compared with severe deafness.
Subject(s)
Deafness/physiopathology , Meniere Disease/physiopathology , Neuroma, Acoustic/physiopathology , Otoacoustic Emissions, Spontaneous/physiology , Adult , Aged , Evoked Potentials, Auditory/physiology , Female , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Neuroma, Acoustic/diagnosis , Prognosis , Tomography, X-Ray ComputedABSTRACT
OBJECTIVES: Confocal laser endomicroscopy (CLE) is a technology that enables microscopic visualization of lesions in real-time (optical biopsy) and has been successfully applied for clinical use in gastroenterology. Recently, it was also introduced for head and neck squamous cell carcinoma (HNSCC) diagnostics. We previously designed a self-made CLE, which can provide bichrome images, with topical contrast agents that are safe for use in patients. Herein, we report findings of a pilot study using our self-made CLE to image pairs of normal and cancerous tissues. This study aimed to characterize the features of HNSCC compared with normal mucosa and to establish a methodology of in vivo real-time optical biopsy of HNSCCs. METHODS: HNSCC tissues were acquired from 10 patients who underwent surgical resection. Dissected specimens were first evaluated for their auto-fluorescence spectral profiles with 473 nm laser excitation and further optical observation. While obtaining the image, auto-fluorescence spectrum and intensity of the reflectance fluorescent signals were measured in real-time by a spectrometer. Subsequently, acriflavine was applied to the specimen to fluorescently label the nuclei and observe the difference between normal and cancerous tissues with 473 nm laser excitation. Finally, double staining with acriflavine and edible Food Red No.106 was performed to observe both nuclei and the cytoplasm of normal and cancerous tissues at 473 nm and 561 nm laser excitation. RESULTS: Lower signals were detected from auto-fluorescence images of cancer tissues than normal tissues with 473 nm laser excitation. After acriflavine application, there was a clear difference between cancer and normal mucosa in the uniformity of nuclear size and shape. In normal mucosa, cells were arranged in an orderly manner, with each cell resembling a frog's egg. By contrast, in cancer tissues, the cell density was higher, and the cellular arrangement was less orderly. Using both acriflavine and Food Red No.106, images became more vivid, but more complicated because red dye staining of the cytoplasm emerged as fluorescence at different wavelengths. CONCLUSIONS: Real-time in vivo imaging using the newly developed CLE and conditions may be used to distinguish cancer tissue from normal mucosa without invasive biopsy.
Subject(s)
Endoscopy/methods , Head and Neck Neoplasms/pathology , Microscopy, Confocal/methods , Squamous Cell Carcinoma of Head and Neck/pathology , Acriflavine , Aged , Aged, 80 and over , Biopsy , Female , Fluorescent Dyes , Head and Neck Neoplasms/surgery , Humans , Intravital Microscopy , Laryngeal Neoplasms/pathology , Laryngeal Neoplasms/surgery , Male , Middle Aged , Mouth Neoplasms/pathology , Mouth Neoplasms/surgery , Optical Imaging , Pharyngeal Neoplasms/pathology , Pharyngeal Neoplasms/surgery , Pilot Projects , Squamous Cell Carcinoma of Head and Neck/surgeryABSTRACT
OBJECTIVE: Salivary gland carcinoma is rare among head and neck cancers. Sublingual gland carcinoma, a type of salivary gland carcinoma, is even rarer; therefore, the number of cases at a single institute is too small for sufficient evaluation of tumor characteristics. We conducted a multicenter, retrospective analysis of sublingual gland carcinomas in patients who visited 12 institutions associated with the Kyoto Hospital and Affiliated Facilities Head and Neck Clinical Oncology Group. METHODS: Thirteen previously untreated patients who visited the institutions between 2006 and 2015 were enrolled. The overall survival (OS) and disease-free survival (DFS) rates for all patients and by disease stage were analyzed. Statistical analyses were performed for all patients with respect to disease stage. RESULTS: Eight of thirteen patients were diagnosed with adenoid cystic carcinoma on pathological study. A significant difference in OS rate was observed between patients with Stage I-III and Stage IV disease; however, the difference in DFS rate by disease stage was not significant. CONCLUSION: Stage IV disease was identified as a poor prognostic factor in patients with sublingual gland carcinoma. However, even patients with Stage I-III disease experienced relatively short DFS. Distant metastasis is a serious problem among patients with sublingual gland carcinoma.