[TWO CASES OF LARYNGEAL EDEMA CAUSED BY SUBLINGUAL ALLERGEN IMMUNOTHERAPY].

Sublingual immunotherapy is a widely used treatment, and serious adverse reactions such as anaphylaxis are rare. We report two cases of laryngeal edema as adverse reactions to sublingual immunotherapy, which could be continued due to a change in the administration method. Case 1 presents a 15-year-old male suspected to have had anaphylaxis due to the dust at the age of 6 years. He started treatment with Miticure® and developed laryngeal edema 30 minutes after taking the 10000JAU dose on the 10th day. laryngeal edema was treated with intravenous infusion. Case 2 presents a 48-year-old woman. She started treatment with Cidacure® and developed respiratory distress and laryngeal edema 1 hour after taking the 5000JAU dose on the 5th day. she had resolved mildly without therapeutic intervention. In both cases, the patients were switched to sublingual spitting, resumed with the initial dose cautiously, and were able to continue. Sublingual immunotherapy is a safe treatment, but sudden adverse reactions may occur. Laryngeal symptoms may be treated by changing to the sublingual spitting method, but laryngeal findings should be examined, and the dosage should be carefully increased.

The Utility of Pneumatic Cavity Volume in the Treatment of Exudative Otitis Media in Children with Cleft Palate.

OBJECTIVE: Measure the volume of air-containing space in children with cleft palate and assess age-related changes, recurrence rate of otitis media with effusion (OME) after tube removal, and temporal bone development trend based on time of tube placement. DESIGN: Interventional prospective study. SETTING: Cleft Lip and Palate Center at a Tertiary-level institution. PATIENTS/PARTICIPANTS: One hundred sixty-eight ears of 86 patients who visited our center from January 2018 to December 2019. INTERVENTIONS: We performed tympanometry (impedance audiometry) after tube placement. MAIN OUTCOME MEASURES: Recurrence (at least one episode of OME after tympanic membrane closure), tympanic cavity volumes, and timing of tube placement. RESULTS: The mean air-containing cavity volume was 1.62 mL, 2.99 mL, and 3.29 mL in patients aged 1, 2, and 3 years, respectively. A rapid increase in volume was observed around 2 years of age. Twenty-two (42.3%) of the 52 ears with pneumatic cavity volumes <3 mL, and four (14.3%) of the 28 ears with pneumatic cavity volumes ≥3 mL had recurrence. Tubes were placed at ages <1 year and ≥1 year in 28 and 62 ears, respectively. The pneumatic cavity volume tended to be greater in the ears with tube placement at age <1 year. CONCLUSION: This study provided insights into using pneumatic cavity volume measurements to determine the appropriate timing for tube removal. Tubes should be placed as early as possible (before the age of 2 years) for prolonged OME associated with children with cleft palate.

Changes in oral function, swallowing function, and quality of life in patients with head and neck cancer: a prospective cohort study.

BACKGROUND: Head and neck cancer (HNC) treatment can cause oral morbidities, such as oral dryness and dysphagia, affecting the patient's quality of life (QOL). The relationship between oral functions and QOL in patients with early-stage HNC remains poorly studied. This study aimed to evaluate changes in the QOL of patients with early-stage HNC and identify factors that affect the QOL of these patients. METHODS: In this prospective cohort study, 37 patients who underwent early-stage (Stage I/Stage II) HNC treatment were evaluated for their oral function, swallowing function, and the QOL score at baseline (BL) and 12 months after surgical treatment (12 M). The participants were divided into two groups: patients who returned to the BL QOL score at 12 M (RE; n = 26) and those who did not (NR; n = 11). RESULTS: In total, 29.7% (11/37) patients with early-stage HNC did not return to the BL QOL score at 12 M. There was no significant difference between the RE and NR groups regarding the oral and swallowing function. Moreover, oral and swallowing function of all patients returned to the BL at 12 M. The NR group showed lower QOL scores than the RE group in the global health status, and "sticky saliva" parameters in the questionnaires. CONCLUSION: Restoration of the oral function is insufficient to improve the QOL of patients with early-stage HNC. The treatment of these patients should instead consider several factors that affect their QOL.

Autophagy Prevents Osteocyte Cell Death under Hypoxic Conditions.

Hypoxia occurs under important clinical conditions such as cancers, heart disease, and ischemia. However, the relationship between hypoxia and autophagy in osteocytes is still unclear. The objective of the present study was to uncover the regulatory mechanisms that prevent regulated cell death, such as apoptosis, necrosis, and autophagy, under hypoxia. MLO-Y4 cells, a mouse osteocyte cell line, were exposed to various O2 partial pressures (PO2). Subsequently, the cells underwent apoptosis, autophagy, autophagic cell death, and/or necrosis, and thereby we designated PO2 = 2% as a representative hypoxic condition. Immunofluorescence staining showed an increase of LC3 and a decrease of p62 in MLO-Y4 cells exposed to hypoxia, indicating the induction of autophagy. We then hypothesized that ß-estradiol (E2) and vitamin D play an important role in apoptosis and autophagy of osteocytes under hypoxia. 1,25α-dihydroxyvitamin D3 (VitD) protected MLO-Y4 cells from cell death and induced autophagy. However, E2 showed little effect. Finally, Western blotting for phosphorylated mTOR and Akt was carried out in order to investigate the altered autophagy signaling pathways affected by the addition of VitD and E2. However, neither E2 nor VitD were capable of recovering the decreased phosphorylation of those factors. Our results indicated that the effects of VitD on autophagy under hypoxia were dependent on the Akt and mTOR pathways. Thus, the results of the present study showed that VitD suppresses osteocyte cell death in an mTOR pathway-dependent manner in hypoxic conditions. This suggests the potential of VitD as a therapeutic intervention for diseases in which the cell death of osteocytes mainly occurs via hypoxia.

Survey of the Time-Onset Profiles of Nedaplatin-Induced Adverse Events in Head and Neck Cancer Therapy.

OBJECTIVE: Cisplatin(CDDP)is a key drug for head and neck cancer therapy, but frequently induces severe adverse events including renal dysfunction. Nedaplatin(CDGP)was developed and is used in Japan; it has certain benefits over CDDP. Unlike CDDP, CDGP treatment does not require hydration. However, CDGP is not used globally and thus safety information is lacking. Therefore, we surveyed safety profiles for CDGP-based chemotherapy. METHODS: A survey was conducted at Showa University Hospital. Thirty-eight patients treated for head and neck cancer combined with radiotherapy(RTx)and tegafur- gimeracil-oteracil(S-1)between April 2012 and March 2015 were included. Laboratory-based adverse events(WBC, Hb, platelet[Plt], SCr, Alb)and oral mucositis were assessed according to CTCAE v5.0. Time-onset profiles for adverse events were evaluated after starting chemoradiotherapy. RESULTS: In 38 patients, Plt nadir was observed following 40(30-70)Gy and sustained for 14(7-35)days. WBC patterns followed similar profiles, but for Hb, nadir was observed following 60(40- 70)Gy and was less frequently sustained throughout the RTx. Alb and SCr levels were not correlated with therapy. Oral mucositis was observed following 50(10-70)Gy. CONCLUSION: In conclusion, at approximately 40 Gy, we observed decreases in WBC and Plt, with an increase in oral mucositis. Based on these results, medical staffs must closely monitor patients, especially at doses within range of 40 Gy.

Sox9 regulates the luminal stem/progenitor cell properties of salivary glands.

Exocrine glands share a common morphology consisting of ductal, acinar, and basal/myoepithelial cells, but their functions and mechanisms of homeostasis differ among tissues. Salivary glands are an example of exocrine glands, and they have been reported to contain multipotent stem cells that differentiate into other tissues. In this study, we purified the salivary gland stem/progenitor cells of adult mouse salivary glands using the cell surface marker CD133 by flow cytometry. CD133+ cells possessed stem cell capacity, and the transplantation of CD133+ cells into the submandibular gland reconstituted gland structures, including functional acinar. CD133+ cells were sparsely distributed in the intercalated and exocrine ducts and expressed Sox9 at higher levels than CD133- cells. Moreover, we demonstrated that Sox9 was required for the stem cell properties CD133+ cells, including colony and sphere formation. Thus, the Sox9-related signaling may control the regeneration salivary glands.

Tumor protein D52 expression is post-transcriptionally regulated by T-cell intercellular antigen (TIA) 1 and TIA-related protein via mRNA stability.

Although tumor protein D52 (TPD52) family proteins were first identified nearly 20 years ago, their molecular regulatory mechanisms remain unclear. Therefore, we investigated the post-transcriptional regulation of TPD52 family genes. An RNA immunoprecipitation (RIP) assay showed the potential binding ability of TPD52 family mRNAs to several RNA-binding proteins, and an RNA degradation assay revealed that TPD52 is subject to more prominent post-transcriptional regulation than are TPD53 and TPD54. We subsequently focused on the 3'-untranslated region (3'-UTR) of TPD52 as a cis-acting element in post-transcriptional gene regulation. Several deletion mutants of the 3'-UTR of TPD52 mRNA were constructed and ligated to the 3'-end of a reporter green fluorescence protein gene. An RNA degradation assay revealed that a minimal cis-acting region, located in the 78-280 region of the 5'-proximal region of the 3'-UTR, stabilized the reporter mRNA. Biotin pull-down and RIP assays revealed specific binding of the region to T-cell intracellular antigen 1 (TIA-1) and TIA-1-related protein (TIAR). Knockdown of TIA-1/TIAR decreased not only the expression, but also the stability of TPD52 mRNA; it also decreased the expression and stability of the reporter gene ligated to the 3'-end of the 78-280 fragment. Stimulation of transforming growth factor-ß and epidermal growth factor decreased the binding ability of these factors, resulting in decreased mRNA stability. These results indicate that the 78-280 fragment and TIA-1/TIAR concordantly contribute to mRNA stability as a cis-acting element and trans-acting factor(s), respectively. Thus, we here report the specific interactions between these elements in the post-transcriptional regulation of the TPD52 gene.

[Complete response in a case of advanced oropharyngeal cancer (T4aN2bM0) treated with concomitant cetuximab and radiotherapy].

We report favorable results achieved using a combination of cetuximab and radiotherapy to treat an elderly patient with advanced oropharyngeal cancer complicated by cardiovascular disease and renal dysfunction.The case was a 78-year-old man who was referred to our hospital with the chief complaint of pharyngeal pain and swelling of the right side of the neck. The patient was diagnosed with oropharyngeal cancer (T4aN2bM0) based on a cytological diagnosis of Class V squamous cell carcinoma and CT findings.Because the patient had a history of hypertension, chronic renal failure, diabetes mellitus, cerebral infarction, angina pectoris, and prostate cancer, we determined that surgical excision and chemoradiotherapy using platinum-based drugs would be difficult.We therefore treated the patient with a combination of cetuximab and radiotherapy. Grade 3 mucous membrane disorder and Grade 2 dermatitis were observed during the course of treatment, but the treatment was completed without any other adverse events.A contrasted CT image taken after the completion of treatment showed that the primary tumor and cervical lymph node metastases had disappeared and the patient thus achieved a complete response.As of 6 months after treatment, there has been no recurrence or metastasis.As shown in this case, combination therapy with cetuximab and radiotherapy can be curative even in elderly patients with advanced oropharyngeal cancer and numerous complicating conditions.

Isobutyric acid enhances the anti-tumour effect of anti-PD-1 antibody.

The low response rate of immune checkpoint inhibitors (ICIs) is a challenge. The efficacy of ICIs is influenced by the tumour microenvironment, which is controlled by the gut microbiota. In particular, intestinal bacteria and their metabolites, such as short chain fatty acids (SCFAs), are important regulators of cancer immunity; however, our knowledge on the effects of individual SCFAs remains limited. Here, we show that isobutyric acid has the strongest effect among SCFAs on both immune activity and tumour growth. In vitro, cancer cell numbers were suppressed by approximately 75% in humans and mice compared with those in controls. Oral administration of isobutyric acid to carcinoma-bearing mice enhanced the effect of anti-PD-1 immunotherapy, reducing tumour volume by approximately 80% and 60% compared with those in the control group and anti-PD-1 antibody alone group, respectively. Taken together, these findings may support the development of novel cancer therapies that can improve the response rate to ICIs.

Successful Omalizumab Treatment of Rhinogenic Contact Point Headache Complicated by Severe Cedar Pollinosis: A Case Report.

Headache is one of the most common neurological disorders in children. The most common headache in children is a primary headache, including migraine and tension-type headache, but note that secondary headaches should be differentiated as a cause of headache in pediatric patients. The management of cedar pollinosis in pediatric patients is important because it can cause quality-of-life deficits in addition to nasal and ocular symptoms. Omalizumab, an anti-immunoglobulin E (IgE) monoclonal antibody, is approved in Japan as an add-on treatment option for severe cedar pollinosis, but few studies have investigated its real-world clinical efficacy in pediatric patients with seasonal allergic rhinitis. We report the case of a 15-year-old male patient with cedar pollinosis who suffered from uncontrolled naso-ocular symptoms, facial pain, and headache despite using histamine H1-receptor antagonists and intranasal corticosteroid spray. A sinus computed tomography scan and nasal endoscopic findings showed a swollen inferior turbinate and nasal septum in contact with the nasal cavity ipsilateral to the headache. Application of local anesthesia to the contact points within the nasal cavity resulted in the rapid relief of headaches. Therefore, we diagnosed rhinogenic contact point headache triggered by cedar pollinosis and initiated the add-on therapy of omalizumab for seasonal allergic rhinitis. Three days after the administration of omalizumab, his naso-ocular symptoms, quality-of-life deficits, and headache improved markedly, accompanied by improved nasal endoscopic findings. Omalizumab was immediately effective for the treatment of rhinogenic contact point headaches complicated by severe cedar pollinosis in a pediatric patient.

Suprabasin enhances the invasion, migration, and angiogenic ability of oral squamous cell carcinoma cells under hypoxic conditions.

Suprabasin (SBSN) is a secreted protein that is isolated as a novel gene expressed in differentiated keratinocytes in mice and humans. It induces various cellular processes such as proliferation, invasion, metastasis, migration, angiogenesis, apoptosis, therapy and immune resistance. The role of SBSN was investigated in oral squamous cell carcinoma (OSCC) under hypoxic conditions using the SAS, HSC­3, and HSC­4 cell lines. Hypoxia induced SBSN mRNA and protein expression in OSCC cells and normal human epidermal keratinocytes (NHEKs), and this was most prominent in SAS cells. The function of SBSN in SAS cells was analyzed using 3­(4,5­dimethylthiazol­2­yl)­2,5­diphenyltetrazolium bromide (MTT); 5­bromo­2'­deoxyuridine (BrdU); cell cycle, caspase 3/7, invasion, migration, and tube formation assays; and gelatin zymography. Overexpression of SBSN decreased MTT activity, but the results of BrdU and cell cycle assays indicated upregulation of cell proliferation. Western blot analysis for cyclin­related proteins indicated involvement of cyclin pathways. However, SBSN did not strongly suppress apoptosis and autophagy, as revealed by caspase 3/7 assay and western blotting for p62 and LC3. Additionally, SBSN increased cell invasion more under hypoxia than under normoxia, and this resulted from increased cell migration, not from matrix metalloprotease activity or epithelial­mesenchymal transition. Furthermore, SBSN induced angiogenesis more strongly under hypoxia than under normoxia. Analysis using reverse transcription­quantitative PCR showed that vascular endothelial growth factor (VEGF) mRNA was not altered by the knockdown or overexpression of SBSN VEGF, suggesting that VEGF is not located downstream of SBSN. These results demonstrated the importance of SBSN in the maintenance of survival and proliferation, invasion and angiogenesis of OSCC cells under hypoxia.

A Case of Cervical Intraneural Lipoma That Was Removed by Intercapsular Resection with No Resultant Postoperative Neurological Deficit.

Intraneural lipomas in peripheral nerves of cervical lesions are extremely rare and have not been previously reported. We present a 48-year-old male with a gradually increasing right cervical mass since 5 years. He visited our department because of pain and difficulty in raising the right upper limb. A tumor about 80 mm in size was palpable in the right neck along the cervical nerve. The tumor was suspected to involve fatty degeneration in schwannoma of cervical nerve origin, for which intercapsular resection was performed under general anesthesia. Histopathologically, bifurcated growth of mature adipocytes with sparse fibrous septa and lack of tumor proliferation of Schwann cells was observed on H&E staining, suggesting a diagnosis of intraneural lipoma. The patient had no new motor or sensory deficits postoperatively and with improvement in his preoperative symptoms.

Case Report: A 29-Year-Old Pregnant Woman at 24 Weeks of Gestation Presenting with Laryngotracheitis and COVID-19 Due to the R.1 Variant of SARS-CoV-2.

BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was discovered in December 2019 in Wuhan, China. Coronavirus disease (COVID-19) mainly presents with lower respiratory tract symptoms. On the other hand, laryngotracheitis or croup shows barky cough and it is rare in adults. There were no reports of laryngotracheitis with COVID-19 in pregnant women. We report the case of a pregnant woman at 24 weeks of gestation presenting with acute laryngotracheitis and COVID-19 due to the R.1 variant of SARS-CoV-2. CASE REPORT A 29-year-old previously healthy woman at 24 weeks of gestation presented with hoarseness and sore throat without fever, of 1-day duration. Although she was treated by her primary care physician with nebulized epinephrine, her symptoms did not resolve. She came to our hospital the same day. On arrival at our department, she was tachypneic and had a 95% oxygen saturation. She had stridor and barking cough. Laryngeal endoscopy revealed edema under the vocal cords. She was hospitalized urgently. SARS-CoV-2 polymerase chain reaction (PCR) testing was positive and the E484K mutation was confirmed. She was treated with oral and inhaled corticosteroids. Two days after admission, her symptoms were improved. She was discharged 10 days after admission. Edema under the vocal cords was completely improved 24 days after discharge. There were no adverse effects on the pregnancy. CONCLUSIONS COVID-19 laryngotracheitis has a more severe disease course than other causes, especially in pregnancy. COVID-19 laryngotracheitis should be use corticosteroids to treatment. Prednisolone is recommended for laryngotracheitis with COVID-19 during pregnancy.

Delayed Epistaxis which Was Developed after Orthognathic Surgery with Le Fort I Osteotomy and Managed by Endoscopic Cauterization.

A case of delayed epistaxis from the mucosa behind the right side of the inferior nasal mucosa 11 days after orthognathic surgery by Le Fort I osteotomy is presented. The patient was a 31-year-old man who underwent orthognathic surgery under general anesthesia. No abnormal findings were found during or after the operation. The patient was discharged from the hospital 10 days postoperatively. However, bleeding from the right nasal cavity occurred suddenly on the night after discharge, and he presented to our hospital again. The epistaxis was stopped once by nasal packing containing 0.001% epinephrine and systemic infusion of carbazochrome sulfonic acid and tranexamic acid. However, when the nasal packing was removed the next day, right nasal epistaxis was observed again. Curvature of the nasal septum and thickening of the inferior turbinate mucosa were seen on inspection; although, no active bleeding point was identified. Decreased nasal mucosa thickening and bleeding were observed after nasal packing containing 0.02% epinephrine. When the inside of the nasal cavity was observed endoscopically, an approximately 2 mm laceration was found in the mucosa behind the side wall of the right inferior nasal mucosa, and bleeding from the same part was confirmed. After endoscopic cauterization for hemostasis of the nasal mucosa, no rebleeding was observed. Although delayed epistaxis after Le Fort I osteotomy are often performed CT angiography to confirm the bleeding site, endoscopic cauterization would be primarily useful because of less invasiveness.

Human induced pluripotent stem cell-derived salivary gland organoids model SARS-CoV-2 infection and replication.

Salivary glands act as virus reservoirs in various infectious diseases and have been reported to be targeted by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, the mechanisms underlying infection and replication in salivary glands are still enigmatic due to the lack of proper in vitro models. Here, we show that human induced salivary glands (hiSGs) generated from human induced pluripotent stem cells can be infected with SARS-CoV-2. The hiSGs exhibit properties similar to those of embryonic salivary glands and are a valuable tool for the functional analysis of genes during development. Orthotopically transplanted hiSGs can be engrafted at a recipient site in mice and show a mature phenotype. In addition, we confirm SARS-CoV-2 infection and replication in hiSGs. SARS-CoV-2 derived from saliva in asymptomatic individuals may participate in the spread of the virus. hiSGs may be a promising model for investigating the role of salivary glands as a virus reservoir.

[Efficacy of concurrent chemoradiotherapy with S-1 plus nedaplatin for hypopharyngeal cancer].

Many reports have been published on the treatment for hypopharyngeal cancer, and the treatment modalities and results have become uniform to some extent. More specifically, reconstruction by means of free jejunal grafts has become widespread, and the results of surgical treatments have stabilized. On the other hand concurrent chemoradiotherapy has been widely performed, and the results from the standpoint of organ and function preservation have revealed the various differences between institutions. In our department, we have been using concurrent chemoradiotherapy for advanced cancer with a view to organ and function preservation. In this article, we report 6 cases with hypopharyngeal cancer treated by concurrent chemoradiotherapy with S-1 plus nedaplatin(SN therapy)in our department between January 2005 and December 2008. The complete response rate after SN therapy was 83. 3%, and the laryngeal preservation rate was 100%.

[Effects of concurrent chemoradiation therapy in three cases of nasopharyngeal cancer].

Nasopharyngeal cancer has an abundance of lymphatic tissues, and is therefore frequently associated with cervical and distant metastases. Most cases with nasopharyngeal cancer have poorly-differentiated squamous cell carcinomas or undifferentiated carcinomas, for which radiotherapy alone or a combination of radiotherapy and chemotherapy has been reported to be effective. However, under the present circumstances, even if the primary focus is controlled, distant metastases appear early and worsen the treatment outcomes. In this report, we present the results of concurrent chemoradiation therapy(CCRT) administered to three cases of nasopharyngeal cancer at our department. In terms of treatment outcomes, two of the three patients who had undergone CCRT showed no relapse of the primary focus, but distant metastases appeared in early stages and worsened their survival outcomes. Currently in our department, S-1 and nedaplatin have been used as chemotherapy agents at rather high dosages. It may be difficult to control the distant metastases just by strengthening the impact of our regimen. A new treatment modality with novel drugs would be required in the future. Further studies on novel prophylactics and treatment methods for distant metastases are expected.

[Laryngeal cancer treatment outcomes in our department].

Laryngeal cancer is one of the most common types of head and neck cancer. Numerous studies have reported treatment outcomes, and therapeutic approaches and results are generally well established. However, the widespread use of concurrent chemoradiation therapy(CCRT)has led to differences among hospitals in laryngeal preservation rates in patients with T2 and T3 tumors. CCRT is the mainstay of treatment for laryngeal cancer in our department, given our goals of achieving organ and functional preservation, as well as radical cure. Our regimen for CCRT is comprised of chemotherapy with S-1 plus nedaplatin, concurrently with radiation therapy(SN therapy). We report outcomes obtained from 60 patients with laryngeal cancer who received first-line treatment in our department from April 2005 through March 2010. Cumulative survival rates according to disease stage were as follows: Stage I, 100%; Stage II, 96. 2%; Stage III, 83. 3%; and Stage IV, 48. 8%. The complete response rate after SN therapy was 84. 3%. After excluding patients with T4 tumors, the laryngeal preservation rate was 85. 7%.

[T2 laryngeal cancer study in our department].

Laryngeal cancer is the most common malignant tumor in the head and neck region.Because early detection and treatment are possible, outcomes are relatively good.Many studies have reported on the treatment of laryngeal cancer.Different hospitals have used generally similar treatment regimens.However, factors such as laryngeal preservation and the treatment of choice for patients with T2 laryngeal cancer still differ among hospitals.Survival rates can be increased depending on treatment, sometimes at the cost of losing voice functions that could have been preserved.In our department, we have emphasized curative treatment and the preservation of organs and functions.We have mainly used chemoradiotherapy concurrently with S-1 and nedaplatin for the treatment of T2 laryngeal cancer.We studied 27 patients(23 men and 4 women)with T2 laryngeal cancer, who received first-line therapy in our department from April 2005 through March 2010. Their mean age was 64.1 years(range, 42 to 80).The mean follow-up period was 30.6 months(range, 2 to 60 months).The tumor-nodemetastasis classification was T2N0M0 in 24 patients, T2N1M0 in 1, and T2N2bM0 in 2.In our department, the disease-specific survival rate was 96.3%. The complete response rate was 88.9%, and the laryngeal preservation rate was 92.6%.

[Efficacy of concurrent chemoradiotherapy in cases with cervical lymph node metastasis from oropharyngeal or hypopharyngeal cancer].

We reported the efficacy of concurrent chemoradiotherapy(CCRT)for cervical lymph node metastasis in patients with oropharyngeal or hypopharyngeal squamous cell carcinoma. The subjects were 17 patients with oropharyngeal or hypopharyngeal cancer with cervical lymph node metastasis, who underwent CCRT treatment between January 2005 and December 2009. The proportion of patients showing a complete response(CR)was 64. 7%; however, if patients without any residual viable cancer cells in the specimens obtained by neck dissection were also defined as CR, then, 82. 4% achieved CR. Thus, CCRT showed good efficacy without the need for planned neck dissection(PND). The limited recurrence cases and absence of serious complications associated with neck dissection after CCRT suggested that PND is not necessarily required. However, since assessment of cervical lymph nodes after CCRT is difficult, it would be desirable to develop a reliable examination and to study the most suitable examination for detecting the presence/absence of cervical lymph node metastasis.