Language：Japanese   Publisher：The Japan Broncho-esophagological Society  

DOI： 10.2468/jbes.75.106

CiNii Research

Language：English   Publisher：The Pharmaceutical Society of Japan  

<p>Hypomagnesemia is a characteristic adverse event of cetuximab in patients with head and neck cancer (HNC). However, there is limited information about its prevalence, risk factors, and preventive strategies. This study aimed to investigate the risk factors of hypomagnesemia and examine the preventive effects of prophylactic magnesium (Mg) administration. We initially investigated HNC patients treated with cetuximab between 2013 and 2019. Our institute started prophylactic Mg treatment (20-mEq Mg sulfate administration before cetuximab) in practice during this period. We retrospectively assess the preventive efficacy by comparing patients before and after its implementation. In total, 109 patients were included. In 60 patients without prophylaxis, all-grade and grade ≥2 hypomagnesemia at 3 months occurred in 61.7 and 15.0% of patients. The incidence of hypomagnesemia was not affected by regimens and concomitant medications. In 49 patients treated with prophylactic Mg treatment, there was no significant decrease in the cumulative incidence of hypomagnesemia. However, the preventive Mg treatment eliminated the need for additional Mg repletion to maintain Mg levels in patients treated with paclitaxel + cetuximab. A risk factor in patients without prophylaxis was a low Mg level at pre-treatment (≤2.0 mg/dL) (odds ratio: 6.03, 95% confidence interval: 1.78–20.4, <i>p</i> = 0.004), whereas that in patients with prophylaxis was the number of cetuximab doses (≥10) (odds ratio: 5.50, 95% confidence interval: 1.52–19.87, <i>p</i> = 0.009). In conclusion, a low pre-treatment Mg level was the only risk factor that could be avoided by prophylactic Mg administration. This preventive intervention is recommended for managing cetuximab-induced hypomagnesemia.</p>

DOI： 10.1248/bpb.b23-00714

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CiNii Research

Language：Japanese   Publisher：日本口腔・咽頭科学会  

口腔領域の転移性悪性腫瘍は,全口腔悪性腫瘍の約1%で,中でも膵癌の舌転移は極めて稀とされる.今回,膵癌舌転移の1例を経験したので報告する.症例は56歳男性,主訴は舌痛,舌腫瘤.X年膵癌cT3N1aM0,StageIIBの診断で膵全摘術を施行.X+2年縦隔リンパ節再発を来し,緩和化学療法を開始した.PDによるレジメン変更及び縦隔病変への放射線治療により,病勢はコントロールできていた.X+4年,舌に疼痛を伴う腫瘤性病変が出現した.各種検査で膵癌舌転移と診断した.舌腫瘍は増大傾向で疼痛悪化に伴う経口摂取困難が生じていたため,緩和治療として舌部分切除術を施行した.舌痛は改善,経口摂取も良好となった.今回の外科治療は,がん終末期のQOL改善に寄与できた.(著者抄録)

Language：English   Publisher：(公社)日本薬学会  

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Language：English  

DOI： 10.21873/cdp.10294

PubMed

Language：Japanese   Publisher：耳鼻と臨床会  

頭頸部領域には発生学的に病因の異なる嚢胞が生じることがあり、正中頸嚢胞、側頸嚢胞、リンパ管腫/奇形などの先天性嚢胞や、ガマ腫などの後天性嚢胞が挙げられる。これら嚢胞の治療法としては、手術摘出とOK-432(ピシバニール)に代表される硬化療法の2つに大別される。手術摘出や複数回の穿刺排液を繰り返すも難治性であった、咽頭に発生した嚢胞に対し、OK-432(ピシバニール)を投与し、効果を認めた2例を経験したので報告する。症例1は30代の女性で、舌根の嚢胞を2回切除するも数ヵ月で再増大した症例である。症例2は60代の女性で、30年以上にわたり舌根の嚢胞に手術処置を繰り返した症例である。2例ともOK-432(ピシバニール)投与で、縮小した状態が維持できるようになった。頭頸部領域に発生する嚢胞の中には、まれではあるが複数回再発し難治性のものもあり、この場合治療に難渋することとなる。外科的治療法で対応が困難な症例において、OK-432(ピシバニール)による硬化療法は、外来で対応可能な、かつ効果的な治療選択肢の一つとなり得ると思われた。(著者抄録)

Language：Japanese   Publisher：Japan Society of Stomato-pharyngology  

Metastasis to the oral cavity accounts for about 1％ of all oral malignancies. Among them, tongue metastasis of pancreatic cancer is considered to be extremely rare. We report a case of tongue metastasis of pancreatic cancer. The patient was a 56-year-old man with a chief complaint of tongue pain and a mass on the tongue. In year X, he underwent pancreatectomy for pancreatic cancer cT3N1aM0, Stage ⅡB. In year X＋2, mediastinal lymph node recurrence occurred, and palliative chemotherapy was started. The patient underwent a regimen change due to PD and radiotherapy to the mediastinal lesion, and the disease was stable thereafter. In year X＋4, a painful mass lesion appeared on the tongue. After several appropriate tests, he was diagnosed with tongue metastasis of pancreatic cancer. The tongue tumor tended to grow and worsening pain made oral intake difficult, so a partial tongue resection was performed as palliative treatment. As a result, the patient’s tumor-induced tongue pain and oral intake improved. This surgical treatment contributed to the improvement of QOL in the terminal stage of cancer.

DOI： 10.14821/stomatopharyngology.37-048

CiNii Research

Language：Japanese   Publisher：耳鼻と臨床会  

症例は91歳女性で、右硬口蓋から歯肉にかけての腫瘤を主訴とした。CTで上顎骨破壊を伴う6cm大の腫瘤を認めたが、精査にて遠隔転移は認めなかった。腫瘍は1週間で急速に増大したため臨床的に悪性腫瘍と判断し、右上顎部分切除術と右頸部郭清術を施行し、病理所見で血管肉腫と診断した。術後20日目に切除創の一部に腫瘤病変が出現して1週間で急速に増大し、Combined Positive Scoreは100であったため、術後39日目よりPembrolizumab投与を開始した。最初は3週ごとに200mg/回を、その後は6週ごとに400mg/回を投与した。その結果、手術から6ヵ月経過して腫瘍はほぼ消失した状態を維持し、6週間ごとの投与を継続中である。有害事象は出現せず経過している。

Language：English   Publisher：BMC Cancer  

Background: Rhabdomyosarcoma is the most common soft tissue sarcoma in children, but rare in adults. Para-meningeal rhabdomyosarcoma in head and neck (PM-HNRMS) is less applicable for surgery due to the anatomic reason. PM-HNRMS has a poor prognosis in children. However, its clinical outcomes remain unclear in adults due to the rarity. Further, there is almost no detailed data about salvage therapy. Methods: We retrospectively examined the adult patients with PM-HNRMS treated at institutions belonging to the Kyushu Medical Oncology Group from 2009 to 2022. We evaluated the overall survival (OS) and progression-free survival (PFS) of the patients who received a first-line therapy. We also reviewed the clinical outcomes of patients who progressed against a first-line therapy and received salvage therapy. Results: Total 11 patients of PM-HNRMS received a first-line therapy. The characteristics were as follows: median age: 38 years (range 25 – 63 years), histology (alveolar/spindle): 10/1, and risk group (intermediate/high): 7/4. As a first-line therapy, VAC and ARST0431-based regimen was performed in 10 and 1 patients, respectively. During a first-line therapy, definitive radiation for all lesions were performed in seven patients. The median PFS was 14.2 months (95%CI: 6.0 – 25.8 months): 17.1 months (95%CI: 6.0 – not reached (NR)) for patients with stage I-III and 8.5 months (95%CI: 5.2 – 25.8 months) for patients with stage IV. The 1-year and 3-year PFS rates were 54.5% and 11.3% for all patients. Median OS in all patients was 40.8 months (95%CI: 12.1 months–NR): 40.8 months (95%CI: 12.1 – NR) for patients with stage I-III and NR for patients with stage IV. The 5-year OS rate was 48.5% for all patients. Among seven patients who received salvage therapy, three are still alive, two of whom remain disease-free for over 4 years after completion of the last therapy. Those two patients received multi-modal therapy including local therapy for all detected lesions. Conclusion: The cure rate of adult PM-HNRMS is low in spite of a first-line therapy in this study. Salvage therapy might prolong the survival in patients who received the multi-modal therapy including local therapy for all detected lesions.

DOI： 10.1186/s12885-023-11528-4

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Language：Japanese   Publishing type：Research paper (scientific journal)  

Language：English   Publisher：International Journal of Surgery Case Reports  

Introduction: Cholesterol granulomas, which frequently present in the temporal bone of the skull, are recognized as benign lesions occurring due to chronic inflammation or hemorrhage. However, cholesterol granuloma of the mediastinum is extremely rare. Presentation of case: An asymptomatic 43-year-old man with an incidental finding of anterior mediastinal mass by positron emission tomography scan was referred to our hospital. Preoperative computed tomography showed a well-circumscribed nodule 2 cm in size in the anterior mediastinum. A total tumor resection through a suprasternal approach was performed. Microscopically, numerous cholesterol clefts with an alveolar-like growth pattern and foreign body reaction were observed, indicating a pathological diagnosis of cholesterol granuloma. Discussion: Cholesterol granuloma is generally thought to be initiated by cell degeneration and hemorrhage resulting from trauma or inflammation. The patient's long-term rugby experience may have played a role in the development of cholesterol granuloma. It is difficult to diagnose a cholesterol granuloma based on preoperative imaging alone, and anatomy often makes preoperative biopsy or cytology difficult. Conclusion: Complete resection and pathological examination may be unavoidable for diagnosis and treatment.

DOI： 10.1016/j.ijscr.2023.108852

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Language：English   Publishing type：Research paper (scientific journal)  

Language：English   Publishing type：Research paper (scientific journal)  

Language：English   Publisher：In Vivo  

Background/Aim: In recent years, individual patient cancer genomic profiling (CGP) has become more accessible, allowing determination of therapeutic strategies using driver gene mutations in cancer therapy. However, this precision oncology approach, tailored to specific patients, remains experimental. In this study, we verified the feasibility and benefit of using CGP to guide treatment of malignant head and neck tumors. We aimed to evaluate the profiling and clinical courses of patients with head and neck malignancies who underwent CGP and determine the extent to which CGP for head and neck malignancies has resulted in beneficial drug administration. Patients and Methods: We analyzed CGP results, prognosis, and drug administration status in 27 patients. These patients had completed (or were expected to complete) standard therapy or had rare cancers without standard therapy. Results: At least one somatic actionable gene alteration was seen in 25 (92.6%) patients, with a median number of actionable alterations per patient of 4 (range=0-11). Drugs in clinical trials were recommended to 22 (81.5%) patients, but none could participate. However, 3 patients (11.1%) could use approved drugs off-label based on CGP results. The most common genetic abnormality was TP53 (66.7%), with TP53 mutations leading to poor prognosis. Conclusion: CGP is clinically useful and serves as a bridge to increase the number of therapeutic options. However, candidate drugs confirmed using CGP may be ineffective when administered. Therefore, oncologists should not blindly accept CGP therapeutic recommendations but should make recommendations that lead to optimal therapies after proper verification.

DOI： 10.21873/invivo.13312

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Language：English   Publisher：In Vivo  

Background/Aim: Pembrolizumab monotherapy and pembrolizumab with chemotherapy (combination therapy) are standard treatments for recurrent and metastatic head and neck squamous cell carcinoma (R/M-HNSCC). This study aimed to explore which of the two, pembrolizumab monotherapy or combination therapy is superior for long-term use. Patients and Methods: Participants of the study were 139 patients with histologically confirmed squamous cell carcinoma who had been treated with pembrolizumab monotherapy or combination therapy at the Kyushu University and related facilities. We analysed differences regarding long-term survival rate and adverse events (AEs) between the pembrolizumab monotherapy and combination therapy groups. Results: The overall 2-year progression-free survival and 2-year overall survival were 28.6% and 41.8%, respectively; these results were not significantly different between the two groups. Patients in the monotherapy group with AEs had a significantly better prognosis than those without AEs (in both the monotherapy and combination

DOI： 10.21873/invivo.13318

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Language：English   Publisher：American Journal of Surgical Pathology  

The prevalence and prognostic significance of high-risk human papillomavirus (HR-HPV) have been well-established in oropharyngeal squamous cell carcinoma (OPSCC), but not in hypopharyngeal squamous cell carcinoma (HPSCC) or laryngeal squamous cell carcinoma (LSCC). Moreover, HR-HPV infection in squamous cell carcinoma with multisite involvement has not been examined. To clarify these issues, we retrospectively collected 480 invasive tumors from 467 patients with HPSCC, LSCC, or OPSCC, and comprehensively analyzed the detailed tumor localization, transcriptionally active HR-HPV infection by messenger RNA in situ hybridization, and immunohistochemical staining for p16 and Rb. HR-HPV infection was observed in 115/480 tumors (24%). Human papillomavirus (HPV)-positive cases were closely related with p16 positivity and the partial loss pattern of Rb. HR-HPV was detected in 104 of 161 tumors (64.6%) in the pure OPSCC group and only 1 of 253 tumors (0.4%) in the pure HP/LSCC group; the positive case occurred in the vocal cords. In the multisite-involving combined-type squamous cell carcinoma group, HPV infection was observed in 10/40 (25%) cases, and the 10 HPV-positive cases had OPSCC extending to the larynx or hypopharynx. Among high T-stage (T3/T4) cases of pure OPSCC, HPV-positive cases showed a better prognosis (P=0.0144), whereas the HPV-positive combined OPSCC group did not show a better prognosis (P=0.9428), as compared with HPV-negative counterpart. The results suggest that HR-HPV infection in pure HPSCC and LSCC may be extremely rare. HR-HPV infection seems to be present in a substantial proportion of patients with combined OPSCC and HPSCC/LSCC, but it may not improve prognosis at such advanced disease stages. Confirmation of these points awaits future studies with larger cohorts.

DOI： 10.1097/PAS.0000000000002086

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Language：English   Publisher：Ear, Nose and Throat Journal  

Objective: Early detection of hypopharyngeal squamous cell carcinoma (SCC) is important for both an improved prognosis and less-invasive treatment. We retrospectively analyzed the detection rates of early hypopharyngeal SCCs according to the evaluation methods and the clinical management of early hypopharyngeal SCCs. Methods: Sixty-eight patients with early hypopharyngeal SCC who were diagnosed were reviewed. Results: The number of early hypopharyngeal cancer patients with asymptomatic or synchronous or metachronous esophageal cancer examined by upper gastrointestinal endoscopy with narrow-band imaging (NBI) was significantly higher than those examined by laryngopharyngeal endoscopy with NBI. The 3-year disease-specific survival rates according to T classification were as follows: Tis, 100%; T1, 100%; T2, 79.8%; and overall, 91.2%, respectively. Conclusions: Early-stage hypopharyngeal SCC can be cured by minimally invasive transoral surgery or radiotherapy. Observation of the pharynx using NBI in patients with a history of head and neck cancer, esophageal cancer, gastric cancer, or pharyngeal discomfort is very important, and routinely examining the pharynx with NBI, even in patients undergoing endoscopy for screening purposes, is recommended.

DOI： 10.1177/01455613211013084

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Language：Japanese   Publisher：(NPO)日本頭頸部外科学会  

炎症性筋線維芽細胞性腫瘍(Inflammatory myofibroblastic tumor:IMT)は,炎症細胞浸潤と紡錘形細胞の増生を特徴とする稀な中間悪性腫瘍である。3例の喉頭IMTを報告する。1例目は60歳男性で,声帯腫瘍に対し直達喉頭鏡下腫瘍摘出術を施行。2例目は53歳男性で,同様に摘出術を施行した。3例目は40歳男性で,声門下腫瘤の生検のみ施行した。全例FISH法にてALK融合遺伝子を確認しIMTと診断した。治療は外科的切除が第一選択だが,緩徐な増大であることが多く,経過観察に留めることもある。しかし喉頭IMTは,急速増大し窒息に至ることもあり,適切な治療時期の選択が重要である。(著者抄録)

Language：English   Publisher：In Vivo  

Background/Aim: Lacrimal sac tumors are rare tumor types, with a long time interval from disease onset to diagnosis. We aimed to investigate the characteristics and outcomes of patients with lacrimal sac tumors. Patients and Methods: The medical records of 25 patients with lacrimal sac tumors initially treated at the Kyushu university hospital from January 1996 to July 2020 were reviewed. Results: Our analysis included 3 epithelial benign tumors (12.0%) and 22 malignant (88.0%) tumors (squamous cell carcinoma, n=6; adenoid cystic carcinoma, n=2; sebaceous adenocarcinoma, n=2; mucoepidermoid carcinoma, n=1; malignant lymphoma, n=10). The average time from symptom onset to diagnosis was 14.7 months (median=8 months; range=1-96 months). The analysis of patients revealed that lacrimal sac mass (22/25, 88.0%) was the most frequent symptom and a possible tumor marker. Most epithelial benign (n=3) and malignant epithelial (n=12) tumors were treated surgically (14/15, 93.3%). One malignant case was treated with heavy ion beam therapy. Eight patients were treated with postoperative (chemo)radiation therapy because of positive surgical margins (including one unanalyzed case). Local control was ultimately achieved in all but one case. The patient survived for 24 months with immune checkpoint inhibitors and subsequent chemotherapy for local and metastatic recurrence. Conclusion: We report our experience in the diagnosis and treatment of lacrimal sac tumors and analyze the clinical trends in cases involving these tumors. Postoperative radiotherapy and pharmacotherapy, including immune checkpoint inhibitors, may be useful for recurrent cases.

DOI： 10.21873/invivo.13198

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Language：Japanese   Publisher：JIBI TO RINSHO KAI  

<p>In 2018, the new TNM classification (AJCC 8th edition) was introduced. We investigated the prognosis of nasopharyngeal cancer in 45 nasopharyngeal cancer patients who underwent first-line therapy at the Department of Otolaryngology, Head and Neck Surgery, Kyushu University between January 2010 and January 2020. There were 31 male and 14 female patients, ranging in age from 12 to 88 years old, with a median age of 59 years old. Of these, 40 patients with nasopharyngeal squamous cell carcinoma were evaluated for their five-year overall survival (OS) and progression-free survival (PFS) as well as prognostic factors. The 5-year OS rate was 75.5%, and the 5-year PFS rate was 64.3%. As prognostic factors, there were no significant differences in outcome by stage, histological type, and Epstein-Barr virus positivity. In addition, it was considered necessary to further investigate the optimal dose of cisplatin for chemoradiotherapy combined with cisplatin, which is the main treatment for nasopharyngeal cancer.</p>

DOI： 10.11334/jibi.69.2_75

CiNii Research

Language：Japanese   Publisher：耳鼻と臨床会  

上咽頭癌は、ほかの頭頸部癌とは異なる側面を持つことから、予後因子も通常の頭頸部扁平上皮癌とは異なる。2018年にTNM分類が改訂され、上咽頭癌も変更されたため、今回われわれは、新TNM分類を用いて、当科で加療を行った上咽頭癌症例について予後の検討を行った。対象は、2010年1月から2020年1月に九州大学病院耳鼻咽喉・頭頸部外科で一次療法を施行した上咽頭癌45例である。男性31例、女性14例、年齢は12-88歳、中央値59歳であった。これらのうち、上咽頭扁平上皮癌であった40例における5年全生存率(以下OS)、無増悪生存率(PFS)、予後関連因子などについて後方視的に解析を行った。その結果、5年OSは75.5%、5年PFSは64.3%であった。予後関連因子として、Stage別や組織型、Epstein-Barr Virus陽性か否かによる有意差は認められなかった。また、上咽頭癌治療の軸となるシスプラチン併用化学放射線療法については、シスプラチンの至適投与量についてさらなる検討が必要と考えられた。(著者抄録)

Language：English   Publisher：In Vivo  

Background/Aim: The advent of immune checkpoint inhibitor (ICI) treatment has transformed the treatment of recurrent or metastatic head and neck cancer; however, nasopharyngeal carcinoma (NPC) has not been included in major phase III trials. The clinical outcomes of ICI for NPC in real-world practice remain to be fully elucidated. Patients and Methods: We retrospectively reviewed 23 patients with recurrent or metastatic NPC treated with nivolumab or pembrolizumab at 6 institutions from April 2017 to July 2021 and investigated the correlation of clinicopathological factors and immune-related adverse events with the effects of ICI therapy and the prognosis. Results: The objective response rate was 39.1% and the disease control rate was 78.3%. The median progression-free survival was 16.8 months and overall survival has not been reached. As with other treatment procedures, the efficacy and the prognosis tended to be better in EBER-positive cases than in EBER-negative cases. The rate of significant immune-related adverse events that necessitated discontinuation of treatment was only 4.3%. Conclusion: ICI monotherapy (e.g., nivolumab and pembrolizumab) was effective and tolerable for NPC in a real-world setting.

DOI： 10.21873/invivo.13137

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Language：English   Publisher：Anticancer Research  

Background/Aim: Differentiated thyroid cancer (DTC) has a good prognosis, except in the case of patients with radioiodine therapy (RIT)-refractory cancer. However, since DTC is essentially a slowly progressing cancer, it is usually judged to be a DTC with a poor prognosis after multiple RITs and yearly follow-up with echo, computed tomography (CT), and serum thyroglobulin values. This study investigated whether fluorodeoxyglucose-positron emission tomography/CT (FDG PET/CT) combined with initial RIT could identify early-stage patients with poor prognosis. Patients and Methods: We evaluated 100 patients with high-risk DTC who underwent total thyroidectomy and received RIT at our institution. We analyzed the clinical outcomes of patients and 18F-FDG accumulation using univariate and multivariate Cox proportional hazards regression models. Results: The 10-year overall survival (OS) was 87.9%, with no significant difference in OS between 18F-FDG accumulation at pre-total or near-total thyroidectomy (NTT) (p=0.180) and 131I accumulation at initial RIT (p=0.577). However, 18F-FDG positive patients had a significantly worse prognosis than negative patients (p=0.005) at initial RIT. Conclusion: 18F-FDG PET/CT plays an important role in both the diagnosis and prognostic prediction of RIT refractory disease in DTC patients. 18F-FDG PET/CT can be a useful tool particularly at the time of initial RIT since the 18F-FDG accumulation enables the screening of high-risk DTC with poor prognosis at a very early time stage.

DOI： 10.21873/anticanres.16148

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Language：Japanese   Publisher：特定非営利活動法人 日本頭頸部外科学会  

経頸部切開による甲状腺手術の中でも，良性もしくは被膜外浸潤のない甲状腺癌への甲状腺峡葉切除術は，甲状腺手術の基本である。甲状腺を手術する時のポイントとして，1）反回神経麻痺が発生しにくい Berry靭帯周囲の操作方法，2）上喉頭神経外枝麻痺を低減できる上極の処理方法，3） エナジーデバイスの使用による術後血腫対策が挙げられる。また，甲状腺組織の全摘出が必要な際に，副甲状腺機能を温存できる甲状腺準全摘術は有用な選択肢となる。以上のような合併症への対策をまじえ，経頸部切開法による甲状腺手術手技について述べる。

DOI： 10.5106/jjshns.33.121

CiNii Research

Language：Japanese   Publisher：JAPAN SOCIETY FOR HEAD AND NECK SURGERY  

Inflammatory myofibroblastic tumor （IMT） is a rare intermediate malignant tumor characterized by inflammatory cell infiltration and proliferation of myofibroblastic and fibroblastic spindle cells. In the present study, we experienced three cases of laryngeal IMT. The first case was a 60-year-old man. He underwent laryngomicrosurgery for a right vocal cord tumor, 7mm in size. One year after the surgery, no evidence of recurrence was seen. The second case was a 53-year-old man with a left vocal cord polyp-like lesion 15mm in diameter with a tendency to enlarge. He underwent laryngomicrosurgery. One year after the surgery, no evidence of recurrence was seen. The third case was a 40-year-old man with IMT diagnosed by a biopsy of a subglottic mass. The case was placed on observation and has remained unaffected for four years. Anaplastic lymphoma kinase （ALK） gene rearrangement was confirmed by fluorescence in situ hybridization in all cases. Preoperative diagnosis of IMT is usually difficult because of the lack of characteristic findings. Surgical resection is the first-line treatment. Although it can cause asphyxia, the increase is generally slow and the choice of timing of treatment needs to be tailored to the pathology. IMT usually has a benign course, but cases with local recurrence or distant metastasis have been reported. In laryngeal IMT, local recurrence was reported in about 20％ of cases, and no metastasis was reported. Surgical treatment should be considered in the presence of a hard, enlarging laryngeal mass, with the possibility of IMT.

DOI： 10.5106/jjshns.33.59

CiNii Research

Language：Japanese   Publishing type：Research paper (scientific journal)  

Language：English   Publishing type：Research paper (scientific journal)  

Language：English   Publishing type：Research paper (scientific journal)  

Language：English   Publisher：Journal of Medical Case Reports  

Background: Molecular-targeted agents used as a treatment for cancer can cause some rare and serious adverse events such as, delayed wound healing. Depending on the anticancer drug used, temporary withdrawal may be recommended before and after surgery to avoid complications. Once a surgical incision has healed and closed completely, wounds rarely open because of the initiation of molecular targeted therapy several months to years after surgery. Here, we aimed to describe a rare complication of pharyngocutaneous fistula in two patients that was thought to be caused by molecular targeted therapy. Case presentation: Case 1 involved a 64-year-old asian man who developed a delayed pharyngocutaneous fistula 3 months after total laryngectomy for laryngeal cancer. Ramucirumab, a vascular endothelial growth factor receptor inhibitor used for recurrent gastric cancer, was speculated to be involved. Case 2 involved a 71-year-old japanese man who developed a delayed pharyngocutaneous fistula 2 years and 1 month after total pharyngeal laryngectomy for pharyngeal cancer. It was speculated that imatinib, a platelet-derived growth factor receptor alpha inhibitor used for chronic myeloid leukemia, was involved. Conclusions: Although the incidence of late drug-induced anastomotic leakage is very low, when it occurs, it makes oral intake impossible for an extended period and interferes with the appropriate cancer treatment. In this report, we demonstrate the details of these two patients with such a rare complication, which may help accumulate essential data on this topic.

DOI： 10.1186/s13256-022-03621-2

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PubMed

Language：Japanese   Publisher：JIBI TO RINSHO KAI  

<p>An impalement wound is a form of traumatic injury in which a blunt-tipped, stick-like object pierces the body. Oral and pharyngeal trauma often occurs when a person falls with an instrument in their mouth, and the most common causative instrument is a toothbrush. In this study, we experienced a case of toothbrush impalement injury that penetrated the parapharyngeal space. The patient was a 67-year-old woman who fell while holding a toothbrush in her mouth. The toothbrush penetrated the parapharyngeal space from the left wall of the middle pharynx and reached the left posterior cervical muscles. The internal carotid artery was significantly narrowed by the toothbrush. The toothbrush was removed from the head side of the toothbrush through an external neck incision. There was no bleeding during removal and the wound healed without subsequent infection. When treating patients with pharyngeal impalement wounds, inadvertent removal may result in massive bleeding due to vascular injury or nerve damage. Thus, it is necessary to select an appropriate removal method after observing the anatomical structures by contrast-enhanced CT or angiography. In addition, impalement wounds can cause serious complications, including abscess and other infections, and traumatic internal carotid artery occlusion a few days after injury. It is therefore important to provide appropriate antimicrobial treatment and follow-up of neurological findings.</p>

DOI： 10.11334/jibi.68.5_346

CiNii Research

Language：Japanese   Publisher：耳鼻と臨床会  

杙創は,先端の鈍な棒状の物体が身体に突き刺さる外傷形態の一つである。口腔・咽頭外傷は、器具を口腔内に挿入したまま,転倒した際に発症することが多く、原因器具は、歯ブラシが最多とされる。今回、われわれは、副咽頭間隙を貫通した歯ブラシ杙傷の1例を経験した。症例は67歳の女性で、歯ブラシをくわえたまま転倒した。歯ブラシは中咽頭左側壁から副咽頭間隙を貫通し、左後頸部の筋間に刺入していた。また異物によって内頸動脈は著しく狭窄していた。頸部外切開によって歯ブラシのヘッド側から異物を摘出したが、抜去による出血はなく、その後の感染症の併発もなく治癒した。咽頭杙創の場合、不用意な抜去は血管損傷による大出血や神経障害の可能性があるため、造影CTや血管造影等で正常構造物との関係を把握した上で、適切な抜去法を選択する必要がある。また杙創は受傷後数日経過してから、膿瘍等の感染症や外傷性内頸動脈閉塞症などの重篤な合併症を来すこともあり、適切な抗菌薬治療や神経学的所見の経過観察などを怠らないことが重要であると考えられた。(著者抄録)

Language：English   Publisher：PLoS ONE  

Objectives The benefit of sequential therapy after immune checkpoint inhibitor (ICI) treatment for recurrent or metastatic head and neck squamous cell carcinoma (R/M HNSCC) has been recently reported. Furthermore, there is a growing interest in the impact of cetuximab (Cmab)-containing salvage chemotherapy (SCT) and the therapeutic efficacy and adverse events (AEs) of Cmab administration prior to ICI administration. Materials and methods We retrospectively reviewed the medical records of 52 patients with R/M HNSCC treated with SCT (weekly paclitaxel [PTX], n = 7, or weekly PTX and Cmab [PC], n = 45). Results The objective response rate (ORR) and a disease control rate (DCR) was 53.3% and 91.1% in the PC group and 42.9% and 57.1% in the PTX group, respectively. There was a significant difference in the DCR between the PC and PTX groups (p = 0.0143). The overall survival (OS) and progression-free survival were significantly better in the PC group than in the PTX group. On the other hand, the incidence of drug-induced interstitial pneumonia (DI-IP) in R/M HNSCC patients who received SCT was 21.2%. Patients in the PC group were divided according to whether they received Cmab (Group A) or did not receive Cmab (Group B) as palliative therapy prior to ICIs. Group B had a significantly better OS than Group A. Furthermore, our findings suggest that the incidence rate of DI-IP during SCT might be higher in Group B. Conclusion Although PC following ICIs shows dramatic efficacy, careful monitoring of AEs, including DIIP, is recommended.

DOI： 10.1371/journal.pone.0271907

Web of Science

Scopus

PubMed

Language：English   Publisher：European Archives of Oto-Rhino-Laryngology  

Purpose: We herein report the treatment outcome of oropharyngeal squamous cell carcinoma (OPSCC) at Kyushu University Hospital, the total number of OPSCC cases, and changes in the proportion of human papilloma virus (HPV)-related carcinomas over time. Method: We performed a retrospective analysis of 237 cases treated for OPSCC at Kyushu University Hospital between 2013 and 2019. We performed HPV-mRNA in situ hybridization and p16 immunohistochemistry. Result: This study included 197 males (82.1%) and 40 females (17.9%). The disease-specific, progression-free and overall survival (OS) were 69%, 62% and 61%, respectively, over the decade-long study period. p16-Immunohistochemistory and highrisk HPV mRNA in situ hybridization were positive in 114 (48.1%) and 105 (44.3%) cases, respectively. The number of HPV-related OPSCC cases increased according to an annual analysis. HPV+ cases had a significantly better prognosis than HPV− cases. In addition, p16+/HPV− cases had a significantly worse prognosis than p16+/HPV+ cases (OS: p = 0.0484). HPV+ OPSCC cases were associated with a younger age (< 60 years old) (p = 0.0429), non-smoker (p = 0.0001), lateral tumor site (< 0.00001), lymphoid metastasis (< 0.0001) and low clinical stage (< 0.0001). Conclusion: The frequency of HPV-related OPSCC cases is increasing in Japan as well as worldwide, and such cases are characterized by no smoking habit, a young age, and a good prognosis. Even in p16+ OPSCC, HPV− cases had a poor prognosis, suggesting the importance of accurate HPV determination. To determine the intensity of treatment for HPV-related and non-related OPSCC, it is necessary to accumulate cases for the accurate HPV determination and comparison of treatment effects.

DOI： 10.1007/s00405-021-07236-z

Web of Science

Scopus

PubMed

Language：English   Publisher：Anticancer Research  

Background/Aim: This study investigated the effectiveness of pembrolizumab with or without chemotherapy on advanced-stage head and neck cancer (HNC), including nasopharyngeal, sinonasal cavity and external auditory canal cancer, in a real-world setting. Patients and Methods: We retrospectively collected data from 97 HNC patients who were treated with pembrolizumab alone (n=60) or with chemotherapy (n=37), and we investigated the association between clinicopathological findings and treatment response or prognosis. Results: Patients treated with pembrolizumab and chemotherapy had a 1-year overall survival (OS) of 72.8%, objective response rate (ORR) of 48.6%, and serious (≥G3) adverse events (AEs) of 29.7%. Patients treated with pembrolizumab alone had a 1-year OS of 51.9%, ORR of 21.7%, and ≥G3 AEs of 6.7%. Both the ORR and disease control rate (DCR) in the pembrolizumab with chemotherapy group were significantly better than those in the pembrolizumab group (p=0.074 and p=0.00101, respectively). Among patients with distant metastasis, patients on pembrolizumab with chemotherapy achieved significantly better OS than pembrolizumab alone (p=0.0039). Among patients in the pembrolizumab group, both AE-positive and better performance status were associated with longer OS (p=0.011 and p=0.0037, respectively). Conclusion: Our real-world experience reinforces the durability and effectiveness of pembrolizumab for HNC patients. Additionally, our results suggest that pembrolizumab with chemotherapy might be recommended for patients with distant metastasis and no prior treatment. Further studies are needed to determine the optimal treatment strategy for HNC.

DOI： 10.21873/anticanres.15854

Web of Science

Scopus

PubMed

Language：English   Publisher：In Vivo  

Background/Aim: A long-term effect has been confirmed in clinical practice since the introduction of nivolumab for treating various malignant tumors. A similar phenomenon is speculated to occur in head and neck cancer; however, details remain unclear due to the lack of long-term reports. We aimed to investigate the five-year outcomes in long-term responders for over two years, and evaluate the optimal duration of therapy with nivolumab. Patients and Methods: In this retrospective observational study, we analyzed 203 cases of recurrent/metastatic head and neck squamous cell carcinoma (R/MHNSCC), including 33 long-term responders. Results: The median overall survival (OS), 5-year OS, median progression-free survival (PFS), and 5-year PFS values in the 203 cases were 13.1 months, 19.2%, 3.1 months, and 13.2%, respectively. Of the 33 long-term responders, 14 (42.4%) continued using nivolumab for more than 2 years. The remaining 19 patients (57.6%) discontinued nivolumab. The most common reason for discontinuation was severe immune-related adverse events (irAEs) (9 cases; 27.3%); in these 9 cases, the median disease-free survival was 33.2 (range=10.7-44.3) months. Nine patients (21.2%) were considered to have progressive disease (PD) after at least 2 years of administration, and 3 patients (9.1%) requested to discontinue treatment because a complete response (CR) was achieved. Conclusion: This study demonstrated the durable and long-term benefit of nivolumab in R/MHNSCC. In the future, we aim to accumulate real-world data for the establishment of criteria for completion of nivolumab treatment in long-term responders.

DOI： 10.21873/invivo.12907

Web of Science

Scopus

PubMed

Language：Japanese   Publisher：耳鼻と臨床会  

DOI： 10.11334/jibi.68.2_136

CiNii Research

Publisher：東京医学社  

DOI： 10.24479/ohns.0000000069

CiNii Research

Language：Japanese   Publishing type：Research paper (scientific journal)  

Language：Japanese   Publisher：耳鼻と臨床会  

症例は62歳男性で、約10日前に出現した舌のしびれと舌根部腫瘤を主訴に、当科を紹介受診となった。舌根部の生検によって得られた病理診断はp16陰性の扁平上皮癌であったことから、中咽頭癌と診断し、加療を予定して治療前採血を施行した。この結果、梅毒とHIVへの重複感染が判明した。その後、性生活を聴取したところ、20代よりsex activityが高く、風俗店などで女性と性交渉を行うことが多かったことが判明、28歳の時に淋病、62歳で性器ヘルペスの既往があった。アモキシシリンの内服を開始したところ、投与開始直後より全身の皮疹の改善に加え舌根部腫瘤も縮小した。再生検による病理診断は炎症性変化のみで癌は否定されたため、初回生検の標本を見直した。その結果、高度炎症による異型上皮であり、癌ではなかったと診断が変更された。現在、アモキシシリンによる梅毒治療は続行しつつ、HIV治療としてHARRT療法も開始されている。

Language：English   Publisher：In Vivo  

Background/Aim: Surgery remains the standard treatment for salivary gland carcinoma (SGC). Our study investigated the association between epidermal growth factor receptor (EGFR) status in recurrent/metastatic SGC and the effectiveness of treatment with cisplatin/carboplatin and 5-fluorouracil plus cetuximab (EXTREME). Patients and Methods: We retrospectively collected 19 SGCs from patients treated with the EXTREME regimen. After analyzing EGFR expression and gene copy number gain, we evaluated the correlation between EGFR status and clinicopathological factors and prognosis. Results: EGFR overexpression was detected in 77.8% cases, but not statistically associated with clinicopathological factors or prognosis. EGFR gene copy number gain was detected in 16.7% cases, and statistically positively correlated with lymph node metastasis (p=0.0291). The best overall response was partial response in two cases, stable disease in 15, and progressive disease in one case. The EXTREME regimen was discontinued in all cases. Conclusion: Our results suggest that SGCs are positive for EGFR protein expression but the response rate to the EXTREME regimen was unremarkable.

DOI： 10.21873/invivo.12790

Web of Science

Scopus

PubMed

Language：English   Publisher：In Vivo  

Background/Aim: The inflammation-based prognostic score (IBPS) has attracted attention recently as a prognostic biomarker for head and neck cancer patients. However, as the IBPS often changes after anticancer drug therapy, its independent prognostic value remains controversial. We aimed to investigate the relationship between the IBPS and prognosis in recurrent and/or metastatic head and neck squamous cell carcinoma (RMHNSCC) treated with nivolumab, and investigate changes in the IBPS before and after nivolumab treatment. Patients and Methods: Total of 164 patients with RMHNSCC received nivolumab therapy were retrospectively analyzed. Results: Univariate analysis among the 164 patients revealed that the performance status (PS), immune-related adverse event (irAE) status, pre- and post-therapy Glasgow Prognostic Score (GPS), neutrophil-to-lymphocyte ratio (NLR), C-reactive protein-to-albumin ratio (CAR), platelet-to-lymphocyte ratio (PLR), and post-eosinophil count, were all significant predictors of overall survival (OS) (p<0.05). A multivariate analysis revealed that PS, irAEs, post-GPS, post-NLR, post-CAR, and post-eosinophil count were independent prognostic factors for overall survival. Conclusion: Post-treatment factors were identified as independent prognostic factors for RMHNSCC and can more accurately predict prognosis compared to nivolumab-treated RMHNSCC pre-treatment factors.

DOI： 10.21873/invivo.12780

Web of Science

Scopus

PubMed

Language：English   Publisher：Anticancer Research  

Background/Aim: The efficacy of programmed cell death 1 (PD-1) inhibitor therapy for patients with recurrent and/or metastatic salivary gland carcinoma (R/M SGC) remains unclear. Patients and Methods: We retrospectively analyzed 36 patients with R/M SGC treated with PD-1 inhibitor. The expression of programmed cell death ligand 1 (PD-L1) and mismatch repair (MMR) proteins was also analyzed. Results: The objective response rate (ORR) was 11.1%. The histopathological subtypes of patients who achieved complete response or partial response were salivary duct carcinoma (SDC) in three patients and poorly differentiated carcinoma in one patient, all of whom showed a positive PD-L1 expression. The expression of MMR proteins was not associated with the efficacy of PD-1 inhibitors. Conclusion: Although the efficacy of PD-1 inhibitor therapy in R/M SGC is limited, certain patients may respond and achieve long-term disease control. There is a potential therapeutic effect in SDC patients with positive PD-L1 expression.

DOI： 10.21873/anticanres.15558

Web of Science

Scopus

PubMed

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Event date： 2023.5 - 2023.9

Language：Japanese   Presentation type：Oral presentation (general)  

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