Evaluation of overall tumor cellularity after neoadjuvant chemotherapy in patient with locally advanced hypopharyngeal cancer.

The aim of this study is to clarify the prognostic value of the pathological overall tumor cellularity after neoadjuvant chemotherapy for locally advanced hypopharyngeal cancer. In consecutive series of 45 operable patients with locally advanced hypopharyngeal cancer, neoadjuvant chemotherapy by cisplatin and 5-fluorouracil was administered. Pathological image analysis was performed in 30 patients using the large cross-section specimen after total resection to evaluate the overall tumor cellularity. The chemotherapeutic responses were classified according to the pathological grading scale by dividing into four categories; more than 70% overall tumor cellularity in Grade 1, between an estimated 10 and 70% in Grade 2, less than 10% in Grade 3, and no identifiable malignant tumor cells in Grade 4. The pathological grades were taken into account for analysis of the survival. In 30 available patients, 40% had Grade 1 pathological response, 30% had Grade 2, and 30% had Grade 3. There was no Grade 4 patient. The overall 5-year survival rate for these 30 patients was 53.33%. The survival rate (61.66%) for patients with Grade 2 and 3 responses was significantly higher than that (27.78%) for patients with Grade 1 response (p = 0.009). Cox regression analysis revealed that the increasing pathological grade was an independent predictor of a better survival in patients undergoing neoadjuvant chemotherapy. We have shown that the prognosis of patients with locally advanced hypopharyngeal cancer, who had been treated by neoadjuvant chemotherapy followed by total resection, can be predicted by evaluation of pathological overall tumor cellularity from the large section specimen.

[Voice reconstruction of the recurrent laryngeal nerve after nerve resection].

Our treatment of choice in voice reconstruction for recurrent laryngeal nerve (RLN) resection is concurrent nerve reconstruction. If this is not possible, we secondarily inject fat. We studied postoperative voice function and the feasibility of this voice reconstruction treatment strategy. Subjects were 39 patients with advanced thyroid cancer having the primary lesion resected together with RLN between 2001 and 2007. Of these 39, 9 underwent concurrent reconstruction by directly anastomosing the ansa cervicalis to the peripheral RLN. Fat was secondarily injected in 25 and 5 did not undergo any reconstruction. We found that: 1) Postoperative maximum phonation time (MPT), mean flow rate (MFR) and pitch perturbation quotient (PPQ) in the direct anastomosis group were significantly better than in the nonreconstruction group (p < 0.05). 2) Postoperative MPT, MFR, and PPQ in the fat injection group were significantly better than in the nonreconstruction group (p < 0.05). 3) MPT in the fat injection group was significantly better than in the direct anastomosis group one month postoperatively (p = 0.007), although this finding was reversed six months postoperatively (p = 0.08). 4) MFR in the fat injection group tended to be better than the direct anastomosis group one month postoperatively (p = 0.1), although this finding was reversed six months postoperatively (p = 0.1). We thus recommend concurrent voice reconstruction by direct anastomosis in conjuction with nerve resection.

[Clinical study of cervical lymph node metastasis in maxillary cancer patients].

The clinical characteristics of lymph node metastasis in maxillary cancer patients were analyzed. Thirty-eight (23%) of the 166 patients who received intial treatment at Kurume University Hospital between 1978 and 2003 had cervical lymph node metastasis at the time of diagnosis. The disease-specific 5-year survival rate was 63% in the lymph node metastasis negative group and 18% in the lymph node metastasis positive group (p<0.01). There was a statistically significant correlation between bone invasion and lymph node metastasis in the case of the group with bone invasion of the posterior wall of the maxillary sinus. Cervical neck lymph node metastasis developed in 38 (28%) of 135 posterior-wall-invasion-positive group and in none (0%) of the 31 patients in the negative group (p<0.01). Because distant metastasis is common in patients with lymph node metastasis, postoperative adjuvant chemotherapy is highly recommended.

[Clinical study of neck dissection for lymph node metastasis in patients with malignant skin tumors of the forehead and face].

We reviewed the records of 10 patients with malignant skin tumors of the forehead and face who underwent neck lymph node dissection at Kurume University Hospital between 2000 and 2004. Two patients underwent selective neck dissection (SND), 5 patients underwent SND and superficial parotidectomy (SP) and 3 patients underwent modified radical neck dissection and SP. Lymph node metastasis to the upper jugular group was found in 3 patients, and metastasis to lymph nodes of the parotid region was found in 3 patients. In a patient with malignant melanoma of the forehead, the patent blue dye was injected intradermally around the tumor and blue-stained lymph nodes were identified in the upper jugular group and parotid region. From these results, we consider that the sentinel lymph nodes of frontal and facial malignant tumors are located in the upper jugular group and parotid region. Thus, in malignant skin tumor patients, SND and SP might be mandatory.

[A retrospective study of malignant parotid tumors].

The clinical features of 74 patients (39 men, 35 women; mean age, 62 years) with malignant parotid tumors were retrospectively investigated. According to the TNM Classification, 4 patients were classified as T1, 9 as T2, 6 as T3, and 55 as T4. Fifty cases were staged as N0, 9 as N1, 14 as N2 and 1 as N3. Tumors located in both lobes of the parotid gland were the most frequent type of tumor (49%). Twenty-four percent of the 74 patients exhibited facial nerve palsy before treatment. Facial palsy was found predominantly in cases with a higher T classification or with deep lobe occupation. Histopathologically, sixteen tumor types were observed; mucoepidermoid carcinoma was the most common. The overall five-year and ten-year survival rates determined using the Kaplan-Meier method were 65% and 61%. The factors influencing a poor outcome were T4 classification (p=0.0189), an N+ stage (p<0.0001), and facial palsy (p<0.0001). As for the major histopathologic types, the five-year survival rates were 69% for mucoepidermoid carcinoma, 48% for adenocarcinoma, 71% for adenoid cystic carcinoma, and 100% for acinic cell carcinoma and malignant mixed tumor. With respect to the treatment modality, patients who were classified as T1 or T2 and whose tumors were located in the superficial lobe without facial nerve invasion could be satisfactorily treated with only a superficial lobectomy conserving the facial nerve. A total parotidectomy with total removal of the facial nerve seemed necessary for T3 and T4 cases, especially those with adenocarcinoma or mucoepidermoid carcinoma. Modified neck dissection may be necessary for N0 cases, especially those with adenocarcinoma, adenoid cystic carcinoma or undifferentiated carcinoma. Nerve grafting after total nerve resection is recommended for a better quality of life.