[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.

[Autologous tumor-specific immunotherapy for recurrent malignant melanoma of the nasal cavity].

Malignant melanoma usually occurs in tissues containing large numbers of melanocytes, such as the skin, mucosa and eye, and is one of the most highly malignant tumors known. No satisfactory treatment results have ever been reported. We report here an effective course of immunotherapy consisting of the local injection and intra-venous administration of autologous tumor-cell-stimulated cytotoxic T lymphocytes in a patient with recurrent malignant melanoma. The patient was a 45-year-old woman. She had been diagnosed as having malignant melanoma in 1996 and under went radio-chemotherapy at our hospital. Seven years later, recurrences were recognized in bilateral nasal cavities. Following systematic chemotherapy, 23 local injections of cytotoxic T lymphocytes were performed. Mediastinal lymphonode metastasis was recognized in March, 2004, so 15 additional intravenous administrations of cytotoxic T lymphocytes were performed. At present, no obvious regrowth has been recognized. Immunotherapy using cytotoxic T lymphocytes may be a useful strategy for controlling recurrent malignant melanoma.

[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.

[Clinical review of mucoepidermoid carcinomas].

Mucoepidermoid carcinoma is a rare head and neck cancer tumor, composed of both mucous and epidermoid cells. We retrospectively reviewed the case of 36 such patients hospitalized in the last 24 years (between 1978 and 2002) at Kurume University Hospital, focusing on origin, treatment, and treatment outcome. In this study, 33 patients undergoing currative treatment were studied in detail. Tumors originated in major salivary glands in 24 and in the oral cavity, paranasal cavity, and oropharynx in 3 each. Salivary gland carcinomas were graded, clinically and histopathologically based on the criteria of Goode et al. as follows: low (n = 3), intermediate (n = 3), and high (n = 18). All patients underwent radical surgery. Lymphnode metastasis was detected in 9, distant metastasis in 6 (lung: 4; liver: 1; bone: 1), and local recurrence in 5 patients. Lymphnode recurrence was detected in 3. Survival was calculated with Kaplan-Meier's methods. Five-year overall survival was 64%, i.e., 56% in salivary gland malignancy, 67% in oral cavity malignancy, 100% in paranasal cavity malignancy and 100% in oropharynx malignancy. Five-year survival was 76% in T2, 75% in T3, 51% in T4. Five-year survival in NO was 80% and 22% in N+ cases, with a statictically significant difference (p < 0.05). Five-year survival was 71% in stage I, 83% in stage II, and 54% in stage IV. Five-year survival in low and intermediate grade was 100%, whereas that in high grade was 43%. The 21 patients undergoing modified neck dissection has a 5-year survival of 52%. In 20 patients undergoing postoperative radiotherapy, 4 died of local recurrence. In 31 patients not undergoing chemotherapy, 6 died of distant metastasis. These results emphasize the necessity of radiotherapy and chemotherapy after surgical treatment for head and neck mucoepidermoid carcinoma.

[Clinical investigation of squamous cell carcinoma of the posterior oropharyngeal wall].

Clinical features of 33 patients with squamous cell carcinoma of the posterior oropharyngeal wall treated at the Department of Otolaryngology, Head and Neck Surgery, Kurume University Hospital from 1973 to 2003 were analysed. Of these, 23 (21 men and 2 women, mean age: 66 years) underwent radical treatment, and 10 (8 men and 2 women, mean age: 78 years) did not. In those treated radically, 2 were stage I, 5 stage II, 6 stage III, and 10 stage IV. The primary disease was surgically treated in 16, and reconstruction added in 5, using the free jejunum in 4 and a forearm flap. Radical radiotherapy was done in 7. Five-year local control in the 23 was 35.3%. Disease-specific 5-year survival was 32.0%. Seven died of primary oropharyngeal cancer. After treatment, 78.3% were able to eat orally. In conclusion, squamous cell carcinoma of the posterior oropharyngeal wall is relatively rare and has a poorer prognosis than other types of oropharyngeal cancer.