Avoidance of postoperative irradiation for cervical lymph node metastases of human papillomavirus-related tonsillar cancer

BACKGROUND

Several reports have suggested that selected patients with human papillomavirus-related oropharyngeal cancer can be managed with surgery alone. We retrospectively reviewed tonsillar cancer cases to analyze treatment de-intensification after transoral resection.

METHODS

Eighteen patients with tonsillar cancer who had undergone transoral resection were included. The patients' characteristics, p16 status, adverse features, clinical course, overall survival, and relapse-free survival according to p16 status were retrospectively examined.

RESULTS

Four lesions showed positive surgical margins and one lesion showed close surgical margin; these patients were treated with postoperative irradiation. Seven p16-positive patients had multiple node metastases and two had extracapsular spread. No p16-positive patients agreed to postoperative irradiation, and recurrence within the surgical field was not observed. The five-year overall and relapse-free survival rates were 89% and 74%, respectively. The five-year relapse-free survival rates of p16-positive and p16-negative patients were 81% and 50%, respectively (p = .075).

CONCLUSIONS

Postoperative irradiation for cervical lymph node metastases might be avoidable in selected patients with human papillomavirus-related tonsillar cancer.

LEVEL OF EVIDENCE

4.

DEVELOPMENT OF THE NEW GLASS BADGE

The glass dosemeter, which is a component of the glass badge (GB), is used on the basis of radiophotoluminescence phenomenon. Chiyoda Technol Corporation has been providing it for personal monitoring services since the year 2000. Through the experience acquired over 15 y, Chiyoda Technol Corporation has developed the New GB, which was brought into service in Japan for radiation monitoring in January 2014. The New GB was developed with the aim of improving radiation measurement methods, streamlining the provision of GB monitoring services and realising a user-friendly dosemeter. As the result, in this study, the measurable energy range covered for beta rays was expanded to include those emitted from ¹⁴⁷Pm, the directional dependency was improved, a film was designed to remove secondary electrons arising from interactions between incident photons and the metallic filters, and the arrangement of the metallic filters was optimised.

Significance of delayed primary excision in localized nonmetastatic adult head and neck rhabdomyosarcoma

Adult rhabdomyosarcoma (RMS) is a highly aggressive tumor. Multidisciplinary treatment is important. However, the role of surgery is controversial. The purpose of this study was to reveal the role of a delayed primary excision (DPE) after induction chemotherapy (IC) in localized nonmetastatic adult head and neck RMS. We retrospectively reviewed 24 adult head and neck RMS. Treatment was classified into the following two groups: the DPE group, who received IC followed by surgery, postoperative radiotherapy, and adjuvant chemotherapy (17 patients); the chemoradiotherapy (CRT) group, who received IC followed by chemoradiotherapy (seven patients). We analyzed the efficacy of IC, local control rate (LCR), and overall survival (OS). In the DPE group, 10 patients (59%) underwent complete surgical resection. In the evaluation of the surgical specimens, 14 patients (82%) had residual viable tumors after IC. The response to IC was significantly associated with the 3‐year LCR (CR/PR vs. SD/PD: 100% vs. 33%, P = 0.0014). In patients with good response to chemotherapy, the DPE group had a significantly better 3‐year LCR compared with that of the CRT group (DPE group vs. CRT group, 100% vs. 44%, P = 0.018). However, the treatment modalities were not associated with OS (DPE group vs. CRT group, 65% vs. 57%: P = 0.98). The recurrence patterns differed according to treatments, and distant metastases were more frequent in the DPE group. DPE may impact local control of localized nonmetastatic adult head and neck RMS. Poor response to IC is a risk factor for local recurrence.

The short-term and long-term outcomes of the endoscopic resection for the superficial pharyngeal squamous cell carcinoma

BACKGROUND AND STUDY AIMS

Early detection of superficial pharyngeal squamous cell carcinoma (SPSCC) using narrow-band imaging as well as the increasing use of ER for gastrointestinal cancers may increase the number of ER for SPSCC. The aims of this study were to clarify the feasibility of ER for SPSCC and its long-term outcomes.

PATIENTS AND METHODS

In total, 84 patients with 115 lesions were treated by endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) between March 2004 and August 2012. We retrospectively assessed the en bloc and R0 resection rates, complications, lymph node metastasis (LNM), local recurrence, metachronous pharyngeal and esophageal SCC, 5-year overall and cause-specific survival rates.

RESULTS

Higher proportions of en bloc and R0 resection were achieved with ESD compared to EMR (en bloc 100 % vs. 60 %, P < 0.001; R0 59 % vs. 26 %, P < 0.005). There were no significant complications in both groups. None of the patients died from primary SPSCC during the median follow-up of 34 months (range, 3 - 115). LNM occurred in three patients and local recurrence was detected in seven patients (8.3 %) with eight lesions. Tumor thickness over 1000 μm (P < 0.005) and positive or inconclusive horizontal margins (P < 0.05) were significant risk factors for LNM and local recurrence, respectively. Twelve patients died because of co-existing clinical conditions. The 5-year overall and cause-specific survival rates were 80.7 % and 100 %, respectively.

CONCLUSIONS

ER for SPSCC is a feasible treatment with promising results. Tumor thickness over 1000 μm is a significant risk factor for LNM and positive or inconclusive horizontal margin is a risk factor for local recurrence.

Evaluating the significance of level IIb neck dissection for hypopharyngeal cancer

BACKGROUND

This study evaluated cervical lymph node metastases at level IIb in cases of hypopharyngeal cancer and analyzed the possibility of preservation of level IIb during neck dissection.

METHODS

In total, 34 patients (51 neck sides) with hypopharyngeal cancer that underwent neck dissection from April 2008 to April 2011 were retrospectively analyzed. We evaluated the distribution of metastatic lymph nodes at various levels (particularly level IIb) in cases treated with therapeutic neck dissection and elective neck dissection.

RESULTS

The incidence of metastases in level IIb was 13.3% (4 of 30 patients) for therapeutic neck dissection and 0% (0 of 21 patients) for elective neck dissection. All the level IIb metastases were found on the ipsilateral side in the cases treated with therapeutic neck dissection.

CONCLUSIONS

The results suggest that preservation of level IIb during neck dissection was possible in N0 cases of hypopharyngeal cancer.

Transoral en bloc resection of superficial laryngeal and pharyngeal cancers

BACKGROUND

The objective of this study was to evaluate the efficacy and safety of minimally invasive transoral en bloc resection of superficial pharyngeal and laryngeal cancers.

METHODS

Forty-one superficial lesions (from 35 patients) were resected transorally under a surgical microscope using a monopolar cautery. Quality of life (QOL) was assessed using a questionnaire European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Head and Neck Cancer Module (EORTC QLQ-H&N35) 1 year after the surgery.

RESULTS

Twenty-eight hypopharyngeal, 5 oropharyngeal, and 8 laryngeal cancers were operated on using this method. The surgical field was widely exposed with a wide-caliber scope or extending laryngoscope. A bimanual procedure under a surgical microscope enabled us to achieve en bloc resection. The local control rate was 98%. No postoperative dyspnea or dysphagia was observed. Postoperative QOL scores were favorable.

CONCLUSIONS

Our transoral en bloc resection technique can be easily adopted, and it effectively maintained QOL after treatment.

Prevention of wound complications in salvage pharyngolaryngectomy by the use of well-vascularized flaps

CONCLUSIONS

We successfully reduced the incidence of pharyngocutaneous fistulas (PCFs) in high-risk patients undergoing surgery by using pectoralis major myocutaneous flaps (PMMCFs) and deltopectoral flaps (DPFs) to cover suture lines.

OBJECTIVES

We used coverage of suture lines with PMMCFs and DPFs in patients with high risk of PCFs undergoing total laryngectomy (TL) or total pharyngolaryngectomy (TPL) to determine whether coverage of suture lines during salvage surgery can reduce the incidence of PCFs.

METHODS

This retrospective study was based on a review of 52 patients who underwent salvage TL or TPL between 2001 and 2011; we have been using PMMCFs or DPFs during salvage surgery since 2008. Details of postoperative complications including PCFs were analyzed.

RESULTS

The incidence rate of PCF was lower in the flap group (7.7%) than that in the non-flap group (30.1%). No carotid ruptures were observed in the flap group (0%) as contrasted with patients in the non-flap group (7.7%).

Transoral Resection of the Pharyngeal and Laryngeal Cancers

Objective: Evaluate the efficacy and safety of the transoral en bloc resection of superficial pharyngeal and laryngeal cancers. Transoral tumor resection is one option of minimally invasive surgery.

Method: From 2008 to 2010, 34 lesions (from 31 patients) were resected transorally under microscope with monopolar cautery.

Results: Twenty-four hypopharyngeal, 4 oropharyngeal, and 6 laryngeal cancers were operated on using this method. Operation field was widely exposed with wide caliber scope or extending laryngoscope. Bimanual procedure under microscope enabled us to achieve en bloc resection. Radical neck dissection was done simultaneously in one case. Local control rate was 97%. No postoperative dyspnea or dysphagia was observed. Two-thirds of the patients had no symptoms, which were detected by screening of the esophageal cancer patients. Narrow Band Imaging (NBI) system was very useful for detection of the superficial lesions.

Conclusion: Transoral robotic surgery is now applied for minimally invasive surgery, which is not applicable yet in Japan. Our technique of en bloc resection can be easily introduced and was effective in maintaining the quality of life after treatment.

Development of confocal laser microscope system for examination of microscopic characteristics of radiophotoluminescence glass dosemeters

A confocal laser microscope system was developed for the measurement of radiophotoluminescence (RPL) photons emitted from a minute alpha-ray-irradiated area in an RPL glass dosemeter. The system was composed mainly of an inverted-type microscope, an ultraviolet laser, an XY movable stage and photon-counting circuits. The photon-counting circuits were effective in the reduction of the background noise level in the measurement of RPL photons. The performance of this microscope system was examined by the observation of standard RPL glass samples irradiated using (241)Am alpha rays. The spatial resolution of this system was ∼ 3 μm, and with regard to the sensitivity of this system, a hit of more than four to five alpha rays in unit area produced enough amount of RPL photons to construct the image.

Development of thermal neutron-sensitive glass dosemeter containing lithium

New radiophotoluminescence (RPL) phosphate glass containing (6)Li was successfully made from the powder of NaPO(3), Al(PO(3))(3), LiOH, HPO(3) and AgCl. The ternary diagram of NaPO(3)-Al(PO(3))(3)-LiPO(3) has clarified the region where satisfactory RPL characteristics of the glass are kept up. The synthesised phosphate glass indicated good RPL characteristics on the condition that the content of LiPO(3) was below 10 wt%. Gamma-ray irradiation experiments showed that the newly synthesised phosphate glass had satisfactory linearity and wide dynamic range in dose measurement and low variation in sensitivity. It was confirmed from thermal neutron irradiation experiments that a pair of the newly synthesised phosphate glass containing enriched (6)Li and (7)Li, or (n)Li and enriched (7)Li could be effectively used for the evaluation of thermal neutron dosimetry.