In our department, we provide treatment for malignant head and neck tumors with the goal of preserving organs and function. We report the treatment outcomes for five patients with maxillary cancer who underwent S-1 and nedaplatin treatment with concurrent radiation therapy (SN therapy) in our department from April 2005 to March 2009. The patients included one case classified as T2N0M0 and four cases classified as T4N0M0. All patients were male and were aged between 29 and 67 years with a mean age of 55.6 years. Among the five cases, four achieved cancer-free survival with preservation of all functions after undergoing treatment. In the remaining case, the tumor did not disappear but was locally controlled via superselective arterial injection and CyberKnife treatment; however, pulmonary metastasis occurred and the patient is surviving with cancer. SN therapy has allowed a reduction in the extent of surgery required and the preservation of organs and function. It will be necessary to study an increased number of cases in the future to determine the survival rate and the effectiveness of organ and function preservation in maxillary cancer patients after SN therapy.
Many cases of traumatic cerebral spinal fluid (CSF) rhinorrheas arise from head injury or surgery. Cases of nontraumatic CSF rhinorrhea arise rarely due to tumors or inherent bone defects. We report a case of CSF rhinorrhea associated with meningoencephalocele at two bone defect loci requiring surgery. A 65-year-old man experienced watery rhinorrhea of the right nasal cavity in March 1997, followed a year later by meningitis yielding the diagnosis of CSF rhinorrhea. Computed tomography (CT) showed two bone defects and the associated meningoencephalocele in the right ethmoidal cell and left sphenoidal sinus. Initial skull base reconstruction surgery was conducted only for the right side where the symptom occurred. Ten years later, recurrent meningitis necessitated the left side skull base reconstruction surgery for a large infected defect for which could not obtain endoscopic sinus surgery closure. Combined transcranial surgery eventually attained sufficient closure.
We report a case of amebic dysentery during combination chemoradiotherapy for hypopharyngeal cancer. The patient was a 52-year-old man with suspected hypopharyngeal cancer who was referred by his local physician after presenting with pharyngeal pain. The results of detailed investigations, including CT, showed hypopharyngeal cancer (T2N0M0), and the patient was admitted for simultaneous radiotherapy and S-1 plus nedaplatin (hereafter, SN therapy). On hospital day 36 (on day 6 after the second course of SN was started), 10 episodes of mucous, bloody stools and diarrhea were observed on the same day, accompanied by a left lower abdominal pain. We performed a lower gastrointestinal endoscopy that revealed aphthous ulcers from the ascending colon to the lower rectum. The biopsy showed numerous trophozoites consuming red blood cells, leading to a diagnosis of amebic dysentery. The patient was given oral metronidazole (1 g/day) for 10 days, and the symptoms improved. After treatment, a lower gastrointestinal endoscopy showed that the ulceration had disappeared and that the mucosa appeared normal. In this case, we believe that amebic dysentery occurred because of the patient’s background of decreased immune function caused by the administration of chemotherapy and steroids. Mucous, bloody stools and diarrhea during chemotherapy should lead to concerns not only of an adverse chemotherapy event causing gastrointestinal mucosal edema and ulceration, but also of an opportunistic infection and amebic dysentery. In the present case, early diagnosis by a skilled doctor was an important factor; the disease might have become more severe if the diagnosis had not been reached. For this reason, obtaining a sufficient history as well as performing a lower gastrointestinal endoscopy and biopsy are important for early diagnosis.
We report a case of multiple cranial neuropathy caused by nasopharyngeal necrosis occurring long after radiotherapy for nasopharyngeal carcinoma. The patient was a 63-year-old male with the chief complaint of headache. He had received chemoradiotherapy for nasopharyngeal carcinoma 27 years earlier and for paranasal sinus cancer 19 years earlier. Endoscopy revealed nasopharyngeal necrosis, and a contrast-enhanced CT of the neck revealed a low-density area across a wide region from the skull base to the nasopharynx. The patient was also found to have paralysis of the left glossopharyngeal nerve, right vagus nerve, left accessory nerve, and the hypoglossal nerves bilaterally. Although systemic administration of antimicrobial agents and steroids halted the progression of the necrosis, the cranial neuropathy remained. Treatment with appropriate radiation doses is necessary to mitigate the adverse events of radiotherapy, and adequate consideration must be given to radiation exposure, particularly in cases of relapse and cases such as this one, in which adjacent areas are also involved.
We identified chemical components that exhibited antitumor activity against oral squamous cell carcinoma (OSCC) cells and examined their effective concentrations and additive and/or synergistic effects in combinational usage on the proliferation, apoptosis and cell cycle of OSCC cells.Using high-performance liquid chromatography, nuclear magnetic resonance spectroscopy and electrospray ionization-mass spectrometry, we identified the main chemical components of the methanol extracts from Paeonia lutea. We investigated the pharmaceutical effects of those components on the proliferation, apoptosis, and cell cycle of an OSCC cell line, SAS, using the tetrazolium salt 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide (MTT) and caspase assays, as well as flow cytometry cell cycle analysis. We also examined the effects of those components on the mitogen-activated protein kinase signal transduction pathway by western blotting. Finally, the effects on normal human epidermal keratinocyte cells were also examined in similar experiments.Three chemicals have been identified in P. lutea leaves using high performance liquid chromatography: gallic acid methyl ester (GAME), pentagalloyl glucose (PGG) and paeoniflorin (PF). Both GAME and PGG significantly suppressed cell proliferation, and their combined effects were synergistic, while the effect of PF was minimal. However, those chemicals did not induce apoptosis. Cell cycle and western blotting analysis showed that the suppressive effects on cell proliferation resulted from G2 arrest and the suppression of phosphorylation of Akt/PKB. No effect was identified on normal human epidermal keratinocyte cells.These results indicate that GAME and PGG are the main chemical components of P. lutea leaves that have potential anti-cancer therapeutic effects.
In elderly patients treated with concurrent chemoradiation therapy (CCRT), complications after initiation of therapy, such as delirium, as well as adverse events such as radiation mucositis and granulocytopenia, are considered to affect the subsequent therapy completion rate and treatment effect and may also lead to a poor performance status (PS). Various factors should be taken into consideration prior to the therapy, such as complications, estimated residual function, PS, life expectancy, and the family environment, along with sufficient informed consent. This study evaluated 100 subjects, including 30 elderly patients (age, ≧70 years) and 70 non-elderly patients (age, <70 years) who underwent primary therapy (S-1, nedaplatin with CCRT; SN therapy) for head and neck squamous cell carcinoma in our hospital from January 2005 to August 2011. The following variables were clinically compared between the elderly and non-elderly groups: primary site, staging, response to treatment, therapy completion rate, recurrence rate, adverse events, PS, and complications. In the elderly group, 90% of the patients achieved complete response (CR) while the remaining 10% achieved partial response (PR), giving a response rate of 100%. In the non-elderly group, 87.1% and 12.9% of the patient achieved CR and PR, respectively, again giving a response rate of 100%. The therapy completion rate was 73.3% in the elderly and 90.0% in the non-elderly group, with recurrence rates of 6.7% and 15.7%, respectively. With regard to adverse events, in the elderly group, 73.3% of the patients experienced hematological toxicities of grade 3 or higher, and 50.0% experienced non-hematological toxicities of grade 3 or higher. In the non-elderly group, 57.1% experienced hematological toxicities of grade 3 or higher and 42.9% experienced non-hematological toxicities of grade 3 or higher. Major complications occurring after initiation of therapy were reported in 20.0% of the elderly population and in 5.6% of the non-elderly population. Significant differences between the groups were found in the therapy completion rate, incidence of adverse events, and complications after therapy initiation. These results suggest that CCRT is as effective in the elderly as it is in non-elderly patients, but applying the therapy in the elderly requires careful consideration of pre-treatment care, management of complications during therapy, and post-treatment rehabilitation.
S-1 consists of tegafur and two biochemical modulators and reduces adverse effects such as neuro- and cardiac toxicity, hand-foot syndrome and gastrointestinal (GI) toxicity. It can be used as a relatively safe anti-cancer agent for various types of cancers in not only the head and neck region but also the GI, breasts, lungs and so forth.
Infectious mononucleosis is a viral syndrome that is most often caused by Epstein-Barr virus (EBV). A few patients, at the time of the initial infection with EBV, reportedly manifest neurological symptoms, such as meningitis, Guillain-Barré syndrome, and encephalitis. We report a case of infectious myelitis in association with infectious mononucleosis caused by EBV. The patient was a 23-year-old woman who presented with persistent sore throat, fever, and cervical lymphadenopathy. Examination revealed bilateral tonsillar hypertrophy with redness and pus discharge. After making a diagnosis of infectious mononucleosis based on the laboratory data and findings of physical examination, we treated the patient with antibiotics. On the fourth day after the initiation of treatment, the patient showed unilateral motor and sensory paralysis of acute onset. Cervical MRI revealed high signal intensities in the C5 section of the spinal cord. Neurologists at our institution began the patient on pulse therapy with methylprednisolone. After two courses of steroid pulse therapy, the motor and sensory paralysis improved. Cerebrospinal fluid examination revealed a negative test result for EBV-DNA, but the patient was diagnosed as having infectious myelitis caused by EBV from the clinical course.
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%.
