下咽頭がんは本邦の頭頸部がんの中でも2番目に多いがん種であり，予後は不良である。頭頸部癌の予後に対しての炎症や栄養のパラメータについての研究が多くなされているが，その結果の臨床応用についての一致した見解は得られていない。本研究は，これらのパラメータの当院下咽頭がん集団における再現性と有用性を評価した。2015年から2020年までに当院で根治治療を施行した下咽頭がん83例について診療録から後方視的に調査を行った。5年全生存率は59.3％（95％信頼区間 46.8〜69.8％）であり，炎症や栄養のパラメータの予後予測因子としての再現性が確認できた。その中でもGeriatric nutritional risk indexやGlasgow prognostic scoreはカットオフ値が予め定義されているため，臨床応用の際に施設間格差の均一化という点で汎用性の高いパラメータであると考えられた。

上歯肉，硬口蓋腫瘍に対する外科的切除は口腔と鼻副鼻腔が交通することにより咀嚼，嚥下，構音障害といった機能障害をきたすため，顎義歯の作成や皮弁再建などの機能再建が必要となる場合が多い。今回，われわれは硬口蓋発生の粘膜悪性黒色腫に対し，鼻腔粘膜を温存することで機能障害を残さず治癒した1例を経験した。骨浸潤のない粘膜悪性黒色腫cT3N0M0の診断で手術加療を行った。手術では内視鏡下に鼻中隔，鼻腔底粘膜を温存し，口蓋粘膜と上顎骨，口蓋骨，鋤骨を一塊に切除し，鼻腔粘膜を裏打ちとしてMCFP（Mucosal defect Covered with Fibrin glue and Polyglycolic acid sheet）法を施行した。皮弁再建や顎義歯を使用せず機能障害なく回復が可能であった。

PURPOSE The standard treatment for postoperative high-risk locally advanced squamous cell carcinoma of the head and neck (LA-SCCHN) is chemoradiotherapy with 3-weekly cisplatin (100 mg/m(2)). However, whether chemoradiotherapy with weekly cisplatin (40 mg/m(2)) yields comparable efficacy with 3-weekly cisplatin in postoperative high-risk LA-SCCHN is unknown. PATIENTS AND METHODS In this multi-institutional open-label phase II/III trial, patients with postoperative high-risk LA-SCCHN were randomly assigned to receive either chemoradiotherapy with 3-weekly cisplatin (100 mg/m(2)) or with weekly cisplatin (40 mg/m(2)) to confirm the noninferiority of weekly cisplatin. The primary end point of phase II was the proportion of treatment completion, and that of phase III was overall survival. A noninferiority margin of hazard ratio was set at 1.32. RESULTS Between October 2012 and December 2018, a total of 261 patients were enrolled (3-weekly cisplatin, 132 patients; weekly cisplatin, 129 patients). At the planned third interim analysis in the phase III part, after a median follow-up of 2.2 (interquartile range 1.19-3.56) years, chemoradiotherapy with weekly cisplatin was noninferior to 3-weekly cisplatin in terms of overall survival, with a hazard ratio of 0.69 (99.1% CI, 0.374 to 1.273 [< 1.32], one-sided P for noninferiority = .0027 < .0043). Grade 3 or more neutropenia and infection were less frequent in the weekly arm (3-weekly v weekly, 49% v 35% and 12% v 7%, respectively), as were renal impairment and hearing impairment. No treatment-related death was reported in the 3-weekly arm, and two (1.6%) in the weekly arm. CONCLUSION Chemoradiotherapy with weekly cisplatin is noninferior to 3-weekly cisplatin for patients with postoperative high-risk LA-SCCHN. These findings suggest that chemoradiotherapy with weekly cisplatin can be a possible treatment option for these patients.

Purpose Olfactory dysfunction occurs after laryngectomy due to the loss of nasal airflow and inability to sniff. However, the reason for the loss of olfactory function after laryngectomy is unclear on evaluation with sniffing type tests performed individually. It is expected that the sensorineural olfaction remains, and the results of the sniffing test would be negative, while that of the odour-blowing test would be positive. Therefore, the aim of this study was to investigate both tests and prove normal olfaction in the patients. Methods Patients who had undergone laryngectomy were evaluated using the T&T olfactometer for odour-sniffing tests, Jet Stream Olfactometer (JSO) for odour-blowing tests, and visual analogue scale (VAS). Evaluations were performed pre-operatively, and 1 month, 6 months, and 1-year post-laryngectomy. Results Thirty-two patients were included in the study. The median recognition thresholds using the T&T and JSO were 1.4 and 2.2 before surgery, 5.8 and 5.4 at 1 month, 5.8 and 5.2 at 6 months, and 5.8 and 5.0 at 1 year after surgery, respectively. Results of the olfactory threshold test in both T&T and JSO and VAS score were significantly worse after surgery compared to that before laryngectomy (p < 0.05). The degree of increase was significantly smaller with JSO than with T&T (p < 0.05). Conclusion While we could not prove normal olfaction in patients after laryngectomy, the odour-blowing test was superior to the odour-sniffing test in detecting patients with residual olfaction. Simply blowing a scent is insufficient to obtain good olfaction; active airflow is crucial for recognizing odours.

The original article can be found online.

Objective To investigate the predictability of ophthalmic artery involvement in maxillary sinus cancer using preprocedural contrast enhanced CT and MRI. Methods We analyzed advanced (T3, T4a, and T4b) primary maxillary sinus squamous cell carcinoma treated with super-selective intra-arterial cisplatin infusion and concomitant radiotherapy (RADPLAT) from Oct 2016 to Mar 2020. Two diagnostic radiologists evaluated the tumor invasion site around the maxillary sinus using preprocedural imaging. These results were compared with the angiographic involvement of the ophthalmic artery using statistical analyses. We also evaluated our RADPLAT quality using complication rate, response to treatment, local progressive free survival (LPFS), and overall survival (OS). Results Twenty patients were included in this study. There were ten cases of ophthalmic artery tumor stain and there was a correlation between ophthalmic artery involvement and invasion for ethmoid sinus with statistically significant differences. Other imaging findings were not associated with ophthalmic artery involvement. Conclusions Ethmoid sinus invasion on preprocedural imaging could suggest ophthalmic artery involvement in maxillary sinus cancer. It may be useful in predicting prognosis and treatment selection.

Purpose The study aimed to analyse radiological differences in computed tomography (CT) findings and texture analysis between cystic lymph node metastases (CNM) in human papillomavirus (HPV)-positive oropharyngeal cancer (OPC) and second branchial cleft cysts (2nd BC). Material and methods Patients with pathological evidence of CNM-HPV-OPC and 2nd BC, who underwent contrast-enhanced CT, were retrospectively evaluated. The evaluated characteristics include age, sex, and CT findings. CT findings included the maximum and minimum transverse diameters, maximum caudal diameter, thickness of the peripheral wall, presence of internal septation, presence of surrounding fat stranding, location, and 40 texture parameters. Results A total of 13 patients had CNM-HPV-OPC (19 lesions), while 20 patients had 2nd BC (20 lesions). Patients with 2nd BC were significantly younger than those with CNM-HPV-OPC (p < 0.001). In terms of diameter, 2nd BC lesions were significantly larger than the CNM-HPV-OPC lesions (p < 0.001). CNM-HPV OPC lesions had significantly thicker walls than 2nd BC lesions (p < 0.001). CNM-HPV-OPC lesions had significantly higher association with internal septations than 2nd BC lesions (p < 0.001). Second BC lesions were significantly less common at level III than CNM-HPV-OPC lesions (p = 0.047). Among the 40 texture parameters measured, 8 had significant differences (p ≤ 0.001). Conclusions There were significant differences in CT findings and textural parameters between CNM-HPV-OPC and 2nd BC lesions. These results may help in differentiating one from the other.

The original article can be found online.

BACKGROUND:Few studies have addressed how human papilloma virus (HPV) infection in oropharyngeal squamous cell carcinoma (OPSCC) affects the outcome of surgical therapy; furthermore, the relationship between the presence of HPV DNA and neck lymph node (LN) metastasis has not been well established.METHODS:A total of 65 patients who underwent surgery as a first-line therapy for OPSCC were enrolled in this study. In HPV-positive patients, the presence of HPV DNA in metastatic neck LN lesions was evaluated.RESULTS:The HPV-positive patients had significantly better overall survival than the HPV-negative patients (log-rank test, p = 0.04), whereas HPV infection status did not significantly affect disease-free survival (log-rank test, p = 0.65). In all of the HPV-positive OPSCC patients who developed cervical LN metastasis, the same HPV DNA type was found in both the primary tumour and the metastases.CONCLUSIONS:The present results suggest that HPV infection is a determining factor for good prognosis in patients undergoing first-line surgical therapy for OPSCC.

Sarcoidosis is a systemic granulomatous disease of unidentified cause, most commonly affecting the lungs, heart, eyes and skin; neurologic involvement is seen in approximately 5% of cases. Neurologic involvement in sarcoidosis could affect the brain parenchyma, meninges, or indeed any other site of the central nervous system; however, cranial nerve involvement is the most common site of neurologic involvement. The most frequently affected cranial nerve in neurologic sarcoidosis is the facial nerve, with 40–60% of cases manifesting facial paralysis.We encountered a case of sarcoidosis in which facial paralysis was the presenting symptom. It is important to rule out intracranial lesions or neuromuscular disorders as the cause in patients presenting with facial paralysis, and evaluation by chest X-ray, electrocardiography, and brain MRI are important to identify relevant findings consistently, such as the shifted strain of the forehead.

Primary malignant tumors of the lacrimal passage, particularly of the nasolacrimal duct, are rare. We describe a 72-year-old woman who presented with lacrimation 5 years previously. She had pain and bloody and purulent lacrimation, and a mass was identified in the inferior meatus. Accordingly, she was diagnosed with primary adenoid cystic carcinoma of the nasolacrimal duct. She was treated with proton beam therapy and showed a favorable response. Owing to the long-term risks of recurrence and distant metastasis, adenoid cystic carcinoma requires sufficient follow-up.

術前の頸部リンパ節転移の評価は重要であり，正確な診断が求められている。今回当科における頸部リンパ節転移の超音波断層法（以下エコー）による診断の評価を行った。対象は2012年1月～12月までに頸部エコーを施行した頭頸部扁平上皮癌症例のうち術前治療を行わずに頸部郭清術を行った62症例88側のリンパ節転移の検出率について検討した。結果は感度61%，特異度97%，正診率90%であった。内部エコーの所見を含めて診断した場合，リンパ節の厚みのみにより診断した場合に比べ正診率は良好であった。また，内部評価をしやすい口腔癌は咽頭癌と比べ正診率が良好であった。偽陰性となったリンパ節の特徴として，(1)角化および変性物や壊死の少ないもの(2)転移病巣がリンパ門から離れて存在するもの(3)びまん性に腫瘍が存在するものが示唆された。エコーは頸部リンパ節転移の診断に有効な検査であるが，その診断能には限界がある。そのためCT，MRI，PET等その他のモダリティーや穿刺吸引細胞診による質的診断を併用して正診率を向上させていくことが重要であると考えられた。

背景：顎下腺癌は比較的まれな疾患であり，まとまった報告は少ない。本研究では過去32年間に当院で抗癌治療を行った顎下腺癌症例76例について後方視的解析を行い検討した。方法：1979年から2012年に当院で抗癌治療を行った顎下腺癌症例76例を対象とした。1次治療例（58例）の累積生存率を病理組織型，臨床病期，Tstage，Nstage，術前の悪性診断の可否に関して検討した。また，当院における顎下腺癌に対する化学療法に関しても検討した。結果：顎下腺癌1次根治例の累積5年生存率は51.0%，10年生存率48.0%であった。臨床病期とNstageにおいて予後に統計学的有意差を認めた。NstageはN0，1群とN2b，N2cの2群に大別され，それら2群間に予後との強い関連を認めた。顎下腺癌遠隔転移症例に対するcarboplatin/paclitaxelを用いた化学療法は，奏効率43%であった。結論：carboplatin/paclitaxelは有効な化学療法だが，今後Nstageの進行した予後不良症例に対しては積極的な補助治療が必要と考えられ，さらに有効な化学療法の開発が期待される。