Correction: Effectiveness and safety of weekly paclitaxel and cetuximab as a salvage chemotherapy following immune checkpoint inhibitors for recurrent or metastatic head and neck squamous cell carcinoma: a multicenter clinical study

[This corrects the article DOI: 10.1371/journal.pone.0271907.].

Chemoradiotherapy and Lymph Node Metastasis Affect Dendritic Cell Infiltration and Maturation in Regional Lymph Nodes of Laryngeal Cancer

Dendritic cells (DCs) are the most specialized antigen-presenting cells, and lymph nodes (LNs) play an important role in the DC-mediated T-cell response. We evaluated the infiltration of CD1a-positive DCs (CD1a-DCs), i.e., immature DCs, and S100-positive dendritic cells (S100-DCs), a mixture of immature and mature DCs, in 73 cases of laryngeal cancer and its regional LNs. Among them, 31 patients underwent radiotherapy (RT) or chemoradiotherapy (CRT) prior to surgery. No significant difference was found for CD1a-DC infiltration in the primary tumors, metastatic LNs and non-metastatic LNs, while S100-DCs were significantly fewer in number in the primary tumors and metastatic LNs compared to non-metastatic LNs. The cases which showed a high infiltration of S100-DCs in the metastatic LNs appeared to show a favorable prognosis, although statistical significance was not reached. In the RT/CRT group, the infiltration of the CD1a-DCs and S100-DCs was less in the primary tumors and metastatic LNs compared to the treatment-naive group. Conversely, the RT/CRT group showed higher CD1a-DC and S100-DC numbers in the non-metastatic LNs compared to the treatment-naïve group. Thus, DC maturation in metastatic LNs plays an important role in tumor immunity in laryngeal cancer, and the infiltration of DCs into the primary tumor and metastatic LNs is impaired by RT/CRT.

Cetuximab Plus Concurrent Radiotherapy in Patients With Nasopharyngeal Carcinoma

BACKGROUND/AIM

Several reports have evaluated the efficacy and safety of concurrent radiotherapy with cetuximab (BRT) in patients with nasopharyngeal carcinoma (NPC). Combination therapy with cetuximab can be a treatment option for NPC. Although clinical data regarding the efficacy and safety of BRT without induction chemotherapy (ICT) or adjuvant chemotherapy is essential for the development of new therapeutic strategies, such data are rarely reported.

PATIENTS AND METHODS

We retrospectively investigated a series of patients with NPC treated in our institution to evaluate the efficacy and safety of BRT. Eleven patients with newly diagnosed NPC were identified from an inpatient database from July 2015 to April 2018. Seven patients who received BRT were reviewed.

RESULTS

All patients completed BRT without cessation of treatment. Six (85.7%) patients achieved a complete response and one (14.3%) achieved stable disease. The response rate was 85.7%. All patients with ≤T3 disease achieved a complete response. Both patients with T3 disease developed local recurrence, and one of the four patients with T1-2 disease developed distant metastases. The 1- and 3-year overall survival rates were 85.7% and 47.6%, respectively. The most common adverse events (AEs) were pharyngeal mucositis (100%), radiation dermatitis (100%), anorexia (28.6%), weight loss (28.6%), acneiform rash (28.6%), and dry mouth (28.6%). Grade 3 AEs were pharyngeal mucositis (42.9%), radiation dermatitis (28.6%), and anorexia (14.3%). No grade 4/5 AEs were observed.

CONCLUSION

BRT for NPC was tolerable, but our findings suggest that BRT without induction chemotherapy or adjuvant chemotherapy is insufficient at least for ≥T3 disease.

Collision tumor of a papillary and follicular thyroid carcinoma: a case report

BACKGROUND

Papillary thyroid carcinoma (PTC) and follicular thyroid carcinoma (FTC) are common differentiated thyroid cancers, but the detection of a collision tumor is an extremely rare event.

CASE PRESENTATION

The patient was a 69-year-old Japanese female with multiple cervical lymph node swellings and a thyroid tumor. Preoperative fine needle aspiration cytology of the enlarged lymph node revealed a cytological diagnosis of papillary thyroid carcinoma (PTC). A total thyroidectomy, right cervical dissection and paratracheal dissection were performed. Histopathological and immunohistochemical analyses of resected specimens revealed a collision tumor of PTC and FTC. Multiple metastases of papillary carcinoma were found in the dissected lymph nodes. In the PTC lesion, IHC for BRAF (V600E) was positive but negative for the FTC lesion. Genetic analyses further revealed a TERT promoter C228T mutation in PTC and a NRAS codon 61 mutation in FTC. The patient died of recurrent cancer 8 months after surgery.

CONCLUSIONS

A case of a collision tumor of PTC and FTC is very rare, and even fewer cases have been subjected to genetic scrutiny. The present case was successfully diagnosed by pathological examination using immunohistochemical and genetic analyses. The TERT promoter mutation in the PTC lesion was consistent with the aggressive behavior of the cancer.

Cerebellar Abscess Induced by Cochlear Fistula due to Chronic Suppurative Otitis Media

Cochlear fistulas with cholesteatoma as the primary disease have been reported frequently in the relevant literature. However, there are no reports of cochlear fistula without cholesteatoma due to chronic suppurative otitis media with intracranial complications. We report a case of cochlear fistula due to chronic otitis media that was diagnosed after the onset of a cerebellar abscess. The patient was a 25-year-old man with severe autism. He was admitted to our hospital with otorrhea from his left ear, emesis, and impaired consciousness. Computed tomography (CT) of the head showed left suppurative otitis media, left cerebellar abscess, and brainstem compression due to hydrocephalus. Right extra-ventricular drainage and brain abscess drainage were urgently performed. The next day, foramen magnum decompression and abscess drainage with partial resection of the swollen cerebellum were performed for decompression purposes. He was subsequently treated with antimicrobial therapy, but magnetic resonance imaging of the head showed an increase in the size of the cerebellar abscess. Re-examination of the temporal bone CT scans revealed a bony defect in the left cochlear promontory angle. We assumed that the cochlear fistula was responsible for the otogenic brain abscess. Thus, the patient underwent surgical closure of the cochlear fistula. After the operation, the cerebellar abscess lesion gradually shrank, and his general condition stabilized. Cochlear fistula should be considered in the management of patients with inflammatory middle ear disease associated with otogenic intracranial complications in the middle ear.

WPOI-4/5 Correlates With Lymph Node Recurrence and Poor Prognosis in Early-stage Tongue Squamous Cell Carcinoma

BACKGROUND/AIM

Neck management in patients with early-stage tongue cancer remains controversial. The worst pattern of invasion (WPOI) of the primary tumor has been associated with the incidence of regional metastasis. We investigated the prognostic role of WPOI, especially in relation to regional lymph node recurrence and disease-specific survival (DSS).

PATIENTS AND METHODS

We retrospectively reviewed medical records and evaluated tumor specimens of 38 patients with early-stage tongue cancer who underwent primary tumor resection without elective neck dissection.

RESULTS

Regional lymph node recurrence rates were significantly higher in patients with WPOI-4/5 compared with WPOI-1 to -3. The 5-year DSS rates were significantly higher for WPOI-1 to -3 than for WPOI-4/5. Notably, patients with WPOI-1 to -3 achieved a 100% 5-year DSS rate with salvage neck dissection and postoperative treatment, even those with cervical lymph node recurrence, whereas patients with WPOI-4/5 had a poorer prognosis.

CONCLUSION

Patients with WPOI-1 to -3 tumors can be followed up without neck dissection until regional lymph node recurrence is detected, with a good course after salvage treatment. In contrast, patients with WPOI-4/5 tumors who are followed up until the appearance of regional lymph node recurrence have a poor prognosis, even with adequate treatment for recurrent disease.

Induction Chemotherapy With 5-Fluorouracil, Cisplatin, and Cetuximab in Advanced Head and Neck Squamous Cell Carcinoma

BACKGROUND/AIM

Chemoradiotherapy (CRT) with high-dose cisplatin has become the standard of care for larynx preservation in patients with locally advanced squamous cell carcinoma of the head and neck (LA-SCCHN). However, the long-term results are unsatisfactory. Induction chemotherapy (ICT) with docetaxel/cisplatin/5-fluorouracil (TPF) is associated with hematologic toxicity, and a safer therapy with comparable efficacy is desired. We conducted a pilot study to investigate the efficacy and safety of 5-fluorouracil/cisplatin/cetuximab (FPE) therapy as a candidate regimen for ICT in comparison with TPF.

PATIENTS AND METHODS

Patients with stage cN2/3 LA-SCCHN of the larynx/oropharynx/hypopharynx were treated with FPE or TPF followed by radiotherapy. We reviewed patients' medical records and evaluated treatment efficacy and safety retrospectively.

RESULTS

The response rates for ICT and ICT-radiotherapy were 71% and 93%, respectively, in the FPE group and 90% and 89%, respectively, in the TPF group. The 1-year progression-free and overall survival rates were 57% and 100%, respectively, in the FPE group and 70% and 90%, respectively, in the TPF group. TPF was linked to significantly higher rates of Grade 3/4 hematologic toxicity during ICT. The rates of Grade 3 or higher toxicity did not differ between the two groups during radiotherapy.

CONCLUSION

The efficacy of ICT was comparable between the FPE and TPF groups, whereas FPE was associated with less toxicity. It is suggested that FPE therapy is an alternative ICT regimen to TPF therapy, but further long-term follow-up is needed.

Effectiveness and safety of weekly paclitaxel and cetuximab as a salvage chemotherapy following immune checkpoint inhibitors for recurrent or metastatic head and neck squamous cell carcinoma: A multicenter clinical study

OBJECTIVES

The benefit of sequential therapy after immune checkpoint inhibitor (ICI) treatment for recurrent or metastatic head and neck squamous cell carcinoma (R/M HNSCC) has been recently reported. Furthermore, there is a growing interest in the impact of cetuximab (Cmab)-containing salvage chemotherapy (SCT) and the therapeutic efficacy and adverse events (AEs) of Cmab administration prior to ICI administration.

MATERIALS AND METHODS

We retrospectively reviewed the medical records of 52 patients with R/M HNSCC treated with SCT (weekly paclitaxel [PTX], n = 7, or weekly PTX and Cmab [PC], n = 45).

RESULTS

The objective response rate (ORR) and a disease control rate (DCR) was 53.3% and 91.1% in the PC group and 42.9% and 57.1% in the PTX group, respectively. There was a significant difference in the DCR between the PC and PTX groups (p = 0.0143). The overall survival (OS) and progression-free survival were significantly better in the PC group than in the PTX group. On the other hand, the incidence of drug-induced interstitial pneumonia (DI-IP) in R/M HNSCC patients who received SCT was 21.2%. Patients in the PC group were divided according to whether they received Cmab (Group A) or did not receive Cmab (Group B) as palliative therapy prior to ICIs. Group B had a significantly better OS than Group A. Furthermore, our findings suggest that the incidence rate of DI-IP during SCT might be higher in Group B.

CONCLUSION

Although PC following ICIs shows dramatic efficacy, careful monitoring of AEs, including DI-IP, is recommended.

Real-world Experience With Pembrolizumab for Advanced-stage Head and Neck Cancer Patients: A Retrospective, Multicenter Study

BACKGROUND/AIM

This study investigated the effectiveness of pembrolizumab with or without chemotherapy on advanced-stage head and neck cancer (HNC), including nasopharyngeal, sinonasal cavity and external auditory canal cancer, in a real-world setting.

PATIENTS AND METHODS

We retrospectively collected data from 97 HNC patients who were treated with pembrolizumab alone (n=60) or with chemotherapy (n=37), and we investigated the association between clinicopathological findings and treatment response or prognosis.

RESULTS

Patients treated with pembrolizumab and chemotherapy had a 1-year overall survival (OS) of 72.8%, objective response rate (ORR) of 48.6%, and serious (≥G3) adverse events (AEs) of 29.7%. Patients treated with pembrolizumab alone had a 1-year OS of 51.9%, ORR of 21.7%, and ≥G3 AEs of 6.7%. Both the ORR and disease control rate (DCR) in the pembrolizumab with chemotherapy group were significantly better than those in the pembrolizumab group (p=0.074 and p=0.00101, respectively). Among patients with distant metastasis, patients on pembrolizumab with chemotherapy achieved significantly better OS than pembrolizumab alone (p=0.0039). Among patients in the pembrolizumab group, both AE-positive and better performance status were associated with longer OS (p=0.011 and p=0.0037, respectively).

CONCLUSION

Our real-world experience reinforces the durability and effectiveness of pembrolizumab for HNC patients. Additionally, our results suggest that pembrolizumab with chemotherapy might be recommended for patients with distant metastasis and no prior treatment. Further studies are needed to determine the optimal treatment strategy for HNC.

Retrospective Study of Cisplatin/Carboplatin, 5-Fluorouracil Plus Cetuximab (EXTREME) for Advanced-stage Salivary Gland Cancer

BACKGROUND/AIM

Surgery remains the standard treatment for salivary gland carcinoma (SGC). Our study investigated the association between epidermal growth factor receptor (EGFR) status in recurrent/metastatic SGC and the effectiveness of treatment with cisplatin/carboplatin and 5-fluorouracil plus cetuximab (EXTREME).

PATIENTS AND METHODS

We retrospectively collected 19 SGCs from patients treated with the EXTREME regimen. After analyzing EGFR expression and gene copy number gain, we evaluated the correlation between EGFR status and clinicopathological factors and prognosis.

RESULTS

EGFR overexpression was detected in 77.8% cases, but not statistically associated with clinicopathological factors or prognosis. EGFR gene copy number gain was detected in 16.7% cases, and statistically positively correlated with lymph node metastasis (p=0.0291). The best overall response was partial response in two cases, stable disease in 15, and progressive disease in one case. The EXTREME regimen was discontinued in all cases.

CONCLUSION

Our results suggest that SGCs are positive for EGFR protein expression but the response rate to the EXTREME regimen was unremarkable.

Infiltration of CD1a-positive dendritic cells in advanced laryngeal cancer correlates with unfavorable outcomes post-laryngectomy

Background

The prognosis of advanced laryngeal cancer is unfavorable despite advances in multidisciplinary therapy. Dendritic cells (DCs) play a central role in antitumor immunity. Tumor-infiltrating CD1a⁺ DCs have been reported to be associated with clinical outcomes in carcinomas of various organs, but the clinical impact of CD1a⁺ DCs in laryngeal cancer remains to be unequivocally established.

Methods

We retrospectively analyzed the cases of 57 patients with Stage III or IV laryngeal cancer who underwent a total laryngectomy. Immunohistochemistry detection of CD1a, S100 and CD8 was performed on representative resected specimens. CD1a⁺ DCs, S100⁺ DCs and CD8⁺ cytotoxic T-lymphocytes (CTLs) were evaluated, and the cases divided into high and low groups according to the cut-off of the median values for each of these 3 parameters.

Results

Compared to the CD1a-low group, the CD1a-high group had more advanced cases and showed significantly worse disease-specific survival (DSS) (P = 0.008) and overall survival (OS) (P = 0.032). The analyses of S100 DCs and CD8⁺ CTLs revealed no significant impact on clinical outcomes. However, multivariate analysis revealed that infiltration of CD1a⁺ DCs was an independent unfavorable prognostic factor for both DSS (P = 0.009) and OS (P = 0.013).

Conclusions

Our results demonstrated that the infiltration of CD1a⁺ DCs was associated with unfavorable clinical outcomes in patients with advanced laryngeal cancer who underwent a total laryngectomy as the initial treatment.

Evaluation of olfactory dysfunction to estimate the presence of eosinophilic chronic rhinosinusitis in patients with asthma

BACKGROUND

Eosinophilic chronic rhinosinusitis (ECRS) is often complicated by asthma and can be difficult to diagnose. This study aimed to clarify the usefulness of the self-administered odor questionnaire (SAOQ) and visual analog scale (VAS) to identify olfactory disorders in patients with asthma.

METHODS

This retrospective study was conducted on patients with asthma who were referred to the Otolaryngology clinic between May and September 2018. The treatment step of asthma, asthma control test (ACT), pulmonary function test, peripheral blood eosinophils, and fractional exhaled nitric oxide (FeNO) were analyzed. ECRS was diagnosed based on the Japanese Epidemiological Survey of Refractory Eosinophilic Chronic Rhinosinusitis Study score. Olfactory dysfunction was evaluated using the SAOQ and VAS for olfactory disorders.

RESULTS

The study included 56 patients (18 males and 38 females), who were divided into two groups; those with ECRS (n = 18) and those without ECRS (n = 38). Age, sex, treatment step, ACT score, and pulmonary function were not significantly different between the groups. The ECRS group had a significantly higher FeNO value (89.1 ppb vs. 39.1 ppb) and a significantly lower SAOQ score (40.1% vs. 96.1%). The area under the receiver operating characteristic curve for the efficacy of ECRS diagnosis was 0.88, 0.889, 0.799, and 0.757 for SAOQ, VAS, blood eosinophil count, and FeNO, respectively.

CONCLUSION

The SAOQ and VAS scores were useful tools that presented similar results to the blood eosinophil count and FeNO, and may help to improve the diagnosis of ECRS in patients with asthma.

Didactic surgical experience of thyroid metastasis from renal cell carcinoma: A case report

BACKGROUND

The optimal therapeutic strategy in treating thyroid metastasis from renal cell carcinoma (RCC) has not been clearly established. Here we describe a case of didactic surgical experience of the disease which caused massive intraoperative bleeding.

CASE SUMMARY

A 59-year-old male patient presented with a thyroid left lobe soft mass detected by chest computed tomography scans prior to the surgical treatment of RCC of the left kidney. The thyroid mass was initially considered to be benign, then he underwent left radical nephrectomy. One year after the nephrectomy, stereotactic radiosurgery was performed for brain metastasis. During follow-up, the thyroid nodule gradually grew, and the patient manifested swallowing discomfort. Under a clinical diagnosis of thyroid follicular neoplasm, left hemithyroidectomy was performed. Although hemithyroidectomy is usually a safe and straightforward procedure, massive bleeding from markedly developed tumor vessels made the operation very difficult. The thyroid tumor was finally diagnosed as metastasis from clear cell RCC.

CONCLUSION

For proper timing of the surgery, a clinician should take into consideration the possibility of thyroid metastasis of RCC when a thyroid lesion is found in patients with RCC or in patients with a previous history of RCC. We recommend that thyroid metastasis of RCC should be resected as early as possible even if a patient has other metastatic sites.

Dental and oropharyngeal lesions in rats with chronic acid reflux esophagitis

OBJECTIVE

In this study, we evaluated pathological changes in the tooth and pharynx of GERD rats to elucidate the association between gastric acid reflux and oral and pharyngeal diseases.

METHODS

An experimental rat model of chronic acid reflux esophagitis was surgically created. The oral cavities were observed histologically every 2 weeks until 20 weeks after surgery.

RESULTS

At 10 weeks after surgery, molar crown heights in GERD rats were shorter than that in control rats, and inflammatory cell infiltration by gastric acid reflux was found in the periodontal mucosa of GERD rats. Furthermore, dental erosion progressed in GERD rats at 20 weeks after surgery, and enamel erosion and dentin exposure were observed. During the same period, inflammatory cell infiltration was observed in the mucosa of the posterior part of the tongue. These findings suggest that gastric acid reflux may be one of the exacerbating factors of dental erosion, periodontitis and glossitis.

CONCLUSION

We investigated oral changes in an experimental rat model of GERD and observed development of dental erosion, periodontitis and glossitis. Our findings suggested chronic gastric acid reflux may be involved in the pathogenesis of oral disease.

Difficulty in the Cytodiagnosis of Mammary Analogue Secretory Carcinoma: Survey of 109 Cytologists with a Case Originating from a Minor Salivary Gland

BACKGROUND

Mammary analogue secretory carcinoma (MASC) of the salivary gland shows morphologic similarities and shares an immunophenotype and characteristic ETV6-NTRK3 translocation with secretory carcinoma of the breast. We present a buccal case of MASC along with a survey-based debate about its cytologic diagnosis by fine-needle aspiration (FNA).

CASE

FNA of the buccal nodule of a 58-year-old Japanese man was initially performed by 3 cytologists who gave different assessments of the Papanicolaou classification (i.e., class II, III, and V). To investigate the potential for discrepant diagnosis of MASC on a larger scale, we distributed a survey with questions about the cytological diagnosis of the present case to cytologists at other institutions. A total of 109 cytologists completed the survey, providing varying assessments of the Papanicolaou classification: class I/II (14%), class III (53%), and class IV/V (33%). Most of the respondents (72%) could not identify a particular tumor or disease. Even the respondents who identified a particular tumor suggested widely differing diagnoses, from a benign lesion to various malignant tumors. Only 2 respondents correctly identified MASC.

CONCLUSION

Our experience and the results of the survey suggest difficulty in the cytodiagnosis of MASC.

Laryngeal Granuloma in Experimental Rats With Gastroesophageal Reflux Disease and Mechanically Injured Vocal Cord Mucosa

Objective:

This study was undertaken to elucidate the mechanisms underlying laryngeal granuloma formation in a rat model of gastroesophageal reflux disease (GERD) with mechanically injured vocal cord mucosa.

Methods:

The rat model of GERD was surgically created by tying the pyloric sphincter and ligating the transitional region between the forestomach and the glandular portion (limiting ridge). The control rats received only a midline incision. In all the animals, a plastic bar was inserted into the trachea, and moved vertically thrice in 3 seconds to cause mechanical injury of the vocal cord mucosa. The rats were sacrificed 2 weeks postsurgically, and their pharynx and larynx were observed histologically.

Results:

Granulomas were observed in the vocal cord mucosa of the GERD group (3 of 5 animals); they presented a similar pathological structure to that of human laryngeal granulomas. In contrast, only abrasions and blisters were observed on the vocal cord mucosa in the control group (all 5 animals).

Conclusions:

The development of laryngeal granuloma may involve both mechanical injury and gastric acid reflux.

Innate Immune Reactions in Locally Early Tonsillar Cancer

Objective: The palatine tonsil contains innate immune cells such as natural killer (NK) cells and macrophages. Tonsillar cancers often present locally early tumors with cervical metastases. This study was performed to clarify the possibility that the growth of primary tumors might be inhibited by innate immune cells in the palatine tonsil.

Method: NK cells and macrophages were immunohistochemically identified using anti-HNK-1 and anti-CD68 antibodies. The degree of the immune cell infiltration in tonsillar cancers, tongue cancers, and normal tonsils was estimated by counting the number of NK cells and macrophages in formalin-fixed, paraffin-embedded blocks. Phagocytosis of the tumor cells was also studied.

Results: There was a significant increase in the number of NK cells in locally early tonsillar cancers (a median of 100 in 8 patients) in comparison to locally early tongue cancers (a median of 8 in 15 patients) and 5 normal tonsils (a median of 35; P < .0001). The number of macrophages was also significantly increased in tonsillar cancers (a median of 247) in comparison to tongue cancers (a median of 81) and normal tonsils (a median of 82; P < .0001). Phagocytosis of tumor cells by macrophages was observed significantly more frequently in tonsillar cancers than in tongue cancers ( P < .01).

Conclusion: The innate immune reactions were observed to significantly increase and they might therefore inhibit the growth of the primary tumor in locally early tonsillar cancer. In addition, these inhibitory immune reactions against the primary tumor in the palatine tonsil might be part of the etiology of developing primary-unknown cervical metastasis.

Experimental Laryngeal Granuloma in Rats with GERD

Objective: Acid reflux and mucosal injury of the larynx may be involved in the development of laryngeal granuloma. This study developed an experimental laryngeal granuloma by mechanical injury to the vocal cord mucosa in rats with chronic acid refluesophagitis to clarify the pathological mechanism of laryngeal granuloma.

Method: An experimental rat model of chronic acid reflux esophagitis was surgically created. A plastic bar was inserted into the trachea of the model rat to mechanically injure the vocal cord mucosa. The pharynx, larynx, and esophagus of these rats were observed histologically every 2 weeks after the operation.

Results: A granuloma was observed in the vocal cord mucosa of the rat after 2 weeks of the surgery, and this presented the same pathological structure as human laryngeal granuloma. In contrast, only mucosal abrasions and blister formations of the vocal cord mucosa were observed in the control rats without surgery.

Conclusion: The current results showed both mechanical injury and acid refluwas involved in the development of a laryngeal granuloma.

[A comparative study of concurrent chemoradiotherapy with S-1 or CDDP for pharyngeal or laryngeal cancer]

Adverse events and therapeutic effects were analyzed in patients with pharyngeal or advanced laryngeal squamous cell carcinomas(SCCs)receiving concurrent chemoradiotherapy (CCRT) with S-1 or weekly CDDP between 2004 and 2007. Low-dose CDDP (25 mg/m2) was administered once a week and S-1 (65 mg/m2) was administered for 3 weeks with one-week rest during conventional radiation with 2 Gy/fraction. Both of the two CCRT regimens showed little toxicity with grade 4 toxicities in less than 5%of the patients. However, CCRT with S-1 more frequently induced grade 3 and 4 oral mucositis than CCRT with CDDP. As a result, the completion rate of CCRT with S-1 was lower than that of CCRT with CDDP. The two regimens achieved a similar complete response rate of the primary sites, local control rate(LCR)and larynx preservation rate; the LCR for T1 and 2 disease was more than 70%. However, the LCR for T3 or 4 disease by the two regimens was less than 50%. CCRT with S-1 showed significantly higher LCR in patients with poorly or undifferentiated SCCs than those with well or moderately-differentiated SCCs. It is suggested that the two CCRT regimens are useful treatment modalities for patients with locally(primary site)non-advanced pharyngeal or laryngeal SCCs, and that CCRT with S-1 is highly sensitive to poorly or undifferentiated SCCs. In order to achieve local control and larynx preservation, more intensive CCRT might be necessary for patients with locally(primary site)advanced pharyngeal or laryngeal SCCs.

Relationship between squamous cell carcinoma antigen and the clinical severity of allergic rhinitis caused by Dermatophagoides farinae and Japanese cedar pollen

OBJECTIVES

Allergic rhinitis is known to be related to the Th2-type immune response, but no sensitive biomarker of severity yet exists. Serum squamous cell carcinoma antigen (SCCA) is clinically used as a popular tumor biomarker. We have demonstrated that SCCA is related to allergic diseases such as asthma. The purpose of the present study was to clarify the relationship between allergic rhinitis and SCCA, which had not yet been investigated.

METHODS

We compared the serum SCCA levels in patients with allergic rhinitis due to Japanese cedar pollen and Dermatophagoides farinae with those in normal subjects. Thereafter, the correlations between the clinical severity of allergic rhinitis and the serum levels of SCCA were investigated. Furthermore, the influence of 8 variables (serum levels of SCCA, immunoglobulin E, eosinophil cationic protein, and eosinophils; age; gender; oral administration of antiallergic or antihistaminic agents; and use of nasal drops) in regard to the severity of allergic rhinitis was studied by a multiple regression analysis.

RESULTS

The SCCA levels of the D farinae group were statistically higher than those of the control group, and they correlated with the severity of rhinitis. Among the 8 variables, only the SCCA level was found to be a predictive factor of severity on a multiple regression analysis. No relationship between SCCA level and Japanese cedar pollen allergy was demonstrated.

CONCLUSIONS

These results suggest that the serum SCCA level may be a useful biomarker to evaluate the severity of allergic rhinitis caused by D farinae.

[Cepharanthin effect on radiation-induced xerostomia and taste disorder in patients with head and neck cancer]

In evaluating the effect of cepharanthin on xerostomia and taste disorder in 40 patients undergoing radiotherapy for head and neck cancer, we administered cepharanthin intravenously during chemoradiotherapy to 22 patients, with 18 others as a control group. Cepharanthin did not significantly affect salivary secretion during and after chemoradiotherapy, although taste disorder and oral discomfort were alleviated. Cepharanthin may thus be effective in maintaining the quality of life of patients with head and neck cancer.

Histological changes of the pharynx and larynx in rats with chronic acid reflux esophagitis

CONCLUSIONS

The histological changes of the pharynx and the larynx associated with surgically induced chronic acid reflux esophagitis were observed in rats. Chronic inflammatory change due to gastric acid reflux was found microscopically in the pharynx and larynx. This indicated that inflammatory changes due to gastric acid reflux are associated with the pathogenesis of laryngopharyngeal reflux disease (LPRD).

OBJECTIVE

To clarify the pathological mechanism of LPRD by studying the histological changes of the pharynx and the larynx in rats with chronic acid reflux esophagitis.

MATERIALS AND METHODS

An experimental rat model of chronic acid reflux esophagitis was created surgically. The pharynx, larynx, trachea, lung, and esophagus of these rats were observed histologically every 2 weeks until 20 weeks after the operation.

RESULTS

At 8 weeks after the operation, mucosal thickening and inflammatory cell infiltration were observed in the hypopharynx of the rat model. Moreover, chronic inflammation with proliferation of fibroblasts, deposition of collagen fibers, and proliferation and dilatation of the capillaries were found as time progressed. However, little macroscopic change was observed in the hypopharyngeal mucosa. In addition, at 16 weeks post-operation, inflammatory cell infiltration was identified in the nerve cells around the thoracic esophagus, the arytenoid region, and the lung.

Serum concentrations of laminin gamma2 fragments in patients with head and neck squamous cell carcinoma

BACKGROUND

The laminin (LN) gamma2 chain expression has been linked to tumor invasion and prognosis. To provide a convenient clinical use, procedures that analyze LNgamma2 expression by using the serum and/or urine of patients should be developed.

METHODS

The serum concentrations of the N-terminal fragments of the LNgamma2 chain in 73 patients with head and neck squamous cell carcinomas were measured by immunoassay.

RESULTS

The concentrations of the LNgamma2 fragments ranged between 14.5 and 324.2 ng/mL, and the normal upper limit was estimated to be 50 ng/mL. The LNgamma2 fragment concentrations increased according to the T classification. The amount of elevated LNgamma2 fragment concentrations decreased after the use of curative treatments. Three patients displayed a continuous increase of the concentrations and subsequently died of the diseases.

CONCLUSIONS

The serum concentrations of the LNgamma2 fragments may prove useful in assessing the treatment results and clinical courses of patients with head and neck squamous cell carcinomas.

A Case of Follicular Carcinoma of Thyroid Gland with Concurrent Tuberculous Lymphadenitises

We report a case of follicular carcinoma of the thyroid gland with concurrent tuberculous lymphadenitises as neck lymph node metastases of thyroid carcinoma. A 71-year-old woman presented with multiple painless masses in the thyroid gland and painless lymphadenopathies in the right neck. She and her family had no previous history of tuberculosis. A diagnosis of thyroid cancer with lymph node metastases was made, and the patient underwent total thyroidectomy with neck dissection. Lymph nodes were hard and severely adhered to the internal jugular vein. The histopathological diagnosis was follicular carcinoma and multiple nodes of adenomatous goiter of the thyroid gland, and tuberculous lymphadenitises of lymph nodes in the right neck. There was no findings of coexisting pulmonary tuberculosis. The possibility of coexisting tuberculous lymphadenitis must thus be ruled out when we find painless lymph node swelling in aged patients with head and neck cancer including thyroid cancer.

Spindle epithelial tumor with thymus-like differentiation (SETTLE): Youngest reported patient

Spindle epithelial tumor with thymus-like differentiation (SETTLE) is a very rare thyroid tumor. It is one of a family of tumors arising either from ectopic thymus or remnants of branchial pouches that retain the potential to differentiate along the thymic line. Herein is reported a case of SETTLE in a 2-year-old girl. The patient underwent right thyroid lobectomy for a tumor of the right thyroid lobe. The resected specimen of this tumor revealed a whitish and solid mass. On microscopy, the tumor exhibited an area of spindle cells, glandular epithelium, and mucinous cystic lesions. The following findings were obtained on immunohistochemistry: the spindle cell area was diffusely positive for cytokeratin AE1/3 and vimentin, and partially positive for alpha-smooth muscle-specific actin. The glandular structures consisted of columnar cells and the cystic area was also positive for cytokeratin AE1/3. All three components of the tumor were negative for thyroglobulin, thyroid transcription factor-1, S-100 protein, carcinoembryonic antigen, somatostatin, synaptophysin, and chromogranin A. On the basis of the aforementioned findings, SETTLE was diagnosed. The patient remains disease free to date, 2 years after surgery with no additional treatment. To the best of the authors' knowledge the present SETTLE patient is the youngest yet reported.

Hypopharyngeal squamous cell carcinoma bordering ectopic gastric mucosa "inlet patch" of the cervical esophagus

OBJECTIVE

Ectopic gastric mucosa of the cervical esophagus, referred to as inlet patch (IP), is considered to be a common development abnormality of the esophagus. We report here a case of hypopharyngeal squamous cell carcinoma bordering on IP of the cervical esophagus.

METHODS

A 44-year-old female underwent partial pharyngectomy, total laryngectomy, cervical esophagectomy, and bilateral neck dissection under the diagnosis of hypopharyngeal carcinoma.

RESULTS

Resected specimens of the hypopharynx revealed a well-differentiated squamous cell carcinoma in the ulcerative tumorous lesion (3.5 cm x 0.5 cm). A brown patch (2 cm x 1.5 cm) bordering the anal aspect of the tumor comprised ectopic gastric mucosa of fundic type epithelium. Immunohistochemistry revealed the surface mucosal cells of this lesion were strongly positive for human gastric mucin (HGM) and the fundic cells were positive for gastrin.

CONCLUSION

The hypopharyngeal squamous cell carcinoma likely developed in association with chronic irritation due to gastric acid from the IP. To our knowledge, this is the first reported case of squamous cell carcinoma related to IP.

[Blood concentration of laminin gamma2 chain in patients with head and neck cancer]

Laminin gamma2 chain (LN gamma2), expressed in human cancer cells and correlated with cancer malignancy, is cleaved by proteases and secreted into circulation. We measured the blood concentration of LN gamma2 in patients with head and neck cancer by an immuno-fluorescence assay using monoclonal antibodies against human LN gamma2. The normal blood concen- showed normal LN gamma2 concentration less than 50 ng/ml and 20 (33%) increased concentration exceeding 50 ng/ml. The relative ratio of the number of patients who showed increased LN gamma2 concentration correlated with the clinical stages of cancer. The blood concentration of LN gamma2 in 24 who initially showed normal concentrations did not change after radical treatments. Five who initially showed increased LN gamma2 concentration showed decreased concentration of less than 50 ng/ml after radical treatment. Four showed increased LN gamma2 concentration after treatment, and presented residual cancer, which killed them. Three of the 4 patients showed marked increase in LN gamma2 concentration exceeding 100 ng/ml and developed multiple distant metastases to the lung, liver, bone, and skin. The blood concentration of LN gamma2 in patients with head and neck cancer may thus indicate the amount of highly malignant cancer cells expressing LN gamma2. The blood concentration of LN gamma2 could therefore serve as a new tumor marker that might indicate the malignancy of and efficacy of treatments for head and neck cancer.

Expression of laminin 5 basement membrane components in invading and recurring adenoid cystic carcinoma of the head and neck

OBJECTIVE

Adenoid cystic carcinoma (ACC) of the head and neck grows slowly with structural differentiation, however, this tumor nevertheless also shows a highly invasive potential and a high recurrence rate. Extracellular matrices have been suggested to play an important role in the differentiation and growth of ACC. The aim of this study is to understand the roles of laminin 5 basement membrane (BM) components, including collagen IV and laminin gamma2 for the high degree of invasiveness and the recurrence of ACC.

METHODS

Collagen IV and laminin gamma2 were immunohistochemically localized in tissue sections from nine patients with ACCs.

RESULTS

Cribriform structures with pseudocysts were preserved in small invading tumor nests, and the expression of both of collagen IV and laminin gamma2 was observed in the inner border of the pseudocysts and the surrounding area of the tumor nests. In areas of perineural invasion, the BM components continued to be expressed around the long tumor nests. Recurrent tumors consisted of multiple small nests with a few tumor cell layers, and the expression of the BM components was observed on both the inside of the inner tumor cells and the outside of the outer tumor cells, which was an obviously different appearance from that of the primary tumor.

CONCLUSION

ACC appears to possibly grow and invade using the laminin 5 BM matrices while also preserving their differentiated architecture. The laminin 5 BM matrices might play an important role not only in the differentiation and growth, but also in the invasion and recurrence of ACC of the head and neck.

A case of an upper cervical bronchogenic cyst in an adult

We herein report a case of a rare cervical cystic lesion, namely a congenital bronchogenic cyst, which presented as an asymptomatic upper cervical mass in a 22-year-old female. Although cervical bronchogenic cysts are rare lesions in adults which are very difficult to accurately diagnose preoperatively, they deserve inclusion in the differential diagnosis of cervical cystic lesions.

Is glossectomy necessary for late nodal metastases without clinical local recurrence after initial brachytherapy for N0 tongue cancer? A retrospective experience in 111 patients who received salvage therapy for cervical failure

PURPOSE

To assess the efficacy of neck dissection (ND) without glossectomy (GL) for late nodal metastases without local recurrence after brachytherapy for N0 tongue cancer.

MATERIALS AND METHODS

Among 396 patients with N0 tongue cancer treated with brachytherapy, a retrospective analysis was performed in 111 patients who were clinically diagnosed as having nodal metastases without local recurrence and whose neck lymph nodes turned out to be pathologically positive after salvage surgery. One hundred and five patients had undergone only ND (the ND group), six patients had undergone ND with GL (the ND+GL group).

RESULTS

The 5 year disease-free and cause-specific survival rates after salvage therapy for the 111 patients included in this study were 58.1 and 61.9%, respectively. In the ND group, there were only nine patients who had local recurrence after ND. In addition, only six patients (5.7%) had a local recurrence within 2 years in the ND group. Sixty-three patients were free of disease after ND, 31 patients had regional or distant metastases without local recurrence and two patients had progressive disease at ND. In the ND+GL group, four patients were alive without disease and two died from regional or distant metastases. None of the patients in the ND+GL group were found to have malignant tissue in the pathological findings from the excised tongue.

CONCLUSION

GL should be avoided or suspended when the clinical evaluation had revealed cervical failure without apparent local recurrence in the mobile tongue cancer patients after initial brachytherapy.

Effects of a novel NF-κB inhibitor, dehydroxymethylepoxyquinomicin (DHMEQ), on growth, apoptosis, gene expression, and chemosensitivity in head and neck squamous cell carcinoma cell lines

BACKGROUND

Recent studies provide evidence that the constitutive activation of nuclear factor-kappa B, NF-kappaB plays a critical role in enhancing the growth of several types of malignancies, including head and neck squamous cell carcinoma (HNSCC).

METHODS

In this study, we examined the effects of a newly synthesized NF-kappaB inhibitor, dehydroxymethylepoxyquinomicin (DHMEQ), on growth, induction of apoptosis, gene expression, and chemosensitivity in two HNSCC cell lines (YCU-H891 and KB), which expressed high levels of nuclear NF-kappaB protein.

RESULTS

DHMEQ showed strong growth inhibitory effects on these two cell lines, with a 50% cell growth inhibition (IC50) concentration of approximately 20 microg/mL. These growth inhibitory effects were associated with inhibition of the NF-kappaB activity. Treatment with DHMEQ induced apoptosis in a dose-dependent manner accounting, at least in part, for the growth inhibition by DHMEQ. DHMEQ strongly inhibited cyclin D1 and vascular endothelial growth factor (VEGF) promoter activity and decreased the levels of cyclin D1 protein and VEGF mRNA in KB cells. In addition, low concentrations of DHMEQ (1.0 or 5.0 microg/mL) synergistically enhanced the cellular sensitivity of YCU-H and KB cells to cisplatin, which is a key chemotherapeutic agent in the treatment of HNSCC.

CONCLUSIONS

These results suggest that DHMEQ may be effective when used alone or in combination with other agents in the treatment of HNSCC.

Role of squamous cell carcinoma antigen 1 expression in the invasive potential of head and neck squamous cell carcinoma

BACKGROUND

Serine proteases have important roles in tumor invasion and metastasis, and their inhibitors, serine protease inhibitors (serpins), are attractive targets for therapeutic strategies. On chromosome 18q21, there is a cluster of serpins: maspin, headpin, and squamous cell carcinoma antigen 1 (SCCA1)/SCCA2. Others and we have reported that the expression of these serpins is down regulated in head and neck squamous cell carcinoma (HNSCC) cells compared with normal squamous epithelial cells. In this study, we hypothesized that expression of SCCA1 is biologically disadvantageous to HNSCC cells.

METHODS

HNSCC cell lines were transfected with a mammalian expression vector with SCCA1 cDNA. In vitro proliferation, migration, or invasive potential (matrigel assay) of the transfectants were assayed. In addition, the in vivo growth and invasion was analyzed using the floor-of-mouth model of nude mice.

RESULTS

SCCA1 expression did not alter the in vitro growth rate of established HNSCC cells. However, SCCA1 expression significantly inhibited the in vitro invasion in matrigel assays. Furthermore, the in vivo growth and invasion in nude mice was also inhibited by SCCA1 expression.

CONCLUSIONS

Overexpression of SCCA1 in a HNSCC cell line inhibited its invasive potential. Loss of expression of the serpin SCCA1 may play a role in the malignant progression of HNSCC.

Smell intensity monitoring using metal oxide semiconductor odor sensors during intravenous olfaction test

The intravenous olfaction test using prosultiamine (PST) solution is simple to perform and has been used clinically in Japan. We monitored intranasal intensity of smell continuously in real time under various conditions of administration using metal oxide semiconductor odor sensors and established an optimal PST injection procedure. In this study, we found that 1) although there was fluctuation in the pattern of intensity of increase in smell in the PST original solution test, the pattern of increase in intranasal smell intensity could be stabilized by prolonging the injection time to 40 s and 2) dilution of PST with physiological saline was effective in preventing angialgia during intravenous injection. It appears that PST administration is best performed by adding 10 ml of saline to 10 mg (2 ml) of PST and injecting the resulting 12-ml solution (6x dilution) and that the best respiratory cycle for testing is once in every 2 s.

Basal cell adenoma and lymphoepithelial cyst as recurrent tumors of pleomorphic adenoma of the parotid gland

Basal cell adenoma of the parotid gland is a rare benign tumor. Lymphoepithelial cyst of the parotid gland is also a rare benign tumor-like lesion. We report an elderly woman, who previously underwent a removal of pleomorphic adenoma, with multiple masses in the left parotid gland. Physical, MR and intra-operative examination suggested the masses as multiple recurrences of the previous pleomorphic adenoma. A total parotidectomy with facial nerve preservation was performed. The histological examination revealed that the masses were two basal cell adenomas and one lymphoepithelial cyst. These rare tumors should be considered in the differential diagnosis of recurrent masses after a removal of pleomorphic adenoma of the parotid gland.

Diffuse expression of laminin gamma2 chain in disseminating and infiltrating cancer cells indicates a highly malignant state in advanced tongue cancer

The expression of laminin (LN)gamma2 chain in the primary lesions of 20 patients with advanced tongue cancer was analyzed. Positive expressions of LNgamma2 were noted in all of the primary tissue specimens, however, the expression patterns clearly differed according to the mode of growth and invasion of cancer cells. In tumor nests where cancer cells preserved cell-cell adhesiveness and showed polar differentiation, LNgamma2 was expressed only in the peripheral cells of the tumor nests; peripheral expression. On the other hands when cancer cells diminished their cell-cell adhesiveness and strongly infiltrated through stroma, almost all of the cancer cells diffusely expressed LNgamma2; diffuse expression. The peripheral expression of LNgamma2 were noted in 13 patients and the diffuse expressions were noted in 7 patients. The rates of positive cervical metastases according to the expression type were 7/13 for the peripheral expression and 7/7 for the diffuse expression (p = 0.02). The diseases specific 3-year survival rates for the patients with the peripheral expression and the diffuse expression were 68% and 14%, respectively (p = 0.02). The diffuse expression of LNgamma2 in the disseminating and infiltrating cancer cells might indicate a highly malignant state in advanced tongue cancer. Therefore, a more intensive treatment modality would be necessary for the patients with advanced tongue cancer showing the diffuse LNgamma2 expression.

Chemoradiation therapy with or without salvage surgery for early squamous cell carcinoma of the hypopharynx

PURPOSE

Early squamous cell carcinoma of the hypopharynx is a rare clinical entity. Our objective was to analyze the outcome of patients with early hypopharyngeal cancer treated with curative radiotherapy or the combination of preoperative radiotherapy with surgery.

METHODS AND MATERIALS

Forty-three patients with Stage I-II hypopharyngeal cancer were initially treated with 30-40 Gy of irradiation with or without chemotherapy. Thirty-two patients (74.4%) who demonstrated a complete response continued to receive further radiotherapy, with a median total dose of 61.2 Gy. Eleven other patients (25.6%) received surgery.

RESULTS

Local control with laryngeal voice preservation was achieved in 8 (88.9%) of 9 patients with Stage I disease, and in 23 (67.6%) of 34 patients with Stage II disease. The overall and disease-specific 5-year survival rates for all patients were 70.4% and 89.5%, respectively. The disease-specific survival rates according to the T-category were 100% for patients with T1 disease and 87.2% for patients with T2 disease (p = 0.32). Twenty patients (46.5%) had synchronous or metachronous cancers. Four patients died of hypopharyngeal cancer, and 5 died of second-primary esophageal cancer.

CONCLUSIONS

A majority of patients with early hypopharyngeal cancer was curable. However, second malignancies influenced the overall outcome of patients with early hypopharyngeal cancer.

[Phase I study of concurrent radiotherapy with TS-1 and vitamin A (TAR Therapy) for head and neck cancer]

The triple combination of 5-fluorouracil (5-FU), vitamin A and radiation (FAR therapy) has been effectively used to treat head and neck cancer. The biological anti-tumor effect of 5-FU depends on the activity of its metabolizing enzyme, dihydropyrimidine dehydrogenase (DPD). TS-1 is a novel oral DPD inhibitory fluoropyrimidine (DIF). To improve the anti-tumor effect of FAR therapy, we have applied TS-1 in place of 5-FU injection in the combination of Vitamin A and radiation (TAR therapy). In this study, we have examined the appropriate duration of TS-1 medication and the clinical efficacy and safety of TAR therapy. TS-1 was administered orally at a dose of 65 mg/m2 twice a day. Vitamin A (Retinol Palmitate: 50,000 U/day) was administered intra-musculary on each day of radiation. Radiation was given (1.5-2 Gy/day: 5 days/week) for 30-40 Gy. The levels were divided according to the length of TS-1 application as follows: level 1, 2 weeks; level 2, 3 weeks; level 4, 4 weeks. Grade 4 toxicity of anorexia was observed in one case of level 3. We decided that level 2 (3 weeks of TS-1 administration) was the appropriate length of TS-1 application. TAR therapy is a useful concurrent chemo-radiotherapy which might improve the response rate and QOL of patients with HNSCC.

CXCR2 Expression on neutrophils is upregulated during the relapsing phase of ocular Behcet disease

PURPOSE

To search for markers of Behcet disease (BD) activity,we measured CXCR1 and CXCR2 levels on the circulating leukocytes of patients suffering from ocular BD.

METHODS

Peripheral blood leukocytes were harvested from healthy volunteers (n = 16) and ocular BD patients (n = 35). The patients consisted of 15 individuals in relapsing phase (6 with prednisolone treatment) and 20 individuals in remission phase (9 with prednisolone treatment). Expression of CXC chemokine receptors (CXCRs) on leukocytes (including lymphocytes, monocytes, neutrophils) was measured using flow cytometry.

RESULTS

Without prednisolone treatment, CXCR2 expression (on both total leukocytes and neutrophils) in relapsing phase was significantly higher than in remission-phase patients or normal individuals. By contrast, no significant difference was detected in the expression of CXCR1 between any ofthe groups. Importantly, low-dose prednisolone therapy reduced CXCR2 expression on neutrophils.

CONCLUSIONS

CXCR2 has a potential role in promot-ing uveitis during ocular attack and might also be a useful marker for disease activity.

Irradiation impairment of umami taste in patients with head and neck cancer

BACKGROUND

Previous studies have reported the alteration of the four basic tastes (sweet, salty, sour and bitter) in patients with head and neck cancer (HNC) during radiotherapy. However, there has been no investigation on the function of umami taste, a novel basic taste recognized recently, during head and neck irradiation.

OBJECTIVE

To investigate the recognition threshold of umami and the four basic tastes at different irradiation dose intervals during radiotherapy for head and neck cancer.

METHODS

In 30 patients with malignant neoplasm of head and neck, objective taste thresholds were examined by use of a whole-mouth method at pre-radiotherapy, irradiation doses at 15, 30, 45, and 60 Gy, respectively. Subjective taste loss and some distresses were recorded simultaneously.

RESULTS

Sweet, sour, salty, and bitter tastes showed temporarily and slightly increased thresholds during the treatment, but no statistical difference was found between the threshold at pre-radiotherapy and that at 15, 30, 45, and 60 Gy in any taste quality (all P > 0.05). Significantly impaired threshold of umami taste was revealed at 30 Gy (P < 0.05) and remained throughout the following treatment (at 45 and 60 Gy, both P < 0.01). Subjective taste impairment, appetite loss and satisfaction with the current state tended to deteriorate significantly during the irradiation. Mean body weight of the patients experienced a continuous loss, decreasing from an average of 60.4 kg before treatment to 57.3 kg at 60 Gy (P < 0.01). Scores of satisfaction with current state showed a significant correlation with umami taste thresholds (P = 0.035).

CONCLUSION

The clinical impairment pattern of umami taste is different from that of the other four basic tastes in HNC patients during radiotherapy. Impaired umami taste acuity plays an important role in impacting the quality of life of the patients irradiated to the head and neck.

The effect of cyclin D1 overexpression in human head and neck cancer cells

Overexpression of cyclin D1 in head and neck cancer has been suggested to be a poor prognostic factor. To understand the role of cyclin D1 expression in head and neck cancer, we overexpressed cyclin D1 in TU182 (a cell line derived from pharyngeal cancer) using a retroviral vector. Stable transfectants were isolated by neomycin (G418) selection. Compared to the parental and control-vector transfected cells, the cyclin D1 transfected cells revealed a decrease of the G1/G0 population and resulted in continuous proliferation under low serum conditions. Proliferation assays revealed an increase in resistance to cisplatin in cyclin D1 overexpressing cells. These observation suggest that deregulation of cyclin D1 may reduce growth factor requirements and contribute to the resistance to some chemotherapeutic agents among head and neck cancer patients.

[Laminin gamma2 chain expression in squamous cell carcinomas of the tongue and its clinical relevance]

Laminin gamma2 chain (LNgamma2) expression and its clinical relevance were examined in squamous cell carcinomas of the tongue. When tumor cells were attached to each other and showed expansive growth, LNgamma2 was expressed only in the peripheral cells of the tumor nests (peripheral expression). In contrast, when tumor cells showed infiltrative growth diminishing cell-cell adhesion, LNgamma2 expression was diffusely observed in almost all of the cells (diffuse expression). Patients with caricinoma cells of the primary lesions showing peripheral LNgamma2 expression were classified as the peripheral expression type, whereas patients with carcinoma cells showing diffuse LNgamma2 expression at least in part of the invasive fronts were classified as the diffuse expression type. Among 30 patients with tongue carcinomas of more than stage II, 19 patients were the peripheral expression type and 11 patients were the diffuse expression type. The 3-year disease-specific survival rates for the peripheral type and diffuse type were 64% and 34%, respectively. LNgamma2 may play an important role in growth and invasion of tongue carcinomas. In particular, it seems likely that the diffuse LNgamma2 expression in carcinoma cells has a significant relevance to the malignant characteristics of infiltrative carcinoma cells. In addition, LNgamma2 expression may be a useful prognostic factor for the patients with carcinomas of the tongue.

Effects of the angiotensin-I converting enzyme inhibitor perindopril on tumor growth and angiogenesis in head and neck squamous cell carcinoma cells

PURPOSE

Recently, it has been reported that angiotensin-I converting enzyme (ACE) inhibitors have anticancer activity. In particular, the ACE inhibitor, perindopril, significantly inhibits tumor growth and angiogenesis in hepatocellular carcinoma cells along with suppression of the VEGF level. However, the mechanisms of suppression of the VEGF level are still unclear, and there are no previous reports on this subject related to head and neck squamous cell carcinoma (HNSCC). In some previous studies, angiotensin II, which is produced from angiotensin I by ACE, directly stimulates VEGF expression.

METHODS

In the present study, we focused upon angiotensin II, and investigated the effect of perindopril on VEGF expression, angiogenesis, and tumor development of HNSCC with in vitro and in vivo studies.

RESULTS

In the in vitro cell proliferation assays, there was no significant difference between the perindopril-treated group and the control group. However, the perindoprilat-treated group showed a significant reduction in mRNA expression of VEGF and inhibited the induction activity of the VEGF promoter in comparison to the control group. Perindoprilat treatment also significantly suppressed angiotensin II production in vitro. In the in vivo studies, perindopril had a significant inhibitory effect on tumor growth, and reduced blood vessel formation surrounding the tumors.

CONCLUSIONS

Our findings suggest that perindopril has no direct cytotoxicity against tumor cells, but has a potential to inhibit tumor growth due to suppression of VEGF-induced angiogenesis in vivo. Angiotensin II might have an important role in carcinogenesis, and the antiangiogenic activity of perindopril is at least partly mediated by angiotensin II inhibition. The ACE inhibitor perindopril has clinical potential as a useful antitumor agent.

Cyclin D1 expression does not effect cell proliferation in adenoid cystic carcinoma of the salivary gland

Adenoid cystic carcinoma is a malignant tumor of salivary gland origin. It tends to grow slowly, but shows frequent recurrence and metastasis. Cyclin D1, a cell-cycle regulation protein, has been reported to be overexpressed in various types of cancer and to correlate with poor survival of the patients. However, the prognostic significance of cyclin D1 expression in ACC of the salivary glands has not yet been determined. To evaluate the role of cyclin D1 in the biological regulation of ACC, we constitutively expressed an antisense cyclin D1 complementary DNA (cDNA) in an established ACC cell line that exhibits high endogenous expression of cyclin D1. The effect of cyclin D1 expression on in vitro cell growth and cell cycle were examined. In addition, we also examined the immunohistochemical expression of cyclin D1 protein in 31 cases of ACC of the salivary gland and correlated its expression with proliferative activity or prognosis. There were no significant differences of the in vitro growth and in the percentage of the total cell population in the G1 phase and S phase between antisense cyclin D1 clones and control clones. Thirty-two percent of tumors derived from surgical specimens examined were immunohistochemically positive for cyclin D1 protein. No association was found between cyclin D1 expression and cell proliferation or the clinical outcome of the patients. It is concluded that cyclin D1 overexpression alone does not induce a marked increase in the proliferative activity of ACC cells and that expression of this protein is not linked to poor prognosis in adenoid cystic carcinoma of the salivary gland.

Clinical value of serum squamous cell carcinoma antigen in the management of sinonasal inverted papilloma

BACKGROUND

Although sinonasal inverted papilloma (IP) is a rare benign tumor, it has a tendency to recur and is sometimes associated with squamous cell carcinoma (SCC). Therefore, postoperative long-term follow-up of these patients is recommended. We previously reported that serum SCC antigen might be a useful tumor marker for sinonasal IP. In this study, we investigated whether serum SCC antigen level has a correlation with disease status and is useful in the early detection of recurrent disease.

METHODS

Blood samples for the analysis of serum SCC antigen were taken from 28 IP patients before and after surgical treatment.

RESULTS

Twenty-five (89%) of 28 cases showed evaluated serum SCC antigen levels above the upper limit. This marker level decreased in all cases after surgical resection. Four of these patients had a recurrence. None of the patients with recurrent tumor showed symptoms at the time of detection of their recurrent tumor, and recurrence was discovered from elevated levels of SCC antigen.

CONCLUSIONS

Serum SCC antigen level has a correlation with disease status of IP and has a potential to serve as a useful tool for monitoring the course of disease. SCC antigen is a reliable tumor marker in the management of sinonasal IPs.

Treatment of Hypopharyngeal Carcinomas-an Institutional Analysis of the Results of FAR Radiochemotherapy, Radical Resection, and Free Jejunum Flap Reconstruction and the Indication of Neck Dissection-

The treatment results of 65 patients with hypopharyngeal carcinomas treated at our institute between 1995 and 2000 were analyzed. In general, concurrent radiochemotherapy (RCT), consisting of intravenous 5-FU injection, intra-muscular vitamin A injection, and radiation (FAR therapy) was used as an initial treatment for advanced hypopharyngeal carcinomas and early hypopharyngeal carcinomas. Tumor responses were evaluated at the time of radiation doses of 30Gy. Patients who showed a complete response (CR) subsequently received curative radiation doses of 60 to 70Gy. Patients who did not show a CR underwent radical surgery consisting of pharyngo-laryngo-cervical esophagectomy, neck dissection for positive cervical nodes and/or the primary tumor sides, and reconstruction using a free jejunum flap. The disease-specific 5-year survival rates were 92%, 55%, 35% and 49% for stage I/II, III, IV and all cases, respectively. Eight out of 9 patients with stage I/II disease who showed a CR after receiving 30Gy of RCT survived with an intact larynx after definitive RCT. All the patients with stage II/III disease who underwent radical surgery after receiving 30Gy of RCT did not have a recurrence, whereas the 5-year survival rate of patients with stage IV disease who underwent RCT and radical surgery was 45%. Seventeen out of 19 patients with clinically negative cervical nodes on the opposite side of their primary tumors showed no nodal metastasis after RCT without neck dissection. This result suggests that elective neck dissection after RCT is not necessary. To improve the treatment results for hypopharyngeal carcinomas, early detection of this disease is prerequisite. In addition, the clinical diagnosis of highly malignant cases and new molecular-targeted therapies based on an analysis of distant metastasis mechanisms should be developed to overcome the poor prognosis of advanced hypopharyngeal carcinomas.

[Laryngeal preservation with definitive radiotherapy in radiosensitive hypopharyngeal cancer]

Fifty-seven patients with hypopharyngeal cancer treated by irradiation at Kyushu University Hospital between 1985 and 1992 were analyzed retrospectively. They included 53 men and 4 women, and their ages ranged from 39 to 83 years (mean, 63 years). Two patients had stage I, 7 had stage II, 13 had stage III, and 35 had stage IV disease according to the UICC (1997) classification. Initially, they were irradiated in the conventional way with a dose of 30 Gy, and 17 patients with good response were irradiated to curative dose (more than 60 Gy), and 32 patients with poor response were operated immediately. Medically inoperable or unresectable patients were treated in a semiradical way (n = 8). The 5-year overall and cause-specific survival rates were 46% and 51%, respectively. Five-year cause-specific survival rates were 88% for stages I and II (n = 9), 67% for stage III(n = 13), and 35% for stage IV (n = 35). Five-year cause-specific survival according to treatment method was 58% for surgery and 51% for curative radiotherapy. There was no statistically significant difference between the two rates. These results suggest that initial radiation response is an important factor in deciding on the following treatment method. Curative radiotherapy for hypopharyngeal cancer according to initial radiation response is a desirable treatment strategy.

Follicular dendritic cell sarcoma of the neck; a case report and literature review

Follicular dendritic cell (FDC) sarcomas, also known as dendritic reticulum cell tumors, are uncommon neoplasms arising from antigen-presenting cells in B-lymphofollicles of nodal and extra-nodal sites. It is considered as an intermediate grade malignancy since it has significant recurrent and metastatic potential. We report a case of FDC sarcoma arising in the neck. A 56-year-old female presented with a left neck tumor. Neck dissection was performed. Microscopically, the tumor showed spindle-shaped stromal cells with large oval and polygonal nuclei. Immunohistologically, the cells were positive for CD21 and CD35, consistent with FDC sarcomas. Adjuvant chemotherapy of cyclophosphamide/doxorubicin/vincristine/prednisone (CHOP) was given. Literature review provides the current information for the diagnosis and treatment of this unusual tumor.