Auris Nasus Larynx

Long-term efficacy and toxicity of concurrent chemoradiotherapy with nedaplatin and S-1 for head and neck squamous cell carcinoma Publication date: Available online 5 June 2019 Source: Auris Nasus Larynx Author(s): Hiroshi Okuda, Masami Ohnishi, Hiroki Takahashi, Chiaki Takagi, Natsuki Takada, Toshimitsu Ohashi Abstract Objective The present study aimed to retrospectively analyze the long-term efficacy and toxicity of concurrent chemoradiotherapy with nedaplatin and S-1 for head and neck squamous cell carcinoma. Methods The study enrolled 53 patients (23 with stage II disease, 13 with stage III disease, and 17 with stage IV disease). S-1 was administered orally twice a day for 14 days, followed by a two-week rest period. Nedaplatin was intravenously administered on day 4. Where possible, two courses of chemotherapy were performed. Radiotherapy was started with the administration of S-1. We analyzed the clinical response, survival rate, acute adverse events, and late swallowing toxicity. Results The complete response rates for the primary tumor and neck lymph node metastases were 94.3% and 79.3%, respectively. The five-year overall survival rate was 79.5%, the five-year disease-specific survival rate was 84.8%, and the five-year relapse-free survival rate was 73.7%. The main acute adverse events were leukopenia, neutropenia, mucositis, and dermatitis. No patient had severe nephrotoxicity. Late swallowing toxicity was observed in 13 patients. Conclusions The low toxicity, and low nephrotoxicity of chemoradiotherapy with nedaplatin and S-1 have a positive impact on long-term survival. The combination of nedaplatin and S-1 can be used instead of cisplatin and 5-fluorouracil as a safer regimen, especially in patients with some complications and those requiring treatment in an outpatient setting.

Corrigendum to "Environmental factors associated with allergic rhinitis symptoms in Japanese university students: A cross-sectional study" [Auris Nasus Larynx 45 (2018) 1006–1013] Publication date: June 2019 Source: Auris Nasus Larynx, Volume 46, Issue 3 Author(s): Hironobu Nishijima, Sayaka Suzuki, Kenji Kondo, Tatsuya Yamasoba, Shintaro Yanagimoto

Cancer of the mandibular gingiva metastasizing to the small intestine Publication date: June 2019 Source: Auris Nasus Larynx, Volume 46, Issue 3 Author(s): Takeshi Okamura, Takeshi Beppu, Takao Tokumaru, Masato Yamada, Tomonori Sugiyama, Nobuaki Koide, Miyuki Tani, Masayuki Kaneko, Atsumori Hamahata, Yu Nishimura, Takashi Fukuda Abstract Head and neck cancer metastasizing to the small intestine is very rare. Here we report a case of cancer of the mandibular gingiva metastasizing to the small intestine. The patient was an 82-year-old man who had squamous cell carcinoma of the mandibular gingiva staged as T2N2bM0. Two months after surgery, he presented with lower abdominal pain accompanied by signs of peritoneal irritation. Urgent abdominal surgery was performed, during which a crater-shaped perforation was noted on the wall of the ileum. Microscopic findings at this site confirmed a diagnosis of metastatic squamous cell carcinoma in the small intestine from the mandibular gingiva. To our knowledge, this is the first case report of oral cancer metastasizing to the small intestine. If gastrointestinal symptoms appear in a patient with advanced oral cancer, a differential diagnosis of metastasis to the gastrointestinal tract should be kept in mind.

Laryngeal fractures treated with titanium mesh fixation Publication date: June 2019 Source: Auris Nasus Larynx, Volume 46, Issue 3 Author(s): Taku Sato, Takaharu Nito, Rumi Ueha, Takao Goto, Tatsuya Yamasoba Abstract The larynx plays a vital role in respiration, swallowing, and vocal function. Thus, laryngeal fractures that are not appropriately managed may lead to permanent dyspnea, dysphagia, and voice disorders. In cases of laryngeal fractures, surgical repair by internal fixation has been performed with materials such as thread, steel wire, and titanium miniplates. However, thyroid and cricoid cartilage have a complicated morphology, and ossification at each site in the cartilage is not uniform; thus, in some cases it is difficult to perform internal fixation with conventional methods. In this case report, we describe two patients who underwent successful fixation of fractures in their laryngeal cartilage after trauma by using titanium mesh with thread and screws. Since optimal reduction and fixation of fractured laryngeal cartilage cannot be performed with conventional methods in patients with unossified cartilage, titanium mesh may be considered a safe and reliable alternative.

Neck stiffness in a post-irradiated nasopharyngeal carcinoma adult: An unusual diagnosis Publication date: June 2019 Source: Auris Nasus Larynx, Volume 46, Issue 3 Author(s): Kang Ni Lorna Ting, Yew Toong Liew, Zulkiflee Abu Bakar, Prepageran Narayanan Abstract Nasopharyngeal carcinoma is a neoplasm commonly found in population of South East Asia. The mainstay of treatment is high dose irradiation. Complications from radiotherapy are not uncommon especially to those nearby structures such as vertebrae and spinal cord. A 57 year-old gentleman with nasopharyngeal carcinoma (NPC) who was treated with chemo-radiation (total of 35 fractions,70 Gy) presented to us 6 months post therapy with bilateral nasal discharge and progressive neck stiffness. Nasoendoscopy showed inflamed nasophayngeal mucosa and Computed Tomography (CT) brain and cervical spine showed retropharyngeal and anterior epidural collection with extension into atlantoaxial bone and spinal cord compression. Histopathological specimen revealed features of chronic inflammations with multiple actinomycetes colonies. Our patient suffered severe neck stiffness and loss of sensations on both upper limbs. He was treated conservatively with Halo vest and intravenous antibiotics for 8 weeks and recovered fully. Irradiation in NPC is known to cause devastating complications to cervical spine such as osteoradionecrosis, osteomyelitis. It also renders tissues hypoxic and risk of getting rare infection like actinomycosis. This report can represent a great diagnostic and therapeutic challenge with differentials of tumor recurrence, osteoradionecrosis or osteomyelitis. Patients must be regularly followed up to look for possible cervical complications as a result from irradiation, to prevent devastating outcome or prognosis.

The inflammatory pseudotumor presenting periodic acid-Schiff-positive inclusions with acute unilateral facial nerve palsy Publication date: June 2019 Source: Auris Nasus Larynx, Volume 46, Issue 3 Author(s): Akira Inagaki, Masaomi Motegi, Yuji Sato, Hideo Hattori, Shingo Murakami Abstract Although most acute peripheral facial palsies can be attributed to Bell's palsy, other factors, such as infection, trauma, and neoplasm, can cause facial palsy as well. Among these, facial nerve tumors are rare but should be considered in the differential diagnosis of facial palsy. Palsies due to facial nerve tumors usually present with slow onset but occasionally present as acute episodes. In such cases, facial nerve decompression is the treatment of choice to allow the tumor room to grow without compressing the nerve or its blood supply. We describe a case of severe, acute facial palsy presenting with a spindle-shaped bone erosion on the mastoid portion of the facial canal. Although facial neuroma was suspected preoperatively, emergency decompression surgery revealed that an unusual inflammatory pseudotumor was responsible for the finding. Postoperative histological analysis revealed extensive destruction of the nerve fibers, with extensive infiltration of foamy macrophages containing characteristic, diastase-resistant, periodic acid-Schiff (PAS)-positive inclusions, which are hallmark of the uncommon bacterial infections. This was a case of facial palsy with an unusual etiology. The case shows the benefit of decompression surgery not only as treatment for the palsy but also as exploratory surgery in cases of facial nerve tumor.

Risk factors and distribution features of level IB lymph nodes metastasis in nasopharyngeal carcinoma Publication date: June 2019 Source: Auris Nasus Larynx, Volume 46, Issue 3 Author(s): Lei Zeng, Qin Zhang, Fan Ao, Chun-Ling Jiang, Yun Xiao, Hong-Hui Xie, Yi-Qiang Tang, Xiao-Chang Gong, Jin-Gao Li Abstract Objective The objective of this study is to investigate the risk factors and distribution features for level IB metastasis in nasopharyngeal carcinoma (NPC) and provide clinical evidence for defining the indications and clinical target volume (CTV) of prophylactic level IB irradiation. Methods We retrospectively analyzed 798 patients with newly-diagnosed, non-metastatic and histologically confirmed NPC underwent intensity-modulated radiation therapy (IMRT). Two sides of neck in each patient have been analyzed separately. The correlations of level IB metastasis and the clinical risk factors were analyzed with Chi-square test and logistic regression model. The risk score model (RSM) of level IB metastasis was calculated by totaling up the scores of each independent variable. We divided level IB into three areas, including anterolateral space of submandibular glands, medial space of the submandibular glands and submandibular glands. Results Maximal axial diameter (MAD) of level IIA nodes >20 mm or extra capsular spread (ES) of level IIA nodes, anterior half of nasal cavity involvement and submandibular gland involvement/compression were independently significantly risk factors for level IB lymph nodes (LNs) metastasis at diagnosis. Two groups based on RSM were obtained: low risk (total score = 0–2.5); high risk (4–8.5). The incidence of IB LNs metastasis at diagnosis of the two groups were 0.9% and 6.3%, respectively (P < 0.001). The cervical lymph nodes of level IB were distributed in the anterolateral space of submandibular glands. There was no positive/negative LNs inside or medial space of the submandibular glands. Conclusion Level IB LNs metastasis is associated with MAD of level IIA nodes >20 mm or ES of level IIA nodes, anterior half of nasal cavity involvement and submandibular gland involvement/compression in NPC patients. Omission of level IB irradiation may be feasible for patients with low-risk IB LNs metastasis at diagnosis. The submandibular gland should not be included in level IB.

Evaluation of folded amniotic membrane and injectable amniotic membrane pieces as soft tissue filler materials Publication date: June 2019 Source: Auris Nasus Larynx, Volume 46, Issue 3 Author(s): Mustafa Caglar Buday, Murat Ozturk Abstract Objective The search for safe and effective tissue fillers has been an ongoing effort for many years. Obtaining biological materials from patients can require additional incisions and brings surgical and cosmetic risks as a major disadvantage. The aim of this experimental study was, therefore, to evaluate the efficacy of folded amniotic membrane as a soft tissue filler and to assess its volume, and to investigate the possible usage of injectable amniotic membrane for augmentation. Methods Multi-layer amniotic membranes are transplanted to the subcutaneous tunnels created in the rat's back, and the amniotic membrane transformed into the injection material is inoculated transcutaneously under the rat's skin. At the end of two months, the amount of volume loss and histopathological changes in the grafts were examined under light microscope. Results The multi-layer amniotic membrane grafts maintain its volume around 92%. It has been shown that the injectable amniotic membrane maintains its presence in the tissue, can augment it, and can be used as a soft tissue filler. The availability of using amniotic membrane for injection material is shown. No foreign body reaction to the amnion grafts, fibrosis, and necrosis were observed in our study. Conclusion According to our study results, multi-layer amnion graft and amnion injection seem to be used as camouflage grafts and soft tissue augmentation materials. Although further clinical trials are mandatory before considering the use of amniotic membrane as a tissue filler material in humans, we are hopeful about its long-term safety and efficacy.

Inhibition of autophagy by chloroquine makes chemotherapy in nasopharyngeal carcinoma more efficient Publication date: June 2019 Source: Auris Nasus Larynx, Volume 46, Issue 3 Author(s): Tomomi Aga, Kazuhira Endo, Akira Tsuji, Mitsuharu Aga, Makiko Moriyama-Kita, Takayoshi Ueno, Yosuke Nakanishi, Miyako Hatano, Satoru Kondo, Hisashi Sugimoto, Naohiro Wakisaka, Tomokazu Yoshizaki Abstract Objectives A combination of platinum-based chemotherapy and radiotherapy is the standard treatment for nasopharyngeal carcinoma (NPC). However, the efficacy of chemotherapy has reached a plateau. Many autophagy studies suggest that autophagy can either promote or suppress to cancer progression. Thus, a role of autophagy in the acquisition of chemoradioresistance has recently been a notable event. Therefore, we examined the relationship between autophagy and chemotherapy in NPC. Methods The expression of Beclin 1 and microtubule-associated protein light chain 3 (LC3), a marker of autophagy, was determined by immunohistochemistry in the biopsy samples of patients with NPC before and after the first course of chemotherapy. Additionally, to investigate in the effect of autophagy suppression in chemotherapy, NPC cell line C666-1 cells were treated with cisplatin and/or chloroquine, an inhibitor of autophagy. Results The expression of Beclin 1 increased after chemotherapy in all patients. In NPC cell line C666-1, compared to cisplatin alone, combination therapy (cisplatin and chloroquine) reduced cell viability, and promoted cell apoptosis. Conclusions These results suggest that autophagy, represented by Beclin 1, is upregulated after chemotherapy in both in vitro and in vivo NPC studies. Inhibition of autophagy could therefore be new strategy for NPC treatment.

Clinical features of poorly differentiated thyroid papillary carcinoma Publication date: June 2019 Source: Auris Nasus Larynx, Volume 46, Issue 3 Author(s): Masaaki Higashino, Yusuke Ayani, Tetsuya Terada, Yoshitaka Kurisu, Yoshinobu Hirose, Ryo Kawata Abstract Objective To investigate the clinical feature of the poorly differentiated thyroid papillary carcinoma. Methods We investigate retrospectively 276 thyroid papillary carcinoma patients who underwent initial treatment at our Department who underwent initial treatment at our Department during the 13-year period from 2000 to 2012. We examine the pathological samples of papillary carcinoma retrospectively to investigate the prevalence of a poorly differentiated component in the tumor. Then the disease-specific survival rate, metastasis-free survival rate, and relapse-free survival rate were compared between patients with or without a poorly differentiated component. In addition, well differentiated carcinoma and poorly differentiated carcinoma were compared in relation to the age, sex, TNM stage, and recurrent laryngeal nerve infiltration. Results It was considered appropriate to define tumors with a poorly differentiated component of 10% or more as poorly differentiated carcinoma. There was a significant difference of the T classification but not the N classification between well and poorly differentiated thyroid papillary carcinomas. The disease-specific survival rate, metastasis-free survival rate, and relapse-free survival rate of patients with poorly differentiated carcinoma was significantly lower than that of patients with well differentiated carcinoma, and we considered that this might be due to the higher frequency of local infiltration in patients with poorly differentiated tumors. Conclusion The higher relapse rate compared with well differentiated carcinoma suggests that careful postoperative follow-up of patients with poorly differentiated carcinoma is important, particularly surveillance of distant metastasis.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
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6948891480

alsfakia@gmail.com