Department of Head and Neck Oncology

Seiichi Yoshimoto, Fumihiko Matsumoto, Kenya Kobayashi, Masanori Teshima, Masahiko Fukazawa, Yoshifumi Matsumoto, Satoko Matsumura

Introduction

The treatment strategy for head and neck cancer is to improve the survival rate while preserving the significant functions including speech, mastication, swallowing, and cosmetic appearance. In order to achieve this strategy, our department has tried to select the best treatment modality and devise new surgical procedures based on clinic-pathological findings and our large database of patients with head and neck cancer.

Our department has developed and performed original surgical procedures of partial or subtotal laryngectomy for newly-diagnosed and radiation-failed laryngeal cancer, partial pharyngectomy for hypopharyngeal cancer, and total glossectomy for advanced tongue cancer. These surgical approaches can be performed without sacrificing the larynx. Compared with the results of conventional surgery, there are apparently fewer wound complications. Patients can resume social activities more easily when they maintain their ability to communicate vocally.

Our team and what we do

The Department of Head and Neck Oncology at the National Cancer Center Hospital (NCCH) consists of seven head and neck surgeons. Many operations are performed under general and local anesthesia with or without microsurgical reconstructive surgery. In addition to radiotherapy, concurrent chemo-radiotherapy is performed with the Department of Radiation Oncology.

In 2016, 463 patients with head and neck tumor underwent surgery under local or general anesthesia; 145 and 318, respectively, including 78 patients with major ablation and free flap reconstructive surgery. Table 1 shows the number of surgical cases with each primary site. Table 2 shows the number of each surgical procedure.

Table 1. Number of patients

Table 2. Type of procedures

Research activities

We have been taking part in multi-institutional studies of sentinel lymph node navigation surgery for oral cavity cancer using RI and laryngopharyngeal cancer using ICG. We are also taking part in the JCOG (Japanese Clinical Oncology Group) study concerning postoperative chemoradiotherapy and intra-arterial chemoradiotherapy for maxillary sinus cancer.

Clinical trials

We are participating in a few clinical trials about immune checkpoint inhibitors and BNCT (Boron Neutron Capture Therapy).

Education

We provide plenty of educational opportunities for resident doctors, especially focusing on acquiring operative techniques. They can learn everything about perioperative management, such as physical examination, image diagnosis, informed consent, preoperative preparation and postoperative management.

Future prospects

Trans-oral resection for superficial laryngo-pharyngeal cancer will be indicated for more patients. The number of patients with HPV-elated oropharyngeal cancer has increased. The treatment strategy for this disease should be discussed. Immune checkpoint inhibitors will be used for chemo-resistant patients with recurrent or metastatic tumor. We will be able to get useful information about the response rate of these drugs for Japanese patients.