Annual Report 2017

Seiichi Yoshimoto, Fumihiko Matsumoto, Go Omura, Kenya Kobayashi, Satoko Matsumura, Masahiko Fukazawa, Yoshifumi Matsumoto, Ayaka Mori

Introduction

 The treatment strategy for head and neck cancer is to improve the survival rate while preserving significant functions including speech, mastication, swallowing and cosmetic appearance. In order to achieve this strategy, the Department of Head and Neck Oncology 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 NCCH consists of eight 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 2017, 464 patients with head and neck tumor underwent surgery under local or general anesthesia; 117 and 347, respectively, including 85 patients with major ablation and free flap reconstructive surgery. Table 1 shows the number of surgical cases under general anesthesia.

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 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. Treatment strategy for this disease should be discussed. Immune checkpoint inhibitors are 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.