高カルシウム血症を随伴した口腔扁平上皮癌の１０例

Abstract

Ten cases of terminal oral squamous cell carcinoma with hypercalcemia are presented to provide a perspective on palliative medicine. The initial primary site was the tongue in 6 patients and the gingiva in 4, including one case with delayed occurrence of multiple oral cancers (lower gingiva, tongue, and palate). There were 6 men and 4 women, with a mean age of 57.4 years (29-80 years). Serum calcium levels ranged from 10.8 to 17.1mg/dl (mean 13.05±2.07mg/dl). The serum parathyroid hormone-related protein level was above the normal range in 9 of the patients. Mean survival from the onset of hypercalcemia was 68.6 days (13-209 days), except for 1 patient who died on the day of diagnosis. The causes of death were respiratory failure in 8 patients and hemorrhage in 2 both of which are common causes of death in patients with oral cancer. There were no deaths due to kidney failure caused by hypercalcemia. For treatment, excluding the patient who died on the day of diagnosis, bisphosphonates were given at 2-week intervals. In patients who received palliative therapy against recurrence, delayed lymph node metastasis, or both bisphosphonate treatment improved the main symptoms, including nausea, vomiting, and anorexia. Furthermore, oral ingestion of food, feeding-tube nutrition, or both could be continued longer in the 7 patients (maximal survival: 209 days) who received palliative therapy than in the 3 who underwent aggressive treatment (radical neck dissection combined with high-dose radiation therapy. These latter patients had large areas of necrosis in the neck extending to the soft tissue or orofacial-neck lymphedema.)(mean survival: 13.7 days). Our findings in this series suggest that the survival time of patients with oral squamous cell carcinoma who have hypercalcemia depends on the aggressiveness of treatment, which is considered a cause of malnutrition, before the onset of hypercalcemia.