Treatment Of Tongue Cancer Research Articles

免疫賦活剤ＯＫ‐４３２により好酸球性血管性浮腫を認めた舌癌患者の１例

Episodic angioedema associated with eosinophilia (EAE) was first reported by Gleich et al. in 1984. Clinical features of EAE include recurrent edema, urticaria, fever, increased body weight, and peripheral eosinophilia. We encountered a patient with EAE during the treatment of tongue cancer and describe the clinical features and mechanism considered responsible for the development of EAE. A 24-year-old man was given a diagnosis of tongue cancer (T 2 N 0 M 0) and underwent partial resection of the tongue. After the operation, the patient received immunochemotherapy, including UFT and OK-432, as well as radiotherapy. Shortly after beginning treatment, localized edema in the limbs and peripheral eosinophilia developed. In addition, because interleukin (IL)-5 and eosinophil cationic protein (ECP) were detected in serum, EAE was diagnosed. The symptoms disappeared after immunochemotherapy and radiotherapy were withdrawn. Because the symptoms became serious after increasing the dose of OK-432 and the patient showed positivity for OK-432 on examination of lymphocyte blastogenesis, EAE in our patient was attributed to OK-432.

Prolactin as a local growth promoter in patients with locally advanced tongue cancer: GCRI experience

The purpose of this study was to assess the role of prolactin (PRL) in men with locally advanced tongue cancer. Circulating PRL was assayed immunoradiometrically in pretherapeutic and sequential blood samples of 99 patients with locally advanced tongue cancer. Patients were followed for 3 years or until their death within a stipulated time. Immunohistochemical localization of PRL was performed on formalin-fixed paraffin-embedded tissue sections. Tumoral prolactin receptors (PRLR) were estimated by ligand binding assay; the expression of PRL mRNA and PRLR mRNA were carried out by reverse transcriptase polymerase chain reaction (RT-PCR). Furthermore, PRL amplimer was sequenced and compared with human pituitary PRL amplimer. Pretherapeutic PRL levels were significantly higher in patients with locally advanced tongue cancer compared with controls (p =.01). Thirty-four percent (34 of 99) of the patients had hyperprolactinemia (PRL >/=15.0 ng/mL). Univariate survival analysis showed that patients with pretherapeutic hyperprolactinemia had a significantly shorter overall survival than patients with pretherapeutic PRL <15.0 ng/mL serum (p =.0009). In multivariate analysis, PRL emerged as the most significant independent prognostic factor influencing overall survival. Furthermore, changes in serial PRL levels showed excellent correlation with response to therapy and progression of disease. Forty-four percent (24 of 54) of the tumors showed positive immunoreactivity with PRL antibody, indicating that PRL or a molecule similar to it is produced by tongue tumors. PRL mRNA expression was seen in 85% (43 of 50) of the tumors and confirmed the de novo synthesis of PRL. Sequence analysis of the 234 bp PRL amplimer revealed that the sequence was homologous to exon 5 of pituitary PRL mRNA. The action of PRL is mediated by PRLR, and it was observed that the PRLR positivity by ligand binding assay was 33%. The expression of PRLR mRNA by RT-PCR showed two forms of PRLR mRNA (ie, intermediate form [500-600 bp] seen in 82% (41 of 50 ) of the tumors and the long form [800-900 bp] seen in 36% (18 of 50) of the tumors. In 82% (41 of 50) of the tumors, either the intermediate or long form was seen. This multifaceted study of PRL suggests that tongue cancer cells produce PRL, and this ectopically produced PRL might be acting as a major local growth promoter by means of autocrine and paracrine mechanisms. Looking at its prognostic value and correlation with disease activity, it may provide new insights into treatment of tongue cancer.

Surgical management of tongue cancer

Educational objectives: To understand the factors that are essential in successful surgical treatment of tongue cancer and to formulate a plan for surgical resection that incorporates those factors.

舌癌治療中化学療法により生じた溶血性尿毒症症候群の１例

舌癌治療中化学療法により生じた溶血性尿毒症症候群の１例

Neue Methode der Zungenrekonstruktion mit neurovaskulären infrahyoidalen Muskelfaszienlappen*

Surgical treatment of tongue cancer can lead to extended defunctionalization, depending upon the size and localisation of the defect. Great problems of swallowing arise after total glossectomy or extensive resections of the base of the tongue even after reconstruction with myocutaneous island flaps or free flaps. We developed a neuromuscular island flap derived from the infrahyoidal musculature to reconstruct a total tongue or large defects of the tongue base. This fasciomuscular flap is formed by the M. sternothyroideus, M. sternohyoideus and the upper part of the M. omohyoideus. The axial blood supply arises from the A. thyroidea sup. The innervation is derived from the Ansa cervicalis N. hypoglossi. In case of total glossectomy we took this flap from both sides of the neck. With this new method we reconstructed total tongues after glossectomy in two patients and large defects of the tongue base in six patients. In the present paper the new surgical method and the functional results are described.

Causes of oral tongue cancer treatment failures: Analysis of autopsy cases

Eighty-three autopsy cases of squamous cell carcinoma of the oral tongue were reviewed to identify retrospectively the causes of treatment failure. The cure rate for the primary cancers at autopsy was 48.2% (40 of 83). Regional lymph node metastases were found in 71.1% (59 of 83). Regional metastases and/or juxtaprimary recurrence frequently spread continuously and diffusely, forming bulky neck tumors in 38.6% (32 of 83). The incidence of distant lymph node metastasis (below the clavicle) and hematogenous metastasis was 35.4% (29 of 82) and 58.5% (48 of 82), respectively. The lung was the most common site of hematogenous metastases (52.4%, 43 of 82). Hematogenous metastasis occurred more frequently in the younger age group (less than 40 years of age; P = 0.03). Distant lymph node metastases were identified in the lung hilar, bifurcation, and paratracheal nodes in 89.7% (26 of 29) and had a statistically significant association with lung hematogenous metastasis. Univariate analysis revealed that gross appearance, tumor stage, clinical stage, presence of cervical lymph node metastasis, and interval from N0 to NX were significant predictors of survival time (duration from initial treatment to death). Rupture of the neck vessels was fatal in eight patients (9.6%), and hypercalcemia was seen in six (7.2%). Pulmonary infection was the direct cause of death in 33.7% of patients (28 of 83). Secondary malignant lesions occurred in 22.9% (19 of 83).

舌癌の治療成績 生存率に影響を及ぼす重複癌と遠隔転移

Ninety-nine patients with tongue cancer treated at Shikoku Cancer Center Hospital from 1977 to 1987 were reviewed, with special attention to prognostic factors and duration of survival.Survival rates were analized according to the Kaplan-Meier method, and the prognostic factors were correlated with distant metastases and multiple cancers.1) The 5-year survival rate was 86%, 54%, 38% and 12%, respectively for stage I, II, III and IV.2) Unfavorable factors influencing survival were multiple cancers (15 of the 99 patients, 15%) and distant metastases (12 of the 44 who died, 27%).3) A definite relationship was not found between the number of cervical lymph node and distant metastases and tumor invasion of blood vessels.4) In 40% of the patients who died, death was considered to be due to multiple cancers and distant metastases.A treatment plan of chemotherapy preceding radiotherapy in patients with advanced disease should be studied to improve the prognosis.

Analysis of Pre-surgical Treatment for Tongue Cancer

Analysis of Pre-surgical Treatment for Tongue Cancer

CLINICAL ANALYSIS OF THE DOSIMETORY WITH THE COMPUTER SYSTEM IN THE TREATMENT OF TONGUE CANCER

The application of the computer in medicine is recent development. In radiotherapy the computer has been used for dosimetory. The dosimetory for interstitial implantation, however, has not been established clinically as yet.In the treatment of tongue cancer, in the T1 and some T2 stages, it is recognized that a conservative treatment with Radium needle should be followed. So the dosimetory using the computer system Artronix PC-12 is applied. The planning for the Radium implant is determined by the computed dosimetory. The relation between the Radium source and distance was also studied for protection from such side effects.The results of this study are as follows : 1) According to the computer dosimetory system, radiation dose on every face of tongue is useful for the analysis of the results of the treatment.2) Finer dosimetory in each case was computed the time of treatment and was used for radiotherapy planning. Planning included the determination of the needling time and additional treatment.3) An approximate formula has been established between the Radium source and the distance from the tongue. Rolled gauze was used as an isolater. The appearance of osteonecrosis of the mandibular bone was decreased using this method.

Treatment of Tongue Cancer with Reference to Long-term Follow-up

1. 昭和41年より同55年までの15年間に天理よろづ相談所病院耳鼻咽喉科で治療した口腔舌扁平上皮癌症例は36例であった. その男女比は1.6対1, 平均年令は58.3才であった.2. 全症例の5年実測生存率は, 49%であった. 女性および高令者の成績は不良であった.3. stage 分類と生存率は正相関した. 特に, 頸部リンパ節転移の有無は予後に大きく影響した.4. 術前照射群の成績は手術単独群のそれより不良であった. これに対し, 術後照射群での成績は手術単独群のそれを上回って良好であった.

The current state of the tongue cancer treatment

The author points out the importance of early diagnosis of tongue cancer and suggests biopsy of any tongue ulcer that has not healed within 15 days. In this suffering, the regional lymph glands are affected extremely early.