Advances in Modern Medicine

Kiyomi Taniyama, Wataru Kamiike, Kiyomi Taniyama, Wataru Kamiike

• Publisher: Bentham Science Publishers
• Year: 2017
• Print ISBN:
  9781681080246
• eBook ISBN:
  9781681080239
• Topic: Medicine
• Subtopic: Emergency Medicine & Critical Care

Advances in Modern Medicine introduces recent advanced medical practices performed at the Kure Medical Center and Chugoku Cancer Center (KMCCCC) - one of the leading hospitals in Japan - to those working in the field of medicine throughout the world, including physicians, surgeons, pharmacists, psychologists, medical engineers, medical technologists, nurses, and students. Readers will be updated on the general trends in modern medicine relevant to a variety of medical specialties performed at KMCCCC. The volume covers topics such as cancer management, acute phase reaction against a national-level disaster, depression management, emergency medicine, hepatobiliary and gastrointestinal diseases, orthopedics, organ transportation, infection control, blood disease, chronic kidney disease, palliative care, dermatology, ophthalmology, pathology, and nursing for cancer patients. Aspiring medical students can learn more about the latest developments in their field of interest, while patients can learn about treatment options available for different diseases.

Part 1
TOPICS IN THE MODERN MEDICINE
A: CANCER MANAGEMENT

A New Therapeutic Strategy for Advanced Squamous Cell Carcinomas of the Head and Neck

Haruo Hirakawa^{1, *}, Yasuyuki Nishi¹, Taisuke Watanabe¹, Makoto Tada¹, Kiyomi Taniyama², Wataru Kamiike²

¹ Departments of Otorhinolaryngology, Head and Neck Surgery

² National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Japan

Abstract

A concurrent superselective intra-arterial chemoradiotherapy (SIACRT) is a new therapeutic strategy for advanced squamous cell carcinomas of the maxillary sinus and upper gingiva that might enable patients to keep the shape and function as well as improve curability. We have been applying SIACRT since 2008. We will present the results of SIACRT compared to conventional combined therapy at our hospital. SIACRT is promising to preserve patient’s quality of life (QOL) both under and after the treatment without sacrificing a cure rate.

Keywords: Cisplatin, Head and neck cancer, Superselective intra-arterial chemoradiotherapy, 5-Fluorouracil.

---

^* Corresponding author Haruo Hirakawa: Department of Otorhinolaryngology, Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital, Hiroshima, Japan; Tel: [phone]; Fax: [phone]; E-mail: [email protected]

INTRODUCTION

A combination of intra-arterial chemotherapy, radiotherapy (RT), and surgical therapy has been a common therapy for advanced squamous cell carcinomas (SCC) of the maxillary sinus and upper gingiva in Japan for nearly 30 years [1]. The conventional combined therapy (CTx) has remarkably improved the survival rate compared to each therapy alone; however, functional and cosmetic problems remain. The longer patients survived after treatment, the more they suffered from

face deformity and dysfunctions of speech, mastication, and vision, even though they were free of the disease.

A concurrent chemoradiotherapy (CRT) has become a standard therapy for advanced pharyngeal and laryngeal SCC, which enables patients to keep the functions of the larynx and pharynx (i.e., speaking and swallowing) without sacrificing curability [2].

Superselective intra-arterial chemotherapy (SIAC) has more effect on the target lesion without increasing general adverse effect than general chemotherapy. Localized cancer without metastatic lesion is good indication for SIAC [3].

SIACRT, combination of CRT and SIAC, is a new therapeutic strategy for advanced squamous cell carcinomas of the maxillary sinus and upper gingiva that might enable patients to keep the shape and function as well as improve curability [4]. We have been applying SIACRT since 2008. We present the results of SIACRT compared to CTx at our hospital.

PATIENTS AND METHODS

CTx was applied to 9 cases from 2004 to 2010, containing 6 males and 3 females of which the age-range was from 61 to 80.

SIACRT was applied to 10 cases from 2009 to 2012, containing 7 males and 3 females of which the age-range was 57 to 81.

A carcinoma of the upper gingiva involving the maxillary sinus was treated in the same way as a maxillary cancer involving the upper gingiva.

PROTOCOL OF CTX (Fig. 1)

The 1^st day, the affected side of the maxillary sinus is opened through transalveolar incision to reduce the volume of the tumor and to examine the frozen section histopathologically if necessary. An indwelling catheter is inserted into the superficial temporal artery under local anesthesia.

Fig. (1))
Protocol of combined therapy. It takes nine weeks to complete.

The 2^nd day, irradiation, continuous intra-arterial administration of 5 Fluorouracil (5FU), and intra-venous weekly administration of carboplatin (CBDCA) are started. Daily necrotomy of the tumor is performed with the maxillary sinus open till the surgery. Partial or total maxillectomy is performed 2 weeks after a total dose of 40Gy irradiation. A total dose of 10 to 20Gy additional irradiation and weekly administration of CBDCA are started again 1 week after the surgery.

PROTOCOL OF SIACRT (Fig. 2)

Intra-arterial micro-catheter is inserted into a feeding artery of the tumor super-selectively with Seldinger’s method contrasting the tumor. Cisplatin (CDDP) is intra-arterially injected into the tumor through the catheter at the rate of 5 mg a minute. At the same time sodium thiosulfate (STS) was intravenously administered at 200-fold the dose of CDDP in molar quantity to reduce the toxicity of CDDP. Irradiation was started on the same day. Five-day-continuous intra-venous administration of 5FU was started on the next day. CDDP and 5Fu were administered in the same way four weeks later. A total dose of irradiation was 50 to 60 Gy.

Fig. (2))
Protocol of combination of chemoradiotherapy and superselective intra-arterial chemotherapy. It takes 6 weeks to complete.

EVALUATIO...

Table of contents

• Welcome
• Table of Contents
• Title
• BENTHAM SCIENCE PUBLISHERS LTD.
• FOREWORDS
• PREFACE
• List of Contributors
• Part 1 TOPICS IN THE MODERN MEDICINE A: CANCER MANAGEMENT
• A New Therapeutic Strategy for Advanced Squamous Cell Carcinomas of the Head and Neck
• The Long-Term Outcomes of Partial Breast Irradiation Using External Beam after Breast Conserving Surgery
• Is It Possible to Optimize Neoadjuvant Chemotherapy Response by EGFR and CK5/6 Expression Status in Breast Cancer Patients?
• Auto-Analysis of Immunohistochemical Findings for Breast Cancer
• How does Pathology Clinic Have Effect on Mental State and Adjustment in Patients with Breast Cancer?
• Recurrence Pattern and Long-Term Survival After Two Types of VATS Lobectomy for Clinical T1N0 Lung Cancer
• The Role of DNA Methylation as A Biomarker in Lung Cancer: Prognostic Prediction and Early Detection
• Efficacy and Safety of Endoscopic Submucosal Dissection Using A Scissors-Type Knife for Early Colorectal Neoplasms
• Influence of Endoscopic Stent Insertion on Detection of Circulating Tumor Cells from Obstructing Colon Cancer
• Clinical Outcome of Liver Resection in Single Center Experience: Laparoscopic versus Open Procedure
• Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma: Does TACE Have a Future?
• Immunotherapy for Pancreatic Cancer: Clinical Relevance of α-gal Epitope/Natural Anti-gal Antibody Reaction
• Evaluation of Cervical Liquid-Based Cytology in Glandular Abnormalities of Japanese Women
• Clinical Application on Telomere Biology for Cancer
• Cancer Counseling and Pathology Clinic
• Late Endocrine Effect for Childhood Cancer Survivors
• Changes in Esophageal Cancer Treatment Over the Past Decade at Our Hospital
• Part 1 TOPICS IN THE MODERN MEDICINE B: NON-CANCER MANAGEMENT
• Adiponectin, Its Roles in Diabetes and Cardiovascular Disease
• Novel Strategy for Treatment in Type 2 Diabetes Mellitus: Targeting Systemic and Adipose Tissue Inflammation
• Improved Adaptation of Laparoscopic Partial Nephrectomy based on the Evaluation of Renal Function Using 99mTc-MAG3 Renal Imaging
• Recent Findings in Genetic and Enzymatic Analysis of Newborn Screening-Positive Subjects Based on Tandem Mass Spectrometry
• The Role of an Expert in Medical Engineering in Japan
• Part 1 TOPICS IN THE MODERN MEDICINE C: DEPRESSION AS A TARGET OF THERAPY
• Depression: A Novel Mechanism of Antidepressant Action with a Focus on Astrocytes
• Advances in Electroconvulsive Therapy for Psychiatric Disorders
• How Does Electroconvulsive Therapy Work in the Brain? –Involvement of the Astrocyte-Derived Synaptogenic Factor, Thrombospondin-1-
• Part 1 TOPICS IN THE MODERN MEDICINE D: EXPERIENCE IN NATIONAL DISASTER
• Response to the Great East Japan Earthquake: Medical Aid Activities by National Hospital Organization
• Part 2 ADVANCES IN THE MODERN MEDICINE
• The Yin and Yang of Von Willebrand Factor in Thrombosis and Hemostasis: Lessons from Von Willebrand Disease and Thrombotic Thrombocytopenic Purpura
• Topics in Neurology
• Impact of Dose Reduction on the Efficacy of Triple Therapy for Patients Infected with Genotype 1b and High Viral Loads
• Characteristics of Acute Cholangitis and Endoscopic Management of Elderly Patients at Our Institute
• Hyperbaric Oxygen Therapy for Salvage of Flaps with Unstable Blood Flow
• Efficacy of Wound Closure with Cyanoacrylate Glue for Total Knee Arthroplasty without Drain
• Effects of Switching from Allopurinol to Febuxostat in Chronic Kidney Disease Patients
• Infection Control Program for MRSA in Intensive Care Units
• Prevention and Management of Persistent Postoperative Pain – A Review of Literature and A Proposal of Therapeutic Strategy
• Bland-Altman Analysis for Method Comparisons
• Prospective Study of the Treatment of Biotin in Patients with Drug Erythema due to Gefitinib or Erlotinib
• Talking about Life Expectancy with Our Cancer Patients Considering Palliative Chemotherapy
• End-of-Life Care
• Humanized Mouse Models as An Experimental Tool to Investigate Disease Immunology
• What are Clinical Studies?
• The Hospital Information System Using Two Separate Virtual Servers Connected to the Internet with Strong Security
• Part 3 CASE REPORTS
• Dermoscopy for Pigmented Skin Lesions: Four Case Reports
• A Case of Superior Sagittal Sinus Thrombosis Presented with Papilledema
• Verification of New Method for Stroke Volume Assessment by Echocardiography: Preliminary Study Report
• Eosinophilic Pancreatitis with Psoriasis Vulgaris
• Acute Renal Failure Due to Ethylene Glycol Poisoning: A Case Report
• Intraductal Papilloma of the Breast with Necrosis Due to An Infarction: A Case Report
• Imprint Cytology of Extrarenal Retroperitneal Angiomyolipoma: A Case Report
• Internal Coil Trapping of a Ruptured PICA-Involved-Type Vertebral Artery Dissecting Aneurysm: A Case Report
• Part 4 SHORT REPORTS
• An Approach for More Effective Detection of Clostridium Difficile in Patients
• Quality Assurance of Immunohistochemistry for Breast Cancers using a Whole-slide Imaging System, Specified Software and Cell Lines