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Background/Aim: Locally advanced squamous cell carcinoma of the head and neck (L/A SCCHN) is typically treated with surgery or chemoradiation therapy (CRT), whereas salvage surgery is considered for residual disease post-CRT. However, salvage surgery after radiation therapy presents challenges due to tissue fibrosis. Planned neck dissection (ND) combined with CRT, as well as positron emission tomography after CRT, have been proposed strategies, but no definitive consensus has been reached. Therefore, this study aimed to investigate the utility of "upfront ND" performed prior to CRT to enhance local control and reduce complications. Patients and Methods: We retrospectively reviewed 121 patients who underwent primary CRT for oropharyngeal, hypopharyngeal, or laryngeal cancer at Tokyo Medical University Hospital from January 2015 to September 2021. Patients without cervical lymph node metastasis or with unresectable nodes were excluded. All patients underwent pre-treatment imaging and staging. CRT consisted of intensity-modulated radiation therapy (IMRT) and cisplatin-based chemotherapy. Selective ND or modified radical neck dissection was performed based on lymph node involvement. Results: Overall, 35 patients underwent upfront ND, whereas 54 did not. The upfront ND group exhibited significantly better 2-year locoregional recurrence-free survival than the group without upfront ND (93.7% vs. 71.0%). No significant differences were noted in adverse events between groups. Conclusion: The findings highlight upfront ND before CRT as a viable option for locally advanced head and neck cancer, particularly beneficial in cases with extranodal extension. This approach enhances local control and may reduce the need for salvage surgery, thus improving patient outcomes. [ABSTRACT FROM AUTHOR]

Background/Aim: First bite syndrome (FBS) is a symptom of severe pain at the beginning of a meal that lessens as the meal progresses. It is a common postoperative complication of parapharyngeal space tumors and is rarely reported as the first symptom of parotid carcinoma. The parapharyngeal space is considered a difficult area for approach; hence, preoperative histopathology is often challenging. However, there are hardly any reports on the approach of performing biopsies under computerized tomography (CT) guidance. Case Report: A 28-year-old woman presented to our hospital with the chief complaint of pain in the left parotid region since the past year. Contrastenhanced magnetic resonance imaging of the parotid gland revealed a 10-mm high-signal area on T2-weighted images extending from the deep lobe of the left parotid gland to the parapharyngeal space, which could not be visualized on ultrasound. She was suspected to have a malignant tumor because of the presence of a parotid tumor with FBS. Therefore, she underwent CT-guided fine-needle aspiration cytology (FNAC) and was diagnosed with adenoid cystic carcinoma. The patient underwent left parotid tumor resection and left cervical dissection, and her pain during feeding improved postoperatively. Conclusion: In a patient with parotid tumor extending into the parapharyngeal space with FBS as the initial symptom, CT-guided FNAC was successfully used to diagnose parotid carcinoma. Symptoms of pain, including FBS, should be considered in cases of malignancy. CT-guided FNAC is effective for lesions that cannot be visualized by ultrasound, such as those in the parapharyngeal space. [ABSTRACT FROM AUTHOR]

Background/Aim: A pharyngeal fistula is the most common complication of total laryngectomy; thus, accurate diagnosis and treatment are important. Diagnosis is usually made by the finding of leakage of the contrast agent outside the pharynx during swallowing contrast examination. Herein, we encountered a case in which fine leaks not detected on contrast examination during swallowing were visualized and diagnosed by computed tomography (CT) imaging with oral contrast media with the patient in a prone position. Case Report: During imaging in a prone position, the contrast agent entered the sutures on the cephalocaudal and ventral sides of the surgical site, which were particularly prone to leaks due to gravity, and it was possible to diagnose minute leaks. When there is a high risk of postoperative pharyngeal fistula, such as in reconstructive cases with a pedunculated flap or with overlapping risk factors such as preoperative irradiation, CT imaging with contrast medium in a prone position is considered useful when swallowing contrast examination does not provide a clear diagnosis. However, suture failure is possible, and this should be evaluated. Conclusion: This case suggests that routine prone CT may lead to the early detection of postoperative pharyngeal fistula in high-risk cases. Further accumulation of cases is required to confirm our findings. [ABSTRACT FROM AUTHOR]

Background/Aim: Salivary gland adenocarcinoma not otherwise specified (NOS) is classified under the 2017 WHO Classification of Head and Neck Tumors as a malignant neoplasm without the histological features characteristic of other cancer types. Japan's national health insurance program began covering nivolumab in March 2017 for the treatment of patients with recurrent or metastatic head and neck cancer, including salivary gland carcinoma, previously treated with platinum agents. Existing literature does not include cases of patients with salivary gland carcinoma, adenocarcinoma NOS or otherwise, who have achieved complete response to nivolumab. Case Report: Our patient was a 32-year-old woman. Following diagnosis of adenocarcinoma of a right accessory parotid gland, she underwent reconstructive surgery of the parotid gland followed by postoperative adjuvant therapy with radiotherapy and cisplatin. Multiple lung metastases were found 14 months thereafter. Given a history of cisplatin administration, she was treated with nivolumab. Computed tomography (CT) showed partial response after 5 months and complete response after 9 months of nivolumab treatment. Based on CT findings, the lung metastases remained absent 39 months after nivolumab treatment was halted due to the patient's plans for pregnancy. Conclusion: Nivolumab may be an effective option for treating high-grade salivary gland carcinomas that recur or metastasize. [ABSTRACT FROM AUTHOR]

Background: No clear chemotherapy regimen for recurrent or metastatic parotid cancer exists. We describe our experience with pembrolizumab to treat recurrent or metastatic parotid cancer. Case Report: A 73-year-old woman with swelling in the lower part of the right ear for 10 years before surgery was diagnosed with right parotid cancer, underwent total right parotidectomy, and reported recurrence. She requested treatment due to diminished quality of life caused by neurological symptoms. Tissue was collected from the recurrent lesion and its combined positive score was >20; pembrolizumab was started 9 years postoperatively. Results: To date, the patient has received 14 cycles of pembrolizumab. Evaluation by computed tomography showed a partial response to treatment. The only immune-related adverse event was grade 1 pneumonia in both lungs. Conclusion: Significant response to pembrolizumab in recurrent or metastatic parotid cancer is rarely reported, making this a remarkable case. We plan to continue pembrolizumab administration. [ABSTRACT FROM AUTHOR]

Background: Head and neck photoimmunotherapy specifically destroys tumor cells by irradiating them with 690 nm red light after administering cetuximab sarotalocan sodium. The key point in the technique of photoimmunotherapy is to set the irradiation area precisely with a margin added to the target lesion while securing a safety zone with large vessels such as the internal carotid artery. Case Report: At our Institution, we performed photoimmunotherapy in combination with use of a navigation system on a male patient in his 70s with maxillary gingival carcinoma who had a recurrent lesion deep in the lateral pterygoid muscle. Three months after photoimmunotherapy, the superficial lesion had disappeared, the area of contrast within the lateral pterygoid muscle had improved, and the patient was deemed to have a complete response. Conclusion: The Navigation System was successfully used in combination with photoimmunotherapy. Additionally, this allowed the location of the internal carotid artery to be confirmed in real time. [ABSTRACT FROM AUTHOR]

Background/Aim: For recurrent/metastatic squamous cell carcinoma of the head and neck (R/M SCCHN), popular regimens containing platinum-based anticancer agents and immune checkpoint inhibitors are impractical for platinum-intolerant patients. Herein, the efficacy and safety of paclitaxel and cetuximab combination therapy in R/M SCCHN were evaluated. Patients and Methods: In this retrospective study, paclitaxel (80 mg/m2) and cetuximab (400 mg/m2 loading dose followed by 250 mg/m2 weekly) were administered in 28-day cycles on days 1, 8, and 15. Results: Thirty-eight patients were treated. The overall response and disease control rates of first-line therapy were 43% and 79%, respectively, while those of second-line and later therapies were 20% and 90%, respectively. The median progression-free and overall survival were 5.3 and 12.5 months, respectively. All adverse events were manageable, including grade 3/4 neutropenia and anaemia affecting 8-13% of patients. Conclusion: Paclitaxel and cetuximab combination therapy may be suitable for treating R/M SCCHN. [ABSTRACT FROM AUTHOR]

Background/Aim: Nivolumab, an anti-PD-1 inhibitor, has demonstrated efficacy in patients with several types of recurrent and metastatic (R/M) squamous cell carcinoma of the head and neck. We evaluated patients with R/M-NPC receiving nivolumab. Patients and Methods: Twelve patients with R/M-NPC were enrolled at 4 institutions. The primary endpoint was overall survival, and secondary endpoints were i) progression-free survival (PFS), ii) overall response rate (ORR), iii) disease control rate (DCR), and iv) treatment-related toxicity. Results: The 1-year survival rate was 75.8%, the median PFS was 2.8 months, and the 1-year PFS rate was 33.3%. The best therapeutic response was complete response in 2, stable disease in 3 and progressive disease in 7 patients. The ORR of all patients was 16.7% and the DCR was 41.7%. Conclusion: Nivolumab is a useful and relatively safe second-line systemic therapy in patients with R/M-NPC, and even patients who do not respond to nivolumab may survive for a long time. [ABSTRACT FROM AUTHOR]

Background: In head and neck cancer, docetaxel, cisplatin and 5-fluorouracil (TPF) is often given in two or three cycles. The purpose of this study was to perform single-cycle TPF for chemoselection in patients with advanced hypopharyngeal laryngeal cancer. Patients and Methods: The study included 56 patients with stage III/IV advanced hypopharyngeal/laryngeal squamous cell carcinoma. The primary endpoint was progression-free survival (PFS), and secondary endpoints were overall survival (OS), TPF response rate, laryngeal sparing, and grade 3 or more adverse events. Results: The median PFS was 34.8 months. The median OS was not evaluable. The response rate was 71%. The median laryngeal preservation period was not estimable. Grade 3 or 4 adverse events were reported in 46 patients. Conclusion: PFS rate in this study may have been improved by selecting surgical treatment for patients for whom chemoradiotherapy seemed less effective. One cycle of TPF in induction chemotherapy appeared effective for chemoselection. [ABSTRACT FROM AUTHOR]