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Background/aim This study was conducted to compare the efficacy and safety of the weekly cetuximab plus paclitaxel (wCmab-PTX) regimen with those of the EXTREME regimen in patients with recurrent or metastatic oral squamous cell carcinoma (R/M OSCC). Patients and methods This multicenter retrospective study involved a chart review of the clinical records of R/M OSCC patients treated with wCmab-PTX in each institution between January 2013 and December 2017. Data were collected, and the efficacy, safety, and treatment outcomes were analyzed. Results The best overall response and disease control rates were 48.4% and 61.3%, respectively. The median PFS and OS were 6 and 13 months, respectively. There was no significant difference in prognosis with or without previous platinum administration. The grade 3-4 adverse events were leukopenia (16.1%), followed by acne-like rash (12.9%), and neutropenia (9.7%). All adverse events, excluding more than grade 3 infusion reactions, were tolerable and manageable. Conclusion wCmab-PTX may be considered as a treatment option for R/M patients with OSCC that is refractory to platinum-based chemotherapy, or progressive disease after receiving chemotherapy.

Although rare, ameloblastic carcinoma (AC) is one of the most common malignant tumors occurring in the odontogenic epithelium. Evidenced-based medical guidelines for AC are not established because AC is a rare type of cancer. However, surgery for AC is the primary initial treatment modality. A few reports suggest that radiotherapy (RTx) is effective for AC; however, the tumor is generally considered to be radioresistant. Furthermore, if RTx is performed for AC, osteonecrosis may occur because most of the ACs arise from the jaw. Here, we report a case of an older patient with maxillary AC who had underlying medical problems and who received conventional RTx with good outcomes. Ten years after the treatment, no major adverse event accompanying irradiation, local recurrence, or metastasis was observed. We discuss the therapeutic effect and usefulness of RTx on AC. As indicated by our findings, RTx for AC may represent a definitive treatment strategy for patients with poor general conditions or those with tumors that cannot be resected completely.

Japan's aging society has an increasing incidence of oral cancer. This study investigated perioperative changes in quality of life (QoL) among 172 oral cancer patients (elderly ≥75 years vs non-elderly75 years), pre-treatment, at treatment completion, and at 1, 3, and 6 months post-treatment, using the following Functional Assessment of Cancer Therapy - Head and Neck (FACT-HN) subscales: physical well-being (PWB), social/family well-being (SWB), emotional well-being (EWB), functional well-being (FWB), additional head- and neck-specific concerns (HN). SWB (P=0.026), HN (P=0.024), and total FACT-HN (P=0.009) scores were significantly lower in the elderly group than in the non-elderly group at 6 months post-treatment, especially for mastication items (HN1, P=0.047; HN11, P=0.004), but not for swallowing items (HN5 and HN7, both P0.05). PWB (P= 0.004), EWB (P0.001), and FWB (P= 0.022) scores in the non-elderly group were significantly higher at 6 months post-treatment than before treatment. In the elderly group, no subscale showed a better score at 6 months post-treatment. Post-treatment QoL in elderly oral cancer patients did not improve, unlike in non-elderly patients.

BACKGROUND Diffusion-weighted imaging (DWI) has been used for the detection and characterization of liver tumors because it has excellent contrast resolution. DWI using short tau inversion recovery (STIR) can improve tumor-to-liver contrast after gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid (Gd-EOB-DTPA) administration that shortens the T1 relaxation of liver parenchyma. PURPOSE To quantitatively and qualitatively compare the conspicuity of malignant liver tumors on DWI after Gd-EOB-DTPA administration between STIR and chemical shift selective (CHESS) sequences. STUDY TYPE Single-institution retrospective study. SUBJECTS Fifty-seven patients with histologically confirmed malignant liver tumors were evaluated. FIELD STRENGTH/SEQUENCE Low b-value DWIs with STIR and CHESS sequences 18-20 minutes after Gd-EOB-DTPA administration were acquired at 1.5T. ASSESSMENT Tumor contrast-to-noise ratio (CNR) and visual grade of tumor conspicuity on DWI between STIR and CHESS sequences were compared. STATISTICAL TESTS Paired Student's t-test and the Wilcoxon signed rank-test were applied. P

Currently, many studies are being performed that focus on the efficacy and safety of the vessel sealing system (VSS) in various fields of surgery. However, in the field of oral cancer surgery, the efficacy and safety of VSS use have not been clarified.One hundred and fifty-one patients underwent oral cancer resection and reconstructive surgery. They were divided into two groups: Ligasure vessel sealing system (LVSS) group and conventional surgery (CS) as control. Intra-operative blood loss, operating time, and incidence of post-operative complications and recurrence were analyzed.LVSS use significantly reduced intra-operative blood loss. The operating time was shortened only in mandibular gingiva cancer surgery. There were no differences between the two groups with regard to the incidence of post-operative complications and recurrence.LVSS use was found to be effective and proved to be efficient and safe, and may be useful in oral cancer surgery.

We report on the findings of the first antimicrobial susceptibility surveillance study in Japan of isolates recovered from odontogenic infections. Of the 38 facilities where patients representing the 4 groups of odontogenic infections were seen, 102 samples were collected from cases of periodontitis (group 1), 6 samples from pericoronitis (group 2), 84 samples from jaw inflammation (group 3) and 54 samples from phlegmon of the jaw bone area (group 4) for a total of 246 samples. The positivity rates of bacterial growth on culture were 85.3%, 100%, 84% and 88.9%, respectively, for groups 1, 2, 3 and 4. Streptococcus spp. isolation rates according to odontogenic infection group were 22% (group 1), 17.7% (group 3) and 20.7% (group 4). Anaerobic isolation rates were 66.9% (group 1), 71.8% (group 3) and 68.2% (group 4). Drug susceptibility tests were performed on 726 strains excluding 121 strains that were undergrown. The breakdown of the strains subjected to testing was 186 Streptococcus spp., 179 anaerobic gram-positive cocci, 246 Prevotella spp., 27 Porphyromonas spp., and 88 Fusobacterium spp. The isolates were tested against 30 antimicrobial agents. Sensitivities to penicillins and cephems were good except for Prevotella spp. The low sensitivities of Prevotella spp is due to β-lactamase production. Prevotella strains resistant to macrolides, quinolones, and clindamycin were found. No strains resistant to carbapenems or penems were found among all strains tested. No anaerobic bacterial strain was resistant to metronidazole. Antimicrobial susceptibility testing performed on the S. anginosus group and anaerobic bacteria, which are the major pathogens associated with odontogenic infections, showed low MIC90 values to the penicillins which are the first-line antimicrobial agents for odontogenic infections; however, for Prevotella spp., penicillins combined with β-lactamase inhibitor showed low MIC90 values.

Differentiation of glioblastomas (GBMs) and solitary brain metastases (SBMs) is an important clinical problem. The aim of this study was to determine whether amide proton transfer–weighted (APTW) imaging is useful for distinguishing GBMs from SBMs. We examined 31 patients with GBM and 17 with SBM. For each tumor, enhancing areas (EAs) and surrounding non-enhancing areas with T2-prolongation (peritumoral high signal intensity areas, PHAs) were manually segmented using fusion images of the post-contrast T1-weighted and T2-weighted images. The mean amide proton transfer signal intensities (APTSIs) were compared among the EAs, PHAs, and contralateral normal appearing white matter (NAWM) within each tumor type. Furthermore, we analyzed APTSI histograms to compare the EAs and PHAs of GBMs and SBMs. In GBMs, the mean APTSI in EAs (2.92 ± 0.74%) was the highest, followed by that in PHAs (1.64 ± 0.83%, p

The EuroQol 5-dimension scale (EQ-5D) is one of the most frequently used preference-based quality of life (QOL) measures for health technology assessment. The 3-level version of the EQ-5D comprises a descriptive system (the EQ-5D-3L) and a visual analog scale (EQ-VAS). It remains unclear whether this five-item scale correlates with the QOL of patients with oral cancer during the perioperative period. We sought to clarify this point in the present study.Participants were 84 patients with oral malignancies who underwent radical treatment and completed the EQ-5D-3L and Functional Assessment of Cancer Therapy-Head and Neck (FACT-HN) at regular intervals over 3 months after treatment. We analyzed the correlations between the EQ-5D-3L, EQ-VAS, and FACT-HN, and conducted multiple regression analyses to examine how the FACT-HN subscales relate to the EQ-5D-3L and EQ-VAS. We also investigated whether the EQ-5D-3L shows ceiling effects.The EQ-5D-3L and EQ-VAS were strongly correlated with the FACT-HN (rOur results indicate that actual physical performance might be most important for cost-utility analysis, whereas the assessment of familial feelings or friendship seems less important. However, the EQ-5D-3L appears to generally correlate with the FACT-HN of patients with oral cancer during the perioperative period. Therefore, it is reasonable to assess the cost performance of oral cancer treatment using the EQ-5D-3L in Japan.

Objective: The purpose of this study was to use patient data gathered by a hospital information system (HIS) to improve the safe performance of bedside radiography. Method: Hierarchical cluster analysis was used to investigate the factors of hospitalised patients who had undergone radiography in the X-ray room or at the bedside. Logistic regression analysis was then performed to quantify patient factors and calculate the probability of undergoing general radiography or bedside radiography. Results: Patients were grouped into six clusters by hierarchical cluster analysis on the basis of their factors. We found a remarkable difference between clusters for the ratio of bedside radiography. Results indicated that “types of transportation” and “level of mobility” related to the ratio of bedside radiography. Logistic regression analysis of the associations between the probability of undergoing bedside radiography and patient factors indicated that type of transportation and level of mobility were highly correlated with bedside radiography or general radiography. Conclusion: Our results suggested that the secondary use of HIS data for the quantitative evaluation of patient factors and implementation of those quantitative values in medical records may be useful for the safe performance of bedside radiography as well as providing a method of decision support for doctors to order bedside radiography.

Lateral retropharyngeal lymph node (LRPLN) is located between the internal carotid artery and the prevertebral muscles. Metastasis to the LRPLN is frequent in nasopharyngeal cancer, but is rare in oral cancer. The prognosis of patients with oral cancer with LRPLN metastasis is usually poor. The present study reported a patient with LRPLN metastasis from squamous cell carcinoma of the upper gingiva, who survived for >7 years. Docetaxel, cisplatin and fluorouracil (TPF) therapy was performed as induction chemotherapy and it was planned to subsequently conduct chemoradiotherapy or surgery. As the tumor only exhibited a transient response to TPF, surgery was selected. Postoperatively, only radiotherapy was performed and a favorable outcome was achieved.

Intralesional steroid injections were administered in two patients with central giant cell granuloma of the jaw (CGCG). In these patients, intralesional corticosteroid injections resulted in disappearance of the lesions and callus formation at the sites of bone resorption on radiographs during follow-up. Surgical curettage or excision and radiation therapy have been reported as treatments for CGCG, in addition to intralesional steroid injection. However, CGCG occurs predominantly in young adults. Considering the tissue defects caused by surgical treatments and side effects of drugs, intralesional steroid injection appears to be the most minimally invasive procedure and to yield favorable results. In treatment of CGCG, intralesional corticosteroid injection, a minimally invasive procedure, could be considered the first choice for treatment of CGCG, while surgery should be performed for recurrence.

We present a case of a 46-year-old Japanese woman with an eosinophilic ulcer of the oral mucosa (EUOM), located in the buccal mucosa, who was found by various examinations to be a human T-cell leukemia virus type I (HTLV-1) carrier with peripheral eosinophilia. Her peripheral eosinophilia and EUOM promptly improved in response to oral corticosteroid therapy. EUOM has been described to be possibly associated with trauma, but its etiology has not been fully elucidated to date. In the present case, the presence of peripheral eosinophilia in addition to the EUOM indicated possible influence of certain immune system abnormalities associated with HTLV-1 infection.

Numb chin syndrome (NCS), also known as mental nerve neuropathy, is characterized by facial and oral numbness restricted to the distribution of the mental nerve. Although not a common neuropathy, the clinical importance of this syndrome is its frequent association with malignancies, particularly breast cancer and lymphoma. In this paper, we present a rare case of Burkitt cell acute lymphocytic leukemia initially presenting with bilateral NCS. In this case, no abnormalities were detected on initial blood tests and radiologic investigations except for partial loss of lamina dura around mandibular teeth. Furthermore, we found no evidence of any other signs of central nervous system involvement apart from NCS. Nevertheless, the patient continued to experience severe bilateral mandibular pain and paresthesia, prompting us to repeat the blood studies. These showed lymphomatous cells, yielding the diagnosis of leukemia 37 days after the original presentation. When a patient presents with the extremely unusual symptoms of bilateral numbness of lower lip and chin, we should suspect the presence of a malignancy even in the absence of any relevant past history. If the initial radiologic investigations and blood tests reveal no abnormalities, malignancy should not be removed from the differential diagnosis until a definite cause has been found.

Of all oral squamous cell carcinomas, squamous cell carcinomas of the buccal mucosa (BSCC) are most associated with poorest prognosis. In particular, patients treated with surgery alone are reported to experience frequent local failures. This is considered to result from the surgeon's determination of the deep surgical margin for resection based on palpation alone when performing BSCC surgery. Therefore, an objective system for classifying the depth of invasion of a tumor appears to be necessary in order to improve the results of BSCC treatment. While current general practice is to treat based on tumor thickness, we would like to emphasize the importance of how far down the cheek wall layer the tumor has invaded. We performed surgery by classifying the depths of tumor invasion in relation to the buccinator. Depth of tumor invasion was assessed mainly using ultrasonography (US). The tumor was defined as D1 when it extended to the mucosal (m) and submucosal layers (sm). In these cases, the tumor was resected, while the buccinator was spared. The tumor was defined as D2 when it extended to the buccinator, but, based on US, muscle continuity was preserved, and the tumor was resected to include the buccinator and its overlying fascia. When the tumor had spread to the buccinator or invaded subcutaneous or cutaneous tissue it was classified as D3 and resection included the skin. The disease-specific survival rate of BSCC when treated based on our classification was 73.7% and the local control rate was 89.5%. These results are superior to those based on surgery alone and this therapeutic modality was considered to be useful.

A case of nodular type lipomatosis arising from both borders of the tongue is reported. The patient was a 72-year-old man who presented with multiple nodules arising bilaterally from the margin of the tongue. The nodules were elastic and soft, and the mucosa of the tongue surface was normal. Excisional biopsy was performed on the right-side nodules. The left-side nodules were extirpated 9 months after the excisional biopsy on the right side. The histopathological diagnosis was lipomatosis. There has been no sign of recurrence as of 1 year after surgery. The patient had a history of alcoholic hepatitis, hypertension, hyperlipidemia, and hyperuricemia. Lipomatosis of both borders of the tongue was suggested to be associated with local factors (e. g., teeth, bite occlusion, trauma) and systemic disorders (e. g., alcoholism, liver dysfunction, hyperlipidemia).

An 82-year-old woman was referred to Tokai University Hospital because of swelling of the upper jaw. Biopsy was performed, and the diagnosis was squamous cell carcinoma. Because she had coronary artery disease, percutaneous transluminal coronary angioplasty (PTCA) was performed before surgery for the upper gingival cancer. Consequently, surgery was able to be performed without perioperative cardiac complications. However, coronary restenosis occurred 1.5 months after PTCA, and an intracoronary balloon-expanded stent was inserted at the site of restenosis.Currently, there has been no local tumor recurrence and no angina pectoris.

A 56-year-old woman presented to our clinic with a mass in the floor of the mouth. This patient had been given a diagnosis of sleep apnea syndrome at the Department of Respiratory Disease of our hospital. The body mass index was 34.4, indicating slight obesity, and the apnea hypopnea index (AHI) was 38.2/hr. Oral examination revealed a bony eminence arising bilaterally from the mandible anterior to the tongue and extending to the premolar region.After resecting the mandibular eminence, the AHI improved to 20.9/hr. However, since sleepapnea persisted, control of obesity by weight reduction was considered necessary.

Metastatic tumors of the oral region are very rare, accounting for approximately 1% of intraoral malignant tumors. Caudal-related homeobox transcription factor (CDX2) regulates the development and differentiation of intestinal epithelial cells. We report herein a case of metastatic gingival tumor from rectal cancer after low anterior resection in which immunohistochemical analysis of CDX2 was useful for diagnosis of the origin. To the best of our knowledge, our case is the first report that immunohistochemical staining with CDX2 can contribute to diagnose metastatic gingival tumor from rectal cancer.

Purpose The duration of follow-up after treatment of oral squamous cell carcinoma and the frequency of routine visits are based on common usage rather than evidence-based practice. The purpose of this study was to determine the appropriate postoperative routine follow-up program in patients with oral squamous cell carcinoma. Patients and Methods Three hundred four cases treated curatively mainly by surgery at Tokai University Hospital from 1994 to 2004 were analyzed. A secondary event was defined as a local recurrence, a regional recurrence, a distant metastasis, or a second primary cancer. To evaluate the follow-up program, data on the first tumor recurrence or first second primary tumor in the head and neck region or elsewhere in the body were used. Overall survival rate, disease-specific survival rate, relapse-free rate, and cumulative risk of developing a second primary cancer were estimated by the Kaplan-Meier product limit method. Result All relapse cases were detected within 3 years postoperatively, of which 86.3% were detected within 1 year. Most relapses were in the neck, and regional recurrences had a dismal salvage rate. Second primary cancers were constantly detected 1 to 10 years postoperatively. Conclusion Follow-up should be performed more frequently in the first year, with 2 weekly follow-ups with monthly ultrasound examinations, and should be continued after 3 years to exclude the development of second primary cancers.

It has been reported that cyclooxygenase-2 (COX-2) plays roles in cell proliferation, tumor invasion and inhibition of apoptosis. We reported COX-2 expression in salivary adenoma and its involvement in inhibition of apoptosis. COX-2 is known to induce a number of cytokines and growth factors. On the other hand, hepatocyte growth factor (HGF) plays roles such as cell migration, proliferation, angiogenesis and inhibition of apoptosis. Recently it has been reported that HGF also plays a role in tumor differentiation in salivary gland tumors. So, we investigated that whether COX-2 expression affected HGF expression clinicopathologically, and discussed the roles of COX-2 pathway in salivary gland tumors. Tissues samples were pleomorphic adenomas (n = 40) obtained surgically. COX-2 expression and HGF expression were examined immunohistochemically. Immunostaining intensities of COX-2 and HGF were classified as +3 to 0. Spearman's rank correlation was used to examine correlation of COX-2 and HGF expression. Furthermore, a salivary gland tumor cell line, HSG, was cultured after administration of either 0, 10, 100 units of COX-2 and quantification of HGF mRNA was analyzed by Real Time PCR using the Light Cycler System. In pleomorphic adenoma, COX-2 and HGF were mainly expressed in luminal tumor cells, and the sites of expression of the two were almost the same. Immunostaining intensity of COX-2 expression was significantly correlated with intensity of HGF expression (p = 0.003, r = 0.457). Moreover, the content of HGF mRNA expression increased when COX-2 was administered to salivary gland tumor cell line HSG. It is suggested that COX-2 expression may induce HGF expression in salivary gland tumors.

Obese diabetes was induced by monosodium aspartate (MSA) administration in KK male mice and the diabetic KK mice were divided into two groups, younger (12-week-old) and older (35-week-old). The diabetic KK mice were castrated and administered with androgen and effect of androgen on glycosuria appearance was investigated. Androgen dependent tear proteins (Mtp-M) were detected by the method of polyacrylamide gel electrophoresis. Blood androgen level was estimated by observation of change of the pattern of Mtp-M. In the younger mice group, glycosuria disappeared temporarily after castration and then appeared naturally again. The Mtp-M declined with castration, but did not disappear in this experimental period. In the older mice group, glycosuria and Mtp-M disappeared completely and blood glucose level decreased considerably after castration. However, in the castrated older mice, the glycosuria and the Mtp-M appeared again after the administration of dehydroepiandrosterone (DHEA), and the increasing of blood glucose level was observed. These results strongly suggested that androgen had an important role in the onset of diabetes in the KK mice treated with MSA.