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Purpose This study assessed the efficacy of upfront neck dissection (ND) versus concurrent chemoradiotherapy (CRT) in patients diagnosed with T1–3N3 hypopharyngeal carcinoma (HPC).Methods This retrospective study enrolled patients with T1–3N3 HPC who had undergone upfront ND followed by CRT (upfront group) or only CRT (CRT group). Local control rate, neck control rate, metastasis-free rate, disease-free survival, disease-specific survival, and overall survival were compared between the upfront and CRT groups. Univariate and multivariate analyses using Cox proportional hazards models were performed to identify the survival-related clinical and systemic factors.Results Forty-eight patients were enrolled in this study, with 18 in upfront group and 30 in CRT group. The groups differed significantly in terms of neck control rate (p = 0.000121) and disease-free survival (p = 0.0256). The upfront CRT group showed a significantly better overall survival (OS) than that of the unresectable CRT group (p = 0.046). Among the various factors, node status, body mass index, and platelet-to-lymphocyte ratio were significantly associated with OS in a univariate analysis.Conclusion Upfront ND can be recommended for T1–3N3 HPC, provided resectability is feasible.

In December 2019, pembrolizumab was approved in Japan for the treatment of head and neck cancer with recurrence or distant metastasis, making it a new option for first-line treatment. However, there are still many unanswered questions about Overall survival (OS), Progression free survival (PFS), adverse events including immune-related adverse events (irAEs), and biomarkers.The aim of this study was to retrospectively review first-line treatment of head and neck cancer with recurrence or distant metastasis treated with pembrolizumab and to determine whether Combined positive score (CPS) is still useful as a biomarker in the clinical practice.We retrospectively reviewed clinical records of 20 patients who received pembrolizumab as first-line treatment for head and neck cancer with recurrence or distant metastasis between December 2019 and March 2021.Age ranged from 45 to 83 years (median 66 years), 17 male patients and 3 female patients. The response rate was 40%, and the disease control rate was 60%. OS and PFS in patients with CPS1 were significantly worse than those with CPS ≤ 1 (CPS-positive patients). The OS and PFS of patients with CPS1 were s ignificantly worse than those of p atients with 1= CPS (CPS-positive p atients), and there was no significant difference between the group with CPS between 1 and 20 and the group with CPS over 20. And we experiences several CR cases with high CPS.CPS is a useful biomarker for pembrolizumab.There are no reported cases of CR after two courses of pembrolizumab in head and neck cancer. There are no reports of pembrolizumab in patients with head and neck cancer in Japan.

This study aimed to determine the prognostic value of inflammatory and nutritional biomarkers of immune checkpoint inhibitor (ICI) therapy for recurrent or metastatic squamous cell carcinoma of the head and neck (RMHNSCC) and to identify the most useful factor for prognosis assessment. We retrospectively reviewed the medical records of patients with RMHNSCC who received ICI therapy. The response rate for ICI therapy and the relationship between inflammatory and nutritional biomarkers and overall survival were examined. The included biomarkers did not correlate with an objective response rate but were associated with a disease control rate. Univariate analysis showed significant correlations between the serum albumin level, C-reactive protein level, platelet to lymphocyte ratio, neutrophil to lymphocyte ratio, lymphocyte to monocyte ratio (LMR), systemic immune-inflammation index, and controlling the nutritional status score and overall survival; multivariate analysis showed that LMR was significantly correlated with overall survival. LMR was the most important biomarker according to the machine learning model. This study suggests that LMR may be the most useful biomarker for predicting the prognosis of ICI treatment for RMHNSCC.

BackgroundRed ear syndrome is a rare disorder in which the colour of the ear suddenly becomes red, with discomfort, pain and a burning sensation. This paper reports a case of primary red ear syndrome presenting with vestibular migraine.Case reportA 39-year-old woman from Bangladesh reported dizziness and repeated headaches experienced since 18 years of age. She initially attended our hospital with dizziness aged 34 years. When dizzy, the colour of her right ear sometimes became red. Therefore, she was diagnosed with red ear syndrome with vestibular migraine.ConclusionThis patient experienced repeated episodes of a red ear with discomfort, leading to the diagnosis of red ear syndrome. In addition, she had repeated dizziness and headaches, and was also diagnosed with vestibular migraine. The diagnosis of red ear syndrome with vestibular migraine should be considered in cases of dizziness and headache with recurrent redness of the ear.

Gardner syndrome (GS) with odontogenic sinusitis is rare but should be suspected in patients with multiple osteomas of the skull and facial bones, excess teeth, impacted teeth, and odontomas. Early diagnosis of GS and treatment for familial adenomatous polyposis may improve prognosis.

A 42-year-old woman presented to our clinic with tongue pain and dysarthria. She had a smoking history of 22 pack-years and no history of alcohol consumption. A deep ulcer at the left side of the tongue and induration across the whole tongue were observed. The bilateral cervical lymph nodes were palpable. A biopsy from the ulcer revealed squamous cell carcinoma. PET/CT showed sternal bone metastasis resulting in the final diagnosis of left-sided oral tongue cancer (cT4aN2cM1). Systemic chemotherapy treatment involving 6 courses of the EXTREME regimen followed by weekly cetuximab administration was indicated.After the first two courses, diminished tongue pain and improved dysarthria were observed; complete response was obtained after 6 courses. Re-examination of the biopsy specimen showed that the tumor was p16 positive. The p16 protein is a surrogate marker for HPV, but in this case HPV in-situ hybridization was negative. Locoregional or distant failure were not observed during the 5-year follow-up period.The treatment regimen unexpectedly proved successful. It may be beneficial to examine p16 expression in oral tongue cancer to identify patients that are more likely to benefit from the EXTREME treatment regimen.

Background Several reports have suggested that selected patients with human papillomavirus-related oropharyngeal cancer can be managed with surgery alone. We retrospectively reviewed tonsillar cancer cases to analyze treatment de-intensification after transoral resection. Methods Eighteen patients with tonsillar cancer who had undergone transoral resection were included. The patients' characteristics, p16 status, adverse features, clinical course, overall survival, and relapse-free survival according to p16 status were retrospectively examined. Results Four lesions showed positive surgical margins and one lesion showed close surgical margin; these patients were treated with postoperative irradiation. Seven p16-positive patients had multiple node metastases and two had extracapsular spread. No p16-positive patients agreed to postoperative irradiation, and recurrence within the surgical field was not observed. The five-year overall and relapse-free survival rates were 89% and 74%, respectively. The five-year relapse-free survival rates of p16-positive and p16-negative patients were 81% and 50%, respectively (p = .075). Conclusions Postoperative irradiation for cervical lymph node metastases might be avoidable in selected patients with human papillomavirus-related tonsillar cancer. Level of Evidence 4.

Background Several reports have suggested that selected patients with human papillomavirus‐related oropharyngeal cancer can be managed with surgery alone. We retrospectively reviewed tonsillar cancer cases to analyze treatment de‐intensification after transoral resection. Methods Eighteen patients with tonsillar cancer who had undergone transoral resection were included. The patients' characteristics, p16 status, adverse features, clinical course, overall survival, and relapse‐free survival according to p16 status were retrospectively examined. Results Four lesions showed positive surgical margins and one lesion showed close surgical margin; these patients were treated with postoperative irradiation. Seven p16‐positive patients had multiple node metastases and two had extracapsular spread. No p16‐positive patients agreed to postoperative irradiation, and recurrence within the surgical field was not observed. The five‐year overall and relapse‐free survival rates were 89% and 74%, respectively. The five‐year relapse‐free survival rates of p16‐positive and p16‐negative patients were 81% and 50%, respectively (p = .075). Conclusions Postoperative irradiation for cervical lymph node metastases might be avoidable in selected patients with human papillomavirus‐related tonsillar cancer. Level of Evidence 4.