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Biomedical subjects

Y Inuyama

Publications and source records attributed to Y Inuyama.

At least 145 records · Page 8Linked to original sources
PubMed1986

Improved survival of patients with nasopharyngeal squamous cell carcinoma.

One hundred and one patients with nasopharyngeal squamous cell carcinoma (NPC) were treated with irradiation. The UICC TNM staging system (1978) was used: 6 patients were T1N0, 10 T2N0, 5 T3N0, 13 T4N0, 11 T1N+, 18 T2N+, 19 T3N+ and 19 T4N+. Since 1978, 34 patients were examined with computed tomography (CT) at first presentation. Fourteen (41%) of the 34 tumors were upstaged based on the CT findings alone. The technique of radiation therapy was markedly changed around 1978. The fields to the primary site and neck were enlarged. Two-year relapse-free survival was significantly better for the post-CT era than pre-CT era. This was mainly because of improved local-recurrence-free survival, and cervical-relapse-free survival. Improved local-recurrence-free survival, however, was appreciated in only T3 + T4 patients; there was no difference in T1 + T2 patients. It is suggested that merely enlarging radiation fields or increasing radiation doses could not be curative for some subpopulations. In order to increase local control rates further, we have started to use intracavitary irradiation with an after-loading technique as a boost. Preliminary results are encouraging.

Adolescent↗
PubMed1986

Maxillary squamous cell carcinomas staged by computed tomography.

In 72 patients with maxillary squamous cell carcinoma, computed tomography (CT) alone was used for T-staging according to the AJC classification. Five, 31, and 36 tumors were diagnosed as T2, T3, T4, respectively. In N0 patients with a minimum follow-up of 2 years, local control rates for T2, T3, and T4 tumors were 33% (1/3), 64% (16/25) and 38% (9/24), respectively. Addition of maxillectomy to treatment seemed to have improved the local prognoses in T3 and T4 tumors. High radiation doses of 60 Gy or more seemed to be beneficial for patients with T3 tumors and without maxillectomy. CT will be of great help in classifying tumors objectively. But more importantly, it will reveal resectability and dictate treatment of choice by delineating the tumor extent precisely.

Carcinoma, Squamous Cell↗
PubMed1986

Combination chemotherapy with cisplatin and peplomycin in squamous cell carcinoma of the head and neck.

Ninety-three patients with head and neck cancer were treated with combined cisplatin-peplomycin chemotherapy (CP therapy). Cisplatin (CDDP) 50 mg/m2 i.v. (intravenous) or i.a. (intraarterial) over 2 hr was given with hydration and mannitol diuresis on day 1. From day 2 through day 6, peplomycin (PEP) 5 mg/day was administered by 5-hr i.v. or i.a. infusion, or 24-hr continuous hypodermic injection. Of 85 who were evaluable, there were 22 complete responses or CR (26%) and 36 partial responses or PR (42%), with an overall response rate of 68%. Concerning of the route of administration, i.a. infusion obtained the higher CR and overall response rates than i.v. infusion. Effectiveness was clearly greater in previously untreated cases than in cases that had received some previous therapeutic modality. Looking at response in relation to the number of the courses, at least 2 courses of CP therapy are required. Side effects were recognized in 68 out of 87 evaluable cases (78%). Nausea and vomiting were the most common (62%). Renal toxicity was observed in 24% and was mostly transient. From the above results, it is considered that the CP therapy is effective, not only for the palliative treatment of advanced and recurrent cancer of the head and neck, but also as neo-adjuvant chemotherapy of stage III and IV cases.

Adult↗
PubMed1986

[A cooperative phase II study of cisplatin in patients with head and neck cancer].

A cooperative phase II study of cisplatin in head and neck cancer was conducted in 23 institutions. Eighty-nine patients were entered into this trial, of which 73 were evaluable. Two different regimens were employed in this study. Regimen A: cisplatin 10 mg/m2 intravenous (i.v.) infusion daily, days 1-5, q 3 wk. Regimen B: cisplatin 50 mg/m2 i.v. infusion, day 1, q 3 wk. Two patients achieved complete response and 17 achieved partial response with an overall response rate of 26.0%. By histological types, the response rate was 26.3% in the case of squamous cell carcinoma. Partial response were observed in 2 cases of adenocarcinoma and in one case each of adenoid cystic carcinoma and transitional cell carcinoma. The response rate was 19.4% for previously treated patients, as compared to 63.6% for the previously untreated group. Toxic effects were observed in 94.7% of 76 evaluable cases. From 50 to 68% of patients experienced nausea, vomiting and anorexia. No patient exhibited a serum creatinine level exceeding 2 mg/dl. Anemia and leukopenia were observed in 58.9% and 32.9% respectively. It is therefore concluded that cisplatin is markedly useful for the treatment of head and neck cancer.

Adenocarcinoma↗
PubMed1986

[The role of computed tomography in the diagnosis and treatment of malignant tumors of the nasal cavity, paranasal sinuses and nasopharynx].

We studied the value of computed tomography (CT) in diagnosis and treatment of primary malignant tumors of the sinonasal cavities and nasopharynx, and reached the following conclusions. 1) In maxillary carcinomas, bone destruction is always seen on CT. When bone destruction is not apparent despite invasion to the adjacent site, malignant lymphoma or plasmacytoma is suggested. 2) In defining the tumor extent of maxillary SCC, CT is more reliable than maxillotomy, and is equal to maxillectomy. However, clouding of the sinus without bone destruction remains a problem, since this finding can be caused by either tumor invasion or obstructive sinusitis. 3) In maxillary and nasopharyngeal SCC, CT frequently reveals tumors to be more extensive than previously suspected following physical and conventional x-ray examinations. Therefore, the T-stages of these tumors are often upstaged to more advanced ones. 4) CT is of great help in identifying candidates for surgery in maxillary SCC, and in planning radiation therapy for nasopharyngeal and sinonasal tumors. Dose distribution curves displayed directly on the CT slices are becoming essential tools for radiation oncologists. After the introduction of CT, treatment results in cases of nasopharyngeal SCC have improved, probably due to better definition of the tumor volumes. 5) CT is also used for observing tumor response after therapy and for follow-up. In summary, CT is now indispensable in the management of malignant tumors of these sites.

Diagnosis, Differential↗
PubMed1985

Prognostic factors influencing relapse of squamous cell carcinoma of the maxillary sinus.

In 95 surgically staged patients with squamous cell carcinoma of the maxillary sinus, multivariate regression analyses were employed to identify prognostic factors. Possible prognostic factors for local control were TNM stage and type of surgical procedures: T2 or T3 tumors and use of total maxillectomy showed better local control rates (P less than 0.01). High radiation doses of 40 Gy or more also seemed to be of prognostic significance: P less than 0.2 for 40 to 60 Gy, and P less than 0.1 for 60 Gy or more. The risk of cervical relapse increased when the cheek or alveolus was grossly involved (P less than 0.2). However, since cervical relapse frequently accompanied uncontrollable primary recurrence or distant spread, and since cervical relapse alone was frequently salvaged by radical neck dissection, prophylactic irradiation to the neck is not recommended. Sex, age, nodal state, addition of chemotherapy, total doses of bleomycin or 5-fluorouracil (5-FU), or intra-arterial administration of chemotherapeutic agents did not appear to be of prognostic significance.

Adult↗
PubMed1985

Reconstruction of the total cheek defect by free myocutaneous flap.

Our reconstructive method utilizing the free latissimus dorsi myocutaneous flap by microneurovascular anastomosis is a rewarding method for the patient with total cheek defect after cancer surgery of the maxillary sinus from the standpoint of morphology, function, and psychology.

Aged↗
PubMed1985

Neoadjuvant chemotherapy in maxillary sinus carcinoma with cisplatinum and peplomycin intraarterial infusion.

The purpose of this paper is to present our preliminary assessment of a new multimodal treatment including neoadjuvant chemotherapy with cisplatinum and peplomycin for maxillary sinus carcinoma. Fifteen patients with squamous cell carcinoma of the maxillary sinus carcinoma seen at Keio University Hospital, with Stage III and IV disease, were enrolled in this trial between January 1982 and January 1985. Regimen of chemotherapy was as follows: day 1, 50 mg/m2 of cisplatinum, intraarterial infusion over 2 hr, days 2-6, peplomycin at a dose of 5 mg/day, intraarterial infusion over 5 hr. Routinely, radiotherapy of 40 Gy by Linac was given to the primary site, concomitantly combined with 5-fluorouracil intraarterial injections only during the first 10 days, 2 weeks after the end of initial chemotherapy. Additional treatment was performed according to the extent of residual tumor. Response to initial chemotherapy revealed that complete response was achieved in 7 and partial response in 6 out of 15 patients with a response rate of 87%. Nine patients required no surgical intervention while 6 underwent a surgical resection. Median follow-up in this group of patients is 20 months. Thirty-month survival rate calculated by Kaplan-Meier's method was 83%. Chemotherapy toxicity was mild in most cases. This pilot study does not provide conclusive survival information, but the results obtained are encouraging.

Aged↗
PubMed1985

Clinical trials on UFT in the treatment of head and neck cancer.

A new anticancer agent, UFT which is a mixture of 1-(2-tetrahydrofuryl)-5-fluorouracil and uracil in a molar ratio of 1:4 was administered orally at a dose of 600 mg/day every day. Forty-three patients were evaluable. Eight patients achieved a complete response and eight achieved a partial response with an overall response rate of 37.2%. In terms of response by histology, a response rate was 32.4% (11/34) in cases of squamous cell carcinoma and 75% (3/4) in cases of adenocarcinoma. A response rate by primary site was 57.1% in the nose and paranasal sinuses, 50.0% in the oropharynx and 30.0% in the oral cavity. A response rate was 36.1% in patients with prior treatment and 42.9% in patients with no prior treatment, but there was no statistical significance. Eight of 43 patients developed toxic effects. Most of them were mild such as anorexia, nausea, and stomatitis, but in one case of maxillary sinus carcinoma, severe bone marrow suppression was observed. UFT is a considerably effective and useful drug in the treatment of head and neck cancer. It is possible to increase cure rate by examining various usages of UFT.

Adult↗
PubMed1985

[Multidisciplinary treatment of head and neck cancer].

A new multidisciplinary treatment for head and neck cancer was shown by focusing on the maxillary and oropharyngeal carcinoma. Neo-adjuvant chemotherapy which consists of cisplatin and peplomycin was incorporated into it. In terms of maxillary carcinoma, 2 courses of chemotherapy were given with an interval of 2 weeks, followed by radiotherapy (40 Gy) combined with intraarterial chemotherapy (5-FU). When no cancer cells were detected at the completion of this therapy, adjuvant chemoimmunotherapy was given. When an apparent tumor was still revealed by CT, radical surgery was performed. When cancer cells were detected only by histological examination, additional radiotherapy up to 60 Gy was given by Linac. The results obtained were analysed in 14 cases. We also presented another type of multidisciplinary treatment in oropharyngeal carcinoma.

Aged↗
PubMed1985

[Preoperative chemotherapy for head and neck cancer].

The authors have studied preoperative chemotherapy for head and neck cancer since 1963, focusing on intra-arterial chemotherapy. The results obtained revealed that preoperative chemotherapy played an important role in the improvement of 5-year survival in maxillary sinus carcinoma and tongue carcinoma. However, functional and cosmetic damage after radical surgery has newly energed as problems to be resolved. The appearance of cisplatin has raised an important the level of effectiveness of cancer chemotherapy in recent years. Since the combination of cisplatin and bleomycin analogs revealed a remarkable synergistic effect in experimental chemotherapy, it has been used clinically as preoperative or preradiation chemotherapy for advanced Stage III and IV head and neck cancer. Under the above-mentioned circumstances, treatment for head and neck cancer has undergone various changes over the past twenty years. At present it is no exaggeration to say that the period in which dependence was placed on only surgery and/or radiation is over. The authors would like to emphasize that preoperative chemotherapy should be carried out as a part of multidisciplinary approach under a new concept of neo-adjuvant chemotherapy which includes not only preoperative chemotherapy but also preradiation chemotherapy. The role of preoperative chemotherapy, its current status and future prospects are discussed in this paper, looking back on the history of chemotherapy for head and neck cancer.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1985

[Recombinant interferon alpha-2 (Sch 30500) in patients with head and neck cancer].

Fifteen patients with advanced recurrent or metastatic carcinoma of the head and neck were treated with recombinant interferon alpha-2. Cumulative doses for evaluation of at least 1.2 X 10(8) IU were given over a period of 4 weeks. No significant regression was shown in 14 evaluable patients, 6 of which showed no change and 8 progression. Toxicities were minimum and acceptable. All patients had an episode of elevated body temperature. One patient showed transient effects on the central nervous system, which may be a dose-limiting factor. Recombinant interferon alpha-2 was therefore not recommended as a modality for the treatment of recurrent head and neck cancer.

Adult↗
PubMed1985

[Phase II study of UFT for head and neck cancer].

A Phase II study of UFT for head and neck cancer was conducted in 10 institutions. UFT is a mixture of Futraful and uracil. Eighty-four patients entered this trial, of which 60 were evaluable. UFT was administered orally at a daily dose of 600 mg/day. Eight patients achieved complete response and 10 achieved partial response with an over-all response rate of 30.0 %. Evaluating response according to by histology, the response rate was 30.9% for cases of squamous cell carcinoma. Complete response was observed in one case of undifferentiated carcinoma. Response rate according to primary site was 33 to 40% for the nose & paranasal sinuses, mesopharynx, hypopharynx and larynx. The response rate was 28.9% for the group of patients treated previously, and 33.3% for the group previously untreated. The mean time for 50% or more regression of the tumor was 4.3 weeks. Toxic effects appeared in 40.3% of 67 evaluable cases as anorexia, nausea, vomiting, stomatitis, diarrhea etc. In one case of maxillary carcinoma, severe bone marrow suppression was observed. We concluded that UFT therapy was markedly effective for head and neck cancer.

Adult↗
PubMed1984

Patterns of relapse of squamous cell carcinoma of the maxillary sinus.

Ninety-five M0 patients with squamous cell carcinoma of the maxillary sinus were treated mainly with combined surgery, radiation and chemotherapy. They were staged surgically according to the American Joint Committee TNM classification: 3 were T2N0, 55 T3N0, 27 T4N0 and 10 T3-4N1-3 patients. Relapse developed in 66 patients (69%): one (33%), 35 (64%), 22 (81%) and 8 (80%), respectively. All patients experienced relapse within 2 years after diagnosis. Local recurrence developed during the course of disease in 52 (79%) of the 66 patients who relapsed. Three patients with cervical relapse and one with local recurrence were successfully salvaged with rescue surgery. Local control achieved in 39 (41%) of the 95 patients: 2 (67%), 28 (51%), 7 (26%) and 3 (30%) in T2N0, T3N0, T4N0 and T3-4N1-3 patients, respectively. Autopsy findings of 17 patients are presented. An impact of computed tomography on staging of maxillary sinus tumors is discussed.

Adult↗
PubMed1984

[Cancer of the maxillary antrum--a new multidisciplinary treatment containing neo-adjuvant chemotherapy].

During the period 1957-1982, 227 patients with maxillary carcinoma were treated. These cases were divided into 4 groups according to periods and methods of treatment. Five-year determinate survival figures for each group are as follows: I (1957-1966) 22%, 20/91, II (1967-1973) 40%, 27/67, III (1974-1978) 37%, 13/35, IV (1979-1982) 56%, 9/16 (3-year survival). The incorporation of intraarterial chemotherapy into the treatment of maxillary carcinoma has much contributed to an improvement of 5-year survival. Since 1982, a new multidisciplinary treatment containing neo-adjuvant chemotherapy has been introduced into the treatment of this type of carcinoma. Neo-adjuvant chemotherapy: day 1, cisplatin ( CPDD ) 50 mg/m2 or 80 mg/body i.a. over 2 hr., day 2-6, peplomycin (PEP) 5 mg/day i.a. over 5 hr. Two courses of chemotherapy were given with an interval of 2 weeks. Radiotherapy combined with intraarterial chemotherapy: Linac. 40 Gy/4 wks., 5-FU i.a. 250 mg/day q.d. (for 10 days). When no cancer cells were detected at the completion of this therapy, adjuvant chemoimmunotherapy was given. When an apparent tumor was still revealed by CT, radical surgery was performed. When cancer cells were detected only by histological examination, additional radiotherapy up to 60 Gy was given by Linac. The results obtained were analysed in 9 patients who completed this therapy. At the completion of CPDD and PEP treatment, complete response was achieved in 5 cases and partial response in 3 cases with a response rate of 89%. In 2 out of the 9 cases, no cancer cells were detected by histological examination after chemotherapy. No cancer cells were detected in 2 other cases after 40 Gy by Linac. combined with 5-FU i.a. infusion, and in 3 other cases after 60 Gy by Linac. combined with 5-FU. Two patients had radical surgery because of uncontrolled tumors. Periods of follow-up are too short, but it is expected that this new multidisciplinary treatment results in the higher survival.

Aged↗