JSCO2016: International Session 16 Head and Neck Cancer

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The 54th Annual Meeting of Japan Society of Clinical Oncology (JSCO2016)

"Renovation of Cancer Medicine in the Mature Society"



International Session 1: Lung Cancer
International Session 2: Colorectal Cancer
International Session 3: Gastric Cancer
International Session 4: Urological Cancer (Prostate and Renal Cancer)
International Session 5: Supportive Care for Adverse Events
International Session 6: Gynecological Cancer (Uterine Body Cancer and Ovarian Cancer)
International Session 7: Central Nervous System Tumor
International Session 8: New Development of Particle Beam Therapy for Cancer
International Session 9: International Cooperation in Radiation Medicine
International Session 10: Recent Advances In Cancer Immunotherapy
International Session 11: Breast Cancer
International Session 12: Pharmacology of Antitumor Agents: New Drug Application (NDA)
International Session 13: Malignant Lymphoma
International Session 14: Palliative Care
International Session 15: Radiation Therapy
International Session 16: Head and Neck Cancer
International Session 17: Skin Cancer (Malignant Melanoma)
International Session 18: Hepato-Biliary and Pancreas Cancers
International Session 19: Leukemia
International Session 20: Ethics for Clinical Research
International Session 21: Esophageal Cancer
International Session 22: Bone and Soft Tissue Tumor
FACO/JSCO Joint Symposium

Abstract Archives (in Japanese)

International Session 16: Head and Neck Cancer


Japanese Clinical Practice Guideline for Head and Neck Cancer
Ken-ichi Nibu (Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine)
Japanese clinical practice guideline for Head and Neck Cancer was revised in 2013. 34 clinical questions (CQ) were newly adopted and recommendation grades (RG) made by the consensus of the committee were described.
I Oral Cancer:
Surgery is the mainstay of treatment for oral cancers. Brachytherapy is indicated for T1 and T2, and superficial T3 cases (RG C1).
II Maxillary cancer:
As functional and cosmetic qualities are required in addition to radical cure, multimodal therapy consisting of surgery, radiotherapy and chemotherapy has been carried out since early 1960s. Intra-arterial administration in tumor-feeding vessels such as the maxillary artery (RG C1) or systemic administration of anti-cancer drugs is performed.
III Nasopharyngeal cancer:
Radiotherapy is the standard choice of treatment for nasopharyngeal cancers. Since distant metastasis frequently occurs and radiosensitizing effect can be expected, chemotherapy is concomitantly used.
IV Oropharyngeal cancer:
As recently increasing human papillomavirus (HPV)-positive oropharyngeal cancer is more sensitive to chemoradiotherapy and shows favorable prognosis, HPV testing is useful in predicting therapeutic efficacy and prognosis (RG C1).
V Hypopharyngeal cancer:
In early-stages, with the aim of preserving larynx, a choice is made among radical irradiation and larynx-preserving surgery (open or endoscopic) according to the extent of disease (RG B). Surgical treatment is the first choice for advanced cancer cases. From the viewpoint of QOL, concomitant chemoradiotherapy or larynx-sparing surgery is also performed.
VI Laryngeal cancer:
For early-stage cancer, either radiotherapy or larynx-sparing surgery is recommended to preserve larynx (RG A). Total laryngectomy has been performed in advanced cancers. Concomitant chemoradiotherapy and larynx-sparing surgery are increasingly performed.


The evolution of the management of locally advanced head and neck cancer: "Same old, same old, or is there anything new?"
Parvesh Kumar (Department of Radiation Oncology, University of Nevada Las Vegas, USA)
The management of locally advanced head and neck cancer has evolved such that two definitive treatment approaches have now become the "standard of care" as follows: (1) For resectable disease, surgery followed by radiation therapy with or without chemotherapy; or (2) For unresectable disease, concurrent chemoradiation therapy. The long term survival with both of these treatment approaches is approximately 50%, with considerable acute toxicity and long term sequalae.
Recently, new paradigms are being explored to better individualize treatments for selective patient populations as follows: (1) De-escalation of the intensity of the chemoradiation therapy in patients with Human Papilloma Virus (HPV) positive head and neck cancers; and (2) Targeted therapies in patients with specific genomic charactistics. Randomized clinical trials are currently underway to determine if these new treatment paradigms will lead to either better survival outcome and/or improved quality of life in patient with locally advanced head and neck cancers.


Year in review from Japan
Takahiro Asakage (Department of Head and Neck Surgery, Tokyo Medical and Dental University)
The transoral surgery for early staged pharyngeal cancer and skull base surgery for advanced skull base malignancies are the greatest features in our department. Thus, these two surgeries will be introduced.
The transoral robotic surgery (TORS) is not permitted by Japanese Ministry of Health, Labor and Welfare, yet. The clinical trial of TORS is on going in only three hospitals in Japan. Thus, we, Japanese head and neck surgeon, greatly fall behind in TORS. On the other hand, the non-robotic transoral surgery has been developed for these 20 years in Japan. There are two major methods of non-robotic transoral surgery, endscopic laryngo-pharyngeal surgery (ELPS) and tranoral videolaryngoscopic surgery (TOVS). The ELPS is usually carried out by a curved laryngoscope, a curved electrode knife, curved forceps and a flexible upper GI endscope. We have introduced ELPS since 2009 in our department. We have used this technique in over 200 cases of newly diagnosed untreated T1 or T2 N0 pharyngo-laryngeal cancer. Many cases of early-stage pharyngo-laryngeal cancer without neck metastasis can be treated without postoperative radiotherapy. The overall survival rate was over 90%. In almost all cases, the larynx and oral intake were preserved.
Thirty patients of skull base malignancies already have visited our outpatient clinic since April on 2015 when I move to our department. The age of the patients was from 3 to 83, 16 men and 14 women was involved. The clinical diagnoses were varies. The most popular malignancy was nasal cavity and paranasal sinus and next was external ear canal. Eighteen patients underwent skull base surgery. Several representative patients who underwent skull base surgery will be introduced.


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