頭頸部悪性腫瘍に占める軟部肉腫の割合は1％程度と希少疾患である。その組織型は骨肉腫，横紋筋肉腫，Ewing肉腫など多様である。今回，我々は2011年～2020年の10年間に治療を行なった成人発症の胞巣型横紋筋肉腫4症例について検討したので，文献的考察を加え報告する。内訳は男性2例，女性2例，年齢は52～58歳（中央値56歳）であった。初診の時点で3症例がリンパ節転移，2症例が遠隔転移を伴っており，化学療法，放射線治療および手術を組み合わせた集学的治療を行った。全症例で一定の治療効果を認め，1例は治療終了後1年間無再発生存，1例は治療継続中である。初診時から遠隔転移を伴っていた2例は遠隔転移病変が制御困難となり死亡した。成人の胞巣型横紋筋肉腫には確立された標準治療がなく，小児と比較して予後不良である。今後，成人に対する標準的治療の確立が待たれる。

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Authorship：Lead author   Publishing type：Research paper (scientific journal)   Publisher：The Society of Practical Otolaryngology  

DOI： 10.5631/jibirin.115.1099

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Authorship：Lead author   Publishing type：Research paper (scientific journal)   Publisher：Elsevier BV  

DOI： 10.1016/j.visj.2022.101551

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Springer Science and Business Media LLC  

BACKGROUND: Cervical esophageal cancer (CEC) carries a poor prognosis; however, due to its low incidence, optimal treatment for CEC remains to be established. The purpose of this study was to clarify the current status of treatment of CEC in Japan and obtain evidence for establishing the appropriate treatment method. PATIENTS AND METHODS: We asked specialist training facilities accredited by the Japanese Broncho-Esophageal Society to register data on CEC cases that received curative treatment from January 2009 to December 2014, and conducted a retrospective review of the clinical data of 302 cases registered from 27 facilities. RESULTS: In regard to the initial therapy, of the 302 patients, 33 had undergone endoscopic resection, 41 had undergone surgery, 67 had received induction chemotherapy (IC), and 143 had received chemoradiotherapy (CRT). There were no significant differences in the 5-year overall survival rates among the patient groups that had received surgery, IC or CRT as the initial treatment; advanced stage and recurrent nerve invasion were identified as independent poor prognostic factors. Among the patients who had received IC or CRT as laryngeal-preserving surgery was not indicated at the time of the initial diagnosis, the functional laryngeal preservation rate at the end of the observation period was 34.8%. CONCLUSION: Even in patients with advanced CEC, there is the possibility of preserving the larynx by adopting IC or CRT. However, if the laryngeal function cannot be preserved, there is a risk of complications from aspiration pneumonia, so that the choice of treatment should be made carefully.

DOI： 10.1007/s10388-022-00921-w

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Other Link： https://link.springer.com/article/10.1007/s10388-022-00921-w/fulltext.html

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Language：Japanese   Publisher：克誠堂出版(株)  

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2022&ichushi_jid=J00398&link_issn=&doc_id=20220630260010&doc_link_id=%2Fad3ksgke%2F2022%2F0065s1%2F011%2F5092-5100%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fad3ksgke%2F2022%2F0065s1%2F011%2F5092-5100%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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Authorship：Lead author   Language：Japanese   Publisher：(株)医学書院  

78歳男性。発熱、呼吸苦を主訴に、近医のPCR検査にてCOVID-19陽性と診断された。診断後は4日間の自宅療法ののち、診断5日後に前医の入院加療を開始したが、動脈血酸素飽和度が徐々に増悪し、診断7日後に当院搬送となった。当院でHFNC管理を継続し、レムデシベル、トシリズマブ、バリシチニブによる加療を開始したが、酸素状態は改善せず、診断29日後に肺炎、呼吸不全の改善目的でシングルユース軟性鼻咽喉鏡(Ambu内視鏡)を用いて気管切開術を施行した。術後は引き続き人工呼吸器管理、加療を継続中である。単回使用製品であるAmbu内視鏡はスタッフの感染防御に有用であった。

DOI： 10.11477/mf.1411202970

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Authorship：Lead author  

胆道感染症は，胆石や胆泥により胆汁が鬱滞することで十二指腸乳頭より上行性に細菌感染が生じ発症する。長期間の絶食や経口摂取量不足が続くと胆汁がよどみ，胆石や胆泥発生の好条件となる。また，オピオイド鎮痛薬によるオッジ括約筋機能不全に陥る場合もあり，化学放射線療法中の腹部症状には注意を要する。今回われわれは外耳道癌に対するセツキシマブ併用放射線療法中に発症した胆道感染症を経験した。胆道感染症は診断と治療が遅れれば，開腹手術を要することがある。化学放射線療法を行う機会のある耳鼻咽喉科医は留意すべき治療中合併症のひとつであろう。

DOI： 10.5106/jjshns.21-005

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Elsevier BV  

OBJECTIVE: In the end-of-life stage of head and neck squamous cell carcinoma (HNSCC), predicting survival is essential to determine treatment procedure and place of care. Several reports have compared actual survival (AS) and clinical prediction of survival (CPS), a subjective prognostic prediction by attending physicians. However, specific studies focusing on patients with HNSCC are limited. Likewise, a comparison of the accuracy of CPS and palliative prognostic index (PPI), a prognostic tool using subjective assessment, has not been sufficiently investigated. This study aimed to clarify the correlation between AS and CPS/PPI and compare the accuracy of CPS and PPI in end-stage HNSCC. METHODS: This retrospective study included patients with HNSCC in the end-of-life setting. Patients were recruited from the National Hospital Organization Shikoku Cancer Center between April 2011 and March 2019. Data on basic demography and clinical parameters when patients decided to start end-of-life care at the head and neck oncology division were collected. We examined the correlation between AS and CPS using Spearman's correlation coefficients. The area under the receiver operating characteristic curve of CPS and PPI for 30-day survival prediction were compared for predictive accuracy. RESULTS: Among 98 eligible patients, 59 patients were enrolled in this study and analyzed. Of the 59 patients, CPS and PPI were calculated for 30 patients, whereas, only the PPI was calculated for 29 patients. The median AS and CPS were 35 (IQR: 9-73) days and 30 (IQR: 7-83) days, respectively. CPS and PPI (30 cases) were moderately correlated (r = 0.72, p<0.01). AS and CPS/PPI (30 cases) were significantly correlated (p<0.01) and showed a strong correlation (r = 0.86 and 0.80, respectively). In the 30-day survival prediction, the AUROCs of CPS and PPI (30 cases) were 0.967 (95%CI: 0.919-1) and 0.884 (95%CI: 0.767-1), respectively. Both CPS and PPI (30 cases) showed high accuracy in predicting the 30-day prognosis, with no significant difference (p = 0.077). The AUROC of PPI (59 cases) was 0.840 (95%CI: 0.711-0.969). CONCLUSIONS: AS and CPS/PPI showed significant correlations. The high accuracy of CPS may have been influenced by the fact that multiple head and neck cancer specialists at a comprehensive cancer center estimated CPS. Both CPS and PPI showed high prognostic accuracy in predicting 30-day survival. This suggests that PPI is useful in centers among physicians and healthcare workers unfamiliar with head and neck cancer.

DOI： 10.1016/j.anl.2021.06.003

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DOI： 10.2468/jbes.72.329

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Authorship：Lead author   Language：Japanese   Publisher：耳鼻咽喉科臨床学会  

当科で化学療法を施行した小児、思春期・若年(CAYA)世代がん患者20例を対象に、妊孕性温存に関する説明の実態調査を行った。その結果、妊孕性低下・消失について説明していた患者は2例のみであり、それぞれ17歳と23歳の未婚若年女性であった。一方、その他の女性5例(30歳台)や男性(13〜38歳)には説明が行われていなかった。また、妊孕性温存ガイドラインが出版された2017年の前後で妊孕性低下・消失について説明を実施した割合には著しい変化はみられず、妊孕性に対する配慮は担当医レベル、診療科レベルでも改善できる余地が十分にあると考えられた。

DOI： 10.5631/jibirin.114.957

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Authorship：Lead author   Publishing type：Research paper (scientific journal)   Publisher：Springer Science and Business Media LLC  

DOI： 10.1007/s10147-021-01905-z

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Other Link： https://link.springer.com/article/10.1007/s10147-021-01905-z/fulltext.html

Authorship：Lead author  

今回われわれは放射線誘発悪性腫瘍の一例を経験したので報告する。放射線誘発悪性腫瘍は放射線療法後，照射部位に一致して発生する悪性腫瘍である。潜伏期間が長期に及ぶため，実態は十分解明されていない。近年増加傾向の強度変調放射線療法（IMRT）では多くの正常組織が放射線に曝されるため放射線誘発悪性腫瘍の発生率は従来の2倍に上昇すると推定されている。自験例はIMRTではなく従来の放射線療法後の発症であるが，今後，IMRTや化学放射線療法の増加により放射線誘発悪性腫瘍が増加する可能性は高い。常日頃からの患者教育と地域医療機関との強固な連携が必要不可欠であると啓発すべきである。

DOI： 10.5981/jjhnc.47.83

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：SAGE Publications  

Objectives: Palliative care patients with head and neck squamous cell carcinoma (HNSCC) often experience dysphagia and airway trouble; thus, each patient requires a specific palliative care plan based on their prognostication. However, no established specific prognostic tool performed on the day of starting end-of-life care is available for such patients. We assessed the accuracy of Glasgow prognostic score (GPS) and palliative prognostic index (PPI) and their combination to establish a specified prognostic tool for patients with HNSCC in end-of-life setting.

Methods: A retrospective clinical chart review was undertaken on patients with HNSCC in end-of life setting who were decided in Kagawa University Hospital and National Hospital Organization Shikoku Cancer Center between April 2011 and March 2019. The patients were divided into 2 categories according to GPS (0-1 and 2) and PPI (groups A-B and C). These were combined into 4 categories (PPI group A-B and GPS score 0-1: good; PPI group A-B and GPS score 2: intermediate; PPI group C and GPS score 2: poor; and PPI group C and GPS score 0-1: others). The survival curves were compared for the former 3 categories.

Results: The median survival of the scores 0-1 and 2 on GPS were 114 (72-148) and 39 (25-52) days, respectively (P < .01). These of groups A-B and C on PPI were 79 (64-99) and 16 (9-29) days, respectively (P < .01). The median survival of the good, intermediate, and poor categories was 127 (73-149), 64 (44-80), and 15 (9-27) days, respectively (P < .01 among all categories).

Conclusions: In this study, the survival of terminally ill patients with HNSCC can be predicted by the GPS, PPI, and their combination with sufficient probability.

Keywords: Glasgow prognostic score; head and neck cancer; palliative care; palliative prognostic index; terminal care.

DOI： 10.1177/01455613211005114

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Other Link： http://journals.sagepub.com/doi/full-xml/10.1177/01455613211005114

Authorship：Lead author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：Springer Science and Business Media LLC  

Purpose: Immune checkpoint proteins programmed cell death 1 (PD-1) and programmed cell death ligand 1 (PD-L1) are important therapeutic targets for head and neck cancer. This large-scale case study aimed to analyze tongue squamous cell carcinomas (SCCs) and evaluate the correlation between PD-L1 expression and clinical prognosis. So far, this study is the largest case study on PD-L1 expression in tongue SCCs.

Methods: This is a case-control study that analyzed 121 tongue SCCs. Paraffin-embedded sections and clinical data were obtained retrospectively and immunohistochemistry with PD-L1 was performed.

Results: 11.6% contained ≥ 50% of PD-L1-positive cells, 57.1% of these cases had a poor prognosis with nodal metastasis. Among cases of T1/2 primary lesions with nodal metastasis, cases of high PD-L1 expression had a significantly shorter disease-free survival than cases of no PD-L1 expression (p = 0.018). The hazard ratio for high PD-L1 expression was 3.21 (95 per cent CI, 1.26-8.72) compared with no PD-L1 expression after adjusting for other factors.

Conclusions: These data indicate that PD-L1 upregulation in tongue SCCs is associated with a more advanced stage and shorter disease-free survival. PD-1/PD-L1 inhibitors might hence constitute potential adjuvant therapy for tongue SCCs with PD-L1 upregulation.

Keywords: Adjuvant therapy; Nodal metastasis; Programmed cell death 1; Programmed cell death 1 ligand; Tongue squamous cell carcinoma.

DOI： 10.1007/s00795-020-00261-7

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Other Link： http://link.springer.com/article/10.1007/s00795-020-00261-7/fulltext.html

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Authorship：Lead author   Publishing type：Research paper (scientific journal)   Publisher：Springer Science and Business Media LLC  

DOI： 10.1007/s00795-020-00270-6

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Other Link： http://link.springer.com/article/10.1007/s00795-020-00270-6/fulltext.html

Authorship：Lead author   Language：Japanese   Publisher：(NPO)日本気管食道科学会  

中咽頭前壁は他の頭頸部領域と比較し術野が得られにくく，嚥下機能や構音機能，整容面など術後の問題点も多岐に渡る。中咽頭前壁へのアプローチ方法は大きく分けて，口内法，頸部外切開法，下顎骨離断法の3種が考えられる。口内法は視野が狭く，頸部外切開法は嚥下機能の低下や縫合不全のリスクがあり，下顎骨離断法は侵襲性と整容面で問題が生じる。中咽頭前壁腫瘍に対する舌正中アプローチ・舌弁後方移動術は，舌尖より正中切開を行い，腫瘍を摘出後，患側の舌前方部分を後方に移動し舌根を再建する術式である。舌根のみならず舌尖の可動性や血流も一部温存を期待できる。当科では，T2以下の症例で表在性腫瘍であればTOVS、深部浸潤を疑う画像所見を認めれば舌正中アプローチ・舌弁後方移動術，尾側や側方への進展を認めればFKリトラクターの併用や頸部外切開法を検討している。舌正中アプローチ・舌弁後方移動術や，同術式とFKリトラクター®との併用法にて機能面・整容面・根治性いずれも良好な結果を得た症例を当科での治療方針を交え報告する。本法は腫瘍進展範囲，全身状態を考慮すれば，根治性を確保し機能障害を最小限に抑えられる術式と考えられる。

DOI： 10.2468/jbes.72.38

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2021&ichushi_jid=J01054&link_issn=&doc_id=20210215240006&doc_link_id=10.2468%2Fjbes.72.38&url=https%3A%2F%2Fdoi.org%2F10.2468%2Fjbes.72.38&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_2.gif

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後天性血友病Aは,凝固第Ⅷ因子に対する自己抗体が出現し出血症状を呈する疾患である。 われわれはセツキシマブ併用放射線療法後に生じた後天性血友病Aの1例を経験した。症例は81歳,男性。20XX-5年に下咽頭癌に対しセツキシマブ併用放射線療法を施行しCRとなったが，20XX年に頬粘膜に出血を認め，後天性血友病と診断され現在治療中である。
後天性血友病の原因は様々な疾患が考えられているが，本疾患患者のうち17%は担癌状態との報告もある。悪性腫瘍治療後の患者が後天性血友病を発症した場合，再発・転移の可能性を考慮し一層注意深く経過観察を行う必要があることは，内科医のみならずわれわれ耳鼻咽喉・頭頸部外科医も留意すべきである。

DOI： 10.5106/jjshns.30.395

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梅毒は Treponema pallidum によって引き起こされる性感染症である. 口腔咽頭領域の梅毒病変は特徴的であり, 医療者側に知識があれば比較的容易に鑑別できるとされている. しかし, 中には典型的な所見を欠く症例も存在する. 特に, 抗菌薬が既に投与されている場合には診断に至らず無症候梅毒に移行し, 感染拡大の要因となることが懸念されている. 今回われわれは頸部腫瘤を主訴に受診した2例の梅毒を経験した. 2例とも典型的な粘膜病変を欠いていた. 本邦では2013年以降梅毒患者が急増しており, 梅毒は決して過去の疾患ではない. われわれ耳鼻咽喉科医は頸部腫瘤の鑑別に梅毒性リンパ節炎を挙げる必要がある.

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To clarify the scenario regarding the emergency medical treatment of patients undergoing otolaryngology in southeastern Okayama Prefecture in Japan, we evaluated the conditions in three hospitals that mainly provide emergency medical treatment to patients undergoing otorhinolaryngology at night or on holidays. The data (age, sex, type of disease, and address) of patients who visited Japanese Red Cross Okayama Hospital, Kawasaki Medical School General Medical Center, and Okayama Medical Center in 2018 were collected and compared. All three hospitals reported many cases of tonsillar abscess and nasal bleeding. In the study population, the number of patients aged ≤10 and 10-20 years were the lowest and highest, respectively. Patients residing in southern Okayama City and Tamano City tended to visit Japanese Red Cross Okayama Hospital or Kawasaki Medical School General Medical Center. Patients residing in northeastern Okayama Prefecture and northern Okayama City tended to visit Okayama Medical Center. A ceiling for the senior physicians’ capacity will be introduced in April 2020, and thus the number of otolaryngology-related treatments performed in Okayama Prefecture is expected to decrease. The otolaryngologyrelated emergency medical treatment in southeastern Okayama Prefecture may collapse. Emergency medical care systems must therefore be considered in the future.

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耳鼻咽喉科救急で確実な気道確保のためには，迅速な喉頭評価が肝心であるが，喉頭評価まで時間を要してしまう症例もある．我々は患者来院から喉頭評価までの各ポイントでの時間を記録しボトルネックとなる要因を調べた．当科にて初回喉頭評価を行った15例において，患者来院・CT撮影・耳鼻咽喉科医への連絡・耳鼻咽喉科医到着・喉頭評価それぞれの時間を記録し検討した．耳鼻咽喉医への連絡から喉頭評価までは29±17分（平均±標準偏差）であり症例間の差は少なかったが，患者来院から耳鼻咽喉科医への連絡までは症例によって大きな差があった．喉頭評価までの時間短縮のために，各病院においてボトルネックとなる要因を検証し改善すべきである．

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Publishing type：Research paper (scientific journal)  

DOI： 10.1080/00016489.2018.1541506

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DOI： 10.1080/00016489.2019.1610574

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後天性血友病 A とは、凝固第Ⅷ因子に対する自己抗体が出現し出血症状を呈する疾患である。われわれは鼻出血を契機に発見された後天性血友病 A の 1 例を経験した。症例は 73 歳、男性。鼻出血を繰り返し、当科を受診した。出血点を認め焼灼するも再出血した。APTT 延長を認めたため当院血液内科に紹介し、後天性血友病と診断され現在治療中であり、治療開始後は再出血なく経過している。後天性血友病の初発症状は、皮下や筋肉内の出血が多く、鼻出血を契機に発見された症例はまれである。比較的まれな疾患ではあるが、診断が遅れれば、頭蓋内出血や腹腔内出血といった致死的な出血を来す可能性がある。早期診断・治療が重要であり、耳鼻咽喉科医も知識を有しておくべき疾患である。

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Publishing type：Research paper (scientific journal)  

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DOI： 10.1093/jjco/hyy009

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Language：Japanese   Publisher：(一社)日本頭頸部癌学会  

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Event date： 2025.6.13 - 2025.6.14

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Event date： 2025.6.7

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ミレニアルセッション U-40 新時代の口腔咽頭科学を担う！

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Event date： 2022.9.8 - 2022.9.9

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Presentation type：Oral presentation (invited, special)  

File： jsco2023_0147_unit_prog_ext_ja.pdf

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Presentation type：Oral presentation (general)  

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Presentation type：Symposium, workshop panel (nominated)  

セッション名: 領域横断的ワークショップ 13
セッションテーマ: がん患者における妊娠・出産

File： 抄録.pdf

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Presentation type：Oral presentation (invited, special)  

小児，思春期・若年がん患者に対する妊孕性温存療法 ―現状と改善の取り組み―

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Presentation type：Oral presentation (general)  

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Presentation type：Oral presentation (general)  

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ディスカッション パネリスト

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Presentation type：Public lecture, seminar, tutorial, course, or other speech  

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