Vol. 94 No.7 July　2001

Treatment of Advanced Head and Neck Cancer
-Problems and Management-

Yoshitaka Okamoto (Yamanashi Medical University)

    The results of planned combination therapy in patients with advanced head and neck cancer, particularly maxilla and hypopharynx, at Akita University School of Medicine  (~1996), and at Yamanashi Medical University (1996~) were reviewed. Combination therapy consisted of a full dose irradiation together with chemotherapy followed by en bloc resection and primary reconstruction. Retrospective analysis of the patients with maxillary cancer showed that en bloc resection seemed to be adequate, but in some cases, irradiation combined with chemotherapy without maxillectomy was useful. In the treatment of advanced hypopharyngeal cancer, the histopathological effects (pT, pN) of preoperative chemotherapy and radiotherapy were the most important factors in prognosis. In paticular, the presence of pN predicted a very low possibility of survival and a very high incidence of distant metastasis. The advantages and disadvantages of preoperative radiotherapy are also discussed.
    Finally, the treatment of head and neck carcinoma involving the carotid artery was also reviewed ; Carotid artery resection is the only modality therapy offering the potential for care. However, aggressive resections involving the carotid artery should include the reconstruction of this vessel with a graft, particularly in cases where extensive resection of the skull base including the carotid canal and sigmoid sinus is performed. Preoperative temporary occlusion of the carotid artery is not necessarily an accurate predictor of morbidity after permanent occlusion. In extracranial-intracranial bypass surgery, temporary occlusion of middle cerebral artery also may induce serious brain ischemia, but our finding show that two-stage extracranial-intracranial bypass surgery may minimize this risk.

Key words : advanced head and neck cancer, combination therapy, carotid artery resection