論文 - 安慶名　信也

甲状腺未分化癌の経過―個別化治療指針の妥当性―

真栄田 裕行, 安慶名 信也, 金城 秀俊, 上里 迅, 平川 仁, 鈴木 幹男

日本気管食道科学会会報 ( 特定非営利活動法人 日本気管食道科学会 )  68 ( 6 ) 396 - 402   2017年

掲載種別: 研究論文（学術雑誌）

　概要を見る

<p>甲状腺未分化癌は極めて予後不良な疾患として知られており，治療の有無にかかわらず確定診断後1年以上の生存を見ることはまれである。近年新たな治療法としてレンバチニブやソラフィニブ等の分子標的薬が登場したが，現状では手術が根治治癒の期待できる第一選択であることに変わりはない。2012年甲状腺未分化癌コンソーシアムにおいて，未分化癌に関する予後規定因子およびそれに基づいた個別化治療指針が提唱された。今回当科で経験した未分化癌症例の治療と，コンソーシアムにおける治療指針がどの程度合致するか検証した。その結果，個別化治療指針の内容はかなりの程度で許容できるものであり，未分化癌治療方針決定の一助となり得ると思われた。ただし現状の予後不良因子該当数のみですべての治療方針を決定するのは困難であり，実際には患者ごとの検討が必要であることは言うまでもない。</p>

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Branchiogenic carcinoma with high-risk-type human papillomavirus infection: A case report.

Maeda H, Deng Z, Ikegami T, Matayoshi S, Agena S, Kiyuna A, Yamashita Y, Uehara T, Ganaha A, Suzuki M

Oncology letters ( Oncology Letters )  12 ( 3 ) 2087 - 2091   2016年09月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Branchiogenic carcinoma (BC) usually appears as a mass lesion with a predominant cystic component. Since lymph node metastasis from oropharyngeal carcinoma (OPC) has a cystic appearance, it is occasionally difficult to distinguish between BC and nodal metastases from clinically silent OPC. Factors associated with the malignant transformation process in BC remain obscure. The present study reports the case of a 56-year-old man with a right cystic cervical mass that was diagnosed as squamous cell carcinoma based on examination by fine-needle aspiration biopsy. The primary tumor could not be detected despite several imaging examinations, a pan-endoscopy of the head and neck, esophagus and stomach, biopsies of the head and neck regions, and bilateral tonsillectomies. The pathological findings of the surgical specimens from a radical neck dissection were consistent with the histological characteristics of BC, with evidence of transition from dysplasia through intraepithelial carcinoma to invasive carcinoma. Normal squamous epithelium and dysplastic and cancerous portions in the BC showed strong p16(INK4a) immunoreactivity. The expression of p16(INK4a) was also observed in all 9 nodal metastases in the neck dissection specimens. The cystic formation observed in the BC was not observed in the nodal metastases. As the presence of human papillomavirus-16 in the tumor was confirmed by polymerase chain reaction, quantitative polymerase chain reaction was employed for the measurement of human papillomavirus-16 viral load and integration. The results showed that the viral load of human papillomavirus-16 was 3.01x107/50 ng genomic DNA, and the E2/E6 ratio was 0.13, so the integration state was judged to be the mixed type. To the best of our knowledge, this is the first report of BC associated with high-risk-type human papillomavirus infection. The study indicates that a human papillomavirus-positive neck mass may not necessarily be OPC, but that it could be BC with a poor prognosis. This report lends support to the existence of BC and proposes that the etiology is human papillomavirus infection.

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選択的動注化学放射線療法により根治を得たRouviereリンパ節転移を伴う上顎洞癌の1例

山城 啓太, 平安名 常一, 安座間 喜明, 伊良波 裕子, 山城 恒雄, 木下 亮, 戸板 孝文, 當山 昌那, 安慶名 信也, 真栄田 裕行, 鈴木 幹男, 村山 貞之

癌と化学療法 ( (株)癌と化学療法社 )  43 ( 2 ) 243 - 246   2016年02月

掲載種別: 研究論文（学術雑誌）

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症例は71歳、男性。鼻出血の精査にて右外側咽頭後リンパ節(Rouviere node:RN)および右上内深頸リンパ節(superior internal jugular node:SN)に転移を有する右上顎洞癌の診断となった。外科治療での病変制御は困難と判断したため、われわれは選択的動注化学療法(動注療法)と放射線治療を施行した。動注療法はnedaplatin(CDGP)とdocetaxel(TXT)を選択し上顎洞癌およびRNに注入した。動注療法と同時に強度変調放射線治療(IMRT)を行い、66Gy/33Frを照射した。治療終了後の画像所見では、すべての病変は消失していた。病変は動注化学放射線療法にて十分に局所制御できたと判断し、追加治療を要することなく、現在は外来にて経過観察中である。(著者抄録)

[Maxillary Cancer with Metastasis to the Rouviere Nodes -- Complete Response to Chemoradiotherapy Using a Selective Intra-Arterial Infusion Technique].

Yamashiro K, Heianna J, Azama K, Iraha Y, Yamashiro T, Kinoshita R, Toita T, Toyama M, Agena S, Maeda H, Suzuki M, Murayama S

Gan to kagaku ryoho. Cancer & chemotherapy   43 ( 2 ) 243 - 246   2016年02月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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We report a case of advanced maxillary cancer with multiple lymph node metastases, including metastasis to the Rouviere nodes, which were successfully treated with chemoradiotherapy using a selective intra-arterial infusion technique.A 71-yearold man presented to our hospital with complaints of a staggering gait and epistaxis.He was diagnosed with maxillary cancer (squamous cell carcinoma)classified as T4a disease.Because multiple lymph node metastases were detected, including metastasis to the Rouviere nodes, radical surgical treatment was considered inadequate.Thus, the patient was treated with concurrent chemoradiotherapy with selective intra-arterial infusion of nedaplatin and docetaxel.After chemoradiotherapy, the maxillary cancer and lymph metastasis nearly resolved and the patient achieved a complete response.No additional surgery was needed, and the patient was discharged.We suggest that chemoradiotherapy using a selective intra-arterial infusion technique is a highly effective treatment option for patients with maxillary cancer and metastasis to the Rouviere nodes.

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副咽頭間隙に発生した海綿状血管腫の1手術例

真栄田 裕行, 當山 昌那, 安慶名 信也, 又吉 宣, 鈴木 幹男

頭頸部外科 ( 特定非営利活動法人 日本頭頸部外科学会 )  26 ( 1 ) 109 - 113   2016年

掲載種別: 研究論文（学術雑誌）

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今回われわれは副咽頭間隙に発生した海綿状血管腫の極めてまれな1例を経験した。患者は66歳の男性で主訴は嚥下時の違和感であった。MRI画像上，右副咽頭間隙に境界明瞭な楕円形の腫瘤を認めたため神経原性腫瘍と診断し，経耳下腺経頸部複合アプローチ法により腫瘍を摘出した。ところが術後の病理学的所見により最終的に海綿状血管腫と診断された。副咽頭間隙に初発した海綿状血管腫の報告はわれわれの渉猟しえた範囲では海外の報告と併せても3例のみであった。本症例においては術中の大量出血は認められなかった。血管原性腫瘍は術中出血のリスクが高いため術前に確定診断をつけておくことは重要であるが，本症例のように確定診断が得られない場合においても，当術式で十分に対応が可能であると考えられた。

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Human papillomavirus infection and immunohistochemical expression of cell cycle proteins pRb, p53, and p16(INK4a) in sinonasal diseases.

Yamashita Y, Hasegawa M, Deng Z, Maeda H, Kondo S, Kyuna A, Matayoshi S, Agena S, Uehara T, Kouzaki H, Shimizu T, Ikegami T, Ganaha A, Suzuki M

Infectious agents and cancer ( Infectious Agents and Cancer )  10 ( 1 ) 23   2015年 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Background: We aimed to clarify the possible role of human papillomavirus (HPV) infection in the malignant transformation of sinonasal inverted papilloma (IP). Methods: Subjects comprised 32 patients with chronic rhinosinusitis (CRS), 17 with IP, 5 with IP and squamous cell carcinoma (IP + SCC), and 16 with primary sinonasal SCC. HPV presence, viral loads, and physical status were investigated using polymerase chain reaction. Retinoblastoma (pRb), p53, and p16(INK4a) gene products were investigated by immunohistochemistry. Results: HPV DNA was detected in 6.3 % of cases with CRS, 29.4 % with IP, 40 % with IP + SCC, and 25 % with SCC. IP cases had significantly higher HPV presence than CRS cases (p = 0.04). High-risk HPV-16 was the most frequently encountered subtype (10/13, 76.9 %). HPV-16 viral loads varied from 2.5 to 7953 E6 copies/50 ng genomic DNA. Patients in the SCC and IP + SCC groups had significantly higher viral loads than those in the IP and CRS groups (p &lt; 0.01). All SCC and IP + SCC patients with HPV-16 demonstrated mixed-type integration, whereas 4 of 5 HPV-16 patients in the IP and CRS groups showed episomal type infection (p = 0.04). Positivity to pRb was found in 78.1 % of CRS, 35.3 % of IP, and 68.8 % of SCC cases. The presence of HPV DNA negatively correlated with pRb expression in SCC (p = 0.029) and IP (P = 0.049) groups. Although 62.5 % of SCC cases exhibited p53 positivity, only 5.9 % of IP, and no CRS cases were positive. Regardless of HPV status, p16(INK4a) positivity was frequently detected in IP cases (82.4 %), less in SCC (12.5 %) cases, and was not detected in the CRS group. Neither the IP nor SCC cohorts showed any correlation between HPV presence and the expression of either p53 or p16(INK4a). Conclusions: HPV infection was more frequent in the IP, IP + SCC, and SCC groups than the CRS group. Higher viral loads and integration observed in the IP + SCC and SCC groups, and an inverse correlation between HPV presence and positive pRb indicated that persistent infection and integration play a part in tumorigenesis and malignant transformation in certain IP cases. However, p16(INK4a) is not a reliable surrogate marker for HPV infection in IP.

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Clinical Outcome of Palliative Radiotherapy in Patients with Head and Neck Cancer

Uehara Takayuki, Maeda Hiroyuki, Yamashita Yukashi, Hasegawa Masahiro, Agena Shinya, Suzuki Mikio

耳鼻咽喉科臨床　補冊 ( 耳鼻咽喉科臨床学会 )  144 ( 0 ) 110 - 110   2015年

掲載種別: 研究論文（学術雑誌）

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Patient profiles, compliance with palliative radiotherapy and the treatment outcomes were investigated in head and neck cancer patients who received palliative radiotherapy from 2006 to 2012. Clinicians selected patients who received palliative radiotherapy considering the clinical stage and the general body condition. There were no patients with severe acute or late toxicities during treatment and the completion rate of palliative radiotherapy was 79.3%. The palliative irradiation group showed significantly better overall survival rates as compared to the no-treatment group. Paliative irradiation of the primary tumor and lymph node metastases at the dose of over 50 Gy contributed to long-term disease-free survival and improvement of the quality of life (QOL), including reduction of tumorigenic pain and dysphasia. Thus, palliative radiotherapy may be a useful treatment option for patients with advanced head and neck cancer under the careful management.

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A Study on 13 Cases of Bone and Soft Tissue Sarcomas in the Head and Neck

Agena Shinya, Uehara Takayuki, Yamashita Yukashi, Matayoshi Sen, Hasegawa Masahiro, Maeda Hiroyuki, Suzuki Mikio

耳鼻咽喉科臨床　補冊 ( 耳鼻咽喉科臨床学会 )  144 ( 0 ) 86 - 88   2015年

掲載種別: 研究論文（学術雑誌）

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Since bone and soft tissue sarcomas arising from the head and neck region are very rare, the standard treatment protocol has yet to be established. In the present study, 13 cases with bone and soft tissue sarcomas treated from 2007 to 2014 were analyzed. The mean period from initial visit to final pathological diagnosis was approximately 3 weeks, and 38.5% of the cases needed several biopsies for an accurate diagnosis. Death occurred early for those cases in which more than 40 days was needed to obtain the histological diagnosis. The 3-year overall survival in 13 cases was 35.2%. As the cause of death was uncontrolled local lesion, the locoregional control was more important than distant metastasis control for the prognosis. Tumor location, TNM stage, and histological grade affected the prognosis of the sarcomas. Radiation therapy including heavy ion and proton beam radiotherapy was not so effective as the primary treatment, as was the case with salvage treatment of sarcomas in the head and neck. Although the primary treatment of sarcomas was surgical treatment with an adequate margin, an efficient treatment protocol should be established to obtain a better prognosis.

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頭頸部癌に対する姑息的照射治療

上原 貴行, 真栄田 裕行, 山下 懐, 長谷川 昌宏, 安慶名 信也, 鈴木 幹男

耳鼻咽喉科臨床 ( 耳鼻咽喉科臨床学会 )  108 ( 6 ) 475 - 481   2015年

掲載種別: 研究論文（学術雑誌）

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Patient profiles, compliance with palliative radiotherapy and the treatment outcomes were investigated in head and neck cancer patients who received palliative radiotherapy from 2006 to 2012. Clinicians selected patients who received palliative radiotherapy considering the clinical stage and the general body condition. There were no patients with severe acute or late toxicities during treatment and the completion rate of palliative radiotherapy was 79.3%. The palliative irradiation group showed significantly better overall survival rates as compared to the no-treatment group. Paliative irradiation of the primary tumor and lymph node metastases at the dose of over 50 Gy contributed to long-term disease-free survival and improvement of the quality of life (QOL), including reduction of tumorigenic pain and dysphasia. Thus, palliative radiotherapy may be a useful treatment option for patients with advanced head and neck cancer under the careful management.

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頭頸部骨軟部肉腫13例の検討

安慶名 信也, 上原 貴行, 山下 懐, 又吉 宣, 長谷川 昌宏, 真栄田 裕行, 鈴木 幹男

耳鼻咽喉科臨床 ( 耳鼻咽喉科臨床学会 )  108 ( 2 ) 145 - 152   2015年

掲載種別: 研究論文（学術雑誌）

　概要を見る

Since bone and soft tissue sarcomas arising from the head and neck region are very rare, the standard treatment protocol has yet to be established. In the present study, 13 cases with bone and soft tissue sarcomas treated from 2007 to 2014 were analyzed. The mean period from initial visit to final pathological diagnosis was approximately 3 weeks, and 38.5% of the cases needed several biopsies for an accurate diagnosis. Death occurred early for those cases in which more than 40 days was needed to obtain the histological diagnosis. The 3-year overall survival in 13 cases was 35.2%. As the cause of death was uncontrolled local lesion, the locoregional control was more important than distant metastasis control for the prognosis. Tumor location, TNM stage, and histological grade affected the prognosis of the sarcomas. Radiation therapy including heavy ion and proton beam radiotherapy was not so effective as the primary treatment, as was the case with salvage treatment of sarcomas in the head and neck. Although the primary treatment of sarcomas was surgical treatment with an adequate margin, an efficient treatment protocol should be established to obtain a better prognosis.

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