Sequential Evaluation of Swallowing Function During Chemoradiotherapy for Head and Neck Cancer

[Background] Many studies have addressed chronic dysphagia resulting from chemoradiotherapy for head and neck cancer (HNC) because of its severity, but changes in the swallowing function during chemoradiotherapy has been rarely reported. This study aimed to elucidate the changes in the swallowing function during chemoradiotherapy for HNC. [Methods] From April 2018 to July 2020, 20 patients who underwent definitive or postoperative chemoradiotherapy at our hospital for head and neck squamous cell carcinoma were evaluated by flexible endoscopy with the Hyodo scoring system for swallowing, the Penetration–Aspiration Scale (PAS), and the Functional Outcomes Swallowing Scale (FOSS). [Results] Assessments at the start of treatment, at 40 Gy, and at the end of treatment yielded these mean values: Hyodo score—0.39, 1.22, and 2.56; PAS—1.00, 1.05, and 1.5; FOSS—0.2, 0.55, and 1.1, respectively. The Dunn multiple comparison test was used for analysis to determine significance (P < 0.05). The Hyodo score and FOSS were significantly increased at the end of treatment versus initial evaluation; however, score was maintained at a tolerable level for oral intake. PAS did not show a significant increase. [Conclusion] In conclusion, changes in the swallowing function during chemoradiotherapy for HNC were mild, and swallowing function was maintained at a tolerable level for oral intake

Application of an Immobilization Device for the Modified Killian’s Method

[Background] The hypopharynx is a closed space that is difficult to observe. The modified Killian’s (MK) method was introduced to obtain wider exposure. However, this method requires keeping the head forward during the examination. Postural maintenance might be problematic. To use the MK method safely for a thorough endoscopic examination, we introduced a new body immobilization device. The aim of this study was to evaluate the effectiveness of this body immobilization device. [Methods] Twenty-five patients underwent transnasal laryngoscopy using the MK method with the immobilization device. This device consists of a board to place the chest and a shaft. We classified hypopharynx visualization using a 5-point scale, in various combinations of head torsion, Valsalva maneuver, and MK position. Furthermore, we classified the feasibility of the MK method for 54 patients. Age, BMI, and performance status were evaluated by MK position feasibility class. [Results] The MK method with the body immobilization device was completed in all patients. It was significantly associated with higher hypopharyngeal visibility score. BMI and performance status were significantly associated with MK method feasibility. There were no significant differences in hypopharynx visualization scores with versus without this device for the patients that could maintain the MK position on their own. [Conclusion] For patients with poor nutrition or poor ability to perform activities of daily living, it was difficult to maintain the MK position. Thus, this immobilization device might be useful to complete the MK method and provide accurate detection of hypopharyngeal lesions in these patients

Unseiin, a Kampo medicine, Reduces the Severity and Manifestations of Skin Toxicities Induced by Cetuximab: A Case Report

Cetuximab is an effective drug used to treat patients with recurrent or metastatic head and neck squamous cell carcinoma. Skin toxicities such as paronychia and skin exsiccation are common adverse events caused by cetuximab. Skin toxicities may cause significant physical and psychosocial discomfort. The goal of managing skin toxicities is to minimize the detrimental effects on quality of life and continue the treatment. In one patient, skin toxicities became severe, up to grade 2, during treatment. The pain induced by paronychia and skin exsiccation made daily life difficult. Ten days after starting Unseiin, symptoms and finger findings resolved significantly. The patient could resume daily activities. No adverse effects induced by Unseiin were observed during treatment. Unseiin was effective on paronychia and skin exsiccation in this case and may contribute to successful treatment of skin toxicities induced by cetuximab

Immunohistochemical Features of Primary Pure Squamous Cell Carcinoma in the Thyroid: An Autopsy Case

Primary squamous cell carcinoma (SCC) in the thyroid is extremely rare and has been reported in &#x3c; 1% of all thyroid cancer cases. Primary SCC in the thyroid was thought to be a transitional form derived from adenocarcinomas; therefore, the majority of reported cases have focused on the conjunction with other histological adenocarcinomas. A 73-year-old male presented to our hospital with bilateral vocal fold palsy and an anterior neck mass. Ultrasound sonography revealed a bulky tumor in the thyroid and bilateral cervical lymphadenopathy. We performed fine-needle aspiration cytology from the thyroid tumor, which revealed SCC. Positron emission tomography/computed tomography showed distant metastases in the lungs, mediastinal lymph nodes, and vertebra. We diagnosed the patient as having stage IVC SCC in the thyroid and administered weekly paclitaxel. Four and a half months after treatment initiation, the tumor progression resulted in aspiration pneumonia, which proved fatal. We performed an autopsy in accordance with the patient’s wishes. Pathological findings revealed that all carcinomas in the thyroid, cervical lymph nodes, and lungs were pure SCCs. Immunohistochemical examinations for PAX8, thyroglobulin, and TTF-1 were all negative. Differentiated thyroid carcinomas have 3 major positive markers – PAX8, thyroglobulin, and TTF-1 –, and PAX8 is also sometimes positive for SCC in the thyroid. PAX8 positivity of SCC in the thyroid might, however, be associated with conjunction with other histological adenocarcinomas such as papillary or follicular thyroid carcinoma; therefore, pure SCC in the thyroid might be negative for PAX8

Imaging of radiation during impurity gas puffing in LHD

In LHD, several methods of detachment have been attempted, including impurity gaspuffing [1], and the application of an m/n=1/1 magnetic perturbation [2]. LHD is equipped with an imaging bolometer (IRVB) [3] that views the plasma from an upper port. Two scenarios are shown and compared, Ne puffing and N2 puffing. In the case of Ne puffing, radiation becomes more intense near the helical divertor X-point as the radiation increases. In the case of N2 puffing, a double stripe pattern evolves around the upper helical divertor X-point, which appears to be localized near the gas puff inlet. In addition, probe data also indicates that the drop in divertor flux with N2 is localized, while uniform with Ne

Effects of Resonant Magnetic Perturbation on Particle Transport in LHD

In this study, the effects of resonant magnetic perturbation (RMP) on particle transport are investigated in Large Helical device (LHD). The magnetic configuration is selected to be the outwardly shifted configuration, for which the magnetic axis position (Rax) is 3.9 m. At Rax = 3.9 m, the main plasma is surrounded by a thick ergodic layer, with width of about 30% of the plasma minor radius. The perturbation mode m/n = 1/1, where m and n are poloidal and toroidal mode numbers, is applied. The resonant layer is around the last closed flux surface. With RMP, a region in which both the connection and Kolmogorov lengths are finite and the magnetic field is ergodic forms; this region extends inside the main plasma. In the low-collisionality regime, where νh* 1), a clear difference in particle transport is found. A clear difference in turbulence is also observed, suggesting that turbulence plays a significant role in particle transport in the high-collisionality regime both with and without RMP

Experimental observations and modelling of radiation asymmetries during N2 seeding in LHD

N2 gas has been seeded in the Large Helical Device (LHD) to reduce the divertor heat load through enhanced radiation. Radiation is observed by two imaging bolometers, viewing the same poloidal cross-section from top and bottom ports, at a location which is 36° toroidally removed from the N2 gas puff nozzle located at the bottom of the machine. During N2 seeding, these measurements both confirm that additional radiation from the outboard side is coming exclusively from the top of the cross-section, indicating up/down asymmetry, which is also reproduced by modelling with EMC3-EIRENE using a half torus model. In addition, a toroidally localized, magnetic field direction-dependent radiation enhancement is observed with N2 seeding, but is not reproducible by the model

Development of impurity seeding and radiation enhancement in the helical divertor of LHD

Impurity seeding to reduce the divertor heat load was conducted in the large helical device (LHD) using neon (Ne) and krypton (Kr) puffing. Radiation enhancement and reduction of the divertor heat load were observed. In the LHD, the ratio between the total radiated power and the heating power, f rad = Prad/Pheating, is limited up to around 30% in hydrogen plasmas even for high density plasma just below the radiative collapse (ne, bar  >  1   ×   1020 m−3), where ne, bar is the line averaged density. With Ne seeding, the ratio could be raised to 52% at ne, bar ~ 1.3   ×   1019 m−3, albeit with a slight reduction in confinement. f rad ~ 30% could be sustained for 3.4 s using multi-pulse Ne seeding at ne, bar ~ 4   ×   1019 m−3. The localized supplemental radiation was observed along the helical divertor X-points (HDXs) which is similar to the estimated structure by the EMC3-EIRENE code. Kr seeding was also conducted at ne, bar ~ 3.1   ×   1019 m−3. f rad ~ 25% was obtained without a significant change in stored energy. The radiation enhancement had a slower time constant. The supplemental radiation area of the Kr seeded plasma moved from the HDXs to the core plasma. Highly charged states of Kr ions are considered to be the dominant radiators from the plasma core region

Current Status of Large Helical Device and Its Prospect for Deuterium Experiment

Achievement of reactor relevant plasma condition in Helical type magnetic devices and exploration in its related plasma physics and fusion engineering are the aim of the Large Helical Device (LHD) project. In the recent experiments on LHD, we have achieved ion-temperature of 8.1 keV at 1 × 1019 m−3 by the optimization of wall conditioning using long pulse discharge by Ion Cyclotron Heating (ICH). The electron temperature of 10 keV at 1.6 × 1019 m−3 was also achieved by the optimization of Electron Cyclotron Heating (ECH). For further improvement in plasma performance, the upgrade of the Large Helical Device (LHD), including the deuterium experiment, is planned. In this paper, the recent achievements on LHD and the upgrade of LHD are described