Posted at the Institutional Resources for Unique Collection and Academic Archives at Tokyo Dental College,
Author(s)
Kosuke, Takahashi; Takashi, Eda; Mai, Tajima;
Yusuke, Suzuki; Shun, Watanabe; Ko, Ito; Naomi,
Ogura; Kazutoshi, Kamei; Toshirou, Kondoh
Journal
日本口腔検査学会雑誌, 13(1): 61-64
URL
http://doi.org/10.15041/jsedp.13.61
Right
Description
Complete response achieved with TS-1
in tongue squamous cell carcinoma; Report of a case
Kosuke Takahashi
1)*, Takashi Eda
2), Mai Tajima
1),
Yusuke Suzuki
1), Shun Watanabe
1), Ko Ito
3),
Naomi Ogura
4), Kazutoshi Kamei
1), Toshirou Kondoh
5)1)Department of Dentistry and Oral Surgery, Yokohama Rosai Hospital 2)Department of Oral and Maxillofacial Radiology and Diagnosis,
Tsurumi University School of Dental Medicine
3)Department of Oral and Maxillofacial Surgery, Saitama Medical University 4)Department of Maxillofacial Surgery, Nihon University School of Dentistry at Matsudo 5)Department of Education for Dental Medicine, Tsurumi University School of Dental Medicine
Abstract
A 74-year-old woman was referred to our hospital for treatment of discomfort on the left side of her tongue. On examination, a 15×8 mm cauliflower like tumor was observed on the left side of the tongue. Cytological examination showed a Papanicolaouʼs Class Ⅴ tu-mor. The clinical diagnosis was squamous cell carcinoma. Radiographic examination in-dicated no cervical lymph node metastasis. We performed preoperative chemotherapy with TS-1 prior to conservative surgical excision. After one course of treatment, the tongue lesion had markedly reduced. She received a total of three courses of TS-1 fol-lowed by surgery, which resulted in a complete response. At follow-up evaluation 5 years after the chemotherapy, there was no evidence of recurrence.
Key words:TS-1, Complete response, oral cancer, SCC Received: November 2nd 2020 Accepted: December 1st 2020
Introduction
Early stage squamous cell carcinoma (SCC) of the tongue has a good survival rate and ex-cellent outcomes1). The primary treatment for tongue cancer that is still in the early stages is surgical resection. TS-1 that contain Tegafur, Gimeracil, Oteracil Potassium is a useful antican-cer agent approved for use in Japan since 2001. Here, we report a case in which administration of TS-1 as the single agent for preoperative che-motherapy resulted in complete response of tongue cancer eliminating the need for surgery.
Case report
A 74-year-old woman was referred to our hos-pital for discomfort on the left side of her tongue. Examination revealed a 15
×
8 mm cau-liflower like tumor on the left side of her tongue, with induration around the tumor, but with no associated pain, swelling or paresthesia (Fig. 1). Her medical and family histories were only posi-tive for hypertension. Cervical examination re-vealed no abnormal findings related to the sub-mandibular and upper internal cervical lymph nodes. Contrast enhanced CT imaging and Case report
*:3211 Kozukue-cho, Kouhoku-ku, Yokohama 222︲0036, JAPAN TEL:+81︲45︲474︲8111 FAX:+81︲45︲474︲8323
chest radiography showed no abnormal findings indicative of metastasis (Fig. 2). Blood tests were normal at the first visit. Cytological exam-ination revealed the presence of a keratinized pearl-like structure with a large number of atypical squamous epithelial cells, suggestive of Class Ⅴ SCC (Fig. 3). A provisional diagnosis of SCC (T1N0M0) was made and incisional bi-opsy was scheduled. In the interim period till biopsy, we commenced administration of TS-1 100 mg/day as preoperative chemotherapy. This resulted in obvious decrease in the size of the tumor to 10 mm 17 days after the oral ad-ministration. Cytological examination at this time indicated that the tumor had downgraded to Papanicolaouʼs Class Ⅲ. Although we had ini-tially planned to biopsy the tumor, we decide to continue the chemotherapy and the second TS-1 course was continued under strict follow up. The tumor subsequently decreased in size and completely disappeared by 57 days (third
course) after administration of TS-1, at which time cytological examination indicated Papanico-laouʼs Class Ⅰ cells (Fig. 4). Blood tests per-formed every week during administration of TS-1 indicated that there were no serious side effects of therapy. A total of three courses of TS-1 were administered. There was clinically no recurrence at the 5-year follow-up evaluation, and cytological examination (Fig. 5) and contact macroscopy examination were negative.
Discussion
Recent studies have reported 5-year disease-free survival and overall survival rates of 75% and 89%, respectively, in patients with early stage SCC of the tongue1︲4). Head and neck pri-mary SCC reportedly have a high sensitivity to
Fig. 1 At the first visit, a 15×8 mm cauliflower-like tumor with surrounding induration was observed on the left side of the tongue.
Fig. 2 Contrast enhanced CT image. The arrow indicates a soft tissue mass lesion with uneven contrast effect on the left side of the tongue.
Fig. 3 Cytology examination showed a keratinized pearl-like structure with a large number of atypical squamous epithelial cells, based on which the tumor was classified as Class Ⅴ disease.
multiple drug chemotherapy, such as CDDP, with a 70︲90% response rate5, 6).
TS-1 is an oral anticancer drug that combines two types of modulators, otastat potassium and tegafur7). It inhibits the activity of dihydropy-rimidine dehydrogenase (DPD), which is the degrading enzyme of 5-fluorouracil (5-FU), and contains otastat potassium, which reduces the gastrointestinal toxicity of 5-FU. According to the results of a preclinical phase Ⅱ trial of TS-1, the response rate for primary head and neck cancers is 48.1%, and a very high effect is re-ported using TS-1 as a single agent8). However, as with conventional anticancer agents, marrow suppression, which is one of the adverse effects of 5-FU, with TS-1 therapy has not been allevi-ated. Hence, we performed weekly blood tests from the first course of chemotherapy in our pa-tient. Our patient showed leukopenia during
the TS-1 administration period, although there were no severe adverse events, such as marrow suppression or gastrointestinal toxicity.
Surgical resection is one of the best treatment modalities in cases of stage 1 SCC of the tongue9). However, surgical resection is accompanied by considerable functional impairment. On the oth-er hand, radiation thoth-erapy and anticancoth-er drug treatment are alternative therapeutic options for oral cancer9). Both treatments also carry the risk of xerostomia and radiation osteoarthri-tis10). In this case, the outcomes in terms of pa-tient satisfaction and quality of life were ex-tremely high. Our experience suggests that TS-1 is a good choice as single-agent cancer treatment that can potentially lead to a com-plete response. Depending on the case, TS-1 could be a new option for the treatment of ma-lignant tumors by oral drug therapy alone. It might suggest that to choose the TS-1 is useful treatment when surgical treatment is difficult especially in elderly people or patients with poor general condition. Further study is needed to confirm our observation.
Acknowledgments
We would like to thank Dr. Suemitsu for his invaluable as-sistance with the pathological diagnosis of this case.
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Fig. 4 After 57 days of administration of TS-1, the tumor had disappeared and there was no residual induration. The dotted line indicates where the tumor disappeared.
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