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Summary: Intensity-modulated radiation therapy (IMRT) is an evolution of 3D conformal radiation therapy, which is the current standard radiation therapy technique in head-and-neck cancer. Modulating the radiation intensity of each beam by dynamic interposition of the computer-assisted collimator leaves yields dose distributions that are particularly well adapted to head-and-neck tumor volumes. It is thus possible to predetermine dose per element: i.e., the minimum effective dose to be delivered to tumor areas, and the maximum to be safely delivered to organs at risk. The technique thereby enables complex tumoral targets to be optimally covered, while sparing healthy tissue, and salivary glands in particular. In addition, the technique allows dose-escalation, with a higher dose per session delivered to the macroscopic tumor than to other irradiated areas. The first results of ongoing randomized trials confirmed those of earlier comparative studies, showing marked improvement in side effects, including post-radiation xerostomia. Although the positive impact of this technique on tumor control remains to be proven, salivary function conservation currently makes IMRT the standard treatment in most head-and-neck cancer. [ABSTRACT FROM AUTHOR]

Résumé: Objectif: Évaluer les résultats de la radiothérapie chez les patients atteints de carcinomes épidermoïdes du larynx avec atteinte sous-glottique. Patients et méthodes: Entre 1998 et 2012, 56 patients ont reçu une radiothérapie ou une radiochimiothérapie (63 %) sans ou avec chimiothérapie d’induction (37 %) dans notre établissement. Résultats: Le suivi médian était de 74mois. À cinq ans, les probabilités de survie globale, de survie sans progression et de survie spécifique étaient respectivement de 64 % (intervalle de confiance à 95 % [IC 95 %] : 48–90 %), 45 % (IC 95 % : 28 %–61 %) et 88 % (IC 95 % : 78 %–98 %), respectivement. Les probabilités de contrôle locorégional et de contrôle à distance à cinq ans étaient de 69 % (IC 95 % : 56–83) et 95 % (IC 95 % : 89–100). Il n’y avait pas de différence de survie globale ni de contrôle locorégionale en fonction des traitements reçus (radiothérapie/chimioradiothérapie contre chimiothérapie puis radiothérapie/chimioradiothérapie) ou en cas d’atteinte sous-glottique primitive. Un indice de performance de 1 ou plus et la présence d’adénopathie cervicale au moment du diagnostic étaient des facteurs pronostiques défavorables de survie globale en analyse multifactorielle (hazard ratio [HR] [IC 95 %], respectivement de 6,5 [1,3–34 ; p =0,03] et 11 [1,6–75 ; p =0,02]). La probabilité de contrôle locorégional des cancers de stades T3-T4 était plus basse (HR : 3,1 ; IC 95 % : 1,1–9,2, p =0,04) en analyse unifactorielle mais aucun facteur pronostique n’a été retrouvé dans l’analyse multifactorielle. Aucune différence de probabilité de contrôle locorégional n’a été observée en fonction du premier traitement reçu (p =0,3). La probabilité de préservation laryngée à cinq ans était de 88 % (IC 95 % : 78–98) pour l’ensemble des patients et 58 % en cas de cancer de stade T3. Les probabilités de préservation laryngée à cinq ans étaient de 91 % (IC 95 % : 79–100) et 83 % (IC 95 % : 66–100), respectivement chez les patients qui n’ont pas et ont reçu une chimiothérapie néoadjuvante. Conclusion: Cette analyse suggère que les résultats obtenus pour les cancers du larynx avec atteinte sous-glottique par la radiothérapie avec ou sans chimiothérapie seraient comparables à ceux obtenus pour les autres tumeurs laryngées. Des protocoles de préservation laryngée pourraient donc être proposés en cas d’atteinte sous-glottique, dans certains cas sélectionnés. D’autres études sont nécessaires pour préciser ces données préliminaires. [ABSTRACT FROM AUTHOR]

Summary: Purpose/objectives: To analyze the clinical features, treatment modalities and outcome of patients treated for a localized esthesioneuroblastoma (ENB). Materials and methods: Forty-three consecutive patients with biopsy proven ENB treated at two referral cancer centers between 1998 and 2010 were retrospectively reviewed. Results: Overall, 5 patients had stage A disease, 13 stage B, 16 stage C and 9 stage D according to the modified Kadish classification. Neo-adjuvant chemotherapy was performed in 23 patients leading to a 74 % response rate. Thirty-one patients were treated by surgery. Thirty-nine patients (90.6%) underwent radiation therapy. Twelve patients received bilateral cervical lymph node irradiation (LNI). After a median follow-up of 77months, the 5-year overall and progression free survival were 65% and 57%. Twelve patients (28%) had a locoregional relapse leading to 10 ENB-related deaths. The major prognostic factor was the modified Kadish stage with a 3-year survival for stage A–B, C and D of 100%, 48% and 22% respectively (p <0.0001). Two (9%) isolated cervical lymph node relapses occurred among staged B and C patients treated without elective LNI and none after elective or adjuvant LNI. Conclusion: The high risk of locoregional failure in ENB justifies the use of multimodal therapy. Induction chemotherapy leads to a high response rate. Elective LNI might prevent regional failure in locally advanced disease. [Copyright &y& Elsevier]

BACKGROUND: Concomitant chemoradiotherapy and accelerated radiotherapy independently improve outcomes for patients with locally advanced head and neck squamous-cell carcinoma (HNSCC). We aimed to assess the efficacy and safety of a combination of these approaches. METHODS: In our open-label phase 3 randomised trial, we enrolled patients with locally advanced, stage III and IV (non-metastatic) HNSCC and an Eastern Cooperative Oncology Group performance status of 0-2. We randomly allocated patients centrally with a computer program (with centre, T stage, N stage, and localisation as minimisation factors) in a 1:1:1 ratio to receive conventional chemoradiotherapy (70 Gy in 7 weeks plus three cycles of 4 days' concomitant carboplatin-fluorouracil), accelerated radiotherapy-chemotherapy (70 Gy in 6 weeks plus two cycles of 5 days' concomitant carboplatin-fluorouracil), or very accelerated radiotherapy alone (64·8 Gy [1·8 Gy twice daily] in 3·5 weeks). The primary endpoint, progression-free survival (PFS), was assessed in all enrolled patients. This trial is completed. The trial is registered with ClinicalTrials.gov, number NCT00828386. FINDINGS: Between Feb 29, 2000, and May 9, 2007, we randomly allocated 279 patients to receive conventional chemoradiotherapy, 280 to accelerated radiotherapy-chemotherapy, and 281 to very accelerated radiotherapy. Median follow-up was 5·2 years (IQR 4·9-6·2); rates of chemotherapy and radiotherapy compliance were good in all groups. Accelerated radiotherapy-chemotherapy offered no PFS benefit compared with conventional chemoradiotherapy (HR 1·02, 95% CI 0·84-1·23; p=0·88) or very accelerated radiotherapy (0·83, 0·69-1·01; p=0·060); conventional chemoradiotherapy improved PFS compared with very accelerated radiotherapy (0·82, 0·67-0·99; p=0·041). 3-year PFS was 37·6% (95% CI 32·1-43·4) after conventional chemoradiotherapy, 34·1% (28·7-39·8) after accelerated radiotherapy-chemotherapy, and 32·2% (27·0-37·9) after very accelerated radiotherapy. More patients in the very accelerated radiotherapy group had RTOG grade 3-4 acute mucosal toxicity (226 [84%] of 268 patients) compared with accelerated radiotherapy-chemotherapy (205 [76%] of 271 patients) or conventional chemoradiotherapy (180 [69%] of 262; p=0·0001). 158 (60%) of 265 patients in the conventional chemoradiotherapy group, 176 (64%) of 276 patients in the accelerated radiotherapy-chemotherapy group, and 190 (70%) of 272 patients in the very accelerated radiotherapy group were intubated with feeding tubes during treatment (p=0·045). INTERPRETATION: Chemotherapy has a substantial treatment effect given concomitantly with radiotherapy and acceleration of radiotherapy cannot compensate for the absence of chemotherapy. We noted the most favourable outcomes for conventional chemoradiotherapy, suggesting that acceleration of radiotherapy is probably not beneficial in concomitant chemoradiotherapy schedules. FUNDING: French Ministry of Health. [ABSTRACT FROM AUTHOR]