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Introduction Pour les tumeurs de l’hypopharynx et de l’œsophage cervical, une premiere ligne radiochimio est de plus en plus utilisee, la chirurgie etant reservee aux tumeursrecurrentes ou qui ne repondent pas. Methodes Nous rapportons une etude retrospective sur 190 patients avec un carcinome epidermoide de l’hypopharynx et de l’œsophage cervical, traites dans notre Service de 1992 a 2012. Le stade clinique etait T3–4 dans 164 (86,3 %) patients, et N + dans 129 (67,9 %). 26 patients (14 %) ont eu une chirurgie premiere, et 164 (86 %) ont ete traites avec une radiochimio premiere. Resultats Pour la chirurgie premiere la mortalite postoperatoire etait de 15,4 % (4 sur 26) et la survie a 3 et 5 de 23 % et 19 %. Dans le groupe radiochimio premiere (164 patients) la reponse clinique etait : complete (CR) chez 58 patients (41 %), et partielle (PR) chez 40 patients (28 %). La mortalite postop. apres traitement radiochimio etait de 4 %. Le taux de survie a 3 ans et 5 ans des patients avec un CR clinique etait de 57 % et 41 %, et pour les patients avec une PR clinique, il a ete de 39 % et 33 %. Discussion Les patients ayant subi une chirurgie primaire avaient un plus mauvais pronostic que les patients qui ont eu une premiere ligne radiochimio malgre le fait qu’ils avaient des tumeurs de stade precoce. Conclusion La radiochimio premiere devrait etre le traitement de choix pour le cancer de l’hypopharynx et de l’œsophage cervical, et la chirurgie premiere seulement pour les tumeurs que ne repondent pas.

Background Skeletal muscle is the major reservoir of body proteins and it can be affected in conditions associated to altered protein turnover and metabolism such as cancer. Although severe wasting is seen primarily in patients with advanced malignancy, some of them present degree of wasting at the onset of disease. Autophagy has been recently described to play a relevant role inmuscle wasting.Materials andMethodsWeperformedmorphometric studies and immunohistochemical analyses on intraoperative rectus abdominis muscle biopsies from 50 consecutive weight stable colorectal patients and 25 weight-stable patients operated for non-inflammatory benign diseases with no clinical signs of myopathies. Biochemical and molecular analyses have been performed in order to evaluate protein profile, the presence of autophagy induction and their correlation with clinical outcome. Results In cancer patients, we observed a subclinical myopathy characterized by an abnormal distribution of myonuclei relocated from the periphery inside themyofiber. The percentage ofmyofibers with abnormally located myonuclei was significantly higher in patients (median= 9%) compared to controls (median= 2.7%) (p=0.0002). Analyses on serum samples showed that, in the absence of systemic inflammation, in the prevalence of cancer patients the levels of albumin and prealbumin were below the normal range and the mean value was significantly lower compared to that detected in controls (albumin: 34.82 ± 5.8 g/L vs 45.2 ± 5.3, p< 0.01; prealbumin: 174.38±57.86 mg/L vs 264.00±69.73, p

Background Skeletal muscle is the major reservoir of body proteins and it can be affected in conditions associated to altered protein turnover and metabolism such as cancer. Although severe wasting is seen primarily in patients with advanced malignancy, some of them present degree of wasting at the onset of disease. Autophagy has been recently described to play a relevant role in muscle wasting. Materials and Methods We performed morphometric studies and immunohistochemical analyses on intraoperative rectus abdominis muscle biopsies from 50 consecutive weight stable colorectal patients and 25 weight-stable patients operated for non-inflammatory benign diseases with no clinical signs of myopathies. Biochemical and molecular analyses have been performed in order to evaluate protein profile, the presence of autophagy induction and their correlation with clinical outcome. Results In cancer patients, we observed a subclinical myopathy characterized by an abnormal distribution of myonuclei relocated from the periphery inside the myofiber. The percentage of myofibers with abnormally located myonuclei was significantly higher in patients compared to controls. Analyses on serum samples showed that, in the absence of systemic inflammation, in the prevalence of cancer patients the levels of albumin and prealbumin were below the normal range and the mean value was significantly lower compared to that detected in controls. Molecular analyses showed an accumulation of p62, a typical marker of autophagy induction, significantly higher in cancer patients compared to controls. We found an inverse correlation between the number of abnormally nucleated myofibers and the presence of lymph node metastasis. Cancer relapse was correlated with low serum levels of prealbumin and high levels of p62 in myofibers of cancer patients. Conclusions Colorectal cancer patients have a subclinical myopathy characterized by myofibers with internally located myonuclei. In the absence of inflammation, cancer patients show low levels of prealbumin and albumin as markers of altered protein turnover and persistent high levels of p62 in myofibers as expression of autophagy induction with an impairment in physiological autophagic flux. Up to now our data indicate that skeletal muscle fibers show nuclear abnormalities that seems to be associated to a better prognosis, while the presence of an altered protein turnover at an early stage of disease, with an impairment in the physiological autophagic flux, that could be predictive of cancer relapse and onset of cancer cachexia.