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A substantial number of patients with oropharyngeal squamous cell carcinoma (OPSCC) have two oncogenic risk factors: Human papilloma virus (HPV) infection and tobacco use. These factors can be competitive or synergistic at the chromosomal and genomic levels, with strong prognostic and therapeutic implications. HPV16 has been shown in vitro to be a high‑risk HPV that induces low rates of chromosomal copy number alterations. However, chromosomal instability can be increased by smoking. Evaluating chromosomal instability in HPV‑positive patients according to their smoking status is therefore critical for assessing the prognosis and therapeutic impact. The aim of this study was to assess chromosomal instability in patients with HPV‑positive OPSCC according to smoking status. Chromosomal instability was investigated with array‑based comparative genomic hybridization (aCGH) in 50 patients with OPSCC. Differences in chromosomal alterations were examined according to the HPV and smoking status of the patients. HPV‑positive tumors (24/26 were HPV16‑positive) had fewer genomic aberrations (P=0.0082) and fewer breakpoints (P=0.048) than HPV‑negative tumors. We confirmed the association between HPV‑positive OPSCC and chromosomal losses at 11q. We verified the association between HPV‑negative OPSCC and losses at 3p and 9p and gains at 7q and 11q13. In the patients with OPSCC who were HPV‑positive, the total number of chromosomal aberrations per tumor was significantly higher in the group of patients who were smokers (P=0.003). However, the cytobands did not differ significantly according to the smoking status. On the whole, the data of this study may help to improve the stratification of HPV‑positive OPSCC patients and must be supplemented by next‑generation sequencing studies in order to describe the mutational and transcriptomic profiles of such patients according to smoking status.

International audience; BACKGROUND:The purposes of this study were to describe the characteristics of a prospective multicenter series of patients with salivary duct carcinoma and to investigate prognostic factors.METHODS:Patients included for salivary duct carcinoma between 2009 and 2016 in the Réseau d'Expertise Français des Cancers ORL Rares (REFCOR) database were selected. Immunohistochemical analyses were performed.RESULTS:Sixty-one patients were included in this study. The primary site was the parotid gland in 90% of the cases. Fifty-seven percent of the tumors were stage IV, 65% of patients had lymph node involvement, and 10% had metastases. Tumors showed androgen receptor (89%) and human epidermal growth factor receptor 2 (HER2)/neu (36%). Ninety-four percent of patients underwent surgery and 86% had postoperative radiotherapy. Six patients were treated with targeted therapies. The 3-year overall survival (OS) was 74% and the 3-year disease-free survival (DFS) was 44%. Tumor stages III to IV reduced DFS (hazard ratio [HR] 4.3; P = .04). The N2/3 class reduced distant metastasis-free survival (HR 7.3; P = .007).CONCLUSION:Salivary duct carcinoma prognosis is poor and is correlated with tumor stage and lymph node classification. Androgen receptor and HER2/neu should be tested as they offer the possibility of targeted therapies.

Lymphatic malformations are benign malformations frequently occurring in the head and neck. Retropharyngeal location is rare, can be life threating and its management is particularly challenging. Over a three-year period, three patients presented with symptomatic (dyspnea and/or dysphagia) retropharyngeal lymphatic malformation. All were treated using a radiofrequency ablation of lymphatic malformation through a trans-oral approach. No major complications occurred following the surgery. During the follow-up, no recurrence was noted and all patients were asymptomatic. Radiofrequency ablation in the management of retropharyngeal lymphatic malformations is a simple technique with very good results and allows a fast recovery with minimum morbidity and a short hospital stay.

e17535 Background: HPV-driven oropharyngeal cancer (OPC) patients are characterized by a better prognosis than their HPV-negative counterparts. However, this significant survival advantage is not homogeneous and studies have highlighted that among HPV-positive patients those with a smoking history have a significantly increased risk of disease progression and death compared to those who have never smoked. The reason why tobacco consumption impacts negatively the prognosis is still elusive. Tobacco might induce additional genetic alterations leading to a more aggressive phenotype. The purpose of this study is to characterize the mutational profile of HPV-positive OPC by smoking status. We hypothesize a higher frequency of mutations affecting among smokers. Methods: Targeted next-generation sequencing of 38 oncogenes/tumor suppressor genes that are commonly mutated in cancers caused by tobacco/alcohol consumption was performed in 62 HPV-driven OPC cases stratified by smoking status. Results: The study population included 37 (60%) non-smokers and 25 (40%) smokers distributed as follows: 1 (4%) patient smoked 20 PY. Twenty (31%) patients had no mutation, 14 (23%) had 1 mutation and 28 (46%) had 2 or more mutations. The most commonly mutated genes regardless of tobacco consumption were PIK3CA (20%), MLL2 (20%), TP53 (8%), FAT 1 (15%), FBXW7 (16%), NOTCH 1 (9%) and FGFR3 (9%). Mutation rate was not significantly different in smokers compared to non-smokers even when analyses focused on heavy smokers (>20 pack-years compared to

The use of the bone anchoring device associated with a fiducial marker, both fixed close to the operating field, improves the reproducibility and effectiveness of the computer-assisted navigation in lateral skull base surgery.Computer-assisted navigation in lateral skull base surgery using the electromagnetic system Digipointeur(®) needs an external fiducial marker (titanium screw) close to the operating field to increase position accuracy (PA) to about 1 mm. Displacement of the emitter placed in the mouth (Buccostat(®)) induces a drift of the system, leading to at least 20% of unsuccessful procedures. The aim of this study was to evaluate the PA, stability, and reproducibility of computer-assisted navigation in lateral skull base surgery using a bone anchoring device to provide a fixed registration system near the operating field.Forty patients undergoing a lateral skull base procedure with the Digipointeur(®) system performed with both the titanium screw and bone anchoring device were included in this prospective study. They were divided in two groups. In the first one (n = 9), the PA was measured before and after screw registration for five intratemporal landmarks, during a translabyrinthine approach. In the second group (n = 31), all lateral skull base procedures were included and the PA was evaluated visually by the surgeon on different landmarks of the approaches as well as the stability of the system.In the first group, the PA was 7.08 ± 0.59 mm and 0.77 ± 0.17 mm (mean ± SEM, p0.0001) before and after screw registration, respectively. In the second group, the PA was considered as accurate by the surgeon in all cases and no drift of the system was observed. Computer-assisted surgery was never abandoned due to increased stability of the bone-anchored emitter.