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Resume Le traitement des petites lesions cancereuses laryngees (T1 et T2) repose sur la chirurgie partielle, endoscopique ou externe et la radiotherapie. Outre l’imperatif carcinologique ces techniques doivent au maximum preserver les fonctions de respiration, de deglutition et de phonation. Objectif Analyser les fonctions de respiration, de deglutition et de phonation chez des patients traites par laryngectomie supra-cricoidienne et reconstruction a l’aide des muscles sous-hyoidiens. Materiels et methodes Notre travail consistait a analyser les fonctions de respiration, de deglutition et de phonation chez 37 patients traites dans deux instituts entre 2005 et 2015. Nous avons inclus tous les patients beneficiant de ce type de reconstruction avec un recul d’au moins un an par rapport a la chirurgie. L’etude de la fonction respiratoire consistait a noter l’existence ou non d’une tracheotomie et a mesurer le debit inspiratoire de pointe. La preservation ou non des unites crico-arytenoidiennes, le delai de maintien de la sonde nasogastrique et le remplissage de l’auto-questionnaire DHI 30 etaient recueillis pour analyser la fonction de deglutition. La phonation etait appreciee a l’aide de l’auto-questionnaire VHI 30. Resultats Nos resultats montrent un taux de chirurgie initiale sans tracheotomie de 64,9 % (13 patients) avec une reprise rapide de l’alimentation orale (delai moyen d’ablation de la sonde de 13 jours). Le score moyen au VHI 30 etait de 28,3 et de 2,7 au DHI 30. La valeur moyenne du debit inspiratoire de pointe etait de 203,3 mL/mn. Conclusion La laryngectomie supra-cricoidienne avec reconstruction a l’aide des muscles sous-hyoidiens est une technique alternative pour le traitement des petites lesions cancereuses laryngees. Sa realisation permet d’offrir des suites fonctionnelles simples.

Treatment of small laryngeal cancerous lesions (T1 and T2) is based on partial endoscopic or open surgery and radiotherapy. In addition to the oncological imperative, these techniques must optimally preserve the functions of breathing, swallowing and phonation. Objective To analyze the above functions in patients treated with supracricoid laryngectomy and reconstruction using infrahyoid muscle. Materials and methods Breathing, swallowing and phonation were analyzed in 37 patients treated in two institutes between 2005 and 2015. All patients undergoing the above type of reconstruction with a minimum 1 year's follow-up were included. Respiratory study noted any tracheotomy and measured peak inspiratory flow. Preservation of cricoarytenoid units and nasogastric intubation time, and DHI-30 self-administered questionnaire results were collected to analyze swallowing function. Phonation was assessed on the VHI-30 self-administered questionnaire. Results The rate of primary surgery without tracheotomy was 64.9% (13 patients), with rapid resumption of oral feeding (mean intubation time, 13 days). Mean VHI score was 28.3 and mean DHI 30 score 2.7. Mean peak inspiratory flow was 203.3 mL/min. Conclusion Supracricoid laryngectomy with reconstruction using subhyoid muscle is an alternative technique for the treatment of small laryngeal cancerous lesions, providing uncomplicated functional outcome.

International audience; Background: To describe the characteristics of the largest European study of MEC of salivary glands and to determine the prognostic factors for overall and disease free survival.Patients and methods: Patients with MEC were prospectively included in the Réseau d'Expertise Français sur les Cancers ORL Rares (REFCOR, French Network of Rare Head and Neck Tumors) database between 2009 and 2015.Results: A total of 292 patients were included. Tumors were classified as low grade in 175 cases (60%), intermediate in 39 (13%) and high grade in 78 (27%). Median follow-up was 26 months. The 5-year OS and DFS rates were respectively 83% and 69%. In multivariate analysis, age (p = 0.004), diabetes (p = 0.02) and advanced stage (p = 0.03) were found to have a significant negative impact on OS. Diabetes (p = 0.001), alcohol consumption (p = 0.003) and advanced stage (p = 0.001) were found to have a significant negative impact on DFS. Compare to low grade, high grade tended to have a negative impact on OS (p = 0.05) and had a significant effect on DFS (0.002) while intermediate grade had no significant influence on survival. The surgical treatment had a positive impact on both OS (p = 0.00005) and DFS (p = 0.0005). Postoperative radiotherapy had no impact in multivariate analysis.Conclusion: Advanced clinical stage, high grade tumor, high age, the impossibility of carrying out a complete surgical resection, and diabetes are the main prognostic factors in this prospective series of patients with MEC. Such findings open new research perspectives on the influence of these components on initial patient care.

Resume Objectifs Evaluer l’efficacite et la tolerance du rechallenge en sel de platine chez les patients presentant un carcinome epidermoide des voies aerodigestives superieures (CE VADS) recidivant apres une radiochimiotherapie a base de sels de platine. Materiel et methodes Nous avons inclus retrospectivement tout patient traite par polychimiotherapie a base de sels de platine entre 2007 et 2016 pour la prise en charge d’un CE VADS en recidive apres radiochimiotherapie a base de sels de platine (traitement exclusif ou postoperatoire). L’objectif principal etait le taux de controle de la maladie lors du rechallenge en platine. Resultats Quarante-cinq patients ont ete inclus. L’intervalle sans maladie, median apres la radiochimiotherapie, etait de 5,7 mois. Le taux de controle de la maladie lors du rechallenge platine etait de 40 %. La mediane de survie sans progression a la recidive etait 3,7 mois et la mediane de survie globale de 5,0 mois. Parmi les patients presentant une recidive dans les 6 mois suivant la radiochimiotherapie, le taux de controle de la maladie etait de 47,8 %. Un intervalle sans maladie ≥ 4,5 mois etait associe a un meilleur taux de controle de la maladie (28,5 % versus 54,8 %, p = 0,0311). Conclusion Le rechallenge en platine permet un taux interessant de controle de la maladie en situation de CE VADS recidivant apres radiochimiotherapie.

International audience; BACKGROUND:Head and neck mucosal melanoma (HNMM) is aggressive and rare, with a poor prognosis because of its high metastatic potential. The two main subtypes are sinonasal (sinonasal mucosal melanoma [SNMM]) and oral cavity (oral cavity mucosal melanoma [OCMM]). Consensual therapeutic guidelines considering the primary tumour site and tumour-node-metastasis (TNM) stage are not well established.MATERIAL & METHODS:Patients with HNMM from the prospective national French Rare Head and Neck Cancer Expert Network database between 2000 and 2017 were included. Clinical characteristics, treatment modalities, outcomes and prognostic factors were analysed.RESULTS:In total, 314 patients were included. The 5-year overall survival (OS) and progression-free survival (PFS) rates were 49.4% and 24.7%, respectively, in the surgery group; no long-term survivors were observed when surgery was not feasible. Moreover, even after surgery, a high recurrence rate was reported with a median PFS of 22 months. In multivariate analysis, Union for International Cancer Control (UICC) stage and tumour site correlated with PFS and OS. Postoperative radiotherapy (PORT) improved the PFS but not OS in patients with small (T3) SNMM and OCMM tumours. Nodal involvement was more frequent in patients with OCMM (p < 10-4), although, as in SNMM, it was not a significant prognostic predictor.CONCLUSION:Even early HNMM was associated with poor oncologic outcomes due to distant metastases despite surgical resection with clear margins. Lymph node metastases had no impact on the prognosis, suggesting treatment de-escalation in cervical node management. PORT might be useful for local control.

Resume La fiabilite de la technique du ganglion sentinelle (GS) est etablie depuis plus d’une dizaine d’annees dans les carcinomes epidermoides T1-T2 de la cavite buccale et de l’oropharynx. Bien que la plupart des auteurs insistent sur la rigueur necessaire a sa realisation, il n’existe pas de reference consensuelle. De plus, d’autres indications sont decrites sur d’autres aires anatomiques des voies aerodigestives superieures (VADS) ainsi qu’en cas d’antecedents chirurgicaux ou de radiotherapie. Les equipes expertes dans cette technique sous l’egide du GETTEC ont realise une mise au point sur les points cles de la realisation de la technique des ganglions sentinelles dans les VADS a travers un guide pour la pratique, ainsi que sur les indications classiques et etendues. La fiabilite de cette technique repose sur le respect des points cles du reperage preoperatoire par lymphoscintigraphie, du prelevement peroperatoire et de l’analyse anatomo-pathologique des GS. Cette technique est le meilleur moyen de diagnostiquer une atteinte ganglionnaire occulte quelle que soit la localisation de la tumeur primaire, son stade T ou les antecedents du patient.

Objective To evaluate platinum rechallenge efficacy and tolerance in patients presenting recurrent head and neck squamous cell carcinoma (HNSCC) after platinum-based chemoradiation. Materials and methods We retrospectively included all patients treated from 2007 to 2016 by platinum-based polychemotherapy for recurrence of HNSCC previously treated by primary or postsurgical platinum-based chemoradiation. The primary end-point was disease control rate (DCR) on platinum rechallenge. Results Forty-five patients were included. Median disease-free interval (DFI) after chemoradiation was 5.7 months. DCR on platinum rechallenge was 40%. Progression-free survival at recurrence was 3.7 months and overall survival 5.0 months. DCR in patients with recurrence within 6 months of chemoradiotherapy was 47.8%. DFI > 4.5 months was associated with better DCR: 28.5% versus 54.8%; P = 0.0311. Conclusion Platinum rechallenge provided good DCR in recurrent HNSCC after chemoradiation.

The long-term results of the EORTC 24954 trial comparing sequential versus alternating chemotherapy and radiotherapy (RT) for patients with locally advanced laryngeal and hypopharyngeal cancer are reported. From 1996 to 2004, 450 patients were randomly assigned (1-1) to a sequential arm (SA = induction cisplatin-5fluorouracil followed by a 70Gy-RT for the responders or a total laryngectomy and post-operative RT for the non-responders) and an alternating arm (AA = cisplatin-5fluorouracil alternated with three 2-week courses of 20 Gy-RT for a total dose of 60 Gy). Median follow-up was 10.2 years. Ten-year survival with functional larynx (primary end-point) and overall survival were similar in both arms (18.7% and 33.6% in SA versus 18.3% and 31.6% in AA). Late toxicity was also similar; however, a trend for higher larynx preservation and better laryngeal function was observed in AA. (C) 2016 Elsevier Ltd. All rights reserved.

Resume La surveillance est essentielle dans la prise en charge des patients atteints de cancers des voies aerodigestives superieures. Ces recommandations de la SFORL ont ete etablies par un groupe d’experts dans ce domaine. Elles ont pour but de preciser les modalites de cette prise en charge a partir de l’etude de la litterature et, en l’absence de donnees, d’etablir un consensus professionnel. Nous aborderons ici les recommandations concernant le diagnostic des recidives locales et regionales et des localisations metachrones des VADS. Les recidives locoregionales surviennent le plus souvent dans les trois ans suivant le traitement initial et sont principalement liees aux caracteristiques de la tumeur initiale et aux modalites therapeutiques mises en œuvre. Les localisations laryngees, les limites d’exerese saines initialement, les faibles envahissements ganglionnaires, les traitements initiaux unimodaux et le diagnostic precoce des recidives sont des facteurs de bon pronostic. La surveillance systematique par imagerie peut se discuter pour des patients pour lesquels il reste une technique curative et lorsque la surveillance est difficile. La place du TEP-scanner est encore a determiner. Les localisations metachrones sont frequentes, meme a distance et justifient une surveillance prolongee. L’arret de l’intoxication ethylo-tabagique constitue la meilleure prevention. L’education du patient est primordiale.

International audience; Surveillance is fundamental to the management of head and neck cancer. The present guidelines of the French ENT society (SFORL) were drawn up by a group of experts in the field, and are intended to specify the modalities of management, based on a review of the literature and, where data are lacking, to provide expert opinion. The present paper deals with guidelines for the diagnosis of local and regional recurrence and metachronous head and neck locations. Locoregional recurrence usually occurs within 3 years of primary treatment and is mainly related to the characteristics of the primary tumor and the treatment measures taken. Laryngeal location, safe primary resection margins, low level of lymph node invasion, unimodal primary treatment and early diagnosis of recurrence are factors of good prognosis. Systematic imaging surveillance may be considered for patients for whom a curative technique exists and when surveillance is difficult. The role of PET-scanning remains to be determined. Metachronous locations are frequent, even in the late course; prolonged surveillance is appropriate. The best preventive measure is cessation of alcohol abuse and smoking. Patient education is primordial

Resume Objectif Les auteurs exposent les recommandations de la Societe francaise d’oto-rhino-laryngologie et de chirurgie de la face et du cou (SFORL) concernant l’actualisation de la recommandation du suivi post-therapeutique des carcinomes epidermoides des voies aerodigestives superieures de l’adulte. Ce chapitre de la recommandation concerne la recherche des metastases et des localisations metachrones œsophagiennes et bronchiques. Methodes Un groupe de travail multidisciplinaire a ete charge d’effectuer une revue de la litterature scientifique sur la thematique etudiee. A partir de ces textes et de l’experience de chacun, des recommandations ont ete redigees. Elles ont ensuite ete relues par un groupe de lecture independant du groupe de travail. Une reunion de synthese a permis d’aboutir a la version finale de la recommandation Les recommandations proposees ont ete classees en grade A, B, C ou accord professionnel selon un niveau de preuve scientifique decroissant.

Objectives A 10-year retrospective study investigated factors for survival and laryngeal preservation in advanced laryngeal, hypopharyngeal or epilaryngeal neoplasia. Material and method Two hundred and forty-six patients with advanced cancer of the larynx (17.48%), hypopharynx (48.78%) or epilarynx (33.74%) undergoing primary organ-sparing treatment were included from 1998 to 2008. Treatment comprised chemotherapy followed by radiation therapy for 92.68% of patients, isolated radiation therapy for 1.6% and concomitant or sequential radiation-chemotherapy for 5.7%. General health status, history and tumor status were recorded. Factors influencing survival were analyzed by Kaplan-Meier estimator, log-rank test and Cox models. Results Median overall survival of the population was 2.3 years and median laryngeal preservation 0.99 years in male patients and 2 years in female patients. Survival correlated significantly with body mass index (BMI; P = 0.0004), WHO performance status (P = 0.0064), alcohol consumption (P = 0.0004) and cessation (P

Resume Objectif Etude retrospective sur 10 ans avec recherche de facteurs influencant la survie et la preservation laryngee chez les patients souffrant d’une neoplasie avancee du larynx, de l’hypopharynx ou de la margelle. Patients et methode Entre 1998 et 2008, nous avons inclus 246 patients porteurs d’un cancer avance du larynx (17,48 %), de l’hypopharynx (48,78 %) ou de la margelle laryngee (33,74 %) qui ont beneficie en premiere intention d’un protocole de preservation d’organe (PPO). Celui-ci a ete effectue pour 92,68 % des patients par chimiotherapie puis radiotherapie, 1,6 % ont eu une radiotherapie exclusive, 5,7 % une radiochimiotherapie concomitante ou sequentielle. Des criteres sur l’etat general des patients, leurs antecedents et leur tumeur ont ete releves. Les facteurs influencant la survie ont ete etudies avec la methode de Kaplan-Meier, le test de Log-Rank et le modele de Cox. Resultats La mediane de survie brute de notre population est de 2,3 ans et pour la preservation laryngee, celle-ci est de 0,99 an pour les hommes et de 2 ans pour les femmes. Il existe un lien statistiquement significatif entre la survie et l’IMC du patient (p = 0,0004), l’etat general (stade OMS) (p = 0,0064), la consommation (p = 0,0004) et le sevrage alcoolique (p Conclusion Outre les criteres deja connus, ce travail met en exergue l’importance de l’etat general et nutritionnel de nos patients lors de leur prise en charge.

I sintomi e i trattamenti correlati ai carcinomi del faringolaringe intralciano le funzioni fisiologiche primordiali del paziente: la fonazione, la deglutizione e la respirazione. La faringolaringectomia o la laringectomia totale costituiscono la terapia ultima per i cancri avanzati faringolaringei. Questi interventi sono altamente mutilanti e fonti di ripercussioni fisiche, psichiche e sociali. Il monitoraggio dei pazienti nei postumi di una chirurgia radicale e indispensabile, a causa del rischio di recidiva o di seconda localizzazione. Le sue modalita sono state definite dalla Societa francese di otorinolaringoiatria (SFORL). Dopo una laringectomia totale, il reinserimento dei pazienti e in funzione della loro qualita di vita e delle possibilita di riabilitazione fisica (voce, respirazione, alimentazione). La qualita di vita dei laringectomizzati e fortemente alterata. La presenza di un tracheostoma, le alterazioni nell’alimentazione e gli sforzi per ottenere una voce soddisfacente sono altrettante difficolta incontrate dal paziente. Delle patologie psicologiche e psichiatriche (depressione) possono sopraggiungere nel tempo. La sociabilita degli individui e trasformata, con relazioni familiari frequentemente alterate e una riduzione della capacita di lavoro, collegata all’invalidita generata dalle menomazioni fisiche. La riabilitazione fisica del laringectomizzato richiede di riconquistare una voce. Le protezioni tracheali, i filtri o, ancora, gli scambiatori di calore e di umidita riducono i fastidi legati al tracheostoma. La riabilitazione digestiva si basa sulla ripresa progressiva di un’alimentazione normale e sullo screening di una stenosi faringea. Lo svezzamento alcoltabagico e obbligatorio. La faringolaringectomia e la laringectomia totale hanno trasformato la vita quotidiana delle persone. Oltre al monitoraggio attento per evidenziare la comparsa di un nuovo evento oncologico, l’obiettivo dei sanitari e di restituire queste persone alla societa con delle funzioni ottimali, permettendo un migliore reinserimento sociale.

Objectif Le role de l’elastographie par ondes de cisaillement (EOC) dans le bilan des nodules thyroidiens a cytologie indeterminee (CI) reste controverse. L’objectif de cette etude prospective bicentrique etait d’evaluer les performances de l’EOC dans des nodules a CI en termes de prediction de malignite, reproductibilite, et analyse combinee avec l’echographie standard. Patients et methodes Les patients eligibles presentaient un nodule thyroidien ≥ 15 mm avec CI (Bethesda III a V) pour lequel la chirurgie etait conseillee. Une echographie et une EOC standardisee ont ete realisees avant chirurgie ( Resultats Sur 131 nodules a CI, 21 (16 %) etaient malins dont 9 cancers papillaires (CPT), 6 vesiculaires, 5 peu differencies et 1 lymphome. Les parametres EOC etaient similaires dans les nodules benins et malins, notamment EImoy (20,2 contre 19,6 kPa), EImax (34,3 contre 32,5 kPa) ou ratio (1,57 contre 1,38). Dans les cancers, les EImoy, EImax et ratio etaient plus eleves dans le variant classique (n = 4) que dans les autres variants CPT (n = 5) (p Discussion Malgre des valeurs d’elasticite elevees dans le variant classique du CPT, les parametres conventionnels EOC ne permettent pas de predire la malignite dans les nodules thyroidiens a CI.

International audience; The reliability of the sentinel lymph node (SN) technique has been established for more than ten years in T1-T2 oral cavity and oropharynx squamous cell carcinoma. Although most authors stress the necessity of rigorous implementation, there are no agreed guidelines. Moreover, other indications have been described, in other anatomical areas of the upper aerodigestive tract and in case of previous surgery or radiotherapy. SN expert teams, under the GETTEC head and neck tumor study group, conducted a review of the key points for implementation in head and neck cancers through guidelines and a review of classical and extended indications. Reliability depends on respecting key points of preoperative landmarking by lymphoscintigraphy, and intraoperative SN sampling and histological analysis. The SN technique is the best means of diagnosing occult lymph node involvement, whatever the primary tumor location, T stage or patient history.

Los sintomas y los tratamientos relacionados con los canceres de la faringolaringe dificultan las funciones fisiologicas primordiales del paciente: la fonacion, la deglucion y la respiracion. La faringolaringectomia o la laringectomia total son el tratamiento de ultima instancia para los canceres faringolaringeos avanzados. Estas intervenciones son muy mutilantes y ocasionan repercusiones fisicas, psiquicas y sociales. El seguimiento de los pacientes despues de una cirugia radical es obligatorio, debido al riesgo de recidiva o de segunda localizacion. En Francia, sus modalidades estan definidas por la Societe Francaise d’Otorhinolaryngologie (SFORL). Despues de una laringectomia total, la reinsercion de los pacientes depende de su calidad de vida y de las posibilidades de rehabilitacion fisica (voz, respiracion, alimentacion). La calidad de vida de los laringectomizados se altera en gran medida. La presencia de un traqueostoma, los trastornos de la alimentacion y los esfuerzos para lograr una voz satisfactoria son otras de las dificultades que se encuentra el paciente. Con el tiempo, pueden desarrollarse patologias psicologicas y psiquiatricas (depresion). La sociabilidad de las personas se transforma, con una alteracion frecuente de las relaciones familiares y una reduccion de la capacidad de trabajo, relacionada con la invalidez provocada por las discapacidades fisicas. La rehabilitacion fisica del laringectomizado requiere la recuperacion de la voz. Las protecciones traqueales, los filtros o incluso los intercambiadores de calor y de humedad reducen los inconvenientes relacionados con el traqueostoma. La rehabilitacion digestiva se basa en la reanudacion progresiva de una alimentacion normal y en la deteccion sistematica de una estenosis faringea. Es obligatorio que el paciente deje de fumar y de beber alcohol. La faringolaringectomia y la laringectomia total transforman el dia a dia de los pacientes. Ademas del seguimiento atento para detectar la aparicion de un nuevo proceso oncologico, el objetivo de los profesionales sanitarios es reintegrar a estas personas a la sociedad con unas funciones optimas, lo que permita una mejor reinsercion social.

Resume Objectif Etude de patients atteints d’un cancer glottique classe T1N0M0 ou T2N0M0 traites par radiotherapie exclusive. Confronter nos resultats a ceux de la litterature en termes de survie et de resultats fonctionnels. Methode Etude retrospective des tumeurs laryngees neoplasiques classees T1N0M0 ou T2N0M0 traitees par radiotherapie exclusive et diagnostiquees entre le 1 er janvier 2000 et le 31 decembre 2010. Evaluation des taux de survie, de recidive et de preservation laryngee. Lieu CLCC Francois Baclesse et CHU de Caen. Patients Cinquante-neuf patients (53 hommes et six femmes) suivis pour un carcinome larynge (57 carcinomes epidermoides, deux carcinomes verruqueux) dont 51 T1N0M0 et huit T2N0M0. Traitement par radiotherapie exclusive (dose moyenne de 70 Grays limitee au cartilage thyroide pour 57 patients, avec irradiation des aires ganglionnaires pour deux patients). Resultats Dans notre serie, cinq (9,8 %) patients avec un carcinome larynge T1N0M0 et trois (37,5 %) avec une tumeur classee T2N0M0 ont recidive, soit un taux global de recidive de 13,6 %. Sur les huit recidives, trois ont evolue sur le plan ganglionnaire uniquement (N), deux ont recidive uniquement sur le site tumoral initial (T) et trois ont recidive localement et au niveau ganglionnaire (T et N). Leur traitement a consiste pour trois d’entre elles en une laryngectomie totale de rattrapage avec curage cervical bilateral, deux recidives ont ete traitees par curage cervical bilateral et radiotherapie sensibilisee, une par chimiotherapie seule, une par curage cervical et radiotherapie cervicale. Le dernier patient avec recidive est decede avant tout autre traitement. Le taux de preservation laryngee etait de 94,9 %. Conclusion En comparaison avec la litterature, le traitement par radiotherapie exclusive des cancers larynges classes T1T2N0M0 donne de tres bons resultats, avec un taux de preservation laryngee egal a 95 %.

Summary Objectives The French Society of Otorhinolaryngology (SFORL) set up a work group to draw up guidelines for initial staging of head and neck squamous cell carcinoma. Locoregional and remote extension assessment are dealt with in two separate reports. The present part 3 deals with the assessment of frequent associated symptoms and pathologies, requiring early treatment and the collection of data on a certain number of clinical and paraclinical parameters for therapeutic decision-making in the multidisciplinary team meeting. Materials and methods A multidisciplinary critical analysis of the literature was conducted. General assessment here covers screening, assessment and initial management of the following: usual risk factors (smoking, alcohol, HPV), the most frequent medical comorbidities, nutritional status, social and psychological status, dental status, pain and possible anemia. As oncologic management frequently associates surgery, radiation therapy and chemotherapy, the underlying examinations should be early, as part of initial staging. The levels of evidence for the examinations were estimated so as to grade guidelines, failing which expert consensuses were established. Results The high rates of pain, malnutrition and anemia call for systematic screening and early management, especially as rapidly effective treatments exist. Assessing comorbidity and social and psychological status enables general health status to be assessed, along with possible contraindications to the usual treatments. Tracheal intubation problems may require intubation under flexible endoscopy or jet-ventilation by inter-cricothyroid catheterization from the diagnostic endoscopy stage. Assessment and adapted dental care should be conducted if radiation therapy is likely or certain. Conclusion Early management of symptoms and comorbidity and anticipation of subsequent treatment are intended to shorten initial staging time and to collate the data needed for therapeutic decision-making. This assessment should be performed at the same time as the locoregional and remote extension assessment, and is obviously to be adapted according to tumoral extension stage and the possible treatment options.

Resume Objectifs La Societe francaise d’otorhinolaryngologie (SFORL) a organise un groupe de travail charge de la redaction de recommandations pour le bilan initial des carcinomes epidermoides des voies aerodigestives superieures (VADS). Le bilan d’extension locoregional et a distance est traite dans deux autres publications. Cette troisieme partie aborde l’evaluation de symptomes ou de pathologies frequentes chez ces patients et dont la prise en charge precoce est necessaire, ainsi que le recueil d’un certain nombre de parametres cliniques ou paracliniques necessaires a la prise de decision therapeutique en reunion de concertation pluridisciplinaire. Materiels et methodes Lecture critique multidisciplinaire de la litterature. Le champ de ce bilan general comprenait le depistage, l’evaluation et la prise en charge initiale des points suivants : les facteurs de risque habituels (tabac, alcool, HPV), les comorbidites medicales les plus frequentes, le statut nutritionnel, le statut social et psychologique, l’etat de la dentition, l’existence de douleurs, la recherche d’une anemie. Le traitement de ces cancers associant souvent une intervention chirurgicale, une radiotherapie et une chimiotherapie, les auteurs ont estime que les examens necessaires a ces traitements devaient etre realises precocement et faisaient donc partie du bilan initial. Le niveau de preuve des etudes a ete estime, permettant de grader le niveau des recommandations. Le cas echeant, des avis d’experts ont ete proposes. Resultats La frequence des douleurs, de la denutrition et de l’anemie impose leur depistage systematique et leur prise en charge precoce, d’autant plus que des traitements rapidement efficaces existent. L’evaluation des comorbidites et du statut social et psychologique permet d’evaluer l’etat de sante general du patient, et de depister d’eventuelles contre-indications aux traitements habituellement proposes. Les difficultes d’intubation tracheale peuvent necessiter le recours a une intubation sous controle fibroscopique ou une jet-ventilation par catheter inter-cricothyroidien des l’endoscopie diagnostique. Le bilan et les soins dentaires adaptes seront realises si une radiotherapie est certaine ou fortement probable. Conclusion La prise en charge precoce des symptomes et des comorbidites et l’anticipation des traitements ont pour but de reduire la duree du bilan initial et de rassembler les elements necessaires a la prise de decision therapeutique. Ce bilan doit etre realise en meme temps que le bilan d’extension locoregional et a distance. Ce bilan sera evidemment adapte en fonction du stade d’extension tumorale et des options therapeutiques potentielles.

Resume Objectifs Ce travail presente les recommandations de la SFORL pour la recherche de metastases a distance et d’un second cancer synchrone lors du bilan initial des cancers epidermoide des VADS. Materiels et methodes Revue exhaustive de la litterature analysee par un groupe de travail multidisciplinaire. Resultats Le thorax constitue la localisation la plus frequente des metastases a distance et des seconds cancers synchrones hors VADS. Le scanner thoracique est preconise chez tous les patients en premiere intention (grade B). Une TEP-TDM au 18-FDG est preconisee en cas d’image thoracique douteuse ou de risque metastatique eleve pour la detection des metastases a distance non pulmonaires (grade B). Une exploration de l’œsophage est recommandee pour les patients a risque significatif de cancer synchrone de l’œsophage (tumeur de l’hypopharynx et de l’oropharynx, intoxication alcoolique chronique) (grade B). L’examen de reference est la fibroscopie digestive haute (grade B). Conclusions Ces recommandations de grade B permettent de rationnaliser la place des differents examens radiologiques et endoscopiques realises en premiere intention pour la recherche des metastases a distance et des seconds cancers synchrones. Cette rationalisation devrait permettre de limiter le nombre d’examens realises et ainsi reduire le temps necessaire au bilan initial.

International audience; OBJECTIVES: This report presents the French Society of ORL (SFORL) guidelines for exploration for remote metastasis and synchronous second cancer in initial staging of head and neck squamous cell carcinoma. MATERIALS AND METHODS: An exhaustive literature review was analyzed by a multidisciplinary work-group. RESULTS: The thorax is the most frequent location of remote metastases and synchronous second cancer outside of the upper aerodigestive tract. Thoracic CT is recommended as first-line examination in all cases (grade B). 18-FDG PET/CT is recommended when the thoracic CT image is doubtful or in case of high metastatic risk (grade B), for the detection of non-pulmonary remote metastasis. Esophageal exploration is recommended in case of significant risk of synchronous esophageal cancer (hypopharyngeal or oropharyngeal tumor, chronic alcohol intoxication) (grade B). The reference examination is flexible endoscopy of the upper digestive tract (grade B). CONCLUSION: The present grade B recommendations rationalize the roles of the various first-line radiological and endoscopic examinations for remote metastasis and synchronous second cancer, so as to limit the number of examinations performed, thereby reducing the time needed for initial staging.

Resume Objectifs Les auteurs proposent d’exposer les recommandations de bonne pratique concernant le bilan d’extension locoregional des cancers epidermoides des voies aerodigestives superieures (VADS) : cavum, fosses nasales et sinus exclus. Materiels et methodes Lecture critique multidisciplinaire de la litterature concernant le bilan d’extension locoregional des cancers epidermoides des VADS selon les niveaux de preuve scientifique en accord avec le guide d’analyse de la litterature publie par l’HAS en janvier 2000. Conclusion A partir du niveau de preuve des articles selectionnes et de facon collegiale au sein du groupe de travail, des recommandations ont ete proposees et gradees concernant le bilan d’extension locoregional clinique, endoscopique et iconographique des cancers des VADS.

Resume Objectifs Les auteurs exposent les recommandations de la Societe francaise d’oto-rhino-laryngologie (SFORL) concernant le bilan anatomopathologique des cancers des voies aerodigestives superieures (VADS). Materiel et methodes Un groupe de travail pluridisciplinaire, constitue par la SFORL, a effectue une revue detaillee de la litterature selon les niveaux de preuve scientifique en accord avec le guide d’analyse de la litterature publie par l’Anaes en janvier 2000. Resultats Une confrontation anatomoclinique est indispensable. En cas de discordance entre les examens cliniques, radiologiques et histologiques, une relecture ou la realisation d’un nouveau prelevement peuvent etre necessaires (Accord professionnel). La seule suspicion d’un carcinome epidermoide sur une cytoponction ganglionnaire n’autorise pas la mise en route d’un traitement agressif, sauf cas exceptionnels (Accord professionnel). La recherche systematique de l’HPV n’est pas recommandee en l’absence de modification therapeutique (Accord professionnel). L’etude immunohistochimique de p16 a but epidemiologique est optionnelle (Accord professionnel). Le stockage en tumorotheque doit etre realise dans le respect strict de la legislation et des regles de bonnes pratiques de prelevement et de conservation (Accord professionnel). Conclusion Le bilan anatomopathologique des patients soupconnes de carcinome epidermoide des VADS est absolument essentiel, nous proposons des recommandations de bonnes pratiques pour une prise en charge optimale de ces patients.

SummaryObjectivesThe authors present the French Society of Otorhinolaryngology (SFORL) guidelines for histopathologic assessment of head and neck cancer.Materiel and methodsA multidisciplinary workgroup set up by the SFORL performed an exhaustive review of the literature according to levels of evidence, following the 2000 guidelines of the French national health approvals and assessment agency (ANAES).ResultsComparison between histologic and clinical data is essential. In case of discrepancy between clinical, radiological and histological findings, reinterpretation or new biopsy may be required (professional consensus). Mere suspicion of carcinoma on fine-needle aspiration lymph-node biopsy only exceptionally warrants aggressive treatment (professional consensus). Exploration for HPV is not recommended as routine practice, being without therapeutic impact (professional consensus). Anti-p16 immunohistochemistry is optional, for epidemiological purposes (professional consensus). Tumor-bank tissue storage must conform strictly to prevailing legislation and good practice rules for sampling and preservation (professional consensus).ConclusionPathology assessment is mandatory in suspected H&N squamous cell carcinoma. The present guidelines are intended to optimize management.

Background We report the 10-year results of the EORTC trial 24891 comparing a larynx-preservation approach to immediate surgery in hypopharynx and lateral epilarynx squamous cell carcinoma. Material and methods Two hundred and two patients were randomized to either the surgical approach (total laryngectomy with partial pharyngectomy and neck dissection, followed by irradiation) or to the chemotherapy arm up to three cycles of induction chemotherapy (cisplatin 100 mg/m2 day 1 + 5-FU 1000 mg/m2 day 1–5) followed for complete responders by irradiation and otherwise by conventional treatment. The end points were overall survival [OS, noninferiority: hazard ratio (preservation/surgery) ≤ 1.428, one-sided α = 0.05], progression-free survival (PFS) and survival with a functional larynx (SFL). Results At a median follow-up of 10.5 years on 194 eligible patients, disease evolution was seen in 54 and 49 patients in the surgery and chemotherapy arm, respectively, and 81 and 83 patients had died. The 10-year OS rate was 13.8% in the surgery arm and 13.1% in the chemotherapy arm. The 10-year PFS rates were 8.5% and 10.8%, respectively. In the chemotherapy arm, the 10-year SFL rate was 8.7%. Conclusion This strategy did not compromise disease control or survival (that remained poor) and allowed more than half of the survivors to retain their larynx.

Background. The management of the neck remains controversial in the definitive chemoradiation setting of advanced N2-3 head and neck squamous cell carcinoma. Most published data favor omission of neck dissection (ND) after complete response for N2-3 or selective ND for residual disease Methods. We studied the patterns of care in the French-Belgian Groupe d'Etude des Tumeurs de la Tete Et du Cou (GETTEC) through a questionnaire-based survey. Results. Eighteen percent of institutions never performed up-front ND, 20% rarely, 40% sometimes, 14% often, and 8% systematically. Induction chemotherapy was indicated in 30% of the cases, and most ND were performed either between induction and radiation or after chemoradiation for residual disease. Response to chemoradiation was assessed by computed tomographic scan and positron emission tomography in 72% of cases. Selective ND was more common than radical ND. Conclusions. Omission of ND based on computed tomographic scan and positron emission tomography-based complete response to chemoradiation is the most common strategy for advanced nodal disease among centers. However, neck management strategies vary among institutions, and some institutions continue advocating systematic ND before irradiation. The new treatment options and the changing epidemiology, namely docetaxel-based induction chemotherapy and human papilloma virus-related head and neck squamous cell carcinoma having better response profiles and prognosis, are adding to the nonconsensual approach. The best therapeutic index in terms of neck management remains to be defined in this evolving context. © 2012 Society of Surgical Oncology.

Objectif Evaluer de facon prospective l’interet de la TEP/TDM a la F18-choline (FCH) pour la localisation preoperatoire d’adenome parathyroidien chez des patients atteints d’une hyperparathyroidie primaire et presentant un bilan d’imagerie conventionnel consistant en une echographie cervicale et une TEMP/TDM au Tc99m-sestaMIBI (MIBI), negatif ou non concluant. Materiel et methode Vingt patients eligibles ont beneficie d’une TEP/TDM a la FCH. Le resultat etait considere positif, negatif ou non concluant. Les caracteristiques des foyers ont ete notees. Le geste chirurgical a ete adapte au resultat de la TEP/TDM a la FCH (chirurgie mini-invasive, exploration cervicale bilaterale ou autre en cas de foyer ectopique ou multiple). Les donnees TEP ont ete confrontees aux donnees chirurgicales et anatomopathologiques et au suivi biologique post-operatoire. Resultats Les taux moyens de calcemie et PTH preoperatoire etaient, respectivement, de 2,75 ± 0,22 mmol/L et 98,1 ± 38,4 pg/mL. L’examen TEP/TDM a la FCH a ete considere positif pour 17 patients (85 %), non concluant pour 2 (10 %) patients et negatif pour 1 (5 %) patient, revelant au total 22 foyers (21 en position habituelle et 1 ectopique) de taille moyenne 13,4 mm [6,3–37,0]). La chirurgie, adaptee au resultat TEP chez 19 (95 %) patients, a consiste en 16 chirurgies mini-invasives, 1 exploration cervicale bilaterale pour foyers multiples bilateraux et 2 autres types de chirurgie. Le patient avec TEP negative a beneficie d’une exploration cervicale bilaterale. L’analyse anatomopathologique a retrouve 20 lesions presentant un adenome chez 17 patients. Au total, la sensibilite, par lesion et par patient, d’un examen TEP/TDM a la FCH pour detecter un adenome parathyroidien est, respectivement, de 95,0 % (95 %CI : 75,1–99,9) et 94,4 % (95 %CI : 72,7–99,9), avec des valeurs positives predictives de 90,5 % (95 %CI : 89,6–91,3) et 89,5 % (95 %CI : 88,4–90,5). La calcemie moyenne post-operatoire etait de 2,39 ± 0,19 mmol/L. Conclusion La TEP/TDM a la FCH permet de guider la parathyroidectomie avec succes chez la majorite des patients atteints d’une hyperparathyroidie primaire avec imagerie conventionnelle negative ou non concluante. Clinicaltrial NCT02432599

Background: A phase III trial demonstrated that cetuximab is the first agent in 30 years to improve survival when added to platinum-based chemotherapy (platinum-fluorouracil) first line for recurrent and/or metastatic squamous cell carcinoma of the head and neck (SCCHN). This analysis of the trial assessed the impact of treatment on quality of life (QoL). Patients and methods: The European Organisation for Research and Treatment of Cancer QoL Questionnaire-Core 30 (QLQ-C30) and QLQ-Head and Neck 35 (QLQ-H&N35) module were used to assess QoL. Results: Of 442 patients randomly assigned, 291 (QLQ-C30) and 289 (QLQ-H&N35) patients completed at least one evaluable questionnaire. For QLQ-C30, cycle 3 and month 6 mean scores for platinum–fluorouracil plus cetuximab were not significantly worse than those for platinum–fluorouracil. Pattern-mixture analysis demonstrated a significant improvement in the global health status/QoL score in the cetuximab arm (P = 0.0415) but no treatment differences in the social functioning scale. For QLQ-H&N35, the mean score for the cetuximab arm was not significantly worse than that for the chemotherapy arm for all symptom scales at all post-baseline visits. At cycle 3, some symptom scores significantly favored the cetuximab arm (pain, swallowing, speech problems, and social eating). Conclusion: Adding cetuximab to platinum–fluorouracil does not adversely affect the QoL of patients with recurrent and/or metastatic SCCHN.

Resume Objectif Estimer si la chirurgie exclusive dans le traitement des cancers precoces de l’hypopharynx peut donner des resultats identiques, voire meilleurs en termes de survie et de controle local que la radiotherapie. Methodes Quarante-cinq patients ont ete operes de 1991 a 2004. Quatre patients ont ete operes par voie endoscopique et 41 par pharyngolaryngectomie partielle. Quarante-trois patients ont eu un evidement ganglionnaire. Resultats La survie globale a un, trois et cinq ans etait de 100, 95 et 75 %. Le taux de controle locoregional a un, trois et cinq ans etait de 93, 88 et 82 % et etait influence par la presence de dysplasie sur les marges de resection ( p = 0,027). Les evenements carcinologiques observes ont ete cinq recidives locales, deux recidives ganglionnaires, dix secondes localisations et deux evolutions metastatiques. Cinq recidives locoregionales sur sept ont pu etre controlees par un traitement de rattrapage. Conclusion La chirurgie exclusive donne des resultats pleinement satisfaisants en termes de survie et de controle locoregional. Face a une recidive, elle permet d’operer des patients en territoire non irradie avec une diminution de la morbidite et de la mortalite et avec de meilleurs resultats. Ces resultats doivent etre confirmes par une etude randomisee.

International audience; Objective: The present article is an update of the guideline of the French Society of Otorhinolaryngology and Head and Neck Surgery (SFORL) on the post-treatment follow-up of adult head and neck squamous cell carcinoma concerning screening for metastasis and metachronous esophageal and bronchial locations.Methods: A multidisciplinary work-group was entrusted with a review of the literature on the above topic. Guidelines were drawn up, based on the articles retrieved and the work-group members' own experience. These were then reviewed by an editorial group independent of the work-group. A coordination meeting then finalized the guidelines. Guidelines were graded A, B, C or "expert opinion" according to decreasing level of evidence.

Objectifs L’impact de l’envahissement ganglionnaire microscopique sur le risque de maladie residuelle ou recidivante (MRR) reste controverse dans le cancer papillaire de la thyroide (CPT). L’objectif de l’etude est d’evaluer le risque de MRR et le statut evolutif a 4 ans chez des patients atteints de CPT en fonction du statut ganglionnaire initial (pNx, pN0, pN1 microscopique [cN0/pN1] ou pN macroscopique [cN0/pN1]. Patients et methodes Trois cent cinq patients consecutifs ayant eu une dose ablative d’I131 entre 2006 et 2011 ont ete inclus dans cette etude (128 pNx, 84 pN0, 44 pN1 micro et 49 pN1 macro). A l’ablation, la maladie residuelle a ete evaluee sur la scintigraphie post-therapeutique a l’I131 associant un corps entier et une tomographie cervico-thoracique couplee a un scanner de reperage (TEMP/TDM). Resultats Sur un suivi de 48 mois (13–84), 51 patients (17 %) ont presente une MRR (32, cou ; 11, a distance ; 8, cou et a distance) detectee sur la scintigraphie post-ablation dans 63 % des cas et la TEP-FDG dans 31 % des cas. Le risque cumule de MRR a 4 ans est plus faible chez les pN1 micro que chez les pN1 macro (24 vs 49 %, p = 0,03), mais plus eleve que chez les pN0 (12 %, p = 0,01) ou pNx (6 %, p p = 0,0001), l’extension extra-thyroidienne (RR = 2,6, p p p p p p Conclusions Les patients avec un envahissement ganglionnaire microscopique ont un pronostic intermediaire entre les pNx-pN0 et les pN1 microscopique justifiant de modifier les echelles de risque actuellement utilisees.

The objective of the study was to evaluate the effect of neoadjuvant chemotherapy on the survival of patients with oropharyngeal cancer. Patients with a squamous cell carcinoma of the oropharynx for whom curative radiotherapy or surgery was considered feasible were entered in a multicentric randomized trial comparing neoadjuvant chemotherapy followed by loco-regional treatment to the same loco-regional treatment without chemotherapy. The loco-regional treatment consisted either of surgery plus radiotherapy or of radiotherapy alone. Three cycles of chemotherapy consisting of Cisplatin (100 mg/m2) on day 1 followed by a 24-hour i.v. infusion of fluorouracil (1000 mg/m2/day) for 5 days were delivered every 21 days. 2–3 weeks after the end of chemotherapy, local treatment was performed. The trial was conducted by the Groupe d'Etude des Tumeurs de la Tete Et du Cou (GETTEC). A total of 318 patients were enrolled in the study between 1986 and 1992. Overall survival was significantly better (P = 0.03) in the neoadjuvant chemotherapy group than in the control group, with a median survival of 5.1 years versus 3.3 years in the no chemotherapy group. The effect of neoadjuvant chemotherapy on event-free survival was smaller and of borderline significance (P = 0.11). Stratification of the results on the type of local treatment, surgery plus radiotherapy or radiotherapy alone, did not reveal any heterogeneity in the effect of chemotherapy. © 2000 Cancer Research Campaign http://www.bjcancer.com

Head and neck cancers are the fifth among the most common cancers in France. Two thirds of cases occur at an advanced stage. For advanced disease, progression-free survival, despite undeniable progress, remains below 50% at three years. The last 20 years have been marked by the necessity to identify situations where less intense surgery and/or radiotherapy and/or chemotherapy is possible without jeopardizing the prognosis, and situations where a therapeutic intensification is necessary and results in a gain in survival while better preserving function with less toxicity. French cooperative groups gathering radiation oncologists (GORTEC), surgeons (GETTEC) and medical oncologists or physicians involved in the management of systemic treatments in head and neck cancers (GERCOR) are now belonging to the INCa-labelled Intergroup ORL to deal with the challenges of head and neck cancers.

SummaryObjectiveStudy of patients with stage T1N0M0 or T2N0M0 glottic cancer treated by exclusive radiotherapy and comparison of the survival and functional results of this series with those of the literature.MethodRetrospective study of stage T1N0M0 or T2N0M0 glottic cancers diagnosed between 1st January 2000 and 31st December 2010 and treated by exclusive radiotherapy. Evaluation of survival, recurrence and larynx preservation rates.Study centresCLCC François-Baclesse and CHU de Caen.PatientsFifty-nine patients (53 men and sixwomen) treated for glottic cancer (57 squamous cell carcinomas, two verrucous carcinomas) comprising 51 T1N0M0 and eight T2N0M0 tumours. Treatment with exclusive radiotherapy (mean dose of 70Grays limited to the thyroid cartilage for 57 patients, with lymph node irradiation for two patients).ResultsIn this series, five (9.8%) patients with stage T1N0M0 glottic cancer and three patients (37.5%) with stage T2N0M0 glottic cancer relapsed, corresponding to a global recurrence rate of 13.6%. Three of the eight recurrences involved lymph nodes exclusively (N), two patients relapsed exclusively at the primary tumour site (T) and three patients presented local and lymph node recurrence (T and N). Treatment consisted of salvage total laryngectomy with bilateral cervical lymph node dissection in three cases, bilateral cervical lymph node dissection and sensitized radiotherapy in two cases, exclusive chemotherapy in one case, cervical lymph node dissection and cervical radiotherapy in one case. The last patient with recurrence died prior to salvage therapy. The larynx preservation rate was 94.9%.ConclusionIn comparison with the literature, treatment of stage T1-T2N0M0 glottic cancer by exclusive radiotherapy gives very good results, with a larynx preservation rate of 95%.

The aim of the present article is to demonstrate the relevance of revascularized free scapular flap in mandibular reconstruction in oncological cervicofacial salvage surgery. We will discuss the advantages and the disadvantages, indications and contraindications, together with possible complications and sequelae for this type of surgical flap.Retrospective study of 93 revascularized free scapular flaps used to reconstruct segmental substance defects in the mandible from April 1997 to October 2009 (in 91 patients). All patients benefited from 10 months to 12 years follow-up surgical and functional results. Functional assessment following anatomic site restoration focused on the quality of feeding and deglutition.The anatomical success rate was 94.63% (5 complete necroses out of 93 flaps). Results were considered to be good (normal or close to normal function for feeding and deglutition) in the majority of patients (83% at 6 months, 91% at 18 months). On the donor site: Functional sequelae were moderate when post-operative reeducation was correctly performed.Vascularized free scapular flap bone graft is very interesting for the reconstruction of mandibular discontinuity, composite (soft tissue and cutaneous resection) or exclusively osseous defects (not in excess of 13 cm), secondary to oncologic or osteoradionecrotic resections.

Background: Lapatinib is a dual inhibitor of epidermal growth factor receptor (EGFR) and human EGFR-2 (HER-2) tyrosine kinases. This study investigated the pharmacodynamic and clinical effects of lapatinib in patients with locally advanced squamous cell carcinoma of the head and neck (SCCHN). Methods: In total, 107 therapy-naive patients with locally advanced SCCHN were randomised (2 : 1) to receive lapatinib or placebo for 2–6 weeks before chemoradiation therapy (CRT). Endpoints included apoptosis and proliferation rates, clinical response, and toxicity. Results: Versus placebo, lapatinib monotherapy did not significantly increase apoptosis detected by terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate-biotin nick-end labelling or caspase-3 assays. A statistically significant decrease in proliferation using Ki67 assay was observed (P=0.030). In a subset of 40 patients that received ⩾4 weeks of lapatinib or placebo, objective response rate (ORR) was 17% (n=4/24) vs 0% (n=0/16). In the lapatinib single-agent responders, all had EGFR overexpression, 50% had EGFR amplification, and 50% had HER2 expression by immunohistochemistry (including one patient with HER2 amplification). However, these patients showed variable modulation of apoptosis, proliferation, and phosphorylated EGFR on drug treatment. Following CRT, there was a statistically non-significant difference in ORR between lapatinib (70%) and placebo (53%). There was no clear correlation between changes in apoptosis or proliferation and response to chemoradiation. Mucosal inflammation, asthenia, odynophagia, and dysphagia were the most commonly reported adverse events with lapatinib. Conclusion: Short-term lapatinib monotherapy did not demonstrate apoptotic changes, but provided evidence of clinical activity in locally advanced SCCHN, and warrants further investigation in this disease.

But de la presentation Jusqu’au debut des annees 1990, la chirurgie laryngee etait la principale therapeutique utilisee dans la prise en charge des carcinomes epidermoides avances du larynx et de l’hypopharynx. L’alternative a ce traitement mutilant a repose sur l’apparition de nouveaux protocoles dits de « preservation laryngee » que sont la radiotherapie exclusive ou la radiotherapie en association avec de la chimiotherapie (concomitante ou alternee). Plusieurs facteurs ont montre un impact sur la survie et la preservation laryngee (stade OMS, consommation alcoolique, stade TNM, etc.). Notre travail a cherche a montrer l’influence sur la survie et la preservation laryngee d’un facteur rarement etudie : l’indice de masse corporelle (IMC). Materiel et methodes Nous avons recueilli les donnees de 246 patients porteurs d’un carcinome epidermoide localisee soit au larynx (17,48 %), soit a l’hypopharynx (48,78 %) soit a la margelle laryngee (33,74 %) chez qui un protocole de preservation d’organe (PPO) a ete decide en RCP. Les facteurs determinant de la survie ont ete etudie avec la methode de Kaplan-Meier, le test de log-Rank et le modele de Cox. Resultats La mediane de survie brute des patients masculin est de 2,16 ans et pour les femmes 6,48 ans. Nous avons mis en evidence un impact statistiquement significatif entre la survie et l’IMC du patient ( p = 0,0004), l’etat general (stade OMS) ( p = 0,0064), la consommation ( p = 0,0004) et le sevrage alcoolique ( p p = 0,0038), la mobilite laryngee initiale (p = 0,0002) et l’evaluation en fin de chimiotherapie ( p p = 0,016), le stade OMS lors de la premiere consultation ( p = 0,0005), le bilan endoscopique initial permettant d’evaluer la mobilite laryngee ( p p = 0,0009). Conclusion Outre les criteres deja connus dans la litterature, cette etude a montre l’importance de l’etat general et nutritionnel des patients lors de leur prise en charge initiale.

Consider whether surgery alone in the treatment of early cancers of the hypopharynx can give identical or better results in terms of survival and local control than radiotherapy.Forty-five patients were operated on during the years 1991-2004. Surgical treatment consisted in a resection by the transoral approach in four patients and 41 patients had a partial pharyngolaryngectomy. An elective neck dissection was performed on 43 patients.The 1-, 3-, and 5-year overall survival rates were 100, 95, and 75%. The 1-, 3-, and 5-year locoregional control rates were 93, 88, and 82% and were influenced by the presence of dysplasia on surgical margins (p=0.027). The oncological occurrences observed were five local recurrences, two nodal recurrences, ten second primary cancers, and two metastases. Five locoregional failures out of seven were controlled after a second treatment.Surgery alone gives completely satisfactory results in terms of survival and locoregional control. In case of recurrence, this makes it possible to operate on patients in nonirradiated areas with lower morbidity and mortality and better results. These results must be confirmed by a randomized trial.

Background: Both induction chemotherapy followed by irradiation and concurrent chemotherapy and radiotherapy have been reported as valuable alternatives to total laryngectomy in patients with advanced larynx or hypopharynx cancer. We report results of the randomized phase 3 trial 24954 from the European Organization for Research and Treatment of Cancer. Methods: Patients with resectable advanced squamous cell carcinoma of the larynx (tumor stage T3T4) or hypopharynx (T2T4), with regional lymph nodes in the neck staged as N0N2 and with no metastasis, were randomly assigned to treatment in the sequential (or control) or the alternating (or experimental) arm. In the sequential arm, patients with a 50% or more reduction in primary tumor size after two cycles of cisplatin and 5-fluorouracil received another two cycles, followed by radiotherapy (70 Gy total). In the alternating arm, a total of four cycles of cisplatin and 5-fluorouracil (in weeks 1, 4, 7, and 10) were alternated with radiotherapy with 20 Gy during the three 2-week intervals between chemotherapy cycles (60 Gy total). All nonresponders underwent salvage surgery and postoperative radiotherapy. The KaplanMeier method was used to obtain time-to-event data. Results: The 450 patients were randomly assigned to treatment (224 to the sequential arm and 226 to the alternating arm). Median follow-up was 6.5 years. Survival with a functional larynx was similar in sequential and alternating arms (hazard ratio of death and/or event = 0.85, 95% confidence interval = 0.68 to 1.06), as were median overall survival (4.4 and 5.1 years, respectively) and median progression-free interval (3.0 and 3.1 years, respectively). Grade 3 or 4 mucositis occurred in 64 (32%) of the 200 patients in the sequential arm who received radiotherapy and in 47 (21%) of the 220 patients in the alternating arm. Late severe edema and/or fibrosis was observed in 32 (16%) patients in the sequential arm and in 25 (11%) in the alternating arm. Conclusions: Larynx preservation, progression-free interval, and overall survival were similar in both arms, as were acute and late toxic effects.

Contains fulltext : 79497.pdf (Publisher’s version ) (Closed access) BACKGROUND: Treatment options for recurrent or metastatic head and neck squamous cell carcinoma (HNSCC) are limited with response rates to cytotoxic chemotherapy of approximately 30% and median survival of 6 months. PATIENTS AND METHODS: In a multicentre phase II study, 32 patients with recurrent or metastatic HNSCC received 3-AP Triapine (3-aminopyridine-2-carboxaldehyde thiosemicarbazone), an inhibitor of ribonucleotide reductase, 96 mg/m2, daily for 4 days every 14 days (one cycle). Eligibility criteria required Eastern Cooperative Oncology Group performance status (ECOG PS) of zero to two with a life expectancy of >3 months; one prior chemotherapy regimen was allowed. RESULTS: Thirty patients were assessable for response and toxicity. Median age was 57 years (range 36-79) and median ECOG PS was one (range 0-2). Thirteen patients had previously been treated with chemotherapy. A total of 130 cycles were administered with a median number of cycles of 3.5 (range 1-8). Mild anaemia (40%), nausea (22%) and fatigue (22%) were commonly reported with G3 and G4 neutropenia documented in 22% and 22%, respectively. Overall response rate was 5.9% (95% confidence interval 0.2% to 28.7%). One patient achieved a partial response, eight had stable disease and 21 progressive disease. Median time to disease progression was 3.9 months. CONCLUSIONS: 3-AP Triapine as a single agent, at this dose and schedule, is well tolerated but has only minor activity in the treatment of advanced HNSCC.

In presenting a case of laryngeal schwannoma, the authors emphasize the difficulties in diagnosing this rare pathology and review treatment options. The recent literature concerning this benign tumour is reviewed.The authors present a case of laryngeal schwannoma in a 29 year old man, revealed by exertional inspiratory dyspnea.The patient was treated by a conservative surgery with no recurrence after two years follow-up.CT scan and magnetic resonance imaging provide essentiel data on the spread of this benign tumour. The possibility of malignant change and recurrence warrant long-term follow-up.

Introduction: Small cell neuroendocrine carcinoma (SNEC) of the sinonasal tract is a rare disease.Objective: Report a descriptive study of a relatively large cohort of SNEC of the nasal cavity and paranasal sinuses.Method: The medical records of 21 patients presenting with nasal and paranasal SNEC to various French hospitals, from 1989 to 2003, were analysed to determine the clinical features and current treatment of the disease.Results: Patient data were obtained from eight French hospitals. Twelve of the patients were male and nine were female, with a mean age at presentation of 55 years (range: 27 to 79 years). Patients' staging for nasal cavity malignancy was: T1, four; T2, three; T3, one; T4, 13; N0, 18; N2, three; M0, 20; and M1, one. None of the patients suffered from SNEC of the sinonasal tract with ectopic hormone production. Immunohistochemistry proved useful for diagnosis in 20 cases. Twelve cases were positive for cytokeratin, 14 for chromogranin, eight for neuron-specific enolase and 11 for neuron-specific synaptophysin. One patient had an adenocarcinoma and an inverted papilloma associated with neuroendocrine carcinoma. Patients underwent surgery (11 cases), radiotherapy (14 cases) and chemotherapy (12 cases). Recurrence occurred in 10 cases. Five patients had visceral metastases or cervical lymph node involvement. Nine of the patients died within four years of onset of the disease.Conclusion: Small cell neuroendocrine carcinoma of the sinonasal tract is an uncommon neoplasm with aggressive clinical behaviour. Recurrence is frequent and the prognosis is poor. However, the current treatment of these neuroendocrine neoplasms varies widely.

But de la presentation La prise en charge chirurgicale des cancers localement avances du larynx ou de l’hypopharynx entraine des mutilations definitives. La laryngectomie totale ou la pharyngolaryngectomie totale modifie fondamentalement les fonctions primaires du larynx que sont la parole, la deglutition et la respiration. Les repercussions du stigmate lie au tracheostome sont non seulement physiques, mais egalement psychologiques et sociales. Les patients tracheostomises necessitent donc un accompagnement pluridisciplinaire parmi lequel, le medecin generaliste tient une place primordiale. En tant que referent de proximite et coordinateur de soins, le medecin generaliste est souvent en premiere ligne dans la gestion des souffrances psychologiques, algiques, la surveillance de la recidive et l’accompagnement des familles. La relation privilegiee entre le medecin generaliste et le malade et sa famille apporte une valeur ajoutee au suivi carcinologique. Le lien entre les soins de ville et ceux des etablissements de sante est donc indispensable. Or, une etude de 2010 de la Ligue Nationale Contre le Cancer montrait que seuls 48 % des medecins generalistes interroges etaient satisfaits de l’information donnee par leurs correspondants chirurgiens et oncologues. L’objectif de ce travail etait donc de realiser un etat des lieux de la communication entre medecins generalistes et praticiens hospitaliers oto-rhino-laryngologues (ORL) dans le cadre de la prise en charge des patients ayant ete traites par (pharyngo-) laryngectomie totale. Materiel et methodes Une etude transversale descriptive basee sur un entretien (ou un questionnaire par voie postale en cas de refus d’entretien) a ete realisee afin d’obtenir un etat des lieux de la relation entre le medecin generaliste et le chirurgien ORL. Ces entretiens ont ete effectues entre mai et juillet 2013. Resultats Notre etude realisee au sein d’un echantillon de 41 medecins generalistes d’une region francaise a montre qu’il existait une insuffisance de communication entre praticiens generalistes et chirurgiens ORL. Plus de 75 % des medecins etaient insatisfaits des echanges effectues et 66 % d’entre eux estimaient que leur role dans la prise en charge des patients laryngectomises etait insuffisant. La plupart des medecins (75,6 %) declarait avoir des difficultes dans la prise en charge des patients laryngectomises (notamment des difficultes techniques en rapport avec les canules et protheses phonatoires). Notre travail a egalement mis en evidence un manque de formation universitaire et post-universitaire dans la prise en charge ambulatoire des patients laryngectomises. Conclusion Un echange d’information de qualite permettrait d’ameliorer les rapports ville-hopital et contribuerait a la formation des medecins generalistes. Une formation post-universitaire aurait egalement un effet benefique sur la prise en charge des patients laryngectomises et donc sur leur qualite de vie. Les nouveaux moyens de communication et le developpement reaffirme du Dossier Communicant de Cancerologie sont porteurs d’espoir quant a l’amelioration de ces relations medecin generaliste-praticien hospitalier.

But de la presentation 1) Determiner les criteres cliniques et/ou paraclinique permettant d’identifier les patients pouvant beneficier d’une chirurgie laryngee radicale de rattrapage apres echec d’un protocole de preservation d’organe. 2) Analyser l’evolution clinique des patients. Materiel et methodes Serie retrospective de 246 malades pris en charge sur une periode de 10 ans pour des neoplasies du larynx, de l’hypopharynx ou de la margelle laryngee. Ces patients ont initialement beneficie d’un protocole de preservation d’organe, la plupart par chimiotherapie d’induction a base de 5FU et cisplatine. Sur ces 246 malades, 60 (24,4 %) ont necessite une prise en charge chirurgicale dont 25 (10,2 %) dans le cadre d’une chirurgie radicale de rattrapage. Resultats Le delai moyen entre la fin de traitement initial et la recidive etait de 9,3 mois et la mediane de survie depuis le debut de la prise en charge a ete de 2,4 ans pour ce groupe de malade. A la fin de notre etude, 4 patients etaient encore en vie, 20 decedes et un perdu de vue. Seul deux patients (10 %) sont decedes des complications de leur chirurgie, les autres de recidives locales (45 %) ou a distance (35 %) et 10 % de causes autres que leur cancer. Conclusion La chirurgie de rattrapage reste une alternative therapeutique valide si on mesure les risques encourus par le malade. Aucun critere n’a ete mis en avant permettant de determiner un groupe plus a meme de subir ce traitement. Le pronostic de la pathologie initiale reste tout de meme grave et les alternatives rares.