Search

International audience

International audience; Purpose: Return to work (RTW) following cancer diagnosis is a challenge for both the patient and society. As thyroid cancer (TC) incidence is increasing, this study aims to assess difficulties in returning to work and income changes in TC survivors 5 years post-diagnosis.Methods: This study belongs to the national VICAN survey conducted in France among TC patients diagnosed between January and June 2010. Data were collected through phone interviews, medical surveys and from the national medico-administrative register in 2012 and 2015. We used multivariate logistic regressions to investigate TC impact on employment and income changes.Results: Of 146 patients, 121(82.9%) were women; the mean age was 42 years (SD = 8.34), 119 (81.3%) were diagnosed at an early stage, and 142(97.6%) underwent thyroidectomy. At 5 years post-diagnosis, 116 (79.7%) of the TC survivors were professionally active, 22 (15.4%) were unemployed and 8 (4.90%) were receiving disability. Among the patients employed at the time of diagnosis (n = 122), 15 (12.3%) had not returned to work 5 years post-diagnosis. Between 2 and 5 years post-diagnosis, there was no significant improvement in rates of RTW. At 5 years post-diagnosis, 90 (61.6%) reported an income decline. All TC survivors who have not returned to work were women and declared higher fatigue. Moreover, in multivariate analyses, not returning to work was associated with weight gain (OR = 8.41 (1.21; 58.23)) and working arrangements (6.90 (1.18-38.48)), while income decline was associated with comorbidities (OR = 2.28 (1.07; 4.86)) and to be engaged in manual work (OR = 2.28 (1.07; 4.88)).Conclusion: This study highlights that, despite a good prognostic, up to 12.3% of TC survivors had not returned to work and 61.6% reported an income decline, 5 years post-diagnosis. Weight gain, fatigue, to be a woman and working-type arrangement were associated with higher probability of not returning to work.Implications for cancer survivors: TC affects a young working population. Our study identified potentially vulnerable TC survivors and important modifiable factors which may help TC survivors to be professionally active and, therefore, increase their overall quality of life.

Background: Refining the risk of malignancy in patients presenting with thyroid nodules with indeterminate cytology (IC) is a critical challenge. We investigated the performances of 18F-fluorocholine (FCH) positron emission tomography/computed tomography (PET/CT) to predict malignancy. Methods: Between May 2016 and March 2019, 107 patients presenting with a thyroid nodule ≥15 mm with IC and eligible for surgery were included in this prospective study. Head-and-neck PET/CT acquisitions were performed 20 and 60 minutes after injection of 1.5 MBq/kg of FCH. PET/CT acquisition was scored positive when maximal standardized uptake value in the IC nodule was higher than in the thyroid background. Pathology was the gold standard for diagnosis. Results: At pathology, 19 (18%) nodules were malignant, 87 were benign, and one was a noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). Sensitivity, specificity, accuracy, positive-predictive value (PPV), and negative-predictive value (NPV) of FCH PET/CT in detecting cancer or NIFTP were 90%, 50%, 55%, 29%, and 96% at 20 minutes and 85%, 49%, 67%, 28%, and 94% at 60 minutes, respectively. Higher specificity (58% vs. 33%, p = 0.01) was observed in nononcocytic (n = 72) than in oncocytic IC nodules (n = 35). The pre-PET/CT probability of cancer or NIFTP in Bethesda III–IV nodules was 11% and the post-PET/CT probability was 19% in PET-positives and 0% in PET-negatives. In retrospective analysis, 42% of surgeries would have been unnecessary after PET/CT and 81% before (p

Pain is an increasing concern in the growing number of head and neck cancer survivors. This study aimed to analyze the 5-year prevalence of pain in French survivors of head and neck cancer and to identify associated factors. Analyses were performed among 296 5-year cancer survivors diagnosed in 2010. Using multivariable logistic regressions, we studied the associations between pain and factors collected in the French representative national “vie apres le cancer” (VICAN) survey. Eligible participants were aged from 18 to 82 years; patients’ living conditions, socioeconomic characteristics, and medical data were collected. Pain was reported by 72.6% of the participants. In the multivariable analyses, decreasing level of physical activity was the only determinant of increased overall pain (OR= 2.77, CI= 1.48–5.17). The chronic pain prevalence was 62.3%. The main risk factors found were tumor localization in the oropharynx (OR= 2.49, CI= 1.27–4.88), education (at least a high school’s degree) (OR= 0.33, CI= 0.13–0.9), and decreased physical activity (OR= 2.20, CI= 1.24–3.9). Five years after diagnosis, pain is a very frequent sequelae that has a significant impact on quality of life in head and neck cancer survivors. Reduced physical activity, a low level of education, and tumor localization in the oropharynx are factors associated with pain. Pain frequency and its impact on patients’ lives imply that an adaptation must be made in terms of both pain diagnosis and management and the training of healthcare professionals. This is not a clinical trial. ISP number: INSERM C11-63.

International audience; Purpose: Thyroid cancer (TC) incidence is increasing. With its good prognosis and the young population concerned, the number of survivors is rising. However, their quality of life appears worse than expected. This study aims to assess the social and sexual health (SSH) of TC survivors and associated factors after a 2- and 5-year follow-up.Methods: This study belongs to the National VICAN Survey implemented in France among TC patients diagnosed between January and June 2010. Data were collected via phone interviews, medical surveys, and from medico-administrative register in 2012 and 2015. We used multivariable logistic regressions to qualify TC impact on SSH.Results: Across 146 patients, 121 were women, 50.7% were less than 42 years old, 77.5% were diagnosed at an early-stage, and 97.6% underwent thyroidectomy. At 2 years, 60.0% experienced social life discomfort because of cancer, 40.6% reported a decreased sexual desire, 37.4% fewer intercourse, 31.9% felt dissatisfied with this frequency, 30% reported difficulties achieving orgasm, and 15.2% considered that cancer had a negative influence for procreation. No significant difference was observed at 5 years. SSH was never discussed with medical professionals for 96.7% patients, as it was not proposed as a topic of concern (79.1%). In multivariable analysis, depression, embarrassment regarding their physical appearance since treatment, and reduced gestures of affection remained associated with decreased sexual desire.Conclusion: This study highlights that TC is associated with an alteration of SSH which remains even at 5 years post-diagnosis. SSH should be discussed during diagnosis and considered during follow-up.

Riassunto I sintomi e i trattamenti legati ai cancri del faringolaringe ostacolano le principali funzioni fisiologiche del paziente: fonazione, deglutizione e respirazione. La faringolaringectomia o la laringectomia totale costituiscono la terapia radicale per i cancri faringolaringei avanzati. Questi interventi sono altamente mutilanti e causano ripercussioni fisiche, psicologiche e sociali. Il monitoraggio dei pazienti dopo un intervento chirurgico radicale e indispensabile, a causa del rischio di recidiva o di seconda localizzazione. Le sue modalita sono state definite dalla Societa francese di oto-rino-laringoiatria. Dopo una laringectomia totale, il reinserimento dei pazienti dipende dalla loro qualita di vita e dalle possibilita di riabilitazione fisica (voce, respirazione, alimentazione). La qualita di vita dei pazienti laringectomizzati e fortemente alterata. La presenza di una tracheostomia, i disturbi dell’alimentazione e gli sforzi per ottenere una voce soddisfacente sono altrettante difficolta incontrate dal paziente. Patologie psicologiche e psichiatriche (depressione) possono insorgere nel tempo. La socialita degli individui si trasforma, con rapporti familiari frequentemente alterati e una riduzione della capacita lavorativa, legata all’invalidita generata dalle disabilita fisiche. La riabilitazione fisica del paziente laringectomizzato richiede il recupero di una voce. Protezioni tracheali, filtri o, anche, scambiatori di calore e umidita riducono i fastidi legati alla tracheostomia. La riabilitazione digestiva si basa sulla ripresa graduale di un’alimentazione normale e sull’individuazione di una stenosi faringea. La sospensione di alcol e fumo e imperativa. La faringolaringectomia e la laringectomia totale hanno trasformato la vita quotidiana delle persone. L’implementazione di un programma di educazione terapeutica puo aiutare i pazienti e i loro cari a gestire meglio le conseguenze della laringectomia.

BackgroundIn patients with differentiated thyroid cancer (DTC), tumor burden of persistent disease (PD) is a variable that could affect therapy efficiency. Our aim was to assess its correlation with the 2015 American Thyroid Association (ATA) risk-stratification system, and its impact on response to initial therapy and outcome.MethodsThis retrospective cohort study included 618 consecutive DTC patients referred for postoperative radioiodine (RAI) treatment. Patients were risk-stratified using the 2015 ATA guidelines according to postoperative data, before RAI treatment. Tumor burden of PD was classified into three categories, i.e. very small-, small- and large-volume PD. Very small-volume PD was defined by the presence of abnormal foci on post-RAI scintigraphy with SPECT/CT or18FDG PET/CT without identifiable lesions on anatomic imaging. Small- and large-volume PD were defined by lesions with a largest size ResultsPD was evidenced in 107 patients (17%). Mean follow-up for patients with PD was 7 ± 3 years. The percentage of large-volume PD increased with the ATA risk (18, 56 and 89% in low-, intermediate- and high-risk patients, respectively,p p = 0.01) and at last follow-up visit (75, 28 and 16%, respectively;p = 0.04). On multivariate analysis, age ≥ 45 years, distant and/or thyroid bed disease, small-volume or large-volume tumor burden and18FDG-positive PD were independent risk factors for indeterminate or incomplete response at last follow-up visit.ConclusionsThe tumor burden of PD correlates with the ATA risk-stratification, affects the response to initial therapy and is an independent predictor of residual disease after a mean 7-yr follow-up. This variable might be taken into account in addition to the postoperative ATA risk-stratification to refine outcome prognostication after initial treatment.

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.

Resume Les soins de l’orifice de tracheotomie/stomie et la tracheotomie sont consideres a fort risque de contamination par le coronavirus 19 (SARS-CoV-2). La propagation de cette infection etant rapide, tous les patients sur le territoire francais doivent, en cette periode de pandemie, etre consideres comme potentiellement porteurs du virus. Neanmoins, les patients ne presentant pas de manifestations cliniques ni radiologiques (scanner thoracique) du COVID-19, et dont le prelevement viral nasopharynge est negatif 24 h avant le geste, sont consideres a faible risque. Les consignes de protections reposent sur un habillage et une desinfection de tout materiel utilise ou souille specifiques. La piece utilisee doit etre aeree apres les soins et la pression de celle-ci nulle ou negative. La technique percutanee est privilegiee a la cervicotomie pour reduire l’aerosolisation et eviter de deplacer le patient d’une unite de reanimation au bloc operatoire. La desaturation des patients etant souvent rapide, l’oxygenation doit etre optimisee lors de la tracheotomie. Un blocage neuromusculaire medicamenteux est conseille pour diminuer la toux lors de l’insertion de la canule. Une equipe experimentee est indispensable pour que les gestes soient fluides, securises et peu contaminants.

International audience; Tracheostomy post-tracheostomy care are regarded as at high risk for contamination of health care professionals with the new coronavirus (SARS-CoV-2). Considering the rapid spread of the infection, all patients in France must be considered as potentially infected by the virus. Nevertheless, patients without clinical or radiological (CT scan) markers of COVID-19, and with negative nasopharyngeal sample within 24h of surgery, are at low risk of being infected. Instructions for personal protection include specific wound dressings and decontamination of all material used. The operating room should be ventilated after each tracheostomy and the pressure of the room should be neutral or negative. Percutaneous tracheostomy is to be preferred over surgical cervicotomy in order to reduce aerosolization and to avoid moving patients from the intensive care unit to the operating room. Ventilation must be optimized during the procedure, to limit patient oxygen desaturation. Drug assisted neuromuscular blockage is advised to reduce coughing during tracheostomy tube insertion. An experienced team is mandatory to secure and accelerate the procedure as well as to reduce risk of contamination.

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.

Resume Introduction On definit la sociabilite comme etant l’ensemble des experiences reliant l’individu a d’autres personnes. Il s’agit de la premiere etude s’interessant specifiquement a l’impact du cancer ORL sur la sociabilite des conjoints. Patients et methodes Le recueil a ete realise via un questionnaire original envoye aux conjoints des patients. Le critere de jugement principal retenu a ete l’auto-evaluation par le conjoint de l’influence ou non de la maladie sur sa vie quotidienne. L’impact de la sociabilite sous ces differents aspects a egalement ete etudie : l’environnement amical, l’environnement inconnu, l’environnement exterieur connu, l’environnement necessaire et les activites solitaires. Discussion Deux cent soixante-dix conjoints ont repondu au questionnaire. Leurs activites quotidiennes etaient influencees par la maladie dans 71,5 % des cas. Resultats L’environnement amical a ete juge deteriore dans 46,4 %. L’environnement inconnu a ete juge deteriore dans 44,0 % des cas. Les pratiques sociales liees a l’environnement exterieur connu ont diminue chez 67,8 % des conjoints. L’environnement necessaire a ete juge altere chez 26,0 % des conjoints. Le nombre d’activites solitaires a augmente dans 35,6 % des cas. Conclusion L’impact social pour les conjoints des patients est donc majeur.

Background Cancer patients are thought to have an increased risk of developing severe Coronavirus Disease 2019 (COVID-19) infection and of dying from the disease. In this work, predictive factors for COVID-19 severity and mortality in cancer patients were investigated. Patients and Methods In this large nationwide retro-prospective cohort study, we collected data on patients with solid tumours and COVID-19 diagnosed between March 1 and June 11, 2020. The primary endpoint was all-cause mortality and COVID-19 severity, defined as admission to an intensive care unit (ICU) and/or mechanical ventilation and/or death, was one of the secondary endpoints. Results From April 4 to June 11, 2020, 1289 patients were analysed. The most frequent cancers were digestive and thoracic. Altogether, 424 (33%) patients had a severe form of COVID-19 and 370 (29%) patients died. In multivariate analysis, independent factors associated with death were male sex (odds ratio 1.73, 95%CI: 1.18-2.52), ECOG PS ≥ 2 (OR 3.23, 95%CI: 2.27-4.61), updated Charlson comorbidity index (OR 1.08, 95%CI: 1.01-1.16) and admission to ICU (OR 3.62, 95%CI 2.14-6.11). The same factors, age along with corticosteroids before COVID-19 diagnosis, and thoracic primary tumour site were independently associated with COVID-19 severity. None of the anticancer treatments administered within the previous 3 months had any effect on mortality or COVID-19 severity, except cytotoxic chemotherapy in the subgroup of patients with detectable SARS-CoV-2 by RT-PCR, which was associated with a slight increase of the risk of death (OR 1.53; 95%CI: 1.00-2.34; p = 0.05). A total of 431 (39%) patients had their systemic anticancer treatment interrupted or stopped following diagnosis of COVID-19. Conclusions Mortality and COVID-19 severity in cancer patients are high and are associated with general characteristics of patients. We found no deleterious effects of recent anticancer treatments, except for cytotoxic chemotherapy in the RT-PCR-confirmed subgroup of patients. In almost 40% of patients, the systemic anticancer therapy was interrupted or stopped after COVID-19 diagnosis., Highlights • A total of 1289 patients with solid tumours and COVID-19 were analysed. • Mortality and COVID-19 severity were mainly driven by patient general characteristics. • Overall, we found no deleterious effects of recent anticancer treatments on mortality. . • Systemic anticancer treatment was interrupted or stopped in 39% of patients.

International audience; Objectives: To assess the factors associated with long-term quality of life (QoL) and patient concerns in elderly oral or oropharyngeal cancer (OOPC) patients after oncologic surgery and free-flap reconstruction. Methods: Patients aged over 70 years who were still alive and disease-free at least 1 year after surgery were enrolled in this cross-sectional multicentric study. Patients completed the EORTC QLQ-C30, -H&N35 and -ELD14 QoL questionnaires, and the Hospital Anxiety and Depression Scale (HADS). Patient needs were evaluated using the Patient Concerns Inventory (PCI). Factors associated with these clinical outcomes were determined in univariate and multivariate analysis. Results: Sixty-four patients were included in this study. Long-term QoL, functioning scales and patient autonomy were well-preserved. Main persistent symptoms were fatigue, constipation and oral function-related disorders. Salivary and mastication/swallowing problems were the main patient concerns. The mean number of patient concerns increased with the deterioration of their QoL. Psychological distress (HADS score ≥ 15) and patient frailty (G8 score

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.

Minimal invasive surgery and reconstructive surgery tend to become the standard in France in the management of head and neck tumors. The use of endoscopic approaches (through endoscopic endonasal/transoral approaches±robot-assisted) instead of open surgery and the use of reconstructive surgery using autologous (flaps) or heterologous materials aim to reduce surgical morbidity by making-up for the loss of substance to restore the function. The impact of these substantial changes in surgical techniques has not been assessed with respect to postoperative radiotherapy practice. Endoscopic endonasal approaches result, however, in piecemeal resection, which, along the analysis of resection margins (a key prognostic factor), make the interpretation of the quality of resection more complex for radiation oncologists. The definition of tumour sub-volumes to be irradiated and doses to these sub-volumes then requires accurate histosurgical mapping and close multidisciplinary consultation between surgeons, pathologists, radiologists and radiation oncologists. Similarly, the increasing use of various types of flaps (of soft tissue or bone flaps), adapted to the patient and tumor anatomy, is associated with substantial modifications to the operating bed. The delineation of tumour volumes in postoperative radiotherapy is made more complex. Tremendous multidisciplinary efforts should now be initiated to fully take advantage of surgical advances and to further optimize the therapeutic index by making radiotherapy also less toxic, i.e. "mini-morbid".

To assess patient needs and concerns after head and neck squamous cell carcinoma (HNSCC) treatment and their possible correlations with long-term quality of life (QoL) and to examine the potential impact of psychological distress on these results.Alive and disease-free HNSCC patients at least 1 year after treatment were enrolled in this cross-sectional multicentric study and completed the EORTC QLQ-C30 and HN35 QoL questionnaires, the head and neck cancer-specific patient concerns inventory (PCI-HN) questionnaire and the hospital anxiety and depression scale (HADS). Correlations between QoL outcomes and patient needs and concerns were investigated using Spearman's correlation tests.Seventy-two patients were enrolled in the study. Fear of cancer recurrence was the main patient concern followed by dental, salivary, fatigue, speech, and eating problems. The leading patient needs in terms of consultation were to be referred to the surgeon, the speech, and swallow therapist and the oral rehabilitation team. The number of patient concerns correlated negatively (r .40) with functioning scales score and positively (r .40) with general and head and neck symptoms. Psychological distress was the main determinant of QoL outcomes (p .0001). We found a significant impact of gender (p = .002) on the number of patient concerns, and of patient age (p = .003) on the number of staff members selected by patients.Identification of patient needs and concerns along with multidisciplinary management of persistent symptoms and psychological distress seem essential steps towards improving QoL of HNSCC patients.

Minimal invasive surgery and reconstructive surgery tend to become the standard in France in the management of head and neck tumors. The use of endoscopic approaches (through endoscopic endonasal/transoral approaches±robot-assisted) instead of open surgery and the use of reconstructive surgery using autologous (flaps) or heterologous materials aim to reduce surgical morbidity by making-up for the loss of substance to restore the function. The impact of these substantial changes in surgical techniques has not been assessed with respect to postoperative radiotherapy practice. Endoscopic endonasal approaches result, however, in piecemeal resection, which, along the analysis of resection margins (a key prognostic factor), make the interpretation of the quality of resection more complex for radiation oncologists. The definition of tumour sub-volumes to be irradiated and doses to these sub-volumes then requires accurate histosurgical mapping and close multidisciplinary consultation between surgeons, pathologists, radiologists and radiation oncologists. Similarly, the increasing use of various types of flaps (of soft tissue or bone flaps), adapted to the patient and tumor anatomy, is associated with substantial modifications to the operating bed. The delineation of tumour volumes in postoperative radiotherapy is made more complex. Tremendous multidisciplinary efforts should now be initiated to fully take advantage of surgical advances and to further optimize the therapeutic index by making radiotherapy also less toxic, i.e. "mini-morbid".

Purpose Both concurrent chemoradiotherapy (CT-RT) and cetuximab radiotherapy (cetux-RT) have been established as the standard of care for the treatment of locally advanced squamous cell carcinoma of the head and neck. It was not known whether the addition of induction chemotherapy before cetux-RT could improve outcomes compared with standard of care CT-RT. Patients and Methods The current trial was restricted to patients with nonmetastatic N2b, N2c, or N3 squamous cell carcinoma of the head and neck and fit for taxotere, cisplatin, fluorouracil (TPF). Patients were randomly assigned to receive three cycles of TPF followed by cetux-RT versus concurrent carboplatin fluorouracil and RT as recommended in National Comprehensive Cancer Network guidelines. The trial was powered to detect a hazard ratio (HR) of 0.66 in favor of TPF plus cetux-RT for progression-free survival at 2 years. The inclusion of 180 patients per arm was needed to achieve 80% power at a two-sided significance level of .05. Results Between 2009 and 2013, 370 patients were included. All patients and tumors characteristics were well balanced between arms. There were more cases of grade 3 and 4 neutropenia in the induction arm, and the induction TPF was associated with 6.6% treatment-related deaths. With a median follow-up of 2.8 years, 2-year progression-free survival was not different between both arms (CT-RT, 0.38 v TPF + cetux-RT, 0.36; HR, 0.93 [95% CI, 0.73 to 1.20]; P = .58). HR was 0.98 (95% CI, 0.74 to 1.3; P = .90) for locoregional control and 1.12 (95% CI, 0.86 to 1.46; P = .39) for overall survival. These effects were observed regardless of p16 status. The rate of distant metastases was lower in the TPF arm (HR, 0.54 [95% CI, 0.30 to 0.99]; P = .05). Conclusion Induction TPF followed by cetux-RT did not improve outcomes compared with CT-RT in a population of patients with advanced cervical lymphadenopathy.

Median survival for recurrent/metastatic head and neck squamous cell cancer (HNSCC) patients is about 10 months after first-line best systemic treatment. We aimed to assess current approaches of oligometastatic HNSCC patients by the analysis of current concept and published data (1995–2017) in this population. Five-year survival rates are over 20% in selected patients who undergo metastasis-directed therapy by either surgery or stereotactic irradiation. Human papillomavirus(+) HNSCC patients have more disseminated metastases but respond more favorably and also benefit from ablative treatments. Treatments of oligometastases are expanding rapidly. Unmet needs include revised imaging follow-up strategies to detect metastases earlier, identification of predictive noninvasive biomarkers for treatment guidance, assessment and corrections of biases in current studies and randomized clinical trials.

Le fistole faringee corrispondono a comunicazioni tra la cavita faringea e l’esterno che si verificano nel 50% dei casi in media dopo chirurgia di exeresi faringolaringea. I fattori di rischio, come la denutrizione, l’estensione dell’exeresi o la radioterapia neoadiuvante, sono numerosi ma molto discussi. La diagnosi e clinica. Gli esami complementari sono utilizzati principalmente per rilevare sovrainfezioni, complicanze vascolari o un’evoluzione tumorale. Il transito esofago-gastro-duodenale puo essere utile per individuare una fistola incipiente prima della rialimentazione orale. Il trattamento iniziale e medico, basato sulle cure locali, e, poi, chirurgico, in caso di insuccesso. Occorre tenere conto dello stato locale e generale per fare la migliore scelta terapeutica. Misure di prevenzione devono essere utilizzate per ridurre l’incidenza delle fistole e le loro conseguenze psicologiche, estetiche ed economiche sulla prognosi e sulla qualita di vita dei pazienti.

Las fistulas faringeas son comunicaciones entre la cavidad faringea y el exterior. Se producen en el 50% de los casos en promedio tras la cirugia de reseccion faringolaringea. Existen numerosos factores de riesgo, como la desnutricion, la extension de la reseccion o la radioterapia neoadyuvante, pero son controvertidos. El diagnostico es clinico. Las pruebas complementarias se utilizan sobre todo para detectar las sobreinfecciones, las complicaciones vasculares o una evolucion tumoral. El transito esofago-gastro-duodenal puede ser util para detectar una fistula inicial antes de reanudar la alimentacion oral. El tratamiento inicial es medico, basado en los cuidados locales, y despues quirurgico si lo anterior fracasa. Hay que tener en cuenta el estado local y general para tomar la mejor decision terapeutica. Se deben utilizar medidas preventivas para reducir la incidencia de las fistulas y sus consecuencias psicologicas, esteticas, economicas, asi como sobre el pronostico y la calidad de vida de los pacientes.

Objectives In advanced hypopharyngeal and cervical esophageal carcinoma, the choice of reconstruction technique after total circumferential pharyngolaryngectomy (TCPL) remains controversial. We studied results of digestive tract reconstruction using gastric pull-up, concomitant or secondary to TCPL or after failure of reconstruction. Material and methods Twenty-four patients treated by gastric pull-up after TCPL for advanced hypopharyngeal or cervical esophageal carcinoma between December 1998 and January 2011 were retrospectively reviewed. Results Two-year survival was 37.5% ( n = 9). Thirty-day mortality was 4.1% ( n = 1), but 3 more patients died before discharge. Perioperative morbidity was 54.1% ( n = 13), including 9 fistulas (37.5%). Seventeen patients (71%) recovered oral feeding. Conclusion Gastric pull-up is an interesting reconstruction technique after TCPL with invasion of the esophageal mouth, allowing comfortable oral feeding, but with non-negligible morbidity and mortality. Long-term survival is not high, partly due to the unfavorable prognosis of advanced hypopharyngeal and cervical esophageal tumor. The present high rate of fistula raises doubts for this surgery as second-line reconstruction after primary failure.

Resume Objectif Dans les cancers pharyngo-œsophagiens evolues, le choix des techniques de reconstructions apres pharyngolaryngectomie totale circulaire (PLTc) demeure controverse. Nous avons etudie les resultats de la reconstruction des voies digestives par l’utilisation d’un transplant gastrique en reconstruction synchrone de la PLTc et en reconstruction secondaire a distance ou apres echec d’une premiere tentative de reconstruction. Materiel et methodes Etude retrospective realisee entre decembre 1998 et janvier 2011, chez 24 patients atteints d’un carcinome pharyngo-œsophagien evolue traites par PLTc avec rehabilitation digestive par gastroplastie tubulisee. Resultats La survie a 2 ans des patients etait de 9 patients (37,5 %). La mortalite postoperatoire a 30 jours concernait un patient (4,1 %) mais 3 patients sont decedes dans les suites de l’intervention. La morbidite perioperatoire concernait 13 patients (54,1 %) dont 9 fistules (37,5 %). La realimentation etait possible chez 17 patients (71 %). Conclusion La gastroplastie tubulisee est une technique de reconstruction interessante apres PLTc avec envahissement de la bouche œsophagienne qui permet un confort alimentaire acceptable au prix d’une morbimortalite encore importante. La survie a distance reste modeste en partie liee au pronostic defavorable des tumeurs pharyngo-œsophagiennes avancees. Le taux eleve de fistule dans notre serie doit faire discuter cette chirurgie pour reconstruction en deuxieme intention apres echec d’une premiere technique.

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.

International audience; no abstract

BACKGROUND: The aim was to collate and contrast patient concerns from a range of different head and neck cancer follow-up clinics around the world. Also, we sought to explore the relationship, if any, between responses to the patient concerns inventory (PCI) and overall quality of life (QOL). METHODS: Nineteen units participated with intention of including 100 patients per site as close to a consecutive series as possible in order to minimize selection bias. RESULTS: There were 2136 patients with a median total number of PCI items selected of 5 (2-10). "Fear of the cancer returning" (39%) and "dry mouth" (37%) were most common. Twenty-five percent (524) reported less than good QOL. CONCLUSION: There was considerable variation between units in the number of items selected and in overall QOL, even after allowing for case-mix variables. There was a strong progressive association between the number of PCI items and QOL. peerReviewed

International audience

International audience; Introduction Le carcinome adénoïde kystique est une tumeur rare de la sphère ORL pour laquelle peut se poser la question d’un traitement systémique. L’objectif de cette revue est de faire l’état des lieux des traitements systémiques (chimiothérapies, thérapies ciblées, immunothérapies) au stade de rechute locale ou métastatique. Méthodes Les articles traitant des thérapies systémiques de la sphère ORL de l’adulte, en situation métastatique ou localement avancée, comprenant au moins 10 patients ont été inclus. Résultats Quarante articles ont été sélectionnés dans cette revue. Le taux de réponse objective sous chimiothérapie était en moyenne < 10 % (0–70 %), avec des réponses objectives en monothérapie sous cisplatine, mitoxantrone, vinorelbine et éribuline, et en bithérapie par cisplatine-vinorelbine. Les inhibiteurs de l’EGFR ont permis d’obtenir 40 % de réponse objective en association avec de la chimiothérapie. Les inhibiteurs du VEGF et de l’histone désacétylase ont permis une stabilisation de la maladie prolongée chez des patients en progression, avec 10 % de réponses objectives. Les inhibiteurs de c-KIT en monothérapie ont permis d’obtenir < 5 % de réponse objective. Les inhibiteurs directs de la voie PI3 K/AKT/mTOR ont pour l’instant obtenu 0 % de réponse objective. Discussion Les meilleurs taux de réponse objective ont été obtenus avec la bithérapie à base de cisplatine-vinorelbine. De nombreuses anomalies moléculaires ont été identifiées. Les anti-EGFR, anti-VEGF et HDAC permettent des stabilisations prolongées. La présentation des dossiers en réunion de concertation pluridisciplinaire (RCP) de recours, telle que le Réseau d’expertise français des cancers ORL rares (REFCOR) et les RCP moléculaires, devrait être proposée, permettant notamment de diriger les patients vers des essais thérapeutiques.

To evaluate the frequency of use, modalities and potential interest of locoregional irradiation (LRT) in patients with upfront metastatic head and neck squamous cell carcinoma (HNSCC).Retrospective multicentric study. Were included all patients presenting an upfront metastatic HNSCC treated by platin-5FU- cetuximab based regimen, from 2008 to 2016. Patients with past history of cervical irradiation or HNSCC within the 5 years before metastasis diagnosis were excluded.65 patients were included. 25 patients (38%) presented a response or stable disease with chemotherapy. Forty-one patients (63%) underwent a locoregional irradiation: 5 patients before chemotherapy (upfront RT), 13 patients with stable disease or response after chemotherapy (consolidation RT), and 23 patients with progressive disease. Median overall survival (OS) was 11.6 months, median progression free survival was 7.9 months. OS was significantly improved for patients who underwent LRT (median OS 16.1 vs 7.5 months, p 0.01). Among patients who received LRT, OS trended to be better if LRT was performed as consolidation RT compared to upfront RT (median OS of 22.1 vs 15.5 months, p = 0.11). Among patients with stable disease or response after chemotherapy, there was a non-significant better OS for the 13 patients treated by LRT (median OS 22.1 vs 11.8 months, p = 0.21)). Radical dose was not associated with better locoregional control compared to palliative dose (p = 0.37).LRT is frequently performed during management of upfront metastatic HNSCC and associated with better OS. Non-progressive disease after firs-line chemotherapy seems a good way to select patients who would benefit from radical LRT.

Aim Cetuximab is an anti-epidermal growth factor receptor antibody used for the treatment of metastatic colorectal cancer and head and neck cancer. Hypersensitivity reactions (HSRs) are associated with cetuximab use. The aim of the study was to evaluate the utility of anti-cetuximab immunoglobulin E (IgE) detection in order to identify patients at risk of HSR to cetuximab. Methods We included patients ready to receive a first cetuximab infusion in a prospective cohort carried out at nine French centres. Pretreatment anti-cetuximab IgE levels were measured. We compared the proportion of severe HSRs in the low anti-cetuximab IgE levels (≤29 IgE arbitrary units) subgroup with that in a historical cohort of 213 patients extracted from a previous study. Results Of the 301 assessable patients (mean age: 60.9 ± 9.3 years, head-and-neck cancer: 77%), 66 patients (22%) had high anti-cetuximab IgE levels, and 247 patients received cetuximab (including 38 with high anti-cetuximab levels). Severe HSRs occurred in eight patients (five grade 3 and three grade 4). The proportion of severe HSRs was lower in the low anti-cetuximab IgE levels subgroup vs. the historical cohort (3/209 [1.4%] vs. 11/213 [5.2%], odds ratio, 0.27, 95% confidence interval, 0.07–0.97), and higher in high vs. low anti-cetuximab IgE levels subgroup (5/38 [13.2%] vs. 3/209 [1.4%]; odds ratio, 10.4, 95% confidence interval, 2.4–45.6). Patients with severe HSRs had higher anti-cetuximab IgE levels than patients without reaction (median, 45 vs. 2 IgE arbitrary units, P = 0.006). Conclusions Detection of pretreatment anti-cetuximab IgE is feasible and helpful to identify patients at risk of severe cetuximab-induced HSRs.

Nutritional care improves quality of life (QOL) in head and neck cancer patients treated with radiotherapy. The aim of our study was to determine whether intensive nutritional care (INC) would further improve QOL. In addition to a control group based on European and American guidelines, patients included in the INC group received six meetings with a dietitian. QOL was measured after radiotherapy using the EORTC QLQ-C30. We performed a meta-analysis to determine the best nutritional care. In the 87 patients, the QOL scores, weight, energy, and protein intakes were similar between the INC group (n = 43) and the control group (n = 44). The meta-analysis revealed no heterogeneity and significant differences in QOL (three studies) (p = 0.46) or weight changes after radiotherapy (four studies) (p = 0.06). The nutritional care specified in the European and American guidelines is composed of well-defined recommendations, and appears sufficient to maintain QOL without further intervention.

Head and neck cancers (HNC) have a poor prognosis and a long treatment delay may have a negative impact on this. Some studies have investigated the determinants of this delay but not in the general population and rarely taking into account socio-economic factors. A high-resolution population-based study about cancer management was conducted, using registries in the north-west of France, on HNC diagnosed between 2008 and 2010. The median time between diagnosis and multidisciplinary team meeting (DMI) (N = 1631) was 14 days (Q1: 7 to Q3: 26). The median time between diagnosis and first treatment (DTI) (N = 1519) was 35 days (Q1: 21 to Q3: 54). When the first treatment was radiotherapy, the interval was 54.5 days (Q1: 40 to Q3: 71). In multivariate analysis, DTI was associated with the type of first treatment and place of treatment. For advanced stage HNC, DTI was associated with comorbidities, topography of the cancer and socio-economic status, underprivileged patients being treated later than privileged ones. Given the French governmental cancer plans which set out to coordinate care pathways via nursing coordinators and to improve the availability of radiotherapy, the waiting times observed in this study still seem long. The optimal care pathway should include adapted social management but the DTI was still longer for underprivileged patients.

International audience; OBJECTIVES:To describe the clinical, histological and therapeutic characteristics of a prospective multicenter series of 95 head and neck adenoid cystic carcinoma patients, and to determine any prognostic factors for disease-free survival.PATIENTS AND METHODS:Ninety-five patients with adenoid cystic carcinoma were included in the Réseau d'Expertise Français Des Cancers ORL Rares (REFCOR, French Rare Head and Neck Cancer Expert Network) database between 2009 and 2012. The primary site was the salivary glands in 39 cases, sinus cavities (including hard palate) in 36 cases, pharynx-larynx-trachea in 14 cases, and lips and oral cavity in 4 cases. The tumor was stage I in 15% of cases, stage II in 23%, stage III in 26% and stage IV in 36%. Nine patients had cervical lymph node involvement and 5 had metastases at diagnosis. Fifty-six percent of patients were managed by surgery with postoperative radiation therapy. During follow-up, 3 patients died, 9 developed metastases and 12 showed recurrence or local progression.RESULTS:Mean follow-up was 18 months. On univariate analysis, disease-free survival correlated with T stage (P=0.05), N stage (P=0.003), resection margins (P=0.04), lymph node involvement on histology (P=0.01), and absence of chemotherapy (P=0.03). On multivariate analysis, disease-free survival correlated with T stage (P=0.01), N stage (P=0.09) and surgery (P=0.005).CONCLUSION:The essential issue in adenoid cystic carcinoma is long-term control. The present results confirm that the reference attitude is radical surgical resection for optimal local control. Adjuvant radiation therapy did not emerge as a prognostic factor. This study also provides a starting-point for translational studies in pathology and genetics.

Resume Les breches meningees du sinus frontal sont rares et leur prise en charge chirurgicale difficile. Jusqu’a recemment, elles necessitaient la realisation d’un abord chirurgical externe avec volet osseux de table externe. Depuis le developpement de la chirurgie endoscopique, des techniques moins invasives telles que des abords endoscopiques exclusifs sont apparues et permettent aujourd’hui des suites operatoires plus simples. Neanmoins, la realisation de ces techniques requiert une connaissance approfondie de l’anatomie du sinus frontal et de la prise en charge endoscopique des breches meningees. Cette connaissance est essentielle pour assurer a la fois la fermeture de la breche et preserver la permeabilite du sinus frontal.

International audience; Frontal sinus cerebrospinal fluid leaks are rare and their surgical management is difficult. Up until recently, they could only be treated by open surgery with an osteoplastic flap. With the development of endoscopic surgery, less invasive techniques such as an exclusive endoscopic approach can now be used, ensuring a simpler postoperative course. However, these techniques require a thorough knowledge of frontal sinus anatomy and endoscopic CSF leak repair. This knowledge is essential both to ensure closure of the CSF leak and to preserve frontal sinus patency.

International audience; Background: Among patients with T0-2 N3 head and neck squamous cell carcinomas (HNSCC), those undergoing upfront neck dissection have better oncological outcomes. However, there is no consensual definition of disease resectability of N3 nodes, leading to major treatment attrition and interpretation biases between studies. We established a Delphi method-based consensus to define resectability and impact on decision-making for upfront neck dissection in N3 patients.Methods: The Delphi method was designed as recommended by the French Haute Autorite de Sante among head and neck surgeons from university hospitals and cancer centers, using a 24-item questionnaire. Strong and relative agreements were subsequently established, and recommendations were written. The resulting recommendations were assessed by 30 independent surgeons.Results: N3 nodes with intraparenchymal brain invasion, foramen invasion, skull base erosion, nodes requiring bilateral XIIth cranial nerve sacrifice, retropharyngeal N3 node or a node above the plan of soft palate are major contraindications to neck dissection. When neck dissection requires unilateral sacrifice of the IXth or Xth or XIIth cranial nerves or cervical nerve roots, upfront neck dissection may be performed, based on a case-by-case assessment of other patient and tumor estimates.Conclusion: Consensual contraindications to neck dissection in patients with T0-2 N3 HNSCC were defined among French head and neck surgeons as concerns skull base invasion, retropharyngeal nodes and bilateral XIIth cranial nerve sacrifice. This consensus should allow more reliable comparisons between surgical and non-surgical strategies in N3 patients.

Background The impact of obesity on total thyroidectomy (TT) morbidity (recurrent laryngeal nerve palsy and hypocalcaemia) remains largely unknown. Methods In a prospective study (NCT01551914), patients were divided into five groups according to their body mass index (BMI): underweight, normal weight, overweight, obese, and severely obese. Preoperative and postoperative serum calcium was measured. Recurrent laryngeal nerve (RLN) function was evaluated before discharge, and if abnormal, at 6 months. Results In total 1310 patients were included. Baseline characteristics were similar across BMI groups except for age and sex. Postoperative hypocalcaemia was more frequent in underweight compared to obese patients but the difference was not statistically significant in multivariate analysis. There was no difference between groups in terms of definitive hypocalcaemia, transient and definitive RLN palsy, and postoperative pain. Conclusion Obesity does not increase intraoperative and postoperative morbidity of TT, despite a longer duration of the procedure.