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The purpose of our study was to investigate the impact of HPV status in oncologic outcomes in patients with T1-2 oropharyngeal SCC associated with bulky N3 nodes, and to determine progression prognosis factors aiming to define the best therapeutic strategies for these patients.This multicenter retrospective study included patients with T1-2 oropharyngeal SCC with N3 nodes treated between 2010 and 2015 in 8 French comprehensive cancer centers. HPV status was determined with P16 hyperexpression in immunohistochemistry. HPV-positive patients were separated into 2 groups according to the associated smoking history (HPV + T +) or not (HPV + T-). We compared the oncological outcomes of patients according to HPV-status and smoking history.Of 67 patients with T1-2 N3 oropharyngeal SCC, 36 patients (53.7%) were HPV negative and 31 patients (46.3%) HPV positive. 2-year PFS was significantly better in HPV + T- group (p = 0.036). The risk of death or progression was significantly reduced in HPV + T- comparatively to HPV- (HR 0.25 95%CI [0.07; 0.89]). 2-year OS was significantly better in HPV + T- group than in the other two groups (p = 0.017).In patients with T1-2 oropharyngeal SCC associated with bulky N3 nodes, HPV positive patients without smoking history had better OS and PFS than HPV positive patients with smoking history and HPV negative patients. Thus, HPV status is a significant prognostic factor for survival but this benefit is altered when smoking history is associated. N3 HPV positive patients with smoking history have to be classified as high-risk.

The aim of the survey was to define the indications for preventive tracheostomy in transoral robotic surgery (TORS) for head and neck cancers.From October 2019 to January 2020, an online questionnaire was e-mailed to French surgical ENT teams with considerable experience of the TORS procedure (Gettec group). A descriptive analysis of the answers was performed.Eighteen French surgical teams answered the questionnaire. For 77.8% of the surgical teams, a past history of radiotherapy with residual edema was an indication for prophylactic tracheostomy, and for 88.9%, 75 mg of antiplatelet medication or anticoagulation treatment was an indication.Early preventive tracheostomy during TORS can protect airway from uncommon but potentially life-threatening complications, such as transoral hemorrhage or airway edema. We recommend it in high-risk situations, such as a past history of radiotherapy or antiplatelet therapy associated with large resections. Further studies are needed to establish evidence-based recommendations.

Chronic rhinosinusitis with nasal polyps (CRSwNP) is associated with inflammation and tissue remodeling including myofibroblasts differentiation and extracellular matrix (ECM) deposition mediated by TGF-β1 and IL-4. Oncostatin M (OSM) is a cytokine involved in fibrotic processes in other cellular subtypes. We investigated the mechanisms of action of OSM in the fibrosis process associated with CRSwNP. The expression of IL-4, OSM and TGF-β1 was assessed by RT-qPCR. Primary human cultures of nasal-polyp-derived fibroblasts were established and stimulated by TGF-β1 and/or IL-4 and/or OSM. The expression of ECM components and αSMA was determined by RT-qPCR and Western blot. TGF-β1-Smad3 signaling was investigated by immunofluorescence. TGF-β1, IL-4 and OSM as well as αSMA were overexpressed in nasal polyps when compared to noninflammatory nasal mucosa. In TGF-β1-stimulated nasal-polyp-derived fibroblasts, ECM genes and αSMA gene and protein were overexpressed, as well as αSMA in IL-4-stimulated fibroblasts. OSM counteracted the profibrotic effect of TGF-β1 on ECM components and αSMA. TGF-β1-induced nuclear translocation of Smad3 was completely reversed by OSM. OSM counteracts the profibrotic effect of IL-4 and also TGF-β1, by inhibiting the nuclear translocation of Smad3. We suggest OSM could be an efficient tool to protect against fibrosis in CRSwNP.

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a typical type-2 inflammation involving several cytokines and is associated with epithelial cell dysfunction. Oncostatin M (OSM) (belonging to the interleukin(IL)-6 family) could be a key driver of epithelial barrier dysfunction. Therefore, we investigated the presence of OSM and IL-6 and the expression pattern of tight junctions (TJs) in the nasal tissue of CRSwNP patients and controls using reverse transcriptase quantitative polymerase chain reaction (RT-qPCR) and Western blotting. Then, their potential role in the epithelial barrier was evaluated in vitro in 27 different primary cultures of human nasal epithelial cells (HNECs) by measuring TJ expression and transepithelial electric resistance (TEER) with or without OSM or IL-6 (1, 10, and 100 ng/mL). The effect on ciliary beating efficiency was evaluated by high-speed videomicroscopy and on repair mechanisms with a wound healing model with or without OSM. OSM and IL-6 were both overexpressed, and TJ (ZO-1 and occludin) expression was decreased in the nasal polyps compared to the control mucosa. OSM (100 ng/mL) but not IL-6 induced a significant decrease in TJ expression, TEER, and ciliary beating efficiency in HNECs. After 24 h, the wound repair rate was significantly higher in OSM-stimulated HNECs at 100 ng/mL. These results suggest that OSM could become a new target for monoclonal antibodies.

Main: To describe 1-year overall survival (OS) after primary or salvage management of head and neck squamous cell carcinoma (HNSCC) invading the common or internal carotid artery (CCA/ICA). Secondary: To assess disease control rate, treatment morbidity, and radio-anatomopathologic correlation.Retrospective study of 67 patients, treated between 1999 and 2020 for N3bM0 HNSCC invading the CCA/ICA as identified by CT-scan. Tumors that could not have been resected with a complete en-bloc resection sacrificing and reconstructing the CCA/ICA were excluded. Patients were separated into two groups (primary or salvage treatment) and studied according to the type of treatment they received: radiotherapy/radiochemotherapy (RT/RCT), surgery, or systemic therapy (ST).For newly treated patients, the 1-year OS was significantly better after RT/RCT (73%) than after surgery (40%, p 0.0001). In the salvage setting, the 1-year OS after surgery (40%) was better than after ST (14%, statistically suggestive difference with p = 0.0241). Surgery improved cervical control, but distant metastases occurred in more than 50% of cases regardless of treatment. No neurological complication occurred after carotid reconstruction. Perioperative mortality was 7% (1/15). The carotid invasion was confirmed by pathological examination in all five patients with an arterial deformation on CT-scan, in seven among eight patients with CCA/ICA encasement greater than 270°, and in four out of seven patients with CCA/ICA encasement between 180° and 270°.Neck dissection with carotid resection and reconstruction is technically feasible with acceptable neurovascular morbidity. For newly treated patients, survival is better after RT/RCT. For salvage treatment, surgery could be proposed to selected patients.

The prognosis of advanced nodal (N3) squamous cell carcinoma of the head and neck (HNSCC) is poor. We investigated whether surgery or radiotherapy of early (T1–2) primary stage HSNCC is preferable to limit the overall morbidity after upfront neck dissection (uND) for N3 disease. This retrospective multicentric Groupe d’Etude des Tumeurs de la Tete Et du Cou study included patients undergoing uND and surgery or radiotherapy of their primary. Prognostic factors were evaluated using propensity score matching to account for biases in performing surgery depending on primary site and stage. Of 189 T1–2, N3 HNSCC patients, 70 (37.0%) underwent uND: 42 with surgery of their primary and 28 with radiotherapy only. Radiotherapy alone was more frequent in patients with hypopharyngeal primaries. All local (N = 3) and regional (N = 10) relapses (included 2 locoregional relapses) occurred within the first 2 years. There were 16 distant metastatic failures. Five-year locoregional relapse and survival incidences were 15.7% and 66.5% and were similar regardless of the treatment of the primary. The overall morbidity rate was 65.2% and was similar after weighting by the inverse propensity score (p = 0.148). The only prognostic factor for morbidity was the radicality of the uND. Prolonged parenteral feeding was not more frequent in patients only irradiated to their primary (p = 0.118). Prolonged tracheostomy was more frequent after surgery of the primary. In patients with T1–2, N3 HNSCC undergoing uND, radiotherapy and surgery of the primary yield similar oncological outcomes. Morbidity was related to the extent of neck dissection.

International audience

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 But Les pharyngolaryngectomies totale circulaires sont realisees pour des tumeurs evoluees du pharynx ou dans un contexte de recidive post-radique. Plusieurs procedes de reconstruction du pharynx par lambeau libres ou pedicules sont utilises et sont choisis selon l’operateur. Cette etude a pour but d’evaluer les resultats fonctionnels sur la deglutition a long terme de ces patients en fonction du type de lambeau utilise pour la reconstruction. Materiel et methode Une etude retrospective multicentrique a ete menee de janvier a septembre 2016 dans le groupe Gettec. Tous les patients operes d’une pharyngolaryngectomie totale circulaire et en remission etaient inclus et devaient remplir le questionnaire du deglutition handicap index (DHI) et avoir une fibroscopie de deglutition. 46 patients (39 hommes 7 femmes) ont ete inclus pendant cette periode. Le lambeau ante-brachial tubulise (groupe LABT) etait utilise dans 19 cas, le grand pectoral en fer a cheval (groupe LGP) dans 15 cas et le jejunum libre (groupe LJL) dans 12 cas. Resultats Le DHI moyen etait de 24 : 20 groupes LABT, 23 groupes LJL, 25 groupes LGP, sans difference significative ; 27 patients avaient une deglutition normale, 9 mixee, 8 liquide, 3 etaient alimentes par gastrostomie. La nasofibroscopie de la deglutition obtenait un pourcentage de patient avec une deglutition normale de salive et de yaourt significativement plus important pour les patients reconstruits avec un lambeau libre (LJL et LABT) par rapport au groupe LGP (p = 0,04). Conclusion Cette etude a montre que le type de lambeau de reconstruction d’une pharyngolaryngectomie totale circulaire n’a pas d’impact sur la qualite de la deglutition postoperatoire evaluee par le patient par autoquestionnaire du DHI.

Background Sinonasal undifferentiated carcinoma (SNUC) is a very rare entity with a poor prognosis. Due to the lack of studies on the subject, evidence is lacking concerning its management. Methods A multicenter collaborative study was conducted to assess treatment strategy, oncological outcome, and prognostic factors. Results Definitive analyses focused on 54 patients with a majority of advanced stage; the 3-year overall survival (OS) and 3-year recurrence-free survival (RFS) rates were, respectively, 62.4% and 47.8%. During the follow-up, 18 patients (33.3%) died, 10 (18.5%) developed metastases, 7 had lymph-node involvement (13%), and 12 (22.2%) showed recurrence or local progression. In univariate analyses, treatment modalities associated with improved RFS were induction chemotherapy (p = 0.02) and intensity-modulated radiotherapy (p = 0.007). In the multivariate analyses, only induction chemotherapy (p = 0.047, hazard ratio [HR] = 0.39) was significantly associated with improved RFS. Conclusion Multimodal therapies including induction chemotherapy and intensity-modulated radiotherapy may improve the prognosis of SNUC; surgery might improve local control. Further multicenter studies are required.

Cytokines are well known to play a central role in chronic rhinosinusitis with nasal polyps (CRSwNP), particularly in maintenance of the inflammatory response and the recruitment of eosinophils. The pathophysiological concepts concerning the involvement of inflammatory cytokines in CRSwNP have gradually evolved. Although the Th2 cytokines environment associated with an eosinophilic infiltration has retained a central role in the genesis of polyps, the role of other cytokine subpopulations has also and more recently been detailed, leading to a specific and complex signature in CRSwNP. The purpose of this review is to summarize the current state of knowledge about the cytokine signature in CRSwNP, the role of cytokines in the pathogenesis of this disease and in the intercellular dialog between epithelial cells, fibroblasts and inflammatory cells. Knowledge of this precise cytokine signature in CRSwNP is fundamental in the perspective of potential targeting biotherapies.

Background Indications and techniques of rehabilitation differ widely across types of lumbar surgery, including timing (before or after surgery) and prescriptions (surgeons but also medical or paramedical professionals). Objectives This project aimed to build consensual recommendations for practice in this context. Methods The SOFMER methodology was used to establish recommendations for physical medicine and rehabilitation: a steering committee defined the types of lumbar surgery involved and developed the main questions to be addressed; a scientific committee performed a literature review for grading evidence and proposed the first version of recommendations, which were discussed during a dedicated session at the national Physical and Rehabilitation Medicine congress; then an e-Delphi method with cross-professional experts was used to finalise recommendations and reach a multidisciplinary consensus. Results The main questions developed were the value of rehabilitation before and after surgery, timing and type of rehabilitation, benefit of supervision and instrumental rehabilitation, value of patient education, and complementary interventions concerning rehabilitation for discectomy, fusion, and disc prosthesis (excluding decompression for spinal stenosis). The literature review identified 60 articles, but for several of the questions, no article in the literature addressed the issue. The multidisciplinary scientific committee analysed the literature and addressed the questions to propose the first version of a set of 23 recommendations. The congress session failed to answer all questions or to reach consensus for all items. After a three-step e-Delphi, 20 recommendations were retained, for which consensus among experts was reached. The recommendations are applicable only to patients without a neurological lesion. Conclusions These recommendations provide important and consensual knowledge to assist clinicians in decision-making for rehabilitation in lumbar surgery. Despite many of the recommendations relying exclusively on expert opinion rather than published evidence, this approach is an important advance to improve concordance among healthcare professionals.

Resume Les dernieres donnees anatomiques qui notent une absence d’innervation nociceptive du cartilage articulaire et les etudes biomecaniques du rachis lombaire en extension amenent a remettre en question certaines idees recues, devenues un « leitmotiv » trop facilement avance pour justifier certains echecs therapeutiques. L’arthrose n’est pas une « sentence » d’algies, du moins tant que l’os sous-chondral ou la synoviale ne sont pas impactes. La perte de liberte articulaire qu’elle peut engendrer donne une place privilegiee aux masseurs-kinesitherapeutes pour proposer des solutions de traitement tant qu’un phenomene inflammatoire ne s’ajoute pas aux signes cliniques. On ne peut plus dire qu’un processus arthrosique decouvert a la lecture de resultats radiologiques soit l’explication systematique de la douleur des patients. De nombreuses etiologies autres que l’arthrose peuvent etre a l’origine d’une lombalgie. Sa chronicite doit amener le therapeute a s’interroger sur l’origine centrale potentielle de la douleur ressentie. Il s’agit d’affiner au mieux le bilan diagnostic pour cibler l’etiologie et y adapter une strategie therapeutique, en ne se fiant aux imageries et aux examens complementaires que dans les cas de correlation radio-clinique.

OBJECTIVES In patients with N3 head and neck squamous cell carcinoma (HNSCC), N3 disease is associated with high regional relapse and metastatic risks. Patients with resectable N3 disease have better prognosis although their metastatic risk may be similar as in patients with unresectable disease. Neoadjuvant chemotherapy has been associated with lower metastatic rates, but N3 patients may die of rapid locoregional progression. We assessed outcomes with the three modalities in patients with low primary burden to better assess the specific prognosis of N3 disease. METHODS This retrospective multicentric study included T0-2 N3 HNSCC patients. Outcomes and morbidity in upfront neck dissection (uND) vs non-surgical groups were analysed and oncological outcomes and morbidity compared between patients undergoing chemoradiation or neoadjuvant chemotherapy in patients with initially unresectable N3 nodes. RESULTS Of 301 patients, 142 (47%) underwent uND, 68 (23%) neoadjuvant chemotherapy and 91 (30%) chemoradiation. The 24- and 60-month incidence of locoregional relapse was 23.2% [18.3%; 28.4%] and 27.4% [21.8%; 33.3%]; it was lower in patients undergoing uND (P = .006). In patients with non-surgical treatments, success rates were 57.8% [49.4%; 66.3%] after chemoradiation and 38.1% [29.6%; 46.7%] after neoadjuvant chemotherapy (P = .001). Overall morbidity was more frequent in patients undergoing uND (68.8%) (P

Background Patterns of nodal involvement in adenoid cystic carcinoma (ACC) of the head and neck have not been sufficiently assessed to guide a decision of prophylactic neck dissection (ND). The objective of this study is to analyse the influence of ND on event-free survival (EFS) for patients with cN0 ACC. Patients and methods A multicentre prospective study was conducted between 2009 and 2018. Patients presenting cN0 non-metastatic ACC on any site, and who received surgery on the tumour, were included. EFS was the main judgement criterion. A comparative survival analysis between the groups that received a ND versus those that did not was performed, using a propensity score. Analyses were carried out using the R software. Results Between 2009 and 2018, 322 patients with cN0 ACC were included, out of which 58% were female. The average age was 53 years. Tumours were in minor salivary glands in 58% of cases, and 52% had T3/T4 stages. ND was performed on 46% of patients. Out of them, seven had histological lymph node invasion, out of which six had tumour infiltration in the mucosa of oral cavity. After propensity score, the median EFS for N0 patients with ND was 72 months (95% Confidence Interval (CI) [48–81]), compared to 73 months (95% CI [52–85]) for patients without ND (HR = 1.33; 95% CI [0.82–2.16]; p = 0.2). Conclusion ND of cN0 patients does not provide any benefit on EFS, which suggests that its application on such patients is not necessary.

BACKGROUND Specify place of video-fluoroscopic swallowing study (VFS) in the decision of oral refeeding after total pharyngolaryngectomy. METHODS At postoperative day 7, a blue dye testing was performed. If negative, a VFS was performed looking for a blind fistula. If this exam was negative, oral refeeding was started, but if a blind fistula was observed, cervical compression bandage was performed. RESULTS In 186 patients, a VFS was performed for 142 patients with negative blue dye testing. It was negative for 98 patients (69%) and positive for 44 patients (31%) (blind fistula). Patients had a probability of 7.1% to have a secondary pharyngocutaneous fistula (PCF) if the VFS was negative, and 15.9% if it was positive. No risk factor for the development of a secondary PCF or a blind fistula emerged from our analysis. CONCLUSION VFS should be performed before any oral refeeding in all patients operated with a total pharyngolaryngectomy.

Background Low back pain (LBP) in general and chronic LBP specifically is frequent with high impact on both individuals and Society. In 2017, the French national public health insurance (CNAMTS, Caisse Nationale d’Assurance Maladie des Travailleurs Salaries) has decided to launch a countrywide mass media campaign to improve general population (POP) and general practitioners (GPs) beliefs and behaviors about LBP and tend to reduce its impact on health resource use and including sick leaves. Objectives To evaluate the impact on population and physician beliefs and behaviors of the nationwide population-based campaign on LBP. Methods A campaign was conducted by the CNAMTS with the help of health experts (rheumatologists, rehabilitation specialists, algologists, GP and physiotherapists). It ran between November 2017 and November 2018, using multi media: booklets for POP and GPs available on CNAMTS website, TV and radio spots, large size wall posters hanged in public areas, videos on social networks, publicity articles and a smartphone application. The campaign main messages were: “LBP is not a severe disease” and “rest doesn’t help to heal” with a tagline: “Low back pain? The right treatment is the movement”. The impact of the campaign was assessed by internet surveys conducted by a private polling company (BVA, Brule, Ville et Associes), in random samples of the two populations (POP and GP). The respondents were selected according to the quota method, which enabled adequate representativeness based on sex, age, region of living and socio-economic status. The pre-test survey was performed on June 2017 and the post-test in May 2018, 6 months after beginning of the campaign. The questions explored different domains: 1) memorization, understanding and perception of the campaign, 2) knowledge and beliefs about LBP, and 3) repercussions on behaviors. Statistical significance at 5% was assessed with student test for means and sd, and chI2 test for categorical variables. Results Among the 2000 POP, 92% have already experienced LBP with mean pain intensity of 5.7/10 on VAS. Among the 400 GPs, 74% reported to be consulted for LBP almost every day. 35% of the POP and 74% of GPs saw, read or listened to the campaign. Overall, it was well perceived with an average rating of 7.0 and 7.3/10, respectively. POP and GP beliefs and behaviors about LBP are summarized in the table 1. There were statistically significant improvements in beliefs and behaviors related to activity in both populations. GPs are more confidence in preventing chronicization of back pain and declare to prescribe less sick leave superior to 5 days. Conclusion The French media campaign appears to have significant impact on public and physicians beliefs, mainly related to the message of staying active. An additional campaign focused on employers and occupational therapists is currently conducted. Other outcomes, of which health resource use and sick leave, will be assessed at the end of the program. Disclosure of Interests Martin Badard: None declared, Marie Helene Certain: None declared, Francois Rannou: None declared, Patricia Ribinik: None declared, Xavier Dufour: None declared, Florian Bailly: None declared, Bruno Fautrel Grant/research support from: AbbVie, Lilly, MSD, Pfizer, Consultant for: AbbVie, Biogen, BMS, Celgene, Janssen, Lilly, Medac, MSD, NORDIC Pharma, Novartis, Pfizer, Roche, Sanofi-Aventis, Sanofi Genzyme, SOBI, UCB, Violaine Foltz: None declared

International audience; Background:The incidence of cancer during pregnancy is low but is slightly increas-ing. Data on incidence and etiology of head and neck (HN) cancers in pregnantwomen are rare. We evaluated the frequency, tumor type, associated factors, and spe-cific biomarkers in HN cancers occurring in pregnant (and peripartum) women.Methods:A systematic literature search was performed on PubMed, for any HNtumor site occurring in pregnant women.Results:Sixty cases of HN cancers occurring during pregnancy were identified.Most of them were oral cavity cancers. Relationships with oncogenic viruses, hor-monal disturbance, and shift in maternal immunity profile were identified.Conclusion:Carcinogenesis of HN cancers in pregnant women may be led by dif-ferent cancer type–specific hallmarks. Relevance of these etiological factors withrespect to treatments and birth control recommendations is being investigated bythe REFCOR in an ambispective study.

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.

Objective Circumferential pharyngolaryngectomy is performed for advanced pharyngeal tumor or in a context of postradiation recurrence. Several free or pedicle flaps have been described for pharyngeal defect reconstruction, with choice at the surgeon's discretion. The aim of this study was to evaluate long-term swallowing function according to the type of flap used for reconstruction. Material and method A multicenter retrospective study was conducted from January to September 2016 within the French GETTEC head and neck tumor study group. All patients in remission after circumferential pharyngolaryngectomy were included and filled out the Deglutition Handicap Index (DHI) questionnaire and underwent swallowing function fiberoptic endoscopy assessment. 46 patients (39 men, 7 women) were included. Reconstruction used a tubularized forearm free flap (FFF group) in 19 cases, pectoralis major myocutaneous flap (PMMF group) in 15 cases and free jejunum flap (FJF group) in 12 cases. Results Mean DHI was 24: 20 in the FFF group, 23 in the FJF group and 25 in the PMMF group, without significant differences. 27 patients had normal swallowing, 9 mixed diet, 8 liquid diet and 3 were fed by gastrostomy. On endoscopy, free flaps (FJF and FFF) were associated with significantly greater rates of normal swallowing of saliva and yogurt than in the PMMF group (P = 0.04). Conclusion Type of flap reconstruction after circumferential pharyngolaryngectomy had no significant impact on postoperative swallowing function assessed on the self-administered DHI questionnaire.

SummaryBackground Fungal rhinosinusitis has a worldwide distribution, comprises distinct clinical entities but is mostly due to Aspergillus among which A. fumigatus plays a major role in European countries. Although, there is accumulating evidence for the emergence of environmentally acquired-azole resistance in A. fumigatus (such as TR34/L98H) in various clinical settings, there is few data for patients with fungal rhinosinusitis. Objectives To investigate the prevalence of A. fumigatus azole resistance due to TR34/L98H in a multicenter cohort of patients with fungal rhinosinusitis. Patients/methods 137 patients with fungal rhinosinusitis admitted between 2002 and 2016 at four French medical centers were retrospectively enrolled. Clinical and mycological findings were collected. Aspergillus fumigatus and the TR34/L98H alteration conferring azole resistance were investigated directly from clinical samples using the commercial CE-IVD marked MycoGENIE® Aspergillus fumigatus Real-Time PCR assay. Results/Conclusions Fungal ball was the more frequent clinical form (n=118). Despite the presence of fungal hyphae at direct microscopic examination, mycological cultures remained negative for 83 out of the 137 patients (60.6%). The PCR assay proved to be useful allowing the identification of A. fumigatus and etiological diagnosis in 106 patients (77.4%) compared with 44 patients (32.1%) when using culture as the reference method. Importantly, neither TR34 nor L98H alterations were evidenced. This article is protected by copyright. All rights reserved.

Fungal rhinosinusitis (FRS) has a worldwide distribution, comprises distinct clinical entities but is mostly due to Aspergillus among which Aspergillus fumigatus plays a major role in European countries. Although, there is accumulating evidence for the emergence of environmentally acquired-azole resistance in A. fumigatus (such as TR

// Floriane Legot 1, * , Florent Tixier 1, * , Minea Hadzic 1 , Thomas Pinto-Leite 1 , Christelle Gallais 2 , Remy Perdrisot 1 , Xavier Dufour 3 and Catherine Cheze-Le-Rest 1 1 Department of Nuclear Medicine, Poitiers University Hospital, Poitiers, France 2 Radiotherapy Department, Poitiers University Hospital, Poitiers, France 3 Head and Neck Department, Poitiers University Hospital, Poitiers, France * These authors contributed equally to this work Correspondence to: Florent Tixier, email: florent.tixier@gmail.com Keywords: 18F-FDG PET; head and neck cancer; recurrence Received: June 21, 2017 Accepted: March 19, 2018 Published: April 24, 2018 ABSTRACT Introduction: Head and neck squamous cell carcinoma (HNSCC) treated by radio-chemotherapy have a significant local recurrence rate. It has been previously suggested that 18F-FDG PET could identify the high uptake areas that can be potential targets for dose boosting. The purpose of this study was to compare the location of initial hypermetabolic regions on baseline scans with the metabolic relapse sites after radio-chemotherapy in HNSCC. Results: The initial functional tumor volume was significantly higher for patients with proven local recurrence or residual disease (23.5 cc vs. 8.9 cc; p = 0.0005). The overlap between baseline and follow-up sub-volumes were moderate with an overlap fraction ranging from 0.52 to 0.39 between R40 and I30 to I60. Conclusion: In our study the overlap between baseline and post-therapeutic metabolic tumor sub-volumes was only moderate. These results need to be investigated in a larger cohort acquired with a more standardized patient repositioning protocol for sequential PET imaging. Methods: Pre and post treatment PET/CT scans of ninety four HNSCC patients treated with radio-chemotherapy were retrospectively reviewed. Follow-up 18F-FDG PET/CT images were registered to baseline scans using a rigid body transformation. Seven metabolic tumor sub-volumes were obtained on the baseline scans using a fixed percentage of SUV max (I30, I40, I50, I60, I70, I80, and I90) and were subsequently compared with two post-treatment sub-volumes (R40, R90) in 38 cases of local recurrence or residual metabolic disease. Overlap fraction, Dice and Jaccard indices, common volume/baseline volume and common volume/recurrent volume were used to determine the overlap of the different estimated sub-volumes.

International audience; Aims :To evaluate the impact of human papillomavirus (HPV) status, tobacco smoking and initial treatment approach on progression-free survival (PFS) and overall survival (OS) for oropharyngeal cancer (OPC) in France, a country where smoking declines started late (1990s).Methods :340 OPC patients (median age: 60 years) from 14 French hospitals were followed up (median 26.7 months). PCR-based positivity for both HPV DNA and E6/E7 mRNA was used to distinguish HPV-positive OPC (27.1%). Hospital-stratified hazard ratios (HR) and corresponding 95% confidence intervals (CI) were used to compare PFS and OS according to HPV and other prognostic factors in hospital-stratified unadjusted and multivariate models. The combined effect of HPV status with either smoking, stage, or initial treatment on PFS was also evaluated.Results :PFS in multivariate analysis was better in HPV-positive patients (HR = 0.42; 95% CI: 0.24–0.73) and worse in older patients (HR for 5-year age increase = 1.12) and those having had firstly radiotherapy (HR = 1.86; 95% CI: 1.19–2.92) or induction chemotherapy (HR = 1.73; 95% CI: 1.08–2.79) instead of upfront surgery. Findings for OS were similar. Loco-regional recurrences were less frequent in HPV-positive (10.5%) than HPV-negative patients (26.0%) but distant recurrences were similarly frequent. HPV status did not modify the influence of smoking or stage on PFS but the impossibility to perform upfront surgery may be more relevant for HPV-negative patients.Conclusions :HPV-positive OPC patients fare better than HPV-negative OPC and may benefit from toxicity-sparing. Whether HPV-negative patients responded less well to radiation and chemotherapy because of more severe genomic damage or bulkier tumours is unclear.

An aberrant course of the internal carotid artery, such as a carotid loop or kinking, is a rare type of malformation. These malformations are typically asymptomatic, their occurrence is unpredictable, and they can exacerbate clinical disorders such as heart failure. We report the case of a seven-year-old child who died consecutively to cardiac arrest during otologic surgery for a cholesteatoma. After rapid and effective cardiorespiratory resuscitation, the child was transferred to a paediatric intensive care unit. In the following days, pronounced cerebral hypoperfusion led to the death of the child. The autopsy revealed a right carotid loop and a left carotid kink that presumably led to the cerebral hypoperfusion.

This study was designed to assess the efficacy and morbidity of the endoscopic endonasal approach for the treatment of sinonasal adenocarcinomas. This was a retrospective, multicenter study of nine French tertiary referral centers, including untreated patients. All patients were operated by an endoscopic approach. Tumors were classified according to the UICC 2002. Demographic, therapeutic, histological, morbidity data, and the course of the disease were recorded. Survival rates were obtained using the Kaplan-Meier method. A total of 159 patients were included with a mean age of 69 years. There were 19T1, 62T2 (1M1), 36T3 (1N1), 26T4a, and 16T4b (1N2a-1N2c). The mean duration of hospitalization was 4.4 days. The histologic outcomes showed that the olfactory cleft, the posterior and anterior ethmoid sinus, and the sphenoid, maxillary, and frontal sinuses were invaded in 95, 64, 55, 19, 7, and 3 % of cases, respectively. Histologic margins were positive in 17 % (1T1, 4T2, 3T3, 2T4a, and 8T4b). In total, 130 patients received adjuvant radiotherapy on the primary tumor site (58 Gy), 24 cases were not irradiated, and 5 refused treatment. The mean follow-up was 32.5 ± 24 months. The complication rate was 19 %: 6 epistaxis, 3 meningitis, 6 CSF leaks, 2 dacryocystitis, and 8 septoplasties. The recurrence rate was 17.6 % (28 cases) within 23 ± 21 months. Eleven patients underwent a second surgical procedure. Nine patients died of their disease (3T2, 2T3, 4T4b). The global and disease-specific, recurrence-free survival rate at 3 years was 74 and 84 % respectively. The endoscopic approach seems to be efficient to remove sinonasal adenocarcinoma with low morbidity.

The treatment of carcinomas of unknown primary revealed by cervical lymphadenopathy is based on neck dissection and nodal and pan-mucosal irradiation to control the neck and avoid the emergence of a metachronous primary. The aim of this review was to assess diagnostic and therapeutic approaches and criteria that may be used for a customized selective approach to avoid severe toxicities of pan-mucosal irradiation. A literature search was performed with the following keywords: cervical lymphadenopathy, unknown primary, upper aerodigestive tract, cancer, radiotherapy, squamous cell carcinoma, variants. The diagnostic workup includes a head and neck scanner or MRI, ((18)F)-FDG PET CT, a panendoscopy and tonsillectomy. Squamous cell carcinoma represents over two thirds of cases. The number of metastatic cervical nodes, nodal level, and histological variant (associated with HPV/EBV status) may determine the primary site origin and might be weighted for the determination of radiation target volumes on a multidisciplinary basis. A selective customized approach is relevant to decrease radiation toxicity only if neck and mucosal control is not impaired. Although no recommendation can yet be made in the absence of sufficient level of evidence, the relevance of systematic pan-mucosal irradiation appears questionable in a number of clinical situations. Accordingly, a customized selective redefinition of target volumes may be discussed and be prospectively evaluated in relation to the therapeutic index obtained.

Resume Le spondylolisthesis presente des caracteristiques anthropometriques particulieres. Si la reeducation ne peut pas avoir d’action dessus, il est indispensable de comprendre les facteurs pelviens et les desequilibres biomecaniques pour pouvoir proposer une reeducation particuliere, specifique aux contraintes biomecaniques. Il est indispensable d’adapter les phases de gain d’amplitude, de renforcement et de prophylaxie a cette pathologie. Niveau de preuve Non adapte.

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.

Resume En dehors de la sphere genitale, les papillomavirus humains (HPV) sont responsables d’infections des voies aero-digestives superieures (VADS) dont l’histoire naturelle est mal comprise. En marge des manifestations benignes (papillomes, verrues, condylomes), connues depuis longtemps, les HPV a haut risque (HR) sont egalement impliques dans 25% des cancers de l’oropharynx toutes localisations confondues et dans au moins 50% des cancers de l’amygdale. HPV16 est le genotype responsable dans pres de 90% des cas. Concernant les autres localisations des cancers des VADS, l’existence d’un lien reste incertaine. L’incidence des cancers des VADS positifs pour la detection d’HPV a augmente dans les pays occidentaux alors que celle des cancers negatifs pour HPV reste stable ou diminue. Les cancers de l’oropharynx positifs pour HPV surviennent preferentiellement chez des patients plus jeunes, ne presentant generalement pas les facteurs de risque classiques que sont le tabac et l’alcool, et sont associes a des facteurs de risque d’infection sexuellement transmissible, notamment les rapports sexuels oro-genitaux. Ils repondent mieux a la radio- et chimiotherapie et sont de meilleur pronostic que les cancers negatifs pour HPV. Ils presentent des profils moleculaires et genetiques distincts de ceux des tumeurs negatives pour HPV refletant les consequences de l’expression des oncoproteines virales E6 et E7. Connaitre le statut HPV des tumeurs deviendra necessaire pour optimiser les choix therapeutiques, et est d’ores et deja indispensable dans les essais therapeutiques. Le debat de la vaccination des garcons, deja pratiquee dans certains pays, est relance mais les vaccins devront faire la preuve de leur efficacite pour prevenir les infections orales et a terme induire une diminution de l’incidence des cancers oropharynges.

Objectif de l’etude Devant une tumeur des voies aerodigestives superieures de stade T1 ou T2 associee a une adenopathie de stade N3 non metastatique, le pronostic est lie au stade N3. Le choix entre une chirurgie de la tumeur primitive lorsque cela est possible et une chimioradiotherapie pourrait impacter la morbidite a taux de controle local au moins equivalent. Nous avons evalue les pratiques dans cette situation. Materiel et methode Onze centres francais ont collige leurs cas de cancers des voies aerodigestives superieures de stade T1-2 N3 M0, entre 2008 et 2017 retrospectivement. Resultats Au total, les dossiers de 210 patients atteints d’un cancer des voies aerodigestives superieures de stade T1-2 et N3 clinique ont ete inclus. Une chirurgie de la tumeur primitive suivie d’une chimioradiotherapie a ete realisee dans 21 % des cas, un traitement dissocie par curage cervical seul suivi d’une chimioradiotherapie dans 12 %, une chimioradiotherapie dans 39 %, une chimiotherapie neoadjuvante par docetaxel, cisplatine et 5-fluoro-uracile (TPF) dans 21 %, et un autre protocole de chimiotherapie dans 7 % ; 22 % des patients ont ete operes a un moment de la prise en charge de la tumeur primitive, et 43 % des aires ganglionnaires Il n’existait pas de difference significative de survie globale en cas de chirurgie du site tumoral primitif ou d’abstention chirurgicale (p = 0,16). En analyse unifactorielle, la survie etait correlee avec la resecabilite ganglionnaire, la localisation oropharyngee et la realisation du curage ganglionnaire. En analyse multifactorielle, la survie globale etait impactee par la realisation ou non du curage cervical (p = 0,022). Pour les patients operes de la tumeur primitive, on retrouvait une tendance a l’augmentation du taux de tracheotomie (p = 0,07) et il existait une augmentation du taux d’epaule douloureuse (p = 0,004), egalement correle avec le curage. Conclusion En cas de tumeur de stade T1 ou T2, associee a une adenopathie de stade N3, le pronostic est lie au traitement ganglionnaire, lui-meme lie a la resecabilite ganglionnaire. La morbidite etait augmentee en cas de chirurgie de la tumeur primitive. La morbidite pourrait etre limitee, a taux de controle local identique, en n’operant pas la tumeur primitive, qui sera incluse dans les volumes cibles de la radiotherapie.

Background: This study had two objectives: firstly, to describe and compare sublocations of all cancer of the oral cavity, oropharynx, hypopharynx, larynx and primary carcinoma cervical lymph node diagnosed in Reunion Island, a tropical French overseas territory in the southern hemisphere between 2009 to 2013; and secondly others epidemiological features.Methods: A retrospective study included 621 patients diagnosed with cancer of the oral cavity, oropharynx, hypopharynx or larynx or primary cervical node between 2009 and 2013 in Reunion Island. 13 possible sublocations of cancer for mouth are described, 14 for larynx, 12 for oropharynx, 3 for hypopharynx, 8 for primary cervical lymph node. Demographic characteristics, data on alcohol consumption, smoking habits, HPV infection, denutrition were analyzed. Results: Cancer location consisted of oropharynx (36.2%), larynx (25.6%), oral cavity (20.8%), hypopharynx (13.8%), primary carcinoma lymph node (3.6%). Sublocations in oral cavity mainly concerned palatin tonsil and base tongue. Vocal fold was the mostly frequent sublocation involved in larynx. Cancer in oral cavity were portion out more homogeneously. Excluding primary lymph node, sex ratio was 7.7 and mean age was 60 years. Cancer consisted of squamous cell carcinoma in 99.1% of patients. 340/375 patients (81.25%) showed alcohol abuse; 309/359 (86.1%) were smokers; 31/184 (16.8%) had HPV infection.Conclusions: First study including all cases of pharyngolarynx and oral cavity cancer and depicting all sublocations involved in one series. We found no significant difference of distribution between sublocations for larynx but some for oropharynx and oral cavity compared to literature.

Resume Les mobilisations specifiques sont des techniques de masso-kinesitherapie qui permettent de redonner aux differentes articulations concernees une mobilite perdue pour des raisons traumatiques ou rhumatologiques. Les articulations a synoviale presentent des mouvements de glissement et de rotation, permettant leur mobilite analytique. La perte de ces mouvements specifiques participe a la restriction de mobilite analytique de l’articulation concernee. C’est le bilan articulaire qui permet au praticien de diagnostiquer les mouvements limites et la finesse operatoire qui lui permet de redonner une mobilite perdue. Ces techniques font partie de l’arsenal kinesitherapique. Elles interviennent le plus souvent en debut de traitement avec les techniques myofasciales. Leur mode d’action en fait des techniques de choix pour les problemes articulaires et conjonctifs. Niveau de preuve : non adapte.

Background. Primary involvement of the sphenoid sinus occurs in 2% of all paranasal sinus tumors and is associated with dismal prognosis. Optimal management remains debatable. Methods. A total of 23 patients were treated for a primary cancer of the sphenoid sinus from 1988 to 2004. Charts were reviewed for patient-, tumor-, and treatment-related parameters. Univariate and multivariate analyses were conducted to identify prognostic factors for locoregional control and survival. Results. Cranial neuropathies were present in 12 patients. Pathologic findings included adenoid cystic carcinoma, adenocarcinoma, lymphoma, squamous cell carcinoma, sarcoma, neuroendocrine carcinoma, melanoma, and malignant hemangiopericytoma. All but 2 patients had stages III to IV cancer. Radiotherapy was performed in 18 patients and chemotherapy in 12. Of 10 patients undergoing surgery, total excision with grossly negative margins was achieved in 4 patients and subtotal resection in 6. Median locoregional control and overall survival were 12 and 41 months, respectively. On multivariate analysis, cranial neuropathy was associated with worse locoregional control and survival. Surgery was rarely complete because of advanced stages at presentation, but it yielded better outcomes than other treatments without surgery in non lymphoma-cases. Conclusion. Early CT and MRI should be performed when facing aspecific, rhinological, or neuro-ophtalmological symptoms. Cranial neuropathies indicate a worse prognosis. Surgery, including debulking surgery, may be preferred to combined modality treatments without surgery. Its apparently favorable impact on prognosis would need to be tested in homogenous histological groups of patients, which is impossible because of the rarity of the disease. Highly conformal radiotherapy (adjuvant or definitive) should be encouraged and optimized with concurrent chemotherapy in advanced stages. Aggressive multidisciplinary management including surgery, chemotherapy, and radiotherapy should be encouraged and adapted on histology and tumor extensions. Progress is still warranted to improve outcomes. © 2008 Wiley Periodicals, Inc. Head Neck, 2009

Las pruebas radiologicas se realizan despues de la exploracion fisica y rinoscopica, por lo que no se efectuan de forma sistematica. Su indicacion se establece para evaluar la difusion lesional y obtener una vision mas precisa de la morfologia y del contenido de las cavidades nasosinusales. En la actualidad, las pruebas que se realizan para establecer el diagnostico y la eleccion terapeutica son las que permiten obtener imagenes de cortes anatomicos (tomografia computarizada y resonancia magnetica), que han sustituido a la radiologia convencional. La tomografia computarizada (TC) mediante adquisicion helicoidal ofrece un analisis anatomico detallado multiplano de las estructuras nasales y sinusales, asi como de las variaciones de neumatizacion que pueden modificar las relaciones sinusales; se realiza de forma sistematica antes de la cirugia sinusal y puede integrarse en un programa de cirugia asistida. La TC es muy sensible para detectar opacificaciones sinusales, pero sigue siendo poco especifica sobre su naturaleza. La resonancia magnetica (RM) estudia de forma mas detallada el contenido sinusal y las relaciones con las estructuras meningeas y encefalicas; no puede sustituir a la TC para el estudio de los elementos oseos, pero completa dicha valoracion en el analisis de los procesos tumorales y de las enfermedades sinusales que implican a la base del craneo.

La diagnostica per immagini trova indicazione solo dopo l’esecuzione di un esame clinico e rinoscopico; non deve pertanto essere eseguita in modo sistematico. Si pone l’indicazione al suo utilizzo per valutare la distribuzione della lesione e per ottenere una visione piu precisa della morfologia e del contenuto delle cavita rinosinusali. Attualmente, e la diagnostica per immagini in sezioni (tomografia e risonanza magnetica) che partecipa all’iter diagnostico e terapeutico; dopo aver rimpiazzato l’esame radiologico standard. La tomografia (TC) spirale offre un’analisi anatomica dettagliata, su piani multipli, delle strutture nasali e sinusali e delle variazioni di pneumatizzazione che possono modificare i rapporti sinusali. Viene effettuata sistematicamente prima della chirurgia sinusale e puo essere inquadrata in un programma di chirurgia assistita. La TC e molto sensibile nella diagnosi delle opacita sinusali, ma rimane poco specifica sulla loro natura. La risonanza magnetica (RM) studia in modo piu pertinente il contenuto sinusale e i rapporti con le strutture meningee ed encefaliche; Non puo sostituire la TC nell’analisi delle parti ossee, ma la completa nella valutazione delle formazioni neoplastiche e nell’analisi delle patologie sinusali che interessano la base del cranio.

Annales Francaises d'Oto-Rhino-Laryngologie et de pathologie cervico-faciale - Vol. 124 - N° 3 - p. 115-119