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Abstract
OBJECTIVES Coronavirus disease 2019 (COVID-19) was first discovered in Wuhan, China, in December 2019, and soon spread around the entire world. As no effective treatment is known, prediction of disease severity is very important in order to estimate a patients outcome. Aim of this study was to evaluate routine hematology parameters in time after admission. METHODS Data from routine blood analyses from confirmed COVID-19 cases admitted to the University Hospital of Leuven in Belgium were collected. COVID-19 patients (n = 197) were assigned to three groups: a 'non-ICU' group, a 'ICU' group and a 'deceased' group. A control group of 60 Influenza A (non-COVID-19) patients was also included. The parameters evaluated were platelet count (PLT, 109/L), hemoglobin concentration (Hb, g/dL), leukocyte count (LEU, 109/L), neutrophil count (NEU, %), eosinophil count (EO, %), lymphocyte count (LYM, %) and monocyte count (MONO, %). RESULTS Deceased COVID-19 patients had significant lower platelet count, higher leukocyte/neutrophil count, and lower eosinophil/lymphocyte/monocyte count compared to recovered patients. Especially lymphocyte count showed important differences; they were significantly lower between day 9 and 12 after admission making this time window important in predicting clinical worsening of a patient. CONCLUSION Patients with COVID-19 with poor outcome showed significant differences in results of routine hematological parameters compared with patients that recovered. Especially lymphocyte count can be helpful in the prediction of a patients outcome.
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Affiliation(s)
- S. Blomme
- Clinical Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium
| | - L. Smets
- Clinical Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium
| | - M. Van Ranst
- Clinical Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
- Laboratory of Clinical and Epidemiological Virology (Rega Institute), KU Leuven, Leuven, Belgium
| | - N. Boeckx
- Clinical Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium
- Departement of Oncology, KU Leuven, Leuven, Belgium
| | - C. Van Laer
- Clinical Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium
- Departement of Cardiovascular Sciences, Center for Molecular and Vascular Biology, KU Leuven, Leuven, Belgium
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Engelen M, Van Laer C, Jacquemin M, Vandenbriele C, Peerlinck K, Verhamme P, Vanassche T. Heparin is more effective than apixaban in inhibiting in vitro contact activated coagulation. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Introduction
Contact of blood with artificial surfaces such as mechanical support devices, catheters, and mechanical heart valves activates the contact activation (CA) pathway of coagulation. Furthermore, recent animal data and clinical studies suggest a more important contribution of CA in pathological thrombus formation in other cardiovascular diseases. Direct oral anticoagulants (DOACs) are recommended as first-line treatment in most patients who require long-term anticoagulation. However, because DOACs directly inhibit a single downstream coagulation factor (thrombin (fXIIa) or factor Xa (fXa)), it has been suggested that their efficacy could be reduced in the presence of strong activation of the CA pathway as compared to anticoagulants that target multiple, more upstream located coagulation factors.
Purpose
To compare the efficacy of a DOAC (apixaban) and heparin to suppress thrombin generation in the presence of strong CA pathway activation.
Methods
Pooled platelet-poor plasma was spiked with either apixaban (dissolved in DMSO and PBS) or unfractionated heparin to achieve therapeutic plasma levels. SynthASil, a commercially available mixture of phospholipids and silica, was used to stimulate the CA pathway in two different dilutions (1–80 and 5–80). Downstream coagulation was accessed by Thrombin Generation Test using Thrombinoscope by Stago and associated Thrombin Calibrator (activity 640 nM). The endogenous thrombin potential (area under the thrombin generation curve; ETP), peak thrombin generation (PTG), time to peak (ttPeak) and time to start (ttStart) were accessed.
Results
With decreasing concentrations of apixaban, stimulation with the lower dose SynthASil reveals an increasing ETP and PTG. As expected, ttPeak and ttStart decreased. Even supratherapeutic levels of apixaban (i.e. 1120 ng/mL) could not inhibit thrombin from being generated, in striking contrast with UFH where no thrombin was formed. Using a five times higher dose of SynthASil showed comparable ETP for all concentrations of apixaban, allocated around the control value. PTG, however, slightly increased with decreasing concentrations of apixaban. ttPeak and ttStart slightly decreased. Except for the subtherapeutic UFH concentration of 0,114 IU/mL, no thrombin was generated with UFH.
Conclusion
UFH is more effective in inhibiting downstream thrombin generation compared to apixaban as a response to activation of the CA pathway in vitro. These findings could help explain why direct inhibitors were not able to show non-inferiority in patients with mechanical heart valves and support the development of specific CA pathway inhibitors for patients with conditions that activate the CA pathway.
Thrombin generation curves
Funding Acknowledgement
Type of funding source: None
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Van Den Heuvel B, Van Laer C, Specenier P. Role of follow-up (FU) FDG-PET/CT (FU-FDG-PET/CT) in patients with locoregionally advanced squamous cell carcinoma of the head and neck (LA-HNSCC) treated with chemotherapy and radiotherapy (RT), either concurrent (CRT) or sequential (ST). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz252.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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4
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Colpaert C, Vanderveken OM, Wouters K, Van de Heyning P, Van Laer C. Changes in Swallowing-related Quality of Life After Endoscopic Treatment For Zenker’s Diverticulum Using SWAL-QOL Questionnaire. Dysphagia 2017; 32:339-344. [DOI: 10.1007/s00455-017-9782-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 01/27/2017] [Indexed: 10/20/2022]
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Verdonck P, de Schoutheete JC, Monsieurs KG, Van Laer C, Vander Poorten V, Vanderveken O. Penetrating and blunt trauma to the neck: clinical presentation, assessment and emergency management. B-ENT 2016; Suppl 26:69-85. [PMID: 29558578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
Penetrating and blunt trauma to the neck: clinical presentation, assessment ana emergency management. In Belgium, and even in Western Europe, penetrating and blunt injury to the neck is relatively uncommon in both the civilian and military populations. Pre-hospital and emergency assessment and management will therefore always prove challenging, as individual exposure to this specific type of injury remains low. Historically, the neck has been divided into three anatomical zones with specific landmarks to guide the diagnostic and therapeutic approach to penetrating neck injuries. Most penetrating injuries need to be explored surgically, although with the advent of multi-detector computed tomographic angiography (MDCTA), which yields high diagnostic sensitivity, this inflexible approach has recently changed to a more targeted management, based on clinical, radiographic and, if deemed necessary, endoscopic findings. However, some authors have addressed their concern about this novel, 'no-zone' approach, since the risk of missing less apparent aerodigestive tract injuries may increase. It is recommended, therefore, that all patients with penetrating neck injuries be closely observed, irrespective of the initial findings. The incidence of blunt neck injury is much lower, and this makes risk assessment and management even more difficult in comparison with penetrating injuries. Again, MDCTA is most often the first diagnostic tool if a blunt neck injury is suspected, due to its good sensitivity for blunt cerebrovascular injuries (BCVI) as well as for aerodigestive tract injuries. Specific patterns of injury and unexpected neurological and neuro-radiological findings in trauma patients should always warrant further investigation. Despite ongoing debate, systemic anticoagulation is recommended for most BCVI, sometimes combined with endovascular treatment. Aerodigestive tract injuries may present dramatically, but are often more subtle, making the diagnosis more difficult than other types of neck injuries. Treatment may be conservative if damage is minimal, but surgery is warranted in all other cases.
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Szturz P, Vanderveken O, Specenier P, Merlano M, Benasso M, Van Gestel D, Wouters K, Van Laer C, Weyngaert DVD, Peeters M, Vermorken J. 2822 Gemcitabine-based chemoradiotherapy in locally advanced squamous cell carcinoma of the head and neck: A literature review and meta-analysis. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31565-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Dewaele E, Vermorken J, Verschueren C, Vanderveken O, Van Laer C, Mariën S, Specenier P. 2817 12-year Follow-up (FU) Data and late local toxicity Of Two Cohorts of patients with locoregionally advanced squamous cell carcinoma of the head and neck (LA-SCCHN) treated with Concomitant Chemoradiation (CCRT) With Or Without Induction Chemotherapy (ICT). Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31560-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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8
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Van Oevelen K, Vanderveken O, Dewaele E, Verschueren C, Mariën S, Van Laer C, Wouters K, Van Fraeyenhove B, Specenier P. 1560 Quality of life (QoL) evaluation in head and neck cancer (HNC) patients: Electronics beats paper. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)30650-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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9
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Boeckx N, Laer CV, Roover JD, Wilmsen B, Bruyninckx K, Pauwels S. Comparison of molecular responses based on BCR-ABL1% (IS) results from an in-house TaqMan-based qPCR versus Xpert(®) assay in CML patients on tyrosine kinase inhibitor therapy. Acta Clin Belg 2015; 70:237-43. [PMID: 26166681 DOI: 10.1179/2295333715y.0000000009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVES Tyrosine kinase inhibitors (TKIs) have drastically changed the prospects for chronic myeloid leukemia (CML) patients. The European LeukemiaNet (ELN) recommends molecular monitoring of BCR-ABL1 mRNA levels at distinct time points to define an optimal response, warning, or failure of treatment. METHODS Sixty-four follow-up peripheral blood samples from CML patients on TKI were tested by two methods. Molecular responses based on BCR-ABL1% (IS) from an Xpert(®) BCR-ABL1 Monitor assay were compared with TaqMan-based qPCR. RESULTS Seven samples showed 'molecularly undetectable leukaemia' by both methods (11%). In-house qPCR showed 57 BCR-ABL1+ samples; 45/57 samples (79%) were concordant for 'major molecular response' (MMR, n = 32) and 'no MMR' (n = 13) by both assays, whereas nine were BCR-ABL1 negative by Xpert(®). Identical molecular responses (i.e. 'optimal') were defined in 41 samples. Discordances seen in patients < 10 months on TKI (n = 2) had no impact on clinical management, whereas for patients >12 months on TKI, a different molecular response was defined ('warning' versus 'optimal'). Thirteen samples had 'no MMR' by both methods. 10/13 showed identical intervals (>10%(IS), 1-10%(IS) or 0·1-1%(IS)), corresponding to seven 'failures' and three 'warnings'. Discordant intervals were seen in 3/13 samples (all defined as 'failures'). Deep molecular responses (MR(4·0) or MR(5·0)) with detectable BCR-ABL1 showed some fluctuations between both methods, nevertheless, all had 'optimal' responses. 'Molecularly undetectable leukaemia' was observed more frequently by Xpert(®) (n = 16) as by our in-house assay (n = 7). DISCUSSION Based on current ELN recommendations, Xpert(®) BCR-ABL1 assay defines identical molecular responses as TaqMan-based qPCR BCR-ABL1% (IS) data in 98% (63/64) of samples.
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Van Laer C, Harteveld CL, Pauwels S, Desmet K, Kieffer D. Aberrant glycated haemoglobin (HbA1c) results leading to haemoglobinopathy diagnosis in four Belgian patients. Acta Clin Belg 2014; 69:456-9. [PMID: 25109349 DOI: 10.1179/2295333714y.0000000061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
INTRODUCTION We report four cases in which haemoglobinopathy screening was triggered following aberrant HbA1c analysis. Either the HbA1c assay was unable to produce a quantifiable result or it showed the presence of an extra fraction and/or the result was discordant with the clinical context. CASE REPORT In the reported four patients, all from Caucasian, Belgian descent, Hb analysis was performed using cation-exchange high performance liquid chromatography. If necessary, additional Hb electrophoresis was carried out to establish a preliminary (biochemical) diagnosis. Definitive diagnosis was obtained for every sample through DNA-analysis. Three patients were carriers of Hb J-Toronto and one of Hb Stanleyville-II. DISCUSSION This report underlines the importance of correct interpretation of HbA1c results to avoid mismanagement of (diabetic) patients. Since neither the RBC indices, the clinical context, nor the ethnicity of these patients was suspicious for an underlying haemoglobinopathy, the aberrant HbA1c result was the only indicator for further investigation. Laboratory personnel and clinicians should be aware of the possibility of uncommon, sometimes clinically unsuspected, Hb variants to cause aberrant HbA1c values, even in populations with low prevalence for haemoglobinopathies. Further analysis should be prompted to obtain definitive diagnosis. Alternative methods for monitoring glycaemic control should be used.
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Oyaert M, Van Laer C, Claerhout H, Vermeersch P, Desmet K, Pauwels S, Kieffer D. Evaluation of the Sebia Minicap Flex Piercing capillary electrophoresis for hemoglobinopathy testing. Int J Lab Hematol 2014; 37:420-5. [PMID: 25324031 DOI: 10.1111/ijlh.12305] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 09/17/2014] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Capillary zone electrophoresis (CZE) at alkaline pH is one of the techniques used for hemoglobinopathy screening. In this study, an evaluation of the performance of a lower throughput CZE instrument, the Sebia Minicap Flex Piercing system, for this purpose is reported for the first time. METHODS The analytical performance of the Sebia Minicap Flex Piercing system was evaluated. Furthermore, a method comparison between the Sebia Minicap Flex Piercing and two HPLC methods, that is, the Bio-Rad Variant Classic(™) and the Bio-Rad D-10(™) systems was performed by measuring samples with and without clinically relevant hemoglobin disorders. RESULTS The analytical performance was acceptable for the determination of HbA, HbA2, HbS, and HbF, with an imprecision ≤2.0%. Method comparison showed a linear correlation for HbA2, HbF, and HbS measurements. Clinical concordance was acceptable when comparing CZE and HPLC. CONCLUSIONS Lower throughput CZE using the Sebia Minicap Flex Piercing can be used for precise and accurate first line screening and follow-up of hemoglobinopathies.
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Affiliation(s)
- M Oyaert
- Department of Laboratory Medicine, University Hospital Leuven, Leuven, Belgium
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12
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Broes K, Vanderveken OM, Salgado R, Verfaillie J, Pauwels P, Van de Heyning PH, Van Laer C. Atypical adenolymphoma and glomus caroticum tumour: a rare coincidence. B-ENT 2012; 8:43-47. [PMID: 22545390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
We describe the rare simultaneous appearance of an atypical adenolymphoma with a glomus caroticum tumour on the same side of the neck in a middle-aged man. This case report is the first to describe this coexistence. Due to the atypical, cyst-like presentation of the Warthin's tumour, a final diagnosis was made only after surgical resection and histopathological examination. Both the adenolymphoma and glomus caroticum tumour were successfully removed surgically.
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Affiliation(s)
- K Broes
- Department of Otorhinolaryngology and Head & Neck Surgery, Antwerp University Hospital, Edegem, Belgium.
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13
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Speeckaert R, Brochez L, Lambert J, van Geel N, Speeckaert M, Claeys L, Langlois M, Van Laer C, Peeters P, Delanghe J. The haptoglobin phenotype influences the risk of cutaneous squamous cell carcinoma in kidney transplant patients. J Eur Acad Dermatol Venereol 2011; 26:566-71. [DOI: 10.1111/j.1468-3083.2011.04112.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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14
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Vandist V, Deridder F, Waelput W, Parizel PM, Van de Heyning P, Van Laer C. A neuroendocrine tumour of the sphenoid sinus and nasopharynx: a case report. B-ENT 2010; 6:147-151. [PMID: 20681371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
It is rare for neuroendocrine tumours to originate in the sphenoid sinus and the nasopharynx. Neuroendocrine tumours can be classified into typical carcinoids, atypical carcinoids and small cell neuroendocrine carcinomas. Here we report the case of a 48-year-old man with a typical carcinoid tumour of the nasopharynx and sphenoid sinus. This is a very rare diagnosis, and only a few cases of a typical carcinoid in this region have been described in the literature.
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Affiliation(s)
- V Vandist
- Department of Otorhinolaryngology, Antwerp University Hospital, Edegem, Belgium.
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15
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Specenier PM, Weyler J, Van Laer C, Van den Weyngaert D, Van den Brande J, Altintas S, Huizing MT, Vermorken JB. A non-randomized single-center comparison of induction chemotherapy (IC) followed by chemoradiation (CRT) versus CRT for locally advanced (LA) squamous cell carcinoma of the head and neck (SCCHN). J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.17004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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16
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Specenier PM, Van den Weyngaert D, Van Laer C, Weyler J, Van den Brande J, Huizing MT, Dyck J, Schrijvers D, Vermorken JB. Phase II feasibility study of concurrent radiotherapy and gemcitabine in chemonaive patients with squamous cell carcinoma of the head and neck: long-term follow up data. Ann Oncol 2007; 18:1856-60. [PMID: 17823386 DOI: 10.1093/annonc/mdm346] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Radiotherapy (RT) with concurrent chemotherapy is the current standard of care for patients with unresectable locally advanced squamous cell carcinoma of the head and neck (SCCHN). Gemcitabine (GEM) is a potent radiosensitizer and in addition has activity as an anticancer agent in SCCHN. PATIENTS AND METHODS Twenty-six patients with locally far advanced SCCHN were enrolled in a chemoradiation feasibility study between November 1998 and September 2003. Use was made of conventionally fractionated RT and GEM 100 mg/m(2), which was given within 2 h prior to radiotherapy on a weekly basis starting on day 1 of RT. Response was assessed according to WHO criteria, toxicity according to NCI-CTC version 2. RESULTS The patients received a median of 7 (2-8) weekly cycles of gemcitabine and a median cumulative RT dose of 70 Gy (66-84.75). Hematologic toxicity was mild, but non-hematologic toxicity was severe: grade 3-4 stomatitis occurred in 85% of patients, dermatitis in 69%, pharyngitis/esophagitis in 81% and 80% of the patients needed a feeding tube during treatment. All 22 evaluable patients responded (50% complete, 50% partial). Median follow up of the surviving patients is 46 months. Median disease-free and overall survival is 13 months and 19 months, respectively; 27% of the patients are alive without evidence of recurrence beyond 3 years. CONCLUSIONS Conventionally fractionated RT in combination with GEM 100 mg/m(2) weekly is feasible and highly active in the treatment of locally advanced SCCHN. In particular, long-term local control rate is promising. Acute mucosal toxicities are significant but manageable. Long-term toxicity interferes with normal food intake.
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Affiliation(s)
- P M Specenier
- Department of Medical Oncology, University Hospital Antwerp, Edegem, Belgium
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17
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Specenier PM, Van Den Weyngaert D, Van Laer C, Van Den Brande J, Huizing M, Altintas S, Vermorken J. Long term follow up data of a phase II study of concurrent radiotherapy (RT) and gemcitabine (Gem) for patients with stage III or IV squamous cell carcinoma of the head and neck (SCCHN). J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.5574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5574 Background: RT with concurrent chemotherapy is superior to RT alone as treatment for locally advanced SCCHN. Gem is a potent radiosensitizer in vitro and in vivo and in addition has a good activity in SCCHN. Exploitation of these properties was the rationale for a single institution phase II study which evaluates the efficacy and toxicities of standard RT + weekly low dose Gem. Methods: Eligible were patients with primary inoperable or locally advanced stage III and IV SCCHN. Treatment: Planned RT was 70 Gy over 7 weeks with weekly Gem 100 mg/m2 within 2 hours prior to RT (Eisbrüch et al., ASCO, 1997, 1998). Presented endpoints are response rate (according to WHO), acute and late toxicity (according to NCICTC), disease free survival (DFS), local relapse free survival (LRFS) and overall survival (OS). Results: 26 patients (21 male, 5 female; performance status 0–2; no prior treatment) entered the study between November 1998 and September 2003. Median age was 56 years (range 48–78). Tumor sites were oropharynx (6), hypopharynx (17), glottis (1), paranasal sinus (1), unknown (1). Clinical stage was III (2) or IV (24). 7 Patients had T4N2 disease and 2 had T4N3 disease. Patients received a median of 7 Gem cycles (range 2–8) and a median of 70 Gy (66–84.75). 7 patients underwent radical neck dissection. Grade 3–4 acute toxicities included mucositis (22/26), dermatitis (18/26), pharyngitis and/or oesophagitis (21/26), pain (7/25), xerostomia (1/24), neutropenia (1/26) and anemia (1/26). 21/26 patients needed tube feeding and 21/26 needed to be hospitalized. After recovery from acute toxicity 6/23 could feed normally, 5/23 needed soft food, 5/23 were able to swallow liquid food and 2/23 required permanent tube feeding. Response was evaluable in 22 patients (11 CR, 11 PR). Intial relapse was at distant sites in 9/26 and local in 8/26. Median follow up of the patients still alive is 46 months. Median OS is 576 days, median DFS is 401 days, median LRFS is not reached. 7/26 remain free of disease more than 3 years after end of treatment. Conclusions: RT + Gem (100 mg/m2/week) is feasible but toxic. The combination is highly active in SCCHN and provides a good long term local control. [Table: see text]
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Affiliation(s)
- P. M. Specenier
- University Hospital, Edegem, Belgium; ZNA Hospital Netwerk, Antwerp, Belgium
| | | | - C. Van Laer
- University Hospital, Edegem, Belgium; ZNA Hospital Netwerk, Antwerp, Belgium
| | - J. Van Den Brande
- University Hospital, Edegem, Belgium; ZNA Hospital Netwerk, Antwerp, Belgium
| | - M. Huizing
- University Hospital, Edegem, Belgium; ZNA Hospital Netwerk, Antwerp, Belgium
| | - S. Altintas
- University Hospital, Edegem, Belgium; ZNA Hospital Netwerk, Antwerp, Belgium
| | - J. Vermorken
- University Hospital, Edegem, Belgium; ZNA Hospital Netwerk, Antwerp, Belgium
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De Cock M, Van Laer C, Vanwambeke K, Salgado R. Chondrosarcoma of the larynx: a report of two cases and a review of the literature. B-ENT 2006; 2:21-6. [PMID: 16676843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023] Open
Abstract
Chondrosarcoma of the larynx: a report of two cases and a review of the literature. This paper describes two cases of low-grade laryngeal chondrosarcoma. In both cases, the tumours were located on the cricoid, and could be visualized with a CT scan and magnetic resonance imaging. The diagnosis was made by a deep wedge biopsy with a CO2 laser, and after subtotal supracricoid laryngectomy. Most of the reported cases have been successfully managed by voice-sparing surgery, but the two cases reported here, needed more radical treatment.
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Affiliation(s)
- M De Cock
- Departament of Otorhinolaryngology, AZ St. Maarten, Duffel, Belgium.
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19
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Hamoir M, Vander Poorten V, Chantrain G, Van Laer C, Gasmanne P, Deron P. Initial work-up in head and neck squamous cell carcinoma. B-ENT 2005; Suppl 1:129-32. [PMID: 16363274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023] Open
Abstract
OBJECTIVE To propose national guidelines for the initial assessment of head and neck squamous cell carcinoma. METHODS Comprehensive review of the literature and consensus discussion with national experts in the field. RESULTS Consensus guidelines are proposed concerning the work-up of patients with a presumed diagnosis of a squamous cell carcinoma of the upper aero-digestive tract.
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Affiliation(s)
- M Hamoir
- Department of Otolaryngology, Head and Neck Surgery, Cliniques Universitaires St Luc, UCL, Brussels, Belgium.
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Hamoir M, Bernheim N, Vander Poorten V, Chantrain G, Van Laer C, Hamans A, Deron P. Initial assessment of a neck mass in children. B-ENT 2005; Suppl 1:126-8. [PMID: 16363273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023] Open
Abstract
OBJECTIVE To propose national recommendations for the initial assessment of a mass in the neck in children. METHODS Comprehensive review of the available literature and consensus discussion with national experts in the field. RESULTS Consensus guidelines are proposed concerning the work up of children presenting with a mass in the neck.
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Affiliation(s)
- M Hamoir
- Department of Otolaryngology, Head and Neck Surgery, Cliniques Universitaires St Luc, UCL, Brussels, Belgium.
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Schrijvers D, Van Herpen C, Kerger J, Joosens E, Van Laer C, Awada A, Van den Weyngaert D, Nguyen H, Le Bouder C, Castelijns JA, Kaanders J, De Mulder P, Vermorken JB. Docetaxel, cisplatin and 5-fluorouracil in patients with locally advanced unresectable head and neck cancer: a phase I-II feasibility study. Ann Oncol 2004; 15:638-45. [PMID: 15033673 DOI: 10.1093/annonc/mdh145] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To determine the safety profile and activity of the combination of docetaxel, cisplatin and 5-fluorouracil (5-FU) in chemotherapy-naive patients with squamous cell carcinoma of the head and neck (SCCHN). PATIENTS AND METHODS Patients with locally advanced unresectable SCCHN were treated with docetaxel and cisplatin both as a 1-h infusion on day 1 followed by a continuous infusion of 5-FU for 5 days. Cycles were planned every 3 weeks up to four cycles, whereafter the patients were treated with locoregional radiotherapy. Two dose levels were studied. Doses in level I were 75 mg/m(2) of docetaxel, 75 mg/m(2) of cisplatin and 750 mg/m(2)/day of 5-FU; in level II the cisplatin dose was escalated to 100 mg/m(2). Following chemotherapy, all patients were to receive curative radiotherapy according to the standards in the different institutions. RESULTS Twenty-five patients were treated at dose level I with 86 cycles (median four; range one to four), and 23 at dose level II with 84 cycles (median four; range two to four). The median relative dose intensity was 0.99 (range 0.86-1.04) at level I and 0.94 (range 0.79-1.02) at level II. The response rate in the intention-to-treat population was 64% [95% confidence interval (CI) 42.5% to 82%] in level I and 78.3% (95% CI 56.3% to 92.5%) in level II; all were partial responses. The maximum tolerated dose was reached at level II with renal toxicity, nausea, stomatitis and thrombocytopenia as principal dose-limiting toxicities. The median survival of the 48 patients was 18.5 months. The survival at 12, 18, 24 and 30 months was 69, 54, 41 and 31%, respectively. CONCLUSIONS The combination of docetaxel, cisplatin and 5-FU associated with prophylactic ciprofloxacin is feasible and active in patients with SCCHN. Dose level I is recommended for phase III testing.
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Van Den Brande J, Rasschaert M, Van den Weyngaert D, Van Laer C, Dyck J, Wilmes P, Pauwels B, Vermorken J. 141 A phase II feasibility study of concurrent radiotherapy and gemcitabine for patients with cancer of the head and neck. EJC Suppl 2003. [DOI: 10.1016/s1359-6349(03)90174-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Abstract
A patient with a history of schizophrenia was admitted to our hospital in an already severe stage of necrotizing fasciitis of the neck, complicated with mediastinitis and gangrene. Later on, he also developed a vena cava superior syndrome and sepsis. In the few cases and small series described in the literature, necrotizing fasciitis of the neck is usually associated with surgery or trauma. Less frequently, an orodental or pharyngeal infection, often innocuous, is the underlying cause. None of these causes could be identified in our patient. Initially, on computer-assisted tomography (CT) scan, a tracheal rupture was suspected, but this diagnosis could not be confirmed on bronchoscopic examination. On gastroscopy, a stenotic oesophageal segment was discovered. Biopsy of this segment showed a poorly differentiated squamous cell carcinoma. The patient died in sepsis. Autopsy confirmed the presence of a large proximal oesophageal tumour with perforation. As far as we know, no case of a necrotizing fasciitis of the neck caused by perforation of a formerly unknown oesophageal carcinoma has been reported. Even mediastinitis, with or without gangrene, is rarely associated with oesophageal cancer, and in the few cases reported it is always due to fistulization after surgery.
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Affiliation(s)
- S M Francque
- Department of Intensive Care Medicine, University Hospital of Antwerp, Belgium.
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Stappaerts I, Van Laer C, Deschepper K, Van de Heyning P, Vermeire P. Endoscopic management of severe subglottic stenosis in Wegener's granulomatosis. Clin Rheumatol 2001; 19:315-7. [PMID: 10941816 DOI: 10.1007/s100670070053] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The optimal treatment for severe subglottic stenosis secondary to Wegener's granulomatosis remains controversial. We report the case of a symptomatic middle-aged woman who was successfully treated with intratracheal dilation and intralesional injection of corticosteroids. The literature related to this issue is being reviewed.
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Affiliation(s)
- I Stappaerts
- Department of Respiratory Medicine, University Hospital Antwerp, Edegem, Belgium.
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25
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Van Laer C, Van de Heyning P, Hamans E, Verfaillie J, Van den Hauwe L. Diagnostic procedures in head and neck cancer. Acta Otorhinolaryngol Belg 2000; 53:145-8. [PMID: 10635381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
Accurate, methodical diagnostic work up and staging are of the most importance in the treatment of Head and Neck tumours. It allows an initial multidisciplinary decision making, giving the patient the best chance of curation, with the least morbidity. In this paper the authors try to give a generally accepted work-up and try to get in to some of the newer techniques.
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Affiliation(s)
- C Van Laer
- Dep. of Otolaryngology, University Hospital Antwerp
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26
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Van de Heyning PH, Wuyts FL, Claes J, Koekelkoren E, Van Laer C, Valcke H. Definition, classification and reporting of Menière's disease and its symptoms. Acta Otolaryngol Suppl 1997; 526:5-9. [PMID: 9107347 DOI: 10.3109/00016489709124012] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
This review describes the practicalities of using both the inner Ear Profile to define hydrops labyrinthi, and the American Academy of Otolaryngology and Head and Neck Surgery (AAO-HNS) guidelines to define Meniere's disease. The requirement for standardisation is stressed since either system alone may be inadequate. It is suggested that the Inner Ear Profile could be adapted to the AAO-HNS criteria to create a unified method of evaluation.
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Affiliation(s)
- P H Van de Heyning
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Antwerp, Belgium
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27
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Van Hee R, Misset M, Ysebaert D, Van de Heyning P, Koekelkoren E, Claes L, Van Laer C, Peeters L, Hintjens J, Van Elst F, Van Marck E, Bultinck J. Surgical treatment of benign tumours of the salivary glands. Acta Chir Belg 1996; 96:161-4. [PMID: 8830872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
In this multicentre retrospective study 30 patients with benign salivary gland tumours are reviewed. Initial operation consisted of total parotidectomy in 6 patients, superficial lobectomy in 13 and tumour enucleation in 11. There were 5 recurrences, treated by enucleation in 1, superficial lobectomy in 2 and extensive total resection in 2 patients. In 18 cases a typical facial nerve dissection was performed. The resected specimens showed a pleiomorph adenoma in 24 cases and monomorph adenoma's in 6 cases. Complications were haematoma formation, Frey syndrome and facial nerve paresis. Recurrences were related to incomplete resection or fragmentation during operation. In this study benign tumours of the salivary glands proved to have a good prognosis, provided a total tumour excision with nerve dissection is performed; the excision should consist of a superficial lobectomy or total parotidectomy depending on the location of the tumour in the lateral or medial part of the gland.
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Affiliation(s)
- R Van Hee
- Department of Surgery, University Hospital, Antwerpen, Belgium
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Van Laer C, Hamans E, Neetens I, Van Marck E, Van Oosterom A, Van de Heyning P. Benign fibrous histiocytoma of the larynx: presentation of a case and review of the literature. J Laryngol Otol 1996; 110:474-7. [PMID: 8762322 DOI: 10.1017/s0022215100134024] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
A case of a benign histiocytoma of the larynx in a 39-year-old man is presented. Laryngeal fibrous histiocytoma is extremely rare. Its pathology is described including arguments for benignity. The literature is reviewed and management is discussed.
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Affiliation(s)
- C Van Laer
- Department of Otolaryngology, Head and Neck Surgery, University Hospital Antwerp
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Claes J, Van de Heyning PH, Creten W, Koekelkoren E, Van Laer C, De Saegher D, Graff A. Allograft tympanoplasty: predictive value of preoperative status. Laryngoscope 1990; 100:1313-8. [PMID: 2243525 DOI: 10.1288/00005537-199012000-00013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The functional and anatomical results of a series of 181 consecutive allograft tympanoplasties for ears with drum perforation and an intact ossicular chain were retrospectively reviewed and related to preoperative factors. Drum closure was realized in 92% (166 of 181 cases evaluated 1 year after surgery), and 96.6% of the reconstructed drums were still intact 3 years after surgery (118 cases evaluated). An air-bone gap of less than 21 dB was reached in 79.6% (of a total of 162 cases) 1 year after surgery, and in 78% (of a total of 118 cases) 3 years after surgery. Age, contralateral pathology, the wet or dry status of the ear preoperatively, and the preoperative air-bone gap had no influence on anatomical results. The preoperative air-bone gap did not predict the postoperative air-bone gap. The influence of age and existence of contralateral pathology on hearing gain was only visible in some of the strictly defined patient groups. The wet preoperative status of the ear generally predicted lower functional gain.
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Affiliation(s)
- J Claes
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Antwerp, Belgium
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