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Barry B, Dolivet G, Clatot F, Huguet F, Abdeddaim C, Baujat B, Blanchard N, Calais G, Carrat X, Chatellier A, Coste F, Cupissol D, Cuvelier P, De Mones Del Pujol E, Deneuve S, Duffas O, Dupret-Bories A, Even C, Evrard C, Evrard D, Faivre S, Fakhry N, Garrel R, Gorphe P, Houliat T, Kaminsky MC, Krebs L, Lapeyre M, Lindas P, Malard O, Mirghani H, Mondina M, Moriniere S, Mouawad F, Pestre-Munier J, Pham Dang N, Picard A, Ramin L, Renard S, Salvan D, Schernberg A, Sire C, Thariat J, Vanbockstael J, Vo Tan D, Wojcik T, Klein I, Block V, Baumann-Bouscaud L, De Raucourt D. [French national standard for the treatment of squamous cell carcinoma of upper aero-digestive tract - General principles of treatment]. Bull Cancer 2024; 111:393-415. [PMID: 38418334 DOI: 10.1016/j.bulcan.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 12/14/2023] [Accepted: 12/31/2023] [Indexed: 03/01/2024]
Abstract
OBJECTIVES The management of upper aerodigestive tract cancers is a complex specialty. It is essential to provide an update to establish optimal care. At the initiative of the INCa and under the auspices of the SFORL, the scientific committee, led by Professor Béatrix Barry, Dr. Gilles Dolivet, and Dr. Dominique De Raucourt, decided to develop a reference framework aimed at defining, in a scientific and consensus-based manner, the general principles of treatment for upper aerodigestive tract cancers applicable to all sub-locations. METHODOLOGY To develop this framework, a multidisciplinary team of practitioners was formed. A systematic analysis of the literature was conducted to produce recommendations classified by grades, in accordance with the standards of the French National Authority for Health (HAS). RESULTS The grading of recommendations according to HAS standards has allowed the establishment of a reference for patient care based on several criteria. In this framework, patients benefit from differentiated care based on prognostic factors they present (age, comorbidities, TNM status, HPV status, etc.), conditions of implementation, and quality criteria for indicated surgery (operability, resectability, margin quality, mutilation, salvage surgery), as well as quality criteria for radiotherapy (target volume, implementation time, etc.). The role of medical and postoperative treatments was also evaluated based on specific criteria. Finally, supportive care must be organized from the beginning and throughout the patients' care journey. CONCLUSION All collected data have led to the development of a comprehensive framework aimed at harmonizing practices nationally, facilitating decision-making in multidisciplinary consultation meetings, promoting equality in practices, and providing a state-of-the-art and reference practices for assessing the quality of care. This new framework is intended to be updated every 5 years to best reflect the latest advances in the field.
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Affiliation(s)
- Béatrix Barry
- AP-HP, hôpital Bichat-Claude-Bernard, ORL et CCF, Paris (75), France
| | - Gilles Dolivet
- Institut de cancérologie de Lorraine, ORL et CCF, Nancy (54), France.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Olivier Duffas
- Centre hospitalier de Libourne, ORL et CMF, Libourne, France
| | | | | | | | - Diane Evrard
- AP-HP, hôpital Bichat-Claude-Bernard, ORL et CCF, Paris (75), France
| | | | - Nicolas Fakhry
- Assistance publique-Hôpitaux de Marseille, ORL et CCF, Marseille, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Didier Salvan
- Centre hospitalier Sud Francilien, ORL et CCF, Corbeil-Essonnes, France
| | | | | | | | | | | | | | - Isabelle Klein
- Dispositif Spécifique Régional du Cancer Grand Est - NEON, Nancy (54), France
| | - Véronique Block
- Dispositif Spécifique Régional du Cancer Grand Est - NEON, Nancy (54), France
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Dolivet G, Barry B, Abdeddaim C, Baujat B, Blanchard N, Calais G, Carrat X, Chatellier A, Clatot F, Coste F, Cupissol D, Cuvelier P, de Mones Del Pujol E, Deneuve S, Duffas O, Dupret-Bories A, Even C, Evrard C, Evrard D, Faivre S, Fakhry N, Garrel R, Gorphe P, Houliat T, Huguet F, Kaminsky MC, Krebs L, Lapeyre M, Lindas P, Malard O, Mirghani H, Mondina M, Moriniere S, Mouawad F, Pestre-Munier J, Pham Dang N, Picard A, Ramin L, Renard S, Salvan D, Schernberg A, Sire C, Thariat J, Vanbockstael J, Vo Tan D, Wojcik T, Klein I, Block V, Baumann-Bouscaud L, de Raucourt D. [National standard for the treatment of squamous cell carcinoma of upper aerodigestive tract]. Bull Cancer 2024; 111:327-332. [PMID: 38336530 DOI: 10.1016/j.bulcan.2023.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/03/2023] [Accepted: 08/04/2023] [Indexed: 02/12/2024]
Affiliation(s)
- Gilles Dolivet
- ORL et CCF, Institut de cancérologie de Lorraine, Nancy, France.
| | - Béatrix Barry
- ORL et CCF, hôpital Bichat-Claude-Bernard, AP-HP, Paris, France
| | | | | | | | | | | | | | | | | | | | - Philippe Cuvelier
- ORL et CCF libéral à Bayonne et centre hospitalier Oloron, Oloron-Sainte-Marie, France
| | | | | | - Olivier Duffas
- ORL et CMF, centre hospitalier de Libourne, Libourne, France
| | | | | | | | - Diane Evrard
- ORL et CCF, hôpital Bichat-Claude-Bernard, AP-HP, Paris, France
| | | | - Nicolas Fakhry
- ORL et CCF, Assistance publique-Hôpitaux de Marseille, Marseille, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Sophie Renard
- ORL et CCF, Institut de cancérologie de Lorraine, Nancy, France
| | - Didier Salvan
- ORL et CCF, centre hospitalier sud francilien, Corbeil-Essonnes, France
| | | | | | | | | | | | | | - Isabelle Klein
- Dispositif spécifique régional du cancer Grand Est - NEON, Nancy, France
| | - Véronique Block
- Dispositif spécifique régional du cancer Grand Est - NEON, Nancy, France
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Marret G, Temam S, Kamal M, Even C, Delord JP, Hoffmann C, Dolivet G, Malard O, Fayette J, Capitain O, Vergez S, Geoffrois L, Rolland F, Zrounba P, Laccourreye L, Saada-Bouzid E, Aide N, Bénavent V, Klijianenko J, Lamy C, Girard E, Vacher S, Masliah-Planchon J, de Koning L, Puard V, Borcoman E, Jimenez M, Bièche I, Gal J, Le Tourneau C. Randomized phase II study of preoperative afatinib in untreated head and neck cancers: predictive and pharmacodynamic biomarkers of activity. Sci Rep 2023; 13:22524. [PMID: 38110561 PMCID: PMC10728082 DOI: 10.1038/s41598-023-49887-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 12/13/2023] [Indexed: 12/20/2023] Open
Abstract
There is no strong and reliable predictive biomarker in head and neck squamous cell carcinoma (HNSCC) for EGFR inhibitors. We aimed to identify predictive and pharmacodynamic biomarkers of efficacy of afatinib, a pan-HER tyrosine kinase inhibitor, in a window-of-opportunity trial (NCT01415674). Multi-omics analyses were carried out on pre-treatment biopsy and surgical specimen for biological assessment of afatinib activity. Sixty-one treatment-naïve and operable HNSCC patients were randomised to afatinib 40 mg/day for 21-28 days versus no treatment. Afatinib produced a high rate of metabolic response. Responders had a higher expression of pERK1/2 (P = 0.02) and lower expressions of pHER4 (P = 0.03) and pRB1 (P = 0.002) in pre-treatment biopsy compared to non-responders. At the cellular level, responders displayed an enrichment of tumor-infiltrating B cells under afatinib (P = 0.02). At the molecular level, NF-kappa B signaling was over-represented among upregulated genes in non-responders (P < 0.001; FDR = 0.01). Although exploratory, phosphoproteomics-based biomarkers deserve further investigations as predictors of afatinib efficacy.
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Affiliation(s)
- Grégoire Marret
- Department of Drug Development and Innovation (D3i), Institut Curie, 26 Rue d'Ulm, 75005, Paris, France
| | - Stéphane Temam
- Department of Head and Neck Surgery, Gustave Roussy, Villejuif, France
| | - Maud Kamal
- Department of Drug Development and Innovation (D3i), Institut Curie, 26 Rue d'Ulm, 75005, Paris, France
| | - Caroline Even
- Head and Neck Oncology Department, Gustave Roussy, Villejuif, France
| | - Jean-Pierre Delord
- Department of Medical Oncology, Centre Claudius Régaud, Toulouse, France
| | | | - Gilles Dolivet
- Department of Head and Neck Surgery, Institut de Cancérologie de Lorraine, Nancy, France
| | - Olivier Malard
- Department of Head and Neck Surgery, Centre Hospitalier Universitaire, Nantes, France
| | - Jérôme Fayette
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | - Olivier Capitain
- Department of Medical Oncology, Centre Paul Papin, Angers, France
| | - Sébastien Vergez
- Department of Head and Neck Surgery, Institut Claudius Regaud, Toulouse, France
| | - Lionel Geoffrois
- Department of Medical Oncology, Institut de Cancérologie de Lorraine, Nancy, France
| | - Frédéric Rolland
- Department of Medical Oncology, Centre René Gauducheau, Nantes, France
| | - Philippe Zrounba
- Department of Head and Neck Surgery, Centre Léon Bérard, Lyon, France
| | - Laurent Laccourreye
- Department of Head and Neck Surgery, Centre Hospitalier Universitaire, Angers, France
| | - Esma Saada-Bouzid
- Department of Medical Oncology, Centre Antoine Lacassagne, Nice, France
| | - Nicolas Aide
- Department of Nuclear Medicine, Centre François Baclesse, Caen, France
| | | | | | - Constance Lamy
- Department of Drug Development and Innovation (D3i), Institut Curie, 26 Rue d'Ulm, 75005, Paris, France
| | - Elodie Girard
- Bioinformatics Core Facility, INSERM U900, Mines Paris Tech, Institut Curie, Paris, France
| | | | | | - Leanne de Koning
- Department of Translational Research, Institut Curie, PSL Research University, Paris, France
| | - Vincent Puard
- Department of Translational Research, Institut Curie, PSL Research University, Paris, France
| | - Edith Borcoman
- Department of Drug Development and Innovation (D3i), Institut Curie, 26 Rue d'Ulm, 75005, Paris, France
| | | | - Ivan Bièche
- Genetics Department, Institut Curie, Paris, France
| | - Jocelyn Gal
- Department of Biostatistics, Centre Antoine Lacassagne, Nice, France
| | - Christophe Le Tourneau
- Department of Drug Development and Innovation (D3i), Institut Curie, 26 Rue d'Ulm, 75005, Paris, France.
- INSERM U900, Institut Curie, Paris-Saclay University, Paris, France.
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Mastronicola R, Le Roux P, Casse A, Cortese S, Beulque E, Perna M, Dolivet G. Current Approaches to Salvage Surgery for Head and Neck Cancer: A Comprehensive Review. Cancers (Basel) 2023; 15:cancers15092625. [PMID: 37174091 PMCID: PMC10177213 DOI: 10.3390/cancers15092625] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 03/17/2023] [Revised: 04/28/2023] [Accepted: 05/03/2023] [Indexed: 05/15/2023] Open
Abstract
Salvage surgeries of head and neck cancer are often complicated and do not always show decent results. This type of procedure is tough on the patient, as many crucial organs can be affected. A long period of reeducation usually follows the surgery because of the need to rehabilitate functions such as speech or swallowing. In order to lighten the journey of the patients, it is important to develop new technologies and techniques to ease the surgery and limit its damages. This seems even more crucial since progress has been made in the past years, allowing more salvage therapy to take place. This article aims at showing the available tools and procedures for salvage surgeries, such as transoral robotic surgery, free-flap surgery, sentinel node mapping, and many others, that help the work of the medical team to operate or obtain a better understanding of the status of the cancer when taken in charge. Yet, the surgical procedure is not the only thing determining the outcome of the operation. The patient themself and their cancer history also play an important part in the care and must be acknowledged.
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Affiliation(s)
- Romina Mastronicola
- Institut de Cancérologie de Lorraine ICL, 6 Avenue de Bourgogne, 54519 Vandoeuvre-lès-Nancy, France
- CRAN, CNRS, UMR 7039, Université de Lorraine, 54519 Vandoeuvre-lès-Nancy, France
| | - Pauline Le Roux
- Institut de Cancérologie de Lorraine ICL, 6 Avenue de Bourgogne, 54519 Vandoeuvre-lès-Nancy, France
| | - Aurore Casse
- Institut de Cancérologie de Lorraine ICL, 6 Avenue de Bourgogne, 54519 Vandoeuvre-lès-Nancy, France
| | - Sophie Cortese
- Institut de Cancérologie de Lorraine ICL, 6 Avenue de Bourgogne, 54519 Vandoeuvre-lès-Nancy, France
| | - Emilie Beulque
- Institut de Cancérologie de Lorraine ICL, 6 Avenue de Bourgogne, 54519 Vandoeuvre-lès-Nancy, France
| | - Marco Perna
- Technoport 9, Avenue des Hauts-Fourneaux, 4362 Esch-sur-Alzette, Luxembourg
| | - Gilles Dolivet
- Institut de Cancérologie de Lorraine ICL, 6 Avenue de Bourgogne, 54519 Vandoeuvre-lès-Nancy, France
- CRAN, CNRS, UMR 7039, Université de Lorraine, 54519 Vandoeuvre-lès-Nancy, France
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Benna M, Peduzzi L, Lesanne G, Benna AS, Rohrbacher C, Guillez K, Leroux A, Dolivet G, Sirveaux F, Marchal F. Total hip arthroplasty polyethylene wear mimicking a soft tissue tumor. European Journal of Surgical Oncology 2023. [DOI: 10.1016/j.ejso.2022.11.469] [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: 02/25/2023]
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Aydin A, David Manuel G, Cortese S, Marchal F, Dolivet G. Embolie graisseuse carotidienne dans les suites d’un lipofilling temporal. ANN CHIR PLAST ESTH 2022; 68:167-172. [PMID: 36463024 DOI: 10.1016/j.anplas.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 10/11/2022] [Accepted: 10/24/2022] [Indexed: 12/02/2022]
Abstract
Lipofilling is a well-known procedure, initially described by Coleman in 1991. Many cases of fat embolism following this procedure are published. Our patient had a common carotid fat embolism after a temporal autologous fat graft.
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Marret G, Kamal M, Gal J, Temam S, Klijianenko J, Delord JP, Hoffmann C, Dolivet G, Malard O, Fayette J, Capitain O, Even C, Vergez S, Geoffrois L, Rolland F, Zrounba P, Laccourreye L, Guigay J, Aide N, Bénavent V, Lamy C, Girard E, Jimenez M, Bièche I, Tourneau CL. Abstract 1237: Randomized phase II trial of pre-operative afatinib in non-metastatic head and neck squamous cell carcinoma patients: Identification of predictive biomarkers of response. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-1237] [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: 11/16/2022]
Abstract
Abstract
Background: Epidermal growth factor receptor (EGFR) inhibitors, including monoclonal antibodies and tyrosine kinase inhibitors, have limited efficacy in head and neck squamous cell carcinoma (HNSCC) patients. In the randomized phase II PREDICTOR trial, we aimed at identifying predictive and pharmacodynamics biomarkers of 2-4 weeks afatinib (an irreversible pan-HER inhibitor) versus no treatment in the pre-operative setting (NCT01415674). We previously reported a 59% metabolic response rate on PET imaging in the afatinib arm. We report here the evaluation of predictive genomic and transcriptomic biomarkers of afatinib efficacy.
Patients and Methods: All patients (41 in the afatinib arm and 20 in the no treatment arm) underwent a pre-treatment biopsy. We performed targeted DNA sequencing using an in-house NGS panel of 571 genes on baseline biopsies from 56 patients, and RNA-sequencing (RNAseq) in 54 patients. In the afatinib arm, 26 patients had paired pre- and post-treatment tumor samples. DNA and RNA alterations were correlated with metabolic response to afatinib using PET imaging, as well as overall survival (OS).
Results: Most frequent molecular alterations, including known activating mutations and/or focal amplifications for oncogenes or homozygous deletions and inactivating mutations for tumor suppressor genes, involved genome integrity (TP53 [70%]), cell cycle (CCND1 [38%], CDKN2A [32%], CDKN2B [14%]), senescence (TERT [23%]), Wnt signaling (NOTCH1 [16%]), and the PI3K pathway (PIK3CA [14%]). In the afatinib arm, metabolic response was observed in 1 out of 7 patients (14%) and in 19 out of 28 patients (68%) in the Wnt altered and unaltered groups (p = 0.03, fisher exact test), respectively. In the whole cohort of patients, homozygous deletions of both CDKN2A and CDKN2B correlated with shorter OS, with 6-year survival of 22% in the CDKN2A/B altered group and 70% in the CDKN2A/B wild-type group (p = 0.004; log-rank test). In the afatinib treated patients, using a generalized linear mixed model with a patient as random effect and a quasi-binomial family, the ratio of B cells expression levels in the post-treated versus pre-treated samples was significantly higher in responder as compared to non-responder patients (p = 0.001).
Conclusions: Wnt signaling pathway alterations and treatment-related dynamic changes in B cells proportions were identified as predictive and pharmacodynamics biomarkers of afatinib efficacy. CDKN2A/B homozygous deletions were associated with a poor prognosis in HNSCC patients treated with upfront surgery.
Citation Format: Grégoire Marret, Maud Kamal, Jocelyn Gal, Stéphane Temam, Jerzy Klijianenko, Jean-Pierre Delord, Caroline Hoffmann, Gilles Dolivet, Olivier Malard, Jerôme Fayette, Olivier Capitain, Caroline Even, Sébastien Vergez, Lionel Geoffrois, Frédéric Rolland, Philippe Zrounba, Laurent Laccourreye, Joël Guigay, Nicolas Aide, Valérie Bénavent, Constance Lamy, Elodie Girard, Marta Jimenez, Ivan Bièche, Christophe Le Tourneau. Randomized phase II trial of pre-operative afatinib in non-metastatic head and neck squamous cell carcinoma patients: Identification of predictive biomarkers of response [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 1237.
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Affiliation(s)
- Grégoire Marret
- 1Institut Curie, Paris-Saclay University, Paris & Saint-Cloud, France
| | - Maud Kamal
- 1Institut Curie, Paris-Saclay University, Paris & Saint-Cloud, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Constance Lamy
- 1Institut Curie, Paris-Saclay University, Paris & Saint-Cloud, France
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Dolivet G. Salvage surgery in irradiated area for head and neck cancer. Prognostic factors for long-term survival study with a monocentric series of 234 patients treated between 2000 and 2010. Eur J Surg Oncol 2022. [DOI: 10.1016/j.ejso.2021.12.207] [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: 11/28/2022] Open
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Sastre-Garau X, Diop M, Martin F, Dolivet G, Marchal F, Charra-Brunaud C, Peiffert D, Leufflen L, Dembélé B, Demange J, Tosti P, Thomas J, Leroux A, Merlin JL, Diop-Ndiaye H, Costa JM, Salleron J, Harlé A. A NGS-based Blood Test For the Diagnosis of Invasive HPV-associated Carcinomas with Extensive Viral Genomic Characterization. Clin Cancer Res 2021; 27:5307-5316. [PMID: 34108183 PMCID: PMC9401522 DOI: 10.1158/1078-0432.ccr-21-0293] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/29/2021] [Accepted: 06/04/2021] [Indexed: 01/07/2023]
Abstract
PURPOSE Use of circulating tumor DNA (ctDNA) for diagnosis is limited regarding the low number of target molecules in early-stage tumors. Human papillomavirus (HPV)-associated carcinomas represent a privileged model using circulating viral DNA (ctHPV DNA) as a tumor marker. However, the plurality of HPV genotypes represents a challenge. The next-generation sequencing (NGS)-based CaptHPV approach is able to characterize any HPV DNA sequence. To assess the ability of this method to establish the diagnosis of HPV-associated cancer via a blood sample, we analyzed ctHPV DNA in HPV-positive or HPV-negative carcinomas. EXPERIMENTAL DESIGN Patients (135) from France and Senegal with carcinoma developed in the uterine cervix (74), oropharynx (25), oral cavity (19), anus (12), and vulva (5) were prospectively registered. Matched tumor tissue and blood samples (10 mL) were taken before treatment and independently analyzed using the CaptHPV method. RESULTS HPV prevalence in tumors was 60.0% (81/135; 15 different genotypes). Viral analysis of plasmas compared with tumors was available for 134 patients. In the group of 80 patients with HPV-positive tumors, 77 were also positive in plasma (sensitivity 95.0%); in the group of 54 patients with HPV-negative tumors, one was positive in plasma (specificity 98.1%). In most cases, the complete HPV pattern observed in tumors could be established from the analysis of ctHPV DNA. CONCLUSIONS In patients with carcinoma associated with any HPV genotype, a complete viral genome characterization can be obtained via the analysis of a standard blood sample. This should favor the development of noninvasive diagnostic tests providing the identification of personalized tumor markers. See related commentary by Rostami et al., p. 5158.
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Affiliation(s)
- Xavier Sastre-Garau
- Service de Biopathologie, Institut de Cancérologie de Lorraine, Vandoeuvre-Lès-Nancy, France.,Service de Pathologie, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Mamadou Diop
- Institut du Cancer Joliot Curie, CHU Aristide Le Dantec, Dakar, Sénégal
| | | | - Gilles Dolivet
- CNRS CRAN UMR 7039, Université de Lorraine, Vandœuvre-lès-Nancy, France.,Département de Chirurgie, Institut de Cancérologie de Lorraine, Vandoeuvre-Lès-Nancy, France
| | - Frédéric Marchal
- CNRS CRAN UMR 7039, Université de Lorraine, Vandœuvre-lès-Nancy, France.,Département de Chirurgie, Institut de Cancérologie de Lorraine, Vandoeuvre-Lès-Nancy, France
| | - Claire Charra-Brunaud
- Département de Radiothérapie, Institut de Cancérologie de Lorraine, Vandoeuvre-Lès-Nancy, France
| | - Didier Peiffert
- CNRS CRAN UMR 7039, Université de Lorraine, Vandœuvre-lès-Nancy, France.,Département de Radiothérapie, Institut de Cancérologie de Lorraine, Vandoeuvre-Lès-Nancy, France
| | - Léa Leufflen
- Département de Chirurgie, Institut de Cancérologie de Lorraine, Vandoeuvre-Lès-Nancy, France
| | - Birama Dembélé
- Institut du Cancer Joliot Curie, CHU Aristide Le Dantec, Dakar, Sénégal
| | - Jessica Demange
- Service de Biopathologie, Institut de Cancérologie de Lorraine, Vandoeuvre-Lès-Nancy, France
| | - Priscillia Tosti
- Unité de Recherche Clinique, Institut de Cancérologie de Lorraine, Vandoeuvre-Lès-Nancy, France
| | - Jacques Thomas
- Service de Biopathologie, Institut de Cancérologie de Lorraine, Vandoeuvre-Lès-Nancy, France
| | - Agnès Leroux
- Service de Biopathologie, Institut de Cancérologie de Lorraine, Vandoeuvre-Lès-Nancy, France
| | - Jean-Louis Merlin
- Service de Biopathologie, Institut de Cancérologie de Lorraine, Vandoeuvre-Lès-Nancy, France.,CNRS CRAN UMR 7039, Université de Lorraine, Vandœuvre-lès-Nancy, France
| | | | | | - Julia Salleron
- Unité de Biostatistiques, Institut de Cancérologie de Lorraine, Vandoeuvre-Lès-Nancy, France
| | - Alexandre Harlé
- Service de Biopathologie, Institut de Cancérologie de Lorraine, Vandoeuvre-Lès-Nancy, France.,CNRS CRAN UMR 7039, Université de Lorraine, Vandœuvre-lès-Nancy, France.,Corresponding Author: Alexandre Harlé, Service de Biopathologie, Institut de Cancérologie de Lorraine, 6 Avenue de Bourgogne, 54519 Vandoeuvre-lès-Nancy, France. Phone: 3 83–65 6–119; E-mail:
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Clément-Duchêne C, Salleron J, Dolivet G, Cortses S, Mastronicola R, Beulque E, Geoffrois L, Kaminsky M, Faivre J. P07.04 Primary Lung Cancers in Patients With Head and Neck Cancer: Experience of a French Institution. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.293] [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: 11/17/2022]
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11
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Beulque E, Cortese S, Mastronicola R, Dolivet G. [Surgical de-escalation for head and neck cancer surgery]. Bull Cancer 2021; 108:948-952. [PMID: 34556292 DOI: 10.1016/j.bulcan.2021.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 04/30/2021] [Revised: 05/26/2021] [Accepted: 06/07/2021] [Indexed: 10/20/2022]
Abstract
Head and neck cancer surgery often has functional and aesthetic consequences. De-escalation surgery is a major concern for surgeons with a constant desire to develop surgical techniques with less invasive approaches and to preserve anatomical structures as much as possible. This was made possible by the appearance of minimally transoral and endonasal surgery as well as by the limitation of the surgical procedure by neoadjuvant treatments or by the limitation of surgical excision without compromising the oncological outcome and patient survival. This evolution continues with the arrival of new technologies such as virtual reality or artificial intelligence.
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Affiliation(s)
- Emilie Beulque
- Institut de cancérologie de Lorraine, département de chirurgie, 6, avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy cedex, France.
| | - Sophie Cortese
- Institut de cancérologie de Lorraine, département de chirurgie, 6, avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy cedex, France
| | - Romina Mastronicola
- Institut de cancérologie de Lorraine, département de chirurgie, 6, avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy cedex, France
| | - Gilles Dolivet
- Institut de cancérologie de Lorraine, département de chirurgie, 6, avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy cedex, France
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Dahan LS, Giorgi R, Vergez S, Le Taillandier de Gabory L, Costes-Martineau V, Herman P, Poissonnet G, Mauvais O, Malard O, Garrel R, Uro-Coste E, Barry B, Bach C, Chevalier D, Mouawad F, Merol JC, Bastit V, Thariat J, Gilain L, Dufour X, Righini CA, Moya-Plana A, Even C, Radulesco T, Michel J, Baujat B, Fakhry N, Albert S, Andry G, Babin E, Bach C, Badet JM, Badoual C, Baglin A, Banal A, Barry B, Baudin E, Baujat B, Bensadoun R, Bertolus C, Bessède JP, Blanchard D, Borel C, Bozorg-Grayeli A, Breheret R, Breton P, Brugel L, Calais G, Casiraghi O, Cassagnau E, Castillo L, Ceruse P, Chabolle F, Chevalier D, Chobaut J, Choussy O, Cosmidis A, Coste A, Costes V, Crampette L, Darrouzet V, Demez P, Dessi P, Devauchelle B, Dolivet G, Dubrulle F, Duflo S, Dufour X, Faivre S, Fakhry N, Ferron C, Floret F, de Gabory L, Garrel R, Geoffrois L, Gilain L, Giovanni A, Girod A, Guerrier B, Hans S, Herman P, Hofman P, Housset M, Jankowski R, Jegoux F, Juliéron M, Kaminsky MC, Kolb F, St Guily JL, Laccoureye L, Lallemant B, Lang P, Lartigau E, Lavieille JP, Lefevre M, Leroy X, Malard O, Massip F, Mauvais O, Merol JC, Michel J, Mom T, Morinière S, de Monès E, Moulin G, Noel G, Poissonnet G, Prades JM, Radulesco T, de Raucourt D, Reyt E, Righini C, Robin YM, Rolland F, Ruhin B, Sarroul N, Schultz P, Serrano E, Sterkers O, Strunski V, Sudaka A, Tassart M, Testelin S, Thariat J, Timochenko A, Toussaint B, Coste EU, Valette G, Van den Abbeele T, Varoquaux A, Veillon F, Vergez S, Wassef M. Mucoepidermoid carcinoma of salivary glands: A French Network of Rare Head and Neck Tumors (REFCOR) prospective study of 292 cases. Eur J Surg Oncol 2021; 47:1376-1383. [DOI: 10.1016/j.ejso.2020.11.123] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 10/31/2020] [Accepted: 11/13/2020] [Indexed: 12/18/2022] Open
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Dekerle L, Cortese S, Salleron J, Rauch P, Mastronicola R, Beulque E, Chatard M, Hamitouche S, Alao O, Dolivet G. Long-term survival after head and neck cancer surgery with immediate free flap reconstruction. ANN CHIR PLAST ESTH 2021; 66:357-363. [PMID: 33824027 DOI: 10.1016/j.anplas.2021.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/08/2020] [Revised: 02/04/2021] [Accepted: 02/23/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Head and neck cancer is one of the most frequent cancers worldwide. A combination treatment including surgery is known to have a better survival rate than exclusive radiotherapy-chemotherapy. In extreme cases of non-metastatic patients who have voluminous tumor, or complex location, surgery with immediate reconstruction by free flap could be an option to improve long term survival. PURPOSE To share experience of long-term survival of patients with head and neck cancer who underwent oncologic surgery with immediate free flap reconstruction, and to analyze influencing factors. METHODS All consecutive patients treated with free flaps for reconstruction of extensive defects after resection of head and neck cancer in our center (Nancy, France) were retrieved from the hospital database. Data was recorded in a systematic way. Bivariate and multivariate Cox proportional hazards models were used for statistical analysis. RESULTS Between 1997 and December 2007, 70 patients underwent surgical resection of head and neck tumor with free flap reconstruction. 11 patients were excluded because of missing data. Follow-up time was 7.4 years, IQR from 4.3 to 11.3. Overall survival was 53.8%, 95% CI [39.9%; 65.8%] at 5 years and 38.6% [24.8%; 52.3%] at 10 years. Age>60 years at the surgery HR 2,373 (1,143; 4,927) and TNM score 3-4 HR 2,524 (1,093; 5,828) were statistically associated to a lesser survival rate. CONCLUSION The ability to successfully and safely perform free flaps increases treatment options for patients with advanced head and neck cancer in a selected population. it seems worthwhile to perform these microvascular reconstructions.
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Affiliation(s)
- L Dekerle
- Department of Plastic and Reconstructive Surgery, Nancy University Hospital, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54000 Nancy, France.
| | - S Cortese
- Department of Oncologic Surgery "Institut de Cancérologie de Lorraine", Nancy, France
| | - J Salleron
- Department of Oncologic Surgery "Institut de Cancérologie de Lorraine", Nancy, France
| | - P Rauch
- Department of Oncologic Surgery "Institut de Cancérologie de Lorraine", Nancy, France
| | - R Mastronicola
- Department of Oncologic Surgery "Institut de Cancérologie de Lorraine", Nancy, France
| | - E Beulque
- Department of Oncologic Surgery "Institut de Cancérologie de Lorraine", Nancy, France
| | - M Chatard
- Department of Plastic and Reconstructive Surgery, Nancy University Hospital, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54000 Nancy, France
| | - S Hamitouche
- Department of Head and neck surgery, Nancy University Hospital, Nancy, France
| | - O Alao
- Department of Digestive Surgery, Grenoble Alpes University Hospital, Grenoble, France
| | - G Dolivet
- Department of Oncologic Surgery "Institut de Cancérologie de Lorraine", Nancy, France
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14
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Egloff-Juras C, Yakavets I, Scherrer V, Francois A, Bezdetnaya L, Lassalle HP, Dolivet G. Validation of a Three-Dimensional Head and Neck Spheroid Model to Evaluate Cameras for NIR Fluorescence-Guided Cancer Surgery. Int J Mol Sci 2021; 22:ijms22041966. [PMID: 33671198 PMCID: PMC7922741 DOI: 10.3390/ijms22041966] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/10/2021] [Accepted: 02/14/2021] [Indexed: 01/12/2023] Open
Abstract
Near-infrared (NIR) fluorescence-guided surgery is an innovative technique for the real-time visualization of resection margins. The aim of this study was to develop a head and neck multicellular tumor spheroid model and to explore the possibilities offered by it for the evaluation of cameras for NIR fluorescence-guided surgery protocols. FaDu spheroids were incubated with indocyanine green (ICG) and then included in a tissue-like phantom. To assess the capability of Fluobeam® NIR camera to detect ICG in tissues, FaDu spheroids exposed to ICG were embedded in 2, 5 or 8 mm of tissue-like phantom. The fluorescence signal was significantly higher between 2, 5 and 8 mm of depth for spheroids treated with more than 5 µg/mL ICG (p < 0.05). The fluorescence intensity positively correlated with the size of spheroids (p < 0.01), while the correlation with depth in the tissue-like phantom was strongly negative (p < 0.001). This multicellular spheroid model embedded in a tissue-like phantom seems to be a simple and reproducible in vitro tumor model, allowing a comparison of NIR cameras. The ideal configuration seems to be 450 μm FaDu spheroids incubated for 24 h with 0.05 mg/mL of ICG, ensuring the best stability, toxicity, incorporation and signal intensity.
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Affiliation(s)
- Claire Egloff-Juras
- Université de Lorraine, CNRS UMR 7039, CRAN, F-54000 Nancy, France; (I.Y.); (L.B.); (H.-P.L.); (G.D.)
- Université de Lorraine, CHRU-Nancy, F-54000 Nancy, France
- Institut de Cancérologie de Lorraine, F-54000 Nancy, France; (V.S.); (A.F.)
- Faculté d’Odontologie de Lorraine, Université de Lorraine, 7 Avenue de la Forêt de Haye, Vandœuvre-lès-Nancy, 54500 Nancy, France
- Correspondence:
| | - Ilya Yakavets
- Université de Lorraine, CNRS UMR 7039, CRAN, F-54000 Nancy, France; (I.Y.); (L.B.); (H.-P.L.); (G.D.)
- Institut de Cancérologie de Lorraine, F-54000 Nancy, France; (V.S.); (A.F.)
| | - Victoria Scherrer
- Institut de Cancérologie de Lorraine, F-54000 Nancy, France; (V.S.); (A.F.)
| | - Aurélie Francois
- Institut de Cancérologie de Lorraine, F-54000 Nancy, France; (V.S.); (A.F.)
| | - Lina Bezdetnaya
- Université de Lorraine, CNRS UMR 7039, CRAN, F-54000 Nancy, France; (I.Y.); (L.B.); (H.-P.L.); (G.D.)
- Institut de Cancérologie de Lorraine, F-54000 Nancy, France; (V.S.); (A.F.)
| | - Henri-Pierre Lassalle
- Université de Lorraine, CNRS UMR 7039, CRAN, F-54000 Nancy, France; (I.Y.); (L.B.); (H.-P.L.); (G.D.)
- Institut de Cancérologie de Lorraine, F-54000 Nancy, France; (V.S.); (A.F.)
| | - Gilles Dolivet
- Université de Lorraine, CNRS UMR 7039, CRAN, F-54000 Nancy, France; (I.Y.); (L.B.); (H.-P.L.); (G.D.)
- Institut de Cancérologie de Lorraine, F-54000 Nancy, France; (V.S.); (A.F.)
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15
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Locatello LG, Mastronicola R, Cortese S, Beulque E, Salleron J, Gallo O, Dolivet G. Estimating the risks and benefits before salvage surgery for recurrent head and neck squamous cell carcinoma. Eur J Surg Oncol 2021; 47:1718-1726. [PMID: 33549376 DOI: 10.1016/j.ejso.2021.01.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 10/14/2020] [Revised: 12/18/2020] [Accepted: 01/25/2021] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION The risks associated with salvage surgery of head and neck squamous cell carcinoma (SCC) in a previously irradiated field needs to be balanced against the expected survival benefits. We want to identify preoperative predictive factors for overall and disease-specific survival (OS/DSS) and for the development of serious (Clavien-Dindo, CD≥III) complications following salvage surgery for radiorecurrent SCC to help surgeons, patients, and caregivers in the decision-making process in this setting. MATERIALS AND METHODS The records of 234 patients presenting to the Lorraine Cancer Institute with locoregional radiorecurrent SCC were reviewed. The primary endpoint was OS, secondary endpoints were DSS, OS without tracheostomy/gastrostomy, and the risk of CD≥III complications. Multivariate analyses were carried out to explore preoperative factors associated with survival and the risk of postoperative complications. RESULTS With a median follow-up time of 19 months, 5-year OS since the first salvage surgery was 28.3%, 5-year DSS was 38.9%. 2- and 5-year functional OS were 45.6% and 27.2%. rcT-rcN, and WUNHCI ≥4 were both independent significant preoperative predictors of OS and DSS. 30-days postoperative complications occurred in 44.4% of patients (28 CD I, 24 CD II, 34 CD III, 11 CD IV, 7 CD V). A salvage procedure involving T+N plus the presence of a WUHNCI ≥4 was the only independent predictor of CD≥III complications. CONCLUSION When discussing with the patients and the caregivers salvage surgery for recurrent head and neck SCC, a careful evaluation of the preoperative comorbidities by the WUHNCI tool can reliably predict the expected risks and benefits from the procedure.
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Affiliation(s)
- Luca Giovanni Locatello
- Department of Surgical Oncology, Head and Neck Unit, Institut de Cancérologie de Lorraine, Université de Lorraine, F-54519, Vandœuvre-lès-Nancy, France; Department of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla, 3 - 50134, Florence, Italy.
| | - Romina Mastronicola
- Department of Surgical Oncology, Head and Neck Unit, Institut de Cancérologie de Lorraine, Université de Lorraine, F-54519, Vandœuvre-lès-Nancy, France; University of Lorraine, CNRS, CRAN, F-54000, Nancy, France
| | - Sophie Cortese
- Department of Surgical Oncology, Head and Neck Unit, Institut de Cancérologie de Lorraine, Université de Lorraine, F-54519, Vandœuvre-lès-Nancy, France
| | - Emilie Beulque
- Department of Surgical Oncology, Head and Neck Unit, Institut de Cancérologie de Lorraine, Université de Lorraine, F-54519, Vandœuvre-lès-Nancy, France
| | - Julia Salleron
- Biostatistics Unit, Institut de Cancérologie de Lorraine, Université de Lorraine, F-54519, Vandœuvre-lès-Nancy, France
| | - Oreste Gallo
- Department of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla, 3 - 50134, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Gilles Dolivet
- Department of Surgical Oncology, Head and Neck Unit, Institut de Cancérologie de Lorraine, Université de Lorraine, F-54519, Vandœuvre-lès-Nancy, France; University of Lorraine, CNRS, CRAN, F-54000, Nancy, France
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Pflumio C, Thomas J, Salleron J, Faivre JC, Borel C, Dolivet G, Sastre-Garau X, Geoffrois L. Expression of immune response biomarkers (PD‑L1, p16, CD3+ and CD8+ TILs) in recurrent head and neck squamous cell carcinoma within previously irradiated areas. Oncol Rep 2021; 45:1273-1283. [PMID: 33432367 DOI: 10.3892/or.2021.7928] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 04/27/2020] [Accepted: 10/16/2020] [Indexed: 11/06/2022] Open
Abstract
The immune landscape of head and neck squamous cell carcinoma in pretreated areas remains poorly documented. We aimed to assess the tumor microenvironment for biomarkers of antitumor immune responses in tumors in previously irradiated areas compared with de novo tumors. This retrospective monocentric study analyzed 100 paraffin‑embedded surgical samples of invasive head and neck squamous cell carcinoma (oral cavity, oropharynx, larynx, hypopharynx) from patients who underwent surgery between January 2010 and November 2017. We compared the immune microenvironment in 50 de novo tumors and 50 tumors recurring within irradiated areas. We used immunohistochemistry to assess p16 status, CD3+/CD8+ tumor‑infiltrating lymphocytes (TILs), and programmed death‑ligand 1 (PD‑L1) expression on tumor and immune cells in stromal and intratumoral components. CD3+ TIL counts were significantly lower in intratumoral and stromal components (P=0.003 and P=0.020, respectively) in the irradiated area cohort; there was no significant difference between CD8+ TIL counts in the two cohorts. The percentage of tumors with PD‑L1+ tumor cells (tumor proportion score ≥1%) was significantly lower within the irradiated area cohort than the de novo cohort (56.0% vs. 86.0%, P<0.001). There were also significantly fewer tumors with PD‑L1+ immune cells in the irradiated area cohort. Predominantly, tumors from the irradiated area cohort had microenvironments classified as 'adaptive immune resistance'. There was persistence of cytotoxic cells in tumors in the irradiated areas but lower PD‑L1 expression and CD3+ TIL counts than in the de novo tumors. This offers an initial hypothesis to explain why these lesions are less responsive to immunotherapy, even though they may still have antitumor capacities. Assessment of immune response biomarkers in patients treated with immunotherapy in randomized trials is required.
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Affiliation(s)
- Carole Pflumio
- Department of Medical Oncology, Strasbourg Europe Institute of Oncology, F‑67200 Strasbourg, France
| | - Jacques Thomas
- Department of Pathology, Lorraine Institute of Oncology, University of Lorraine, F‑54519 Vandœuvre‑lès‑Nancy, France
| | - Julia Salleron
- Department of Biostatistics and Data Management, Lorraine Institute of Oncology, University of Lorraine, F‑54519 Vandœuvre‑lès‑Nancy, France
| | - Jean-Christophe Faivre
- Department of Radiation Therapy, Lorraine Institute of Oncology, University of Lorraine, F‑54519 Vandœuvre‑lès‑Nancy, France
| | - Christian Borel
- Department of Medical Oncology, Strasbourg Europe Institute of Oncology, F‑67200 Strasbourg, France
| | - Gilles Dolivet
- CNRS‑UMR 7039 CRAN, University of Lorraine, F‑54519 Vandœuvre‑lès‑Nancy, France
| | - Xavier Sastre-Garau
- Department of Pathology, Intercommunal Hospital Center of Creteil, F‑94000 Créteil, France
| | - Lionnel Geoffrois
- Department of Medical Oncology, Lorraine Institute of Oncology, University of Lorraine, F‑54519 Vandœuvre‑lès‑Nancy, France
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Garrel R, Poissonnet G, Moyà Plana A, Fakhry N, Dolivet G, Lallemant B, Sarini J, Vergez S, Guelfucci B, Choussy O, Bastit V, Richard F, Costes V, Landais P, Perriard F, Daures JP, de Verbizier D, Favier V, de Boutray M. Equivalence Randomized Trial to Compare Treatment on the Basis of Sentinel Node Biopsy Versus Neck Node Dissection in Operable T1-T2N0 Oral and Oropharyngeal Cancer. J Clin Oncol 2020; 38:4010-4018. [PMID: 33052754 DOI: 10.1200/jco.20.01661] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
PURPOSE Sentinel node (SN) biopsy is accurate in operable oral and oropharyngeal cT1-T2N0 cancer (OC), but, to our knowledge, the oncologic equivalence of SN biopsy and neck lymph node dissection (ND; standard treatment) has never been evaluated. METHODS In this phase III multicenter trial, 307 patients with OC were randomly assigned to (1) the ND arm or (2) the SN arm (experimental arm: biopsy alone if negative, or followed by ND if positive, during primary tumor surgery). The primary outcome was neck node recurrence-free survival (RFS) at 2 years. Secondary outcomes were 5-year neck node RFS, 2- and 5-year disease-specific survival (DSS), and overall survival (OS). Other outcomes were hospital stay length, neck and shoulder morbidity, and number of physiotherapy prescriptions during the 2 years after surgery. RESULTS Data on 279 patients (139 ND and 140 SN) could be analyzed. Neck node RFS was 89.6% (95% CI, 0.83% to 0.94%) at 2 years in the ND arm and 90.7% (95% CI, 0.84% to 0.95%) in the SN arm, confirming the equivalence with P < .01. The 5-year RFS and the 2- and 5-year DSS and OS were not significantly different between arms. The median hospital stay length was 8 days in the ND arm and 7 days in the SN arm (P < .01). The functional outcomes were significantly worse in the ND arm until 6 months after surgery. CONCLUSION This study demonstrated the oncologic equivalence of the SN and ND approaches, with lower morbidity in the SN arm during the first 6 months after surgery, thus establishing SN as the standard of care in OC.
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Affiliation(s)
- Renaud Garrel
- Head Neck Surgery Department, Montpellier University Hospital Center, Montpellier, France
| | - Gilles Poissonnet
- Head Neck Surgery Department, Antoine Lacassagne Center, Nice, France
| | - Antoine Moyà Plana
- Head Neck Surgery Department, Institut Gustave Roussy, Villejuif, France
| | - Nicolas Fakhry
- Head Neck Surgery Department, Marseille University Hospital Center, Marseille, France
| | - Gilles Dolivet
- Head Neck Surgery Department, Alexis Vautrin Center, Vandœuvre-lès-Nancy, France
| | - Benjamin Lallemant
- Head Neck Surgery Department, Nîmes University Hospital Center, Nîmes, France
| | - Jérôme Sarini
- Head Neck Surgery Department, Toulouse Oncopole, Toulouse, France
| | - Sebastien Vergez
- Head Neck Surgery Department, Toulouse Oncopole, Toulouse, France
| | - Bruno Guelfucci
- Head Neck Surgery Department, Toulon Hospital Center, Toulon, France
| | - Olivier Choussy
- Head Neck Surgery Department, Curie Institute, Paris, France
| | - Vianney Bastit
- Head Neck Surgery Department, François Baclesse Center, Caen, France
| | - Fanny Richard
- Head Neck Surgery Department, Montpellier University Hospital Center, Montpellier, France
| | - Valérie Costes
- Pathology Department, Montpellier University Hospital Center, Montpellier, France
| | - Paul Landais
- Clinical Research University Institute, UPRES EA 2415, Montpellier, France
| | - Françoise Perriard
- Clinical Research University Institute, UPRES EA 2415, Montpellier, France
| | - Jean Pierre Daures
- Clinical Research University Institute, UPRES EA 2415, Montpellier, France
| | - Delphine de Verbizier
- Nuclear Medicine Department, Montpellier University Hospital Center, Montpellier, France
| | - Valentin Favier
- Head Neck Surgery Department, Montpellier University Hospital Center, Montpellier, France
| | - Marie de Boutray
- Head Neck Surgery Department, Montpellier University Hospital Center, Montpellier, France
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18
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Cortese S, Kerrien E, Yakavets I, Meilender R, Mastronicola R, Renard S, Leroux A, Bezdetnaya L, Dolivet G. ICG-induced NIR fluorescence mapping in patients with head & neck tumors after the previous radiotherapy. Photodiagnosis Photodyn Ther 2020; 31:101838. [PMID: 32479902 DOI: 10.1016/j.pdpdt.2020.101838] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 01/14/2020] [Revised: 05/11/2020] [Accepted: 05/22/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND The distinction between tumor and healthy tissues is complicated in the areas previously subjected to radiation therapy (RT). This is related to the fact that tissues can undergo delayed and irreversible deterioration such as inflammation, vascular alteration and fibrosis. The trials related to the fluorescence -guided surgery (FSG) in Head and Neck Squamous Cell Carcinoma (HNSCC) patients, previously subjected to RT, have not yet been reported. The present study addresses for the first time the possibilities of tumor near-infrared (NIR) imaging using Indocynaine Green (ICG) in irradiated areas. METHODS Four patients with histologically confirmed HNSCC were included in this study. All included patients were previously treated with RT with at least 50 Gy. RT-radiation fields from original treatment fully encompassed the second tumor or recurrence. ICG was injected via cephalic vein 45 min before the images were captured using a NIR camera system Artemis. The images were also captured before ICG injection serving as background signal. The fluorescence intensity measurements were carried out using specially designed software. RESULTS ICG fluorescence clearly demonstrated a significant difference in fluorescence intensity between healthy and tumor tissues in 2 of 4 patients. Histology post-resection analysis confirmed a complete tumor resection with safe surgical margins. No difference between tumor and surrounding healthy tissue was detected in patients with an epidermoid carcinoma developed from sclerohypertrophic lichen. CONCLUSIONS In our pilot study, we clearly established the feasibility of using NIR FGS with ICG to delineate tumor and healthy tissues in irradiated areas in infiltrating lichen-free tumors.
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Affiliation(s)
- Sophie Cortese
- Institut de Cancérologie de Lorraine ICL, 6 avenue de Bourgogne, 54519 Vandoeuvre-lès-Nancy, France
| | - Erwan Kerrien
- Inria, Université de Lorraine, Loria, UMR7503, Vandœuvre-lès-Nancy, France
| | - Ilya Yakavets
- Institut de Cancérologie de Lorraine ICL, 6 avenue de Bourgogne, 54519 Vandoeuvre-lès-Nancy, France; CRAN, CNRS, UMR 7039, Université de Lorraine, Vandœuvre-lès-Nancy, France
| | - Rokia Meilender
- Institut de Cancérologie de Lorraine ICL, 6 avenue de Bourgogne, 54519 Vandoeuvre-lès-Nancy, France
| | - Romina Mastronicola
- Institut de Cancérologie de Lorraine ICL, 6 avenue de Bourgogne, 54519 Vandoeuvre-lès-Nancy, France; CRAN, CNRS, UMR 7039, Université de Lorraine, Vandœuvre-lès-Nancy, France
| | - Sophie Renard
- Institut de Cancérologie de Lorraine ICL, 6 avenue de Bourgogne, 54519 Vandoeuvre-lès-Nancy, France
| | - Agnes Leroux
- Institut de Cancérologie de Lorraine ICL, 6 avenue de Bourgogne, 54519 Vandoeuvre-lès-Nancy, France; CRAN, CNRS, UMR 7039, Université de Lorraine, Vandœuvre-lès-Nancy, France
| | - Lina Bezdetnaya
- Institut de Cancérologie de Lorraine ICL, 6 avenue de Bourgogne, 54519 Vandoeuvre-lès-Nancy, France; CRAN, CNRS, UMR 7039, Université de Lorraine, Vandœuvre-lès-Nancy, France
| | - Gilles Dolivet
- Institut de Cancérologie de Lorraine ICL, 6 avenue de Bourgogne, 54519 Vandoeuvre-lès-Nancy, France; CRAN, CNRS, UMR 7039, Université de Lorraine, Vandœuvre-lès-Nancy, France.
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19
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Classe JM, Dolivet G, Evrard S, Ferron G, Lécuru F, Leufflen L, Rivoire M, Sgarbura O. [French Society for Surgical Oncology (SFCO) guidelines for the management of surgical oncology in the pandemic context of COVID 19]. Bull Cancer 2020; 107:524-527. [PMID: 32307107 PMCID: PMC7135219 DOI: 10.1016/j.bulcan.2020.03.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 03/29/2020] [Indexed: 01/08/2023]
Affiliation(s)
- Jean-Marc Classe
- Université de Nantes, institut de cancérologie de l'Ouest, département de chirurgie oncologique, boulevard du Professeur-J.-Monod, 44805 Saint-Herblain, France.
| | - Gilles Dolivet
- Institut de cancérologie de Lorraine, département de chirurgie oncologique, UMR 7039 CRAN CNRS Nancy, Nancy, France
| | - Serge Evrard
- Université de Bordeaux, institut Bergonié, département de chirurgie oncologique, 229, cours de l'Argonne, 33076 Bordeaux, France
| | - Gwenael Ferron
- Institut universitaire du cancer de Toulouse (IUCT)-Oncopole, institut Claudius-Regaud, département de chirurgie oncologique, Inserm CRCT19, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France
| | - Fabrice Lécuru
- Université de Paris, institut Curie, faculté de médecine, service de chirurgie sérologique, gynécologique et plastie, 26, rue d'Ilm, 75005 Paris, France
| | - Lea Leufflen
- Institut de cancérologie de Lorraine, département de chirurgie oncologique, Nancy, France
| | - Michel Rivoire
- Université Claude-Bernard, département de chirurgie carcinologique, centre Léon-Bérard, unité Inserm U1032, 28, rue Laennec, Lyon, France
| | - Olivia Sgarbura
- Université de Montpellier, institut de cancérologie de Montpellier (ICM), département de chirurgie oncologique, Montpellier, France
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Cortese S, Muratori E, Mastronicola R, Roch M, Beulque E, Rauch P, Dekerle L, Deganello A, Dolivet G. Partial pharyngolaryngectomy with infrahyoid flap: Our experience. Am J Otolaryngol 2019; 40:102271. [PMID: 31445929 DOI: 10.1016/j.amjoto.2019.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 07/27/2019] [Accepted: 08/02/2019] [Indexed: 10/26/2022]
Abstract
AIM We evaluated a cohort of advanced hypopharyngeal squamous cell carcinoma, treated with conservative surgery, reconstruction with infrahyoid flap and radio-chemotherapy. METHODS We used partial pharyngo-laryngectomy and radio-chemotherapy to treat fifty-seven patients with stage III-IV hypopharyngeal SCC from November 1994 to December 2011. Clinical examination and speech therapy evaluation were used for estimation of laryngeal function. RESULTS All patients received a partial pharyngo-laryngectomy. All patients underwent neck dissection; 56 patients received bilateral neck dissection. Reconstruction was achieved by infra-hyoid flap. Five-year overall and disease-specific survival rates were 54.4% and 61.4%, respectively. Successful laryngeal function preservation with complete five-year remission was achieved in 44% of the patients. CONCLUSION Selected even if advanced carcinomas of the hypopharynx maybe treated with partial pharyngo-laryngectomy with reconstruction with pedicled flap. Both oncological and functional results showed a good outcome.
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Pflumio C, Thomas J, Salleron J, Faivre JC, Borel C, Dolivet G, Sastre-Garau X, Geoffrois L. Expression of immune response biomarkers in head and neck squamous cell carcinoma (HNSCC) in irradiated area. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz252.042] [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: 11/12/2022] Open
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22
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Egloff-Juras C, Bezdetnaya L, Dolivet G, Lassalle HP. NIR fluorescence-guided tumor surgery: new strategies for the use of indocyanine green. Int J Nanomedicine 2019; 14:7823-7838. [PMID: 31576126 PMCID: PMC6768149 DOI: 10.2147/ijn.s207486] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 07/27/2019] [Indexed: 12/15/2022] Open
Abstract
Surgery is the frontline treatment for a large number of cancers. The objective of these excisional surgeries is the complete removal of the primary tumor with sufficient safety margins. Removal of the entire tumor is essential to improve the chances of a full recovery. To help surgeons achieve this objective, near-infrared fluorescence-guided surgical techniques are of great interest. The concomitant use of fluorescence and indocyanine green (ICG) has proved effective in the identification and characterization of tumors. Moreover, ICG is authorized by the Food and Drug Administration and the European Medicines Agency and is therefore the subject of a large number of studies. ICG is one of the most commonly used fluorophores in near-infrared fluorescence-guided techniques. However, it also has some disadvantages, such as limited photostability, a moderate fluorescence quantum yield, a high plasma protein binding rate, and undesired aggregation in aqueous solution. In addition, ICG does not specifically target tumor cells. One way to exploit the capabilities of ICG while offsetting these drawbacks is to develop high-performance near-infrared nanocomplexes formulated with ICG (with high selectivity for tumors, high tumor-to-background ratios, and minimal toxicity). In this review article, we focus on recent developments in ICG complexation strategies to improve near-infrared fluorescence-guided tumor surgery. We describe targeted and nontargeted ICG nanoparticle models and ICG complexation with targeting agents.
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Affiliation(s)
- Claire Egloff-Juras
- Université de Lorraine, CNRS, CRAN, Nancy F-54000, France.,Université de Lorraine, CHRU-Nancy, Institut de Cancérologie de Lorraine, Nancy F-54000, France
| | - Lina Bezdetnaya
- Université de Lorraine, CNRS, CRAN, Nancy F-54000, France.,Institut de Cancérologie de Lorraine, Nancy F-54000, France
| | - Gilles Dolivet
- Université de Lorraine, CNRS, CRAN, Nancy F-54000, France.,Institut de Cancérologie de Lorraine, Nancy F-54000, France
| | - Henri-Pierre Lassalle
- Université de Lorraine, CNRS, CRAN, Nancy F-54000, France.,Institut de Cancérologie de Lorraine, Nancy F-54000, France
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23
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Harlé A, Guillet J, Thomas J, Demange J, Dolivet G, Peiffert D, Leroux A, Sastre-Garau X. HPV insertional pattern as a personalized tumor marker for the optimized tumor diagnosis and follow-up of patients with HPV-associated carcinomas: a case report. BMC Cancer 2019; 19:277. [PMID: 30922253 PMCID: PMC6437879 DOI: 10.1186/s12885-019-5447-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 03/07/2019] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND In clinical oncology, only a few applications have been developed using HPV as a personalized tumor marker, a lack most probably related to the limited information obtained by the classical Polymerase Chain Reaction (PCR) approach. To overcome this limitation, we have recently developed the capture-based Next-Generation Sequencing (NGS) "CaptHPV" assay, designed to provide an extensive and comprehensive molecular characterization of HPV DNA sequences associated with neoplasias, ie the sequence of the viral genome (245 genotypes), its physical state, viral load, integration site and genomic alterations at integration locus. These data correspond to highly specific tumor markers that can be used to improve diagnosis and patient's follow-up. CASE PRESENTATION We report here a case that is a straightforward and practical illustration of the power of the CaptHPV method. A patient developed successively a carcinoma of the anal canal and of the tongue. The two tumors were squamous cell carcinoma, found associated with HPV16 using PCR. In order to document a possible metastasis to the tongue from the anal cancer, we performed CaptHPV analysis on the two tumors. The analysis of the anal carcinoma found 55 viral/human hybrid reads allowing the identification of the HPV16 DNA integration in the 4q25 chromosomal band locus with a 178,808 bp deletion in the cell genome. Molecular analysis of the tongue tumor disclosed 6110 reads of HPV16, with a viral pattern strictly identical to that of the anal tumor. A total of 131 hybrid reads between HPV16 and the cell genome were found, corresponding exactly to the same locus of integration of viral DNA at the 4q25 site. The 178,808 bp genomic deletion was also found in the lingual tumor. The exact identity of HPV insertional signatures in the two tumors, demonstrates unambiguously that the tongue tumor derived from the anal cancer whereas neither histological immunophenotyping nor classical viral analysis using PCR could allow a definitive diagnosis. CONCLUSION Our observation indicates that the establishment of a detailed cartography of HPV DNA sequences in a tumor specimen provides crucial information for the design of specific biomarkers that can be used for diagnostic, prognostic or predictive purposes.
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Affiliation(s)
- Alexandre Harlé
- Université de Lorraine, Nancy, France
- CNRS, UMR, 7039 CRAN, Nancy, France
- Service de Biopathologie, Institut de Cancérologie de Lorraine, Vandoeuvre-lès-Nancy, France
| | - Julie Guillet
- Université de Lorraine, Nancy, France
- CNRS, UMR, 7039 CRAN, Nancy, France
- Département de chirurgie oncologique, Institut de Cancérologie de Lorraine, Vandoeuvre-lès-Nancy, France
| | - Jacques Thomas
- Service de Biopathologie, Institut de Cancérologie de Lorraine, Vandoeuvre-lès-Nancy, France
| | - Jessica Demange
- Service de Biopathologie, Institut de Cancérologie de Lorraine, Vandoeuvre-lès-Nancy, France
| | - Gilles Dolivet
- CNRS, UMR, 7039 CRAN, Nancy, France
- Département de chirurgie oncologique, Institut de Cancérologie de Lorraine, Vandoeuvre-lès-Nancy, France
| | - Didier Peiffert
- Université de Lorraine, Nancy, France
- Département de radiothérapie, Institut de Cancérologie de Lorraine, Vandoeuvre-lès-Nancy, France
| | - Agnès Leroux
- Service de Biopathologie, Institut de Cancérologie de Lorraine, Vandoeuvre-lès-Nancy, France
| | - Xavier Sastre-Garau
- Service de Biopathologie, Institut de Cancérologie de Lorraine, Vandoeuvre-lès-Nancy, France
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Egloff-Juras C, Salleron J, Phulpin B, Dolivet G. Oral surgery: Perio disease and flap reconstruction failure. Br Dent J 2018; 225:4. [PMID: 30002552 DOI: 10.1038/sj.bdj.2018.556] [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: 11/09/2022]
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25
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Mahieu R, Colletti G, Bonomo P, Parrinello G, Iavarone A, Dolivet G, Livi L, Deganello A. Head and neck reconstruction with pedicled flaps in the free flap era. Acta Otorhinolaryngol Ital 2018; 36:459-468. [PMID: 28177328 PMCID: PMC5317124 DOI: 10.14639/0392-100x-1153] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 06/19/2016] [Indexed: 01/30/2023]
Abstract
Nowadays, the transposition of microvascular free flaps is the most popular method for management of head and neck defects. However, not all patients are suitable candidates for free flap reconstruction. In addition, not every defect requires a free flap transfer to achieve good functional results. The aim of this study was to assess whether pedicled flap reconstruction of head and neck defects is inferior to microvascular free flap reconstruction in terms of complications, functionality and prognosis. The records of consecutive patients who underwent free flap or pedicled flap reconstruction after head and neck cancer ablation from 2006 to 2015, from a single surgeon, in the AOUC Hospital, Florence Italy were analysed. A total of 93 patients, the majority with oral cancer (n = 59), were included, of which 64 were pedicled flap reconstructions (69%). The results showed no significant differences in terms of functional outcome, flap necrosis and complications in each type of reconstruction. Multivariate regression analysis of flap necrosis and functional impairments showed no associated factors. Multivariate regression analysis of complicated flap healing showed that only comorbidities remained an explaining factor (p = 0.019). Survival analysis and proportional hazard regression analysis regarding cancer relapse or distant metastasis, showed no significant differences in prognosis of patients concerning both types of reconstruction. In this retrospective, non-randomised study cohort, pedicled flaps were not significantly inferior to free flaps for reconstruction of head and neck defects, considering functionality, complications and prognosis.
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Affiliation(s)
- R Mahieu
- Department of Surgery and Translational Medicine, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Italy.,University of Groningen, University Medical Center Groningen, the Netherlands
| | - G Colletti
- Department of Maxillo-facial Surgery, University of Milan, Milan, Italy
| | - P Bonomo
- Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Italy
| | - G Parrinello
- Department of Surgery and Translational Medicine, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Italy
| | - A Iavarone
- Department of Surgery and Translational Medicine, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Italy
| | - G Dolivet
- Department of Oncologic Surgery l'institut de Cancérologie de Lorraine, Nancy, France
| | - L Livi
- Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Italy
| | - A Deganello
- Department of Surgery and Translational Medicine, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Italy
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Egloff-Juras C, Gallois A, Salleron J, Massard V, Dolivet G, Guillet J, Phulpin B. Denosumab-related osteonecrosis of the jaw: A retrospective study. J Oral Pathol Med 2017; 47:66-70. [DOI: 10.1111/jop.12646] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2017] [Indexed: 01/15/2023]
Affiliation(s)
- Claire Egloff-Juras
- Department of Head and Neck and Dental Surgery; Institut de Cancérologie de Lorraine; Vandoeuvre-lès-Nancy France
- Dental Faculty of Nancy; Université de Lorraine; Nancy France
| | - Aurélie Gallois
- Department of Head and Neck and Dental Surgery; Institut de Cancérologie de Lorraine; Vandoeuvre-lès-Nancy France
- Dental Faculty of Nancy; Université de Lorraine; Nancy France
| | - Julia Salleron
- Cellule Data-biostatistiques; Institut de Cancérologie de Lorraine; Vandoeuvre-lès-Nancy France
| | - Vincent Massard
- Department of Oncology; Institut de Cancérologie de Lorraine; Vandoeuvre-lès-Nancy France
| | - Gilles Dolivet
- Department of Head and Neck and Dental Surgery; Institut de Cancérologie de Lorraine; Vandoeuvre-lès-Nancy France
| | - Julie Guillet
- Department of Head and Neck and Dental Surgery; Institut de Cancérologie de Lorraine; Vandoeuvre-lès-Nancy France
- Dental Faculty of Nancy; Université de Lorraine; Nancy France
| | - Bérengère Phulpin
- Department of Head and Neck and Dental Surgery; Institut de Cancérologie de Lorraine; Vandoeuvre-lès-Nancy France
- Dental Faculty of Nancy; Université de Lorraine; Nancy France
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Lallemant B, Moriniere S, Ceruse P, Lebalch M, Aubry K, Hans S, Dolivet G, Malard O, Bonduelle Q, Vergez S. Transoral robotic surgery for squamous cell carcinomas of the posterior pharyngeal wall. Eur Arch Otorhinolaryngol 2017; 274:4211-4216. [PMID: 29032418 DOI: 10.1007/s00405-017-4771-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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: 04/14/2017] [Accepted: 10/06/2017] [Indexed: 11/30/2022]
Abstract
Posterior pharyngeal wall squamous cell carcinomas (SCCs) are rare and have an associated poor prognosis. Progress in transoral resection techniques, in particular, transoral robotic surgery (TORS), have renewed the role of surgery in their treatment. This article presents the oncological and functional results obtained by the French Group of Head and Neck Robotic Surgery for TORS for posterior pharyngeal wall SCC-curative surgery. This retrospective, multicentre study presents data collected between September 2009 and November 2013 for patients treated with TORS for posterior pharyngeal wall SCCs. Analysis of patient characteristics, tumour and treatment details were completed. Kaplan-Meier analysis was used to calculate overall survival rates and recurrence-free survival rates. Student's t test and Chi2 test were also calculated. 23 patients were included (mean age of 62 years). 12 patients had a prior HNSCC. Ten patients had pT1 cancers. The overall two-year survival rate was 59%, but 89% for pT1 compared to 28% for pT2-T3 (p = 0.01). It was noted that TORS was simple to perform, but generated significant post-operative dysphagia. Two cases of spondylodiscitis were reported as specific post-operative complications of TORS. In conclusion, TORS is a treatment solution for selected posterior pharyngeal wall SCCs. It provides a possible alternative to medical treatment for early pT1 lesions and is often the only remaining curative solution in patients previously treated with radiotherapy. In cases of bulky resection, or when there is a past medical history of radiotherapy, a tissue reconstruction by forearm free-flap may be indicated.
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Affiliation(s)
- B Lallemant
- Department of Head and Neck Surgery, University Hospital of Nîmes, Place du Pr R. Debré, 30029, Nîmes, France.
| | - S Moriniere
- Department of Head and Neck Surgery, University Hospital Bretonneau, Tours, France
| | - P Ceruse
- Department of Head and Neck Surgery, Hospices Civils de Lyon, University Hospital Lyon-Nord, Lyon, France
| | - M Lebalch
- Department of Head and Neck Surgery, University Hospital of Nîmes, Place du Pr R. Debré, 30029, Nîmes, France
| | - K Aubry
- Department of Head and Neck Surgery, University Hospital Dupuytren, Limoges, France
| | - S Hans
- Department of Head and Neck Surgery, AP-HP, Georges Pompidou Hospital, Paris, France
| | - G Dolivet
- Department of Head and Neck Surgery, Centre Alexis Vautrin, Nancy, France
| | - O Malard
- Department of Head and Neck Surgery, Nantes University Hospital, Nantes, France
| | - Q Bonduelle
- Department of Head and Neck Surgery, University Hospital of Nîmes, Place du Pr R. Debré, 30029, Nîmes, France
| | - S Vergez
- Department of Head and Neck Surgery, University Hospital Larrey, Toulouse, France
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Le Tourneau C, Delord JP, Dolivet G, Malard O, Fayette J, Capitain O, Even C, Hoffmann C, Vergez S, Geoffrois L, Rolland F, Zrounba P, Laccourreye L, Guigay J, Bieche I, Klijanienko J, Aide N, Benavent V, Gal J, Temam S. PREDICTOR (UNICANCER GEP11): Randomized phase II study of preoperative afatinib in untreated head and neck squamous cell carcinoma (HNSCC) patients. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.6021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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
6021 Background: Afatinib, a pan-HER irreversible tyrosine kinase inhibitor, demonstrated limited antitumor activity compared to methotrexate in unselected recurrent and/or metastatic HNSCC patients (LUX-HN1, Machiels et al, Lancet Oncol 2015). The UNICANCER (GEP 11) PREDICTOR study’s objective was to identify predictive and pharmacodynamic biomarkers of biological activity and efficacy of afatinib (EUDRACT N° 2010-024046-29). Methods: This open-label, randomized, multicentric, controlled, phase II study included untreated patients with operable T2-4N0-2M0 HNSCC of the oral cavity, pharynx and larynx, with a PS < 2, adequate organ function and LVEF > 50%. Patients were randomized (2:1) to: oral afatinib (A) 40mg/day (d) for 14-28d or no treatment (NT). Patients had pre-treatment tumor biopsies, tumor imaging, and PET CT scan, with a 2nd tumor imaging before surgery and a PET scan at D15. Adverse events were classified by NCI CTCAE criteria. Based on the biological primary endpoint of tumor reduction the sample size was designed to identify biomarkers associated with a 20% difference between the study arms. Results: 61 patients were included (A: 41/NT: 20). 2 patients in the NT arm were not analyzed (consent withdrawal, no surgery). 7 patients in arm A received < 14d of treatment, including 6 patients with unacceptable toxicity. Afatinib-related toxicities were: grade (G)1 37%, G2 41%, G3 7%, G4 5%, and G5 0%. G≥3 toxicities were mainly gastrointestinal. Partial responses (RECIST1.1) were observed in 3 patients (7.3%) in arm A versus none in the NT arm (p = 0.018). Progressive disease was not observed in arm A versus 3 (16.6%) in the NT arm. Partial responses on PET CT scan by PERCIST were observed in 15/31 evaluable patients (48%) in arm A versus 1/15 (6.7%) in the NT arm (p = 0.005). Conclusions: Afatinib given to HNSCC patients in the preoperative setting is safe and is associated with improved response according to RECIST1.1 and PERCIST compared to no treatment. Clinical trial information: NCT01415674.
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Affiliation(s)
| | | | - Gilles Dolivet
- Institut de Cancérologie de Lorraine, Vandoeuvre-Les-Nancy, France
| | | | | | | | | | | | - Sebastien Vergez
- Department of Head and Neck Surgery, Institut Claudius Regaud, Toulouse, France
| | | | - Frederic Rolland
- Department of Medical Oncology, Institut de Cancérologie de l'Ouest, Nantes, France
| | - Philippe Zrounba
- Department of Head and Neck Surgery, Centre Léon Bérard, Lyon, France
| | | | - Joel Guigay
- Department of Medical Oncology, Antoine Lacassagne Comprehensive Cancer Centre, FHU Oncoage, Nice, France
| | | | | | - Nicolas Aide
- Department of Nuclear Medicine, Centre François Baclesse, Caen, France
| | | | | | - Stephane Temam
- Department of Head and Neck Surgery, Gustave Roussy, Villejuif, France
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Garrel R, Poissonnet G, Temam S, Dolivet G, Fakhry N, de Raucourt D. Review of sentinel node procedure in cN0 head and neck squamous cell carcinomas. Guidelines from the French evaluation cooperative subgroup of GETTEC. Eur Ann Otorhinolaryngol Head Neck Dis 2017; 134:89-93. [DOI: 10.1016/j.anorl.2016.10.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Wu X, Mastronicola R, Tu Q, Faure GC, De Carvalho Bittencourt M, Dolivet G. A rare case of extremely high counts of circulating tumor cells detected in a patient with an oral squamous cell carcinoma. BMC Cancer 2016; 16:552. [PMID: 27465596 PMCID: PMC4964083 DOI: 10.1186/s12885-016-2591-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 07/20/2016] [Indexed: 01/04/2023] Open
Abstract
Background Despite aggressive regimens, the clinical outcome of head and neck squamous cell carcinoma remains poor. The detection of circulating tumor cells could potentially improve the management of patients with disseminated cancer, including diagnosis, treatment strategies, and surveillance. Currently, CellSearch® is the most widely used and the only Food and Drug Administration-cleared system for circulating tumor cells detection in patients with metastatic breast, colorectal, or prostate cancer. In most cases of head and neck squamous cell carcinoma, only low counts of circulating tumor cells have been reported. Case presentation A 56-year-old white male with no particular medical history, was diagnosed with a squamous cell carcinoma of oral cavity. According to the imaging results (computed tomography and 18F-fluorodeoxyglucose positron emission tomography / computed tomography) and panendoscopy, the TNM staging was classified as T4N2M0. A non-interruptive pelvimandibulectomy was conducted according to the multidisciplinary meeting advices and the postoperative observations were normal. The patient complained of a painful cervical edema and a trismus 6 weeks after the surgery. A relapse was found by computed tomography and the patient died two weeks later. The search for circulating tumor cells in peripheral venous blood by using the CellSearch® system revealed a very high count compared with published reports at three time points (pre-operative: 400; intra-operative: 150 and post-operative day 7: 1400 circulating tumor cells). Of note, all detected circulating tumor cells were epidermal growth factor receptor negative. Conclusion We report here for the first time a rare case of oral squamous cell carcinoma with extremely high circulating tumor cells counts using the CellSearch® system. The absolute number of circulating tumor cells might predict a particular phase of cancer development as well as a poor survival, potentially contributing to a personalized healthcare.
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Affiliation(s)
- Xianglei Wu
- Laboratory of Immunology, Nancytomique platform, CHRU of Nancy, rue du Morvan, 54500, Vandoeuvre-lès-Nancy, France.,SBS Department, CRAN, UMR 7039 CNRS, University of Lorraine, Avenue de la Forêt de Haye, 54500, Vandoeuvre-lès-Nancy, France.,Department of Otorhinolaryngology - Head and Neck surgery, Zhongnan Hospital of Wuhan University, No. 169 Donghu Road, 430071, Wuhan, China
| | - Romina Mastronicola
- SBS Department, CRAN, UMR 7039 CNRS, University of Lorraine, Avenue de la Forêt de Haye, 54500, Vandoeuvre-lès-Nancy, France.,Head and Neck Surgery and Dental Units, Oncologic Surgery Department, Institut de Cancérologie de Lorraine, 6 Avenue de Bourgogne, 54500, Vandœuvre-lès-Nancy, France
| | - Qian Tu
- Laboratory of Immunology, Nancytomique platform, CHRU of Nancy, rue du Morvan, 54500, Vandoeuvre-lès-Nancy, France.,SBS Department, CRAN, UMR 7039 CNRS, University of Lorraine, Avenue de la Forêt de Haye, 54500, Vandoeuvre-lès-Nancy, France
| | - Gilbert Charles Faure
- Laboratory of Immunology, Nancytomique platform, CHRU of Nancy, rue du Morvan, 54500, Vandoeuvre-lès-Nancy, France.,SBS Department, CRAN, UMR 7039 CNRS, University of Lorraine, Avenue de la Forêt de Haye, 54500, Vandoeuvre-lès-Nancy, France
| | - Marcelo De Carvalho Bittencourt
- Laboratory of Immunology, Nancytomique platform, CHRU of Nancy, rue du Morvan, 54500, Vandoeuvre-lès-Nancy, France. .,SBS Department, CRAN, UMR 7039 CNRS, University of Lorraine, Avenue de la Forêt de Haye, 54500, Vandoeuvre-lès-Nancy, France.
| | - Gilles Dolivet
- SBS Department, CRAN, UMR 7039 CNRS, University of Lorraine, Avenue de la Forêt de Haye, 54500, Vandoeuvre-lès-Nancy, France.,Head and Neck Surgery and Dental Units, Oncologic Surgery Department, Institut de Cancérologie de Lorraine, 6 Avenue de Bourgogne, 54500, Vandœuvre-lès-Nancy, France
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Sorin T, Fyad J, Delay E, Rouanet P, Rimareix F, Houpeau J, Classe J, Garrido I, Tunon De Lara C, Dauplat J, Bendavid C, Houvenaeghel G, Clough K, Sarfati I, Leymarie N, Trudel M, Salleron J, Guillemin F, Oldrini G, Brix M, Dolivet G, Simon E, Verhaeghe J, Marchal F. Occult cancer in specimens of reduction mammaplasty aimed at symmetrization. A multicentric study of 2718 patients. Breast 2015; 24:272-7. [DOI: 10.1016/j.breast.2015.02.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Revised: 02/09/2015] [Accepted: 02/22/2015] [Indexed: 01/01/2023] Open
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Mastronicola R, Berteau C, Tu Q, Cortese S, Guillet J, Phulpin B, Gangloff P, Bezdetnaya L, Merlin JL, Faure G, Dolivet G. Detection of disseminated tumor cells in aspirative drains after neck dissection. Eur Arch Otorhinolaryngol 2015; 273:465-9. [DOI: 10.1007/s00405-015-3522-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 01/20/2015] [Indexed: 12/17/2022]
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Marchal S, Dolivet G, Lassalle HP, Guillemin F, Bezdetnaya L. Targeted photodynamic therapy in head and neck squamous cell carcinoma: heading into the future. Lasers Med Sci 2015; 30:2381-7. [PMID: 25563461 DOI: 10.1007/s10103-014-1703-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 12/18/2014] [Indexed: 12/16/2022]
Abstract
The aim of this article is to give an insight into the future of photodynamic therapy (PDT) in head and neck squamous cell carcinoma (HNSCC). Through the combination of a photosensitizing agent with light and oxygen, PDT produces highly cytotoxic reactive oxygen species leading to selective tumor eradication. PDT is an attractive treatment for focal therapy of localized tumors, especially in the case of unresectable tumors. In HNSCC, over 1500 patients have been treated by PDT, and the majority of them responded quite favorably to this treatment. However, the non-negligible photosensitization of healthy tissue is a major limitation for the clinical application of PDT. Improvement in tumor selectivity is the main challenge that can be taken up by the use of a new generation of photosensitizing nanoparticles. Passive targeting, by using functionalised nanocarriers to target to overexpressed transmembrane receptors afford attractive solutions. To this day, epidermal growth factor receptor (EGFR) remains the only validated molecular target for HNSCC, and photosensitizer immunoconjugates to EGFR have been developed for the intracellular delivery of photosensitizing agents. Depending on coordinated research between biomarkers, specific ligands, and photosensitizers, similar approaches could be rapidly developed. In addition, some photosensitizers hold high fluorescence yield and therefore could emerge as theranostic agents.
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Affiliation(s)
- Sophie Marchal
- Centre de Recherche en Automatique de Nancy (CRAN), UMR 7039, Campus Sciences, Université de Lorraine, 54506, Vandoeuvre-lès-Nancy Cedex, France. .,CNRS, Centre de Recherche en Automatique de Nancy (CRAN), UMR 7039, Campus Sciences, 54506, Vandoeuvre-lès-Nancy Cedex, France. .,Research Unit, Institut de Cancérologie de Lorraine, Avenue de Bourgogne, 54519, Vandoeuvre-lès-Nancy Cedex, France.
| | - Gilles Dolivet
- Centre de Recherche en Automatique de Nancy (CRAN), UMR 7039, Campus Sciences, Université de Lorraine, 54506, Vandoeuvre-lès-Nancy Cedex, France.,CNRS, Centre de Recherche en Automatique de Nancy (CRAN), UMR 7039, Campus Sciences, 54506, Vandoeuvre-lès-Nancy Cedex, France.,Surgery Department, Institut de Cancérologie de Lorraine, Avenue de Bourgogne, 54519, Vandoeuvre-lès-Nancy Cedex, France
| | - Henri-Pierre Lassalle
- Centre de Recherche en Automatique de Nancy (CRAN), UMR 7039, Campus Sciences, Université de Lorraine, 54506, Vandoeuvre-lès-Nancy Cedex, France.,CNRS, Centre de Recherche en Automatique de Nancy (CRAN), UMR 7039, Campus Sciences, 54506, Vandoeuvre-lès-Nancy Cedex, France.,Research Unit, Institut de Cancérologie de Lorraine, Avenue de Bourgogne, 54519, Vandoeuvre-lès-Nancy Cedex, France
| | - François Guillemin
- Centre de Recherche en Automatique de Nancy (CRAN), UMR 7039, Campus Sciences, Université de Lorraine, 54506, Vandoeuvre-lès-Nancy Cedex, France.,CNRS, Centre de Recherche en Automatique de Nancy (CRAN), UMR 7039, Campus Sciences, 54506, Vandoeuvre-lès-Nancy Cedex, France.,Surgery Department, Institut de Cancérologie de Lorraine, Avenue de Bourgogne, 54519, Vandoeuvre-lès-Nancy Cedex, France
| | - Lina Bezdetnaya
- Centre de Recherche en Automatique de Nancy (CRAN), UMR 7039, Campus Sciences, Université de Lorraine, 54506, Vandoeuvre-lès-Nancy Cedex, France.,CNRS, Centre de Recherche en Automatique de Nancy (CRAN), UMR 7039, Campus Sciences, 54506, Vandoeuvre-lès-Nancy Cedex, France.,Research Unit, Institut de Cancérologie de Lorraine, Avenue de Bourgogne, 54519, Vandoeuvre-lès-Nancy Cedex, France
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Cortese S, Phulpin B, Mastronicola R, Gangloff P, Guillet J, Roch M, Julien L, Verhaeghe JL, Dolivet G. Value of the preservation of an osseous mandibular rim with a fibula free flap reconstruction. Rev Laryngol Otol Rhinol (Bord) 2015; 136:61-66. [PMID: 27483577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Reconstruction of the mandible with microvascularized fibula transplants is actually a well-established procedure, yet the major component is the limited diameter of the diaphysis that can induce oral rehabilitation's failure, especially in dentate patients. In this paper, we report our surgical procedure allowing preservation of the mandibular height. The primary objective was to assess aesthetic and functional improvements of preservation of an osseous mandibular rim with a fibula free flap reconstruction. PATIENTS AND METHODS Five patients (all males, mean age of 60 years) were treated with this method. Aetiologies were tumour in 3 cases, and osteoradionecrosis in the two others cases. We described all step of our surgical procedure and the functional, aesthetic and carcinologic results were evaluated. The follow up varies from 6 to 30 months. RESULTS One patient died at 12 days from unrelated affection. For the other patients, both the aesthetics and functional outcomes were better than in case of mandibular interruption surgery. In fact, the mandibular contour of the mandibule was preserved and the height of mandible was restored. One patient is in progress of dental rehabilitation with osseous implants. Carcinologically, no local recurrence was observed. CONCLUSION This technique is reliable and enables to optimize oral rehabilitation with endosteal implants. Nevertheless, we consider that the 3D scanner is essential before the intervention to evaluate the osseous reach. Moreover, if necessarily the procedure can be modified intraoperatively.
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Durbec M, Couloigner V, Tronche S, Albert S, Kanitakis J, Ltaief Boudrigua A, Malard O, Maubec E, Mourrain Langlois E, Navailles B, Peuvrel L, Phulpin B, Thimonier JC, Disant F, Dolivet G. Guidelines of the French Society of Otorhinolaryngology (SFORL), short version. Extension assessment and principles of resection in cutaneous head and neck tumors. Eur Ann Otorhinolaryngol Head Neck Dis 2014; 131:375-383. [DOI: 10.1016/j.anorl.2014.06.002] [Citation(s) in RCA: 14] [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: 06/14/2014] [Accepted: 06/17/2014] [Indexed: 12/31/2022]
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Le Tourneau C, Delord JP, Dolivet G, Capitain O, Laccourreye L, Fayette J, De Raucourt D, Peyrade F, Malard O, Rolland F, Orsini C, Mariani O, Klijanienko J, de Koning L, Bieche I, Sastre X, Aide N, Paoletti X, Temam S. Predictor: Randomized phase II study of preoperative afatinib in untreated nonmetastatic head and neck squamous cell carcinoma patients (HNSCC) aiming at identifying predictive and pharmacodynamic biomarkers of efficacy. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.tps6105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Gilles Dolivet
- Institut de Cancérologie de Lorraine, Vandoeuvre les Nancy, France
| | | | | | | | | | | | | | | | | | | | | | | | - Ivan Bieche
- Institut Curie - Hôpital René Huguenin, Saint-Cloud, France
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Sorin T, Fyad JP, Pujo J, Colson T, Bordes V, Leroux A, Marchal F, Brix M, Simon E, Verhaeghe JL, Classe JM, Dolivet G. Incidence of occult contralateral carcinomas of the breast following mastoplasty aimed at symmetrization. ANN CHIR PLAST ESTH 2014; 59:e21-8. [PMID: 24530086 DOI: 10.1016/j.anplas.2013.12.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [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: 09/19/2013] [Accepted: 12/22/2013] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Breast carcinomas are the most frequent form of cancer in French women. Following a total mastectomy, only an estimated 25% of patients wish to undergo breast reconstruction. After mammary volume reconstitution, the plastic surgeon often attempts to harmonize the two breasts by carrying out contralateral reduction mammaplasty (CRM). In the literature, the incidence of occult contralateral carcinomas incidentally discovered in surgical specimens ranges from 1.12 to 4.5%. The main objective of this study was to evaluate occurrence of carcinoma in the CRM specimens in the framework of a breast reconstruction operation. The secondary objective was to determine the consequences of the incidentally discovered carcinoma in the contralateral breast. MATERIAL AND METHODS This was a 6-year, bicentric, retrospective study involving women having undergone breast cancer surgery who later underwent contralateral reduction mammaplasty (CRM), that is to say reconstruction aimed at harmonization of the two breasts. RESULTS Three hundred and nineteen patients were included in the study. Mean age during the CRM was 55years (29-79). Mean weight of the surgical specimens was 323grams (12-2500). Incidence of occult carcinomas found in the specimens was 0.94% (3 patients). The mean age for these 3 cases was 58years (47-64). All 3 patients had superior pedicle mammaplasty. One of the patients benefited from monobloc resection with orientation of the surgical specimen. In the other 2 cases, there existed 3 surgical resection specimens; in one case, they were oriented; in the other, they were not. In all 3 cases, the histological findings were unifocal ductal carcinomas in situ (DCIS). Mean tumor size was 5.7mm (3-9). Only the patient having had monobloc resection with orientation of the specimen underwent salvage surgery, which consisted in partial mastectomy, otherwise known as secondary lumpectomy. Adjuvant radiotherapy was administered to all of the patients. After 17months of mean follow-up (12-22), no recurrence was found in any of the three cases. CONCLUSION Incidence of occult contralateral breast carcinomas after symmetrization CRM approximates 1%. Our observations are in agreement with the data in the literature. Incidence is greater than in mammaplasty carried out for esthetic or functional reasons; this is probably due to the higher age and the previous breast cancer history of the breast reconstruction population. Monobloc resection and orientation of the surgical specimens with surgeon's knots facilitate precise pinpointing of the occult carcinoma. A secondary lumpectomy may take place when margins of excision are invaded or inadequate.
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Affiliation(s)
- T Sorin
- Institut de cancérologie de Lorraine-Alexis-Vautrin, 6, avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy, France; Service de chirurgie plastique et maxillo-faciale, hôpital Central, CHU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54000 Nancy, France.
| | - J-P Fyad
- Institut de cancérologie de Lorraine-Alexis-Vautrin, 6, avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy, France
| | - J Pujo
- Institut de cancérologie de Lorraine-Alexis-Vautrin, 6, avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy, France; Service de chirurgie plastique et maxillo-faciale, hôpital Central, CHU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54000 Nancy, France
| | - T Colson
- Service de chirurgie plastique et maxillo-faciale, hôpital Central, CHU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54000 Nancy, France
| | - V Bordes
- Institut de cancérologie de l'Ouest-René-Gauducheau, boulevard Jacques-Monod, 44805 Saint-Herblain, France
| | - A Leroux
- Institut de cancérologie de Lorraine-Alexis-Vautrin, 6, avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy, France
| | - F Marchal
- Institut de cancérologie de Lorraine-Alexis-Vautrin, 6, avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy, France
| | - M Brix
- Institut de cancérologie de Lorraine-Alexis-Vautrin, 6, avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy, France; Service de chirurgie plastique et maxillo-faciale, hôpital Central, CHU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54000 Nancy, France
| | - E Simon
- Service de chirurgie plastique et maxillo-faciale, hôpital Central, CHU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54000 Nancy, France
| | - J-L Verhaeghe
- Institut de cancérologie de Lorraine-Alexis-Vautrin, 6, avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy, France
| | - J-M Classe
- Institut de cancérologie de l'Ouest-René-Gauducheau, boulevard Jacques-Monod, 44805 Saint-Herblain, France
| | - G Dolivet
- Institut de cancérologie de Lorraine-Alexis-Vautrin, 6, avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy, France
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Perrenot C, Berengère P, Mastronicola R, Gangloff P, Dolivet G. Infrahyoid Myocutaneous Flap for Reconstruction after Robotic Transoral Surgery for Oropharyngeal Tumors. Plast Reconstr Surg 2014; 133:236e-237e. [DOI: 10.1097/01.prs.0000437236.07930.fd] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [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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Perrot C, Cortese S, Eluecque H, Mastronicola R, Sergeant C, Marchal F, Demet S, Dolivet G. Laryngeal chondrosarcoma: Repeated laser and radiofrequency ablation in the palliative setting. Eur Ann Otorhinolaryngol Head Neck Dis 2013; 130:91-3. [DOI: 10.1016/j.anorl.2012.02.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Accepted: 02/20/2012] [Indexed: 11/27/2022]
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Abstract
The authors describe a pooled analysis of 23 French patients presenting with oral metastasis between 1981 and 2008. The reviewed cases were collected from the medical records of two cancer institutes. The inclusion criteria were: the histology of the metastases must be known; the primary location must be known; metastasis and primary location must be physically separated; and oral primary locations were excluded. This sample represent 0.48% of all oral malignancies treated during the period. The sex-ratio was 2.3:1 in favour of men, the mean age was 64.5 years (±13.2). Lungs and kidneys represent 52.2% of the primary cancer locations. In most cases, the primary cancer was a carcinoma or an adenocarcinoma (82.6%). The most affected oral regions were the gingiva and alveolar mucosa (60.7%), followed by the tongue (17.9%). The mean survival was 16.6 months. This sample is characterized by the relative absence of specific symptoms and quite different distribution in primary sites. Even if oral metastases are rare, their semiological value necessitates the histopathological examination of any oral tumour, and a systematic search in all patients with cancer history.
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Affiliation(s)
- F Maschino
- Department of Oral Pathology, Oral Medicine and Oral Surgery, Odontology Faculty, Nancy, France.
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Gurney BAS, Schilling C, Putcha V, Alkureishi LW, Alvarez AJ, Bakholdt V, Barbier Herrero L, Barzan L, Bilde A, Bloemena E, Salces CC, Dalla Palma P, de Bree R, Dequanter D, Dolivet G, Donner D, Flach GB, Fresno M, Grandi C, Haerle S, Huber GF, Hunter K, Lawson G, Leroux A, Lothaire PH, Mamelle G, Silini EM, Mastronicola R, Odell EW, O'Doherty MJ, Poli T, Rahimi S, Ross GL, Zuazua JS, Santini S, Sebbesen L, Shoaib T, Sloan P, Sorensen JA, Soutar DS, Therkildsen MH, Vigili MG, Villarreal PM, von Buchwald C, Werner JA, Wiegand S, McGurk M. Implications of a positive sentinel node in oral squamous cell carcinoma. Head Neck 2012; 34:1580-5. [PMID: 22290737 DOI: 10.1002/hed.21973] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2009] [Revised: 08/29/2011] [Accepted: 09/07/2011] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The role of sentinel node biopsy in head and neck cancer is currently being explored. Patients with positive sentinel nodes were investigated to establish if additional metastases were present in the neck, their distribution, and their impact on outcome. METHODS In all, 109 patients (n = 109) from 15 European centers, with cT1/2,N0 tumors, and a positive sentinel lymph node were identified. Kaplan-Meier and univariate and multivariate logistic regression analysis were used to identify variables that predicted for additional positive nodes and their position within the neck. RESULTS A total of 122 neck dissections were performed in 109 patients. Additional positive nodes were found in 34.4% of cases (42/122: 18 same, 21 adjacent, and 3 nonadjacent neck level). Additional nodes, especially if outside the sentinel node basin, had an impact on outcome. CONCLUSIONS The results are preliminary but suggest that both the number and the position of positive sentinel nodes may identify different prognostic groups that may allow further tailoring of management plans.
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Affiliation(s)
- Benjamin A S Gurney
- Department of Oral and Maxillofacial Surgery, Department of Oncology, Guy's King's and St Thomas's Hospital, London, United Kingdom
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Phulpin B, Marchettic N, Mansuyd L, Coffinet L, Lucas C, Dolivet G, Chastagner P, Prevost J. Development of an osteosarcoma following dental extraction after allogeneic stem cell transplantation. Rev Laryngol Otol Rhinol (Bord) 2012; 133:237-240. [PMID: 24006835] [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: 06/02/2023]
Abstract
OBJECTIVES Radio-induced sarcoma is known to occur several years following bone irradiation especially when this treatment is combined to high dose chemotherapy regimens prior to allogeneic haematopoietic stem cell transplantation (HSCT) in very young children. However, little is known about the stimulus of aggressive bony surgery in the development of these tumours. MATERIAL AND METHODS We report the case of a young girl in whom dental extraction was rapidly followed by the occurrence of a localized tumour 11 years after allogeneic haematopoietic stem cell transplantation using total body irradiation (TBI) for a haemophagocytic lymphophistiocytosis (HLH). RESULTS This tumour involved tooth socket and all the right side of the mandible and was diagnosed as an osteogenic osteosarcoma of the zygomatic bone. CONCLUSION This tumour had the characteristics of a radio-induced sarcoma. Thanks to the very short time between the dental extraction and the occurrence of the osteosarcoma at the same location, we discuss the role of the dental extraction as a trigger of osteosarcoma development.
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Affiliation(s)
- B Phulpin
- Institut de Cancérologie de Lorraine, Head and Neck Surgery and Dental Units, Oncologic Surgery Department, Avenue de Bourgogne, 54519 Vandoeuvre-lès-Nancy, France.
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Phulpin B, Tran N, Leroux A, Poussier S, Marie PY, Pinel S, Huger S, Henrot P, Gallet P, Blaise C, Bravetti P, Graff P, Merlin JL, Dolivet G. Experimental model of naturally occurring post-radiation sarcoma: interest of positron emission tomography (PET) for early detection. J Radiat Res 2012; 53:101-109. [PMID: 22302050 DOI: 10.1269/jrr.11008] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Radiotherapy is an integral part of overall cancer therapy. One of the most serious adverse effects of irradiation concern, for long-term survivors, the development of post-radiation sarcoma (PRS) in healthy tissues located within the irradiated area. PRS have bad prognosis and are often detected at a late stage. Therefore, it is obvious that the early detection PRS is a key-point and the development of preclinical models is worthy to evaluate innovative diagnostic and therapeutic procedures. The aim of this study was to develop a spontaneous rodent model of PRS and to evaluate the potency of Positron Emission Tomography (PET) for early detection. Fifteen Wistars rats were irradiated unilateraly on the hindlimb with a single dose of 30 Gy. Sequential analysis was based on observational staging recordings, Computerized Tomography (CT) scanning and PET. Tumors were removed and, histopathological and immunochemistry analyses were performed. Among the irradiated rats, 12 sarcomas (80%) were detected. All tumors occurred naturallty within the irradiated hindlimb and were highly aggressive since most tumors (75%) were successfully transplanted and maintained by serial transplantation into nude mice. Upon serial staging recordings, using PET, was found to enable the detection of PRS earlier after irradiation than with the other methods (i.e. 11.9 ± 1.8 vs 12.9 ± 2.6 months). These results confirmed the interest of experimental models of PRS for the preclinical evaluation of innovative diagnostic strategies and confirmed the potency of PET for early detection of PRS. This preclinical model of PRS can also be proposed for the evaluation of therapeutic strategies.
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MESH Headings
- Animals
- Biomarkers, Tumor/analysis
- Cobalt Radioisotopes
- Early Diagnosis
- Fluorine Radioisotopes
- Fluorodeoxyglucose F18
- Hindlimb
- Male
- Mice
- Mice, Nude
- Models, Animal
- Neoplasm Invasiveness
- Neoplasm Transplantation
- Neoplasms, Radiation-Induced/diagnostic imaging
- Neoplasms, Radiation-Induced/pathology
- Positron-Emission Tomography
- Radiopharmaceuticals
- Rats
- Rats, Wistar
- Sarcoma, Experimental/diagnostic imaging
- Sarcoma, Experimental/etiology
- Sarcoma, Experimental/pathology
- Soft Tissue Neoplasms/diagnostic imaging
- Soft Tissue Neoplasms/etiology
- Soft Tissue Neoplasms/pathology
- Tomography, X-Ray Computed
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Affiliation(s)
- Bérengère Phulpin
- Head and Neck Surgery Unit, Oncologic Surgery Department, Centre Alexis Vautrin, Avenue de Bourgogne, Brabois, 54511, Vandoeuvre-lès-Nancy, France.
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Gallet P, Phulpin B, Merlin JL, Leroux A, Bravetti P, Mecellem H, Tran N, Dolivet G. Long-term alterations of cytokines and growth factors expression in irradiated tissues and relation with histological severity scoring. PLoS One 2011; 6:e29399. [PMID: 22216271 PMCID: PMC3245280 DOI: 10.1371/journal.pone.0029399] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Accepted: 11/28/2011] [Indexed: 02/06/2023] Open
Abstract
Purpose Beside its efficacy in cancer treatment, radiotherapy induces degeneration of healthy tissues within the irradiated area. The aim of this study was to analyze the variations of proinflammatory (IL-1α, IL-2, IL-6, TNF-α, IFN-γ), profibrotic (TGF-β1), proangiogneic (VEGF) and stem cell mobilizing (GM-CSF) cytokines and growth factors in an animal model of radiation-induced tissue degeneration. Materials and Methods 24 rats were irradiated unilaterally on the hindlimb at a monodose of 30 Gy. Six weeks (n = 8), 6 months (n = 8) and 1 year (n = 8) after irradiation the mediators expression in skin and muscle were analyzed using Western blot and the Bio-Plex® protein array (BPA) technology. Additional histological severity for fibrosis, inflammation, vascularity and cellularity alterations scoring was defined from histology and immnunohistochemistry analyses. Results A significant increase of histological severity scoring was found in irradiated tissue. Skin tissues were more radio-sensitive than muscle. A high level of TGF-β1 expression was found throughout the study and a significant relation was evidenced between TGF-β1 expression and fibrosis scoring. Irradiated tissue showed a chronic inflammation (IL-2 and TNF-α significantly increased). Moreover a persistent expression of GM-CSF and VEGF was found in all irradiated tissues. The vascular score was related to TGF-β1 expression and the cellular alterations score was significantly related with the level of IL-2, VEGF and GM-CSF. Conclusion The results achieved in the present study underline the complexity and multiplicity of radio-induced alterations of cytokine network. It offers many perspectives of development, for the comprehension of the mechanisms of late injuries or for the histological and molecular evaluation of the mode of action and the efficacy of rehabilitation techniques.
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Affiliation(s)
- Patrice Gallet
- EA4421 SiGReTO Nancy University, Faculty of Medicine, Vandoeuvre-lès-Nancy, France
| | - Bérengère Phulpin
- EA4421 SiGReTO Nancy University, Faculty of Medicine, Vandoeuvre-lès-Nancy, France
- Head and Neck Surgery and Dental Units, Oncologic Surgery Department, Centre Alexis Vautrin, Vandoeuvre-lès-Nancy, France
- * E-mail:
| | - Jean-Louis Merlin
- EA4421 SiGReTO Nancy University, Faculty of Medicine, Vandoeuvre-lès-Nancy, France
- Pathology and Tumor Biology Department, Centre Alexis Vautrin, Vandoeuvre-lès- Nancy, France
| | - Agnès Leroux
- EA4421 SiGReTO Nancy University, Faculty of Medicine, Vandoeuvre-lès-Nancy, France
- Pathology and Tumor Biology Department, Centre Alexis Vautrin, Vandoeuvre-lès- Nancy, France
| | - Pierre Bravetti
- Oral surgery department, Faculty of Dentistry, Nancy University, Nancy, France
| | - Hinda Mecellem
- Radiotherapy Department, Centre Alexis Vautrin, Vandoeuvre-lès-Nancy, France
| | - Nguyen Tran
- School of Surgery, INSERM U961, Faculty of Medicine, Nancy University, Vandoeuvre-lès-Nancy, France
- INSERM U961, Faculty of Medicine, Nancy University, Vandoeuvre-lès-Nancy, France
| | - Gilles Dolivet
- EA4421 SiGReTO Nancy University, Faculty of Medicine, Vandoeuvre-lès-Nancy, France
- Head and Neck Surgery and Dental Units, Oncologic Surgery Department, Centre Alexis Vautrin, Vandoeuvre-lès-Nancy, France
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Mirghani H, Meyer G, Hans S, Dolivet G, Périé S, Brasnu D, Guily JLS. The musculocutaneous infrahyoid flap: surgical key points. Eur Arch Otorhinolaryngol 2011; 269:1213-7. [DOI: 10.1007/s00405-011-1724-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Accepted: 07/19/2011] [Indexed: 11/25/2022]
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Tan IB, Dolivet G, Ceruse P, Vander Poorten V, Roest G, Rauschning W. Temoporfin-mediated photodynamic therapy in patients with advanced, incurable head and neck cancer: A multicenter study. Head Neck 2011; 32:1597-604. [PMID: 20848401 DOI: 10.1002/hed.21368] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The aim of this study was to confirm the efficacy of temoporfin (Foscan)-mediated photodynamic therapy (PDT) in patients with end-stage head and neck squamous cell carcinoma (HNSCC). METHODS Thirty-nine patients with recurring HNSCC lesions ≤10 mm in depth were injected with temoporfin, followed by illumination of the tumor surface. RESULTS Of 39 treated patients, 19 achieved complete response, 2 partial response, 5 stable disease, 5 had progressive disease, and 8 patients were nonevaluable. Thus, in the per-protocol analysis, the response rate was 68%. Of the treated patients 54% had a response. Median survival was significantly longer for responders (37 months) than for nonresponders (7.4 months). Nine patients were alive at 3.7 to 6.5 years (median, 4.8 years) post-treatment, 7 free of disease. No major toxicities were observed. CONCLUSIONS Patients with advanced HNSCC with lesions ≤10 mm in depth, who have exhausted other treatment options, can achieve significant local control and survival benefit from temoporfin-mediated PDT.
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Affiliation(s)
- Ing Bing Tan
- The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
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Dolivet G, Cortese S, Mastronicola R, Phulpin B, Kaminski MC, Mecellem H, Gillon V, Gangloff P. [Salvage surgery for upper aerodigestive tract tumours]. Bull Cancer 2011; 98:59-71. [PMID: 21591296] [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: 05/30/2023]
Abstract
Salvage surgeries of head and neck tumors are considered as poor satisfactory either for disease control results or for aesthetic and functional outcomes. Several improvements have been made possible since few years in all fields of oncologic treatments. A new approach must be initiated in that context, moreover since take in charge for head and neck region (exclusive initial medical treatment) let us consider an increasement of clinical situations for which a salvage therapy could be performed. The new surgery techniques have to be considered, reconstructive and guided by systems, which can improve surgical skills (navigation, robotic, sentinel node procedure, nervous detection and so on), the help of reirradiation techniques, the use of medical therapy during surgical procedure, the photodynamic therapy and all the help provided by new medical imaging and modern biology, which can determine more precisely the status of the cancer when it is taken in charge. The mastery of those techniques improvements must follow on an evolution of the concepts in the field of combined salvage treatments performed by multidisciplinary teams. Those treatments have to be realized in structures, which have the techniques and the multiple skills for allowing increasement of outcomes of those severe diseases.
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Affiliation(s)
- Gilles Dolivet
- Département de chirurgie oncologique/tête et cou, Centre Alexis-Vautrin, Vandoeuvre-lès-Nancy, France
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Gallet P, Gangloff P, Mastronicola R, Cortese S, Phulpin B, Mecellem H, Kaminski M, Guillet J, Dolivet G. Combined transoral and suprahyoid approach for oropharyngeal cancers: an alternative to mandibulotomy. Rev Laryngol Otol Rhinol (Bord) 2011; 132:95-102. [PMID: 22416489] [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: 05/31/2023]
Abstract
UNLABELLED Surgical treatment of oropharyngeal tumours usually requires mandibular osteotomy. Using this technique allows a better exposure and an easier excision, but this approach often generates complications. Since 1995, we used a less aggressive surgical technique, with a suprahyoid pharyngotomy when the oral approach was not sufficient, thus sparing the mandible. OBJECTIVE The purpose of this study is to evaluate this technical evolution, ensuring that mandibular preservation doesn't affect quality of exeresis, local control and survival, while allowing a lower complication rate. MATERIAL AND METHODS All patients who have had a surgical treatment for an oropharyngeal carcinoma between 1995 and 2001 in our center were included in this study. RESULTS Mandibular sparing was used for 55 patients; 19 patients underwent mandibulotomy. The surgical procedure's quality was classified as clear, close, or insufficient margins. All adjuvant treatments were noted, functional and carcinologic results were evaluated. No significant differences are found for exeresis quality and local control. There are less complications (p = 0.045) and less surgical revisions (p = 0.023) in the preservation group. Survival and functional results are better in the preservation group, but without significant difference. For oropharyngeal tumours, survival is dependent on tumoural aggressivity, on general condition and co-morbidity and on the development of a second tumour. Results in local control rate (83.7% at 1 year) are satisfying compared to literature. CONCLUSION Mandibular preservation is an efficient and safe procedure, even for T3/T4 tumours. Most of oropharyngeal tumours can be removed without mandibulotomy. The suprahyoid approach provides a good exposure when oral approach is insufficient, thus avoiding mandibulotomy and its complications.
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Affiliation(s)
- P Gallet
- Centre Alexis Vautrin, Unité de Chirurgie Cervico-Faciale, Département de Chirurgie Oncologique, Avenue de Bourgogne, Brabois, 54511 Vandoeuvre les Nancy cedex, France
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Gangloff P, Mastronicola R, Cortese S, Phulpin B, Sergeant C, Guillemin F, Eluecque H, Perrot C, Dolivet G. Navigation in head and neck oncological surgery: an emerging concept. Rev Laryngol Otol Rhinol (Bord) 2011; 132:203-207. [PMID: 22908541] [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: 06/01/2023]
Abstract
Navigation surgery, initially applied in rhinology, neurosurgery and orthopaedic cases, has been developed over the last twenty years. Surgery based on computed tomography data has become increasingly important in the head and neck region. The technique for hardware fusion between RMI and computed tomography is also becoming more useful. We use such device since 2006 in head and neck carcinologic situation. Navigation allows control of the resection in order to avoid and protect the precise anatomical structures (vessels and nerves). It also guides biopsy and radiofrequency. Therefore, quality of life is much more increased and morbidity is decreased for these patients who undergo major and mutilating head and neck surgery. Here we report the results of 33 navigation procedures performed for 31 patients in our institution.
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Affiliation(s)
- P Gangloff
- Centre Alexis Vautrin, Head & Neck & Dental Surgery Service, 6 avenue de Bourgogne, 54511 Vandoeuvre-les-Nancy, France
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Schipman B, Desandes E, Mecellem H, Toussaint B, Dolivet G, Marchal F, Kaminsky M, Geoffrois L, Peiffert D, Graff P. Management of Head and Neck Patients Presenting at Diagnosis with a Synchronous Cancer in Another Anatomic Site. Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.1117] [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: 10/19/2022]
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