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Chabrillac E, Zerdoud S, Fontaine S, Sarini J. Multifocal recurrence on the transaxillary robotic thyroidectomy incision. Eur Ann Otorhinolaryngol Head Neck Dis 2019; 137:59-60. [PMID: 31178429 DOI: 10.1016/j.anorl.2019.05.007] [Citation(s) in RCA: 5] [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] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Robotic thyroidectomy (RT) has been reported to achieve satisfactory results. However, its long-term oncological results have not been validated. The use of RT to treat thyroid cancer comprises specific risks that are not encountered with open thyroidectomy (OT). CASE SUMMARY We report the case of a patient operated by two-stage RT for stage pT3a follicular carcinoma, followed by tumour seeding along the incision despite adjuvant Iodine-131 therapy and external beam radiotherapy. DISCUSSION This case illustrates the limitations and insufficient perspective of RT for thyroid cancer, with the recent discovery of a risk of tumour seeding along the incision. Rigorous patient selection should help to avoid this risk of tumour seeding.
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Affiliation(s)
- E Chabrillac
- Département de chirurgie, Institut Universitaire du Cancer Toulouse - Oncopôle, 1, avenue Irène Joliot-Curie, 31059 Toulouse, France.
| | - S Zerdoud
- Département de médecine nucléaire, Institut Universitaire du Cancer Toulouse - Oncopôle, 1, avenue Irène Joliot-Curie, 31059 Toulouse, France
| | - S Fontaine
- Centre Toulouse thyroïde, clinique Rive-Gauche, 49, allées Charles-de-Fitte, 31300 Toulouse, France
| | - J Sarini
- Département de chirurgie, Institut Universitaire du Cancer Toulouse - Oncopôle, 1, avenue Irène Joliot-Curie, 31059 Toulouse, France
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Cavallier Z, Sarini J, Maisongrosse V, Dupret-Bories A. Lesion of the thyroid cartilage. Eur Ann Otorhinolaryngol Head Neck Dis 2018; 135:461-462. [PMID: 30316634 DOI: 10.1016/j.anorl.2018.09.008] [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: 10/28/2022]
Affiliation(s)
- Z Cavallier
- Chirurgie maxillo-faciale et plastique de la face, CHU Toulouse Purpan, place du Docteur Baylac, TSA 40031, 31059 Toulouse cedex 9, France
| | - J Sarini
- Chirurgie ORL et cervico-faciale, institut Claudius-Regaud, IUCT Toulouse Oncopole, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France
| | - V Maisongrosse
- Laboratoire d'anatomie-pathologique, institut Claudius-Regaud, IUCT Toulouse Oncopole, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France
| | - A Dupret-Bories
- Chirurgie ORL et cervico-faciale, institut Claudius-Regaud, IUCT Toulouse Oncopole, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France.
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Temam S, Spicer J, Farzaneh F, Soria JC, Oppenheim D, McGurk M, Hollebecque A, Sarini J, Hussain K, Soehrman Brossard S, Manenti L, Evers S, Delmar P, Di Scala L, Mancao C, Feuerhake F, Andries L, Ott MG, Passioukov A, Delord JP. An exploratory, open-label, randomized, multicenter study to investigate the pharmacodynamics of a glycoengineered antibody (imgatuzumab) and cetuximab in patients with operable head and neck squamous cell carcinoma. Ann Oncol 2017; 28:2827-2835. [PMID: 28950289 PMCID: PMC5834084 DOI: 10.1093/annonc/mdx489] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND In addition to inhibiting epidermal growth factor receptor (EGFR) signaling, anti-EGFR antibodies of the IgG1 'subtype' can induce a complementary therapeutic effect through the induction of antibody-dependent cell-mediated cytotoxicity (ADCC). Glycoengineering of therapeutic antibodies increases the affinity for the Fc-gamma receptor, thereby enhancing ADCC. PATIENTS AND METHODS We investigated the changes in immune effector cells and EGFR pathway biomarkers in 44 patients with operable, advanced stage head and neck squamous cell carcinoma treated with two preoperative doses of either glycoengineered imgatuzumab (GA201; 700 or 1400 mg) or cetuximab (standard dosing) in a neoadjuvant setting with paired pre- and post-treatment tumor biopsies. RESULTS Significant antitumor activity was observed with both antibodies after just two infusions. Metabolic responses were seen in 23 (59.0%) patients overall. One imgatuzumab-treated patient (700 mg) achieved a 'pathological' complete response. An immediate and sustained decrease in peripheral natural killer cells was consistently observed with the first imgatuzumab infusion but not with cetuximab. The functionality of the remaining peripheral natural killer cells was maintained. Similarly, a pronounced increase in circulating cytokines was seen following the first infusion of imgatuzumab but not cetuximab. Overall, tumor-infiltrating CD3+ cell counts increased following treatment with both antibodies. A significant increase from baseline in CD3+/perforin+ cytotoxic T cells occurred only in the 700-mg imgatuzumab group (median 95% increase, P < 0.05). The most prominent decrease of EGFR-expressing cells was recorded after treatment with imgatuzumab (700 mg, -34.6%; 1400 mg, -41.8%). The post-treatment inflammatory tumor microenvironment was strongly related to baseline tumor-infiltrating immune cell density, and baseline levels of EGFR and pERK in tumor cells most strongly predicted therapeutic response. CONCLUSIONS These pharmacodynamic observations and relationship with efficacy are consistent with the proposed mode of action of imgatuzumab combining efficient EGFR pathway inhibition with ADCC-related immune antitumor effects. CLINICAL TRIAL REGISTRATION NUMBER NCT01046266 (ClinicalTrials.gov).
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Affiliation(s)
- S Temam
- Department of Head and Neck Surgical Oncology, Institut Gustave Roussy, Villejuif, France.
| | | | - F Farzaneh
- Department of Haematological Medicine, King's College London, London, UK
| | - J C Soria
- DITEP (Drug Development Department), Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - D Oppenheim
- Department of Haematological Medicine, King's College London, London, UK
| | - M McGurk
- Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - A Hollebecque
- DITEP (Drug Development Department), Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - J Sarini
- Department of Surgery, Institut Claudius Regaud, Toulouse, France
| | - K Hussain
- Head and Neck Surgery, King's College London, Guy's Hospital Campus, London, UK
| | | | - L Manenti
- Roche Innovation Center Zurich, Schlieren, Switzerland
| | - S Evers
- Roche Innovation Center Zurich, Schlieren, Switzerland
| | - P Delmar
- Roche Innovation Center Basel, Basel
| | | | - C Mancao
- Roche Innovation Center Basel, Basel
| | - F Feuerhake
- Institute for Pathology, Hannover Medical School, Hannover; Institute for Neuropathology, University Hospital Freiburg, Freiburg im Breisgau, Germany
| | | | - M G Ott
- Roche Innovation Center Basel, Basel
| | - A Passioukov
- Roche Innovation Center Zurich, Schlieren, Switzerland
| | - J P Delord
- Clinical Research Unit, Institut Claudius Regaud, Toulouse, France
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Modesto A, Galissier T, Lusque A, Delord JP, Uro-Costes E, Laprie A, Sarini J, Graff-Cailleaud P, Vergez S, Rives M. Traitement médical ou chirurgical des cancers de l’oropharynx : place du statut p16 dans la décision thérapeutique ? Cancer Radiother 2017. [DOI: 10.1016/j.canrad.2017.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Modesto A, Galissier T, Lusque A, Uro-Coste E, Delord J, Laprie A, Sarini J, Graff P, Vergez P, Rives M. EP-1097: P16 expression: a predictive marker for treatment-related outcomes in oropharyngeal cancer patients? Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)31533-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Compagnon F, Zerdoud S, Rives M, Laprie A, Sarini J, Grunenwald S, Chaltiel L, Graff P. [Postoperative external beam radiotherapy for medullary thyroid carcinoma with high risk of locoregional relapse]. Cancer Radiother 2016; 20:362-9. [PMID: 27396902 DOI: 10.1016/j.canrad.2016.05.010] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Revised: 04/22/2016] [Accepted: 05/14/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE To assess the outcome of locally advanced medullary thyroid carcinoma treated with surgery and adjuvant external beam radiotherapy. PATIENTS AND METHODS Twenty-nine consecutive patients with non-metastatic medullary thyroid carcinoma treated in our institution between January 1995 and December 2012 were retrospectively evaluated. All underwent curative-intended optimal surgery, followed by external beam radiotherapy because of high risk of locoregional relapse. Twelve patients were stage III, 16 IVa and 1 IVb. Positive surgical margins were present in 11 cases (10 R1 and 1 R2). Median and average preradiotherapy serum calcitonin were 141pg/mL and 699pg/mL, respectively. Fourteen patients received 3D-conformal radiotherapy and 15 received intensity-modulated radiotherapy. Median prescribed dose was 63Gy to the high-risk volumes and 54Gy to the low-risk volumes. Treatment was delivered in 30 fractions. The median gap between surgery and radiotherapy was 1.9months. Median follow-up was 76.4months. RESULTS Kaplan-Meier estimates of 5-year locoregional relapse-free survival and overall survival were 79 and 96 %, respectively. Among the five locoregional relapses, two were related to a macroscopic metastatic cervical lymph node that was unfortunately not removed during the lymphadenectomy. Eight of ten patients with microscopic positive margins (R1) were controlled regarding the thyroidectomy bed. Eight patients had normal serum calcitonin after external beam radiotherapy, of whom only one developed a locoregional relapse during follow-up. Regarding the 21 patients with persistent positive serum calcitonin after treatment, only ten developed a macroscopic locoregional or distant relapse. One grade III and no grade IV acute morbidity were reported. Fifteen patients reported grade II chronic morbidity and no grade III/IV. CONCLUSION Maximal surgery followed by adjuvant external beam radiotherapy as a treatment for locally advanced medullary thyroid carcinoma provides a high rate of long-term locoregional control and overall survival with limited toxicity. Postoperative external beam radiotherapy should be considered when patients present features indicating a high risk of locoregional relapse.
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Affiliation(s)
- F Compagnon
- Département de radiothérapie, institut universitaire du cancer de Toulouse, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France.
| | - S Zerdoud
- Département de médecine nucléaire, institut universitaire du cancer de Toulouse, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France
| | - M Rives
- Département de radiothérapie, institut universitaire du cancer de Toulouse, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France
| | - A Laprie
- Département de radiothérapie, institut universitaire du cancer de Toulouse, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France
| | - J Sarini
- Département de chirurgie cervicofaciale, institut universitaire du cancer de Toulouse, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France
| | - S Grunenwald
- Département d'endocrinologie et des maladies métaboliques, centre hospitalier universitaire Larrey, Toulouse, France
| | - L Chaltiel
- Département de biostatistiques, institut universitaire du cancer de Toulouse, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France
| | - P Graff
- Département de radiothérapie, institut universitaire du cancer de Toulouse, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France
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Modesto A, Laprie A, Vieillevigne L, Graff P, Sarini J, Vergez S, Delord J, Rives M. Apport de la modulation d’intensité à la radiothérapie des cancers laryngés et hypopharyngés. Cancer Radiother 2014. [DOI: 10.1016/j.canrad.2014.07.115] [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: 10/24/2022]
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Thariat J, Schouman T, Brouchet A, Sarini J, Miller R, Reychler H, Ray-Coquard I, Italiano A, Verite C, Sohawon S, Bompas E, Dassonville O, Salas S, Aldabbagh K, Maingon P, de La MotteRouge T, Kurtz J, Usseglio J, Kerbrat P, Raoul G, Lotz J, Bar-Sela G, Brugières L, Chaigneau L, Saada E, Odin G, Marcy P, Thyss A, Julieron M. Osteosarcomas of the mandible: multidisciplinary management of a rare tumor of the young adult a cooperative study of the GSF-GETO, Rare Cancer Network, GETTEC/REFCOR and SFCE. Ann Oncol 2013; 24:824-31. [DOI: 10.1093/annonc/mds507] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Thariat J, Ray-Coquard IL, Thyss A, Italiano A, Sarini J, Miller RC, Bompas E, Brouchet A, Dassonville O, Salas S, Maingon P, Kurtz J, Reychler H, de La Motte Rouge T, Aldabbagh K, Usseglio J, Kerbrat P, Lotz J, Chaigneau L, Julieron M. Primary osteosarcomas of the mandible: Joint study of the Groupe Sarcome Francais (GSF), Rare Cancer Network, and Groupe d’Etude des Tumeurs de la Tete et du Cou (GETTEC). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.10036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Vergez S, Sarini J, Percodani J, Serrano E, Caron P. Lymph node management in clinically node-negative patients with papillary thyroid carcinoma. Eur J Surg Oncol 2010; 36:777-82. [DOI: 10.1016/j.ejso.2010.06.015] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2009] [Revised: 12/24/2009] [Accepted: 06/07/2010] [Indexed: 10/19/2022] Open
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Benlyazid A, Sarini J, Marques B, Garrido-Stowhas I, Delord JP, Zerdoud S, Rives M. [Systematic neck dissection in squamous cell carcinoma of the oral cavity]. ACTA ACUST UNITED AC 2007; 124:285-91. [PMID: 17673159 DOI: 10.1016/j.aorl.2006.06.001] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2005] [Accepted: 06/22/2006] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To evaluate the neck control after prior surgical management of patients with squamous cell carcinoma of the oral cavity and to quantify the ratio of patients among whom neck dissection did not have a real therapeutic value. To discuss the usefulness of the sentinel node biopsy in this group of patients. METHOD Retrospective analysis of patients with epidermoid carcinoma of the oral cavity who had systematically a neck dissection. RESULTS Thirty-nine files of patients have been processed. We found 45% patients classified pN0 (among whom about one half where classified pT4). With a mean follow-up of 19 months, we did not find any cervical lymph node relapse. Five patients died (13.5%) without any cervical disease. CONCLUSION The systematic cervical lymph node dissection remains the most effective means to obtain the neck control of squamous cell cancers of the oral cavity. It however was applied without therapeutic value for 45% of the patients of this series. The validation of the sentinel node concept as a method of cervical staging should make it possible to avoid this surgical procedure in more than one third of the cases.
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Affiliation(s)
- A Benlyazid
- Département de chirurgie, institut Claudius-Regaud, 20-24, rue du Pont-Saint-Pierre, 31052 Toulouse cedex, France.
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Benlyazid A, Thomas F, Sarini J, Rives M, Hamelin D, Courbon F, Rochaix P, Delord J. Investigation of predictive factors of response in patients with squamous-cell carcinoma of the head and neck (SCCHN) given neo-adjuvant erlotinib before surgery, updated results of a single institution experience. Radiother Oncol 2007. [DOI: 10.1016/s0167-8140(07)80095-8] [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: 10/23/2022]
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Delord J, Thomas F, Benlyazid A, Sarini J, Rives M, Begue M, Courbon F, Lefebvre J, Rochaix P. Neo-adjuvant treatment with erlotinb in squamous cell carcinoma head and neck (SCCHN) patients before surgery provides an opportunity to find predictive factors of response. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.5513] [Citation(s) in RCA: 5] [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
5513 Background: To date, neither immunohistochemistry (IHC) nor molecular analyses have identified prognostic markers of response to epidermal growth factor receptor (EGFR) tyrosine kinase (TK) inhibitors in SCCHN. Thus, the selection of patients who could benefit from such agents remains a challenge. We designed a ‘pilot’ clinical trial of patients (pts) with SCCHN pending first-line surgery of their disease. Methods: Pts with resectable SCCHN received erlotinib at 150mg/day during the period between pan-endoscopy and surgery. Pharmacokinetic (PK) samples were collected during treatment, which ceased the day before surgery. Results: Thirty five pts were recruited. All of them had resectable SCCHN: oral cavity (17 pts), oropharyngeal (7 pts), hypopharyngeal (5 pts), larygeal (6 pts). Thirty pts received full treatment with erlotinib and the main reason for discontinuation was rash. The median duration of treatment was 21 days (14–27). All pts were evaluated clinically and their tumors assessed radiologically before and after treatment. Out of 30 evaluable pts, 8 were considered as good responders (30–80% decrease in tumor size), 18 had stable disease and 2 had minor progression. Expected toxicities were observed: rash (grade 2/3 in 11 pts), diarrhea (grade 2 in 1 pt). All pts underwent surgery. The incidence of post-operative complications was similar to our historical series. No mutations in the catalytic domain of EGFR TK were found. All tumors were positive for EGFR by IHC. Correlative statistical analyses between PK, toxicity and response data are ongoing and will be presented. Neither over expression of EGFR nor other IHC markers alone were found to be good predictive markers of efficacy. Retrospective analysis of morphological and IHC evaluation in some cell cycle regulators (mainly p21) appeared to be predictive of erlotinib efficacy (sensitivity 87.5%, specificity 88%). Conclusions: Neo-adjuvant treatment with erlotinib in SCCHN pts is well-tolerated. This trial demonstrated a useful prospective method to potentially aid patient selection to improve the design of post-operative adjuvant treatment combinations. No significant financial relationships to disclose.
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Affiliation(s)
- J. Delord
- Institut Claudius Régaud, Toulouse, France; Centre Oscar Lambret, Lille, France
| | - F. Thomas
- Institut Claudius Régaud, Toulouse, France; Centre Oscar Lambret, Lille, France
| | - A. Benlyazid
- Institut Claudius Régaud, Toulouse, France; Centre Oscar Lambret, Lille, France
| | - J. Sarini
- Institut Claudius Régaud, Toulouse, France; Centre Oscar Lambret, Lille, France
| | - M. Rives
- Institut Claudius Régaud, Toulouse, France; Centre Oscar Lambret, Lille, France
| | - M. Begue
- Institut Claudius Régaud, Toulouse, France; Centre Oscar Lambret, Lille, France
| | - F. Courbon
- Institut Claudius Régaud, Toulouse, France; Centre Oscar Lambret, Lille, France
| | - J. Lefebvre
- Institut Claudius Régaud, Toulouse, France; Centre Oscar Lambret, Lille, France
| | - P. Rochaix
- Institut Claudius Régaud, Toulouse, France; Centre Oscar Lambret, Lille, France
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Dolivet G, Gangloff P, Sarini J, Ton Van J, Garron X, Guillemin F, Lefebvre JL. Modification of the infra hyoid musculo-cutaneous flap. Eur J Surg Oncol 2005; 31:294-8. [PMID: 15780566 DOI: 10.1016/j.ejso.2004.10.006] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2004] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND In 1986, Wang described the infra hyoid musculo-cutaneous flap. Here, we report technical adaptations and improvements to this flap. METHODS From 1994 to 1996, we performed 61 infrahyoid flaps using the classical procedure. After 5 years of technical evolution, we studied a new series of 91 flaps from January 2000 to June 2002. We reviewed our experience with the infra hyoid flap and described the surgical procedure, its evolution and the impact on the viability of the flap. RESULTS In the two series, the main arterial pedicle was usually the superior thyroid artery. Venous drainage was more variable; consequently we always performed a modified neck dissection with preservation of the internal jugular vein. In the first series, the surgical results were good with only seven local complications essentially skin necrosis. The functional and aesthetic results seemed acceptable. In the second series, the results, after technical evolution with better venous drainage and cervical closure, were improved (only one necrosis) and the indications were extended. CONCLUSION With experience, the infra hyoid myocutaneous flaps is reliable and appears as a particularly useful flap for oral cavity, oral pharynx and pharyngeolaryngeal reconstruction.
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Affiliation(s)
- G Dolivet
- Head and Neck Surgery Unit, Unité de chirurgie cervico-faciale, Centre Alexis Vautrin, Avenue de Bourgogne, Brabois, 54511 Vandoeuvre les Nancy Cedex, France.
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Delord J, Thomas F, Hennebelle I, Sarini J, Benlyazid A, Rives M, Chatelut E, Allal B, Rochaix P. 64 Assessment of antitumor effects of erlotinib prior to first-line surgical treatment of head and neck squamous cell carcinoma. EJC Suppl 2004. [DOI: 10.1016/s1359-6349(04)80072-7] [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: 10/26/2022] Open
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Sarini J, Fournier C, Lefebvre JL, Bonafos G, Van JT, Coche-Dequéant B. Head and neck squamous cell carcinoma in elderly patients: a long-term retrospective review of 273 cases. Arch Otolaryngol Head Neck Surg 2001; 127:1089-92. [PMID: 11556858 DOI: 10.1001/archotol.127.9.1089] [Citation(s) in RCA: 103] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND The prolongation of life expectancy results in an increasing number of malignant neoplasms occurring in the elderly population. For a long time these patients were not considered good candidates to receive aggressive therapy and probably were inadequately treated in many instances. OBJECTIVE To assess the outcome of patients older than 74 years who had had head and neck squamous cell carcinoma. MATERIALS AND METHODS In our database of 4610 consecutive patients with head and neck squamous cell carcinomas who were evaluated and treated at the Centre Oscar Lambret, Northern France Comprehensive Cancer Center, Lille, over a 10-year period (1974-1983), we identified 273 patients who were 75 years or older. The outcome was updated for all patients included in the database. RESULTS A significantly higher proportion of females were noted in the older patient group (43/273, 15.8%) than in younger patient group (192/4337, 4.4%, P<.001). There were no differences for primary site except for hypopharyngeal squamous cell carcinoma that occurred less frequently in the elderly patients (8.8% vs 14.5%, borderline significance P =.02). There were no differences for TNM stage grouping, histological classification, incidences of previous cancer, and comorbidities. Surgery was performed in a smaller proportion of older patients (13.9% vs 27.4%, P<.001, for the primary site and 15.4% vs 35.6%, P<.001, for those occurring in the neck) as well as chemotherapy that was delivered in 5.5% vs 17.7% (P<.001). On the contrary, there was no difference in radiotherapeutic treatments. Tolerance to treatment was similar and there was the same proportion of persistent diseases 2 months after completion of the overall treatment (27.8% vs 25.4%, P =.94). Pooling local, regional, and distant failures and metachronous cancers, there was a borderline lower incidence in older patients (57.1% vs 64.2%, P =.02), which is explained by an obvious shorter life expectancy. If survival is not meaningful in such a comparison (5-year survival 23.8% vs 36.4%), then the causes of deaths may be compared. Among the 4067 patients who were dead at the last update, index tumor evolution-related deaths numbered 130 (48.1% of dead patients in this cohort) in older patients compared with 2045 (53.9% of dead patients in this cohort), which was not significantly different. There was no difference in treatment-related deaths (11.1% vs 9.3%). Fewer intercurrent disease-related deaths occurred in the older patients (19.7% vs 11.8%). CONCLUSIONS Head and neck squamous cell carcinoma in elderly patients did not seem to have a significantly different outcome when compared with head and neck squamous cell carcinoma occurring in younger patients. When properly monitored, conventional therapies seem feasible in older patients.
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Affiliation(s)
- J Sarini
- Head and Neck Department, Centre Oscar Lambret, Northern France Comprehensive Cancer Center, Lille, 3, rue Combemale, 59000 Lille, France
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Penel N, Fournier C, Kara A, Sarini J, Lefebvre D. [Anticancer chemotherapy, risk factor for infection at the operated site in cervicofacial surgery]. Presse Med 2001; 30:892-5. [PMID: 11413843] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/20/2023] Open
Abstract
BACKGROUND In order to evaluate occurrence and risk factors for wound infection (WI) in head and neck uncontaminated surgery, we carried out a prospective study. METHODS From january 1997 through january 1999, we prospectively evaluated 212 wounds of all patients having uncontaminated head and neck surgery at the Oscar Lambret Cancer Center (neck dissections, parotidectomies, thyroidectomies, explorative cervicotomies, cutaneous resections). No antibiotic prophylaxis was given. WI was defined as a wound with pus. Statistical evaluation was performed using the chi 2 test. In univariate analysis, differences were considered significant p < 0.05. RESULTS The overall WI rate was 6.6% (14/212). In univariate analysis, previous chemotherapy is the only risk factor for WI were: (p < 0.00001). Multivariate analysis was not performed. CONCLUSION Like other cancer locations, chemotherapy was a major risk factor for WI. In these cases, a phase ill trial could confirm efficacy of standard antibiotic.
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Affiliation(s)
- N Penel
- Département de Cancérologie Cervico-faciale, Centre Oscar Lambret, 3, rue F. Combemale, BP 307, F 59020 Lille.
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Penel N, Lefebvre D, Fournier C, Sarini J, Kara A, Lefebvre JL. Risk factors for wound infection in head and neck cancer surgery: A prospective study. Head Neck 2001; 23:447-55. [PMID: 11360305 DOI: 10.1002/hed.1058] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The goal of this prospective study is to determine risk factors for wound infections (WI) for patients with head and neck cancer who underwent surgical procedure with opening of upper aerodigestive tract mucosa. METHODS One hundred sixty-five consecutive surgical procedures were studied at Oscar Lambret Cancer Center within a 24-month interval. Twenty-five variables were recorded for each patient. Statistical evaluation used Chi2 test analysis (categorical data) and Mann-Whitney test (continuous variables). RESULTS The overall rate of WI was 41.8%. Univariate analysis indicated that five variables were significantly related to the likelihood of WI: tumor stage (p =.044), previous chemotherapy (p =.008), duration of preoperative hospital stay (p = 022), permanent tracheostomy (p =.00008), and hypopharyngeal and laryngeal cancers (p =.008). CONCLUSIONS Despite antibiotic prophylaxis, WI occurrence is high. These data inform the head and neck surgeon, when a patient is at risk for WI and may help to design future prospective studies.
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Affiliation(s)
- N Penel
- Head and Neck Cancer Department, Oscar Lambret Cancer Center, 3 Rue F. Combemale, Lille 59020 BP 207, France
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Dolivet G, Colosetti P, Merlin JL, Depardieu C, Lapeyre M, Wattel E, Sarini J, Ton Van J, Geoffrois L, Lagarde P. [Elements of epidemiology and initiation of carcinogenesis in carcinomas of the upper aerodigestive tract. Future therapeutic consequence?]. Rev Laryngol Otol Rhinol (Bord) 1999; 120:5-12. [PMID: 10371857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
The study of epidemiology and of the carcinogenesis in epidermoid carcinomas of the upper aerodigestive tract shows that their occurrence is not random. Tobacco abuse plays a major role, especially because of benzopyrene, mutagen of the P53 gene, however it is associated with many other potentiating factors: alcohol, metals, hydrocarbures, virus, food, climate, genetic fragility that create genetic lesions at the origin of carcinogenesis. The latter occurs as "field cancerization" with multiple alterations of the mucosa and general attack of the control systems of the differentiation, growth and cell apoptosis which usually protect the cell against the phenomena of carcinogenesis. The P53 protein gene, retinoid receptors as well as the system of detoxifying glutathion S transferase are modified at the very early stage of these diseases, these abnormalities can be logically related to epidemiological data. These data lead us therefore to imagine complementary specific reverting therapies of induced genetic abnormalities, through the reexpression of non mutated gene encoding P53 protein and the use of retinoid. These various modalities are reported hereafter.
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Affiliation(s)
- G Dolivet
- Centre Alexis Vautrin, Unité de Chirurgie Cervico-Faciale, F-54511 Vandoeuvre les Nancy, France
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