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Ghanem W, Qassemyar Q, Julieron M, Kolb F, Leymarie N, Moya-Plana A, Janot F, Temam S, Benmoussa N. Reconstruction of subtotal pharyngolaryngectomy using a fasciocutaneous free flap with cartilage graft: A case series of 17 patients. Head Neck 2023; 45:2335-2343. [PMID: 37482897 DOI: 10.1002/hed.27474] [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: 02/13/2023] [Revised: 07/03/2023] [Accepted: 07/12/2023] [Indexed: 07/25/2023] Open
Abstract
INTRODUCTION Subcricoid-hemilaryngopharyngectomy (SCHLP) with a reconstruction using a fasciocutaneous free flap armed with cartilage graft (FFACG) aims to avoid permanent tracheostomy while still maintaining the laryngopharyngeal functions. The purpose of this study is to report the outcome of this surgical approach. MATERIALS AND METHODS Retrospective study including 17 men operated between 2001 and 2019. Specific survival rate included death caused by cancer or SCHLP complications. Complications, functional and oncological outcomes were evaluated retrospectively. RESULTS There were no locoregional recurrences. One patient died due to inhalation pneumonia 3 years after surgery. Tracheostomy was closed in 13 patients (76.5%). Mean decannulation time was at six [1-14] months after surgery. CONCLUSION SCHPL with FFACG could avoid total pharyngolaryngectomy with good oncologic results. However, tracheotomy is extended and deglutition recovery is long with high risk of aspirations. These complications justify that such surgery should be realized only on selected patients by experienced surgical teams. Expertise of the surgical team is critical.
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Affiliation(s)
- Wahib Ghanem
- Department of Head and Neck Oncology, Gustave Roussy, Paris-Saclay University, Villejuif, France
| | - Quentin Qassemyar
- Department of Plastic Surgery, Gustave Roussy, Paris-Saclay University, Villejuif, France
| | - Morbize Julieron
- Department of Head and Neck Oncology, Gustave Roussy, Paris-Saclay University, Villejuif, France
| | - Frédéric Kolb
- Department of Plastic Surgery, Gustave Roussy, Paris-Saclay University, Villejuif, France
| | - Nicolas Leymarie
- Department of Plastic Surgery, Gustave Roussy, Paris-Saclay University, Villejuif, France
| | - Antoine Moya-Plana
- Department of Head and Neck Oncology, Gustave Roussy, Paris-Saclay University, Villejuif, France
| | - François Janot
- Department of Head and Neck Oncology, Gustave Roussy, Paris-Saclay University, Villejuif, France
| | - Stéphane Temam
- Department of Head and Neck Oncology, Gustave Roussy, Paris-Saclay University, Villejuif, France
| | - Nadia Benmoussa
- Department of Head and Neck Oncology, Gustave Roussy, Paris-Saclay University, Villejuif, France
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Brenet E, Philouze P, Schiffler C, Pommier P, Crozes C, Benzerdjeb N, Monchet E, Boulagnon-Rombi C, Ton Van J, Podeur F, Servagi-Vernat S, Liem X, Merol JC, Ceruse P, Serre AA, Chabaud S, Julieron M, Deneuve S. Influence of postoperative radiotherapy target volumes in unilateral head and neck carcinoma of unknown primary: A multicentric study using propensity score. Radiother Oncol 2021; 160:1-8. [PMID: 33845043 DOI: 10.1016/j.radonc.2021.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 12/01/2020] [Revised: 03/22/2021] [Accepted: 04/01/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To compare the impact of two radiation modalities on loco-regional control, survival and tumour emergence, after node dissection for an unilateral head and neck carcinoma of unknown primary (HNCUP). MATERIALS AND METHODS This is a multicentric retrospective study of 138 patients with unilateral HNCUP treated between 2002 and 2017. The absence of primary tumour was assessed by a systematic panendoscopy and positron emission tomography. Neck dissection was initially performed for all patients. Radiation Therapy was delivered on ipsilateral lymph node areas in 62 cases (44%: UL-RT group) and on bilateral lymph node areas and the entire pharyngeal mucosa in 77 cases (56%: COMP-RT group). Impact of radiation modalities on locoregional control and overall survival was assessed using propensity score matching method in order to balance baseline characteristics between the two groups. RESULTS The population included 80.4% men, 80.4% smokers, 32.6% P16 positive tumours and 71.0% extracapsular extension. After a median follow-up of 5 years, the locoregional control rate was 80.3% in the UL-RT group and 75.3% in the COMP-RT group (p = 0.688). The corresponding rate of contralateral lymph node recurrence was 0% versus 2.6% (p = 0.503) and the rate of tumour emergence was 11.5% versus 9.1% (p = 0.778). No significant difference was observed between the UL-RT and the COMP-RT groups for overall survival (p = 0.9516), specific survival (p = 0.4837) or tumour emergence (p = 0.9034). CONCLUSION UL-RT seems to provide similar outcomes as COMP-RT in unilateral HNCUP post-operative management.
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Affiliation(s)
- Esteban Brenet
- Head and Neck Surgery Department, Centre Hospitalo Universitaire Reims, France
| | - Pierre Philouze
- Head and Neck Surgery Department, Centre Hospitalo Universitaire Lyon Sud, France
| | | | - Pascal Pommier
- Radiotherapy Department, Centre Léon Bérard, Lyon, France
| | - Carole Crozes
- Pathological Anatomy Department, Centre Léon Bérard, Lyon, France
| | - Nazim Benzerdjeb
- Pathological Anatomy Department, Centre Hospitalo Universitaire Lyon Sud, France
| | - Elodie Monchet
- Head and Neck Surgery Department, Centre Oscar Lambret, Lille, France
| | | | - Jean Ton Van
- Head and Neck Department, Centre Oscar Lambret, Lille, France
| | - Fabien Podeur
- Oncologic Surgery Department, Centre Léon Bérard, Lyon, France
| | | | - Xavier Liem
- Radiotherapy Department, Centre Oscar Lambret, Lille, France
| | - Jean-Claude Merol
- Head and Neck Department, Centre hospilato Universitaire Reims, France
| | - Philippe Ceruse
- Head and Neck Surgery Department, Centre Hospitalo Universitaire Lyon Sud, France
| | | | - Sylvie Chabaud
- Biostatistics Department, Centre Léon Bérard, Lyon, France
| | - Morbize Julieron
- Head and Neck Surgery Department, Centre Oscar Lambret, Lille, France
| | - Sophie Deneuve
- Oncologic Surgery Department, Centre Léon Bérard, Lyon, France.
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Deneuve S, Majoufre C, Testelin S, Barry B, Louis MY, Longis J, Bouchet J, Damecourt A, Salvan D, Atallah S, Saroul N, Nokovitch L, Bach C, Berta E, Dupret-Bories A, Julieron M. Donor site sequelae and patient satisfaction after head and neck reconstruction with a radial forearm free flap. Eur Arch Otorhinolaryngol 2021; 278:4051-4058. [PMID: 33721068 DOI: 10.1007/s00405-021-06649-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 11/04/2020] [Accepted: 01/27/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Radial forearm free flap (RFFF) being a workhorse flap in head and neck reconstruction, we investigated its donor site delayed consequences. METHODS Multicentric case series evaluating 189 patients who underwent RFFF for carcinologic reasons at least 6 months before. Patients and surgeon's appreciation regarding the aesthetic and functional consequences of the flap harvest on their daily life were evaluated by questionnaires using likert scales. Medical data were collected from patients' charts retrospectively. RESULTS Thirty percent of patients had at least one sequelae. Experiencing a graft necrosis did not worsen long-term results. Cosmetic satisfaction was significantly worst for women, according to patients' and surgeons' opinion. For 81% and 92% patients, respectively, the flap harvest had no impact on daily life nor sport practice. Ratio between the benefits of reconstruction and the sequelae at the donor site was judged "excellent" for 77% patients. CONCLUSIONS Although objectively important, RFFF morbidity has little impact in head and neck cancer patient's life.
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Affiliation(s)
- Sophie Deneuve
- Surgical Oncology Department, Centre Léon Berard, 28 rue Laennec, 69008, Lyon, France.
| | - Claire Majoufre
- Maxillofacial Surgery Department, University Hospital-Bordeaux, Bordeaux, France
| | - Sylvie Testelin
- Maxillofacial Surgery Department, University Hospital-Amiens, Amiens, France
| | - Béatrix Barry
- Head and Neck Surgery Department, University Hospital Bichat, Paris, France
| | | | - Julie Longis
- Head and Neck Surgery Department, University Hospital-Nantes, Nantes, France
| | - Justine Bouchet
- Head and Neck Surgery Department, Comprehesive Cancer Center Oscar Lambret, Lille, France
| | - Arnaud Damecourt
- Head and Neck Department, University Hospital Montpellier, Montpellier, France
| | - Didier Salvan
- ENT Department, Sud Francilien General Hospital, Corbeil, France
| | - Sarah Atallah
- ENT Department, University Hospital Tenon, Paris, France
| | - Nicolas Saroul
- ENT Department, University Hospital-Clermont-Ferrand, Clermont-Ferrand, France
| | - Lara Nokovitch
- Surgical Oncology Department, Centre Léon Berard, 28 rue Laennec, 69008, Lyon, France
| | - Christine Bach
- Head and Neck Surgery Department, Hopital Foch General Hospital, Suresnes, France
| | - Etienne Berta
- Maxilofacial Surgery Department, Annecy General Hospital, Annecy, France
| | - Agnès Dupret-Bories
- Head and Neck Surgery Department, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse, France
| | - Morbize Julieron
- Head and Neck Surgery Department, Comprehesive Cancer Center Oscar Lambret, Lille, France
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Franco A, Tresch E, Sakji I, Makhloufi S, Abdeddaim C, Julieron M, Dansin E, Chevalier D, Mouawad F, Lefebvre G. 952P Neutrophil-to-lymphocyte ratio (NLR) and survival in recurrent or metastatic head and neck cancer patients treated with immunotherapy. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1067] [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] Open
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Escande A, Crop F, Liem X, Mirabel X, Julieron M, Mouttet-Audouard R, El Bedoui S, Lartigau EF, Cordoba A. Magnetic resonance imaging guided brachytherapy: Time for non-pelvic cancer? Example of tongue brachytherapy. Radiother Oncol 2020; 155:e1-e2. [PMID: 32798598 DOI: 10.1016/j.radonc.2020.07.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/28/2020] [Accepted: 07/28/2020] [Indexed: 11/15/2022]
Affiliation(s)
- Alexandre Escande
- Academic Department of Radiotherapy, Oscar Lambret Comprehensive Cancer Center, Lille, France; CRIStAL Laboratory, UMR 9189, University of Lille, France; Henri Warembourg, School of Medicine, University of Lille, France.
| | - Frederic Crop
- Department of Medical Physics, Oscar Lambret Comprehensive Cancer Center, Lille, France
| | - Xavier Liem
- Academic Department of Radiotherapy, Oscar Lambret Comprehensive Cancer Center, Lille, France
| | - Xavier Mirabel
- Academic Department of Radiotherapy, Oscar Lambret Comprehensive Cancer Center, Lille, France
| | - Morbize Julieron
- Department of Surgery, Oscar Lambret Comprehensive Cancer Center, Lille, France
| | | | - Sophie El Bedoui
- Department of Surgery, Oscar Lambret Comprehensive Cancer Center, Lille, France
| | - Eric Felix Lartigau
- Academic Department of Radiotherapy, Oscar Lambret Comprehensive Cancer Center, Lille, France; CRIStAL Laboratory, UMR 9189, University of Lille, France; Henri Warembourg, School of Medicine, University of Lille, France
| | - Abel Cordoba
- Academic Department of Radiotherapy, Oscar Lambret Comprehensive Cancer Center, Lille, France
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Podeur F, Pommier P, Crozes C, Monchet E, Ton Van J, Roux P, Poupart M, Zrounba P, Julieron M, Deneuve S. Management of unilateral head and neck carcinoma of unknown primary: Retrospective analysis of the impact of postoperative radiotherapy target volumes. Head Neck 2019; 42:302-311. [DOI: 10.1002/hed.26007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 09/20/2019] [Accepted: 10/18/2019] [Indexed: 01/27/2023] Open
Affiliation(s)
- Fabien Podeur
- Oncologic Surgery DepartmentCentre Léon Bérard Lyon France
| | | | - Carole Crozes
- Pathological Anatomy DepartmentCentre Léon Bérard Lyon France
| | - Elodie Monchet
- Head and Neck Surgery DepartmentCentre Oscar Lambret Lille France
| | - Jean Ton Van
- Head and Neck Surgery DepartmentCentre Oscar Lambret Lille France
| | | | - Marc Poupart
- Oncologic Surgery DepartmentCentre Léon Bérard Lyon France
| | | | - Morbize Julieron
- Head and Neck Surgery DepartmentCentre Oscar Lambret Lille France
| | - Sophie Deneuve
- Oncologic Surgery DepartmentCentre Léon Bérard Lyon France
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Lechien JR, Seminerio I, Descamps G, Mat Q, Mouawad F, Hans S, Julieron M, Dequanter D, Vanderhaegen T, Journe F, Saussez S. Impact of HPV Infection on the Immune System in Oropharyngeal and Non-Oropharyngeal Squamous Cell Carcinoma: A Systematic Review. Cells 2019; 8:cells8091061. [PMID: 31510065 PMCID: PMC6769551 DOI: 10.3390/cells8091061] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [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: 08/01/2019] [Revised: 08/23/2019] [Accepted: 09/03/2019] [Indexed: 12/20/2022] Open
Abstract
Objectives: To review the current knowledge regarding the involvement of human papilloma virus (HPV) infection and the immune system in the development of head and neck squamous cell carcinoma (HNSCC). Methods: An electronic literature search was conducted to identify articles published between 1990 and 2019 pertaining to tumor-infiltrating immune cells (TICs) in HNSCC using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Issues of clinical relevance, including tumor location, the number of tumor samples, the inclusion of additional specimens (dysplastic or normal mucosa), tumor size, methods used for HPV detection, relationship between antigen expression and patient characteristics (age, gender, smoking, alcohol consumption, etc.), and prognostic data (overall survival (OS) and recurrence-free survival (RFS)) were assessed by four blinded investigators. Results: The search identified 335 relevant studies, of which 41 met the inclusion criteria. Of these, 7 studies focused on the peripheral blood immune cell concentration in patients with HNSCC according to HPV status, and 36 studies investigated TICs in the intraepithelial and/or stromal compartment(s) according to HPV status. The immune cells studied were CD8+ T cells (N = 19), CD4+ T cells (N = 7), regulatory T cells (Tregs, N = 15), macrophages (N = 13), myeloid-derived suppressor cells (MDSCs, N = 4), and Langerhans cells (LCs, N = 2). Conclusions: Irrespective of tumor location, CD8+ and CD4+ T cells appear to play a key role in the development of HPV−related HNSCC, and their infiltration is likely associated with a significant impact on OS and RFS. To date, the roles and prognostic value of Tregs, macrophages, DCs and MDSCs remain unclear.
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Affiliation(s)
- Jerome R Lechien
- Department of Otolaryngology and Head and Neck Surgery, CHU Saint-Pierre, 1000 Brussels, Belgium.
- Laboratory of Human Anatomy and Experimental Oncology, Faculty of Medicine, Research Institute for Health Sciences and Technology, University of Mons (UMONS), Avenue du Champ de Mars, 8, B7000 Mons, Belgium.
- Department of Otolaryngology and Head and Neck Surgery, Centre Oscar Lambret, 59000 Lille, France.
| | - Imelda Seminerio
- Laboratory of Human Anatomy and Experimental Oncology, Faculty of Medicine, Research Institute for Health Sciences and Technology, University of Mons (UMONS), Avenue du Champ de Mars, 8, B7000 Mons, Belgium.
| | - Géraldine Descamps
- Laboratory of Human Anatomy and Experimental Oncology, Faculty of Medicine, Research Institute for Health Sciences and Technology, University of Mons (UMONS), Avenue du Champ de Mars, 8, B7000 Mons, Belgium.
| | - Quentin Mat
- Department of Otolaryngology and Head and Neck Surgery, CHU de Charleroi, 6042 Charleroi, Belgium.
| | - Francois Mouawad
- Department of Otolaryngology and Head and Neck Surgery, CHU de Lille, Université Lille 2, 59000 Lille, France.
| | - Stéphane Hans
- Department of Otolaryngology and Head and Neck Surgery, Foch Hospital, 92150 Paris, France.
| | - Morbize Julieron
- Department of Otolaryngology and Head and Neck Surgery, Centre Oscar Lambret, 59000 Lille, France.
| | - Didier Dequanter
- Department of Otolaryngology and Head and Neck Surgery, CHU Saint-Pierre, 1000 Brussels, Belgium.
| | - Thibault Vanderhaegen
- Department of Otolaryngology and Head and Neck Surgery, CHU de Charleroi, 6042 Charleroi, Belgium.
| | - Fabrice Journe
- Laboratory of Human Anatomy and Experimental Oncology, Faculty of Medicine, Research Institute for Health Sciences and Technology, University of Mons (UMONS), Avenue du Champ de Mars, 8, B7000 Mons, Belgium.
- Laboratory of Oncology and Experimental Surgery, Institut Jules Bordet, Université Libre de Bruxelles, Rue Heger-Bordet, 1, B1000 Brussels, Belgium.
| | - Sven Saussez
- Department of Otolaryngology and Head and Neck Surgery, CHU Saint-Pierre, 1000 Brussels, Belgium.
- Laboratory of Human Anatomy and Experimental Oncology, Faculty of Medicine, Research Institute for Health Sciences and Technology, University of Mons (UMONS), Avenue du Champ de Mars, 8, B7000 Mons, Belgium.
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Lemelle L, Pierron G, Fréneaux P, Huybrechts S, Spiegel A, Plantaz D, Julieron M, Dumoucel S, Italiano A, Millot F, Le Tourneau C, Leverger G, Chastagner P, Carton M, Orbach D. NUT carcinoma in children and adults: A multicenter retrospective study. Pediatr Blood Cancer 2017. [PMID: 28643357 DOI: 10.1002/pbc.26693] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Nuclear protein of the testis (NUT) carcinoma (formerly NUT midline carcinoma) is an aggressive tumor defined by the presence of NUT rearrangement with a poor prognosis. This rare cancer is underdiagnosed and poorly treated. OBJECTIVE The primary objective of this study was to describe the clinical, radiologic, and biological features of NUT carcinoma. The secondary objective was to describe the various treatments and assess their efficacy. METHODS This retrospective multicenter study was based on review of the medical records of children and adults with NUT carcinoma with specific rearrangement or positive anti-NUT nuclear staining (>50%). RESULTS This series of 12 patients had a median age of 18.1 years (ranges: 12.3-49.7 years). The primary tumor was located in the chest in eight patients, the head and neck in three patients, and one patient had a multifocal tumor. Nine patients presented regional lymph node involvement and eight distant metastases. One-half of patients were initially misdiagnosed. Specific NUT antibody was positive in all cases tested. A transient response to chemotherapy was observed in four of 11 patients. Only two patients were treated by surgery and five received radiotherapy with curative intent. At the end of follow-up, only one patient was still in remission more than 12 years after the diagnosis. Median overall survival was 4.7 months (95% confidence interval [CI]: 2.1-17.7). CONCLUSION NUT carcinoma is an aggressive disease refractory to conventional therapy. Early diagnosis by NUT-specific antibody immunostaining in cases of undifferentiated or poorly differentiated carcinoma to identify the specific rearrangement of NUT gene is useful to propose the optimal therapeutic strategy.
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Affiliation(s)
- Lauriane Lemelle
- Department of Pediatric, Adolescent, Young Adults, Institut Curie, Paris, France
| | - Gaëlle Pierron
- Unité de Génétique somatique, Institut Curie, Paris, France
| | - Paul Fréneaux
- Département de pathologie, Institut Curie, Paris, France
| | - Sophie Huybrechts
- Hematology-Oncology Unit, Hôpital Universitaire des Enfants Reine Fabiola, ULB Université libre de Bruxelles, Brussels, Belgium
| | - Alexandra Spiegel
- Department of Pediatric Hematology-Oncology, CHU Hautepierre, Strasbourg, France
| | - Dominique Plantaz
- Department of Pediatric Hematology-Oncology, Hôpital de Grenoble, Grenoble, France
| | - Morbize Julieron
- Head and Neck Surgery Department, Centre Oscar Lambret, Lille, France
| | - Sophie Dumoucel
- CHU Sainte Justine, University of Montreal, Montreal, Canada
| | - Antoine Italiano
- Department of Medical Oncology, Institut Bergonié, Bordeaux, France
| | - Fréderic Millot
- Pediatric Oncology Department, Centre Hospitalier Universitaire Poitiers, Poitiers, France
| | - Christophe Le Tourneau
- Medical Oncology Department, Institut Curie, Paris, France.,INSERM U900 Research unit, Saint-Cloud, France
| | - Guy Leverger
- Department of Pediatric Hematology and Oncology, Assistance Publique - Hôpitaux de Paris, Hôpital Armand Trousseau, Paris, France
| | - Pascal Chastagner
- Department of Pediatric Hematology-Oncology, Hôpital d'Enfants de Brabois, Vandoeuvre Les Nancy, France
| | - Matthieu Carton
- Population-Based Epidemiological Cohorts Unit, INSERM UMS 11, Villejuif, France
| | - Daniel Orbach
- Department of Pediatric, Adolescent, Young Adults, Institut Curie, Paris, France.,French Pediatric Rare Tumor Group (groupe Fracture)
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Deneuve S, Bodard AG, Delquignies E, Janot F, Zrounba P, Julieron M. Can Early Dissection of Cervical Lymph Nodes Improve Prognosis in Squamous Cell Carcinomas of the Hard Palate. ORL J Otorhinolaryngol Relat Spec 2017; 79:314-322. [DOI: 10.1159/000480351] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 08/14/2017] [Indexed: 11/19/2022]
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10
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Makhloufi S, Lefebvre G, Sakji I, Feutry F, Leroy T, Penel N, Coche B, Fourquet J, Ghestem F, Julieron M, Chevalier D, Tresch E. Prognostic impact of the neutrophil-to-lymphocyte ratio (NLR) on overall survival in patients treated with chemoradiotherapy for head and neck cancer. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx374.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Gorphe P, Von Tan J, El Bedoui S, Hartl DM, Auperin A, Qassemyar Q, Moya-Plana A, Janot F, Julieron M, Temam S. Early assessment of feasibility and technical specificities of transoral robotic surgery using the da Vinci Xi. J Robot Surg 2017; 11:455-461. [PMID: 28064382 DOI: 10.1007/s11701-017-0679-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [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: 10/17/2016] [Accepted: 01/02/2017] [Indexed: 11/26/2022]
Abstract
The latest generation Da Vinci® Xi™ Surgical System Robot released has not been evaluated to date in transoral surgery for head and neck cancers. We report here the 1-year results of a non-randomized phase II multicentric prospective trial aimed at assessing its feasibility and technical specificities. Our primary objective was to evaluate the feasibility of transoral robotic surgery using the da Vinci® Xi™ Surgical System Robot. The secondary objective was to assess peroperative outcomes. Twenty-seven patients, mean age 62.7 years, were included between May 2015 and June 2016 with tumors affecting the following sites: oropharynx (n = 21), larynx (n = 4), hypopharynx (n = 1), parapharyngeal space (n = 1). Eighteen patients were included for primary treatment, three for a local recurrence, and six for cancer in a previously irradiated field. Three were reconstructed with a FAMM flap and 6 with a free ALT flap. The mean docking time was 12 min. "Chopsticking" of surgical instruments was very rare. During hospitalization following surgery, 3 patients experienced significant bleeding between day 8 and 9 that required surgical transoral hemostasis (n = 1) or endovascular embolization (n = 2). Transoral robotic surgery using the da Vinci® Xi™ Surgical System Robot proved feasible with technological improvements compared to previous generation surgical system robots and with a similar postoperative course. Further technological progress is expected to be of significant benefit to the patients.
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Affiliation(s)
- Philippe Gorphe
- Department of Head and Neck Oncology, Gustave Roussy, 114 rue Edouard Vaillant, 94805, Villejuif, France.
| | - Jean Von Tan
- Department of Head and Neck Oncology, Oscar Lambret, Lille, France
| | - Sophie El Bedoui
- Department of Head and Neck Oncology, Oscar Lambret, Lille, France
| | - Dana M Hartl
- Department of Head and Neck Oncology, Gustave Roussy, 114 rue Edouard Vaillant, 94805, Villejuif, France
| | - Anne Auperin
- Department of Head and Neck Oncology, Gustave Roussy, 114 rue Edouard Vaillant, 94805, Villejuif, France
| | - Quentin Qassemyar
- Department of Head and Neck Oncology, Gustave Roussy, 114 rue Edouard Vaillant, 94805, Villejuif, France
| | - Antoine Moya-Plana
- Department of Head and Neck Oncology, Gustave Roussy, 114 rue Edouard Vaillant, 94805, Villejuif, France
| | - François Janot
- Department of Head and Neck Oncology, Gustave Roussy, 114 rue Edouard Vaillant, 94805, Villejuif, France
| | - Morbize Julieron
- Department of Head and Neck Oncology, Oscar Lambret, Lille, France
| | - Stephane Temam
- Department of Head and Neck Oncology, Gustave Roussy, 114 rue Edouard Vaillant, 94805, Villejuif, France
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Bosc R, Hersant B, Carloni R, Niddam J, Bouhassira J, De Kermadec H, Bequignon E, Wojcik T, Julieron M, Meningaud JP. Mandibular reconstruction after cancer: an in-house approach to manufacturing cutting guides. Int J Oral Maxillofac Surg 2016; 46:24-31. [PMID: 27815013 DOI: 10.1016/j.ijom.2016.10.004] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Revised: 07/15/2016] [Accepted: 10/05/2016] [Indexed: 11/28/2022]
Abstract
The restoration of mandibular bone defects after cancer can be facilitated by computer-assisted preoperative planning. The aim of this study was to assess an in-house manufacturing approach to customized cutting guides for use in the reconstruction of the mandible with osteocutaneous free flaps. A retrospective cohort study was performed, involving 18 patients who underwent mandibular reconstruction with a fibula free flap at three institutions during the period July 2012 to March 2015. A single surgeon designed and manufactured fibula and mandible cutting guides using a computer-aided design process and three-dimensional (3D) printing technology. The oncological outcomes, production parameters, and quality of the reconstructions performed for each patient were recorded. Computed tomography scans were acquired after surgery, and these were compared with the preoperative 3D models. Eighteen consecutive patients with squamous cell carcinoma underwent surgery and then reconstruction using this customized in-house surgical approach. The lengths of the fibula bone segments and the angle measurements in the simulations were similar to those of the postoperative volume rendering (P=0.61). The ease of access to 3D printing technology has enabled the computer-aided design and manufacturing of customized cutting guides for oral cancer treatment without the need for input from external laboratories.
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Affiliation(s)
- R Bosc
- Department of Plastic and Maxillofacial Surgery, Henri Mondor Hospital, Créteil, France.
| | - B Hersant
- Department of Plastic and Maxillofacial Surgery, Henri Mondor Hospital, Créteil, France
| | - R Carloni
- Department of Plastic and Maxillofacial Surgery, Henri Mondor Hospital, Créteil, France
| | - J Niddam
- Department of Plastic and Maxillofacial Surgery, Henri Mondor Hospital, Créteil, France
| | - J Bouhassira
- Department of Plastic and Maxillofacial Surgery, Henri Mondor Hospital, Créteil, France
| | - H De Kermadec
- Department of Head and Neck Surgery, Intercity Hospital of Creteil, Creteil, France
| | - E Bequignon
- Department of Head and Neck Surgery, Intercity Hospital of Creteil, Creteil, France
| | - T Wojcik
- Department of Head and Neck Surgery, Oscar Lambret Cancer Centre, Lille, France
| | - M Julieron
- Department of Head and Neck Surgery, Oscar Lambret Cancer Centre, Lille, France
| | - J-P Meningaud
- Department of Plastic and Maxillofacial Surgery, Henri Mondor Hospital, Créteil, France
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Farrow E, Boulanger T, Wojcik T, Lemaire AS, Raoul G, Julieron M. Magnetic resonance imaging and computed tomography in the assessment of mandibular invasion by squamous cell carcinoma of the oral cavity. Influence on surgical management and post-operative course. ACTA ACUST UNITED AC 2016; 117:311-321. [DOI: 10.1016/j.revsto.2016.06.004] [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: 09/07/2015] [Revised: 04/19/2016] [Accepted: 06/10/2016] [Indexed: 11/28/2022]
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Coche-Dequéant B, Cordoba A, Comte P, Lacornerie T, Cheval V, Escande A, Chevalier D, Julieron M, Lartigau É, Mirabel X. Mise en place de la curiethérapie à débit pulsé dans le traitement des carcinomes de la sphère ORL et stomatologique : à propos de 79cas. Cancer Radiother 2016. [DOI: 10.1016/j.canrad.2016.08.081] [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: 10/21/2022]
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Nathalie L, Lefebvre G, Tresch E, Degardin M, Maillard S, Coche-Dequéant B, Singier S, Mailliez A, Marliot G, Sakji I, Amela E, Kotecki N, Penel N, El Bedoui S, Julieron M, Lartigau E. Prospective study of concomitant stereotaxic reirradiation and mitomycin with cetuximab for recurrent head and neck cancer. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e17024] [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)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Eric Lartigau
- Oscar Lambret Comprehensive Cancer Center, Lille, France
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Christophe V, Leroy T, Seillier M, Duthilleul C, Julieron M, Clisant S, Foncel J, Vallet F, Lefebvre JL. Determinants of patient delay in doctor consultation in head and neck cancers (Protocol DEREDIA). BMJ Open 2014; 4:e005286. [PMID: 25063460 PMCID: PMC4120429 DOI: 10.1136/bmjopen-2014-005286] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Reducing the time between the onset of the first symptoms of cancer and the first consultation with a doctor (patient delay) is essential to improve the vital prognosis and quality of life of patients. Longer patient delay is linked to the already known sociodemographic, socioeconomic, socioeducational, sociocultural and socioprofessional factors. However, recent data suggest that some sociocognitive and emotional determinants may explain patient delay from a complementary point of view. The main objective of this study is to assess whether, in head and neck cancer, patient delay is linked to these sociocognitive and emotional factors, in addition to previously known factors. METHODS AND ANALYSIS We intend to include in this study 400 patients with a not yet treated head and neck cancer diagnosed in one of six health centres in the North of France region. The main evaluation criterion is 'patient delay'. Sociocognitive, emotional, medical, sociodemographic, socioeconomic, educational, professional and geographic factors will be assessed by means of (1) a case report form, (2) a questionnaire completed by the clinical research associate together with the patient, (3) a questionnaire completed by the patient and (4) a recorded semidirective interview of the patient by a psychologist (for 80 patients only). The collected data will be analysed to underline the differences between patients who consulted a doctor earlier versus those who consulted later. ETHICS The study has obtained all the relevant authorisations for the protection of patients enrolled in clinical trials (CCTIRS, CCP, CNIL), does not involve products mentioned in article L.5311-1 of the French Code of Public Health, and does not imply any changes in the medical care received by the patients. The study began in October 2012 and will end in June 2015. TRIAL REGISTRATION ID-RCB 2012-A00005-38.
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Affiliation(s)
- Véronique Christophe
- Lille 3 University—URECA EA1059, Villeneuve d'Ascq cedex, France
- U1086 INSERM “Cancers & Préventions”, Université de Caen Basse-Normandie, Avenue de la côte de Nacre, Caen Cedex 5, France
- SIRIC ONCOLille—Maison Régionale de la Recherche Clinique, Lille Cedex, France
| | - Tanguy Leroy
- Lille 3 University—URECA EA1059, Villeneuve d'Ascq cedex, France
- Aix-Marseille University—Public Health and Chronic Diseases, 3 SIRIC ONCOLille, EA 3279, Marseille cedex 05, France
| | - Mélanie Seillier
- Lille 3 University—URECA EA1059, Villeneuve d'Ascq cedex, France
- CERFEP, CARSAT Nord Pas de Calais Picardie, Villeneuve d'Ascq cedex, France
| | | | - Morbize Julieron
- Centre Oscar Lambret—Cervicofacial Oncology Department, Lille cedex, France
| | - Stéphanie Clisant
- Centre Oscar Lambret—Cervicofacial Oncology Department, Lille cedex, France
| | - Jérôme Foncel
- Lille 3 University—EQUIPPE EA 4018, Villeneuve d'Ascq cedex, France
| | - Fanny Vallet
- Lille 3 University—URECA EA1059, Villeneuve d'Ascq cedex, France
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Minard-Colin V, Kolb F, Saint-Rose C, Fayard F, Janot F, Rey A, Canale S, Julieron M, Corradini N, Raquin MA, Habrand JL, Grill J, George B, Ba Huy PT, Couloignier V, Terrier-Lacombe MJ, Luboinski B, Valteau-Couanet D, Oberlin O. Impact of extensive surgery in multidisciplinary approach of pterygopalatine/infratemporal fossa soft tissue sarcoma. Pediatr Blood Cancer 2013; 60:928-34. [PMID: 23303699 DOI: 10.1002/pbc.24374] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Accepted: 09/27/2012] [Indexed: 11/08/2022]
Abstract
BACKGROUND To evaluate a strategy whereby extensive surgery ± external radiotherapy (RT) could improve local control in pterygopalatine/infratemporal fossa (PIF) sarcoma. PROCEDURE Forty-one patients with a diagnosis of sarcoma involving the PIF and referred to our Institute from 1984 to 2009 were included in the analysis. Patients received multidrug chemotherapy and radiotherapy ± surgery, depending on the period of treatment. RESULTS The median age at diagnosis was 7.6 years (range: 0.1-22 years). There were 36 RMS, 3 undifferentiated sarcoma and 2 other soft-tissue sarcomas. Sixty-eight percent of patients had meningeal risk factors at diagnosis. Local treatment consisted of RT alone in 19 patients, surgery in combination to RT in 19 patients and surgery alone in 3 patients. The local progression rate (LPR) at 5 years was 45% for the entire population, 59% for the 19 patients treated with RT alone and 34% for the 22 patients who had surgery as part of their treatment. All locoregional failures after extensive surgery occurred at the skull base and/or in leptomeningeal spaces. CONCLUSIONS Multidisciplinary approach including extensive surgery for PIF sarcoma is feasible and yields good local control with 15/22 patients in local complete remission. Future studies are warranted to confirm these promising results, to evaluate the possibility of avoiding RT or limiting the RT field, and to extend the indication for extensive surgery to other "worse" sites of PM sarcoma such as the paranasal sinuses.
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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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Deneuve S, Bidault F, Casiraghi O, Le Ridant AM, Kolb F, Piaton JM, Julieron M. [Lacrimal duct tumors: diagnostic and therapeutic dilemmas]. J Fr Ophtalmol 2012. [PMID: 23201345 DOI: 10.1016/j.jfo.2012.09.001] [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] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Fewer than 250 primary tumors of the lacrimal duct have been reported in the international literature. Because their signs and symptoms are nonspecific and usually subclinical, delayed diagnosis is common. Treatment for malignant epithelial tumors is surgical, with or without radiation. PATIENTS AND METHODS The present study is a retrospective analysis of five patients with malignant lacrimal duct tumors. RESULTS Three patients were diagnosed with carcinoma requiring wide en bloc surgical resection with surgical reconstruction. One underwent adjuvant radiation therapy. Another experienced simultaneous local and lymph node recurrence after 3 years and underwent curative surgery. Two additional patients were diagnosed with diffuse malignant large B-cell non-Hodgkins lymphoma. DISCUSSION Early symptoms of lacrimal duct tumors are nonspecific and mimic acute dacryocystitis. Lacrimal system CT, MRI and rhinoscopy may allow for earlier diagnosis. Surgical treatment requires resection with wide margins and reconstruction of the medial canthal region. CONCLUSION Only an early diagnosis can reduce the impairment related to surgery and the extent of the required reconstruction, as well as improve survival.
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Affiliation(s)
- S Deneuve
- Département de chirurgie cervicofaciale, institut Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif, France.
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Saada E, Ferrand F, Fekih M, Hamdan D, Janot F, Temam S, Julieron M, Leridant A, Schilf A, Guigay J. Docetaxel, Carboplatin and Fluoro-Uracil (TCF) Induction Therapy in Locally Advanced Head and Neck Squamous Cell Carcinoma (HNSCC) Patients with Contraindication for Cisplatin Based Combination (TPF). Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)33593-6] [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: 10/25/2022] Open
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21
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Thariat J, Julieron M, Brouchet A, Italiano A, Schouman T, Marcy PY, Odin G, Lacout A, Dassonville O, Peyrottes-Birstwisles I, Miller R, Thyss A, Isambert N. Osteosarcomas of the mandible: are they different from other tumor sites? Crit Rev Oncol Hematol 2011; 82:280-95. [PMID: 21868246 DOI: 10.1016/j.critrevonc.2011.07.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Revised: 07/03/2011] [Accepted: 07/29/2011] [Indexed: 10/17/2022] Open
Abstract
BACKGROUND Osteosarcomas of the mandible (MOS) affect 1/10 million persons/year, mostly the young adult. Due to lack of specific data, the treatment of MOS is extrapolated from that of extragnathic OS but varies widely between institutions. MATERIALS AND METHODS We aimed at providing a focused description of MOS histologies and grades through the English literature, at determining the evidence-based role of chemotherapy, of adjuvant radiation therapy and the potential of reconstructive surgery tailored through modern pre-operative multi-modal imaging. RESULTS The estimated proportion of high grade MOS was 58%. However, low-grade MOS may be underestimated as they are mostly reported as case reports. The intermediate grade was hardly found in the literature. Estimated weighted-mean proportions of chondroblastic and osteoblastic MOS were 37% and 46%, respectively. Multimodal imaging modalities including MRI has a great potential for accurate pre-operative assessment of tumor extensions into bone and soft tissues. Surgery is the mainstay of treatment and margins the most important factor. The role of neoadjuvant chemotherapy in treating occult systemic metastases and in increasing the probability of clear margins is controversial, as well as the histology-dependent response to chemotherapy. The role of adjuvant radiotherapy (mostly proposed for positive margins) and/or adjuvant chemotherapy is still controversial. Crude survival is around 77% and local control around 67%. Local failure is the main cause of death in MOS compared to extragnathic sites.
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Affiliation(s)
- Juliette Thariat
- Department of Radiation Oncology/IBDC CNRS UMR 6543, Cancer Center Antoine-Lacassagne - Institut Universitaire de la Face et du Cou, University Nice Sophia-Antipolis, 33 Av. Valombrose, 06189 NICE Cedex 2 France.
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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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Janot F, de Raucourt D, Benhamou E, Ferron C, Dolivet G, Bensadoun RJ, Hamoir M, Géry B, Julieron M, Castaing M, Bardet E, Grégoire V, Bourhis J. Randomized trial of postoperative reirradiation combined with chemotherapy after salvage surgery compared with salvage surgery alone in head and neck carcinoma. J Clin Oncol 2008; 26:5518-23. [PMID: 18936479 DOI: 10.1200/jco.2007.15.0102] [Citation(s) in RCA: 271] [Impact Index Per Article: 16.9] [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
PURPOSE Full-dose reirradiation combined with chemotherapy has been shown to be feasible after salvage surgery with acceptable toxicity. The Groupe d'Etude des Tumeurs de la Tête et du Cou and Groupe d'Oncologie Radiothérapie Tête Et Cou groups performed a randomized study to assess its efficacy. PATIENTS AND METHODS Between 1999 and 2005, 130 patients with head and neck cancer were treated with salvage surgery and randomly assigned to full-dose reirradiation combined with chemotherapy (RT arm) or to observation (a "wait and see" approach; WS arm). Eligibility criteria were recurrence or a second primary tumor in a previously irradiated area, no major sequelae resulting from the first radiotherapy, good general condition, no distant metastasis, and salvage surgery with macroscopic complete resection. Patients in the RT arm received 60 Gy over 11 weeks combined with concomitant fluorouracil and hydroxyurea. RESULTS Sixty-five patients were randomly assigned to each arm. There was no imbalance in the distribution of the main tumor and patients characteristics. The most serious acute toxicity in the RT arm was mucositis, attaining grade 3 or 4 in 28% of patients. At 2 years, 39% of patients in the RT arm and 10% in the WS arm experienced grade 3 or 4 late toxicity according to Radiation Therapy Oncology Group criteria (P = .06). Disease-free survival (DFS) was significantly improved in the RT arm, with a hazard ratio of 1.68 (95% CI, 1.13 to 2.50; P = .01), but overall survival (OS) was not statistically different. CONCLUSION Full-dose reirradiation combined with chemotherapy after salvage surgery significantly improved DFS, but had no significant impact on OS. An increase in both acute and late toxicity was observed.
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Affiliation(s)
- François Janot
- Institut Gustave-Roussy, 39 rue Camille Desmoulins, Villejuif, France.
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Rosenthal EL, Wax MK, Haiti DM, Julieron M, LeRidant AM, Marandas P, Janot F, Lusinchi A, Bourhis J. 11:14: Botulinum Toxin for Radiation-Induced Pain and Trismus. Otolaryngol Head Neck Surg 2007. [DOI: 10.1016/j.otohns.2007.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Janot F, de Raucourt D, Castaing M, Giger R, Babin E, Ferron C, Dolivet G, Bensadoun J, Hamoir M, Julieron M, Mamelle G, Bourhis J. Randomised trial of re-irradiation combined with chemotherapy after salvage surgery in head and neck carcinoma: Carcinologic and quality of life results gettec and gortec groups. Radiother Oncol 2007. [DOI: 10.1016/s0167-8140(07)80055-7] [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: 10/23/2022]
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Mamelle G, Temam S, Casiraghi O, Julieron M, Le Ridant A. Results of prospective study of sentinel node biopsy in oral cavity tumours. Radiother Oncol 2007. [DOI: 10.1016/s0167-8140(07)80045-4] [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: 11/29/2022]
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Bourhis J, Lapeyre M, Tortochaux J, Rives M, Aghili M, Bourdin S, Lesaunier F, Benassi T, Lemanski C, Geoffrois L, Lusinchi A, Verrelle P, Bardet E, Julieron M, Wibault P, Luboinski M, Benhamou E. Phase III randomized trial of very accelerated radiation therapy compared with conventional radiation therapy in squamous cell head and neck cancer: a GORTEC trial. J Clin Oncol 2006; 24:2873-8. [PMID: 16782926 DOI: 10.1200/jco.2006.08.057] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.5] [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: 11/20/2022] Open
Abstract
PURPOSE With the aim to increase the dose intensity of radiation therapy (RT), and subsequently the locoregional control rate, a very accelerated RT regimen was compared with conventional RT in a series of patients with head and neck squamous cell carcinoma (HNSCC). PATIENTS AND METHODS Between 1994 and 1998, 268 patients with T3 or T4, N0 to N3 HNSCC (staged by 1997 International Union Against Cancer criteria) that was not eligible for surgery were randomly assigned to receive either conventional RT, delivering 70 Gy in 7 weeks to the primary tumor and 35 fractions of 2 Gy over 49 days, or to receive very accelerated RT, delivering 62 to 64 Gy in 31 to 32 fractions of 2 Gy over 22 to 23 days (2 Gy/fraction bid). RESULTS The most common tumor site was the oropharynx and most of the patients (70%) had T4 and N1 to N3 tumors in 72% of patients. The main patient and tumor characteristics were well-balanced between the two arms. The median total doses were 63 Gy (accelerated) and 70 Gy (conventional), with a median overall time of 22 days and 48 days, respectively. Acute mucositis was markedly increased in the accelerated-RT arm (P < .001). The locoregional control rate was improved by 24% at 6 years with accelerated RT. In contrast, disease-free survival and overall survival were not significantly different between the two arms. There was no difference in late effects between the two arms. CONCLUSION The very accelerated RT regimen was feasible and provided a major benefit in locoregional control but had a modest effect on survival.
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Affiliation(s)
- Jean Bourhis
- Institut Gustave Roussy, Radiation Oncology, Head and Neck Statistics Department, Villejuif, France.
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Temam S, Janot F, Germain M, Julieron M, Bretagne E, Myers JN, Marandas P, Mamelle G, Leridant AM, Kolb F, Luboinski B. Functional results with advanced hypopharyngeal carcinoma treated with circular near-total pharyngolaryngectomy and jejunal free-flap repair. Head Neck 2006; 28:8-14. [PMID: 16155913 DOI: 10.1002/hed.20286] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Patients treated by a circular pharyngolaryngectomy for advanced hypopharyngeal carcinoma have a poor prognosis and disappointing speech restoration. METHODS Three carefully selected patients underwent a near-total laryngectomy circular pharyngectomy with jejunal free flap repair and dynamic tracheopharyngeal shunt for treatment of advanced hypopharyngeal carcinoma. They received induction chemotherapy and postoperative radiotherapy. We assessed the functional outcome. RESULTS There was no major local complication. One year after the end of radiotherapy, all patients were able to eat solid diets. Two patients were able to speak immediately after the end of the treatment. After speech re-education, a high-quality tracheopharyngeal voice was restored in all three patients. Performance Status Scale for Head and Neck Cancer Patients (PSSHN) showed a mean score equal to 81/100 at 1 year. CONCLUSIONS In selected patients, near-total laryngectomy circular pharyngectomy with tracheopharyngeal shunt and jejunal free-flap repair offers good voice rehabilitation without impairing swallowing function.
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Affiliation(s)
- Stephane Temam
- Department of Otorhinolaryngology-Head and Neck Surgery, Institut Gustave-Roussy, 39 rue Camille Desmoulins, 94805 Villejuif, France.
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Temam S, Pape E, Janot F, Wibault P, Julieron M, Lusinchi A, Mamelle G, Marandas P, Luboinski B, Bourhis J. Salvage surgery after failure of very accelerated radiotherapy in advanced head-and-neck squamous cell carcinoma. Int J Radiat Oncol Biol Phys 2005; 62:1078-83. [PMID: 15990011 DOI: 10.1016/j.ijrobp.2004.12.062] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.6] [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: 08/30/2004] [Revised: 12/14/2004] [Accepted: 12/16/2004] [Indexed: 11/16/2022]
Abstract
PURPOSE To assess the efficacy and toxicity of salvage surgery for local or cervical nodal recurrence after accelerated radiotherapy for locally advanced head-and-neck squamous cell carcinoma (HNSCC). METHODS AND MATERIALS We reviewed the medical records of the 136 patients with HNSCC who had been treated in three consecutive clinical trials at the Institut Gustave-Roussy using a very accelerated radiotherapy regimen (62 to 64 Gy with 2 daily fractions of 1.8 to 2 Gy over 3.5 weeks). Sixty-nine patients of the 136 initial patients (51%) had local or neck lymph nodes relapse, or both. RESULTS Sixteen of these 69 patients (23%) had undergone salvage surgery for recurrence locally (n = 8) or in the cervical nodes (n = 8). All 16 had initially been diagnosed with locally advanced oropharyngeal carcinoma (T4, 11 patients; T3, 5 patients), and 13 had initially had cervical node involvement. After salvage surgery, 6 patients had had a local recurrence; 7, cervical node recurrence; and 3, distant metastasis. Thus, salvage surgery had been successful only in 3 patients. The 3- and 5-year overall actuarial survival rates were 20% and 11%, respectively. Eight patients had major postoperative wound complications, including carotid rupture in three cases. CONCLUSION Salvage surgery for relapse after very accelerated radiotherapy for advanced HNSCC is infrequently feasible and is of limited survival benefit. It should be used only in carefully selected cases.
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Affiliation(s)
- Stephane Temam
- Department of Otorhinolaryngology-Head and Neck Surgery, Institut Gustave-Roussy, 39 rue Camille Desmoulins, 94805 Villejuif, France
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Abstract
Oncologic cervicofacial surgery and plastic surgery have had a common evolution over the last 50 years where progress erasing from one was beneficial to the other one. We review here the historical evolution of these specialties and present the state of the art of plastic surgery in the field of cervicofacial oncology.
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Affiliation(s)
- F Kolb
- Département de cancérologie cervicofaciale, institut Gustave-Roussy, 39, rue Camille-Desmoulins, 94895 Villejuif, France.
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Temam S, Casiraghi O, Lahaye JB, Bosq J, Zhou X, Julieron M, Mamelle G, Lee JJ, Mao L, Luboinski B, Benard J, Janot F. Tetranucleotide microsatellite instability in surgical margins for prediction of local recurrence of head and neck squamous cell carcinoma. Clin Cancer Res 2005; 10:4022-8. [PMID: 15217934 DOI: 10.1158/1078-0432.ccr-04-0199] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Postoperative radiotherapy is used to prevent local recurrence of head and neck squamous cell carcinoma in patients with positive surgical margins. We sought to determine whether tetranucleotide microsatellite instability could be detected in surgical margins and used to predict local recurrence. EXPERIMENTAL DESIGN We prospectively collected tumor and surgical margin specimens from patients with head and neck squamous cell carcinoma who had undergone surgical resection at Institut Gustave-Roussy during a 1-year period. Margins were considered positive if extensive pathological examination revealed either carcinoma within 5 mm or dysplasia. We tested five tetranucleotide microsatellite markers (UT5085, L17686, D9S753, ACTBP2, and CSF1R) in the tumor specimens and paired surgical margins of the patients whose margins were negative on pathological examination. RESULTS Pathological examination revealed that among the 76 patients, 22 had positive margins; therefore, these patients were excluded. Of the 54 remaining patients, 26 (48%) had tumors informative for markers UT5085, L17686, or both; the other 3 markers were not informative. Seven (27%) of the 26 informative tumors had the same instability pattern in the surgical margins. At a median follow-up of 26 months, 5 of the 7 local recurrences occurred in patients with molecularly positive surgical margins. A strong, independent association was found between positive surgical margins and local recurrence (P = 0.01; hazard ratio, 6.49). CONCLUSIONS Tetranucleotide microsatellite instability in surgical margins may be a useful biomarker to predict local recurrence of head and neck squamous cell carcinoma in patients with apparently disease-free margins.
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Temam S, Mamelle G, Marandas P, Wibault P, Avril MF, Janot F, Julieron M, Schwaab G, Luboinski B. Postoperative radiotherapy for primary mucosal melanoma of the head and neck. Cancer 2005; 103:313-9. [PMID: 15578718 DOI: 10.1002/cncr.20775] [Citation(s) in RCA: 154] [Impact Index Per Article: 8.1] [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: 11/06/2022]
Abstract
BACKGROUND Primary head and neck mucosal melanoma (HNMM) has a poor prognosis with a low local control rate and frequent distant metastases. The objective of the current study was to determine the impact of postoperative radiotherapy on local control and survival. METHODS One hundred forty-two patients with primary HNMM treated between 1979 and 1997 were reviewed. Of these, 69 patients with confirmed primary mucosal melanoma, absence of metastatic disease, and definitive management by surgery with or without postoperative radiotherapy and follow-up at the Institut Gustave-Roussy (Villejuif) were selected. The site of primary HNMM was sinonasal in 46 patients, oral in 19 patients, and pharyngolaryngeal in 4 patients. Twenty-two patients (32%) had a locally advanced tumor (T3-T4) and 17 patients had regional lymph node metastases after pathologic examination (pN > 0). Thirty patients underwent surgery alone and 39 received postoperative radiotherapy. Patients with locally advanced tumors had received postoperative radiotherapy more frequently than those with small tumors (P = 0.02). RESULTS Thirty-seven patients (54%) experienced local disease recurrence and 47 patients (68%) developed distant metastasis. The overall survival rates were 47% at 2 years and 20% at 5 years. In the Cox multivariate analysis, patients with early T-classification tumors who received postoperative radiotherapy had a better local disease-free survival (P = 0.004 and P = 0.05, respectively) compared with patients with late T-classification tumors who did not receive postoperative radiotherapy. Patients with advanced T-classification and pN > 0 stage had a shorter distant metastasis disease-free survival compared with patients with early T-classification and pN < 0 stage. Patients with advanced T-classification tumors had a shorter overall survival compared with patients with early T-classification tumors (P = 0.003). CONCLUSIONS The prognosis of patients with HNMM was poor. Patients had a high rate of distant metastasis and a low rate of local control. The current study suggested that postoperative radiotherapy increased local control even for patients with small tumors.
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Affiliation(s)
- Stephane Temam
- Department of Otorhinolaryngology/Head and Neck Surgery, Institut Gustave-Roussy, Villejuif, France.
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Temam S, Koka V, Mamelle G, Julieron M, Carmantrant R, Marandas P, Janot F, Bourhis J, Luboinski B. Treatment of the N0 neck during salvage surgery after radiotherapy of head and neck squamous cell carcinoma. Head Neck 2005; 27:653-8. [PMID: 16035097 DOI: 10.1002/hed.20234] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [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: 11/09/2022] Open
Abstract
BACKGROUND The morbidity and mortality rates of salvage surgery in patients with local recurrence of head and neck squamous cell carcinoma (HNSCC) after radiotherapy are high. The aim of this study was to determine the rate of occult neck node metastasis and the surgical morbidity of patients after salvage surgery for local relapse after definitive radiotherapy. METHODS Thirty patients who underwent salvage surgery with a simultaneous neck node dissection for a local relapse after definitive radiotherapy for HNSCC between 1992 and 2000 were included in this study. The primary tumor sites were oral cavity in six patients, oropharynx in 17, supraglottic larynx in three, and hypopharynx in four. Initially, seven patients had T2 disease, eight had T3, and 15 had T4. RESULTS Twelve patients (40%) experienced postoperative complications, including two deaths. There was no cervical lymph node metastasis (pN0) in 29 of the 30 patients. Fifteen patients (50%) had a recurrence after salvage surgery, including 11 new local recurrences and four patients with distant metastasis. CONCLUSIONS The risk of neck node metastasis during salvage surgery for local recurrence in patients treated initially with radiation for N0 HNSCC is low. Neck dissection should be performed in only limited area, depending on the surgical procedure used for tumor resection.
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Affiliation(s)
- Stephane Temam
- Department of Otorhinolaryngology-Head and Neck Surgery, Institut Gustave-Roussy, 39 rue Camille Desmoulins, 94805 Villejuif, France.
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Faivre S, Marti A, Rixe O, Janot F, Julieron M, Gatineau M, Temam S, Armand JP, Domenge C, Luboinski B, Raymond E. Preoperative sequential chemotherapy in locally advanced squamous cell carcinoma of the head and neck. Head Neck 2005; 27:311-9. [PMID: 15700290 DOI: 10.1002/hed.20155] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Induction chemotherapy may contribute to decreased local and distant recurrences in patients with locally advanced squamous cell carcinoma of the head and neck (SCCHN) resectable for cure. METHODS Patients with previously untreated locally advanced stage III-IV (N0-2, M0) SCCHN received a dose-dense sequential regimen combining cisplatin/5-fluorouracil followed by bleomycin/methotrexate/hydroxyurea. Induction chemotherapy was followed by locoregional surgery and/or radiation therapy. RESULTS Among 37 patients, 23 (62%) had T4 primary tumors. Grade 3 to 4 asymptomatic hematologic toxicity occurred in less than 15% of patients. Nonhematologic toxicities were limited to grade 1 to 2 in less than 20% of patients. In the overall cohort (intent-to-treat; n = 35), 24 (68.5%) of 35 patients had objective clinical responses, including nine complete responses (25.7%). Fifty-seven percent of patients were free of disease at 2.5 years. CONCLUSIONS Sequential induction chemotherapy is feasible and active in patients with locally advanced head and neck cancers and may further include recent compounds such as taxanes.
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Affiliation(s)
- Sandrine Faivre
- Department of Head and Neck Surgery, Department of Head and Neck Surgery, Gustave-Roussy Institute, 39 rue Camille-Desmoulins, 94805 Villejuif Cedex, France
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Julieron M, Temam S. [Locoregional recurrence of ORL cancer: the place of surgery]. Bull Cancer 2004; 91:863-9. [PMID: 15582890] [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: 05/01/2023]
Abstract
Surgery of locoregional failures is mainly represented by salvage surgery after radiotherapy. Due to progress of radiotherapy, especially modification of fractionation and association with chemotherapy, the problem of salvage surgery is nowadays emphasized. Despite the reduction of postoperative mortality and morbidity by the use of myocutaneous flaps the complications are still frequent and the rehabilitation long and difficult. Oncologic results are disappointing too, especially in salvage surgery for oropharyngeal and hypopharyngeal tumors with less than a half of patients being candidates for salvage surgery and 5 year survival rates inferior to 30% in these patients. Laryngeal tumors are more favorable for salvage surgery but in the majority of the cases recurrences after radiotherapy require a total laryngectomy. The poor postoperative, functional and oncologic results after salvage surgery, especially in pharyngeal tumors must be taken into account for the decision of primary treatment. Regarding the important locoregional aggressivity of squamous cell carcinomas of the upper aerodigestive tract, these results must be kept in mind when preservation protocols are in question.
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Affiliation(s)
- Morbize Julieron
- Département d'oto-rhino-laryngologie et de chirurgie cervicofaciale, Institut Gustave-Roussy, 39 rue Camille-Desmoulins, 94805 Villejuif.
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Faivre S, Alsabe H, Djafari L, Janot F, Julieron M, Domenge C, Djazouli K, Armand JP, Luboinski B, Raymond E. Locoregional effects of pegylated liposomal doxorubicin (Caelyx) in irradiated area: a phase I-II study in patients with recurrent squamous cell carcinoma of the head and neck. Eur J Cancer 2004; 40:1517-21. [PMID: 15196535 DOI: 10.1016/j.ejca.2004.03.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [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: 03/03/2004] [Revised: 03/24/2004] [Accepted: 03/25/2004] [Indexed: 11/26/2022]
Abstract
Aim of this study was to determine the antitumour activity and toxicity of pegylated liposomal doxorubicin (Caelyx) in pretreated patients with locally recurrent and/or metastatic squamous cell carcinoma of the head and neck (SCCHN). Caelyx was administrated as 1 h infusion every 3 weeks at doses of 35 mg/m2 (group A) and then subsequently given at 45 mg/m2 (group B). 26 patients received a total of 87 cycles. The median number of cycles was 3 (range 1-7). Four out of 24 evaluable patients (17%, 95% confidence interval (CI) 0.5-32%) showed significant evidence of antitumour activity, with tumour necrosis being observed in 2 patients. Grade 3-4 neutropenia was observed in only 2 patients. There were no grade 3-4 mucosal, skin, digestive, cardiac or hepatic toxicities. Caelyx has activity against locally recurrent SCCHN and is well tolerated up to 45 mg/m2, but a careful utilisation of this drug is required for tumours relapsing in irradiated areas.
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Affiliation(s)
- Sandrine Faivre
- Department of Medicine, Institut Gustave-Roussy, Villejuif Cedex, France.
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Janot F, Julieron M. [Functional surgery for head and neck squamous cell carcinoma]. Bull Cancer 2002; 89:1011-7. [PMID: 12525359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
Surgery for head and neck squamous cell carcinoma can alter speech, swallowing, and cosmoses. Recent tendency is to avoid mutilating surgery unless the tumour is aggressive or resistant to chemotherapy and or radiotherapy. Functional surgery is being widely employed, and for example it may vary between conventional partial surgery and endoscopic laser surgery for small sized vocal cord cancers. Various new reconstructive procedures have been developed to help early functional restoration. Loco-regional flaps can be used to replace gums and avoid dental extractions. Free flaps with micro-vascular anastomosis can be employed for immediate reconstruction of extensive surgical defects involving pharyngeal wall, tongue, mandible and mid-face to restore better function and cosmoses. Few recently developed techniques can be also employed in selected cases of laryngo-pharyngeal cancers to avoid permanent laryngeal mutilation. Another goal of functional surgery is to decrease the postoperative radiotherapy or chemo-radiotherapy sequelae, and obtain successful postoperative functional rehabilitation.
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Affiliation(s)
- François Janot
- Département d'ORL et de chirurgie cervicofaciale, Institut Gustave-Roussy, 39, rue Camille-Desmoulins, 94800 Villejuif, France.
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Schwaab G, Kolb F, Julieron M, Janot F, Le Ridant AM, Mamelle G, Marandas P, Koka VN, Luboinski B. Subtotal laryngectomy with cricohyoidopexy as first treatment procedure for supraglottic carcinoma: Institut Gustave-Roussy experience (146 cases, 1974-1997). Eur Arch Otorhinolaryngol 2001; 258:246-9. [PMID: 11548904 DOI: 10.1007/s004050100348] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PATIENTS AND METHODS Between 1974 and 1997, 297 patients underwent a subtotal laryngectomy at the Institut Gustave-Roussy; 146 of these patients underwent cricohyoidopexy (CHP) for a supraglottic primary as their first treatment. The majority of patients were men (137) aged from 33 to 78 years (median 54 years). The tumour stage at presentation was T1 in 2, T2 in 87, T3 in 53 (preepiglottic space involvement), and T4 (minimal thyroid cartilage invasion) in 4 patients. One hundred and twenty-five patients were N0 (86%) and 21 patients were Np (palpable); 98% had homolateral and 55% had bilateral neck dissections. RESULTS One patient died postoperatively of a myocardial infarction and 68% patients had an uneventful course. Aspiration was the commonest complication (23 patients, 19%). The median time to removal of the tracheotomy cannula was 10 days and for the nasogastric tube 21 days during the past 10 years. Completion of subtotal laryngectomy into total laryngectomy was done in 21 cases (15%): eight times because of oncological events [five local failures, two second primary (hypopharynx), one positive margin] and 13 times because of aspiration (9%). There were six local failures (4%) and eight nodal failures (5%). The rates of distant metastases and second primaries were 6% and 16% respectively. Half of the local and nodal failures were subsequently sterilized. Findings at death were two local recurrences, four nodal recurrences, eight distant metastases, and 11 second primaries. The 3- and 5-year overall survival rates were 92% and 88% respectively, with an overall laryngeal preservation rate of 86%. CONCLUSION When supraglottic laryngectomy is not feasible for supraglottic cancer, subtotal laryngectomy with CHP is a safe and effective oncological procedure, with preservation of satisfactory laryngeal function.
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Affiliation(s)
- G Schwaab
- Département de Chirurgie Cervico-Faciale, Institut Gustave-Roussy, Villejuif, France
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Julieron M, Kolb F, Schwaab G, Marandas P, Billard V, Lusinchi A, Le Ridant AM, Luboinski B. Surgical management of posterior pharyngeal wall carcinomas: functional and oncologic results. Head Neck 2001; 23:80-6. [PMID: 11303637 DOI: 10.1002/1097-0347(200102)23:2<80::aid-hed1002>3.0.co;2-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [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: 11/11/2022] Open
Abstract
BACKGROUND The optimal primary treatment for posterior pharyngeal wall tumors remains controversial. METHODS To assess the relevance of surgical treatment from a functional and oncologic point of view, we reviewed the cases of 77 patients surgically treated between 1984 and 1995. Among them 23 had been previously irradiated. Fifty-five patients underwent a conservative surgery (CS) sparing the larynx; 19 direct closures, 6 reconstructions of the posterior wall with a thoracic myocutaneous flap, 15 with a platysma flap, and 15 with a free forearm flap were performed. Twenty-two patients underwent radical surgery (RS). All previously untreated patients had postoperative radiotherapy. The functional assessment concerned the CS group. Oncologic results, especially local control and survival were studied for the whole group. RESULTS Of the 55 patients who underwent CS, 53 (96%) had their canula and 49 (89%) their feeding tube removed. At 1 year, in the platysma and free forearm groups, 21 of the 24 assessable patients were back to exclusive oral intake. For patients treated by primary surgery followed by radiotherapy, the rate of local failure was 11% (18% for tumors greater than 4 cm), and the 5-year survival rate was 35%. For patients who had previous radiotherapy, the rates were, respectively, 52% and 16%. CONCLUSION The satisfactory functional results, caused by the improvement of reconstructive procedures, allow conservative surgery even in the case of large tumors. Oncologic results, especially local control, suggest that primary surgery followed by radiotherapy is effective for the treatment of posterior wall cancer. The oncologic results of surgery in a previously irradiated area are poor, and CS is not recommended in these cases.
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Affiliation(s)
- M Julieron
- Department of Head and Neck Surgery, Institut Gustave-Roussy, Villejuif, France. julieronigr.fr
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Germain MA, Agudelo D, Julieron M, Luboinski B, Trotoux J, Clavier A, Marzetti A. U-shaped free jejunal transplantation: improved technique and indications. J Otolaryngol 2000; 29:135-8. [PMID: 10883824] [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: 02/16/2023]
Abstract
Reconstruction of the oropharynx and the hypopharynx is difficult due to their wide diameters. We report eight cases of circumferential pharyngolaryngectomies for epidermoid carcinomas of the hypopharynx extended to the oropharynx and classified T4. Reconstruction was performed with a U-shaped free jejunal transplantation. This specific technique consists of a side to side anastomosis between two loops of jejunum. It facilitates reconstruction at the level of the oropharynx and diminishes postoperative complications.
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Affiliation(s)
- M A Germain
- Département de Chirurgie Cervico-faciale, Institut Gustave-Roussy, Villejuif, France
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Abstract
STUDY AIM Midface is situated between the occlusal plane and the transverse midorbital plane. The aim of midface reconstruction is to restore the bony and soft tissue contour of the face, to obtain a rigid support for the velum, to allow oronasal separation, and to allow support for the orbit and obliteration of the maxillary sinus in order to restore the main functions: respiration, speech, deglutition, mastication, olfaction, vision. PATIENTS AND METHODS Between 1988 and 1997, 65 patients with defects to the midface in relation with cancer (n = 60), gunshot (n = 3), or congenital malformation (n = 2), underwent reconstruction with one or more transplants: forearm (n = 21), latissimus dorsi (n = 23), scapula (n = 12), composed subscapula (n = 10), and fibula (n = 4). Forty-seven of the patients were men and 18 were women. The mean age was 56 years (12-90 years). In patients with cancer, tumoral resection was immediately followed by midface reconstruction in the last 43 cases. Free flaps were selected for reconstruction of each part of the midface: cheek, nose, orbit floor, maxillary and palate. RESULTS One post-operative death occurred (1.5%). The morbidity rate (18.7%) included necrosis of the free flaps in four cases. Average resumption of oral intake was ten days. The mean time to discharge was 17 days. Aesthetic and functional results were rated good or excellent in 53 patients. After one year, 52 patients were alive. Oral intake was normal in 48 patients, and mixed in four. Speech was excellent or good in 49 patients. From amongst the patients, 80% were able to find a job. CONCLUSION Free flaps with micro surgery provides an optimal, functional, morphological and aesthetic outcome. Patients with advanced cancer of the midface are best managed through a multidisciplinary team approach. Microsurgical reconstruction represents the technical state of the art in case of extensive and complex midface defect.
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Affiliation(s)
- M A Germain
- Département de chirurgie cervicofaciale, institut Gustave-Roussy, Villejuif, France
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Giaoui L, Salvan D, Casiraghi O, Mamelle G, Julieron M, Janot F, Leridant AM, Marandas P, Schwaab G, Luboinski B. [Primary synovial sarcoma of head and neck. Materials of The Gustave Roussy Institute. Report of 13 cases]. Ann Otolaryngol Chir Cervicofac 1999; 116:71-7. [PMID: 10378035] [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
This report presents the result of our experience with 13 primary synovial sarcoma of the head and neck. The 9 males and 4 females had a median age of 32 years. The predominant location of the tumor was the pharynx, treatment consist of surgical excision alone or associated with post-operative radiotherapy or chemotherapy. Mean follow-up was 48 month. Local recurrence occurred in 2 patient, 4 patient died of pulmonary metastasis. The five year survival rate was 55%. Favorable prognostic findings included age < 20 years and complete initial resection.
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Affiliation(s)
- L Giaoui
- Service de Chirurgie ORL, Institut Gustave Roussy
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Germain MA, Julieron M, Trotoux J, Filippetti M, Santoro E, Marzetti F. [U-shaped free jejunum transplant]. Ann Chir 1999; 52:978-82. [PMID: 9951097] [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: 02/10/2023]
Abstract
Reconstruction of the oro and hypopharynx has specific difficulties due to their wide diameters. Seven patients underwent reconstruction with a free U-shaped jejunal transplant, after circular pharyngolaryngectomy for hypopharyngeal cancer invading the oropharynx. This transplant included a side-to-side anastomosis between the two limbs of the jejunal loop. This transplant allowed reconstruction of the upper digestive tract after wide carcinologic resection of the pharynx. The U-shaped jejunal transplant facilitated the upper anastomosis, especially at the upper part where the resection involved the oropharynx. It formed a reservoir behind the tongue, and avoided nasal reflux. The best indications are large resections involving the oropharynx.
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Affiliation(s)
- M A Germain
- Service de Chirurgie Cervico-Faciale, Institut Gustave-Roussy, Villejuif
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De Crevoisier R, Bourhis J, Domenge C, Wibault P, Koscielny S, Lusinchi A, Mamelle G, Janot F, Julieron M, Leridant AM, Marandas P, Armand JP, Schwaab G, Luboinski B, Eschwege F. Full-dose reirradiation for unresectable head and neck carcinoma: experience at the Gustave-Roussy Institute in a series of 169 patients. J Clin Oncol 1998; 16:3556-62. [PMID: 9817275 DOI: 10.1200/jco.1998.16.11.3556] [Citation(s) in RCA: 232] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To review our experience using full-dose external reirradiation given with a curative intent for patients with unresectable head and neck carcinoma (HNC). PATIENTS AND METHODS Between January 1980 and December 1996, 169 patients who presented with unresectable nonmetastatic HNC in a previously irradiated area were included in this series. The median time between the first and the second irradiation was 33 months. Reirradiation protocols were as follows: radiotherapy alone (65 Gy over 6.5 weeks at 2 Gy/d), 27 patients; Vokes protocol, ie, five to six cycles of radiotherapy (median total dose, 60 Gy; 2 Gy/d) with simultaneous fluorouracil (5-FU) and hydroxyurea, 106 patients; and bifractionated radiotherapy (median total dose, 60 Gy; 2 x 1.5 Gy/d) with concomitant mitomycin, 5-FU, and cisplatin, 36 patients. The median cumulative dose of the two irradiations was 120 Gy. Eighty-five percent of the tumors were squamous cell carcinoma, 14% undifferentiated carcinoma of nasopharyngeal type, and 1% adenocarcinoma. Forty-four percent were local recurrences, 23% nodal recurrences, 14% both local and nodal, and 19% second primary tumors. RESULTS Mucositis grade 3 (World Health Organization [WHO]) was found in 32% and grade 4 in 14% of cases. Four patients presented with neutropenia or thrombocytopenia (grade 3 or 4 WHO). Late toxicities (> 6 months) were as follows: cervical fibrosis (grade 2 to 3 Radiation Therapy Oncology Group [RTOG]), 41%; mucosal necrosis, 21%; osteoradionecrosis, 8%; and trismus, 30%. Five patients died of carotid hemorrhage, apparently in complete remission. Six months after the onset of reirradiation, 37% of patients were in complete response. Patterns of failure were local only (53%), nodal only (20%), metastatic only (7%), and multiple (20%). Median follow-up time was 70 months. Overall survival rate (Kaplan-Meier) was 21% (95% confidence interval [CI], 15% to 29%) at 2 years and 9% (95% CI, 5% to 16%) at 5 years. Median survival time was 10 months for the entire population. Thirteen patients, of whom 12 were treated with the Vokes protocol, were long-term disease-free survivors. In a multivariate analysis, the volume of the second irradiation was the only factor significantly associated with the risk of death: relative risk=1.8 (95% CI, 1.13 to 5.7) (P=.01). CONCLUSION Full-dose reirradiation combined with chemotherapy was feasible in patients with inoperable HNC. The incidence and severity of late toxicity was markedly increased in comparison to that observed after the first irradiation. Median survival was better than that generally obtained using palliative chemotherapy alone. A small proportion of patients were long-term disease-free survivors.
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Affiliation(s)
- R De Crevoisier
- Département de Radiothérapie, Institut Gustave-Roussy, Villejuif, France
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Elias D, Manai M, Eggenspieler P, Julieron M, Girinsky T, Kac J, Ducreux M. [Esophagectomy for epidermoid cancer discovered during evaluation of ENT cancer]. Ann Chir 1998; 52:36-40. [PMID: 9752406] [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: 02/08/2023]
Abstract
UNLABELLED The treatment of synchronous esophageal and head and neck carcinomas is difficult. MATERIAL AND METHOD Retrospective study of 33 patients treated with esophagectomy for an intrathoracic squamous cells carcinoma discovered during pan-endoscopy for a synchronous head and neck cancer. RESULTS In 7 cases (21%) it was advanced (pT3-4) esophageal cancers. The hospital mortality was 9%. Five year survival was 18% without stabilization of the survival curve, 60% of patients died of recurrence of tumor. CONCLUSION Esophagectomy is suitable for usT1-2 tumors if surgery is also indicated for the head and neck tumor. Radiochemotherapy is indicated for advanced usT3-4 esophageal tumors or when the treatment of the head and neck tumor is not surgery.
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Affiliation(s)
- D Elias
- Service de Chirurgie Carcinologieque, Institut Gustave-Roussy, Villejuif
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Elias D, Cavalcanti A, Dubé P, Julieron M, Mamelle G, Kac J, Ducreux M, Bonvallot S, Nitenberg G, Lasser P. Circumferential pharyngolaryngectomy with total esophagectomy for locally advanced carcinomas. Ann Surg Oncol 1998; 5:511-6. [PMID: 9754759 DOI: 10.1007/bf02303643] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [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: 11/24/2022]
Abstract
BACKGROUND Forty-nine cases of circumferential pharyngolaryngectomy with total esophagectomy (PLTE) done between 1982 and 1996 were studied retrospectively. These procedures were performed for advanced squamous cell tumors of the superior esophageal sphincter (n = 23), for hypopharyngeal tumors with synchronous esophageal carcinoma (n = 15), and for hypopharyngeal tumors extensively invading the cervical esophagus (n = 11). METHODS Ninety-six percent of the patients had T3-4 lesions, and it was impossible to use a free jejunal graft reconstruction. Patients underwent primary surgery in 70% of the cases, and salvage surgery (after failure of chemoradiotherapy) in 30%. In most patients, esophagectomy was performed without thoracotomy (n = 45). Resection was curative (R0) in 70% of the cases, in spite of lymph node invasion in 94%. Reconstruction of the digestive tract was achieved with the stomach in 33 patients (67%) or with the colon in 16 patients (33%). RESULTS Before 1989, postoperative mortality was high, was correlated with the high frequency of palliative surgery, and resulted in unsatisfactory survival results (overall 5-year survival rate of 7%). After 1989, as a result of better selection of patients and appropriate training of our team, postoperative mortality decreased from 33% to 10%, R1-2 resections decreased from 39% to 26%, and a 3-year overall survival rate of 28% was obtained for the last 25 patients, all of whom were able to eat without difficulty. These results are superior to the survival rates and functional results obtained with radiochemotherapy alone for such advanced tumors, even though the voice is preserved with radiochemotherapy alone. CONCLUSIONS PLTE for advanced pharyngeal or cervical esophageal tumors is the best treatment currently available, but it is indicated only in very selected cases: when it is technically impossible to perform reconstruction with a free jejunal graft after circumferential pharyngolaryngectomy; as primary surgery, rather than as salvage surgery following chemoradiotherapy; after careful preoperative morphologic and endoscopic assessment of the extent of the tumor; and in patients able to tolerate a thoracotomy for an esophagectomy with lymphadenectomy. Selection according to these guidelines should improve results.
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Affiliation(s)
- D Elias
- Department of Surgical Oncology, Institut Gustave Roussy, Villejuif, France
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Julieron M, Germain MA, Schwaab G, Marandas P, Bourgain JL, Wibault P, Luboinski B. Reconstruction with free jejunal autograft after circumferential pharyngolaryngectomy: eighty-three cases. Ann Otol Rhinol Laryngol 1998; 107:581-7. [PMID: 9682853 DOI: 10.1177/000348949810700707] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.5] [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: 11/17/2022]
Abstract
The free jejunal autograft (FJA) has become a common procedure for pharyngeal reconstruction after circumferential pharyngolaryngectomy. In order to evaluate the postoperative outcome and the functional and carcinologic results, we retrospectively reviewed 83 cases of reconstruction with FJA. Fifty-one patients had received no prior radiotherapy, and 25 had received prior radiotherapy for their hypopharyngeal tumor or for another previous primary. Seven patients underwent a secondary reconstruction. In the postoperative course, there were 2 postoperative deaths, 4 graft failures (5%), and 11 salivary fistulas. The median time to removal of the nasogastric tube was 16 days, and to discharge, 23 days. Forty-eight patients received postoperative radiotherapy, with good tolerance. At 1 year postoperatively, 98% of the patients were able to eat a solid or soft diet. The postoperative radiotherapy did not impair the quality of the functional results in a long-term assessment. The vocal results were disappointing. The 3-year survival rate was 40%. The main carcinologic failures (45 patients) were locoregional recurrences (20 patients) and metastasis, which was the cause of death in 34% of the cases. It seems clear that FJA allows one-stage reconstruction and good swallowing rehabilitation, tolerates postoperative radiotherapy, and increases the quality of life in these patients with a poor prognosis.
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Affiliation(s)
- M Julieron
- Department of Head and Neck Surgery, Institut Gustave Roussy, Villejuif, France
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Abstract
Forty patients were treated or followed up for aesthesioneuroblastoma between 1980 and 1995 at Institut Gustave Roussy, France. There were three T1, seven T2, 15 T3 and 15 T4 lesions. The cervical metastatic rate at presentation was 18 per cent. Distant metastases were detected by bone marrow biopsy and bone scan in three patients at presentation. Treatment modalities included surgery alone in eight patients, radiotherapy alone in three patients, combined modality surgery plus radiotherapy in 11 patients, chemotherapy alone in two patients, chemotherapy plus radiotherapy in 10 patients, and multimodality therapy chemotherapy plus surgery plus radiotherapy in six patients. The five-year survival rate was 51 per cent. Multimodality treatment offered better survival (63 per cent at five years) and disease-free interval (54 months). Overall local, regional, and distant failure rates were 58 per cent, 15 per cent and 40 per cent respectively. Distant metastases commonly occurred in bone (82 per cent). Cervical metastasis was an unfavourable prognostic indicator (0 per cent survival at two years). In conclusion, aesthesioneuroblastoma is sensitive to chemotherapy and radiotherapy. Multimodality therapy should be used initially.
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Affiliation(s)
- V N Koka
- Department of Head and Neck Surgery, Institut Gustave Roussy, Villejuif, France
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Germain MA, Marandas P, Leridant AM, Julieron M, Schlumberger M, Mamelle G, Domenge C. [Isolated mandibular metastases. Therapeutic strategy. Apropos of 7 cases]. Chirurgie 1998; 122:549-51. [PMID: 9616904] [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: 02/07/2023]
Abstract
Among the mandibular tumours, the secondary malignant tumours are uncommon. We relate 7 cases observed between 1977 and 1995. Two cases have revealed the original cancer (rectum, prostate). The five other cases were discovered during the evolution of the original cancer (colon, lung, kidney, thyroid, breast). These 7 mandibular metastases were isolated. The treatment included a mandibular resection in 6 cases. In one of these cases, the reconstruction was performed with a free vascularized fibular transplant with success. Among the seven cases, two patients are alive, at the present time, with a mean follow-up of 3 years. This justifies a curative treatment.
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Affiliation(s)
- M A Germain
- Département de Chirurgie Cervico-Faciale, Institut Gustave-Roussy, Villejuif
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