Impact of the 2nd, 3rd and 4th waves of the COVID-19 pandemic on wait times in head and neck cancer: A retrospective study in a French expert center

BACKGROUND

Treatment delay in head and neck cancer is a major problem, with impact on survival. The COVID-19 (coronavirus disease 2019) pandemic, evolving in waves around the world, caused diagnostic and therapeutic delays in certain cancers. The main objective of the present study was to analyze whether there was a change in wait times during three successive waves in our center.

METHOD

This was a single-center retrospective study of patients with a first diagnosis of head and neck cancer. Three groups, corresponding to waves 2, 3 and 4, were compared to a control group corresponding to a pre-pandemic period. Study data comprised median times between first consultation and tumor board meeting (C1-TB) and between tumor board meeting and treatment (TB-T). The significance threshold was set at P<0.005.

RESULTS

Ninety-six patients were included in the control group, and 154 in the "waves 2-3-4" group. There was no increase in C1-TB interval (respectively 35 and 26days, P=0.046) or TB-T interval (respectively 27 and 28days, P=0.723).

CONCLUSION

Intervals between first consultation and tumor board meeting and between tumor board meeting and treatment did not increase during the 2nd, 3rd and 4th waves of COVID-19 in our center.

Surgery for chronic rhinosinusitis with nasal polyps: An update

This update aimed to evaluate surgical indications in the management of chronic rhinosinusitis with nasal polyps (CRSwNP). It was conducted and reported according to the criteria stipulated by the Synthesis Without Meta-analysis (SwiM) guidelines. From the PubMed-National Library of Medicine database, 1098 articles were identified for the period 2006-2021 using the key words "nasal polyps" and "surgery". After screening and analysis, 39 publications were selected. The efficacy of surgery on functional improvement in CRSwNP, measured by the specific quality-of-life score SNOT-22, is established, and improvement in olfactory function is expected in 50% of patients. The rate of surgical revision is at least 10-15% at 4 years, but the disease can be controlled for several years, with the interval between primary surgery and symptomatic recurrence exceeding 10 years in some cases. The criteria for surgery are not clearly defined in the literature. However, several authors consider failure of ≥ 8 weeks' well-conducted local medical treatment and use of more than 2 courses of systemic corticosteroids as a reliable indication. No studies or meta-analyses are currently available to determine the superiority of one surgical technique over another.

The first wave of COVID-19 did not cause longer wait times in head and neck cancer. Experience of a French expert center

BACKGROUND

Head and neck cancers (HNC) have poor survival prognosis, as tumors are often diagnosed at advanced stages in patients consulting late. The first lockdown linked to the 1st wave of COVID-19 (Coronavirus Disease 2019) disrupted consultation schedules in France.

OBJECTIVE

The principal aim of the present study was to analyze consultation wait time in HNC during and after lockdown, in our university expert oncology reference center, to disclose any increase in treatment wait time.

METHODS

A single-center retrospective study included patients with a first diagnosis of HNC. Three groups were distinguished: "lockdown", "post-lockdown", and a "control" group (corresponding to a reference period 1 year earlier). Intervals between first oncologic consultation and multidisciplinary tumor board (FC-MTB) and between MTB and first treatment (MTB-T) were assessed.

RESULTS

One hundred and seven patients were included in the control group, 60 in the lockdown group and 74 in the post-lockdown group. There was no increase in median FC-MTB interval (respectively 35, 29 and 28 days) between the lockdown and post-lockdown groups compared to the control group (respectively P=0.2298 and P=0.0153). Likewise, there was no increase in MTB-T interval (27, 20 and 26 days respectively) (P=0.4203).

CONCLUSION

No increase in wait times was observed during the lockdown and post-lockdown periods in our center.

T helper 2 inflammatory markers are associated with recurrence in chronic rhinosinusitis with nasal polyps after endoscopic sinus surgery

BACKGROUND

Despite maximum medical treatment and endoscopic sinus surgery (ESS), chronic rhinosinusitis with nasal polyps (CRSwNP) can require revision surgery. With a growing literature on the diversity of cytokine inflammation patterns in CRSwNP, an endotype-driven approach could lead to the identification of cytokine profiles that predict recurrence.

METHODS

A monocentric longitudinal study was carried out until June 2019 following CRSwNP patients who underwent surgery for the first time between December 2010 and January 2012. The biomarker profiles were established on blood and nasal secretions at the time of the first surgery (Interleukin (IL)-5, IgE, IgA, eosinophilic cationic protein (ECP) and eosinophilic- derived neurotoxin (EDN)). Profiles were compared between the patients still controlled by medical treatment and the patients requiring revision surgery during the course of the follow-up period.

RESULTS

Among the 48 patients initially enrolled in our study, 8 required revision surgery (16,7%). Clinical features (asthma, allergy, aspirin intolerance, active smoking) and levels of blood markers measured at the time of the first surgery were comparable between the 2 groups of patients. Levels of IL-5, IgE and ECP in nasal secretions were significantly increased in the group of patients needing revision surgery.

CONCLUSIONS

Based on simple approach of nasal secretions sampling, we showed that a predominant T helper 2 proteins expression profile can be associated with recurrent CRSwNP after ESS. Initial immunoprofiling in CRSwNP disease may contribute to better predict the therapeutic response to optimal medical and surgical treatment, and help define the role of innovative targeted treatment, beside corticosteroids and ESS.

Match between therapeutic proposal in multidisciplinary tumor board and actual treatment in head and neck cancer

OBJECTIVES

There are few published studies evaluating the quality and outcome of multidisciplinary tumor board (MDTB) decisions. The aim of the present study was to evaluate adherence to MDTB recommendations in head and neck cancer and to document reasons in case of discordance.

MATERIAL AND METHODS

We included all patients with newly diagnosed head and neck cancer presented in our MDTB meetings between January 1st and December 31st, 2018, whatever the tumor site, histology type and TNM classification. MDTB recommendations were compared to actual treatment. Discordance was defined as treatment partially or entirely different from the treatment decision recorded in the MDTB minutes.

RESULTS

Board decisions were made for 344 new patients. Complete treatment concordance rate was 91.6% (315/344 patients), with deviation in 29 patients. Reasons for deviation were complications of treatment in 10 cases, patient refusal in 8, and physician's decision in 4 cases. Five patients died before therapy initiation. Mean interval from board discussion to treatment was 21 days, and depended on type of treatment (range, 1 to 74 days).

CONCLUSION

This study shows the importance of evaluating concordance between the protocol proposed in the MDTB and the treatment actually received, to identify factors for deviation and remedy them when possible.

Presence in head and neck cancer multidisciplinary team meeting: The patient's experience and satisfaction

BACKGROUND

In oncology, multi-disciplinary team meetings improve overall survival and reduce time to treatment in head and neck cancer. Interestingly, no study has examined the experience of patients attending an MTM. The present study addressed two questions: Does the MTM cause anxiety/depression for patients who are present? Are patients satisfied at the end of the meeting?

PATIENTS AND METHODS

The study included all patients attending an MTM, who agreed to participate in the study and who fully completed two questionnaires. The Hospital Anxiety and Depression Scale (HADS) and a satisfaction questionnaire were filled out at three time-points: T0 before MTM, T1 at end of MTM, and T2 1 month after MTM for the HADS; and T1 and T2 for the satisfaction questionnaire.

RESULTS

There were no significant differences in the number of patients experiencing anxiety between T0 and T1 (P=0.6085), T0 and T2 (P=1) or T1 and T2 (P=1). Likewise, there were no significant differences in the number of patients in depression between T0 and T1 (P=0.9397), T0 and T2 (P=1) or T1 and T2 (P=1). Mean satisfaction was good (question 14 on the satisfaction questionnaire: 8.7/10 at T1 and 7.7/10 at T2), but with a significant decrease between T1 and T2 (P=0.0009: i.e.,<0.05). Percentage information remembered (question 12) significantly decreased between T1 (mean 86%, standard deviation 0.2, median 94%) and T2 (78%±0.2, median 81%) (P=0.03). Presence in the MTM did not appear to induce or increase anxiety or pre-existing depressive syndrome.

Impact of allergy on phenotypic and endotypic profiles of nasal polyposis

OBJECTIVES

To assess the impact of allergy on clinical presentations (phenotypes) and inflammatory patterns (endotypes) of chronic rhinosinusitis with nasal polyps (CRSwNP).

METHODS

A single-center prospective study was conducted over an 18-month period. Fifty-seven patients with refractory CRSwNP were included. The diagnosis of allergy was based on concordant skin prick tests and symptoms. Phenotypes were determined on symptom severity score, polyp size classification and Lund-Mackay CT staging. Inflammatory endotypes were determined on biomarker analysis (IgE, IgA, IL-5, IL-9, ECP, EDN) in blood and nasal secretions. Eosinophil counts were obtained in blood, nasal secretions and polyps.

RESULTS

Phenotype and endotype profiles were comparable in patients with (n=15) or without (n=42) allergy. Only asthma with high total IgE blood concentration showed association with allergy.

CONCLUSIONS

The present results suggest that allergy is not directly involved in the clinical expression and specific inflammatory pathways of CRSwNP. New therapies target inflammation signaling pathways, and identifying accurate blood and tissue biomarkers will be the line of research most likely to improve treatment of CRSwNP.

Predictors of unanticipated admission within 30 days of outpatient sinonasal surgery

OBJECTIVES

To identify predictive factors of readmission after day-case rhinologic surgery.

METHODS

A 2-year retrospective chart review of patients scheduled for ambulatory sinonasal surgery in a tertiary medical center was conducted. The operating room and the anesthetic files were screened to identify demographic data, types of procedure, comorbidities and post-operative complications.

RESULTS

From January 2014 to January 2016, 924 outpatient sinonasal procedures were identified. The overall readmission rate within the 30-postoperative days was 5.1% (2.9% for overnight hospital stay, 2.2% for unplanned post procedure visit to the hospital via the emergency room, or directly to the surgical unit within 30 days of discharge). Age at least 50 years, surgical duration at least 80 min, endoscopic sinus surgery procedures and postoperative nasal packing were identified as negative predictive factors of readmission.

CONCLUSION

Careful scheduling of those higher-risk patients undergoing sinonasal surgery and appropriate postoperative observation should be implemented to improve healthcare quality in an outpatient setting.

Cost-effectiveness assessment in outpatient sinonasal surgery

AIMS

To assess the cost-effectiveness of outpatient sinonasal surgery in terms of clinical efficacy and control of expenses.

METHODS

A retrospective study was conducted from January 2014 to January 2016. Patients scheduled for outpatient sinonasal surgery were systematically included. Clinical data were extracted from surgical and anesthesiology computer files. The cost accounting methods applied in our institution were used to evaluate logistic and technical costs. The standardized hospital fees rating system based on hospital stay and severity in diagnosis-related groups (Groupes homogènes de séjours: GHS) was used to estimate institutional revenue.

RESULTS

Over 2years, 927 outpatient surgical procedures were performed. The crossover rate to conventional hospital admission was 2.9%. In a day-1 telephone interview, 85% of patients were very satisfied with the procedure. All outpatient cases showed significantly lower costs than estimated for conventional management with overnight admission, while hospital revenue did not differ between the two.

CONCLUSION

This study confirmed the efficacy of outpatient surgery in this indication. Lower costs could allow savings for the health system by readjusting the rating for the procedure. More precise assessment of cost-effectiveness will require more fine-grained studies based on micro costing at hospital level and assessment of impact on conventional surgical activity and post-discharge community care.

Specific immunotherapy in allergic rhinitis

Allergic rhinitis is a common condition, with significant impact on quality of life depending on severity and quality of control. Allergen-specific immunotherapy (allergen-SIT) is the only known treatment able to alter the natural course of allergic rhinitis. Although well known to allergologists, it has yet to be fully adopted by the ENT community. This review, based on the most recent meta-analyses and clinical studies, shows that SIT significantly reduces symptoms and medication requirements (nasal corticosteroids, H1-antihistamines) in allergic rhinitis. It can reduce the risk of progression to asthma and, if initiated early enough, of developing new sensitizations. Immunobiological analysis shows an altered inflammatory profile following SIT, with immune tolerance involving T-regulatory lymphocyte induction and IgG production. Sublingual SIT with drops is as effective as subcutaneous SIT and is simpler to use, with less anaphylactic risk. Standardization of trial protocols in terms of treatment response assessment and side effect grading is recommended to improve comparative studies. Sublingual SIT with tablets has recently been introduced, providing a good opportunity for ENT practitioners to adopt the SIT approach in rhinitis triggered by allergy to pollens and, in the near future, to house dust mites.

Olfactory cleft opacity and CT score are predictive factors of smell recovery after surgery in nasal polyposis

OBJECTIVES

To assess subjective improvement of olfactory function following endoscopic sinus surgery (ESS) in chronic rhinosinusitis associated with nasal polyps (CRSwNP) and to analyse factors of recovery with the European Test of Olfactory Capabilities (ETOC).

METHODS

We carried out a prospective study of 30 patients with CRSwNP from November 2011 to April 2013. The ETOC was filled the day before surgery and in the short term follow-up. Sixteen suprathreshold odorants with a detection task and a forced choice verbal identification task were tested.

RESULTS

The mean composite score (MCS) improved at 3 and 6 months. The preoperative MCS was correlated to the Lund-Mackay score and to the olfactory cleft opacification on preoperative computed tomography (CT) scan. Multivariate linear regression modelling of patients with preoperative anosmia showed that the olfactory recovery at 3 months was predicted by the preoperative Lund-Mackay score and the age, and at 6 months by the preoperative Lund-Mackay score.

CONCLUSION

With a convenient psychophysical test, we showed that olfactory cleft opacification and CT scan score could be predictive factors of olfaction disorder severity and improvement after ESS in CRSwNP. These results need to be strengthened in the long term with a larger panel of patients.

Histopathological classification of refractory chronic rhinosinusitis with nasal polyps

OBJECTIVE

To delineate the histopathological characteristics of nasal mucosa in refractory chronic rhinosinusitis with nasal polyps (CRSwNP) in order to demonstrate subtypes of nasal polyps and their potential relation with lower airway comorbidity.

STUDY DESIGN

Clinical- and pathological-based cross-sectional study Methods: Nasal polyp specimens were prospectively collected from patients with refractory CRSwNP referred to our institution for endoscopic sinus surgery. Oral and topical steroids were stopped 1 month before surgery. The pathological analysis was conducted by 2 independent reviewers with light microscopy on Hematoxylin-Eosin-Saffron stained slides. Each observer fulfilled a standardized protocol with cell count and stromal characterization on the most representative field. Mean grading scores were established. Morphological aspects were compared with the cell distribution and the clinical conditions.

RESULTS

Among 36 patients, three subtypes of nasal polyps were depicted: eosinophilic edematous (64%), fibrous (9%) and intermediate with mixed edematous and collagen stromal structure (27%). Basement membrane thickening and seromucous gland hyperplasia were observed in the fibrosis sub-type (p<0.03). Eosinophilic mucosal infiltrate was significantly increased (p=0.026) in patients with concomitant pulmonary disease (n=21). Nasal polyp distribution was not influenced by asthma, allergy, previous surgery and smoking.

CONCLUSION

Our 3-subtype classification of refractory CRSwNP in Caucasian population shows a predominant edematous structure whatever the clinical conditions may have been. Eosinophilia as a major factor of adaptive immune response in nasal inflammation is a feature of concomitant pulmonary disease. Further studies concerning mucosal remodelling and outcome assessment after sinus surgery are required to evaluate the impact of our classification on a daily basis.

Pilot study of submucosal radiofrequency for epistaxis in hereditary hemorrhagic telangiectasia

OBJECTIVE

To assess the safety and efficacy of submucosal radiofrequency (RF) treatment for hereditary hemorrhagic telangiectasia (HHT) with mild or moderate epistaxis.

METHODOLOGY

We carried out a prospective pilot study of 16 consecutive patients with HHT-related epistaxis from June 2010 to April 2012. Under local anesthesia, RF was applied to one or both sides of the nose from the columella beneath the septal mucosal (50 joules per puncture). Patients were sent a questionnaire at least six months after the procedure.

RESULTS

RF under local anesthesia was well tolerated, according to visual analog scale scores. Neither crusting nor pain was reported one week after the intervention. The frequency of epistaxis per day and per month was significantly lower after RF. The duration of bleeding also decreased from more than 10 minutes to less than 5 minutes in two thirds of patients. Thirteen of the 16 patients were satisfied with the technique and would request it for subsequent procedures to treat repeated bleeding.

CONCLUSION

Submucosal RF treatment for HHT is a safe, well tolerated procedure with significant efficacy in the short term. It should be considered as an alternative technique for managing HHT-related epistaxis, although long-term results remain to be evaluated.

Pilot study of submucosal radiofrequency for epistaxis in hereditary hemorrhagic telangiectasia

Objective: To assess the safety and efficacy of submucosal radiofrequency (RF) treatment for hereditary hemorrhagic telangiectasia (HHT) with mild or moderate epistaxis. Methodology: We carried out a prospective pilot study of 16 consecutive patients with HHT-related epistaxis from June 2010 to April 2012. Under local anesthesia, RF was applied to one or both sides of the nose from the columella beneath the septal mucosal (50 joules per puncture). Patients were sent a questionnaire at least six months after the procedure. Results: RF under local anesthesia was well tolerated, according to visual analog scale scores. Neither crusting nor pain was reported one week after the intervention. The frequency of epistaxis per day and per month was significantly lower after RF. The duration of bleeding also decreased from more than 10 minutes to less than 5 minutes in two thirds of patients. Thirteen of the 16 patients were satisfied with the technique and would request it for subsequent procedures to treat repeated bleeding. Conclusion: Submucosal RF treatment for HHT is a safe, well tolerated procedure with significant efficacy in the short term. It should be considered as an alternative technique for managing HHT-related epistaxis, although long-term results remain to be evaluated.

Endoscopic repair of anterior or middle skull base cerebrospinal fluid leaks after tumour resection

OBJECTIVES

This study analysed the factors influencing the risk of recurrence following endoscopic repair of CSF leaks of the anterior and middle skull base after endonasal skull base tumour resection.

PATIENTS AND METHODS

A retrospective review was conducted on 17 patients operated between May 2007 and December 2010 by endonasal endoscopic resection of anterior or middle skull base tumour who presented an intraoperative CSF leak. Epidemiological data (body mass index [BMI], age, gender) and type of leak (site, size) were studied.

RESULTS

CSF leaks involved the roof of the ethmoid sinus (one patient), cribriform plate (three), posterolateral wall of the sphenoid sinus (six) or the sella turcica (seven). The CSF leak recurrence rate after the first endoscopic procedure was 29.4% (5/17). Failures were not influenced by gender, age, BMI or size of the leak. All recurrences involved the sella turcica or the lateral wall of the sphenoid sinus. The success rate after a second endoscopic procedure was 88.2%.

CONCLUSION

Endonasal endoscopic repair of anterior and middle skull base meningeal injuries after tumour resection is a minimally invasive and effective technique. The main challenge of this method consists of ensuring effective control of the postoperative defect after tumour resection in the sphenoidal region, as this region was the only potential risk factor for recurrence identified in this study.

[Preoperative corticosteroid treatment and nasal polyposis]

OBJECTIVES

Impairment of the surgical view by bleeding in endoscopic ethmoidectomy for chronic rhinosinusitis with nasal polyps (CRSwNP) contributes to the risk of skull base injuries. The aim of this study was to investigate the effect of a short course of a systemic corticoid treatment on bleeding and surgical field quality during endoscopic ethmoidectomy for CRSwNP.

METHODS

A prospective study was conducted on 40 patients. Before surgery, 21 of them (group B) were treated with 1 mg/kg per day of prednisolone for seven days. They were compared with the 19 other patients (group A) on intraoperative blood loss and surgery duration.

RESULTS

The two groups shared identical clinical features (Lidholdt endoscopic grading). There was no statistical difference in terms of bleeding, although the Lund-Mackay CT score was higher in group B (19/24 vs. 21/24, p=0.05). The surgical procedure was shorter in group B (72 min vs. 85 min, p=0.05).

CONCLUSION

Preoperative treatment with systemic corticosteroids does not seem to reduce surgical blood loss. However, we noted a decrease in the procedure's duration. By reducing mucous inflammation, this treatment could improve the local conditions and help the surgeon in the mucous eradication.

Lund-Mackay score is predictive of bleeding in ethmoidectomy for nasal polyposis

OBJECTIVES

To assess the correlation between intraoperative bleeding during endoscopic ethmoidectomy for chronic rhinosinusitis with nasal polyps and objective parameters of disease severity.

STUDY DESIGN

A prospective cohort of 40 patients with nasal polyposis treated by endoscopic ethmoidectomy was analyzed from January 2007 to July 2007.

METHODS

Polyp size and CT scan opacifications were noted. The surgical procedure was performed with a standardized protocol. Intraoperative blood loss was measured. The Spearman test was used to correlate these data.

RESULTS

On nasal endoscopy, the mean polyps' size score was 2.2 (+/- 0.65). On CT scan, the Lund-Mackay grading was 17.2/24 (+/- 5.8). The rate of flow of intraoperative bleeding was 0.077%/min (+/- 0.070%/min). A significant positive correlation was found between the CT scan score and the rate of flow of intraoperative bleeding for the patients who were surgically treated for the first time (n = 23, Spearman Rho = 0.411, p = 0.05).

CONCLUSION

The Lund-Mackay CT score is useful in predicting intraoperative bleeding during endoscopic ethmoidectomy. It could help to identify patients for whom specific measures like preoperative treatment with antibiotics and steroids, topical perioperative preparation of the nose or hypotensive anesthesia are required in order to reduce the risk of intraoperative complications.

Surgical management of sinonasal inverted papillomas through endoscopic approach

We defined a standardized approach to surgery of sinonasal inverted papillomas (IP) for adequate and safe resection. A cohort of 65 patients treated from January 1995 to December 2005 at a single institution was retrospectively analyzed (mean follow-up: 28 months; range 1-132). The extension of the tumor was evaluated on clinical findings and computed tomography (CT) scan and/or resonance magnetic imaging (RMI). External and endoscopic surgical approaches were compared according to tumor extension, rate of local recurrence. Univariate analysis was used to review the impact on disease-free survival of factors related to the histopathological findings and the treatment. Endoscopic (alone or combined with transantral approach) and external surgery were used in 46 patients (71%) and 19 patients, respectively. Endoscopic approach (34/46) was performed to control IP in the nasal fossa, the ostiomeatal complex, the sphenoid sinus. It was combined with Caldwell-Luc procedure (12/46) for tumor extent into the lateral part of the maxillary sinus. The mean time for recurrences to occur was 19 months with range of 5-35 months. The rate of local recurrence was 17.6% (6/34) in endoscopic approach alone, 8.3% in endoscopic approach combined with a Caldwell-Luc procedure and 15.8% (3/19) in external approach. Tumor extension, excision with safe margins, associated malignancy or dysplasia have no significant impact on disease-free survival regardless of surgical procedure. On the basis of imaging evaluation and peroperative view of tumor extent, we propose a surgical strategy in which endoscopic approach could be used on the first attempt by trained surgeons. RMI is very useful to determine acute extent of the disease.

Respiratory epithelial adenomatoid hamartomas of the sinonasal tract

We report the clinicopathologic features of two cases of respiratory epithelial adenomatoid harmartoma (REAH) of the sinonasal tract. Hamartomas are rare in the nasal cavity. Histologically, these lesions were characterized by a glandular proliferation lined by ciliated respiratory epithelium originated from the surface epithelium. The two patients were evaluated by a gastroenterologist to assess intestine colocalization. The treatment was a complete surgical resection through limited approach. We should be aware of this entity as a differential diagnosis for inverted papilloma and well-differenciated adenocarcinoma. Fine histopathological analysis is necessary to avoid aggressive surgery for this benign lesion.

Local recurrence after CO2 laser cordectomy for early glottic carcinoma

OBJECTIVES

To point out prognosis factors of local recurrence after endoscopic cordectomies for Tis, T1a, T1b, and T2 glottic squamous cell carcinomas.

STUDY DESIGN

A cohort of 110 patients treated from January 1990 to December 2000 at a single institution was retrospectively analyzed: 21 had Tis, 76 T1a, 7 T1b, and 6 T2 (mean follow-up 42 mo; range 1-160 mo).

METHODS

The depth and extension of the excision were graded according to the European Laryngological Society Classification. Univariate analysis was used to review the impact on disease-free survival of factors related to the host, the tumor, and the treatment.

RESULTS

According to the Kaplan-Meier method, the 5 year overall survival and the disease-free survival were 87% and 75%, respectively. The rates of cause-specific survival, ultimate local control with laser alone, and laryngeal preservation were 97%, 84%, and 90%, respectively. Univariate analysis by the log rank test revealed that vocal muscle infiltration (P = .001) and subglottic involvement (P = .02) have a significant impact on disease-free survival. Of the 22 patients with local recurrence (17 T1a, 1 T1b, and 4 T2), 9 were managed with total laryngectomy, 5 with partial laryngectomy, 4 with further laser cordectomy, 2 with radiotherapy, and 2 had no curative treatment.

CONCLUSION

Transoral laser surgery for early glottic carcinoma is a valid alternative to radiotherapy and partial laryngectomy in terms of oncologic results. It offers low morbidity and excellent retreatment options in case of local failure. Careful patient selection for laser surgery is essential to secure good results.

[Micro-array based technologies to study the proteome: technological progress and applications]

Since these twenty last years, there is an increasing interest for large-scale analysis of biological function. In the field of transcriptome, the emergence of microarray-based technologies and the design of DNA biochips allow high-throughput studies of RNA expression in cell and tissue at a given moment. In the field of proteome, methods of reference are still the 2D electrophoresis followed by analysis with mass spectrometry. Technological progress makes it possible to apply microarray methods to proteomics study : they are protein biochips or protein arrays. Expression analysis of proteins in a cell or a tissue in simultaneous and highly parallel way give further information for large-scale studies of signaling pathway. Numerous applications of protein microarray-based assays are described in basic biological research and in medical research to identify diagnostic biomarkers of inflammatory and cancerous pathologies and to find out news drugs and new therapeutic targets. This review summarizes concrete applications of microarray-based technology in the field of proteome, describes fundamental technical stages in protein array development and highlights critical points which will be useful to improve this emerging proteomic method.