Prognostic impact of extranodal extension in resected head and neck squamous cell carcinomas in the era of postoperative chemoradiation: A retrospective monocentric study

BACKGROUND

For patients with locally advanced head and neck squamous cell carcinoma (LAHNSCC), surgery (S) followed by radiotherapy (RT) is a standard of care. Randomized controlled trials have shown that postoperative chemoradiation (CRT) increased the locoregional control (LRC) and overall survival (OS) in patient with R1-resection margin and/or extranodal extension (ENE). ENE has been introduced in the 8th TNM staging classification since its presence has been shown to have an independent adverse prognostic impact. The data supporting this finding were however mainly collected in the pre-CRT era.

OBJECTIVES

The objective of this study was to challenge the adverse prognostic factor of ENE in the era of CRT.

METHODS

A retrospective cohort study was performed to evaluate patients diagnosed with LAHNSCC and undergoing a treatment by S and postoperative RT or CRT in Centre Léon Bérard, Lyon, France between 2003 and 2018. Patients with oral cavity, oropharyngeal, laryngeal and hypopharyngeal SCC were included.

RESULTS

439 patients were included in the study. For patients with non-oropharyngeal p16-positive tumors without ENE, five-year OS, local control, and regional control (RC) reached 63.7%, 86.1%, and 94.9%, respectively; corresponding figures for patients with ENE reached, 42.6%, 77.5%, and 81.1%, respectively (p-value of 0.0006, 0.167, and 0.0005). In multivariable analysis, for non-oropharyngeal p16-positive tumors, ENE remained a poor prognostic factor for OS (RR = 1.74, 95%, CI = 1.16-2.61, p = 0.0069) and RC (RR 3.60, 95% CI =: 1.64-7.87, p = 0.0013).

CONCLUSION

In the era or postoperative chemoradiation, pathological ENE remains an adverse prognostic factor for OS and RC.

The Slippery Role of Induction Chemotherapy in Head and Neck Cancer: Myth and Reality

Chemoradiotherapy as an alternative to surgery can be offered to patients affected by loco-regionally advanced head and neck cancer (HNC). Induction chemotherapy is a valid option, supported by few positive trials, but its real efficacy is still a matter of debate. The standard regimen for induction chemotherapy in Europe is a combination of docetaxel (75 mg/m²) and reduced dose doses of cisplatin (75 mg/m²) and 5-fluorouracil (750 mg/m² day, for five consecutive days) (TPF). It is less toxic and more effective than the historical therapy PF (cisplatin 100 mg/m² and fluorouracil 1,000 mg/m²/day for five consecutive days). However, in some studies treatment-related mortality has been reported to be as high as 6%. Therefore, some less toxic combinations, such as a modified TPF regimen and the combination of carboplatin plus paclitaxel have been studied. These regimens are showing promising results but deserve further validation in comparative trials. Furthermore, several trials are underway in order to enhance TPF with immune checkpoints inhibitors. Compared to chemoradiotherapy, induction chemotherapy followed by chemoradiation was shown to be non-inferior, and it could decrease the distant metastatic progression, especially in high-risk populations. For selected patients, induction chemotherapy could be a strong option. The chemoselective process that leads to immediate surgery for non-responders, the high response rate (complete responses are sometimes observed), and the survival data, are all arguments in favor of induction chemotherapy, if performed in experienced centers involving health professionals in the context of a skilled multidisciplinary team.

Induction Chemotherapy in Head and Neck Squamous Cell Carcinoma: A Question of Belief

Induction chemotherapy (IC) in locally advanced head and neck squamous cell carcinoma (LA HNSCC) has been used for decades. However, its role is yet to be clearly defined outside of larynx preservation. Patients with high risk of distant failure might potentially benefit from sequential treatment. It is now widely accepted that TPF (docetaxel, cisplatin, and fluorouracil) is the standard IC regimen. Essays that have compared this approach with the standard of care, concurrent chemoradiotherapy (CCRT), are mostly inconclusive. Radiotherapy (RT) can be used in the post-IC setting and be sensitized by chemotherapy or cetuximab. Again, no consensus exists but there seems to be trend in favor of potentiation by cisplatin. Less toxic schemes of IC are tested as toxicity is a major issue with TPF. IC might have an interesting role in human papilloma virus (HPV)-related LA HNSCC and lead to CCRT de-escalation.

Nivolumab in recurrent/metastatic head and neck cancers

Head and neck cancer is an immunosuppressive disease, with a high proportion expressing PD-L1. Until recently, options were lacking in second line. Prognosis is poor especially for patients who progress during chemotherapy with survival often inferior to 6 months. Nivolumab is the only anti-PD-1 agent to prolong survival in the second-line setting and is now the standard option since the CheckMate-141 trial. Treatment is generally well tolerated, patients seem to have a better quality of life when compared with chemotherapy. Markers of efficacy are lacking even if some data are emerging. Different combinations of immunotherapy are ongoing. Hyperprogression is a phenomenon associated with poor outcome and might be the consequence of anti-PD-1 treatment but this is yet to be proven.

First RFLP linkage map of red clover ( Trifolium pratense L.) based on cDNA probes and its transferability to other red clover germplasm

We constructed a genetic linkage map of red clover ( Trifolium pratense L., 2n=2 x=14) using RFLP markers from cDNA probes of a backcrossed mapping population, and investigated the transferability of the markers to other red clover germplasm. The map contains 157 RFLP markers and one morphological marker on seven linkage groups. The total map distance was 535.7 cM and the average distance between two markers was 3.4 cM. All of the cDNA probes of the map were hybridized to the fragments of genomic DNA from 12 plants derived from three varieties, and 87% of the cDNA probes detected polymorphic bands that corresponded to those of mapping parents. This result indicated that RFLP markers on the present map were transferable to the genome analysis of other red clover germplasm. This is the first report to construct a linkage map of Trifolium species; it should provide fundamental and useful genetic information relevant to the breeding of red clover and genus Trifolium.

[Blue-yellow perimetry in rhegmatogenous retinal detachment. Studies before and after therapy in comparison with white-white perimetry]

INTRODUCTION

Disturbance of the blue light perceptance in rhegmatogenous retinal detachment was demonstrated by Köllner 1907 with the help of colour-perimetries. We examined the blue- and white-function after retinal reattachment by blue-on-yellow-perimetry compared with white-on-white-perimetry.

PATIENTS AND METHODS

10 Patients with rhegmatogenous retinal detachment and a visual acuity > or = 0.1 were examined preoperatively, 4 days and 6 weeks after successful buckling procedure. We performed a white-on-white-perimetry as also perimetries with blue stimuli on a yellow luminance background (program 30-2 of the Humphrey Field Analyzer 750).

RESULTS

Four days after surgery the increase in sensitivity was significantly less for the blue-function compared with the white-function. Preoperatively and 6 weeks postoperatively the sensitivities were not significantly different. Between these time-points function recovered in average for both methods from MD -15 dB to MD -5 dB.

CONCLUSION

After successful retinal detachment surgery the blue- and white-function increased. Blue-on-yellow-perimetry showed more retinal sensitivity loss than white-on-white-perimetry immediately after surgery. Blue-on-yellow-perimetry measured the same retinal sensitivity loss as white-on-white-perimetry preoperatively and 6 weeks postoperatively.

[Penetrating and perforating eye injuries with foreign bodies during motorized brush-cutting while wearing head protection gear]

BACKGROUND

Protective clothing is prescribed concerning gloves, shoes, protective trousers and a helmet for protection of hearing and the face during brush-cutter work.

PATIENTS AND METHODS

Seven patients were observed in a time period from 1994 to 1998. Mostly a nylon head protection had been used. The side of the helmet has no protection shield. The 1- to 4-mm large foreign bodies passed the head protection shield from the side or by entering through the holes of the nylon mesh which may be not small enough to stop the foreign body. A pars plana vitrectomy with foreign body removal was performed after primary wound repair.

RESULTS

An endophthalmitis was diagnosed in two patients after primary wound treatment. In these cases, a pars plana vitrectomy and antibiotic instillation was performed. In 5 patients visual acuity increased postoperatively. We measured a postoperative visual acuity from 1/50 to 1.6. The development of proliferative vitreoretinopathy with retinal detachment in 4 patients was the main complication observed after pars plana vitrectomy.

CONCLUSIONS

A cosmetically satisfactory appearance of the injured eye was reached by pars plana vitrectomy in all patients. Anatomic and functional success was reached in most of the patients. For prophylaxis, a head-protection seems not safe enough. The additional usage of eye protection glasses may be imperative for the prevention of these eye injuries.

The coupling of differential display and AFLP approaches for nonradioactive mRNA fingerprinting

We have modified the differential display of 3'-end restriction fragments of cDNA technique by combining it with the amplified fragment length polymorphism (AFLP) approach and silver staining. Modified oligo-dT primers were used for a reverse transcription step. ds cDNA was digested with the Mse I restriction enzyme and then ligated with an AFLP adapter. The modified template was amplified with oligo-dT primers in a preamplification step (asymmetric PCR) that enriched the template for 3'-end sequences; subsequently, the enriched template was amplified with an AFLP primer having a selective extension and an anchored oligo-dT primer (conventional PCR step). We demonstrated that the asymmetric preamplification step facilitates the preferential amplification of 3'-end fragments and the resulting PCR products can be clear resolved on silver-stained gel. The presented procedure takes advantages of silver-stained gels, generates reproducible display patterns, and allows reliable reamplification of isolated fragments which contain both upstream and downstream primer sequences.

[Pars plana vitrectomy in Borrelia burgdorferi endophthalmitis]

BACKGROUND

Ocular manifestations of Lyme borreliose present with unusual forms of conjunctivitis, keratitis, optic nerve disease, uveitis, vitritis and rarely endophthalmitis.

CASE REPORT

A 57-year-old man working as logger in Sax-ony-Anhalt suffering from an endophthalmitis on his left eye was referred to us. The vision of his left eye was intact light perception and hand motions. The slit-lamp examination revealed severe inflammation of the anterior chamber with hypopyon, posterior synechiae, and opacity of the posterior lens capsule. Funduscopy showed no red reflex, no retinal details. In the local hospital serum analysis was performed and showed in Western-Blot IgM- and IgG-antibodies against Borrelia burgdorferi. Despite of intravenous application of ceftriaxon for 14 days panuveitis persisted, and endophthalmitis developed when antibiotic therapy was finished.

RESULTS

During pars plana vitrectomy a sharply delineated cystic lesion containing yellowish fluid was revealed, and creamy yellow fluid was aspirated. Microscopically in hematoxylineosin stained slides of the aspirate structures consistent with Borrelia burgdorferi were found. Postoperatively vision increased to 1/15. Despite of a second intravenous ceftriaxon treatment for 14 days we observed a retinal vasculitis in the follow up of 6 months.

CONCLUSIONS

Despite intravenous ceftriaxon-therapy borrelia burgdorferi must have survived in the vitreous body. Further investigations are required with respect to the use of other antibiotics or immunosuppressives.

[A retrosellar arachnoid cyst as a rare cause of homonymous hemianopsia]

BACKGROUND

Arachnoidal cysts are cystic lesions filled with a cerebrospinal-fluid-like content within the leptomeninges. Usually arachnoidal cysts represent a congenital malformation. Clinical signs (increased intracranial pressure and/or neurological defects) may become apparent in children or young adults.

PATIENT

A sixteen year old boy was referred to our outpatient clinic because of blurred vision in both eyes since five days. The patient complained of cephalgia and of an increased sleep requirement in the last two weeks. Morphological findings were within the normal range. The visual acuity was 0.7 in the right eye and 0.2 in the left eye. The visual fields showed an incomplete homonymous hemianopia to the right. The CT and MRI revealed a retrosellar arachnoidal cyst. Two weeks after fenestration of the cyst the visual acuity had risen to 1.3 in both eyes and the visual field defects had disappeared nearly completely.

CONCLUSION

A retrosellar arachnoidal cyst can impair the visual pathway. Early fenestration prevents permanent damage.