[Quality of life for patients treated for head and neck carcinoma]. / Qualité de vie chez les patients traités pour un cancer de la sphère ORL.

A large consensus admits that quality of life is a multifactorial concept including at least physical, psychical and social dimensions of the disease as well as symptoms related to the disease and to the requested treatments. Quality of life is actually considered as one of the major assessment criteria for taking care of patients with cancer and to evaluate results of clinical trials. Self-evaluation by the patient is considered as the gold standard to evaluate the clinical symptoms. This evaluation is not unambiguous. Medical doctors underestimate patients' symptoms. In the field of surgery, development of organ preservation strategies should be considered as one of the major improvement observed in the modern era of head and neck oncology. The role of xerostomia, the most frequent complication reported after head and neck radiation therapy, is major in this field. However, odynophagia is considered as the most detrimental component of quality of life. Radiation oncologists should realize the role of these parameters in order to include these concepts as relevant in the global evaluation of treatments.

[Metastatic tumor implantation from a primary cancer of the base of the tongue at the site of placement of a central venous portacath]. / Métastase d'une tumeur de la base de langue sur un système d'accès veineux central totalement implantable.

Central venous catheter placement with an implanted port (portacath) is used to provide long-term venous access. We report a case of metastatic implantation at a port site from a primary cancer of the base of the tongue. Insertion of portacaths must be performed using full sterile precautions to avoid spread of tumor cells; in no case should the port site incisions be in contact with the surgical field in which the tumor resection was performed.

Conservative treatment of early glottic carcinomas with exclusive radiotherapy.

BACKGROUND: Early glottic carcinomas can be treated with radiotherapy or surgery with similar local control rates but with better functional results with radiotherapy. The aim of this study was to analyze the results of our experience of exclusive radiotherapy. PATIENTS AND METHODS: From 1975 to 2001, 155 patients with Tis, T1 and T2 glottic carcinomas were treated with exclusive radiotherapy. Prognostic factors of survival, local control and larynx-preservation rates were analyzed in uni and multivariate analyses. RESULTS: Median prescribed dose was 65 Gy in 44 days. Overall survival was 75% for the whole group, 75% for Tis, 85% for T1a, 72% for T1b, 59% for T2. Specific survival was 88% for the whole group, 75% for Tis, 94% for T1a, 90% for T1b, 69% for T2. Disease-free survival was 68% for the whole group, 75% for Tis, 77% for T1a, 51% for T1b, 58% for T2. Laryngeal preservation rate was 85% (133/155). Twenty-nine (29/155, 18%) patients developed a local relapse within 31 months. Out of the 10/86 (12%) T1a-Tis relapses, 7/10 patients underwent total laryngectomy and 79/86 larynx were preserved (92%). Out of the 8/22 (36%) T1b relapses, 4/8 patients underwent total laryngectomy. Out of the 11/47 (23%) T2 relapses, 8/11 patients underwent total laryngectomy. Increased overall treatment time, tumor stage, sub-glottis extension were associated with poorer local control. Second malignancies remain a major problem in the outcome of this population. CONCLUSION: Radiotherapy remains an efficient option in the treatment of early glottic carcinomas providing a high local control rate with excellent functional results in laryngectomy-free patients. This strategy should be discussed according to the tumor stage, feasibility of conservative surgery and patient's preferences.

[Feasability of the dose adjustment of continuous infusion administration over 120 hours of 5-fluorouracil associated with cisplatin]. / Faisabilité de l'adaptation de la posologie du 5-fluorouracile administré en perfusion continue de 120 heures associé au cisplatine.

Therapeutic monitoring of 120 hours continuous 5-fluorouracil associated with cisplatin. For 31 patients treated by continuous 5-fluorouracil with cisplatin, a therapeutic monitoring of 5-fluorouracil is performed, based on the 48 first hours area under the curve (AUC) and the total AUC. The 5-fluorouracile taylorization allows to reduce some toxicity's while preserving an efficiency (objective responses 42%). Many patients are considered with potentially low 5-fluorouracile clearance. Dose reductions of 5-fluorouracile are frequent, reach 50% during the third cure and allow the achievement of targeted AUC. The role of cisplatin in this necessary reduction of dose is unknown.

[Multiple paragangliomas of the neck localized in the thyroid region. Papillary thyroid cancer associated with parathyroid adenoma]. / Paragangliomes multiples du cou avec localisation thyroïdienne. Cancer papillaire thyroïdien et adénome parathyroïdien associés.

A 58 years-old woman has had a goiter for many years. She was treated by neck irradiation for "lymphadenopathy" 20 years-ago. She is now operated on for bilateral carotid body paragangliomas and a similar tumor of the thyroid gland near the midline. She also presents a papillary carcinoma of the left thyroid lobe with lymph node metastasis and a chief-cell parathyroid adenoma. The diagnosis of thyroid paraganglioma is discussed. Then the authors raise the hypothesis of radiation-induced papillary carcinoma. They try to set a link between thyroid tumors and parathyroid adenoma.