[Combined induction chemotherapy and radiotherapy in case of undifferentiated carcinoma of nasopharynx tumours (UCNT)]. / Traitement par chimiothérapie d'induction et radiothérapie des cancers du cavum de type UCNT.

OBJECTIVE: The objectives of our study were to consider the morbidity and the effectiveness of combined induction chemotherapy and radiotherapy in the treatment of Undifferentiated Carcinoma of Nasopharynx Tumor (UCNT). PATIENTS AND METHODS: It was a retrospective study (1987-2002) of patients who had not received any previous treatment. Patients with distant metastases during initial assessment were excluded. Two types of chemotherapy were administered: The BAC regime (Bleomycin, Adriamycin, Cisplatinum) and the FUCIFOL regime (Fluorouracil, Cispaltinum, Elvorin). The protocol for radiotherapy was either radiotherapy alone or concomitant chemoradiotherapy. The survival rates were calculated with the nonparametric method of Kaplan-Meier and compared with logrank tests. The multivariate analysis were made with the regressive logistic method. RESULTS: Fourty four patients (32 males, 12 females), average age 46 years (14-77) were selected. On the whole, the tolerance of the treatment was good (chemotherapy 71%, radiotherapy 82%). Treatment mortality was null. The BAC regime was the most effective. At the end of the treatment, a total response was obtained in 82% of cases. The commonest cause of treatment failure was the emergence of metastases (64% of deaths). The overall disease free survival rates at 3 years were respectively 78% and 69%. With multivariate analysis, the independent variables inductive radiotherapy and the initial response to treatment were significantly linked to death with a respective p value of 0.02 and 0.0084. CONCLUSIONS: Combined induction chemotherapy and radiotherapy is efficient in the treatment of UCNT. The tolerance of treatment was good. Our results are comparable with those reported in the literature.

[The outcome of treatments for carcinoma of the external auditory canal]. / Résultats des traitements des tumeurs malignes du conduit auditif externe.

OBJECTIVE: A retrospective analysis of management and survival of patients treated for temporal bone carcinoma. PATIENTS AND METHODS: Thirty patients underwent treatment for carcinoma of the temporal bone. Twenty-five squamous cell carcinomas, 1 melanoma, 2 basocellular carcinomas and 2 adenoid cystic carcinomas were treated. Thirteen patients were treated before for the same disease. RESULTS: Staging revealed 12 T1 and T2, 6 T3 and 12 T4 tumours. The mean follow up was 5 years (2-276 months). The Kaplan Meier survival curves showed survival rates at 2 years of 82%, 67% and 32%, and at 5 years of 82%, 67% and 17%, respectively for the stages T1 or T2, T3 and T4. At the end of follow up at 9 years the survival rates were 66%, 66% and 17% for the stages T1 or T2, T3 and T4 respectively. Overall stages a complete remission was found in 65% and 23%, and deceased was 35% and 77%, respectively for the primary treatment group and the salvage surgery group. CONCLUSION: Long-term prognosis of the carcinoma of the external auditory canal mainly depends on the stage and primary treatment. Surgery (lateral temporal bone or subtotal temporal bone resection, both in combination with a neck dissection and a parotidectomy) and adjuvant radiotherapy is the treatment of choice for part of stage T1 and all T2 and T3 tumours. The improved survival (65%) of patients treated de novo compared with those treated with salvage surgery (23%) suggests that early referral and aggressive primary surgical treatment with postoperative radiotherapy offer the greatest chance of cure.

[Course and prognosis of basaloid squamous cell carcinoma: case-control study of 49 patients]. / Evolution et pronostic du carcinome basaloïde squameux des voies aéro-digestives supérieures. Etude cas-témoins à propos de 49 cas.

INTRODUCTION: The course and prognosis of basaloid squamous cell carcinoma (BSCC) are not well known. OBJECTIVES: To study the course and prognosis in a population of BSCC patients. MATERIALS AND METHODS: We analyzed a retrospective cohort of 49 patients with BSCC in comparison with a cross-matched population of 49 patients treated for well- to moderately differentiated squamous cell carcinoma (SCC). RESULTS: The statistical analysis showed that survival in BSCC group was lower than in the SCC group. Local recurrence in the BSCC group was not higher than in the SCC group, but mortality by distant metastasis was six times higher than in the SCC population. CONCLUSIONS: We consider BSCC patients as a high-risk population and we complete diagnosis explorations including a FDG-PET before curative treatment. We also recommend post-operative or exclusive radiotherapy which may be associated with concomitant chemotherapy.

[Reconstruction after tumor resection of the anterior skull base with an of abdominal fat graft]. / Reconstruction après résection tumorale de la base antérieure du crâne par greffon graisseux abdominal.

OBJECTIVES: Reconstruction of the anterior skull base is a surgical stage as significant as tumor removal. The quality of the reconstruction is the primary determinant of postoperative mortality, morbidity. The aim of our work was to assess the results of a reconstruction process combining: 1) a pericranium graft held by biological glue to complete the dura mater; 2) an abdominal fat graft supported by a Silastic arch to maintain the neurological structures. PATIENTS AND METHODS: This was a retrospective study. 55 patients (44 men and 11 women), 59 mean age (14 - 78), were analyzed. 45 had a malignant tumor and 10 a benign tumor. 35 patients were treated using a mixed approach and 18 using a trans frontal-sinus approach alone. Forty-three patients treated for a malignant tumor underwent postoperative radiotherapy. Results were analyzed according to 3 periods: 1) immediate postoperative period (<25 days); 2) early postoperative period (25 days - 3 months); 3) late postoperative period (> 3 months). RESULTS: None of the patients were lost to follow-up. The average follow up was 84 months. All periods considered together, we had five (9.4%) graft infections, 6 (11.3%) CSF leaks and 1 (1.8%) cases of meningitis. CONCLUSION: We use a simple technique for reconstruction. Postoperative complications were exceptional, even after postoperative radiotherapy. Medium and long-term results are good and similar to those obtained with other processes used for reconstruction of the anterior skull base reconstruction.

[Surgical and/or endoscopic treatment of acquired tracheal stenosis in adult patients]. / Prise en charge chirurgicale et/ou endoscopique des sténoses trachéales acquises non tumorales de l'adulte.

OBJECTIVES: Retrospective survey (over 13 Years) of the surgical treatment of 46 acquired tracheal stenosis, in adult patients. Our goals were to study their epidemiology, changes in the surgical technique with the cervical or endoscopic approach, and the recent contribution of endoprotheses. MATERIALS AND METHODS: Sixty-six therapeutic procedures were performed for 46 tracheal stenoses. Most of stenoses were post-intubation and/or post-tracheotomy and were fixed in 50% of the cases. We used 21 sleeve resections with end-to-end anastomoses, 9 tracheal stents, 27 dilations, 6 calibrations, and 3 electro-coagulations. RESULTS: The sleeve resection gave 91% success (1 failure and 1 death). The endoscopic treatments were less efficient: 79% for tracheal stents (2 mobilizations), 50% success for iterative dilations. The respiratory tests were meaningfully improved with a mean follow-up of 18 Months. CONCLUSION: Sleeve resection remains the gold standard treatment. For all temporary or definitive contraindications to open surgery, tracheal stents would be an excellent alternative to avoid often inefficient iterative dilations.

[Malignant carotid paraganglioma. A case report]. / Paragangliome carotidien malin. A propos d'un cas.

The most common sites of paragangliomas occurring in the head and neck region are the carotid body and vagal glomus. The clinical course of carotid body paragangliomas is characterized by two modes of development: locoregional growth and distant metastatic dissemination. Few cases of malignant carotid body paraganglioma have been reported in the literature. We report a case managed in the ENT Department of Grenoble university hospital in 1993. A 53-year-old woman presented a bilateral functional (dopamine secretion) carotid tumor, stage II on the right side and stage I on the left side according to the Shamblin classification. Two successive excisions with complete resection were performed without complication. Two years after the second surgical excision, bone and liver metastases were diagnosed and visualized with a Ostreoscan scintigraphy. Clinical course was rapidly unfavorable and the patient died a few weeks later. Malignant forms of carotid paraganglioma are very uncommon and there is no cellular or histological appearance significantly contributing to the diagnosis of malignancy. Clinical findings are the most reliable criteria for malignancy, with the development of distant metastases usually after about 9 years. Long follow-up is essential. Histology in needed to establish the diagnosis of metastasis. A histology specimen may not be possible for a functional paraganglioma. In this case scintigraphy can provide the diagnosis. Malignant forms are more frequent in case of functional paraganglioma, more particularly in case of dopamine secretion.

[Congenital nasal pyriform aperture stenosis: a case report]. / Sténose congénitale des orifices piriformes: à propos d'un cas.

Congenital nasal pyriform aperture stenosis is a rare and poorly understood pathology. It's etiology is unknown. In cases with severe nasal airway obstruction, this anomaly may produce newborn respiratory destress similar to those seen in bilateral posterior choanal atresia. It can occur as an isolated anomaly or it can be associated with a dental anomaly, craniofacial, ophthalmological or central nervous system malformation. The diagnosis is made by physical examination. Computed tomography confirms the diagnosis. Magnetic resonance imaging of the brain and pituitary endocrine axis must be performed. In patients with severe obstruction, surgical correction is necessary. We describe the case of a 1-month-old child who needed surgical treatment with a sublabial approach for a congenital nasal pyriform aperture stenosis associated with a solitary maxillary central incisor. The follow-up (4 years) reveals normal nasal airway and facial growth.