[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.

[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.

[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.