Squamous cell carcinoma of the pyriform sinus: retrospective study of 351 cases treated at the Institut Gustave-Roussy.

The first part of the study was devoted to 199 tumors treated by surgery, either conservative for the smallest tumors (18 cases) or radical (181 cases), with systematic postoperative radiotherapy. The 3-year survival rate was 48% and the 5-year, 33%, with a 12% local recurrence rate, a 7.5% neck recurrence rate, and 27.6% rate distant metastases. Histologic correlations were developed. The second part of the study reported 152 cases treated by external radiotherapy alone either as a variant of our treatment protocol for the small-sized tumors (31 cases) or, for the major part (121 cases), as a result of surgical inoperability or patient refusal. The former subgroup had a variable survival rate (65% at 3 years and 40% at 5 years) equivalent to similarly staged patients treated with conservation laryngeal surgery, whereas the prognosis of the latter subgroup was poor. The two main causes of failure were the inability to apply the curative treatment protocol in 35% of patients ineligible for a surgery and the high risk of distant metastases in the 65% of patients able to undergo the usual management.

[Ligation of the common carotid. Studies of the circumstances and follow up of 42 ligations]. / Contribution à l'étude des ligatures de l'axe carotidien principal. Etudes des circonstance et des suites de 42 ligatures.

The authors report the results of a series, between 1969 and 1978, of 42 patients who had received ligation to the carotid arterial trunk. In 36 patients, the ligation was performed as an emergency measure, often under extemporary circumstances, because of massive hemorrhage in individuals who had received surgery after previous radiotherapy. The complications after applying these ligatures have been catastrophic for many reasons. Fifteen rapid recurrent hemorrhages occurred, leading to the deaths of 13 patients. Twenty-two patients developed major neurological problems and 12 of these subsequently died. The third complication observed was the onset of extensive necrosis. This necrosis was the direct result of applying a ligature, as a last resort, to the carotid trunk supplying a vascular territory already compromised by previous radiotherapy and surgery. The authors propose different techniques for these subsequent ameliorating operations. They insist, particularly, on performing an arterectomy instead of simply applying a ligature to the carotid trunk.

[Myocutaneous flaps in cervicofacial oncology. Results apropos of 87 patients]. / Les lambeaux myo-cutanés en carcinologie cervico-faciale. Résultats à propos de 87 malades.

Results are reported of the use of 93 musculocutaneous flaps, distinction being drawn between those used for secondary reconstruction and those employed during surgical excision. Secondary flaps were used to close 19 pharyngostomies, 10 orostomies, and 2 necrotic skin lesions, and for reconstruction of a circular pharyngectomy. Large radiation doses had been given in 29 of these 32 patients. Treatment was a total failure in 3 cases, and was partially ineffective in 5 patients, with the need for alternative surgery. Flaps obtained during initial surgery (57 cases) included 33 patients treated by radiation. Partial healing was obtained in 5 cases but the treatment was unsuccessful in 4 cases: all on previously radiated tissue. Unfavourable factors are mainly previous radiation and the hypopharyngeal site of loss of substance. Indications for the different types of flap are discussed.

Superficial extending carcinoma of the hypopharynx: report of 26 cases of an underestimated carcinoma.

Advanced ulcerating and infiltration tumors are commonly found in the hypopharynx, whereas early well-defined lesions are rarely diagnosed. The pathologic reports of 242 uniformly studied surgical specimens after total pharyngolaryngectomy for cancer of the hypopharynx were reviewed. The histologic analysis of 26 cancers (10.7%), which were recorded as having an entire or predominant superficial type of spreading, demonstrated that also in the hypopharynx a "superficial extending carcinoma" (SEC) may occur. SEC of hypopharynx was pathologically defined as a poorly or moderately differentiated squamous cell carcinoma, generally located in the pyriform sinus, which spreads superficially. It was limited to the mucosa (2.9%), but more frequently early infiltrated the underlying muscle or gland structures (6.2%), regardless of the presence of lymph node metastases or lymph vessels invasion. Although the concept that SEC of the hypopharynx may be an expression of a generalized disease of the mucosa must be carefully considered in surgical management, it appeared that this carcinoma in its "pure" intramucosal form may be associated with a good prognosis and a long survival.

Elective versus therapeutic radical neck dissection in epidermoid carcinoma of the oral cavity: results of a randomized clinical trial.

This study concerns 75 patients with squamous cell carcinoma of the oral cavity who were patients at the Gustave-Roussy Institute between December 1966 and July 1973. These patients were divided into two groups. The first group was comprised of 39 patients who underwent elective radical neck dissection; nodal involvement was present in 49% with capsular rupture in 13%. In the second group of 36, neck disease appeared during follow up in 19 cases. Therapeutic radical neck dissection was carried out in 17; the nodes were histologically positive in 15, 9 of which had a capsular rupture. In 2 cases, local or general conditions did not permit operative intervention. In this group, the involvement rate was 47% with a 25% capsular rupture rate. However, the comparison of the survival curves by the log-rank test did not reveal any differences, even though histologic prognostic factors were taken into account. These findings led to the conclusion that in squamous cell carcinoma of the oral cavity staged T1N0, T2N0, or T3N0 (from AJC's and UICC's clinical staging system), it seems possible, without risk, to delay neck dissection until a node is detectable, although it is reasonable to perform elective neck dissection in those cases in which the patient is unavailable for regular followup.

A retrospective study of 131 cases of carcinoma of the posterior pharyngeal wall.

Between 1958 and 1973, 131 patients with carcinoma of the posterior pharyngeal wall were treated at the Institute Gustave-Roussy (127 men, 4 women, mean age 61 years). Nine had a tumor of the oropharynx, 37 of the hypopharynx and 85 of the oro-hypopharynx. Nine had T1 tumors, 19 T2 and 103 T3 (TNM-UICC 1975). 122 patients were treated by irradiation: 83% were T3 lesions, 81% were more than 4 cm in diameter, 80% were ulcerated and 42% were staged N3. The survival rate of these patients was very poor (3% at five years). The nine patients who had been treated by surgical excision had a better survival rate and three are alive at 5 years, but the initial prognostic factors were better in this group. It seems that the indications for surgery should be widened to increase the survival rate in these poor prognosis cancers.

Results of a randomized clinical trial of preoperative irradiation versus postoperative in treatment of tumors of the hypopharynx.

Preoperative radiotherapy vs postoperative radiotherapy in the management of patients with primary tumors of the hypopharynx was evaluated by a prospective, randomized clinical trial. A statistically significant difference (p less than 1%) existed in favor of postoperative radiotherapy relative to survival rates, complications, and quality of survival. The postoperative radiotherapy group showed a 56% 5-year survival rate compared to 20% in the preoperative radiotherapy group. An analysis of the results is discussed.

[Treatment of malpighian epitheliomas of the floor of the mouth with gingival involvement]. / Traitement des épithéliomas malpighiens du plancher buccal avec atteinte gingivale

Within the clinical context of carinomas of the upper respiratory/digestive tract (special underlying features, frequency of multiple localisations), pelvi-gingival tumours pose special problems essentially related to the proximity of the mandible. Over the past 15 years, treatment protocols at the Institut Gustave-Roussy have been progressively oriented towards a surgical solution preceded by short period of chemotherapy and followed by radiotherapy on an "as required" basis. In certain instances (bone resection with defect, especially naterior), such excision surgery results in serious functional and aesthetic impairment and cannot be envisaged in the absence of concomitant reparative surgery. The latter is clearly defined as far as the soft tissues are concerned thanks to the use of facial or thoracic flaps, whilst solutions for restoring bone continuity remain imperfect. The difficulties of covering a bone transplant and the need for postoperative radiotherapy compromise its future. From a tumour standpoint, the results are aggravated essentially by the existence of bone involvement or of histological lymph node invasion. Furthermore, it is closely related to the manifestations of the malignant disease in general. The survival obtained with the current therapeutic protocol is 38% at 3 years and 32% at 5 years.