Sarcomas of nasal cavity and paranasal sinuses: chondrosarcoma, osteosarcoma and fibrosarcoma.

Forty-two patients were treated for sarcoma of the nasal cavity and paranasal sinuses at the Institut Gustave Roussy, Paris, between 1960 and 1993. Twelve patients had chondrosarcoma (CS), 14 had osteosarcoma (OS) and 16 had fibrosarcoma (FS). Ten patients had grade I, six grade II and 26 grade III tumours. All but 10 patients had surgery for the primary tumour. A significantly increased risk of local failure was associated with the male sex (p < 0.01), grade III tumours (p < 0.02) and patients excluded from surgery (p < 0.04). The overall incidence of local and distant failure was 76 and 12 per cent respectively. Overall survival was 28 per cent at three years and 23 per cent at five years. Eight patients (20 per cent) were alive more than 10 years later. The factors significantly influencing survival were sex (p < 0.01), grade (p < 0.05) and local failure (p < 0.01).

Phase II study of cisplatin and continuous-infusion 5-fluorouracil and bleomycin for recurrent and metastatic head and neck squamous-cell carcinoma.

5-Fluorouracil (5-FU) and bleomycin (BLM) are active agents in head and neck squamous-cell cancer (H-N-scc). Less toxicity and an enhanced activity have been reported when these agents are administered by continuous infusion (CI), with or without a bolus of cisplatin (CDDP), another active agent. Thirty-three patients with recurrent and/or metastatic head and neck squamous cell carcinoma were treated with a combination regimen including CDDP (100 mg/m2) on day 1 plus BLM (15-mg bolus followed by 16 mg/m2/day by CI) and 5-FU (650 mg/m2/day by CI) on days 1-5 every 3 weeks. Thirty-one patients were evaluable for toxicity and response. The response rate (RR) was 15% (5 of 31), with one complete response (CR) and four partial responses (PRs), at a confidence interval of 95% (0-34%). Four of the five responders had not received previous radiotherapeutic treatment. Toxicity was deemed acceptable; nausea and vomiting and stomatitis were moderate. Only one patient had irreversible renal toxicity, after two cycles of chemotherapy. No symptomatic lung toxicity was observed. Good antitumour activity was noted for previously untreated disease (3 of 4; 75% RR). This combination of drugs proved to be inactive, however, in previously irradiated recurrent and/or metastatic H-N-scc (1 of 25; 4% RR). These results underscore the need to be extremely attentive to different patient populations when selecting therapeutic schedules and when analyzing reported results.

[Radiotherapy of cancer limited to the vocal cords]. / Radiothérapie des cancers limites de la corde vocale.

197 patients, with an early glottic cancer, were heated with radiotherapy at the Institute Gustave Roussy, between 1970 and 1983. Radiation was delivered up to a dose of 65 Gy over 6 1/2 weeks on a small area centered on the glottic region. All patients had previously undergone direct laryngoscopy and showed T1 stage tumours (175 T1a and 22 T1b) although in 32 cases there was a suspicion of very limited involvement of the ventricle or sub-glottis. 5 year survival for the overall population was 77.5%. 38 local recurrences were observed, 1/4 of these occurring after 3 years. For the overall population, local control at 5 years was 85.7%. Suspicion of supra or sub-glottic involvement and the presence of impaired mobility of the larynx were shown to be important prognostic factors. Local control at 5 years was 90% for "true T1" cases. Few complications were observed and the functional results of irradiation were judged to be excellent.

[Recovery surgery in cancer of the tongue. Apropos of 101 cases]. / Chirurgie de rattrapage dans les cancers de la langue. A propos de 101 cas.

Results of 101 salvage glossectomies, after unsuccessful treatment of cancer of tongue by radiotherapy, showed a 3-year survival of 39% and a 5-year of 31%. Carcinologic failures represented 81% of causes of death: 17% due to distant metastases, 6% to a second focus and principally 32% to local recurrence. Local recurrence varied as a function of tumor size but also of site and type of surgical treatment. Tumors of the mobile tongue have a relatively good prognosis, even when the total organ is involved, with attachment to floor of mouth if an anterior transverse glossectomy is performed. Inversely, lateralized tumors spreading to base and to the mobile tongue treated by partial longitudinal glossectomy tend to have a high frequency of failure of local therapy, probably partly avoidable by wider excision. These same local failures of treatment are the cause of the worsening prognosis after total glossectomy in patients who had been poorly selected perhaps and presented extralingual spread not controlled by surgery. Finally, the authors emphasize the need for a collaboration of the patient in the choice of therapy, which involves surgery with functional sequelae that risk to be extremely heavy.

[Contribution of muscular and musculocutaneous flaps in the early postoperative period in total salvage laryngectomies and pharyngo-laryngectomies. Apropos of 35 cases]. / L'apport des lambeaux musculaires et musculo-cutanés dans les suites immédiates des laryngectomies et pharyngo-laryngectomies totales de rattrapage. A propos de 35 cas.

From 1981 to 1985, 35 patients (34 male, 1 female), mean age, 56 years, underwent salvage total laryngectomy and pharyngo laryngectomy after full course radiotherapy. 13 cases have been closed primarily. 22 cases underwent reconstructive surgery using 15 musculo cutaneous and 7 muscular flaps. Complications occurred in 46% of the patients closed primarily and required further reconstruction by musculocutaneous flap. 90.7% of the cases where a flap was used initially had no post operative complications. This study confirms that the use of muscular and musculocutaneous flaps improve healing in salvage surgery.

[Chronic rhonchopathy or snoring. Clinical aspects and therapeutic indications]. / La rhonchopathie chronique ou ronflement. Aspects cliniques et indications thérapeutiques.

Results of several surveys of variable complexity have provided confirmation that snoring is not only an overall sleep preventer but is mainly an unrecognized asphyxia. Comparison of groups of snorers and non-snorers, and evaluation of biologic and functional improvement following surgical treatment of snoring, have shown that this chronic nocturnal hypoxia is, with the snoring as such, the essential feature of a well individualized new disease for which the term chronic rhonchopathy is proposed. This affection is composed of different clinical aspects of several syndromes, notably the Pickwickian and sleep apnea syndromes. However, a latent form also exists in which snoring is the only symptom, as well as a decompensated form with multiple signs related to the underlying condition. Improvement follows suppression of the respiratory obstacle provoking snoring. The most frequent of these signs is drowsiness, particularly when driving, and is the one with the heaviest social consequences.

[Surgical treatment of snoring: principle and technic]. / Le traitement chirurgical du ronflement. Principe--technique.

Surgical treatment of snoring requires suppression both of the obstacle responsible for the nocturnal respiratory noise but also of the chronic hypoxia on which the sleep of these patients is grafted. The soft palate and its appendages (uvula and tonsillar pillars) are always involved. Precise definition of extent of palatal resection ensures success of operation and avoidance of nasal regurgitation of food or rhinolalia postoperatively. Nasal ventilation must be normal; a septoplasty is sometimes unavoidable and postoperative medical treatment of rhinitis necessary. The pharyngeal lumen must be as wide as possible and tonsillectomy is sometimes required. Indications for these three stages : palatal, nasal and pharyngeal are described, omitting details of maxillary osteotomies capable of improving certain major retrognathies since these are only exceptionally indicated. Details of anesthetic requirements are emphasized and results obtained described.