Prognostic value of EBV markers in the clinical management of nasopharyngeal carcinoma (NPC): a multicenter follow-up study.

Between December 1979 and April 1982, 373 patients with untreated, undifferentiated carcinoma of the nasopharynx (NPC), 99 in Hong Kong, 120 in Tunis and 154 in Villejuif, entered a longitudinal study aimed at determining the clinical prognostic value of EBV serology after radiotherapy. A minimum of 3 years' follow-up was achieved for 319 patients (83 in Tunis, 95 in Hong Kong and 141 in Villejuif) who had regular clinical and serological testing at intervals of 6-8 months. No significant difference in initial serology (i.e., before any treatment) or variations of antibody titers at time of first follow-up was observed between patients who achieved complete remission after radiotherapy and those who did not. This included IgG and IgA antibodies to VCA, EA or EBNA. However, when patients with confirmed clinical remission 1 year after completion of radiotherapy were studied, the value of IgG/EA and mainly of IgA/EA increasing titers became highly significant for prediction of relapse, regardless of the initial titers. This demonstrated the clinical usefulness of EBV serology for NPC patients who have confirmed clinical remission after radiotherapy.

Ten-year results of randomized trial comparing radiotherapy and concomitant bleomycin to radiotherapy alone in epidermoid carcinomas of the oropharynx: experience of the European Organization for Research and Treatment of Cancer.

This trial of treatment for head and neck carcinoma was initiated in 1973 by the European Organization for Research and Treatment of Cancer. Its purpose was to investigate the value of single-agent chemotherapy with bleomycin (BLM) given during the course of a conventional treatment by external radiotherapy (RT) compared to treatment by external RT alone. In this randomized study, we compared treatment results in 2 groups of patients with squamous cell carcinoma of the oropharynx (T2, T3, and T4; International Union Against Cancer classification). One group of 92 patients was treated by RT at the prescribed dose of 70 Gy. The other group of 107 patients received radiation according to the same protocol and simultaneously received im injection of BLM at a dose of 15 mg twice a week, 2 hours prior to the session of RT, for a total dose of 150 mg in 5 weeks. The occurrence of local toxic effects (i.e., mucositis and epidermatitis) was significantly greater in the RT-BLM group (RT-BLM, 72%, vs. RT, 21%). Primary tumor response 6 weeks after completion of RT was the same in both arms of the study (RT, 68%, vs. RT-BLM, 67%). The 6-year survival rate was 24% (RT-BLM) versus 22% (RT). Long-term analysis (10 yr) is given.

La prevention des cancers des voies aero-digestives superieures: quelles sont les perspectives? Par ou commencer? / Prevention of upper respiratory and digestive tract cancer: what would be the perspectives?

No que se refere aos cânceres das vias aerodigestivas superiores, a prevençäo primária possibilita importante reduçäo na incidência destas neoplasias (50 a 75%). A prevençäo secundária, quando seriamente aplicada, torna possível detectar certo número de lesöes pré-cancerosas e neoplasias de pequenas dimensöes, portanto evita a transformaçäo neoplásica das primeiras e resulta em efeitos satisfatórios no tratamento dos tumores inicias. Após dar algumas definiçöes e ilustraçöes sobre a importância do problema, autor insiste na necessidade de campanhas contra dois fatores de risco: álcool e tabaco. Ele discute os meios para atingir tais objetivos. O primeiro estágio consiste no estabelecimento de registros de cancer e estudos epidemiológicos. Num segundo estágio, devem ser tomadas medidas concretas com respeito a tabaco, álcool e higiene bucal. O último estágio consiste na informaçäo e campanhas de diagnóstico precoce baseadas nos princípios que foram expostos

Prognostic factors in cervical lymph node metastasis in upper respiratory and digestive tract carcinomas: study of 1,713 cases during a 15-year period.

A prospective study of 1,713 patients with squamous cell carcinoma of the head and neck submitted to neck dissection between 1957 and 1973 is presented. We confirm the prognostic significance of the histological analysis of the nodal metastasis. Capsular rupture is the most important factor regardless of the primary site or tumor size. The presence of tumor emboli within lymphatics, the number of invaded nodes, and the number of nodes with capsular rupture are of significance though to a lesser extent. Classification of the clinical characteristics or the nodes provided, in 70% of the patients, a good prediction of histological involvement. In the clinical estimation of histological invasion, an important parameter is the size of the largest node detected, and we suggest this characteristic should be included in the TNM classification of UICC.

[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.

HLA-A, -B, and -DR antigens in North African patients with nasopharyngeal carcinoma.

Seventy-six North African patients (most from Algeria) affected with nasopharyngeal carcinoma (NPC) have been studied for their HLA-A, -B, and -DR phenotypes and compared with a control North African population. Antigens HLA-A3, HLA-B5 and HLA-Bw15 were found more frequently in the NPC group than in the control group (30.3% vs 17.6%, 38.2% vs 24.4% and 9.2% vs 0.8%, respectively). HLA-Aw33, HLA-B14 and HLA-DR4 were less frequent in the patients than in the controls (3.9% vs 16.8%, 1.3% vs 16% and 13.2% vs 29.1%, respectively). After correction for the number of specificities tested, these differences were not statistically significant. They were, however, more striking when compared to normal Kabyles (Algerian Berbers), a major ethnical population in Algeria, with lower incidences of the HLA-B5 antigen and of the HLA-Aw33-B14 haplotype. This could suggest, in North Africa, either the existence of MHC-linked genes of resistance or susceptibility to NPC, in Berbers especially, or a preferential occurrence of NPC in non-Berbers. Antibody titers against the Epstein-Barr virus (EBV) associated early antigen (EA) and viral capsid antigen (VCA) have been measured. No correlation was observed between HLA phenotypes and the anti-EBV serological response of the patients.

The value of combining radiotherapy with surgery in the treatment of hypopharyngeal and laryngeal cancers.

Two-hundred and six cases of hypopharyngeal and laryngeal squamous cell carcinoma treated at the Institut Gustave-Roussy were retrospectively analyzed. All of them were treated by surgery and they were divided into three therapeutic groups following the adjuvant radiotherapy: (A) Postoperative radiotherapy at doses equal to or greater than 4500 rad; (B) Postoperative radiotherapy at doses less than 4500 rad; and (C) Preoperative irradiation at doses less than 4500 rad. Group A included a greater proportion of patients with hypopharyngeal cancer and patients with advanced tumors (T3, T4; N1b, N2, N3). However, the local and regional control rate in this group is significantly higher than those of the other groups in spite of the poor prognostic factors. The survival rate is comparable in all the three groups, with distant metastases more frequently found in group A. The results showing a significant improvement in lymph node control with postoperative radiotherapy, this adjuvant therapy is used systematically in this center in patients being operated on for hypopharyngeal and laryngeal cancer with incomplete histologically defined resection and/or with lymph nodes histologically involved.

Lymphoid cells in lymph nodes and peripheral blood of patients with squamous cell carcinoma of the head and neck.

Fifty-five patients with squamous cell carcinoma of the head and neck were evaluated immunologically by measuring the level of T cells (E-RFC) and high affinity subset T cells (E-29) in the peripheral blood and peritumorous lymph nodes. A significant decrease (p less than 0.05) in mean percentage of E-29 was observed in cancer patient peripheral blood. In peritumorous lymph nodes, there was no difference in terms of total T cells or of high affinity subset T cells, as compared to non-malignant lymph nodes, or between tumor-free and metastatic lymph nodes. Macrophage content was much higher in metastatic than in tumor-free lymph nodes (p less than 0.05) and these macrophages frequently appeared to be more active when tested in phagocytosis of sheep red blood cells sensitized with IgG or IgM + C.

[Combination of radiotherapy and chemotherapy in the treatment of upper respiratory and digestive tract carcinomas (author's transl)]. / Association radiothérapie-chimiothérapie dans les carcinomes des voies aéro-digestives supérieures.

The authors set out in detail the conditions for which adjuvant chemotherapy is used in the treatment of carcinomas of the upper respiratory and digestive tracts. The conditions are at the same time of a theoretical (natural history as shown by cell kinetics) and of a practical (general physical state) nature. They evaluate 34 randomised therapeutic trials and 14 phase II trials: chemotherapy given either before, during or after radiotherapy. They finally draw several conclusions concerning the use of adjuvant chemotherapy.

[Muco-epidermoid carcinoma of the mandible. A case report (author's transl)]. / Carcinome muco-épidermoïde de la mandibule. A propos d'un cas.

Muco-epidermoid tumours are reviewed, and a case of a muco-epidermoid carcinoma of the mandible in a 78-year-old man reported. Radiological examination suggested the presence of an ameloblastoma, but the scanner provided evidence of a possible malignant tumour. Diagnosis of a muco-epidermoid carcinoma was confirmed by pathological examination after hemimandibulectomy.

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.

[Tuberculosis of the mucosa of the naso-pharynx. A clinical study of 37 cases seen at the Gustave-Roussy Institute between 1961 and 1978 (author's transl)]. / La tuberculose des muqueuses des V.A.D.S. Etude clinique à propos de 37 cas suivis à l'I.G.R.

The authors report a series of 37 cases presenting with tuberculosis of the mucosa of the upper naso-pharynx. The localization broke down as: 5 cases of tuberculosis of naso-sinuses, 6 of the buccal cavity, 3 of the cavum, 10 of the oro-pharynx, 1 of the hypopharynx, and 12 of the larynx. -- The male-female ratio was unequal (2:1 M:F) -- The mean age was 52.5 years -- Most patients were European. The 3 rhinopharyngeal cases were in North Africans. -- Macroscopically the lesions were of a malignant character in 70%. -- There was palpable lymphadenopathy in 56% of patients. The most commonly involved chain was the jugulo-carotid, especially the subdigastric group. -- There was tuberculosis in the entourage in 20/37 cases. CXR was normal in 17 cases. On hospitalisation active T.b. was discovered in 15 cases. -- Biopsy confirmed a definitive diagnosis in every case. -- All patients were treated medically. There were no cases of resistant organisms. The results were excellent.

[Intra-arterial chemotherapy for the treatment of tumors of the nasal sinuses. Results in 50 cases (author's transl)]. / apport de la chimiothérapie intra-artérielle dans le traitement des tumeurs naso-sinusiennes. A propos de 50 observations.

Fifty patients with primary epidermoid carcinomas of the nasal sinuses were treated by intra-arterial chemotherapy, alone (2 fatal iatrogenic accidents occurred) or in association with surgery and/or radiotherapy (48 cases). Adverse reactions due to chemotherapy were noted in 11 patients (22%), and two of these were fatal (4%). In eleven patients (22%) the initial curative chemotherapy was unsuccessful and all died after a mean survival period of 12 months. Local recurrence was observed in 7 patients (14%), the mean survival period being 11,5 months, and in 6 patients (12%) with local glandular involvement the mean period was 15 months. Identical survival rates of 57% after 3 years (8/14) and 50% after 5 years (6/12) were observed in 14 cases with endosinusal forms and 14 patients in whom the infrastructures were treated. In 22 patients there was exteriorization of the lesion, and the survival rate was 31% after 3 years (7/22) and 15% after 5 years (3/19). All 7 patients with pterygomaxillary lesions died within 3 years. Overall results in the 50 patients treated show that: -- 23/50 (46%) survived for 3 years -- 15/43 (35%) for 5 years -- 5/19 (26%) for 10 years.