G. Valette

Prognostic value of dual-time-point 18F-FDG PET-CT imaging in patients with head and neck squamous cell carcinoma.

ObjectiveThe objective of this study was to investigate the independent prognostic value of dual-time-point 18F-fluorodeoxyglucose (18F-FDG) PET-CT imaging in patients with head and neck squamous cell carcinoma (HNSCC). MethodsPatients referred to our department to undergo 18F-FDG PET-CT for staging of HNSCC were prospectively included. Each patient was scanned using a Philips Gemini PET-CT system 1 h (early acquisition) and 2 h (delayed acquisition) after injection. An intratumoral retention index (RI) of 18F-FDG was measured for each examination by the dual-time-point method. Event-free survival (EFS) and overall survival (OS) were determined by the Kaplan–Meier method and compared with the conventional maximum standardized uptake value (SUVmax) at 60 min, SUVmax at 120 min, and RI in univariate and multivariate analyses including the usual prognostic factors such as age, sex, primary site, SCC histologic grade, and American Joint Committee on Cancer stage (I, II, III, and IV). ResultsSixty-six consecutive patients (60 men and six women; mean age=61±9 years) were included in the study. In univariate analysis, besides age and stage, RI was predictive of EFS (P=0.01) but not of OS (P=0.1), whereas SUVmax at 60 min was not predictive of EFS (P=0.18) or OS (P=0.08) and SUVmax at 120 min was predictive of OS (P=0.02) but not of EFS (P=0.05). In multivariate analysis, RI persisted as an independent predictive factor for EFS (P=0.02) but not SUVmax at 120 min for OS (P=0.12). ConclusionOur results suggest an additional prognostic interest of RI measured by dual-time-point 18F-FDG PET-CT, independent of usual prognostic factors, in patients with HNSCC.

Prognostic value of fluorine-18 fluorodeoxyglucose positron-emission tomography imaging in patients with head and neck squamous cell carcinoma

High tumor uptake of fluorodeoxyglucose (FDG) is associated with an unfavorable outcome in patients with cancer. We evaluated FDG uptake as a prognostic factor in patients with head and neck squamous cell carcinoma.

Prognostic evaluation of percentage variation of metabolic tumor burden calculated by dual‐phase 18FDG PET‐CT imaging in patients with head and neck cancer

The purpose of this study was to investigate the prognostic value of percentage variation of metabolic tumor burden in patients with head and neck squamous cell carcinoma (HNSCC).

Interpretation of Incidental Head and Neck Uptakes on PET/CT in Patients with Lung Cancer

Objectives: Smoking is the major risk factor for lung and head and neck cancer. The purpose of this study is to determine the clinical impact of the incidental head and neck positron emission tomography (PET)/computed tomography (CT) findings in patients undergoing investigation for lung cancer. Methods: The reports from PET/CT studies for patients with lung cancer from September 2005 and April 2012 were retrospectively reviewed. The incidental head and neck findings were interpreted as suggestive of second primary malignancy. These incidental findings were compared with the final diagnosis obtained from clinical and histological investigations. Results: A total of 592 patients were investigated for lung cancer in the study period. Head and neck PET/CT positive lesions suggestive of second primary malignancy were found in 65 (11%) patients. Twenty-three patients had nasoendoscopy, and a biopsy was done in 10 patients. In 4 (0.68%) patients, these lesions were proven of second primary malignancy: 2 squamous cell carcinoma (larynx and oral cavity), 1 undifferenciated carcinoma (parotid), 1 osteosarcoma (mandible). At a median follow-up of 13 months, 3 of 4 patients with a second primary died from a malignancy and 1 had no evidence of disease. Metastasis from lung adenocarcinoma was found in 2 (0.34%) patients. Conclusions: PET/CT detected unexpected head and neck primary malignant tumors in at least 0.68% of patients with lung cancer. Among patients who underwent clinical investigations, 26.1% had a head and neck malignant tumor.

Gestion des antithrombotiques dans les lambeaux libres après chirurgie carcinologique ORL

But de la presentation La reconstruction par lambeaux libres est un procede frequemment utilise pour la couverture des pertes de substances en cancerologie O.R.L. La principale complication de ce type d’intervention est la thrombose precoce des anastomoses vasculaires. Materiel et methodes Il n’existe pas de consensus dans l’utilisation des anticoagulants en prevention des thromboses. L’objectif de cette etude est de faire une revue de la litterature a partir de la base de donnees Pubmed afin de comparer l’efficacite des differents anti-thrombotiques utilises. Les traitements les plus utilises en prevention des thromboses vasculaires sont l’aspirine et les HBPM. Resultats Les traitements les plus utilises en prevention des thromboses vasculaires sont l’aspirine et les HBPM. Pour le moment, aucune etude ne semble demontrer une difference significative entre l’utilisation de l’aspirine, de l’heparine de bas poids moleculaires et l’absence de prevention anti-thrombotiques. L’association aspirine et HBPM majorait les risques hemorragiques. Les statines, par leur effet anti-inflammatoire et vasoprotecteur diminue la morbidite postoperatoire. Conclusion Il est necessaire de trouver une association therapeutique efficace permettant de diminuer les thromboses et la morbidite post operatoire chez ces patients deja fragiles.

Early recurrence or submucosal residual of laryngeal squamous cell carcinoma: diagnosis by CT-guided endolaryngeal core biopsy on a transcutaneous approach.

Ultrasound and CT‐guided biopsy is a common procedure for histologic diagnosis of recurrence of head and neck squamous cell carcinoma. The present study describes a novel CT‐guided endolaryngeal puncture site.

FAMM FLAP in Head and Neck Surgery

Objective: Facial artery mucosa musclar (FAMM) flap is mainly used in head and neck oncologic surgery for primary reconstruction after resection in oral cavity and in surgical treatment of osteoradionecrosis of the mandible. Some benefits are ease of use, good vitality, and no aesthetic prejudice. Recently, robotic surgery has made removal of the flap inside the mouth cavity easier, thanks to a wider field of view and smaller surgical instruments. Method: Retrospective study. Forty cases were analyzed in ENT and head and neck center of Brest University Hospital, between April 2007 and June 2011, in both indications primary reconstruction and surgical treatment of osteoradionecrosis. Complications such as infection, hematoma, necrosis, time within pedicle weaning, and resumption of feeding were studied. Results: Eighteen cases for primary reconstruction and 22 cases for surgical treatment of osteoradionecrosis were analyzed. After radiotherapy, pedicle weaning was delayed (average of 11 more days) and enteral nutrition period lasted longer (average of 22 days vs 7 days). However, no infection and only 1 case of hematoma (2.5%) and 2 cases of necrosis (5%) were identified. Revision surgery for flap removal was necessary in 1 case (2.5%). After 1 month, oral feeding was possible in 35 cases (85%). Eighty percent of bad results occurred after radiotherapy. Conclusion: Thanks to its reliability, the FAMM flap is a good solution in head and neck cancer surgery, even after radiotherapy. However, the size of this flap remains relatively small. For a medium size loss of substance, it is a good alternative between controlled wound healing and bigger flaps.

Facial Artery Mucosa Muscular Flap: Possible after Oral Chemoradiotherapy

Objective: The Facial Artery Mucosa Muscular (FAMM) Flap, described by Pribaz in 1992, can be used in oral surgery on different indications. The primary reconstruction after the resection for an oral cancer is the most evaluated indication. Method: Thirty-five cases from the University Hospital of Brest Head and Neck Surgery Center between April 2007 and November 2010 were analyzed in a retrospective study. The indication, the status of treatment (post chemoradiotherapy or not), complications (hematoma, infection, necrosis), the weaning delay of the pedicula, and time to an oral feeding were all analyzed. Results: Twelve cases for primary reconstruction, 7 cases for buccosinusis defect and 16 cases in osteoradionecrosis. One case of hematoma, no infection and no necrosis were observed. One case did not give a good result. There is no difference in terms of viability between postchemoradiotherapy surgery. The weaning delay and the time delay to an oral feeding is twice longer after radiotherapy. Conclusion: This flap can be used after radiotherapy with a precaution of care. The FAMM flap represents a good solution event after chemoradiotherapy for the loss of medium size substance, it represents a good solution between directed healing and more consistent skin flaps.

Otalgie et otite moyenne aiguë de l’enfant

Otalgie et fievre sont les symptomes les plus evocateurs de l’otite moyenne aigue (OMA) sans en etre specifiques. L’enfant de plus de deux ans peut decrire spontanement une otalgie et ses caracteristiques mais, chez l’enfant plus jeune, il faut savoir interpreter certains signes indirects de la douleur et l’examen otoscopique doit etre systematique devant tout enfant febrile. Dans l’OMA, l’otalgie est classiquement decrite comme pulsatile, insomniante et a predominance nocturne. La prise en charge therapeutique associe un traitement antalgique et antipyretique a un traitement antibiotique en fonction de l’âge, du terrain de l’enfant et de la presentation clinique. Le paracetamol est le traitement de premiere intention a la dose de 60 mg/kg/jour en 4 a 6 prises. L’otalgie, cede habituellement en 48-72 heures apres le debut du traitement et sa reapparition doit faire suspecter une complication ou bien une resistance au traitement.