Jérôme Sarini

Pilot Study of Neoadjuvant Treatment with Erlotinib in Nonmetastatic Head and Neck Squamous Cell Carcinoma

Purpose: To determine the safety and efficacy of erlotinib given as neoadjuvant treatment in patients with head and neck squamous cell carcinoma (HNSCC). Further objectives were to identify markers of response to erlotinib and to assess the pharmacodynamic effects of erlotinib in tumor cells. Experimental Design: Patients with locally advanced nonmetastatic HNSCC were treated with erlotinib 150 mg daily pending surgical management. Tumor samples were collected before and after erlotinib treatment and were analyzed using immunohistochemistry. Epidermal growth factor receptor copy number was determined in tumors using CISH analysis. Results: Between November 2003 and December 2005, 35 patients were included in the study. Neoadjuvant treatment with erlotinib in HNSCC patients was well tolerated and did not necessitate modification to routine surgical procedures. Among 31 evaluable patients, erlotinib was given for a median of 20 days. At the time of surgery, tumor shrinkage was observed in nine patients (29%). Immunohistochemistry analyses were done for 31 patients and showed a decrease in phosphorylated tyrosine residues and phosphorylated erk immunostaining after erlotinib treatment. In a retrospective analysis, baseline p21waf expression in the basal-like cell layer was statistically positively correlated with clinical response to treatment. Epidermal growth factor receptor copy number did not correlate with response to erlotinib. Conclusion: Neoadjuvant treatment of HNSCC with erlotinib was well tolerated. Baseline p21waf expression was associated with response to erlotinib and so might be useful as a tool to select patients for erlotinib therapy in this setting.

Previous chemotherapy as a predictor of wound infections in nonmajor head and neck surgery: Results of a prospective study

The goal of this prospective study was to determine the incidence of wound infections (WI) after clean uncontaminated head and neck cancer procedures and after emergency tracheotomies.

Multicenter prospective micro-costing study evaluating mandibular free-flap reconstruction

Free-flap mandibular reconstruction is a highly specialized procedure associated with severe complications necessitating re-interventions and re-hospitalizations. This surgery is expensive in terms of health workers’ time, equipment, medical devices and drugs. Our main objective was to assess the direct hospital cost generated by osseocutaneous free-flap surgery in a multicentric prospective micro-costing study. Direct medical costs evaluated from a hospital perspective were assessed using a micro-costing method from the first consultation with the surgeon until the patient returns home, thus confirming the success or failure of the free-flap procedure. The mean total cost for free-flap intervention was 34,009€ (5151–119,604€), the most expensive item being the duration of hospital bed occupation, representing 30–90% of the total cost. In the event of complications, the mean cost increased by 77.3%, due primarily to hospitalization in ICU and the conventional unit. This surgery is effective and provides good results but remains highly complex and costly.

Gene expression profiling on pre- and post-erlotinib tumors from patients with head and neck squamous cell carcinoma†‡

The purpose of our work was to identify genomic predictive markers of erlotinib response in patients with head and neck squamous cell carcinoma (HNSCC).

Report of a Track Seeding of Thyroid Papillary Carcinoma During Robot- Assisted Transaxillary Thyroidectomy

Background: The Robotic Thyroidectomy (RT) is a minimally invasive surgical technique initially developed in Asia, for cultural reasons. The principles of its use are still undergoing development. Showing to all appearances satisfying outcomes, the long-time safety and medico-economic benefit of the procedure have not been established yet. The use of this technique in thyroid carcinology remains rare, and provides specific risks, not encountered with the Open Thyroidectomy (OT). Patient Findings: We report the case of a patient who underwent a two-stages RT for a pT3 follicular carcinoma causing dissemination along the surgical track, in spite of the radioactive iodine treatment. Summary: This case reminds us the limits of the RT in the oncologic field and the lack of perspective, with the recent discovery of the risk of dissemination along the surgical track. Our synthetic review of the literature comparing RT to OT shows the advantages and limitations of the RT. Conclusions: The development of the RT should pursue its way, but the use of this procedure in thyroid carcinology must remain reasonable. Further data is necessary to assess the long-term oncologic safety, regarding even the uncommon risks, as the track seeding. To this day, OT remains the gold standard for the complex thyroid pathologies.

Le management par les processus dans un établissement de lutte contre le cancer, une demarche utopique ?

The process approach is a mode of quality improvement. It leans on the cartographys establishment, allows to redefine organization around patients trajectory, the measure of defects and their correction. The process pilot is a new actor in the management of the establishment. It is developed since 3 years in the Institute Claudius Regaud, regional cancer center treatment of Midi-Pyrénées.