Pierre-Yves Marcy

Percutaneous cementoplasty for pelvic bone metastasis

Abstract The aim of this retrospective study was to prove the effectiveness of percutaneous cementoplasty in pelvic bone metastases. We studied the data entered in a multicenter prospective database on 18 cancer patients (average age 58 years) who underwent percutaneous computed tomography (CT) or fluoroscopy-guided cementoplasty from September 1996 to September 1998. The metastatic sites were: acetabulum (n=12), iliac bone (n=2), and sacrum (n=4). Indications were pain recurrence (n=9) or no relief (n=3) after radiotherapy, and 6 procedures were performed before radiation. Mean follow-up was 4.6 months, ranging from 11 days up to 24 months. Improvement in pain and walking was obtained in 81.8% cases, and it was generally maintained, except in 1 patient who experienced pain again at day 15 because of an acetabular fracture. Percutaneous cementoplasty is a safe and efficient technique, and is mandatory when radiotherapy fails or when rapid resolution of pain is requested.

Chemotherapy- and radiotherapy-induced mucositis in head and neck cancer patients: new trends in pathophysiology, prevention and treatment

Abstract Mucositis is the intensity-limiting toxicity in the management of locally advanced non-resectable head and neck cancer with radiotherapy and chemotherapy. New radiation modalities (hyperfractionation and/or acceleration) as well as combined modality regimens in this situation induce higher rates of acute toxicity. Hyperfractionation, for example, allows higher control rates, with few late toxicities, but it slightly increases acute mucositis. The addition of chemotherapy introduces systemic toxicity and can exacerbate local tissue reactions when used concurrently with radiotherapy. Mucositis is recognized as the principal limiting factor to further treatment intensification. As local regional control and overall survival are related to dose-intensity in this case, further research into the assessment, analysis, prevention and treatment of mucosal toxicity is not only crucial to improvement in quality of life, but certainly also to improved rates of disease control. Several topical and systemic treatments are directed to the decrease and the acceptance of this acute toxicity, but few have shown a significant preventive effect. The efficacy of low-level laser therapy in the management of such toxicity could hence yield important developments with this method in the field of oncology.

Free-flap head and neck reconstruction and quality of life: a 2-year prospective study.

Objectives: This prospective study was designed to evaluate quality of life (QOL) after free‐flap head and neck reconstruction.

Is radiologic placement of an arm port mandatory in oncology patients?: analysis of a large bi-institutional experience.

The objective of the current study was 2‐fold: to evaluate a radiologically placed percutaneous arm port device (PRAPD) in a large series of 1000 consecutive cancer patients undergoing chemotherapy (in terms of safety, efficacy, complications, and quality of life [QoL]) and to propose future recommendations.

Radical ablative surgery and radial forearm free flap (RFFF) reconstruction for patients with oral or oropharyngeal cancer: postoperative outcomes and oncologic and functional results

Conclusions. Radical ablative surgery and radial forearm free flap (RFFF) reconstruction provide promising oncologic and functional results in patients with oral or oropharyngeal cancer. Objectives. To assess the postoperative outcomes and the oncologic and functional results, with their main predictive factors, after radical ablative surgery and RFFF reconstruction for patients with oral or oropharyngeal cancer. Patients and methods. Between 2000 and 2006, we prospectively analyzed the postoperative, oncologic and functional outcomes of all previously untreated patients who underwent this type of surgery. Results. A total of 132 patients were enrolled in this study. There were three RFFF failures. The rate of surgical complications was 20%. The 5-year locoregional control and overall survival rates were 68% and 52%, respectively. Advanced age, high comorbidity index, elevated overall stage and tumoral involvement of the inner part of the cheek were correlated with a lower overall survival rate. A good functional result was obtained for oral diet, speech, mouth opening and aesthetic outcome in 87%, 80%, 86% and 88% of the patients, respectively. High comorbidity index, large flap surface, radiotherapy and tumoral involvement of the mobile tongue were significant predictors of poorer functional or aesthetic outcomes.

Controlled transperitoneal percutaneous cecostomy as a therapeutic alternative to the endoscopic decompression for Ogilvie's syndrome.

Acute colonic pseudo-obstruction, the so-called Ogilvies syndrome, results in massive colonic dilation without mechanical obstruction. In most cases, a conservative treatment with or without endoscopic decompression is sufficient. In rare cases of relapses or failures, a cecostomy has to be performed. A surgical cecostomy is associated with high morbidity and mortality. However, a percutaneous cecostomy could be an interesting alternative treatment. We report the case of a 67-yr-old male with colonic pseudo-obstruction for which both the conservative and the endoscopic treatments were unsuccessful. A percutaneous cecostomy was performed, and for the first time in this indication, a transperitoneal access was used with the help of nylon T-fasteners.

Systematic percutaneous fluoroscopic gastrostomy for concomitant radiochemotherapy of advanced head and neck cancer: optimization of therapy

Abstract Wasting is a major complication of advanced head and neck cancer. Concomitant chemotherapy and twice-daily continuous radiotherapy with no acceleration represents a promising treatment modality for these tumors, but increases the risk of mucositis. This report describes the results achieved with percutaneous fluoroscopic gastrostomy (PFG) and its impact on the quality of life of patients with head and neck cancer in terms of their nutritional status. A total of 50 stage IV tumors of the oropharynx and hypopharynx recorded in a prospective database were reviewed retrospectively. All patients were managed by PFG, which was found to be a safe and effective technique with no technical failures. PFG feeding resulted in a mean increase in body weight of 2.5 kg within 3 weeks. The body mass index (BMI) was maintained at 3 and 6 weeks. Minor complications occurred, but no major complications were noted. The overall procedure-related mortality rate was nil. Further prospective investigations are necessary to determine whether treatment of wasting improves patient survival.

Head and Neck Squamous Cell Carcinoma in Patients Aged ‡80 Years Patterns of Care and Survival

Scarce data exist concerning the outcome of very elderly patients with head and neck squamous cell carcinoma (HNSCC).

Renal Failure Secondary to Thrombotic Complications of Suprarenal Inferior Vena Cava Filter in Cancer Patients

AbstractPurpose: To evaluate renal function before and after suprarenal inferior vena cava (IVC) filter placement. Methods: We describe, in a personal series of 13 consecutive cases (all of them stage IV cancer patients, one LGM filter, one Antheor filter, 11 Greenfield filters) in our institution, two cases of fatal renal vein thrombosis after placement of a suprarenal filter. Evaluation of renal function was based on serum urea (in mmol/L; normal 3.30–6.60), serum creatinine (in μmol/L; normal <115.1), and calculation of serum creatinine clearance. Results and conclusion: This study suggests that in advanced-stage cancer patients who have a single functional kidney, renal functional insufficiency, or previous renal vein thrombosis, IVC filter placement above the renal veins may not be appropriate. Suprarenal filter placement should be performed only after analysis of predicted survival, after detailed discussions with the patient, and most importantly after renal function evaluation.

Myositis ossificans imaging: keys to successful diagnosis

Myositis ossificans (MO) is an inflammatory pseudotumor of the muscle that may be mistaken clinically and even histologically for a malignant soft tissue tumor. The aim of this article is to report the imaging characteristics of MO, the emphasis being on the early diagnostic clues. USG can be used at an early stage to reveal the ‘zone phenomenon,’ which is highly suggestive of MO. A short course of nonsteroidal anti-inflammatory drug therapy may be an efficient treatment for early MO.