Stéphane Temam

Outcomes and prognostic factors for squamous cell carcinoma of the oral tongue in young adults: a single-institution case-matched analysis

There is controversy regarding prognosis and treatment of young patients with oral cavity cancer compared to their older counterparts. We conducted a retrospective case-matched analysis of all adult patients younger than 40xa0years and treated at our institution for a squamous cell carcinoma of the oral cavity. Only non-metastatic adult patients (age >18) with oral tongue cancer were eventually included and matched 1:1 with patients over 40xa0years of age, at least 20xa0years older than the cases, with same T and N category and treatment period. Sixty-three patients younger than 40 had an oral cavity squamous cell cancer out of which 57 had an oral tongue primary during the period 1999–2012, and 50 could be matched with an older control. No difference could be seen between younger and older patients with regard to overall, cancer-specific, or progression-free survival. The patterns of failure were similar, although in young patients, almost all failures occurred during the first 2xa0years following treatment. Although overall survival shows a trend toward lower survival in older patients, cancer-specific survival and analysis of pattern failure suggest that disease prognosis is similar between young and older adults with oral tongue cancer. Further work is needed to identify the younger patients with poorer prognosis who overwhelmingly fail during the first year after treatment and could benefit from treatment intensification. Until then, young adults ought to be treated using standard guidelines.

Squamous cell carcinoma of the larynx with subglottic extension: is larynx preservation possible?

PurposeSquamous cell carcinoma of larynx with subglottic extension (sSCC) is a rare location described to carry a poor prognosis. The aim of this study was to analyze outcomes and feasibility of larynx preservation in sSCC patients.Patients and methodsBetween 1996 and 2012, 197xa0patients with sSCC were treated at our institution and included in the analysis. Stage III–IV tumors accounted for 76u2009%. Patients received surgery (62u2009%), radiotherapy (RT) (18u2009%), or induction chemotherapy (CT) (20u2009%) as front-line therapy.ResultsThe 5-year actuarial overall survival (OS), locoregional control (LRC), and distant control rate were 59u2009% (95u2009% CI 51–68), 83u2009% (95u2009% CI 77–89), and 88u2009% (95u2009% CI 83–93), respectively, with a median follow-up of 54.4 months. There was no difference in OS and LRC according to front-line treatments or between primary subglottic cancer and glottosupraglottic cancers with subglottic extension. In the multivariate analysis, age >u200960 years and positive N stage were the only predictors for OS (HR 2, 95u2009% CI 1.2–3.6; HR1.9, 95u2009% CI 1–3.5, respectively). A lower LRC was observed for T3 patients receiving a larynx preservation protocol as compared with those receiving a front-line surgery (HR 14.1, 95u2009% CI 2.5–136.7; pu2009=u20090.02); however, no difference of ultimate LRC was observed according to the first therapy when including T3 patients who underwent salvage laryngectomy (pu2009=u20090.6). In patients receiving a larynx preservation protocol, the 5-year larynx-preservation rate was 55u2009% (95u2009% CI 43–68), with 36u2009% in T3 patients. The 5-year larynx preservation rate was 81u2009% (95u2009% CI 65–96) and 35u2009% (95u2009% CI 20–51) for patients who received RT or induction CT as a front-line treatment, respectively.ConclusionOutcomes of sSCC are comparable with other laryngeal cancers when managed with modern therapeutic options. Larynx-preservation protocols could be a suitable option in T1–T2 (RT or chemo-RT) and selected T3 sSCC patients (induction CT).ZusammenfassungZielPlattenepithelkarzinome des Larynx mit subglottischer Ausdehnung (PECsA) sind selten und haben eine ungünstige Prognose. Das Ziel dieser Studie war es, die Ergebnisse und Durchführbarkeit einer larynxerhaltenden Therapie bei PECsA-Patienten zu untersuchen.Patienten und MethodenIm Zeitraum zwischen 1996 und 2012 wurden 197xa0Patienten mit einem PECsA des Larynx in unserer Klinik therapiert und in die Studie eingeschlossen. Davon befanden sich 76u2009% der Patienten im Stadiumxa0III–IV nach TNM. Als Erstlinientherapie wurden 62u2009% der Patienten operiert, 18u2009% erhielten eine Radiotherapie (RT) und 20u2009% eine Induktionschemotherapie (ICT).ErgebnisseDas 5-Jahres-Gesamtüberleben, die lokoregionale Tumorkontrolle und die Kontrollrate bezüglich einer Fernmetastasierung waren 59u2009% (95u2009%-Konfidenzintervall [KI] 51–68), 83u2009% (95u2009%-KI 77–89) bzw. 88u2009% (95u2009%-KI 83–93) mit einer medianen Nachkontrolle von 54,4xa0Monaten. Es gab keinen Unterschied zwischen dem 5-Jahres-Gesamtüberleben und der lokoregionalen Tumorkontrolle in Anbetracht der Erstlinientherapie oder zwischen den primären subglottischen Karzinomen bzw. den glottosupraglottischen Karzinomen mit subglottischer Ausdehnung. In der multivariaten Analyse waren ein Lebensalter >u200960xa0Jahre und ein positiver Lymphknotenstatus die einzigen Prädiktoren für das 5-Jahres-Gesamtüberleben (jeweils HRxa02, 95u2009%-KI 1,2–3,6; HR 1,9, 95u2009%-KI 1–3,5). Eine schlechtere lokoregionale Tumorkontrolle wurde bei Patienten im T3-Stadium beobachtet, bei denen ein larynxerhaltendes Protokoll eingehalten wurde, im Vergleich mit denjenigen, welche eine Operation erhielten (HRxa014,1; 95u2009%-KI 2,5–136,7; pu2009=u20090,02). Allerdings wurde in Bezug auf die Erstlinientherapie kein Unterschied bei der letzten lokoregionalen Tumorkontrolle festgestellt, wenn Patienten im Stadiumxa0T3 eingeschlossen wurden, bei denen eine salvage Laryngektomie (pu2009=u20090,6) durchgeführt wurde. Bei Patienten mit einem larynxerhaltenden Protokoll war die 5-Jahres-Larynx-Erhaltungsrate 81u2009% (95u2009%-KI 65–96) bzw. 35u2009% (95u2009%-KI 20–51) für Patienten, welche eine Radiotherapie oder eine ICT als Erstlinientherapie erhielten.SchlussfolgerungDie Ergebnisse der PECsA des Larynx sind vergleichbar mit denjenigen anderer Larynxkrebsarten, wenn mit modernen therapeutischen Methoden behandelt wird. Larynxerhaltungsprotokolle könnten eine angemessene Option sowohl bei Patientenim Stadiumxa0T1–T2 (RT oder Chemo-RT) als auch bei ausgewählten T3-PECsA-Patienten sein (ICT).

Revisiting vascular contraindications for transoral robotic surgery for oropharyngeal cancer: TORS and Retropharyngeal Carotid Arteries

We analyzed the outcomes for patients with a retropharyngeal internal carotid artery (ICA) who underwent a transoral robotic surgery (TORS) procedure involving a cervical‐transoral robotic oropharyngectomy course with free flap reconstruction.

Cervical-transoral robotic oropharyngectomy and thin anterolateral thigh free flap

The transoral robotic oropharyngectomy surgical technique was initially described for resection of small stage T1 or T2 lesions and the surgical defect is usually allowed to heal by secondary intention. We propose a refined surgical approach adapted to more complex situations such as salvage surgery and surgery in an irradiated field, based on previous experience in open approaches for oropharyngeal cancer. Via a combined cervical-transoral approach, we perform en bloc resection of the parapharyngeal space combined with transoral robotic lateral oropharyngectomy. Reconstruction of the surgical defect is performed with a thin anterolateral thigh free flap.

Sinonasal squamous cell carcinoma without clinical lymph node involvement

ObjectivesThe purpose of this work was to report outcomes of patients with nonmetastatic sinonasal squamous cell carcinoma (SNSCC) and to discuss the impact of elective neck irradiation (ENI) and selective neck dissection (SND) in clinically negative lymph node (N0) patients.MethodsData from 104 nonmetastatic SNSCC patients treated with curative intent were retrospectively analysed. Uni- and multivariate analyses were used to assess prognostic factors of overall survival (OS) and locoregional control (LRC).ResultsMedian follow-up was 4.5xa0years. Eighty-five percent of tumours were stagexa0III–IV. Treatments included induction chemotherapy (52.9u2009%), surgery (72u2009%) and radiotherapy (RT; 87u2009%). The 5‑year OS, progression-free survival, and LRC rates were 48, 44 and 57u2009%, respectively. Absence of surgery predicted a decrease of OS (hazard ratio [HR] 2.6; 95u2009% confidence interval [CI] 1.4–4.7), and LRC (HR 3.5; 95u2009% CI 1.8–6.8). Regional relapse was observed in 13/104 (13u2009%) patients and most common sites were level II (nxa0= 12; 70.6u2009%), level III (nxa0= 5; 29.4u2009%) and level Ib (nxa0= 4; 23.5u2009%). Management of the neck in N0 patients (nxa0= 87) included 11u2009% SND alone, 32u2009% ENI alone, 20u2009% SNDxa0+ ENI and 37u2009% no neck treatment. In this population, a better LRC was found according to the management of the neck in favour of SND (94u2009% vs. 47u2009%; pxa0= 0.002) but not ENI.ConclusionSND may detect occult cervical positive nodes, allowing selective postoperative RT. ENI (ipsilateral level II, ±Ib and III or bilateral) needs to be proposed in selected patients, especially when SND has not been performed.ZusammenfassungZielsetzungZiel der Arbeit war es, den klinischen Verlauf von Patienten mit einem sinunasalen Plattenepithelkarzinom (SNSCC) retrospektiv zu untersuchen und die Therapieergebnisse von elektiver Halsbestrahlung (ENI, „elective neck irradiation“), selektiver Operation (SND, „selective neck dissection“) und initialer Chemotherapie bei klinischen lymphknotennegativen (N0) Patienten zu diskutieren.MethodenDie Daten von 104xa0Patienten mit metastasenfreiem SNSCC, die mit kurativer Absicht behandelt worden waren, wurden retrospektiv analysiert. Uni- und multivariante Analysen wurden verwendet, um prognostische Faktoren für das Gesamtüberleben (OS) und für die lokale Tumorprogression (LRC) zu erheben.ErgebnisseDie mediane Nachbeobachtungszeit betrug 4,5xa0Jahre. Einen Tumor im Stadiumxa0III–IV zeigten 85u2009% der Patienten. Die Behandlungen umfassten eine Induktionschemotherapie (52,9u2009%), einen chirurgischen Eingriff (72u2009%) sowie eine Radiotherapie (RT; 87u2009%). Das 5‑Jahres-OS, das progressionsfreie Überleben und die LRC betrugen 48, 44 bzw. 57u2009%. Patienten ohne chirurgischen Eingriff hatten eine verminderte OS (HRxa0= 2,6; 95u2009%-KI 1,4–4,7) und eine verminderte LRC (HRxa0= 3,5; 95u2009%-KI 1,8–6,8). Die häufigsten Rezidivlokalisationen waren die Stationenxa0II (nxa0= 12; 70,6u2009%), III (nxa0= 5; 29,4u2009%) und Ib (nxa0= 4; 23,5u2009%). N0-Patienten (nxa0= 87) wurden wie folgt behandelt: 11u2009% nur SND, 32u2009% nur ENI, 20u2009% SND plus ENI und 37u2009% blieben ohne Behandlung. In diesem Kollektiv hatten Patienten mit SND eine signifikant höhere LRC (94u2009% vs. 47u2009%; pxa0= 0,002), nicht jedoch mit ENI.SchlussfolgerungSND bietet die Möglichkeit, okkulte zervikale metastatische Lymphknoten zu entdecken und eine elektive, postoperative RT zu ermöglichen. Eine ENI (ipsilaterale Stationenxa0II, ±Ib und III oder bilateral) sollte ausgewählten Patienten angeboten werden, vor allem wenn keine SND durchgeführt wurde.

Cancers de la cavité buccale chez les sujets jeunes: Résultats thérapeutiques et analyse de facteurs pronostiques

PURPOSEnSquamous cell carcinomas of the oral cavity occurring in young people represent a specific entity. Its management and prognosis are controversial. We performed a retrospective chart review of all patients aged less than 40 years old and treated at Gustave-Roussy Cancer Centre for a squamous cell carcinomas of the oral cavity between 1999 and 2011.nnnMETHODSnPatients and tumour characteristics, type of treatment and follow-up data were collected. Survival data were analysed according to the methods of Kaplan-Meier and both univariate and multivariate analyses were performed to look for prognostic factors regarding overall survival and progression-free survival.nnnRESULTSnSixty-three patients were identified. Median follow-up was 64 months. Most of the tumours were initially located in the mobile tongue (n=54, 85.7%). Overall 17 patients had died, including 15 from the treated cancer. Overall and progression-free survival rates at 5 years were respectively 79.6% and 68.6%. The corresponding 5 years local, regional and metastatic relapse free survival rates were 80%, 91% and 89% respectively. In the multivariate analysis only the absence of initial surgery (hazard ratio [HR]: 13.5 [2.0; 90.5]; P=0.007) was prognostic for overall survival, while alcohol abuse (HR: 0.37 [0.15; 0.9]; P=0.03) and the absence of surgery (HR: 13.6 [2.5; 74.2]; P=0.002) were associated with a decreased progression-free survival. A younger age (less than 30 year old) was not associated with the risk of recurrence or death.nnnCONCLUSIONnSurvival rates and tumour control probabilities are relatively high among young patients suffering from squamous cell carcinomas of the oral cavity treated at a tertiary centre. The early identification of patients at risk of relapse is currently difficult. The balance between recurrence and treatment toxicity warrants further studies, both on the clinical level and for the development of prognostic biomarkers.

Anemia and neutrophil-to-lymphocyte ratio are prognostic in p16-positive oropharyngeal carcinoma treated with concurrent chemoradiation

Objectives We investigated the prognostic value of pre-treatment hematological parameters in patients with p16-positive oropharyngeal squamous-cell carcinoma (OPSCC). Material and methods Neutrophil count, lymphocyte count, neutrophil-to-lymphocyte ratio (NLR), and hemoglobin concentration measurement (Hb), were collected on day one of treatment. Endpoints were overall survival (OS) and progression-free survival (PFS). All patients were planned to receive concurrent chemoradiation. Staging were reviewed according to the recent AJCC 8th edition. Results We included 167 patients in this study. In multivariate analyses, a smoking history > 30 packyears was associated with decreased OS (p = 0.009; HR, 3.4827) and PFS (p = 0.042; HR, 2.421); Hb < 12 g/dL was associated with impaired OS (p = 0.007; HR, 6.527) and PFS (p = 0.014; HR, 4.092); an NLR > 5 before treatment was associated with decreased OS (p = 0.042; HR, 2.945). Hemoglobin concentration and the NLR were not correlated (p = 0.577), nor anemia and an NLR > 5 (p = 0.167). Patients with an NLR > 5 had a significantly higher rate of disease recurrence (30.8% vs. 8.4%, p = 0.0299, RR = 3.922, 95% CI 1.351–11.386). Discussion We found hemoglobin level and the NLR to be independent prognostic factors in p16-positive OPSCC patients. This approach is to be considered for further clinical investigations, and its significance in treatment decision-making should be further explored.

Laser debulking or tracheotomy in airway management prior to total laryngectomy for T4a laryngeal cancer

PurposeRetrospective studies have shown that tracheotomy prior to total laryngectomy (TL) is associated with decreased survival. We sought to investigate whether this is due to higher local invasiveness associated with obstructive disease or whether it is the result of tracheotomy itself.MethodsWe reviewed patients with a T4a (AJCC 7th edition) laryngeal squamous-cell carcinoma treated with a primary TL followed by adjuvant radiotherapy between 2001 and 2013. We compared patients who had obstructive lesions with those who had non-obstructive lesions in terms of preoperative data, pathological features, and treatment outcomes. Second, we compared tracheotomized patients with patients who underwent endoscopic laser debulking (ELD).ResultsOne hundred patients were reviewed. Thirty-seven of them required an airway intervention prior to a TL (tracheotomy nu2009=u200924/ELD nu2009=u200913). Patients with obstructive tumors had more frequently subglottic extension (pu2009=u20090.0066) and a shorter disease-free survival (DFS) (pu2009=u20090.046), due to a higher incidence of additional distant metastases. Tracheotomy was associated with a shorter DFS (pu2009=u20090.035) and more frequent perineural invasion (pu2009=u20090.0272) as compared to ELD, but not with a higher incidence of stomal recurrence.ConclusionsA tracheotomy prior to a total laryngectomy is associated with decreased survival. We recommend laser debulking as the preferred treatment whenever management of an obstructive airway is required prior to a total laryngectomy.

Ethmoid tumor and oncogenic osteomalacia: Case report and review of the literature

INTRODUCTIONnOncogenic osteomalacia is a very rare disease usually caused by a phosphaturic mesenchymal tumor, particularly the mixed connective tissue type, secreting FGF-23 hormone.nnnOBJECTIVEnThe authors report a case of ethmoid tumor associated with oncogenic osteomalacia and discuss management based on a review of the literature.nnnCASE SUMMARYnA 41-year-old woman with multiple fractures causing major disability was diagnosed with early-onset osteoporosis. CT scan followed by MRI, performed due to the concomitant presence of nasal obstruction, showed a right ethmoid tumor in contact with the dura mater and periorbital tissues, but with no signs of invasion. Endoscopic resection was performed with reconstruction of the defect of the cribriform plate by a nasoseptal flap. Nasal and bone symptoms subsequently resolved. Histological examination revealed a phosphaturic mesenchymal tumor.nnnDISCUSSIONnTwelve cases of mesenchymal tumor of the ethmoid sinus associated with oncogenic osteomalacia have been reported to date. FGF-23 assay and whole-body MRI with STIR sequence are useful for the diagnosis. A very favorable outcome is observed after surgical treatment in the majority of cases.