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Malard O, Karakachoff M, Ferron C, Hans S, Vergez S, Garrel R, Gorphe P, Ramin L, Santini L, Villeneuve A, Lasne-Cardon A, Espitalier F, Hounkpatin A. Oncological and functional outcomes for transoral robotic surgery following previous radiation treatment for upper aerodigestive tract head and neck cancers. A French multicenter GETTEC group study. Cancer Med 2024; 13:e7031. [PMID: 38545809 PMCID: PMC10974718 DOI: 10.1002/cam4.7031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 01/11/2024] [Accepted: 02/09/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND Transoral robotic surgery (TORS) opens new perspectives. We evaluated the outcomes for patients having undergone TORS after previous radiotherapy. METHODS A retrospective multicenter study (n = 138) in a previously irradiated area between 2009 and 2020. Survival was assessed with the Kaplan-Meier method. Prognostic factors were evaluated using a chi-squared test, Fisher's test, or Wilcoxon's test. RESULTS The median length of hospital stay was 12.5 days. Bleeding was the most frequent postoperative complication (15.2%, n = 22). Prophylactic vessel ligation did not significantly decrease bleeding. Complications were significantly lower for Tis, T1, and N0 tumors. 91.6% (n = 120) of the patients with a perioperative tracheotomy could be decannulated. Larynx was functional for 65.94% of the patients. The median length of follow-up was 26 months. The 5-year overall and relapse-free survival rates were respectively 59.9% and 43.4%. CONCLUSION Oncological and functional results confirmed the value of TORS as a treatment in previously irradiated area.
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Affiliation(s)
- Olivier Malard
- Department of Otolaryngology Head and Neck Surgery, Nantes University Hospital, Nantes, France
| | - Matilde Karakachoff
- Nantes Université, CHU Nantes, Pôle Hospitalo-Universitaire 11: Santé Publique, Clinique des données, INSERM, CIC 1413, Nantes, France
| | - Christophe Ferron
- Department of Otolaryngology Head and Neck Surgery, Nantes University Hospital, Nantes, France
| | - Stéphane Hans
- Department of Otolaryngology-Head and Neck Surgery, Foch Hospital, Suresnes, France
| | - Sébastien Vergez
- Head and Neck Surgery Department, Cancer Institute Toulouse-Oncopole, Toulouse, France
| | - Renaud Garrel
- Department of Head and Neck Surgery, Montpellier Guy De Chauliac University Hospital, Montpellier, France
| | - Philippe Gorphe
- Department of Head and Neck Oncology, Gustave Roussy Institute, University Paris-Saclay, Villejuif, France
| | - Lionel Ramin
- Department of Head and Neck Surgery, Limoges Dupuytrens University Hospital, Limoges, France
| | - Laure Santini
- ENT-Head and Neck Surgery Department, La Conception University Hospital, Aix Marseille University, Marseille, France
| | - Alexandre Villeneuve
- Head and Neck Surgery Department, Georges-Pompidou European Hospital, Paris, France
| | - Audrey Lasne-Cardon
- Department of Head and Neck Surgery, François Baclesse Cancer center, Normandie University, Caen, France
| | - Florent Espitalier
- Department of Otolaryngology Head and Neck Surgery, Nantes University Hospital, Nantes, France
| | - Audrey Hounkpatin
- Department of Otolaryngology Head and Neck Surgery, Nantes University Hospital, Nantes, France
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Barry B, Dolivet G, Clatot F, Huguet F, Abdeddaim C, Baujat B, Blanchard N, Calais G, Carrat X, Chatellier A, Coste F, Cupissol D, Cuvelier P, De Mones Del Pujol E, Deneuve S, Duffas O, Dupret-Bories A, Even C, Evrard C, Evrard D, Faivre S, Fakhry N, Garrel R, Gorphe P, Houliat T, Kaminsky MC, Krebs L, Lapeyre M, Lindas P, Malard O, Mirghani H, Mondina M, Moriniere S, Mouawad F, Pestre-Munier J, Pham Dang N, Picard A, Ramin L, Renard S, Salvan D, Schernberg A, Sire C, Thariat J, Vanbockstael J, Vo Tan D, Wojcik T, Klein I, Block V, Baumann-Bouscaud L, De Raucourt D. [French national standard for the treatment of squamous cell carcinoma of upper aero-digestive tract - General principles of treatment]. Bull Cancer 2024; 111:393-415. [PMID: 38418334 DOI: 10.1016/j.bulcan.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 12/14/2023] [Accepted: 12/31/2023] [Indexed: 03/01/2024]
Abstract
OBJECTIVES The management of upper aerodigestive tract cancers is a complex specialty. It is essential to provide an update to establish optimal care. At the initiative of the INCa and under the auspices of the SFORL, the scientific committee, led by Professor Béatrix Barry, Dr. Gilles Dolivet, and Dr. Dominique De Raucourt, decided to develop a reference framework aimed at defining, in a scientific and consensus-based manner, the general principles of treatment for upper aerodigestive tract cancers applicable to all sub-locations. METHODOLOGY To develop this framework, a multidisciplinary team of practitioners was formed. A systematic analysis of the literature was conducted to produce recommendations classified by grades, in accordance with the standards of the French National Authority for Health (HAS). RESULTS The grading of recommendations according to HAS standards has allowed the establishment of a reference for patient care based on several criteria. In this framework, patients benefit from differentiated care based on prognostic factors they present (age, comorbidities, TNM status, HPV status, etc.), conditions of implementation, and quality criteria for indicated surgery (operability, resectability, margin quality, mutilation, salvage surgery), as well as quality criteria for radiotherapy (target volume, implementation time, etc.). The role of medical and postoperative treatments was also evaluated based on specific criteria. Finally, supportive care must be organized from the beginning and throughout the patients' care journey. CONCLUSION All collected data have led to the development of a comprehensive framework aimed at harmonizing practices nationally, facilitating decision-making in multidisciplinary consultation meetings, promoting equality in practices, and providing a state-of-the-art and reference practices for assessing the quality of care. This new framework is intended to be updated every 5 years to best reflect the latest advances in the field.
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Affiliation(s)
- Béatrix Barry
- AP-HP, hôpital Bichat-Claude-Bernard, ORL et CCF, Paris (75), France
| | - Gilles Dolivet
- Institut de cancérologie de Lorraine, ORL et CCF, Nancy (54), France.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Olivier Duffas
- Centre hospitalier de Libourne, ORL et CMF, Libourne, France
| | | | | | | | - Diane Evrard
- AP-HP, hôpital Bichat-Claude-Bernard, ORL et CCF, Paris (75), France
| | | | - Nicolas Fakhry
- Assistance publique-Hôpitaux de Marseille, ORL et CCF, Marseille, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Didier Salvan
- Centre hospitalier Sud Francilien, ORL et CCF, Corbeil-Essonnes, France
| | | | | | | | | | | | | | - Isabelle Klein
- Dispositif Spécifique Régional du Cancer Grand Est - NEON, Nancy (54), France
| | - Véronique Block
- Dispositif Spécifique Régional du Cancer Grand Est - NEON, Nancy (54), France
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Dolivet G, Barry B, Abdeddaim C, Baujat B, Blanchard N, Calais G, Carrat X, Chatellier A, Clatot F, Coste F, Cupissol D, Cuvelier P, de Mones Del Pujol E, Deneuve S, Duffas O, Dupret-Bories A, Even C, Evrard C, Evrard D, Faivre S, Fakhry N, Garrel R, Gorphe P, Houliat T, Huguet F, Kaminsky MC, Krebs L, Lapeyre M, Lindas P, Malard O, Mirghani H, Mondina M, Moriniere S, Mouawad F, Pestre-Munier J, Pham Dang N, Picard A, Ramin L, Renard S, Salvan D, Schernberg A, Sire C, Thariat J, Vanbockstael J, Vo Tan D, Wojcik T, Klein I, Block V, Baumann-Bouscaud L, de Raucourt D. [National standard for the treatment of squamous cell carcinoma of upper aerodigestive tract]. Bull Cancer 2024; 111:327-332. [PMID: 38336530 DOI: 10.1016/j.bulcan.2023.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/03/2023] [Accepted: 08/04/2023] [Indexed: 02/12/2024]
Affiliation(s)
- Gilles Dolivet
- ORL et CCF, Institut de cancérologie de Lorraine, Nancy, France.
| | - Béatrix Barry
- ORL et CCF, hôpital Bichat-Claude-Bernard, AP-HP, Paris, France
| | | | | | | | | | | | | | | | | | | | - Philippe Cuvelier
- ORL et CCF libéral à Bayonne et centre hospitalier Oloron, Oloron-Sainte-Marie, France
| | | | | | - Olivier Duffas
- ORL et CMF, centre hospitalier de Libourne, Libourne, France
| | | | | | | | - Diane Evrard
- ORL et CCF, hôpital Bichat-Claude-Bernard, AP-HP, Paris, France
| | | | - Nicolas Fakhry
- ORL et CCF, Assistance publique-Hôpitaux de Marseille, Marseille, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Sophie Renard
- ORL et CCF, Institut de cancérologie de Lorraine, Nancy, France
| | - Didier Salvan
- ORL et CCF, centre hospitalier sud francilien, Corbeil-Essonnes, France
| | | | | | | | | | | | | | - Isabelle Klein
- Dispositif spécifique régional du cancer Grand Est - NEON, Nancy, France
| | - Véronique Block
- Dispositif spécifique régional du cancer Grand Est - NEON, Nancy, France
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Pouvreau P, Coste F, Ramin L, Daste A, De Monès E, Dupin C. [Organ preservation in oropharyngeal cancers treatment: What arguments for radiotherapy?]. Cancer Radiother 2022; 26:760-765. [PMID: 36041969 DOI: 10.1016/j.canrad.2022.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 06/20/2022] [Accepted: 06/25/2022] [Indexed: 11/17/2022]
Abstract
Management of oropharyngeal cancer depends on several factors. Immediate surgery or radiotherapy may be considered. If the patient is operable, the choice depends on the extent of the disease, the contributing factors, and the expected functional results. For HPV-positive cancers, studies show comparable efficacy between surgery and radiotherapy. For early-stage cancers, unimodal treatment should be preferred. For HPV-negative cancers, the results of retrospective and observational studies are in favor of surgery. These studies have some limitations. In observational and/or retrospective studies, reclassification biases and the applicability of propensity scores weaken the validity of studies showing differences in management. Tumor and patient comparability are others majors interpretation biases. It is precipitate to conclude that surgery is superior for HPV-negative oropharyngeal cancers. Toxicity, therefore, becomes a criterion of choice for treatment. Unimodal management by surgery allows limited toxicity for the early stages. Surgery has less impact on salivation. Radiotherapy is rather less deleterious for swallowing in the early stages. For the advanced stages of HPV-induced tumors, the non-superiority of surgery should lead to the choice of radiochemotherapy. For oropharyngeal cancers, the possible benefit of surgery in HPV-negative oropharyngeal cancers must be confirmed in randomized studies. For the early stages of oropharyngeal cancer with unimodal treatment, management could be decided by shared decision making.
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Affiliation(s)
- P Pouvreau
- Service de radiothérapie, CHU de Bordeaux, hôpital Haut-Lévêque, Pessac, France
| | - F Coste
- Pôle régional de cancérologie, service de radiothérapie, CHU de Poitiers, Poitiers, France
| | - L Ramin
- Service d'oto-rhino-laryngologie, CHU de Dupuytren, Limoges, France
| | - A Daste
- Service de radiothérapie, CHU de Bordeaux, hôpital Haut-Lévêque, Pessac, France
| | - E De Monès
- Service d'oto-rhino-laryngologie, de chirurgie cervico-faciale et d'ORL pédiatrique, CHU de Bordeaux, Bordeaux, France
| | - C Dupin
- Service de radiothérapie, CHU de Bordeaux, hôpital Haut-Lévêque, Pessac, France; Inserm, U1312-BRIC, eq BioGO, université de Bordeaux, 33000 Bordeaux, France.
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