[French national standard for the treatment of squamous cell carcinoma of upper aero-digestive tract - General principles of treatment]

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.

[Results of alginate and hypertonic solution in wound healing of head and neck cancers]

INTRODUCTION

In head and neck cancers, complications such as pharyngostoma, orostoma, or fistula can present following surgery or surgery after irradiation.

OBJECTIVE

To report the results of the association of two sea-derived products (Sinomarin and Algosteril) compared to normal saline for the management of healing.

MATERIAL AND METHODS

This is retrospective study (1998-2000). Thirty patients were included in group 1 (Sinomarin-Algosteril) and 17 patients in group 2 (normal saline). The average age was respectively 60 and 56.2. Patients in both groups presented with advanced head and neck carcinoma (T3-T4) and healing complications.

RESULTS

The delay of healing was respectively of 33.53 and 72.94 days. Results were statistically significant (Student T-test P < 0.05).

CONCLUSION

Our results show the efficiency (p < 0.05) of the Sinomarin Algosteril association in head and neck cancer healing complications.

[Surgical methods of removal of T4 nasopharyngeal malignancies. A preliminary report on 18 cases]

OBJECTIVES

To describe the technique and evaluate postoperative sequelae and results of transfacial surgical removal of T4N0 nasopharyngeal malignant neoplasms.

MATERIAL AND METHODS

Eighteen cases of surgically-treated nasopharyngeal cancers, managed between january 1993 and october 2000, were retrospectively studied. Three patients were non-responders to neoadjuvant chemotherapy, 6 suffered local recurrence following standard treatment and 7 were operated first either because of a huge and osteolytic tumor or because of an uncommon histolopathology.

RESULTS

Preoperative Vth nerve neuralgia (8 cases) was alleviated (4 cases) or cured (3 cases). At the time of diagnosis, ophthalmoplegia was observed in 3 cases. It disappeared postoperatively in 2 cases and after following radiation therapy in one. Median follow-up of the series was of 31.8 mths. Four patients were died of disease; one of them from distant metastases 4 years post-surgery. One patient is alive with distant metastases. The 13 last (72.2%) are alive without disease with a 35.6 mths median follow-up (6-77 mths).

DISCUSSION

This short and heterogeneous series cannot lead to any evidence-based conclusion. But mid-term free-of-disease survival of 4 of the 5 patients suffering local recurrence and of patients presenting with so-called non-radiation-sensitive tumors is to be considered. In comparison with the high risk of neurological sequels following reirradiation, absence of specific toxicity of surgery observed in this series is to be underlined.

CONCLUSION

In selected cases surgical treatment does not demonstrate any toxicity and is able to offer mid-term local control of the disease. Its role is to be evaluated further before inclusion in the therapeutic algorithm of these very bad prognosis-associated tumors.

[Malignant melanoma of the nasosinal mucosa. Retrospective study apropos of 20 cases]

Twenty patients were treated for malignant melanoma (MM) of the mucosal surfaces of the nose and sinuses between 1987 and 1999 in our department. The mean age of these patients was 64 years, and there were 11 females and 9 males (sex ratio 1.2). Two patients had a past history of cutaneous or choroidal malignant melanoma, and were considered as having secondary melanoma. All patients presented with nasal obstruction and/or recurrent epistaxis. None of the patients with primary MM had either lymphadenopathy or distant metastases. 17 patients were treated surgically by the transfacial approach, aiming to obtain a cure. Radiotherapy and chemiotherapy were given only to the patients with secondary MM. Six patients have since presented with single or multiple local recurrence, and nine had distant metastases. The 3-year survival rate was 60%. This retrospective study has allowed us to compare the results of our series with these in the literature, and to review the treatment of this rare condition.

[Otolaryngological manifestations of sarcoidosis. Report of 10 cases and review of the literature]

Sarcoidosis is a systemic chronic granulomatous condition of unknown aetiology. Although the mediastino-pulmonary type is the commonest, the condition may affect the head and neck in a significant number of cases, obliging the practising ENT surgeon to be familiar with the condition. The diagnosis is made by a combination of clinical, biochemical, radiological and histopathological features. We present 10 cases of sarcoidosis with exclusively cervico-facial features which have passed through the department between 1985 and 1996, including a typical nasal case with combined features, and a very rare pharyngeal case. The definitive diagnosis, always with histological confirmation, was sometimes made only after some delay, demonstrating the polymorphic nature of the clinical features, which are rarely pathognomonic. Special investigations, carried out virtually routinely once the diagnosis of ENT sarcoidosis was made, demonstrated only one case of associated pulmonary disease. Treatment was reserved for the symptomatic cases (4 out of 10), and consisted of systemic steroids whose dose and duration was determined by the clinical response.