[French national standard for the treatment of squamous cell carcinoma of upper aero-digestive tract - General principles of treatment]. / Référentiel national de traitement des carcinomes épidermoïdes des voies aérodigestives supérieures ­ Principes généraux de traitement.

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.

Anatomo-radiological study of the superior semicircular canal dehiscence of 37 cadaver temporal bones.

PURPOSE: To assess the presence of dehiscence of the superior semicircular canal (SSCC) on computed tomography (CT) scanning and to study the microscopic anatomo-radiological correlation. MATERIALS AND METHODS: Thirty-seven temporal bones preserved in formalin, regardless of the clinical history of cadavers, were studied. A microscopic anatomical study was conducted with an operative microscope (20×). The settings of the CT permitted to obtain 0.6 mm slices contiguous reconstruction in Pöschl plane and in Stenvers plane. Three-dimensional (3D) reconstructions were performed if a radiological dehiscence was observed. The apex thickness was measured in Pöschl plane. The radiological positive criterion of SSCC dehiscence was an absence of bone coverage of more than 1 mm long in Pöschl and Stenvers planes. RESULTS: We observed three dehiscences of the 37 temporal bones on CT in Pöschl and Stenvers planes. However, no dehiscence was found microscopically. The 3D reconstruction was also positive in these three cases. Reconstructions in the Pöschl plane offered good results up to a bone thickness of 0.6 mm. When it was lower than 0.6 mm, the interpretation of the images appeared to be subjective. CONCLUSION: This study emphasizes the limitations of CT imaging, with a risk of false positives to take into account when interpreting the images. The 3D reconstructions also give too many false positives to be used alone and make an accurate diagnosis. The diagnosis of SSCC dehiscence will therefore remain clinical. Complementary and instrumental radiological examinations should be performed only to confirm this clinical suspicion.

Assessment of nasal septoplasty using NOSE and RhinoQoL questionnaires.

The objective was to assess outcomes of nasal septoplasty without turbinectomy using validated subjective instruments and to correlate results with patient satisfaction. The prospective observational study was conducted in a tertiary referral center. The method included the use of NOSE and RhinoQoL questionnaires to assess patients before and 6 months after Cottle septoplasty without turbinectomy. Patient satisfaction was measured on a visual analog scale. Data were compared by the non-parametric Wilcoxon test. Minimal Clinically Important Differences (MCIDs) were calculated. Correlations between post-operative scores and patient satisfaction were assessed using the Spearman test. Univariate analysis was performed to assess predictors of improvement. One hundred patients were enrolled. Their mean age was 43.4 years and 28% had allergic rhinitis. There was a highly significant improvement in each score at 6 months (p < 0.00001). The MCID for the NOSE was comprised between 5 and 7.5, whereas the mean change was 35.2 points. They ranged from 3.8 to 6.1 for RhinoQoL scores, whereas mean changes were comprised between 12.6 and 20.9. Allergic rhinitis was a predictive factor of less improvement (NOSE p = 0.04-RhinoQoL p = 0.0001). Mean patient satisfaction was 8.2 ± 1.8. Post-operative NOSE and RhinoQoL frequency scores were moderately correlated (r = 0.380; r = 0.356, respectively) whereas bothersomeness and impact scores were highly correlated with patient satisfaction (r = 0.459; r = 0.443, p < 0.00001, respectively). This study shows that the NOSE and RhinoQoL questionnaires can be used in English- and French-speaking populations to perform pre- and post-therapeutic assessment. These validated instruments show that septoplasty without turbinectomy allows management of nasal obstruction and its burden.

French validation of the NOSE and RhinoQOL questionnaires in the management of nasal obstruction.

OBJECTIVE: Until now, there has been no validated and specific questionnaire in French allowing the assessment of nasal obstruction and its consequences on quality of life. The aim of this study was to validate the French translation and sociocultural adaptation of the Nasal Obstruction Symptom Evaluation (NOSE) and Rhinosinusitis Quality of Life Survey (RhinoQOL) self-questionnaires. STUDY DESIGN: Prospective instrument validation study. SETTING: French tertiary referral center. SUBJECTS AND METHODS: The questionnaires were translated into French and then translated back into English. The final version was administered twice to an asymptomatic control population (n = 50) and once to a population with symptomatic septal deviation (n = 50). The psychometric properties (reliability, reproducibility, validity, responsiveness) were assessed by test-retest procedure, internal consistency, correlation intra- and interscores, and response sensitivity between both populations. RESULTS: There was no statistical difference in both responses obtained from the control population after the test-retest procedure. Internal consistency was 0.86 for the NOSE and 0.57, 0.67, and 0.83 for the scores of the RhinoQOL (frequency, bothersomeness, and impact, respectively). There was always a strong correlation between all NOSE variables and RhinoQOL scores (r > 0.40; P < 10(-3)). Effect size showed a high sensitivity to change. CONCLUSION: The French versions of both questionnaires appear to be as reliable, valid, and sensitive to change as the English versions. Their association was strong, allowing assessment of nasal obstruction in all its dimensions.