Salvage brachytherapy with or without external beam radiotherapy for oral or oropharyngeal squamous cell carcinomas in previously irradiated areas: carcinologic and toxicity outcomes of 25 patients.

PURPOSE: The aim of this study was to assess outcomes of salvage brachytherapy for oral and oropharyngeal squamous cell carcinoma in previously irradiated areas. MATERIAL AND METHODS: This was a retrospective study with 25 patients, treated between 1997 and 2016 for primary (21 cases) or recurrent (4 cases) oral or oropharyngeal squamous cell carcinomas in previously irradiated areas. Fifteen patients were treated with salvage brachytherapy (BT) alone, while 10 patients additionally received external beam radiotherapy (EBRT). Median BT dose was 45 Gy (range, 15-64 Gy), and a median total cumulative dose was 57 Gy (range, 40-70 Gy). Patient age, tumor stage, radiotherapy dose, and time between first treatment and recurrence were analyzed as prognostic factors. RESULTS: Median overall survival (OS) was 16 months. Patients with less advanced (T1) tumors survived significantly longer (27 vs. 14.5 months, p = 0.046). Five patients experienced a local recurrence, and only one of them was treated with a total dose greater than 60 Gy. In multivariate analysis, patients with T1 lesions had a significant higher OS rate compared to patients with larger lesions (HR = 6.25, 95% CI: 1.18-33.1%, p = 0.031). Patients who received more than 60 Gy had a non-significant, 80% increased OS than those treated with a lower dose (p = 0.072). There was four grade 3 acute toxicities, and no grade 3 or more late toxicities. CONCLUSIONS: Multimodal treatment, including salvage BT, may offer a curative option for selected patients with an acceptable risk of severe toxicity for the treatment of primary or recurrent tumors in previously irradiated areas.

Prevalence and distribution of cervical lymph node metastases in HPV-positive and HPV-negative oropharyngeal squamous cell carcinoma.

OBJECTIVE: In oropharyngeal squamous cell carcinoma (OP-SCC), the prevalence and distribution of clinical and pathological lymph node metastasis in the neck have been extensively reported. It served as the basis for consensus recommendations on the selection of the lymph node levels in the neck requiring a treatment. The objective of the study is to compare the prevalence and distribution of neck node metastases in HPV+ and HPV- OP-SCC from a large series of patients with OP-SCC who underwent a cervical lymph-node dissection (LND) as part of their treatment. METHODS: The study concentrated on OP-SCC patients treated by various neck node dissection (LND) procedures from January 2014 to December 2018 in 3 French institutions. Patients with prior head and neck cancer, prior neck surgery, the use of induction chemotherapy, or patients with carcinoma of unknown primary were excluded. HPV-status was assessed by p16 immunohistochemistry. For each patient, the clinical and the pathological nodal status, as well as the distribution of the positive nodes in each neck level (from Ia to V) were reported. RESULTS: Two-hundred and sixty-three patients were included (126 p16-negative (p16-), and 137 p16-positive (p16+). The rate of clinical positive node (cN+) reached 54% and 88.3% in the p16- and p16+ groups, respectively (p < 0.001); the corresponding rate of pathological positive node (pN+) reached 61.9% and 91.2%, respectively (p < 0.001). Regarding the clinical lymph node distribution, in p16+ patients, more positive nodes were observed in the ipsilateral level IV (p = 0.003), and less positive nodes were observed in the contralateral levels III and IV (p = 0.003 and p = 0.045, respectively). Regarding the pathologic lymph node distribution in the ipsilateral neck, in the cN0 patients, no significant difference was observed between p16- and p16+ patients (p = 0.33 to 1); in the cN+ patients, the nodes were distributed in levels Ib, II, III, IV and V without differences between the p16- and the p16+ patients. In the contralateral neck of p16- patients, nodes metastases were mainly observed in levels II, III and IV, whereas for the p16+ patients, positive nodes were only observed in level II (p = 0.03). CONCLUSION: This study demonstrated the higher prevalence of cN+ and pN+ in p16+ OP-SCC patients, but without meaningful difference in the distribution of the lymph node drainage between p16- and p16+ OP-SCC. It indicates that no difference should be made between p16- and p16+ patients regarding the extend of neck treatment.

[Quality control in pathology and theranostics in head and neck cancers]. / Critères de qualité en anatomopathologie et nouveaux outils théranostiques en cancérologie tête et cou.

Head and neck malignant tumors diagnosis require both standardized technical and personalized management in order to optimize patient care and therapy. The quality of multidisciplinary discussion for that goal needs common vocabulary. More than morphology, immunohistochemistry and in situ hybridization, additional molecular theranostics approaches are in fast progress in head and neck cancers, as well as their other anatomic counterparts.

A model of mandibular irradiation in the rabbit: preliminary results.

Radiotherapy is widely used in the treatment of head and neck cancers. Its major adverse effect is osteoradionecrosis, which can occur during the whole life of the patient, involving the vital prognosis. The aim of the study was to develop a model for irradiation of the rabbit mandible in order to have a better knowledge of radiotherapy-induced bone alterations and thus a better prevention and treatment of osteoradionecrosis. The control group consisted in 7 rabbits and was used to assess anatomical and histological parameters of the rabbit's mandible. A first group of 14 rabbits was weekly irradiated at doses of 5.5 Gy during 5 weeks, at a total dose of 46.8Gy. Sacrifices were done at 1 week, 4 weeks, 12 weeks and 24 weeks. As histological analysis did not reveal statistical differences with the control group, a second group (3 rabbits) was weekly irradiated at 8.0, 8.5 and 9 Gy during 5 weeks. The first histological results seem to show vascular alterations, bone cells decrease and alterations of bone architecture. The role of intra alveolar collagen sponges, PRF®, ultrasounds and stem cells in bone regeneration after radiotherapy will be further studied.

Inverted papilloma with associated carcinoma of the nasal cavity and paranasal sinuses: treatment outcomes.

CONCLUSIONS: Degenerated inverted papilloma is a rare, aggressive, and lethal disease. To avoid missing the target, it is absolutely necessary to consider the microscopic extension even in cases of complete exeresis and to irradiate the whole of the adjacent sinuses. A dose increase may lead to better locoregional control. OBJECTIVE: To evaluate overall survival and progression-free survival of external radiotherapy in the management of nasal cavity and paranasal sinus inverted papilloma with associated carcinoma. METHODS: Clinical data from 11 patients treated by surgery followed by external radiotherapy (three-dimensional conformational radiotherapy until 2007 then intensity-modulated radiation therapy) for degenerated inverted papilloma in the Léon Bérard Cancer Centre between 1985 and 2009 were retrospectively analyzed. RESULTS: Five patients (45%) had a local recurrence and died from their recurrence. Three had a premature recurrence, just before or during radiotherapy. We could not determine the prognostic factors for overall survival and progression-free survival.