RESUMO
PURPOSE: Although HPV-positive and negative oropharyngeal cancers are two distinct diseases, Post-Therapeutic Surveillance (PTS) modalities are similar. Adjusting PTS strategies to HPV status will represent a massive practice change that raises the issue of its acceptability, by both physicians and patients. METHODS: Two distinct surveys were designed and submitted, respectively, to HPV-positive patients and physicians (surgeons, radiation and medical oncologists) involved in head and neck cancer treatment. RESULTS: 133 patients and 90 physicians have participated to the study. Most patients were reluctant to embrace new PTS options (remote consultations, nurse consultations and smart phone applications). However, 84% of patients would be favorable to use HPV Circulating DNA (HPV Ct DNA) measurement to guide surveillance modalities. 57% of physicians acknowledged that our current PTS strategy is improvable and most of them would accept the use of new monitoring options from the third year of follow-up. 87% of physicians would be interested to participate to a trial comparing the current PTS strategy to a new approach, where monitoring modalities (number of visits, imaging prescription) would depend on HPV Ct DNA level. CONCLUSIONS: Patients and physicians are aware that PTS modalities should depend on HPV status. Their adhesion is a prerequisite to any potential changes. Strategies based on HPV Ct DNA measurement should be assessed within a randomized clinical trial.
Assuntos
Neoplasias de Cabeça e Pescoço , Neoplasias Orofaríngeas , Infecções por Papillomavirus , Humanos , Infecções por Papillomavirus/complicações , Infecções por Papillomavirus/diagnóstico , Infecções por Papillomavirus/terapia , Neoplasias Orofaríngeas/diagnóstico por imagem , Neoplasias Orofaríngeas/terapia , Papillomavirus Humano , Inquéritos e Questionários , PapillomaviridaeRESUMO
Dematofibrosarcoma protuberans (DFSP) are very rare (1 to 4 incident cases per million of inhabitants). The local spreading of DFSP is underestimated. The histological diagnosis is challenging but we now know a specific marker (translocation t(17;22)(q22;q13) (COL1A1;PDGFB)). The risk of metastatic relapse is low (and related to fibrosarcoma component); the risk of local relapse depends on the quality of surgery. Management of localized DFSP is based on large resection with meticulous analysis of margins (with or without Mohs microsurgery). Advanced stages not amenable to surgery or metastatic DFSP (with presence of COL1A1;PDGFB) are best treated with imatinib. Locally advanced DFSP potentially amenable to curative intent surgery could be treated with imatinib as neo-adjuvant treatment. The management of these tumours requires multidisciplinary expertise.
Assuntos
Dermatofibrossarcoma , Doenças Raras , Neoplasias Cutâneas , Cromossomos Humanos Par 17/genética , Cromossomos Humanos Par 22/genética , Colágeno Tipo I/genética , Cadeia alfa 1 do Colágeno Tipo I , Dermatofibrossarcoma/diagnóstico por imagem , Dermatofibrossarcoma/genética , Dermatofibrossarcoma/patologia , Dermatofibrossarcoma/terapia , Marcadores Genéticos , Humanos , Recidiva Local de Neoplasia , Proteínas Proto-Oncogênicas c-sis/genética , Doenças Raras/diagnóstico por imagem , Doenças Raras/genética , Doenças Raras/patologia , Doenças Raras/terapia , Neoplasias Cutâneas/diagnóstico por imagem , Neoplasias Cutâneas/genética , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/terapia , Translocação GenéticaRESUMO
BACKGROUND: Pyriform sinus carcinomas (SCC) present specific functional and oncological issues. The recent advent of trans-oral robotic surgery (TORS), as a conservative procedure, has opened up new perspectives. OBJECTIVES: To present the oncological and functional outcomes of TORS for pyriform sinus SCC. MATERIALS AND METHODS: We included, retrospectively, all TORS procedures for pyriform sinus SCC performed between 2009 and 2017 in eight French tertiary referral centers. We excluded lesions involving the pyriform sinus that had developed from the oropharynx, larynx, or other anatomic sub-sites of the hypopharynx. RESULTS: We included 57 TORS procedures. Median hospital stay was 10â¯days. A preventive tracheotomy was performed in seven cases (12%), and all were successfully decannulated. Oral re-feeding was possible for 93%, after a median of 5â¯days. The main surgical complications were hemorrhages (three cases), all successfully handled, although 2 patients with heavy comorbidities died from blood loss in the days after. Adjuvant therapy was proposed in 31 cases (54%), including two cases of salvage surgery (total pharyngolaryngectomy). After a median follow-up of 23â¯months, overall and disease-free survival were, respectively, 84% and 74% at 24â¯months, and 66% and 50% at 48â¯months. At the end of follow-up, organ preservation rate was 96%. None of the surviving patients needed a tracheotomy and oral diet was possible for 96%. CONCLUSION: The functional and oncological outcomes of TORS for pyriform sinus cancer are encouraging, and this procedure can be considered safe for selected early or moderately advanced cases as a conservative treatment.
Assuntos
Neoplasias Hipofaríngeas/terapia , Faringectomia/métodos , Seio Piriforme/patologia , Procedimentos Cirúrgicos Robóticos/métodos , Carcinoma de Células Escamosas de Cabeça e Pescoço/terapia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Quimiorradioterapia Adjuvante/métodos , Quimiorradioterapia Adjuvante/estatística & dados numéricos , Tratamento Conservador/efeitos adversos , Tratamento Conservador/métodos , Intervalo Livre de Doença , Nutrição Enteral/estatística & dados numéricos , Estudos de Viabilidade , Feminino , Seguimentos , França/epidemiologia , Humanos , Neoplasias Hipofaríngeas/mortalidade , Neoplasias Hipofaríngeas/patologia , Masculino , Pessoa de Meia-Idade , Tratamentos com Preservação do Órgão/efeitos adversos , Tratamentos com Preservação do Órgão/métodos , Seleção de Pacientes , Faringectomia/efeitos adversos , Seio Piriforme/cirurgia , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Carcinoma de Células Escamosas de Cabeça e Pescoço/mortalidade , Carcinoma de Células Escamosas de Cabeça e Pescoço/patologiaRESUMO
OBJECTIVE: 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. METHODS: Patients were included in the prospective multicentric trial NCT02517125. These patients were scheduled to undergo surgery for an oropharyngeal localization. By pre-operative CT scan and MRI it was determined that they had a retropharyngeal internal carotid artery. RESULTS: Three patients had a retropharyngeal ICA: a patient with a 35 mm synovial sarcoma of the tonsillar fossa, a patient with a T2N2b squamous-cell carcinoma (SCC) of the glossotonsillar sulcus, and a patient with a T3N0 SCC of the tonsillar fossa in a previously irradiated field. These patients encountered neither preoperative nor postoperative complications. CONCLUSIONS: In our experience, TORS for oropharyngeal cancers appears to be feasible in patients with a retropharyngeal ICA, provided that the procedure has been adapted for complex situations. LEVEL OF EVIDENCE: 4.
RESUMO
The latest generation Da Vinci® Xi™ Surgical System Robot released has not been evaluated to date in transoral surgery for head and neck cancers. We report here the 1-year results of a non-randomized phase II multicentric prospective trial aimed at assessing its feasibility and technical specificities. Our primary objective was to evaluate the feasibility of transoral robotic surgery using the da Vinci® Xi™ Surgical System Robot. The secondary objective was to assess peroperative outcomes. Twenty-seven patients, mean age 62.7 years, were included between May 2015 and June 2016 with tumors affecting the following sites: oropharynx (n = 21), larynx (n = 4), hypopharynx (n = 1), parapharyngeal space (n = 1). Eighteen patients were included for primary treatment, three for a local recurrence, and six for cancer in a previously irradiated field. Three were reconstructed with a FAMM flap and 6 with a free ALT flap. The mean docking time was 12 min. "Chopsticking" of surgical instruments was very rare. During hospitalization following surgery, 3 patients experienced significant bleeding between day 8 and 9 that required surgical transoral hemostasis (n = 1) or endovascular embolization (n = 2). Transoral robotic surgery using the da Vinci® Xi™ Surgical System Robot proved feasible with technological improvements compared to previous generation surgical system robots and with a similar postoperative course. Further technological progress is expected to be of significant benefit to the patients.
Assuntos
Neoplasias de Cabeça e Pescoço/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Viabilidade , Humanos , Neoplasias Hipofaríngeas/cirurgia , Neoplasias Laríngeas/cirurgia , Pessoa de Meia-Idade , Neoplasias Orofaríngeas/cirurgia , Neoplasias Faríngeas/cirurgia , Estudos Prospectivos , Procedimentos Cirúrgicos Robóticos/instrumentação , Resultado do TratamentoRESUMO
PURPOSE: Totally implantable venous access port systems (TIVAPS) are a widely used and an essential tool in the efficient delivery of chemotherapy. Chemotherapy drug extravasation (CDE) can have dire consequences and will delay treatment. The purpose of this study is to both clarify the management of CDE and show the effectiveness of early surgical lavage (ESL). METHODS: Patients who had presented to the Cancer Center of Lille (France) with TIVAPS inserted between January 2004 and April 2013 and CDE had their medical records reviewed retrospectively. RESULTS: Thirty patients and 33 events were analyzed. Implicated agents were vesicants (51.5%), irritants (45.5%) and non-vesicants (3%). Huber needle malpositionning was involved in 27 cases. Surgery was performed in 97% of cases, 87.5% of which were for ESL with 53.1% of the latter requiring TIVAPS extraction. Six patients required a second intervention due to adverse outcomes (severe cases). Vesicants were found to be implicated in four out of six severe cases and oxaliplatin in two others. Extravasated volume was above 50 ml in 80% of cases. Only one patient required a skin graft. CONCLUSIONS: CDEs should be managed in specialized centers. ESL allows for limited tissue contact of the chemotherapy drug whilst using a simple, widely accessible technique. The two main factors that correlate with adverse outcome seem to be the nature of the implicated agent (vesicants) and the extravasated volume (above 50 ml) leading to worse outcomes. Oxaliplatin should be considered as a vesicant.
Assuntos
Antineoplásicos/efeitos adversos , Cateterismo Venoso Central/efeitos adversos , Cateterismo Venoso Central/instrumentação , Cateteres de Demora , Cateteres Venosos Centrais , Falha de Equipamento , Extravasamento de Materiais Terapêuticos e Diagnósticos/terapia , Erros Médicos , Irrigação Terapêutica/métodos , Adulto , Idoso , Antineoplásicos/administração & dosagem , Pré-Escolar , Desenho de Equipamento , Extravasamento de Materiais Terapêuticos e Diagnósticos/diagnóstico , Extravasamento de Materiais Terapêuticos e Diagnósticos/etiologia , Feminino , França , Humanos , Lactente , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Agulhas , Derrame Pleural/etiologia , Derrame Pleural/terapia , Estudos Retrospectivos , Fatores de Tempo , Resultado do TratamentoRESUMO
BACKGROUND: Sinonasal cancers are rare and associated with a poor prognosis. The purpose of this study was to report our experience and analyze the risk factors for oncologic failures. METHODS: A retrospective review of 156 consecutive patients treated with curative intent for sinonasal malignancy between 1995 and 2005 at tertiary cancer center was performed. Demographic, clinical, morphological, and pathological parameters were correlated with oncologic outcomes. RESULTS: Complete response was obtained for 134 patients. Sixty-eight patients relapsed, among which 51 had local recurrence. Nine of these 51 patients (17.6%) underwent successful salvage therapy. Five-year local failure and overall survival rates were 50.0% and 61.1%, respectively. Maxillary sinus tumors, intracranial invasion, and N > 0 classification at initial diagnosis were significantly and independently associated with local failure and survival in multivariate analysis. CONCLUSION: Local control after initial treatment is primordial to optimizing outcomes because of the poor results of salvage therapy.
Assuntos
Recidiva Local de Neoplasia/terapia , Neoplasias dos Seios Paranasais/mortalidade , Neoplasias dos Seios Paranasais/terapia , Terapia de Salvação/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Institutos de Câncer , Quimiorradioterapia/métodos , Estudos de Coortes , Terapia Combinada , Intervalos de Confiança , Intervalo Livre de Doença , Feminino , Seguimentos , França , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica/patologia , Recidiva Local de Neoplasia/mortalidade , Recidiva Local de Neoplasia/patologia , Estadiamento de Neoplasias , Neoplasias Nasais/mortalidade , Neoplasias Nasais/patologia , Neoplasias Nasais/terapia , Neoplasias dos Seios Paranasais/patologia , Modelos de Riscos Proporcionais , Radioterapia Conformacional , Estudos Retrospectivos , Medição de Risco , Terapia de Salvação/mortalidade , Taxa de Sobrevida , Falha de Tratamento , Adulto JovemRESUMO
Few studies reported both functional and sensitive long-term evaluations after tongue reconstruction. The aim of this study was to assess functional outcomes and sensitive recovery after tongue reconstruction with fasciocutaneous free flap (FCFF) or musculocutaneous pedicled flap (MCPF) without nerve anastomosis. We enrolled 30 patients having no recurrence from a consecutive series of 79 tongue reconstructions as part of a cancer treatment. All patients were submitted to functional and sensitive tests. The functional study included intelligibility, tongue motility, food, and swallowing scores. Flap sensibility was evaluated too. Male-to-female sex ratio was 6.5 with a mean age of 52 years old. The lesions were mainly advanced (T3-T4 73%). Mobile tongue and base of tongue resection was carried out in 43% of cases, and resection was limited to the oral tongue for 53%. Twenty-one FCFF and nine MCPF were performed. The mean follow-up was 2 years and 11 months. Swallowing (slightly impaired 63%), food (normal 40%), and intelligibility (excellent 77%) assessments were satisfactory. Spontaneous sensory recovery was regularly observed (mean response 62%). The two groups FCFF and MCPF were similar regarding population and tumors characteristics. Functional results were higher in case of FCFF (food score p=0.05; intelligibility p=0.04). No difference was observed on sensitive recovery. This study emphasizes good functional results either for swallowing or intelligibility, with higher scores for the FCFF, strengthening the opinion that FCFF is the best choice for tongue reconstruction whenever possible.
Assuntos
Procedimentos de Cirurgia Plástica/métodos , Recuperação de Função Fisiológica , Retalhos Cirúrgicos , Neoplasias da Língua/cirurgia , Língua/cirurgia , Adulto , Idoso , Deglutição/fisiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Inteligibilidade da Fala/fisiologia , Língua/fisiopatologia , Resultado do TratamentoRESUMO
There are few data focusing on postoperative course after major head and neck cancer surgery in the elderly compared with the younger population. The aim of this study was to assess the impact of age on postoperative outcomes. At hospital admission, we prospectively collected data from 261 patients separated into two groups with regard to their age (those >or= 70 years and those < 70 years). Twenty-nine of them were over 70 years old. Median length of stay was similar in both populations (22 vs. 21 days, p=0.66). Incidence of severe postoperative complications was similar: surgical site infection (6/29 vs. 89/232, p=0.77), pneumonia (4/29 vs. 29/232, p=0.13) and infection caused by multi-resistant pathogens (1/29 vs. 14/232, p=0.08). There was no significant increase in postoperative deaths (4/29 vs. 6/232, p=0.12). The impact of age on postoperative deaths was assessed after adjustment for potential risk factors. In a logistic regression model, postoperative death risk remained insignificantly increased in the elderly (adjusted Odds Ratio=3.3 [0.7-14.9], p=0.22). In our experience, the postoperative course in elderly patients is not significantly different from that than in younger patients.