[Association of tracheobronchopathia osteochondroplastica and ozène]. / Association trachéobronchopathie chondro-ostéoplastique et ozène.

INTRODUCTION: We report a case of tracheobronchopathia osteochondroplastica associated with Ozena (atrophic rhinitis). OBSERVATION: Fibreoptic bonchoscopy showed irregular tracheal stenosis and histopathological examination displayed zones of bone metaplasia in the tracheal submucosa. We isolated the bacteria Klebsiella pneumoniae sp ozaenae from bronchial aspirate. CONCLUSION: This organism is frequently isolated in both conditions suggesting some link between the two diseases.

[Chondrosarcoma of the cricoid]. / Chondrosarcome du cricoïde.

OBJECTIVE: Chondrosarcoma of the larynx is a rare neoplasm generally observed on the cricoid. The purpose of this study was to define the most appropriate surgical management depending on tumor extension and histological grade. PATIENTS AND METHODS: Three males and one female were treated for chondrosarcoma of the cricoid between 1990 and 2003 in the Ear, Nose and Throat department in Tours, France. There were three grade I tumors and one grade II tumor. Tumor resection by thyrotomy was performed in two patients, total laryngectomy in one and laser desobstruction in one. RESULTS: The patient who underwent total laryngectomy remained in complete remission at five years. Among the two patients who had thyrotomy, one remained in remission at three years and the other experienced recurrence at four years and underwent a second operation. He died five years later due to another disease. Total follow-up was nine years. The patient treated by laser therapy achieved stabilization at twelve months. CONCLUSION: Computed tomography and histological grading enable choosing the best surgical procedure. Partial laryngeal surgery is indicated for small or low-grade chondrosarcomas. For large or high-grade tumors, total laryngectomy must be performed. In the event of patient refusal, laser desobstruction can provide clinical stabilization.

[Infectious complications after surgery for hypopharyngeal and laryngeal carcinomas]. / Complications infectieuses après chirurgie carcinologique du pharyngo-larynx.

OBJECTIVE: The objective of this study was to analyze the infectious complications of procedures for carcinoma of the hypopharynx and the larynx to optimize the prevention of septic risks. MATERIAL AND METHODS: This retrospective study included 608 patients who underwent total (n=270) or partial (n=338) laryngectomy between 1984 and 1999. The procedures were performed under rigorous conditions of surgical asepsis and with prolonged antibiotic chemotherapy depending on the type of laryngectomy and past history of external radiotherapy. Twenty factors were studied. Univariate analysis, including 9 factors, and multivariate analysis were performed. RESULTS: The global rate of infectious complications was 11.1%. The percentages of salivary leaks, other wound infections and non-wound infections were respectively 11.9%; 1.5%; 1.5% for total laryngectomy and 1.8%; 2.4%; 3.8% for partial laryngectomy. Statistically significant factors were tumor stage, postoperative hematoma, postoperative lymphorrhea and, to a lesser degree, pharyngeal localization. CONCLUSION: Our rate of infectious complications in oncologic pharyngeal and laryngeal surgery, which is low compared with data in the literature, emphasizes the importance of strict measures of surgical asepsis and prolonged antibiotic chemotherapy as is recommended for so-called contaminated surgery.

[Prognostic value of the number of involved nodes after neck dissection in oropharyngeal and oral cavity carcinoma]. / Valeur pronostique du nombre de ganglions envahis après curage cervical pour carcinome de l'oropharynx et de la cavité buccale.

PURPOSE: To evaluate the relationship between the number of positive nodes and probabilities of locoregional control and survival in patients with invasive squamous cell carcinomas of the oral cavity and oropharynx. MATERIAL AND METHODS: Between 1976 and 1993, we treated with curative intent 183 patients (median age: 56 years; standard deviation: 10 years). Seventy-nine patients (43%) had oropharyngeal primary invasive carcinoma and 104 (57%) had oral cavity (excluding the lip) primary invasive carcinoma. Patients with simultaneous primary lesion or visceral metastases were excluded from the analysis. All the patients had neck dissection with at least six nodes to analyse. One-hundred fifty-nine patients (87%) underwent resection of the primary lesion and 158 (86%) were treated postoperatively with external beam irradiation alone or combined with interstitial implant (median dose: 60 Gy; standard deviation: 10 Gy). Average follow-up was 52 months. RESULTS: The overall 5-year survival rate using the Kaplan-Meier method was 42.6%. The 5-year survival rates were 60.0% when lymph nodes were histologically negative, 39.5% when one lymph node was positive, 28.0% when two lymph nodes were positive and 24.4% when three or more lymph nodes were positive (P = 0.0004). The number of positive nodes did not significantly influence the specific disease-free survival and locoregional control rates. CONCLUSION: Patients with one or more positive neck nodes must have postoperative treatment.

Enhanced acute toxicity in oropharynx carcinoma treated with radiotherapy and concomitant cisplatin, 5-fluorouracil and mitomycin C.

The aim of this study was to establish the feasibility of giving concomitant radiotherapy and 3 cycles of chemotherapy with cisplatin (CDDP), 5-fluorouracil (5-FU) and mitomycin C (MMC) in locally advanced inoperable oropharyngeal cancer. From March 1990 to September 1993, 27 male patients (mean age 55 years) were included in this study. 3 patients (11%) were T2N0, 19 (70%) T3 (T3N0: n = 9, T3N1: n = 1, T3N2: n = 5, T3N3: n = 4), and 5 (19%) T4 (T4N0: n = 1, T4N1: n = 1, T4N2: n = 2, T4N3: n = 1). All patients received conventional radiotherapy delivering 70 Gy in 35 fractions and 52 days, and three cycles of chemotherapy starting on day 1, 21 and 42 with CDDP 20 mg/m2 and 5-FU 400 mg/m2 day 1 to day 4, and MMC 10 mg/m2 day 1. With a mean follow-up of 34 months (17-59), 10 patients (37%) were alive and free of disease. Among the 17 other patients, 8 died of cancer. Crude locoregional control rate was 78%, and probability of local control at 1 and 2 years was 85 and 80%, respectively. One- and 2-year survival rates were 48 and 31%, respectively, for both overall and disease-free survival. Grade 3 or 4 mucositis occurred in 22 patients (81%); enteral feeding was necessary for 63%; mean weight loss was 5.7 kg. Grade > 2 thrombocytopenia occurred in 11 patients (41%), grade > 2 neutropenia in 8 patients (29%), grade > 2 anaemia in 4 patients (15%). Febrile neutropenia or aplasia occurred in 5 patients (19%). 2 patients (7%) died during treatment of haematological or infectious complications related to the treatment. Another patient died 1 month after treatment with grade 4 thrombocytopenia and septicaemia. In conclusion, a high complete response rate has been achieved with this concomitant chemo- and radiotherapy, but with severe digestive and haematological toxicity. Addition of MMC to 5-FU and CDDP might have been responsible for this increased toxicity. This therapeutic combination is therefore not routinely feasible.

[Concomitant radiochemotherapy with cisplatin (CDDP), 5-fluorouracil (5-FU) and mitomycin C (MMC) in locally advanced carcinoma of the oropharynx. Results of a phase II trial]. / Radiothérapie et chimiothérapie concomitante par cisplatine (CDDP), 5-fluorouracile (5-FU) et mitomycine C (MMC) pour le traitement des cancers localement évolués de l'oropharynx. Résultats d'un essai de phase II.

In order to improve loco-regional control in locally advanced oropharyngeal carcinoma, a phase II trial was designed to establish the feasibility of concomitant conventional radiotherapy and three cycles of chemotherapy at day 1, 21 and 42 with cisplatin (CDDP) 20 mg/m2 and 5-fluorouracil (5-FU) 400 mg/m2 day 1 to day 4, and mitomycin C (MMC) 10 mg/m2 day 1. From March 1990 to September 1993, 27 patients (mean age: 55) were included in this study. Three patients (11%) were T2N0, 19 (70%) T3 (T3N0: n = 9, T3N1: n = 1, T3N2: n = 5, T3N3: n = 4), and 5 (19%) T4 (T4N0: n = 1, T4N1: n = 1, T4N2: n = 2, T4N3: n = 1). With a mean follow-up of 34 months (17-59), ten patients (37%) were alive, free of disease; among the 17 other patients, seven died with cancer. Loco-regional control rate was 85%. One and 2-year survival rates were respectively 48 and 31% for overall and disease-free survival; respective corrected overall survival rates were 68 and 61%. Grade 3 or 4 mucositis was 81%; enteral feeding was necessary for 63% of the patients; mean loss of weight was 5.7 kg. Grade > 2 thrombopenia occurred in 11 patients (41%), grade > 2 neutropenia in eight patients (29%) , grade > 2 anemia in four patients (15%). Febrile neutropenia or aplasia occurred in five patients (19%). Two patients (7%) died during treatment of haematological or infectious complications related to the treatment. Another patient died 2 months after treatment with grade 4 thrombopenia and septicemia. Addition of MMC to 5-FU and CDDP might have been partly responsible of this increased toxicity. A high complete response rate has been achieved with this concomitant radio-polychemotherapy, but with a severe digestive and haematological toxicity, which did not allow to conclude to the feasibility of this therapeutic association.

Oropharynx carcinoma: irradiation alone versus induction chemotherapy plus irradiation--5 year results.

Induction chemotherapy (CT) has demonstrated overall response rates of 80% for oropharynx carcinomas, but no overall survival benefit has been reported. In order to determine the value of induction CT for such patients, we conducted a retrospective study: 121 patients were treated with CT and radiotherapy (RT) (Group 1). This group was compared with a historical group of 84 patients treated by RT alone (Group 2). The CT used was Cisplatinum associated with Bleomycin and Vincristin or Vindesin and with 5 Fluoro-uracil. An objective response to CT was observed for 41% of patients. The 5 year actuarial survival rate was 19% for Group 1 and 24% for Group 2. Patterns of failure were identical in the two groups. The only difference observed was for patients with N3 nodes (26% of 5 year survival rate in Group 1 versus 9% in Group 2) (p = 0.05). The results did not depend on the histological differentiation, the tumour site or the type of CT. We conclude that this retrospective study failed to demonstrate an advantage for induction CT in oropharynx carcinoma except for patients with N3 nodes.

[Results of radiotherapy of carcinomas of the tonsillar area. Study of 137 cases]. / Résultats de la radiothérapie des carcinomes de la loge amygdalienne. Etude de 137 cas.

In our center, carcinomas of the tonsillar region are most often treated by radiotherapy. The aim of this retrospective study was to assess the therapeutical results obtained for such tumors over a period of ten years. From 1976 to 1986, 137 patients with carcinoma of the tonsillar area were exclusively treated by radiotherapy. The mean age of the patients was 54.3 years. 120 male and 17 female patients were included in the study. 63% of the patients had T3 or T4 tumors, while 53% had N2 or N3 adenopathies at enrollment (1979 TNM classification). All the patients had transcutaneous irradiation done either exclusively (121 cases) or in combination with curietherapy (16 cases). 61 patients had induction chemotherapy. Local control of the tumor was obtained in 59% of patients (79/137), and attained 92%, 71%, 58% and 16% for the T1, T2, T3 and T4 groups, respectively. The 5 year survival rate was 34%. 12 patients developed distal metastases. 9 patients developed another type of cancer. Elements of prognosis were tumor size and nodal status. Age, sex and histological differentiation were not determinant prognostic factors.

[Radiotherapy of carcinoma of the oropharynx. Results of 10 years' experience at the University Hospital Center, Tours]. / Radiothérapie des carcinomes de l'oropharynx. Résultats de 10 ans d'expérience au CHU de Tours.

In our centre, the vast majority of patients with oropharyngeal tumours are treated by irradiation. Over a period of 10 years, between 1976 and 1986 we treated 305 patients with squamous carcinomas of the oropharynx. The mean age was 58.2 years. There were 24 women and 281 men. 59% of the patients had advanced tumours, classified as T3 or T4, 54% of the patients showed the presence of adenopathy at the first examination. All patients received radiation therapy. 69 patients had surgical treatment of the tumour or glands. 21 patients had implant therapy (most often combined with transcutaneous irradiation). 165 patients had induction chemotherapy. Local tumour control was obtained in 124 patients (41%), i.e. 82, 56, 31 and 4% for T1, T2, T3 and T4 respectively. The 5 years survival rate of the overall population was 28%. The principle causes of failure were local progression for T3 and T4 tumours and metastases and second cancers in patients with T1 or T2 tumours. The prognostic factors were gland involvement and general health. The site of the tumour, sex and histological type were not prognostic factors. Induction chemotherapy did not improve the results of treatment.

[Cancer of the tonsillar region. Role of irradiation in treatment]. / Cancers de la région amygdalienne. Place de l'irradiation dans le traitement.

In our center, carcinomas of the tonsillar region are usually treated by radiotherapy. This study presents the results of our treatment experience over ten years. Between 1976 and 1986, we treated 137 patients with carcinoma of the tonsillar area. The mean age was 54.3 years. The UICC TNM staging of 1979 was used: 63% of the patients had T3 and T4 tumours and 53% had lymph nodes at the first examination. All patients were treated by radiotherapy, alone for 121 patients and associated with brachytherapy for 16 patients. 61 patients received induction chemotherapy with Cisplatinum. Local control rate at the primary site was 56%, and was respectively 92%, 71%, 57% and 11% for T1, T2, T3 and T4 tumours. Local control rate in the neck was 72%. The 5-year actuarial survival rate was 34%. Distant metastasis occurred in 12 patients. 9 patients had a second primary tumor. Node status and stage were the main prognostic factors. Age, sex, histological subtype were not prognostic factors.

[Carcinomas of the base of tongue: analysis of treatment results in 115 patients]. / Carcinomes de la base de la langue: analyse des résultats du traitement de 115 patients.

Between 1976 and 1986, we have treated 115 patients with base of the tongue carcinomas. The mean age was 53.8 years. Staging system used was the UICC TNM classification of 1979. 70% of the tumors were T3 or T4 and 42% had N2 or N3 lymph nodes. Loco-regional treatment was irradiation alone (98/115) or surgery and post-operative radiotherapy (17/115). 67 patients received an induction chemotherapy. 3 and 5 years actuarial survival was 25% and 23%, and 42, 48, 20 and 17% at 3 years for T1, T2, T3 and T4 lesions respectively. Local control rate at the primary sites was 55%, local control rate in the neck was 78%. Distant metastases occurred for 10% and 8% had a second primary. Nodal status was the only other prognostic factor. Local control rate obtained with irradiation alone was not good. For limited tumors T1 and T2, a better local control rate can be obtained with interstitial therapy or surgery.

[Advanced carcinoma of the oropharynx: the value of induction chemotherapy before locoregional treatment. A retrospective study of 138 cases]. / Carcinomes avancés de l'oropharynx: valeur d'une chimiothérapie d'induction précédant le traitement locorégional. Etude retrospective de 138 cas.

Induction chemotherapy in oropharynx carcinomas had demonstrated overall response rates of 80%, but no overall survival benefit have been reported. In order to determine the value of induction chemotherapy for these patients, we conducted a retrospective study: 86 patients were treated with chemotherapy (CT) and RT (group 1) and 52 patients were treated by radiotherapy (RT) alone (group 2). All patients had T3 or T4 tumors. CT used was cisplatinum based associated with bleomycin and vincristine or vindesine and actually with 5 fluoro-uracil. Objective response to the CT was observed for 34% patients. Five years actuarial survival rate was 18% for group 1 and 17% for group 2. Patterns of failure were identical in the 2 groups. A difference was observed only for patients with N3 nodes (24% 5 years survival rate in group 1 versus 6% in group 2) (P = 0.05). According to the histologic differentiation, the tumor site or the type of CT, no difference was observed. We concluded that this study failed to demonstrate an advantage for induction chemotherapy in advanced oropharynx carcinoma excepted for patients with N3 nodes.

[Study by auditory evoked potentials of the efficacy of transcutaneous electric stimulation in the treatment of tinnitus]. / Etude par les potentiels évoqués auditifs de l'efficacité de l'électrostimulation transcutanée dans le traitement des acouphènes.

Thirty patients complaining about tinnitus were treated by transcutaneous tragal electrical stimulation. The effect of this treatment has been evaluated by BASR recordings before and after treatment. Taking into account the subjective results three groups are described. The first one (10 patients) is relieved of tinnitus. In second and third group the symptoms still exist, whatever the electrode's position (anode or cathode in tragal position). When BASR are studied before the electrical stimulation no inter-subjects difference can be found. After stimulation, the left delta I-V latency is significatively lengthened, and the wave I latency is shortened in the first group. The study of the two other groups do not reveal any difference between the pre- and the post- stimulation evaluation. So the BASR appears to be a good predictive tool for tinnitus suppression by electrical stimulation.

[Effect of nicotine on auditory functions in the rat, studied by electrocochleography and auditory evoked potentials of the brain stem]. / Effet de la nicotine sur les fonctions auditives du rat, exploré par électrocochléographie et potentiels évoqués auditifs du tronc cérébral. Travail préliminaire.

The rôle of nicotine (100 micrograms/kg) on brainstem auditory evoked responses (FFP) and electrocochleography (EcoG) in rats anaesthetized with pentobarbital has been studied. Each component of FFP and EcoG was analysed in terms of its latency and amplitude. Nicotine failed to produce any significant changes in the latencies of the FFP and EcoG components. Nicotine after 30 min increases significantly the amplitude I, I', II and III, of the FFP components, and decreases no significantly IV and V components. These finding suggests the presence of muscarinic and nicotinic effect of nicotine, in the mediation of the brainstem auditory pathway.

[Long-term gentamicin ototoxicity in the rat: research on retro-cochlear involvement by study of evoked auditory potentials of the brain stem]. / Ototoxicité à long terme de la gentamicine chez le rat: recherche d'une atteinte rétro-cochléaire par l'étude des potentiels évoqués auditifs du tronc cérébral.

Four groups of rats treated with single (50 mg/kg and 200 mg/kg) or multiple (3 X 200 mg/kg and 5 X 200 mg/kg) doses of gentamycin were studied over a 6-month period and compared with a control group. At 50 mg/kg no significant changes were observed. Significant signs of intoxication were observed at 200 mg/kg doses and at multiple doses. A significant lengthening of the latencies with changes in amplitude and a transitional increase in the auditory threshold were observed as early as the end of treatment. This was followed by a phase of amplitude decrease, a rise in auditory threshold and a decrease in latencies which remains unexplained.

[Cancer of the larynx and computed x-ray tomography: exploration of the hypothyroepiglottic area and paraglottic space]. / Cancer du larynx et examen tomo-densitométrique: exploration de la loge hyo-thyro-épiglottique et de l'espace para-glottique.

Twenty patients with laryngeal cancer were explored by tomography and a CT scan. Results were compared between cases and, for operated patients, with histosurgical findings. Results of this study and a review of the literature suggest that the CT scan is the most adapted examination for exploration of the paraglottic and hypothyroepiglottic spaces, but that caution should be exercised when assessing results.