[Prospective study of accelerated postoperative radiation therapy in patients with squamous-cell carcinoma of the head and neck]. / Radiothérapie externe accélérée postopératoire des carcinomes épidermoïdes localement évolués de la sphère ORL: étude prospective de phase II.

PURPOSE: To assess the feasibility and efficacy of accelerated postoperative radiation therapy (RT) in patients with squamous-cell carcinoma of the head and neck (SCCHN). PATIENTS AND METHODS: Between December 1997 and July 2001, 68 patients (male to female ratio: 52/16; median age: 60-years (range: 43-81) with pT1-pT4 and/or pN0-pN3 SCCHN (24 oropharynx, 19 oral cavity, 13 hypopharynx, 5 larynx, 3 unknown primary, 2 maxillary sinus, and 2 salivary gland) were included in this prospective study. Postoperative RT was indicated because extracapsular infiltration (ECI) was observed in 20 (29%), positive surgical margins (PSM) in 20 (29%) or both in 23 patients (34%). Treatment consisted of external beam RT 66 Gy in 5 weeks and 3 days. Median follow-up was 15 months. RESULTS: According to CTC 2.0, acute morbidity was acceptable: grade 3 mucositis was observed in 15 (22%) patients, grade 3 dysphagia in 19 (28%) patients, grade 3 skin erythema in 21 (31%) patients with a median weight loss of 3.1 kg (range: 0-16). No grade 4 toxicity was observed. Median time to relapse was 13 months; we observed only three (4%) local and four (6%) regional relapses, whereas eight (12%) patients developed distant metastases without any evidence of locoregional recurrence. The 2 years overall-, disease-free survival, and actuarial locoregional control rates were 85, 73 and 83% respectively. CONCLUSION: The reduction of the overall treatment time using postoperative accelerated RT with weekly concomitant boost (six fractions per week) is feasible with local control rates comparable to that of published data. Acute RT-related morbidity is acceptable.

[Evaluation of perineal comfort following delivery in primiparae]. / Evaluation du confort périnéal en suites de couches chez les primipares.

The authors followed a population of 204 primiparous women in order to be able to tackle the causes of those frequent sexual problems that occur after delivery. Obstetric perineal lesions were found in 46 cases of left lateral episiotomies, 104 cases of midline episiotomies and 54 cases where the perineum was said to be intact. Following delivery at the Maternity Unit, those patients who had a perineal incision suffered more without any difference whether the episiotomy was a midline or a lateral one. After a mean of 78 days following delivery, at the post-partum examination, sexual troubles were found to be frequent and 41% complained of dyspareunia. These troubles were scattered in all three series. There was no difference whether the mother was breast-feeding or not in relationship to her sexuality after delivery. The authors conclude that there is no proper correlation between the way the perineum was dealth with surgically and the quality of sexual activity experienced early after delivery.