Percutaneous radiologic gastrostomy (PRG) requires preliminary gastric inflation through a nasogastric tube (NGT) to safely perform gastric puncture. However, in case of pharyngeal or esophageal obstruction, NGT placement may be impossible even with a hydrophilic angiography catheter and wire. This brief report describes percutaneous computed tomography (CT)–guided gastrostomy with a 2-stick approach without nasogastric insufflation in 13 patients. Technical success rate was 100% with a mean of 1.8 punctures ± 1.0 to access the gastric lumen. Traversal of the colon and liver with a 22-gauge needle was necessary in 4 and 1 patients, respectively. There were no major complications. Minor complications occurred in 6 patients (46%). CT-guided percutaneous gastrostomy is technically feasible with minimal morbidity.

OBJECTIVE:The measure of body surface area (BSA) is a standard for planning optimal dosing in oncology. This index is derived from a model having questionable performances. In this study, we proposed measurement of BSA from whole body CT images (iBSA). We tested the reliability of iBSA assessments and simulated the impact of our approach on patient chemotherapy dosage planning.METHODS:We first evaluated accuracy and precision of iBSA in measuring 14 phantom and 11 CT test-retest images.Secondly, we retrospectively analyzed 26 whole body PET-CT scans to evaluate inter-method variability between iBSA and the most used anthropomorphic models, notably the "Du Bois and Du Bois" model. Finally, we simulated the impact on chemotherapy dose planning of capecitabine based on iBSA.RESULTS:Precision and accuracy of iBSA measurement featured a standard deviation of 1.11% and a mean error of 1.53%. Inter-method variability between iBSA and "Du Bois and Du Bois" assessment featured a standard deviation of 4.11% leading to a reclassification rate of capecitabine of 32.5%.CONCLUSIONS:iBSA could help the oncologist in standardizing assessments for chemotherapy planning. iBSA could also be relevant for applications such as comprehensive body composition and provide a sensitive measurement for changes related to nutritional intake or other metabolism.

Background: Dysphagia is a serious sequel of head and neck cancer (HNC) and its treatment. This dysfunction is frequent and likely underreported by clinical exam. It seems necessary to assess its global burden during the pre, per and post treatment periods (up to 18 months), regardless of the treatment received. Methods: This was a prospective cohort study assessing the rate of dysphagia in first-time treated HNC patients, using the deglutition handicap index questionnaire (DHI) and the clinician reporting. Time to occurrence, severity and length of the dysfunction were recorded. The benefit of an evaluation by the patient himself was investigated. Results: Of 134 evaluable patients: 22 were treated by surgery alone (16.4%), 16 by radiotherapy (RT) alone (11.9%), 3 by chemotherapy (CT) alone (2.2%), 28 by RTCT (20.9%), 31 by induction chemotherapy followed by RTCT (23.1%), 11 by surgery+RT (8.2%) and 23 by surgery+RTCT (17.2%). Patients completed 87.9% of the expected DHI. The dysphagia frequency reported was 92.2% by patient-reporting and 80.9% by clinicians-reporting, whatever the intensity. Self-perceived moderate to severe dysphagia was reported in 69.8% of patients. Conclusions: Given the strong impact of dysphagia on the quality of life and prognosis of HNC patients, it appears essential to perform screening and systematic monitoring. Using a simple and well accepted questionnaire, such as DHI, which is also well correlated with clinical evaluation, we demonstrated a significant frequency of dysphagia. The use of real-time patient-reported outcomes for its early detection would be an asset, particularly during long-term follow-up. Registered under ClinicalTrials.gov Identifier no. NCT03068559.

Concomitant radiotherapy and cetuximab association has shown superiority to exclusive radiotherapy for head and neck cancers. Data on this association are scarce for the elderly population despite its rising incidence. A retrospective monocentric data collection was performed in the Antoine Lacassagne Cancer Center in France. Inclusion criteria were: age >70 years at time of diagnosis, histologically proven head and neck epidermoid carcinoma, treated with radiotherapy combined with cetuximab. Thirty-five patients were included between 2008 and 2012. Median follow-up was 22 months. Median age was 74 years (70–86). Median performance status was 1 (0–2). Female/male sex ratio was 0.34. Tumor sites were: oropharynx (57.1 %), larynx (20 %), hypopharynx (14.3 %), oral cavity (2.9 %), nasopharynx (2.9 %), and lymph node with unknown primary (2.9 %). Using TNM classification, tumors were: T1 (5.9 %), T2 (35.3 %), T3 (35.3 %), T4 (22.9 %), N0 (28.6 %), N1 (8.6 %), N2 (48.6 %), and N3 (14.3 %). Median radiotherapy dose was 70 (60–70). RT was interrupted in 94 % of patients and the dose of cetuximab was reduced in 29 %. Median survivals were, respectively: 49 months for overall survival (standard error (SE) = 8) and 32 months for relapse-free survival (SE = 10). Two-year local–regional relapse and metastatic relapse-free survivals were, respectively, 59 % (SE = 10) and 74 % (SE = 10). Concomitant radiotherapy and cetuximab seem to be an effective therapy in the elderly population with encouraging results similar to the literature concerning its efficacy and toxicity. This treatment should be considered for patients >70 years.

Purpose. Malnutrition is one of the most common symptoms in palliative phase, for which the management overtakes medical framework, because feeding underlies fundamental symbolic values. The purpose of this study was to explore the representations and practices of general practitioners on nutrition of palliative care patients.Method. This is a qualitative study based on individual, semi-directed interviews.Results. Fifteen general practitioners were interviewed. For their patients' comfort, they have first opted for oral feeding. After assessing the benefits/discomfort balance, the state of mind, the quality of Life, and the nutritional status in their patients, they decided whether artificial nutrition needed to be initiated. There was a significant degree of subjectivity in decision making, which raised the questions of suffering due to hunger or thirst, and the correlation between cessation of feeding and death. Interrupting an artificial nutrition is delicate and thus was seldom advocated. The problems highlighted were: lack of time, lack of communication among the various health providers, and lack of knowledge about artificial nutrition.Conclusion. The indication for artificial nutrition is not for the terminally ill patients but is only problematic in early palliative phase. Improved decision making and medical practice for these patients is essential. How to improve it? By training physicians in palliative care, anticipating dialogues with the relatives, improving communication among caregivers, and sharing the knowledge of resources in palliative care. (C) 2017 Elsevier Masson SAS. All rights reserved.

Background > Patient education is the process by which health professionals impart information to patients and their caregivers that will alter their health behaviors; improve their health status to better manage their lives with a chronic disease. Patient education implies a profound paradigm shift in the conception of care among health professionals, and should result in structural core changes. Patient education has been promoted by the French Health system for 30 years, including in the 2009 HPST law and Cancer Plan 2014-2019. A patient education program was designed in our hospital for breast cancer patients.Material and methods > A multidisciplinary and transversal team of health professionals and resource patients was trained before grant application for funding of the program by the regional health care agency. Management of the project required that a functional unit be built for recording of all patient education related activities. A customized patient education program process was built under the leadership of a coordinator and several patient education project managers during bimonthly meetings, using an accurate timeline and a communication strategy to ensure full institutional support and team engagement.Results > The grant was prepared in four months and the program started within the next four months with the aim to include 120 patients during year 1. The program includes a diagnosis of patient abilities and well-being resources, followed by collective and individual workshops undertaken in 4 months for each patient.Discussion > Patient education is positively evaluated by all participants and may contribute to better health care management in the long term but the financial and human resources allocated to such programs currently underestimate the needs. Sustainability of patient education programs requires that specific tools and more commitment be developed to support health care professionals and to promote patient coping and empowerment in the long term.

The objective of the study is to evaluate the nutritional status and determine its impact on clinical outcomes in patients with locally advanced hypopharyngeal cancer included in an induction chemotherapy (ICT)-based larynx preservation program without prophylactic feeding-tube placement. All patients with locally advanced (T3/4, N0-3, M0) hypopharyngeal squamous cell carcinoma, technically suitable for total pharyngolaryngectomy, treated by docetaxel, cisplatin and 5-fluorouracil (TPF)-ICT for larynx preservation at our institution between 2004 and 2013, were included in this retrospective study. Patients' nutritional status was closely monitored. Enteral nutrition was used if and when a patient was unable to sustain per-oral nutrition and hydration. The impact of nutritional status on clinical outcomes was investigated in univariate and multivariate analysis. A total of 53 patients (42 men and 11 women, mean age = 58.6 ± 8.2 years) were included in this study. Six (11.3 %) patients had lost more than 10 % of their usual body weight before therapy. Compared with patients' usual weight, the mean maximum patient weight loss during therapeutic management was 8.7 ± 4.5 kg. Enteral nutrition was required in 17 patients (32 %). We found no influence of the tested nutritional status-related factors on response to ICT, toxicity of ICT, overall, cause-specific and recurrence-free survival, and on post-therapeutic swallowing outcome. Maximum weight loss was significantly associated with a higher risk of enteral tube feeding during therapy (p = 0.03) and of complications (grade ≥3, p = 0.006) during RT. Without prophylactic feeding-tube placement, approximately one-third of the patients required enteral nutrition. There was no significant impact of nutritional status on oncologic or functional outcomes.

L’éducation thérapeutique du patient (ETP) est une démarche visant à aider les patients à acquérir ou maintenir les compétences nécessaires pour gérer au mieux leur vie avec une maladie chronique. En cela, l’ETP implique un changement profond de paradigme dans la conception du soin chez les professionnels de santé. L’ETP est un enjeu dans les politiques de santé successives depuis 30 ans, y compris la loi HPST et le plan Cancer 2014–2019. Un programme d’ETP ambulatoire dans les cancers du sein fut instauré en établissement privé d’intérêt collectif en cours de certification v2014. La formation d’une équipe pluridisciplinaire et transversale constituée de professionnels de santé et patientes ressource a précédé la demande d’autorisation quadriennale et de financement pour pratiquer l’ETP auprès de l’ARS. La gestion du projet a nécessité la création d’une unité fonctionnelle pour traçabilité des actes d’ETP ambulatoire non comptabilisables dans la tarification à l’acte. Sous l’impulsion d’un coordonnateur et de chefs de projets, des réunions de concertation ETP et une stratégie de communication dans l’établissement et des échéanciers (avec rétroplanning) ont permis de réaliser un programme modulaire personnalisé d’ETP pour les patients. Le programme (diagnostic éducatif, 8 ateliers collectifs et 3 individuels, au choix sur 4 mois) a été effectif en 4 mois et l’objectif de plus de 60 patients atteint en 3 mois. Le programme mobilise 0,35 équivalent temps plein médical, et une équipe paramédicale, réunis hebdomadairement par réunion de concertation ETP. Les concepts d’autonormativité, les freins et solutions rencontrés sont développés. L’ETP est perçue très positivement par les patients participants. L’ETP participe à l’attractivité des établissements mais l’incitation financière pour l’ETP est actuellement faible. La pérennisation de l’ETP nécessite de mettre en place des outils spécifiques et de développer une prospective pour favoriser l’engagement des médecins et des patients dans le long terme. Patient education is the process by which health professionals impart information to patients and their caregivers that will alter their health behaviors; improve their health status to better manage their lives with a chronic disease. Patient education implies a profound paradigm shift in the conception of care among health professionals, and should result in structural care changes. Patient education has been promoted by the French Health system for 30 years, including in the 2009 HPST law and Cancer Plan 2014–2019. A patient education program was designed in our hospital for breast cancer patients. A multidisciplinary and transversal team of health professionals and resource patients was trained before grant application for funding of the program by the regional health care agency. Management of the project required that a functional unit be built for recording of all patient education related activities. A customized patient education program process was built under the leadership of a coordinator and several patient education project managers during bimonthly meetings, using an accurate timeline and a communication strategy to ensure full institutional support and team engagement. The grant was prepared in four months and the program started within the next four months with the aim to include 120 patients during year 1. The program includes a diagnosis of patient abilities and well-being resources, followed by collective and individual workshops undertaken in 4 months for each patient. Patient education is positively evaluated by all participants and may contribute to better health care management in the long term but the financial and human resources allocated to such programs currently underestimate the needs. Sustainability of patient education programs requires that specific tools and more commitment be developed to support health care professionals and to promote patient coping and empowerment in the long term.

The objective of this study was to evaluate the potential detection of circulating tumor cells (CTCs) using the CellSearch (CS) Assay™ in patients with locally advanced head and neck squamous cell carcinoma (HNSCC) and then to identify the clinical factors predictive of the presence of CTCs. The presence and number of CTCs were determined using the CS system before treatment, and in 10 healthy individuals (control group). The CS system was able to successfully identify the presence of CTCs in 8 of 49 patients (16 %) before therapy. No CTC was found in the control group. CTCs were detected before therapy in 1 of 19 patients (5 %) with N0 tumor and in 7 of 30 patients (23 %) with N1-2c tumor (p = 0.12; Fisher's exact test). CTCs were identified in a relatively low proportion of patients with locally advanced HNSCC.

5521 Background: We aimed to better characterize the expression of epidermal growth factor receptors family in Or and OC SCC and correlate it to hr HPV status and anatomoclinical features. Methods: In formalin fixed paraffin embedded tumor tissues, chromogenic in situ hybridization (CISH) was performed to detect hr HPV and immunohistochemistry to evaluate EGFR (positive score: 4 to 6), HER2 (0=negative, 1=positive) and P16 (positive score:≥70% labeled cells) expression. Baseline data were collected and analyze will be used. Results: Among 128 pts, 69 were tobacco users and 58 male. Median age at diagnosis was 61 y [23-95]. EGFR, Her2, P16 expression and hrHPV positivity were seen in 84 (65%), 12 (9%), 47 (37%) and 47 (37%) respectively. P16 signal was linked with absence of tobacco (31% vs. 72%, Pearson chi2 test: p<10-3), absence of alcohol (48% vs. 83%, p<10-3), Or site (53% vs. 76%, p=0.005), T1 (34% vs. 19%, p=0.06), N0 (52% vs. 23%, p=0.003), absence of nodal capsular rupture (85% vs. 68%, p=0.02), WHO grade 3 (37% vs. 68%, p=0.001), hr HPV detection (17% vs. 70%, p<10-3). Multivariate analysis confirmed the link between P16 expression and hr HPV CISH positivity (OR=0.05, CI 95% [0.01-0.21], p<10-3) , absence of tobacco (OR=9.2, CI 95% [2.1-40.7], p=0.03) and N0 (OR=0.2, CI 95% [0.04- 0.75], p=0.02). EGFR signal was linked with tobacco (31% vs 78%,p=10-3), alcohol (57% vs 81%, p=0.02), OC localization (77% vs 58%, p=0.03), well differentiated SCC (73% WHO grade 1-2 vs 56% grade 3, p=0.04), absence of hr HPV detection (74% vs 52%, p=0.01) and absence of P16 labeling (78% vs 44%, p<10-3). Multivariate analysis confirmed the link between EGFR positivity and tobacco (OR=0.32, CI 95% [0.1-0.9], p=0.03), alcohol (OR=9.5, CI 95% [1.2- 72.8], p=0.03) and OC localization (OR=0.3, CI 95% [0.1-1], p=0.05). HER2 signal was linked with alcohol (5% vs 18%, p=0.04), history of tobacco associated neoplasia (10% vs 0%, p=0.02), Or site (14% vs 2%, p=0.03) and who grade 3 (5% vs 14%, p=0.06). Her2 labeling was not associated with tobacco, sex, hr HPV detection, P16 positivity or EGFR one. Conclusions: Hr HPV associated SCC have a low expression of EGFR and are not associated with HER2 labeling.

e17503 Background: To evaluate the impact of early response after 40-46 Gy of RTCT on unresectable stage III NSCLC outcome.METHODS71 patients (pts), treated from 2004 to 2010, were included in this study. Pts received 2 cycles of induction chemotherapy (CT): cisplatin (P) and docetaxel (D) followed by concurrent RTCT: 66-70 Gy, 6 weekly cycles of PD. An early evaluation by CT-scan was planned at 40-46 Gy. Pts with complete and partial response (RECIST criteria) were considered as early responders (ER) while pts with stable or progressive disease were considered as non responders (NR). Median follow-up was 13 months [2.8 -72.2].RESULTS45/71 of pts (63%) were male, 12/71(17%) were > 70 years., 36/71(51%), 27/71(38%) had adenocarcinoma or squamous cell histology respectively, 69/71 (97%) had performans status 0 or 1, 45/71 (63%) and 25/71 (35%) were stage IIIB or IIIA respectively. 68/71 (96%) received the planned 2 induction cycles, 57/71 (80%) completed > 4 concurrent cycles and mean radiation dose received was 59 Gy [22-70]. 31% of pts were ER (22/71), all with partial response. N status at baseline was the only factor associated with ER: 19/45(42%) of pts staged N0-N2 were ER vs. 3/26 (11%) of N3, p=0.008. After the completion of RTCT, 68% of ER (15/22) experienced a complete response on tumor and mediastinal nodes vs. 18% (9/49) of NR, p<0.0001. Median disease free survival (DFS) was 30 months in the ER group vs. 7 months in the NR group, p<0.0001. Median overall survival (OS) was 12.5 months. Five year OS was 75% in the ER group vs. 19% in the NR group, p<0.0001. Independent variables for better OS in multivariate analysis were age ≤ 70y (HR=0.29 [%95CI: 0.11-0.78], p=0.014), and ER (HR=0.17 [%95CI:0.05-0.59], p=0.006).CONCLUSIONSER had a significant better DFS and OS than NR. Since the likelihood of complete response in NR is low, the benefit of the RTCT completion in these pts is questionable. Those results incite to compare in NR the completion of RTCT vs. second-line CT in a prospective trial.

Background The aim of this study was to evaluate the effects of a combination of folinic acid, 5-fluorouracil (5FU) and irinotecan (FOLFIRI 1) administered every 2 weeks in a population of elderly subjects with advanced colorectal cancer.Patients and methods Patients with metastatic colorectal cancer included in this study were aged at least 70 years, with a performance status of 0/1, without geriatric syndrome and without previous palliative chemotherapy. They received irinotecan [180 mg/m(2) intravenous (iv) infusion over 90 min] followed by folinic acid (400 mg/m(2) iv over 2 h), then 5FU (400 mg/m(2) iv bolus) and 5FU (2,400 mg/m(2) continuous iv infusion for 46 h) every 2 weeks.Results Forty eligible patients were included. The median age was 77.3 years (range 70-84.7). The objective response rate was 40% and the stabilisation rate was 45%. Median progression-free survival was 8 months, overall survival was 17.2 months and cancer-related specific survival was 20.2 months. In total, 300 cycles of chemotherapy were administered with a median number of eight cycles per patient (range 1-18). Tolerance was good; grade 3/4 toxicities included diarrhoea (15%), asthenia (15%), nausea/vomiting (7.5%) and neutropenia (7.5%). One toxic death was observed due to grade 4 diarrhoea.Conclusion The FOLFIRI 1 regimen is a valid therapeutic option for elderly patients in good clinical condition.

Background: Treatment of newly diagnosed DLBCL in patients aged 65 to 80 is based on 6 to 8 cycles of R-CHOP at 14 to 21 day intervals. Recent data suggest that for patients with an IPI of 0 or 1, a shorter treatment may be considered. Furthermore, early negative PET-CT results after chemotherapy are an important favourable prognostic factor.