Aims. - The head and neck tumors are most often associated with a precarious nutritional status. Radiotherapy increases the risk of denutrition because of its secondary effects on the secretory and sensorial mucous membranes. The purpose of our retrospectively study was to evaluate the interest of a precocious and regular nutritional therapy on the ability to maintain the nutritional status of the patient during the radiotherapy.Patients and methods. - The fifty-two patients included in the survey have been classified retrospectively in two different groups based on their observance to the nutritional therapy: group 1 "good observance", group 2 "bad observance".Results. - The 31 patients of group I have lost an average of 1.9 kg by the end of the irradiation, whereas the 21 patients of group 2 have lost an average of 6.1 kg (p < 0.001). The almost stability in weight of patients in group I was linked to a lower frequency of breaks in the radiotherapy (6 vs 33% p = 0.03) and in a decrease in grade of inflammatory mucous membranes (10% of grade 3 in group 1 vs 52% in group 2, p = 0.006). The quantity of calories ingested in form of nutritional supplements was greater in group 1 and consequently enabled patients to stabilized their weight (1200 calories in group 1 versus 850 calories in group 2, p < 0.005).Conclusions. - The given nutritional advice and the prescription of adapted nutritional supplements consequently allowed limiting efficiently the weight lost during the irradiation and the grade of mucositis. The systematization of a precocious nutritional therapy for patients irradiated for head and neck tumors seems absolutely essential. (C) 2007 Elsevier Masson SAS. Tons droits reserves.

The given nutritional advice and the prescription of adapted nutritional supplements consequently allowed limiting efficiently the weight lost during the irradiation and the grade of mucositis. The systematization of a precocious nutritional therapy for patients irradiated for head and neck tumors seems absolutely essential.

L’approche conformationnelle, radiothérapie conformationnelle tridimensionnelle ou avec modulation d’intensité, est basée sur l’utilisation des techniques d’imagerie médicale numérique, de logiciels de dosimétrie performants, d’accessoires de contention sophistiqués, et de procédures de vérification et d’assurance de qualité rigoureuses. Elle ouvre la voie à une meilleure adaptation au volume tumoral, à une limitation de l’exposition des organes sains, et, à terme, à une augmentation de la dose tumorale. Les voies aérodigestives supérieures représentent une localisation tumorale particulièrement attractive pour la radiothérapie conformationnelle. Du fait de la complexité des structures anatomiques (nasopharynx, ethmoïde) et/ou de la proximité de tissus très sensibles (les glandes parotides, les yeux, le tronc cérébral et la moelle épinière), l’irradiation des tumeurs des voies aérodigestives supérieures reste un défi pour le radiothérapeute. La radiothérapie conformationnelle, compte tenu de ses potentialités, devrait permettre d’améliorer le contrôle tumoral et/ou de diminuer la morbidité des techniques d’irradiation classiques dans cette localisation. Mais, en l’absence d’étude randomisée prospective, la supériorité des techniques conformationnelles par rapport aux techniques classiques est difficile à évaluer. Les travaux actuellement publiés consistent essentiellement en des études dosimétriques comparatives sur un nombre très restreint de patients. Cependant, des publications récentes rapportent l’expérience clinique de quelques centres pionniers avec un recul satisfaisant. Cet article reprend ces principales études qui comparent les techniques conventionnelles à la radiothérapie conformationnelle tridimensionnelle et à la radiothérapie avec modulation d’intensité afin d’évaluer, à la lumière des connaissances actuelles, l’intérêt de la radiothérapie conformationnelle dans l’irradiation des cancers des voies aérodigestives supérieures.

The conformal radiotherapy approach, three-dimensional conformal radiotherapy (3DCRT) or intensity-modulated radiotherapy (IMRT), is based on modern imaging modalities, efficient 3D treatment planning systems, sophisticated immobilization systems and rigorous quality assurance and treatment verification. The central objective of conformal radiotherapy is to ensure a high dose distribution tailored to the limits of the target volume while reducing exposure of normal tissues. These techniques would then allow further tumor dose escalation. Head-and-neck tumors are some of the most attractive localizations to test conformal radiotherapy. They combine ballistic difficulties due to particularly complex shapes (nasopharynx, ethmoid) and problems due to the number and low tolerance of neighbouring organs like parotids, eyes, brainstem and spinal cord. The therapeutic irradiation of head-and-neck tumors thus remains a challenge for the radiation oncologist. Conformal radiotherapy does have a significant potential for improving local control and reducing toxicity when compared to standard radiotherapy. However, in the absence of prospective randomized trials, it is somewhat difficult at present to evaluate the real benefits drawn from 3DCRT and IMRT. The published clinical reports on the use of conformal radiotherapy are essentially dealing with dosimetric comparisons on relatively small numbers of patients. Recently, a few publications have emphasized the clinical experience of several precursor teams with a suitable follow-up. This paper describes the current state-of-the-art of 3DCRT and IMRT in order to evaluate the impact of these techniques on head-and-neck cancers irradiation.

Currently head and neck squamous cell-carcinomas are staged clinically, though this is not ideal. We did a multivariate prospective study of 234 patients with head and neck squamous-cell carcinoma and showed that high serum concentrations of sIL-2Ralpha at diagnosis were highly correlated with a shorter survival (p<0.0001). In addition, patients who had low serum sIL-2Ralpha concentrations at diagnosis were less likely to develop distant metastasis during the 36 months follow up compared with the group with high serum sIL-2Ralpha concentrations (p<0.001). These findings suggest that serum sIL-2Ralpha could be considered as an independent serum biomarker in head and neck cancer patients.

Background. Squamous cell carcinomas of the base of the tongue often are diagnosed at advanced stages, in a context of undernutrition with a history of smoking and alcoholism. The local treatment of these tumours is based on external irradiation, either alone or combined with brachytherapy, followed by salvage surgery in the case of failure. Surgery was rarely performed as first-line treatment in our institution until 1992.Methods. From 1960 to 1992, 216 patients were treated, without prior selection, according to the same protocol comprising external irradiation and salvage surgery in the case of failure. The tumour classification (UICC 88) was as follows: 14% of T1, 26% of T2, 44% of T3; 16% of T4; the median age was 58 years; tumour regression was evaluated during and at the end of irradiation.Results. The locoregional control rates were 45% at 5 years, 37% at 10 years: 82% at 5 and 10 years for stage I, 65% and 54% for stage II, 51% and 45% for stage III, 35% and 32% for stage IV. Overall survival rates were 27% at 5 years and 14% at 10 years; 53% and 27% for stage I, 34% and 17% for stages II and III, 18% and 12% for stage IV. Causes of death were primarily local failures (58%), intercurrent disease (15%), metastases (10%), and second cancers (8%). Multivariate analysis demonstrated three predictive factors of locoregional control and survival: tumour regression at the end of irradiation (p= 0.0001), age (p = 0.04), and tumour stage (p = 0.06).Conclusion. The results of this retrospective series confirm the poor prognosis of tumours of the base of the tongue. Irradiation and surgery remain the standard treatments; possibilities of improvement are currently under evaluation, such as acceleration of irradiation, and concomitant radiochemotherapy combinations, which currently appear to be the most promising approaches. (C) 1999 John Wiley & Sons, Inc. Head Neck 21: 751-759, 1999.

For patients with early stages of laryngeal carcinomas, the local therapeutic modalities of surgery and/or radiation are the accepted standards of treatment. Recently, combined chemotherapy-radiotherapy and new fractionation schedules have received much attention as an alternative to surgery in patients with resectable locally advanced cancer of the larynx to preserve the larynx function. This article is intended to update the reader on the most recent articles written about the treatment of laryngeal carcinomas. The different points are: the results of conventional radiotherapy, the importance of parameters of radiotherapy (dose, fractionation, overall treatment time), new fractionation schedules, combined chemo-radiotherapy, randomized trial results.

For patients with early stages of laryngeal carcinomas, the local therapeutic modalities of surgery and/or radiation are the accepted standards of treatment. Recently, combined chemotherapy-radiotherapy and new fractionation schedules have received much attention as an alternative to surgery in patients with resectable locally advanced cancer of the larynx to preserve the larynx function. This article is intended to update the reader on the most recent articles written about the treatment of laryngeal carcinomas. The different points are: the results of conventional radiotherapy, the importance of parameter of radiotherapy (dose, fractionation, overall treatment time), new fractionation schedules, combined chemo-radiotherapy, randomized trial results.

An account of familial aggregation in breast/ovarian cancer has become possible with the identification of BRCA1 germ-line mutations. We evaluated, for 249 individuals registered with the Institut Curie in Paris, the prior probability that an individual carried a mutation that predisposes to these diseases. We chose 160 women for BRCA1 analysis: 103 with a family history of breast cancer and 57 with a family history of breast-ovarian cancer. To detect small mutations, we generated and analyzed 35 overlapping genomic PCR products that cover the coding portion of the gene, by using denaturing gradient gel electrophoresis. Thirty-eight truncating mutations (32 frameshifts, 4 nonsense mutations, and 2 splice variants) were observed in 15% of women with a family history of breast cancer only and in 40% of those with a history of breast-ovarian cancer. Twelve of 25 distinct truncating mutations identified were novel and unique. Most BRCA1 mutations that had been reported more than five times in the Breast Cancer Information Core were present in our series. One mutation (5149del4) observed in two apparently unrelated families most likely originates from a common ancestor. The position of truncating mutations did not significantly affect the ratio of the risk of breast cancer to that of ovarian cancer. In addition, 15 DNA variants (14 missense mutations and 1 neutral mutation) were identified, 9 of which were novel. Indirect evidence suggests that seven of these mutations are deleterious.

BACKGROUND The diagnosis and follow-up of head and neck carcinoma patients are based exclusively on clinical staging, which cannot always predict clinical outcome accurately. Because oral squamous cell carcinomas produce interleukin (IL)-6 and tumor necrosis factor (TNF)-α and express IL-2 receptors, the authors assessed the prognostic value of the serum levels of these markers. METHODS Serum levels of IL-6, TNF-α, soluble IL-2 receptors (s-IL-2-R), and acute phase proteins were measured at the time of diagnosis in a prospective study of 85 patients with primary squamous cell carcinoma of the head and neck. The influence of each clinical and laboratory parameter on locoregional control and survival was analyzed. RESULTS At presentation, a relationship was observed between advanced tumor (T) classification and high serum levels of CRP (P = 0.0015) and s-IL-2-R (P < 0.05). A high lymph node (N) classification was significantly associated with elevated serum IL-6 (P = 0.01) and CRP levels (P = 0.0002). In the univariate analysis, T classification, N classification, performance status, Prognostic Inflammatory and Nutritional Index, and serum s-IL-2-R level were significantly correlated with both locoregional control and survival. Multivariate analysis showed that the only significant prognostic factors related independently to locoregional control were N classification (P = 0.02) and serum s-IL-2-R level (P = 0.02). In a Cox multivariate analysis, serum s-IL-2-R level was found to be the most predictive factor of survival (P = 0.0001). CONCLUSIONS This study shows that serum s-IL-2-R level at the time of diagnosis represents a new independent prognostic variable for predicting the risk of locoregional recurrence and survival for patients with head and neck squamous cell carcinoma. Cancer 1997; 79:1401-8. © 1997 American Cancer Society.

Depuis les premières buccopharyngectomies transmaxillaires réalisées en France il y a plus de 40 ans, la chirurgie des carcinomes oropharyngés après radiothérapie a évolué. Elle est devenue plus fonctionnelle grâce à la fréquente conservation de la mandibule et aux techniques de reconstruction qui ont simultanément repoussé ses limites. De 1970 à 1990, 250 malades ont été opérés après irradiation exclusive, 163 pour intervention de rattrapage d'un échec ou d'une complication de la radiothérapie, 87 pour exérèse d'un second cancer oropharyngé survenu en zone irradiée. La mortalité postopératoire se maintient aux environs de 6 %. Les progrès techniques ont permis des exérèses plus larges et une extension des indications, sans augmentation du risque d'hémorragie carotidienne. Les taux de survie à 1, 3 et 5 ans sont respectivement de 55 %, 22 %, 16 % en cas de rattrapage et de 69 %, 36 % et 24 % en cas de second cancer. Les complications postopératoires et les échecs locaux et/ou ganglionnaires représentent 60 % des causes de décès. Ces résultats incitent à réserver la radiothérapie exclusive aux carcinomes oropharyngés ne comportant pas d'ulcération profonde.

Purpose: We report a retrospective series of 850 patients treated by external irradiation for carcino of the eyelid at Institut Curie and we compare our results with other techniques: brachytherapy and surgery.Methods and Materials: Eight hundred fifty patients were treated by external radiotherapy for carcinoma of the eyelid, None of these patients have been previously treated, All the patients were classified according to the TNM classification of (UTCC), We distinguished five histological types and five clinical groups according to the site of the skin tumor, Three modalities of external radiotherapy were used: contact therapy, conventional radiotherapy, and electrontherapy, We reviewed the clinical files of the 850 patients who went regularly at follow-up visits.Results: We report the 5-year survival results-alive with no evidence of disease: 72%; alive with progression: 2%; died from tumor progression: 0.5%; died from intercurrent disease: 19.5%; and lost to followup: 5%, The 5-year local control rate was 97.5%, We observed 45 failures-lymph node, metastatic, and local-and emphasize this last group by presenting the results of treatment of these local failures, We studied the complications of treatment: 2.3% of corneal complications, 2% of cataracts, and 1.4% of serious ocular complications.Conclusions: Our results concerning local failures and loss of the eye are comparable to those reported for other techniques involving brachytherapy or surgery. Overall, external radiotherapy is a safe and effective treatment, as it ensures a high local control rate and provides perfectly satisfactory functional and esthetic results, It seemed particularely useful to report this series in that few publications:are available on this subject that, nevertheless, constitutes a topical issue.

Over 40 years after the first commando procedures performed by M Dargent, surgical techniques such as mandibulotomy and myocutaneous flaps yield important changes in oropharyngeal surgery after definitive radiotherapy. Wide resections and simultaneous neck dissection are possible with good functional results. From 1970 to 1990, 250 patients with a carcinoma of the oropharynx were operated on after radiotherapy, 163 because of failure or complication of irradiation, 87 for a metachronous carcinoma occurred in an previously irradiated field. The postoperative mortality rate was 6%. The risk of carotid blow-up did not increase with the extension of the resection. Survival rates at 1, 3 and 5 years are 55%, 22%, 16% in salvage surgery and 69%, 36% and 24% in patients with metachronous cancer. Postoperative complications and failures in the primary and/or the neck account for 60% of causes of death. These results suggest that prior surgery of deeply ulcerative carcinoma of the oropharynx followed by radiotherapy is a better strategy than definitive radiotherapy with salvage surgery in reserve.

PURPOSETo evaluate the prognostic value of anemia in squamous cell carcinomas in the head and neck treated with curative radiation therapy alone.MATERIALS AND METHODSIn a prospective study, the hemoglobin level was measured prior to radiation therapy in 217 patients (188 [87%] men and 29 [13%] women) with cancer of the oral cavity (n = 61 [28%]), oropharynx (n = 53 [24%]), hypopharynx (n = 21 [10%]), and larynx (n = 82 [38%]). Anemia, defined as hemoglobin level below 13.5 g/dL in men and below 12.0 g/dL in women, was diagnosed in 58 (31%) of the men and five (17%) of the women. Median follow-up was 29 months (range, 2-63 months).RESULTSThe 2-year actuarial probability of local-regional control was 69% (95% confidence interval, 63%, 76%). Multivariate analysis showed the relative risk of failure of local-regional control to increase for stage T3 and T4 tumors (1.8 [95% confidence interval, 1.1, 3.1]), stage N3 nodes (3.6 [95% confidence interval, 1.8, 7.1]), weight loss (2.2 [95% confidence interval, 1.3, 4.0]), and anemia (1.6 [95% confidence interval, 1.0-2.7]). The relative risk of death increased for stage T3 and T4 tumors (2.5 [95% confidence interval, 1.4, 4.3]), N3 nodes (4.0 [95% confidence interval, 1.0, 7.9]), oral cavity tumors (2.0 [95% confidence interval, 1.2, 3.2]), male sex (4.1 [95% confidence interval, 1.3, 13.1]), weight loss (2.2 [95% confidence interval, 1.3, 3.7]), and anemia (1.7 [95% confidence interval, 1.03, 2.7]).CONCLUSIONModerate anemia appeared to be an independent prognostic factor in squamous cell carcinoma of the head and neck treated with radiation therapy alone.