Background: In Europe, induction chemotherapy (ICT) followed by radiotherapy is preferred to conventional chemoradiotherapy to avoid total laryngectomy in patients with laryngeal/hypopharyngeal cancer. In comparison with conventional radiotherapy, bioradiotherapy with cetuximab significantly improves locoregional control rates (LCRs) and overall survival (OS) without any increase in unmanageable toxicity. Methods: Patients included had untreated non-metastatic stage III-IV laryngeal/hypopharyngeal invasive squamous cell carcinoma. Good responders after three cycles of docetaxel-cisplatin-5-fluorouracil (TPF)-ICT (docetaxel and cisplatin, 75 mg/m(2) each on day 1, and 5-fluorouracil, 750 mg/m(-2)/day on days 1-5) every 3 weeks were randomised to receive radiotherapy (70 Gy) with concurrent cisplatin (100 mg/m(2)/day on days 1, 22 and 43 of radiotherapy) or cetuximab (400 mg/m(2) of loading dose, 250 mg/m(2)/week during radiotherapy). The primary end-point was larynx preservation. The secondary end-points were laryngo-oesophageal dysfunction-free survival (LEDFS), LCR and OS. Results A total of 153 patients were enrolled. Among 126 TPF-ICT responders, 116 were randomised to receive either cisplatin (n = 60) or cetuximab (n = 56). The median follow-up was 77.5 months. Five-year OS rates were 66.6% (95% confidence interval [CI]: 0.54-0.79) versus 66.9% (95% CI: 0.54-0.79) (p = 0.9), respectively. Five-year LCRs were 79.8% (95% CI: 69.5-90.0) versus 67.8% (95% CI: 55.1-80.5%) (p = 0.18). Five-year LEDFS was 62.2% (95% CI: 49.7-74.8%) versus 56.2% (95% CI: 43.0-69.4) (p = 0.38). Late grade III/IV salivary gland and laryngeal toxicity occurred in 10.3% versus 9.8% and 6.8% versus 11.8% of patients receiving cisplatin-radiotherapy versus cetuximab, respectively. Conclusions No significant difference in LEDFS was observed between the two arms. TPF-ICT followed by conventional chemoradiotherapy or cetuximab was feasible, and long-term toxicity was not statistically different between the two arms. LEDFS appears as a relevant end-point. (C) 2020 Elsevier Ltd. All rights reserved.

BACKGROUND:Reverse shoulder arthroplasty (RSA) is a reliable, long-term treatment option for degenerative shoulder pathology. However, the functional outcomes degrade around the fifth year postoperation, particularly for internal and external rotation. Long-term radiographic changes have been reported around the humeral stem, depending on the fixation method.OBJECTIVES:The primary objective was to compare the clinical outcomes of RSAs by fixation method-cemented vs. press-fit-after a minimum follow-up of 5 years. We hypothesized that proximal humeral osteolysis impacts the functional outcomes.DESIGN AND METHODS:Our study compared 2 matched cohorts: 56 RSAs with cemented stems and 56 RSAs with press-fit stems. We evaluated all the patients using the Constant-Murley score (CMS) and range of motion (ROM), which we measured preoperatively and at the final follow-up visit. We evaluated radiographs from the final follow-up visit to look for proximal humeral osteolysis with tuberosity resorption, signs of stress shielding, periprosthetic radiolucent lines, and scapular notching.RESULTS:At a mean follow-up of 9.5 years (5-21), regardless of the fixation method, the RSA procedure helped to improve the CMS and active joint ROM postoperatively, except for internal and external rotation with elbow at side in the press-fit group. Shoulder ROM was significantly better in the group with cemented stems for anterior elevation (P < .001), abduction (P = .006), and external (P = .02) and internal rotation with elbow at side (P = .02). The CMS did not differ between groups. The presence of tuberosity resorption or scapular notching had no effect on the CMS and active ROM in either group. Osteopenia, which was more prevalent in the press-fit group, had no impact on the functional outcome.CONCLUSION:There was no significant difference between groups in the CMS, although the active shoulder ROM was significantly worse in the press-fit group. This difference could be attributed to more frequent tuberosity resorption in this group.

OBJECTIVE:Our objective was to report our experience and to evaluate the feasibility and toxicity of focal salvage stereotactic body radiation therapy (SBRT) in patients with post-radiation local recurrence of prostate cancer. METHODS:We retrospectively reviewed medical records of patients treated with Cyberknife ® between October 2014 and April 2017 at our institution for a focal reirradiation delivered to the prostate/prostatic bed for local recurrence after radical or adjuvant radiotherapy. All patients underwent prostate biopsies at recurrence at the time of fiducial markers placement, had choline PET/CT and pelvic MRI. The treatment consisted in 36 Gy in six fractions delivered every other day. Post reirradiation toxicities were assessed according to the CTCAE v4 (Common Terminology Criteria for Adverse Events). RESULTS:42 patients were treated with followed with a median follow-up of 21 months (range 3 - 31). 34 patients had biopsy proven recurrence. The initial treatment was radical prostatectomy and radiation therapy for 9 patients and radiation therapy alone for 33 patients. 23 patients from the group of prostate reirradiation had placement of rectal spacers. No Grade 4 or 5 toxicity were observed. 27 acute urinary events were recorded: 18 patients experienced Grade 1, 9 patients experienced Grade 2 toxicity and 1 patient experienced Grade 3 urinary toxicity, namely cystitis and/or dysuria. No Grade 2 or more digestive toxicity was observed. Rectal doses were significantly lower with rectal spacers. CONCLUSION:Salvage focal Cyberknife ® seems feasible and show promising results. ADVANCES IN KNOWLEDGE:SBRT for local prostate cancer recurrence after initial radiotherapy is well tolerated with short follow-up.

Introduction: Referral Centers for Bone and Joint Infection (BJI) were set up to optimize BJI management thanks to multidisciplinary teamwork. The main aim of the present study was to assess the impact of setting up the Western France Bone and Joint Infection Referral Center on arthroscopic treatment of septic arthritis of the shoulder and knee. The secondary aim was to identify other risk factors for failure of this treatment. The null hypothesis was that there was no difference between the "success group" and the "failure group". Material and methods: This single-center retrospective study included 52 patients treated for septic arthritis between January 1, 2000 and December 31, 2013 by arthroscopic joint lavage associated to at least 4 weeks' antibiotic therapy. Exclusion criteria comprised: retrospective diagnosis of rheumatoid arthritis after negative bacteriological analysis, early cessation of antibiotic treatment, and follow-up less than 4 weeks. Failure was defined as non-healing after first-line treatment. The primary endpoint was date of treatment compared to the launch date of the Center in the first quarter of 2010. The influence of pre- and intraoperative criteria related to patient, treatment and microorganism was assessed. Results: At follow-up, 17 patients (32.9%) showed failure of first-line treatment and 5 (9.6%) were non-healed at end of treatment, whatever the re-intervention. The failure rate significantly decreased after setting up the Center, from 42.9% to 11.8% (p = 0.03). In the failure group, 70.6% of patients showed immunosuppression, versus 37.2% in the success group (p = 0.01). Neither time to surgery (p = 1), type of microorganism, or performance of antiseptic lavage (p = 0.25) or synovectomy (p = 0.62) influenced outcome. Conclusion: Multidisciplinary management of septic arthritis improved treatment success. (c) 2018 Elsevier Masson SAS. All rights reserved.

La création des centres de référence pour les infections ostéoarticulaires (CRIOA) a eu pour but d’optimiser la prise en charge de ce type d’infection, grâce à une concertation multidisciplinaire. L’objectif de cette étude était d’étudier l’influence de la mise en place du Centre de référence des infections ostéoarticulaires du Grand Ouest (CRIOGO) sur le traitement arthroscopique des arthrites septiques (AS) de l’épaule et du genou. L’objectif secondaire était d’identifier d’autres facteurs d’échec de ce traitement. L’hypothèse H0 était l’absence de différence entre le groupe « succès » et le groupe « échec ». Cette étude rétrospective monocentrique a inclus 52 patients traités pour une AS entre le 01/01/2000 et le 31/12/2013 par lavage arthroscopique associé à une antibiothérapie d’au moins 4 semaines. Les critères d’exclusion étaient un diagnostic rétrospectif d’arthrite rhumatismale après analyse bactériologique négative, un arrêt précoce du traitement antibiotique et un suivi inférieur à 4 semaines. L’échec était défini comme l’absence de guérison après traitement de première intention. Le critère de jugement principal était la date de la prise en charge par rapport à la date de mise en place du CRIOGO au premier trimestre 2010. L’influence de critères pré- et peropératoires, inhérents au patient, au traitement réalisé et au germe identifié a été recherchée. À la révision, 17 (32,9 %) patients étaient en échec de traitement de première intention et 5 (9,6 %) n’étaient pas guéris en fin de traitement, quel que soit le type de reprise. Le taux d’échec diminuait significativement après la mise en place du CRIOGO : 42,9 % avant contre 11,8 % après (p = 0,03). Dans le groupe échec, 70,6 % des patients étaient immunodéprimés contre 37,2 % dans le groupe succès (p = 0,01). Ni le délai de prise en charge (p = 1), ni le type de germe, ni un lavage antiseptique (p = 0,25) ou une synovectomie (p = 0,62) n’influençaient le résultat du traitement. La prise en charge multidisciplinaire des AS permet d’améliorer le succès thérapeutique. III, étude rétrospective comparative.

6034 Background: Most head and neck cancer (HNC) patients die of locoregional progression. Surgery is feasible in less than half the patients only and chemotherapy only offers palliation. Locoregional reirradiation of recurrent HNC or second HNC primary may achieve long-term disease control in some patients, at the expense of high rates of late sequelae. We evaluated the feasibility and tolerance of slightly accelerated hyperfractionated reirradiation and cetuximab in recurrent inoperable/unresectable HNC in a prospective GORTEC phase II study. Methods: Patients from 13 GORTEC centers underwent twice-daily reirradiation (1.2 Gy / fraction, 5 days a week, over 5.5 weeks) to 66 Gy. Weekly cetuximab was delivered as 400mg/m2 load dose one week before reirradiation and 250mg/m2 thereafter for 6 weeks. Results: From October 2010 to October 2014, 48 patients with recurrent inoperable/unresectable HNC were enrolled. Of those, 71% were in the oropharynx. Median age was 61 years (range 40-75). The median delay between the first and second irradiation was 5 years (0.5-35) years. Median tumor size was 3.5 cm (range 1.3-7.0). Acute grade 3-4 toxicities were dermatitis (15%), mucositis (49%) and dysphagia (24%). Anaphylaxis with cetuximab was observed in one patient (2%). Radiotherapy was completed in 90 %. The full cetuximab course was completed in 79%. Complete response was observed in 40% of the patients. Objective response was 53%. Median follow-up for living patients was 24 months. In 28 evaluable patients, there were 7, 1, 4 and 2 patients with late grade 3 dermatitis/fibrosis, osteoradionecrosis, xerostomia or dysphagia. There was two grade 4 toxicities, mucositis and laryngeal. There was one late grade 5 toxicity carotid blowout. Median survival was 9 months and two-year overall survival rate was 22%. Tumor size at recurrence was identified as a prognostic factor for survival with a median survival time of 11.9 months ( < 35 mm) vs 7.4 months (≥35 mm). Conclusions: High dose twice-daily HNC reirradiation with cetuximab is feasible in this population. Median survival was similar to those observed in previous studies, with 22% of long survivors, especially in patients with tumor diameter < 35 mm. Clinical trial information: A91168-41.

Purpose Both concurrent chemoradiotherapy (CT-RT) and cetuximab radiotherapy (cetux-RT) have been established as the standard of care for the treatment of locally advanced squamous cell carcinoma of the head and neck. It was not known whether the addition of induction chemotherapy before cetux-RT could improve outcomes compared with standard of care CT-RT. Patients and Methods The current trial was restricted to patients with nonmetastatic N2b, N2c, or N3 squamous cell carcinoma of the head and neck and fit for taxotere, cisplatin, fluorouracil (TPF). Patients were randomly assigned to receive three cycles of TPF followed by cetux-RT versus concurrent carboplatin fluorouracil and RT as recommended in National Comprehensive Cancer Network guidelines. The trial was powered to detect a hazard ratio (HR) of 0.66 in favor of TPF plus cetux-RT for progression-free survival at 2 years. The inclusion of 180 patients per arm was needed to achieve 80% power at a two-sided significance level of .05. Results Between 2009 and 2013, 370 patients were included. All patients and tumors characteristics were well balanced between arms. There were more cases of grade 3 and 4 neutropenia in the induction arm, and the induction TPF was associated with 6.6% treatment-related deaths. With a median follow-up of 2.8 years, 2-year progression-free survival was not different between both arms (CT-RT, 0.38 v TPF + cetux-RT, 0.36; HR, 0.93 [95% CI, 0.73 to 1.20]; P = .58). HR was 0.98 (95% CI, 0.74 to 1.3; P = .90) for locoregional control and 1.12 (95% CI, 0.86 to 1.46; P = .39) for overall survival. These effects were observed regardless of p16 status. The rate of distant metastases was lower in the TPF arm (HR, 0.54 [95% CI, 0.30 to 0.99]; P = .05). Conclusion Induction TPF followed by cetux-RT did not improve outcomes compared with CT-RT in a population of patients with advanced cervical lymphadenopathy.

Background: Despite the increasing numbers of reverse total shoulder arthroplasty (RTSA) procedures, the long-term results have been rarely reported. We previously reported early outcomes of a cohort of patients treated with a Grammont-style RTSA. The purpose of this study was to evaluate the outcomes after a minimum of 10 years, and to document prosthetic survival and complications. Methods: Clinical outcome assessment was based on the absolute and relative Constant scores and the active range of motion. Radiographic evaluations of scapular notching, tuberosity osteolysis, and periprosthetic radiolucent lines were done as well. Complications and revisions were compiled, and a Kaplan-Meier survival analysis was performed. Results: The original report included the outcomes for 186 patients (191 RTSAs) who had been followed for a mean of 40 months. In the present study, in which the mean duration of follow-up was 150 months, follow-up clinical evaluations were available for 84 patients (87 prostheses) and radiographic assessments were available for 64 patients (67 prostheses). Seventy-seven patients (79 prostheses) had died before the 10-year follow-up, and 17 patients (17 prostheses) had been lost to follow-up. The mean absolute and relative Constant scores (and standard deviations) were 55 ± 16 points and 86 ± 26 points, respectively, with both having decreased significantly compared with the scores at the medium-term follow-up evaluation (at a minimum of 2 years) (p < 0.001 and p = 0.025, respectively). Forty-nine shoulders (73%) exhibited scapular notching. Forty-seven complications (29%) were recorded, with 10 cases (10%) occurring after 2 years. Sixteen (12%) of the original patients underwent revision surgery. The 10-year overall prosthetic survival rate using revision as the end point was 93%. Conclusions: Despite a high arthroplasty survival rate and good long-term clinical results, RTSA outcomes showed deterioration when compared with medium-term results. The cause of this decrease is probably related to patient aging coupled with bone erosion and/or deltoid impairment over time. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

6070 Background: TPF is a reference induction chemotherapy regimen in non-operated locally advanced (LA) HNSCC. GORTEC 2007-02 phase III randomized trial was restricted to HNSCC patients with large nodal spread (N2b-N3). Results showed no benefit of 3 cycles of induction TPF followed by cetuximab-radiotherapy (RT), as compared to concurrent chemoradiotherapy (CRT) (Geoffrois et al ASCO 2016). Methods: Patients were randomized to receive concurrent CRT (arm A) or induction TPF followed by cetuximab-RT (arm B). RT was 70 Gy/35F/7 weeks. Concurrent chemotherapy was 3 cycles of carboplatin-5FU as previously described (Calais JNCI 1999). About 2/3 of patients had oropharyngeal cancers (OPC) and HPV status was determined in these patients using p16 expression as a surrogate (immunohistochemistry). Smoking status was also collected. Primary endpoint was progression free survival (PFS). Results: Between May 2009 and Aug 2013, 360 eligible patients were randomized including 231 (64%) OPC. Overall, p16 expression could be assessed in 172 / 231 OPC patients (74%) with 84 in arm A and 88 in arm B. 26 patients were found p16+ in arm A (31%) and 19 in arm B (22%). Only 8 out 45 (18%) p16+ patients were non-smokers showing that the large majority of OPC patients randomized were p16- (127/172) and smokers (117/129). A significant improvement in PFS was found in p16+ compared to p16- OPC (p < 0.0001). The absence of benefit in PFS associated with TPF + cetux-RT compared with CRT was suggested both in p16+ (HR: 0.78, 95% CI: 0.28 – 2.20) and in p16- OPC (HR: 1.28, 95% CI: 0.84 – 1.93), and the interaction between p16 and treatment modality was not significant (p = 0.35). A significant benefit was observed in favor of arm B regarding distant metastasis, but this effect was not different between the p16+ and p16- OPC, while there was no benefit of TPF + cetux-RT compared with CRT for loco-regional control, regardless of p16 status. Conclusions: The OPC p16 subpopulations were small. No benefit of induction TPF chemotherapy followed by cetuximab-RT compared with CRT in OPC patients regardless of p16 status. Clinical trial information: NCT01233843.

Background: Despite the increasing numbers of reverse total shoulder arthroplasty (RTSA) procedures, the long-term results have been rarely reported. We previously reported early outcomes of a cohort of patients treated with a Grammont-style RTSA. The purpose of this study was to evaluate the outcomes after a minimum of 10 years, and to document prosthetic survival and complications. Methods: Clinical outcome assessment was based on the absolute and relative Constant scores and the active range of motion. Radiographic evaluations of scapular notching, tuberosity osteolysis, and periprosthetic radiolucent lines were done as well. Complications and revisions were compiled, and a Kaplan-Meier survival analysis was performed. Results: The original report included the outcomes for 186 patients (191 RTSAs) who had been followed for a mean of 40 months. In the present study, in which the mean duration of follow-up was 150 months, follow-up clinical evaluations were available for 84 patients (87 prostheses) and radiographic assessments were available for 64 patients (67 prostheses). Seventy-seven patients (79 prostheses) had died before the 10-year follow-up, and 17 patients (17 prostheses) had been lost to follow-up. The mean absolute and relative Constant scores (and standard deviations) were 55 ± 16 points and 86 ± 26 points, respectively, with both having decreased significantly compared with the scores at the medium-term follow-up evaluation (at a minimum of 2 years) (p < 0.001 and p = 0.025, respectively). Forty-nine shoulders (73%) exhibited scapular notching. Forty-seven complications (29%) were recorded, with 10 cases (10%) occurring after 2 years. Sixteen (12%) of the original patients underwent revision surgery. The 10-year overall prosthetic survival rate using revision as the end point was 93%. Conclusions: Despite a high arthroplasty survival rate and good long-term clinical results, RTSA outcomes showed deterioration when compared with medium-term results. The cause of this decrease is probably related to patient aging coupled with bone erosion and/or deltoid impairment over time. Level of Evidence: Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence.

BACKGROUND:The purpose of GORTEC 2000-01 was to compare the long-term efficacy and safety of induction chemotherapy with cisplatin (P) and 5-fluorouracil (F) with or without docetaxel (T) for larynx preservation.METHODS:Operable patients with untreated stage III or IV larynx or hypopharynx invasive squamous cell carcinoma who required total laryngectomy were randomly assigned to three cycles of induction chemotherapy with either TPF or PF, followed by radiation therapy for responders. The primary endpoint was three-year larynx preservation rate. Secondary endpoints included larynx dysfunction-free survival (LDFFS), overall survival (OS), disease-free survival (DFS), loco-regional control rate (LCR), cause of death, and later toxicity rates. Survival and other data were analyzed by Kaplan-Meier methods. All statistical tests were two-sided.RESULTS:Two hundred thirteen patients were treated with median follow-up of 105 months. The five- and 10-year larynx preservation rates were 74.0% (95% CI = 0.64 to 0.82) vs 58.1% (95% CI = 0.47 to 0.68) and 70.3% (95% CI = 0.58 to 0.8) vs 46.5% (95% CI = 0.31 to 0.63, P = .01) in the TPF vs PF arm, respectively. The five- and 10-year LDFFS rates were 67.2% (95% CI = 0.57 to 0.76) vs 46.5% (95% CI = 0.36 to 0.57) and 63.7% (95% CI = 0.52 to 0.74) vs 37.2% (95% CI = 0.24 to 0.52, P = .001), respectively. OS, DFS, and LCR were not statistically improved in the TPF vs the PF arm. Statistically fewer grade 3-4 late toxicities of the larynx occurred with the TPF regimen compared with the PF arm (9.3% vs 17.1%, G-test, P = .038).CONCLUSION:Long-term follow-up confirms that induction chemotherapy with TPF increased larynx preservation and larynx dysfunction-free survival. In this larynx preservation approach using induction chemotherapy, TPF should be recommended, followed by radiation therapy.

6000 Background: Both CT/RT, and cetux-RT have been established as standard treatments in non-operated locally advanced SCCHN. Taxotere-Platinum-5FU (TPF) is a reference induction regimen in this type of cancer and it is not known whether the addition of induction TPF followed by cetux-RT could improve the outcome of patients with locally advanced SCCHN, as compared to standard CT/RT. Methods: GORTEC 2007-02 trial was restricted to patients (pts) with palpable cervical nodes (N2b/c-N3) and was run in parallel with GORTEC 2007-01 randomized trial testing the addition of concurrent chemotherapy (CT) to cetux-RT in pts with N0-N2a disease. Selection criteria were pts fit for receiving CT with non-metastatic, non-operated stage III-IV SCC of oral cavity, oro/hypopharynx and larynx, regardless of HPV status. Pts were randomized to receive concurrent CT/RT (arm A) or induction TPF plus cetux-RT (arm B). RT was 70 Gy (2 Gy per day, 5 days per week). Concurrent CT was: 3 cycles of carboplatin 70mg/m²/d + 5FU 600mg/m²/d D1-4 (Calais JNCI 1999). Primary end point was progression free survival (PFS). To detect a hazard ratio of 0.66, inclusion of 370 pts was required to achieve 80% power at 2-sided significance level of 0.05. Results: Between 2009 and 2013, 370 pts were randomized. The median follow-up was 31.2 months. There is no difference in PFS, median 11.5 m (arm A) vs 12.5 m (arm B); HR = 0.95, [95%CI 0.72-1.27; p = 0.74]. At the analysis time, 103 deaths were observed in arm A and 107 in arm B. There is no difference in median OS, 24.6 m vs 22.8 m; HR = 1.10; [95%CI 0.84-1.45; p = 0.48]. At 24 months, loco-regional control was 46.6% vs 43.3; HR = 0.97; [95%CI 0.73-1.30; p = 0.85] and distant free metastasis 86.4% vs 92.9% HR = 0.50; [95%CI 0.22-1.11; p = 0.081]. Grade 3-4 neutropenia occurred in 25.8% of pts in arm B vs none in arm A. Conclusions: GORTEC 2007-02 failed to demonstrate any superiority of induction TPF followed by cetux-RT vs CT/RT in this category of very poor prognosis locally advanced SCCHN. CT/RT remains the standard of care in this population. Clinical trial information: NCT01233843.

6002 Background: To compare the long-term efficacy and safety of induction chemotherapy with cisplatin (P) and 5-fluorouracil (F) with or without docetaxel (T) for larynx preservation. Methods: Operable patients with untreated stage-III or -IV larynx or hypopharynx invasive squamous-cell carcinoma and who required a total laryngectomy were randomly assigned to receive three cycles of induction chemotherapy with either TPF or PF, followed by radiation therapy for responders. The primary endpoint was 3-year larynx-preservation rate. Secondary endpoints included larynx dysfunction-free survival (LDFFS), overall survival, disease-free survival, locoregional control rate, cause of death, and later toxicity rates. Results: Two hundred and thirteen patients were treated with a median follow-up for surviving patients of 105 months. The 5- and 10-year larynx preservation rates were, 74.0% (95%CI, 0.64–0.82) vs. 58.1% (95%CI, 0.47–0.68) and 70.3% (95%CI, 0.58–0.8) vs. 46.5% (95%CI, 0.31–0.63, p = 0.01) in TPF versus PF arm, respectively. The 5- and 10-year LDFFS rates were 67.2% (95%CI, 0.57–0.76) vs. 46.5% (95%CI, 0.36–0.57) and 63.7% (95%CI, 0.52–0.74) vs. 37.2% (95%CI, 0.24–0.52, p = 0.001), respectively. Overall survival, disease-free survival, and locoregional control rates were not statistically improved in the TPF vs. the PF arm. Significantly fewer grade 3–4 late toxicities of the larynx occurred with the TPF regimen compared to the PF arm (9.3% vs. 17.1%, g-test, p = 0.038). Conclusions: Long-term follow-up confirms that induction chemotherapy with TPF increased larynx-preservation and larynx dysfunction-free survival. In this larynx preservation approach using induction chemotherapy, TPF should be recommended, followed by radiation therapy. Clinical trial information: NCT00169182.

Background: Scapular notching is a common observation during radiological follow-up of reverse shoulder arthroplasty. The purpose of this study was to evaluate the effect of glenosphere design and humeral component retroversion on movement amplitude in the scapular plane and inferior scapular impingement.Materials and methods: The Aequalis Reversed Shoulder Prosthesis (Tornier) was implanted into 40 cadaver shoulders. On the glenoid side, 8 different combinations were tested:36-mm glenosphere: centered (standard), eccentric, with an inferior tilt, or with the center of rotation (COR) lateralized by 5 or 7 mm; and42-mm centered glenosphere: used alone or with the COR lateralized by 7 or 10 mm.The humeral component was positioned in 0 degrees, 10 degrees, 20 degrees, 30 degrees, and 40 degrees of retroversion. Maximum adduction and abduction were measured when inferior impingement and superior impingement, respectively, were detected.Results: The average increase in abduction amplitude was 10 degrees and inferior impingement occurred 18 degrees later with a 42-mm glenosphere, especially when it was lateralized by 10mm, relative to a 36-mm centered glenosphere (P<.05). These 2 combinations provided a 28 degrees increase in the movement amplitude in the scapular plane. Positioning of the humeral component in 10 degrees or 20 degrees of retroversion or in anatomical retroversion was most effective at avoiding inferior impingement but had less effect on abduction range of motion (except with the 42-mm glenosphere).Conclusion: Our study confirmed published results with various glenosphere designs but was unique in describing the effect of humeral retroversion on scapular impingement. Inferior scapular notching can be most effectively prevented by using large-diameter glenospheres with lateralized COR and by making sure to replicate the patient's native humeral retroversion. (C) 2014 Journal of Shoulder and Elbow Surgery Board of Trustees.

La survenue de l'encoche du pilier de la scapula demeure la complication radiographique la plus importante lors du suivi évolutif des prothèses d'épaule inversées. Plusieurs recommandations techniques d'implantation et modifications du dessin de l'implant glénoïdien ont été proposées dans la littérature. L'analyse morphologique de la scapula à la recherche d'une anatomie prédisposante du conflit inférieur n'a cependant jamais été rapportée. Une forme particulière du pilier de la scapula favoriserait la survenue de l'encoche. Quarante scapulae cadavériques ont été implantées d'une prothèse d'épaule inversée Aequalis Reversedy (Torniery Inc., Edina, MN, États-Unis). Les amplitudes maximales de mouvements en adduction, rotations interne et externe ont été mesurées. Les pièces anatomiques ont ensuite fait l'objet d'une acquisition tomodensitométrique bidimensionnelle. L'angle du col de la scapula, la surface sous le pilier de la scapula et la distance entre le plot central de l'implant glénoïdien et le rebord glénoïdien inférieur ont été mesurés. Les relations entre ces paramètres et les mobilités relevées ont été évaluées par des tests statistiques d'indépendance. Les amplitudes maximales de mouvements ont été retrouvées lorsque la surface sous la scapula était supérieure à 0,8 cm2 (p < 0,5). Les amplitudes étaient encore meilleures si un angle du col de la scapula inférieur à 105° était associé (p < 0,5). L'angle du col de la scapula n'est pas suffisant à lui seul pour identifier une morphologie prédisposante à l'encoche. La surface sous le pilier de la scapula apparaît en revanche discriminante. Elle est influencée par l'offset glénoïdien inférieur. Il n'a pas été possible d'identifier précisément une anatomie scapulaire favorable à la survenue de l'encoche. Sa prévention doit reposer essentiellement sur des critères techniques rigoureux d'implantation glénoïdienne, tels que l'offset inférieur.

Purpose To compare the efficacy and safety of induction chemotherapy (ICT) followed by chemoradiotherapy (CRT) or bioradiotherapy (BRT) for larynx preservation (LP). Patients and Methods Previously untreated patients with stage III to IV larynx/hypopharynx squamous cell carcinoma received three cycles of ICT—docetaxel and cisplatin 75 mg/m2 each on day 1 and fluorouracil 750 mg/m2 per day on days 1 through 5. Poor responders (< 50% response) underwent salvage surgery. Responders (≥ 50% response) were randomly assigned to conventional radiotherapy (RT; 70 Gy) with concurrent cisplatin 100 mg/m2 per day on days 1, 22, and 43 of RT (arm A) or concurrent cetuximab 400 mg/m2 loading dose and 250 mg/m2 per week during RT (arm B). Primary end point was LP at 3 months. Secondary end points were larynx function preservation (LFP) and overall survival (OS) at 18 months. Results Of the 153 enrolled patients, 116 were randomly assigned after ICT (60, arm A; 56, arm B). Overall toxicity of both CRT and BRT was substantial following ICT. However, treatment compliance was higher in the BRT arm. In an intent-to-treat analysis, there was no significant difference in LP at 3 months between arms A and B (95% and 93%, respectively), LFP (87% and 82%, respectively), and OS at 18 months (92% and 89%, respectively). There were fewer local treatment failures in arm A than in arm B; salvage surgery was feasible in arm B only. Conclusion There is no evidence that one treatment was superior to the other or could improve the outcome reported with ICT followed by RT alone (French Groupe Oncologie Radiothérapie Tête et Cou [GORTEC] 2000-01 trial [Induction CT by Cisplatin, 5FU With or Without Docetaxel in Patients With T3 and T4 Larynx and Hypopharynx Carcinoma]). The protocol that can best compare with RT alone after ICT is still to be determined.

Introduction. This study aimed to assess the impact of late treatment toxicity (especially radiotherapy toxicity), chemoradiotherapy treatment type (concurrent or sequential), depression and anxiety on overall, physical and emotional quality of life (QoL) in long-term breast cancer survivors. Method. We assessed 117 patients (mean follow-up since the end of treatment = 8.1 years) for late radiotherapy toxicity (LENT-SOMA scale), patient and doctor ratings of breast cosmetic outcomes, QoL (EORTC QLQ-C30), depression and anxiety (Hospital and Anxiety Depression scale). Results. In univariate analyses, factors associated with significantly decreased QoL were: use of sequential treatment and decreased overall QoL (P = 0.002) and emotional QoL (P = 0.02); few radiotherapy late toxicity symptoms (pain and decreased physical QoL, P = 0.01; fibrosis and decreased emotional QoL, P = 0.04); probable depression or probable anxiety and decreased overall, physical and emotional QoL (P <= 0.005). In multivariate analyses, probable depression and probable anxiety were the most stronger predictors for decreased QoL in the overall, physical and emotional domains (P <= 0.02). Conclusion. Improving screening for and treatment of depression and anxiety might improve QoL in long-term breast cancer survivors.

Ce travail avait pour but d’évaluer l’impact des séquelles tardives de la radiothérapie, du type de traitement radiochimiothérapeutique (concomitant ou séquentiel), de la dépression et de l’anxiété sur la qualité de vie (QV) globale, physique et émotionnelle des survivantes à long terme d’un cancer du sein. Nous avons évalué, chez 117 patientes (durée moyenne de suivi = 8,1 ans), la toxicité tardive de la radiothérapie (échelle LENT-SOMA), l’évaluation du résultat esthétique (par le médecin et la patiente), la QV (EORTC QLQ-C30) et la dépression et l’anxiété (échelle HAD). En analyse univariée, plusieurs facteurs étaient associés à une altération significative de QV: radiochimiothérapie séquentielle et moindre QV globale (p = 0,002) et émotionnelle(p = 0,02); trouble dépressif ou anxieux et moindre QV globale, physique et émotionnelle (p ≤ 0,005); certaines complications tardives de la radiothérapie (douleurs et moindre QV physique, p = 0,01; fibrose et moindre QV émotionnelle, p = 0,04). En analyse multivariée, l’existence d’un trouble anxieux ou dépressif étaient les prédicteurs les plus forts d’altération des trois dimensions de QV (p ≤ 0,02). Un meilleur dépistage de la dépression et de l’anxiété pourrait permettre une amélioration de la QV chez les patientes survivantes à long terme d’un cancer du sein. This study aimed to assess the impact of late treatment toxicity (especially radiotherapy toxicity), chemoradiotherapy treatment type (concurrent or sequential), depression and anxiety on overall, physical and emotional quality of life (QoL) in long-term breast cancer survivors. We assessed 117 patients (mean follow-up since the end of treatment = 8.1 years) for late radiotherapy toxicity (LENT-SOMA scale), patient and doctor ratings of breast cosmetic outcomes, QoL (EORTC QLQ-C30), depression and anxiety (Hospital and Anxiety Depression scale). In univariate analyses, factors associated with significantly decreased QoL were: use of sequential treatment and decreased overall QoL (P = 0.002) and emotional QoL (P = 0.02); few radiotherapy late toxicity symptoms (pain and decreased physical QoL, P = 0.01; fibrosis and decreased emotional QoL, P = 0.04); probable depression or probable anxiety and decreased overall, physical and emotional QoL (P ≤ 0.005). In multivariate analyses, probable depression and probable anxiety were the most stronger predictors for decreased QoL in the overall, physical and emotional domains (P ≤ 0.02). Improving screening for and treatment of depression and anxiety might improve QoL in long-term breast cancer survivors.

Objective: Although depression is prevalent in long-term breast cancer survivors (LTBCS; >= 5 years since diagnosis), it is underdiagnosed and undertreated. A better understanding of factors associated with depression could improve depression screening, treatment, and prevention in this population. Our study aimed to assess the link between patient and doctor ratings of breast cosmetic outcomes, late radiotherapy toxicity, and depression in LTBCS.Methods: In all, 214 patients recruited from the ARCOSEIN study were assessed for late radiotherapy toxicity (by using the LENT-SOMA scale) and patient and doctor ratings of breast cosmetic outcomes (mean = 6.7 years since the end of treatment). We reassessed 120 of these patients for depression (HAD) during a second wave of long-term assessment (mean = 8.1 years since the end of treatment). We used univariate analyses and polytomous logistic regression analyses to predict the HAD depression, which was defined as follows: normal, 0-7 points; and significant depression, >= 8 points (8-10 points, possible depression; >= 11 points, probable depression).Results: The mean HAD depression score was 4.5 +/- 3.6. 19. 2% of our population had significant depression, 6.7% with probable depression, and 12.5% with possible depression. Significant depression was not associated with late radiotherapy toxicity or initial cancer-related variables. Patients with probable depression reported worse cosmetic outcomes than nondepressed patients in terms of perceived breast largeness (p = 0.04), breast deformation (p = 0.02), and changes in skin pigmentation (p = 0.03).Conclusions: In LTBCS, depression seems to be more strongly associated with changes in some patients' perceived breast cosmetic outcome than late treatment toxicity or initial cancer-related variables. Copyright (C) 2012 John Wiley & Sons, Ltd.

PURPOSE:To compare compliance with and efficacy of intravenous (IV) and subcutaneous (SC) amifostine for the treatment of patients undergoing radiotherapy for head and neck cancer.PATIENTS AND METHODS:Patients with newly diagnosed squamous cell carcinoma of the head and neck, who were eligible for radiotherapy and who were not receiving concurrent chemotherapy, were randomly assigned to receive either IV amifostine (200 mg/m(2) daily for 3 minutes, 15 to 30 minutes before irradiation) or SC amifostine (500 mg; two sites; 20 to 60 minutes before irradiation). The primary end point was late xerostomia at 1 year as indicated by unstimulated and stimulated salivary flow rates, a patient benefit questionnaire score, and Radiation Therapy Oncology Group (RTOG) late toxicity grade.RESULTS:Results for IV (n = 143) versus SC (n = 148) administration were as follows. There was no significant difference in compliance (69% for IV v 71% for SC) in patients receiving a full dose of amifostine. Reasons for dose reduction were acute toxicity (25% for IV v 27% for SC; P = .51) and logistics (18% for IV v 9% for SC administration; P = .09). Acute toxicity differed significantly in terms of grade 1 to 2 hypotension (19% for IV v 8% for SC; P = .01), grade 1 to 2 skin rash (9% for IV v 21% for SC; P = .01), and local pain (0% for IV v 8% for SC; P = .003). The incidence of grade 2 or greater xerostomia was significantly higher for patients who received amifostine via SC administration (37% for IV v 62% for SC; P = .005) in the 127 patients (n = 67, IV; n = 60, SC) evaluable at 1 year but not at 2 or 3 years (36% for IV v 51% for SC administration; P = .19; 32% for IV v 41% for SC; P = .63). A generalized linear mixed-model analysis of all data revealed no significant difference in patient self-assessment of salivary function (P = .25), unstimulated or stimulated salivary flow rates (P = .054 and .82, respectively), or grade 2 or greater xerostomia (P = .23).CONCLUSION:SC amifostine administration was not significantly superior to IV amifostine administration in terms of patient compliance or efficacy.