Publications (15)28.52 Total impact
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Article: Large morpheaform cutaneous basal cell carcinoma of the head and neck: multiple tumors carry significant high recurrence rate.
Journal of Plastic Reconstructive & Aesthetic Surgery 12/2010; 64(4):e98-100. · 1.49 Impact Factor -
Article: [Pathology of the salivary glands].
La Revue du praticien 10/2010; 60(8):1142-3. -
Article: DPD-based adaptive dosing of 5-FU in patients with head and neck cancer: impact on treatment efficacy and toxicity.
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ABSTRACT: Fluoropyrimidine drugs are widely used in head and neck cancer (HNC). DPD deficiency is a pharmacogenetics syndrome associated with severe/lethal toxicities upon 5-FU or capecitabine intake. We have developed a simple, rapid, and inexpensive functional testing for DPD activity, as a means to identify deficient patients and to anticipate subsequent 5-FU-related toxicities. We present here the impact of fluoropyrimidine dose tailoring based on DPD functional screening in a prospective, open, non-controlled study, both in term of reduction in severe toxicities and of treatment efficacy. About 65 patients with HNC (59 ± 9 years, 52M/13F, Prospective Group) were entered into the study. Screening for DPD deficiency was performed prior to the beginning of the chemotherapy or radiochemotherapy. DPD status was evaluated by monitoring U/UH2 ratio levels in plasma as a surrogate marker for enzymatic functionality. 5-FU doses were reduced according to the extent of the detected DPD impairment, and adjusted on the basis of age, general condition, and other clinical/paraclinical covariates, if required. Treatment-related toxicities and subsequent impact on treatment delay were carefully monitored next for comparison with a retrospective, Reference subset of 74 other patients with HNC (mean age: 59 ± 10, 58M/16F, Reference Group), previously treated in the same institute with similar schedule but using standard 5-FU dosage. Thirty-one out of 65 patients (48%) were identified as mildly (28%) to markedly (20%) DPD deficient. Subsequently, dose reductions ranging from 10 to 100% with 5-FU were applied in those patients. In this group, six patients (9%) experienced severe toxicities, none of them being life threatening, and no toxic death was encountered. In comparison, 16 out of 74 patients (22%) of the Reference Group displayed severe side effects after standard 5-FU administration, 13% being life-threatening toxicities (e.g., G4 neutropenia + sepsis). Moreover, one toxic death was observed in this Reference Group. No postponement or cancelation of forthcoming chemoradiotherapy courses occurred in the Prospective Group, whereas treatment had to be disrupted in six patients (8%) from the Reference Group. No difference in first-line therapy efficacy was evidenced between the two subsets (78 vs. 79% response, P = 0.790). Although non-randomized, this study strongly suggests that prospective determination of DPD status has an immediate clinical benefit by reducing the drug-induced toxicities incidence in patients treated with 5-FU, allowing an optimal administration of several courses in a row, while maintaining efficacy. Our preliminary results thus advocate for systematic DPD screening in patients eligible for treatment with fluoropyrimidine drugs in HNC.Cancer Chemotherapy and Pharmacology 03/2010; 67(1):49-56. · 2.83 Impact Factor -
Article: [Kinetic values of lymphoscintigraphy of sentinel ganglion in cutaneous cervicofacial melanomas].
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ABSTRACT: The aim of this study was to evaluate the lymphoscintigraphy appearance time (LAT) of the sentinel lymph node (SLN) in head and neck cutaneous melanoma and to determine whether a correlation exists between LAT and SLN status (negativity or positivity). In vivo study. A retrospective cohort of 33 patients with Breslow index >or= 1.5 mm, Clark index >or= 4 mm, and ulceration > 1 mm underwent a lymphoscintigraphy and SLN biopsy for a cutaneous head and neck melanoma. LAT was noted and correlated to SLN status, Breslow and Clark indices, ulceration, and recurrence. Sixty SLNs were identified; 58 were removed, and 17 were positive. In 31% (n = 18), the LAT was < 10 minutes; in 59% (n = 34), the LAT was > 10 minutes and < 30 minutes; and in 10% (n = 6), the LAT was > 30 minutes. SLN was significantly positive (p = .02) when the LAT was less than 10 minutes and the negative predictive value was 100% for LAT > 30 minutes. A recurrence was significantly observed (p = .02) for LAT < 10 minutes. LAT > 30 minutes is associated with negative SLN in head and neck melanoma; however, a prospective study on a more important cohort is needed for a better evaluation of this new variable.Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale 02/2010; 39(1):39-44. · 0.71 Impact Factor -
Article: Impact of the prophylactic gastrostomy for unresectable squamous cell head and neck carcinomas treated with radio-chemotherapy on quality of life: Prospective randomized trial.
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ABSTRACT: Concomitant radio-chemotherapy is the gold standard treatment for unresectable head and neck carcinomas. Placement of prophylactic gastrostomy has been proposed to provide adequate nutrition during the therapeutic sequence. The objectives of this study were to assess the impact of prophylactic gastrostomy on the 6-month quality of life, and to determine the factors related to this quality of life. Design. randomized, controlled, open study ("systematic percutaneous gastrostomy" versus "no systematic gastrostomy"). Patients. squamous cell head and neck carcinoma (stages III and IV, UICC 1997). Setting. oncological departments of French university teaching hospitals. Treatment. optimal concomitant radio-chemotherapy. Evaluations. T0 baseline evaluation, T1 during the treatment, T2 end of the treatment, and T3 6-month post-inclusion. Primary endpoint. 6-month quality of life (Qol) assessed using SF36, EORTC QLQ-C30, EORTC QLQ H&N35 questionnaires. The Qol changes from baseline included a decline (T1 and T2) followed by an improvement (T3). Qol at 6 months was significantly higher in the group receiving systematic prophylactic gastrostomy (p=10(-3)). Higher initial BMI and lower initial Karnofsky index were significant factors related to a higher 6-month Qol. The study results suggest that prophylactic gastrostomy improves post-treatment quality of life for unresectable head and neck cancer patients, after adjusting for other potential predictive quality of life factors.Radiotherapy and Oncology 07/2009; 93(3):503-9. · 5.58 Impact Factor -
Article: Cervical paragangliomas: is SDH genetic analysis systematically required?
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ABSTRACT: To evaluate the prevalence of succinate dehydrogenase (SDH) B, C, and D germline mutations in a surgical series of cervical paragangliomas and to precise the characteristics of patients presenting with familial form. Among 29 patients operated on cervical paragangliomas (carotid or vagal body) at our institution between 1994 and 2007, 23 could be asked for a genetic analysis and a familial study. Clinical characteristics of patients harboring a germline SDH mutation were studied and compared with those presenting without mutation. Mutations were found in 8/23 (35%) patients, mostly in SDHD gene (6 cases), and in SDHB and SDHC gene, respectively, in one case each. Mean age at onset was significantly lower for patients with mutation (34 vs. 51.5 years, P = 0.01). In patients presenting with a mutation, 50% had a family history of paraganglioma compared with 0% for others (P = 0.008) and 87.5% had a multifocal form of paragangliomas versus 0% for others (P = 0.001). No difference was found concerning malignant forms between the two groups (12.5 vs. 13.3%). In the 16 patients who had an apparently sporadic paraganglioma, 6% had mutations in the SDH gene. A positive family history of paraganglioma and/or the presence of bilateral or multiple paragangliomas and/or an early age of onset are the main parameters associated with SDH mutations. Genetic testing should be considered for all patients with a cervical paraganglioma, even for those presenting with an apparently sporadic tumor as familial form may be such identified in 6% of cases.Archiv für Klinische und Experimentelle Ohren- Nasen- und Kehlkopfheilkunde 06/2008; 265(5):557-63. · 1.29 Impact Factor -
Article: Nutritional factors as predictors of response to radio-chemotherapy and survival in unresectable squamous head and neck carcinoma.
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ABSTRACT: This study sought to evaluate nutritional prognostic factors before treatment in patients with unresectable head and neck cancer treated by concomitant radio-chemotherapy. Seventy-two consecutive patients were treated. We studied the potential effects of CRP, Alb, preAlb, orosomucoid, weight, weight history, BMI, PINI, OPR and NRI on response to treatment, Event-Free Survival (EFS) and Overall Survival (OS). Effects of potential risk factors on OS and on EFS were analyzed by computing Kaplan-Meier estimates, and curves were compared using the log-rank test. All biological nutritional factors were statistically correlated with the response to radio-chemotherapy. In multivariate analysis, only CRP (p=0.004) remained statistically significant. A statistical correlation was found between Alb and EFS in multivariate analysis (p=0.04). The factors influencing OS in univariate analysis were Alb (p=0.008), CRP (p=0.004), orosomucoid (p=0.01) and NRI (p=0.01), response to radio-chemotherapy (p<0.001) and staging (p=0.04). In multivariate analysis, only the response to radio-chemotherapy (p<0.001) remained significant. This study illustrates the prognostic value of nutritional status. CRP and Alb may be useful in the assessment of advanced head and neck cancer patients at diagnosis and for stratifying patients taking part in randomized trials.Radiotherapy and Oncology 05/2008; 87(2):195-200. · 5.58 Impact Factor -
Article: Comparison between PET and PET/CT in recurrent head and neck cancer and clinical implications.
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ABSTRACT: The aim of this retrospective study was to compare the diagnostic accuracy between positron emission tomography (PET) and combined PET/computed tomography (PET/CT) in the detection of recurrent head and neck squamous cell carcinoma (HNSCC) and to evaluate the degree of interobserver agreement. Thirty-two patients who had undergone curative treatment for HNSCC and who presented with a suspicion of recurrent local disease were studied with fluoro-2-deoxy-D-glucose (FDG)-PET imaging. All patients had undergone an inconclusive conventional workup (nasofibroscopy, CT scan and/or MRI). PET and PET/CT were reviewed by two nuclear medicine physicians independently. Performances of PET and PET/CT were compared using biopsy and/or clinical follow-up of at least 8 months as gold-standard. ROC curves were employed for statistical analysis. Out of 32 patients, 18 (56%) had a local recurrence. Intraclass correlation coefficients were strong (>90) and statistically significant (P < 0.0001) for the two reviewers in all cases. The sensitivity, specificity and accuracy of PET were found to be 94%, between 36 and 50% and between 69 and 75%, respectively, depending on the consideration of equivocal cases. Results for PET/CT were found to be 94, 57 and 78%. The utility scores of PET and PET/CT were 0.72 and 0.78, respectively. PET/CT could have a direct impact on patient care with the avoidance of 8/14 (57%) unnecessary invasive procedures (panendoscopy under general anaesthesia). Combined PET/CT is more accurate than PET alone for detection of recurrent HNSCC. The findings of this study are reinforced by the strong interobserver agreement in the interpretation of the results.Archiv für Klinische und Experimentelle Ohren- Nasen- und Kehlkopfheilkunde 06/2007; 264(5):531-8. · 1.29 Impact Factor -
Article: [Role of [18F]-FDG PET-CT in the management of the head and neck cancers].
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ABSTRACT: To evaluate the impact of [(18)F]-FDG PET/CT image fusion in the management of carcinomas of the upper aero-digestive tract. This retrospective study included 169 patients with squamous cell cacinoma of the upper aerodigestive tract who underwent a PET/CT for : initial staging (n = 47), cervical lymphadenopathy from an unknown primary (n = 22), post treatment surveillance (n = 68) and detection of recurrent cancer (n = 32). Results of PET/CT were compared with those of standard workup (CT scan of head, neck and chest and abdominal ultrasound). Histology and clinical follow-up were used as gold-standard. PET/CT was more accurate than standard workup for 6.4 % of patients for the initial staging, 18,2 % of patients for cervical lymphadenopathy from an unknown primary, 20,6 % of patients for post-treatment surveillance and 25 % of patients for detection of cancer recurrence. In all patients, 17,9 % of FDG uptake foci found by PET/CT were false-positives. PET/CT is a reliable tool for the management of carcinomas of the upper aerodigestive tract. The high rate of false-positive findings represents the main limitation of this exam.Bulletin du cancer 11/2006; 93(10):1017-25. · 0.67 Impact Factor -
Article: Lymph node biopsy specimens and diagnosis of cat-scratch disease.
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ABSTRACT: We report microbiologic analysis of 786 lymph node biopsy specimens from patients with suspected cat-scratch disease (CSD). The specimens were examined by standard, cell culture, and molecular methods. Infectious agents were found in samples from 391 (49.7%) of 786 patients. The most commonly identified infectious agent was Bartonella henselae (245 patients, 31.2%), the agent of CSD. Mycobacteriosis was diagnosed in 54 patients (6.9%) by culture and retrospectively confirmed by using a specific real-time PCR assay. Neoplasm was diagnosed in 181 specimens suitable for histologic analysis (26.0%) from 47 patients. Moreover, 13 patients with confirmed Bartonella infections had concurrent mycobacteriosis (10 cases) or neoplasm (3 cases). A diagnosis of CSD does not eliminate a diagnosis of mycobacteriosis or neoplasm. Histologic analysis of lymph node biopsy specimens should be routinely performed because some patients might have a concurrent malignant disease or mycobacteriosis.Emerging infectious diseases 10/2006; 12(9):1338-44. · 6.17 Impact Factor -
Article: Ability of lymphoscintigraphy to direct sentinel node biopsy in the clinically NO check for patients with head and neck squamous cell carcinoma; a prospective study (preliminary results).
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ABSTRACT: Detection of metastasis involvement of lymph nodes is essential for management and prognostic evaluation in most cancer cases. The success of lymphatic mapping depends on identifying the sentinel lymph node(s) draining the primary tumour. In this preliminary study we prospectively evaluated the feasibility of sentinel node radio localisation in head and neck squamous cell carcinoma N0 stage to gain insight as to whether the sentinel lymph node (SLN) could be prognostic of regional metastasis disease or not. In 14 patients with squamous cell carcinoma of the head and neck region preoperative lymphoscintigraphy (LSG) mapping of the tumour was performed after subcutaneous injection of 22 to 30 MBq of Tc99m-labelled sulfur colloid. SLN was detected and localised by LSG in all patients with a gamma camera and a hand-held gamma probe. All the patients underwent surgery SLN and cervical nodes dissection. Six SLNs for five patients revealed occult metastasis disease. No skip metastasis were found in the 9 necks with negative SLN analysis. The results of this preliminary study are encouraging. They showed that SLN in squamous cell carcinoma of the head and neck N0 is accurately feasible and could predict the presence of occult metastasis. Nevertheless, more data are needed to validate these results.Bulletin du cancer 05/2004; 91(4):E1-4. · 0.67 Impact Factor -
Article: Acoustic and aerodynamic measurements of voice production after near-total laryngectomy with epiglottoplasty.
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ABSTRACT: Objective voice analysis based on simultaneous aerodynamic and acoustic measurements is not common and there have been no reports dealing specifically with aerodynamic features of laryngeal performance after partial laryngectomy. The present study describes objective voice analysis after near-total laryngectomy using the Tucker technique (NTLT). We performed and compared acoustic and aerodynamic measurements in patients who underwent NTLT (n = 21) and normal controls (n = 10). Acoustic indexes of instability of frequency and intensity (jitter and shimmer) were always higher in patients. Oral airflow and estimated subglottic pressure (ESPG) were significantly greater in patients than in controls (400 vs. 169 cm(3)/s and 23 vs. 6.2 hPa, respectively). Poor closure of the glottis after surgery leads to a significant increase in glottal leakage in comparison with controls. Higher ESGP values observed in patients are probably related to two factors. The first involves compensation for glottal leakage in order to achieve sufficient air pressure to initiate vibration of the mucosa. The second factor is the poor vibratory quality of the residual mucosa, which may require higher pressure levels than the more compliant normal cord to initiate vibration. Our findings confirm the adverse effects of NTLT on the aerodynamic efficiency of the larynx due to glottal leakage and poor compliance of postoperative mucosa. Aerodynamic measurements could provide the basis for standardized objective evaluation of postoperative voice quality.Folia Phoniatrica et Logopaedica 54(6):304-11. · 1.12 Impact Factor -
Article: Correlation of instrumental voice evaluation with perceptual voice analysis using a modified visual analog scale.
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ABSTRACT: Various rating scales have been used for perceptual voice analysis including ordinal (ORD) scales and visual analog (VA) scales. The purpose of this study was to determine the most suitable scale for studies using perceptual voice analysis as a gold standard for validation of objective analysis protocols. The study was carried out on 74 female voice samples from 68 dysphonic patients and 6 controls. A panel of 4 raters with experience in perceptual analysis was asked to score voices according to the G component (overall quality) of the GRBAS system. Two rating scales were used. The first was a conventional 4-point ORD scale. The second was a modified VA (mVA) scale obtained by transforming the VA scale into an ORD scale using a weighted conversion scheme. Objective voice evaluation was performed using the EVA workstation. Objective measurements included acoustic, aerodynamic, and physiologic parameters as well as parameters based on nonlinear mathematics (e.g., Lyapunov coefficient). Instrumental measurements were compared with results of perceptual analysis using either the conventional ORD scale or mVA scale. Results demonstrate that correlation between perceptual and objective voice judgments is better using a mVA scale than a conventional ORD scale (concordance, 88 vs. 64%). Data also indicate that the mVA scale described herein improves the correlation between objective and perceptual voice analysis.Folia Phoniatrica et Logopaedica 54(6):271-81. · 1.12 Impact Factor -
Article: Radiolocalization of sentinel lymph nodes in oral squamous cell carcinoma
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ABSTRACT: Objectives: To prospectively evaluate radiolocalization of sentinel lymph nodes in N0 squamous cell carci-noma of the oral cavity. Material and methods: Between January 2002 and May 2004, 21 consecutive patients with T1/T2 N0 squa-mous cell oral cancer underwent preoperative lymphoscintigraphy (peritumoral injection of technetium-99m colloid) followed by intraoperative gamma-probe SLN localization, SLN removal, neck dissection, and remo-val of the primary. SLNs were examined using step-serial sectioning and immunohistochemistry. Results: All patients had at least one SLN identified, with a total of 41 SLN examined. In 7 patients, SLNs contained occult metastasis. No skip metastases were found in the 14 patients with negative SLNs. Sensitivity and negative predictive value were both 100%. Conclusion: These encouraging preliminary findings show that SLN radiolocalization is feasible in patients with N0 oral squamous cell carcinoma and that negative SLN examination predicts absence of cervical node metastases. (Fr ORL -2005 ; 89 : 155 -163) Keywords: Sentinel lymph node, Ly m p h o s c i n t i grap hy, Squamous Cell Carcinoma, Oral cavity. -
Article: Détection isotopique du ganglion sentinelle des cancers de la cavité orale
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ABSTRACT: ARTICLE ORIGINAL RÉSUMÉ Objectif de l'étude : Evaluer la détection isotopique du ganglion sentinelle (GS) dans les carcinomes épi-d e rmoïdes N0 de la cavité ora l e. M at é riels et Méthodes : De janvier 2002 à mai 2004, 21 patients ont bénéficié d'une lymphoscintigraphie (injection p é ri t u m o rale de sulfure de rhénium tech n é t i é) . L'exérèse chirurgicale du ou des ganglions sentinelles est aidée par une sonde de détection portable et com-plétée dans le même temps d'un évidement ganglion-naire cervical et d'une tumorectomie. Chaque gan-glion sentinelle a été analysé selon une technique his-tologique spécifique (coupes sériées), complétée par une étude immunohistochimique. Résultats : Tous les patients ont eu au moins un GS identifié avec un total de 41 GS analysés. Pour 7 patients, l'analyse des GS a révélé la présence de métastases ganglionnaires occultes. Aucun envahissement ganglionnaire n'a été retrouvé chez les 14 patients ayant présenté un GS négatif. Sensibilité et valeur prédictive négative ont été de 100%. Conclusion : Ces résultats préliminaires encourageants montrent la faisabilité de la détection isotopique du ganglion sentinelle dans les carcinomes épidermoïdes de la cavité orale et la possibilité de prédire l'absence de métastase ganglionnaire cervica-le. (Fr ORL -2005 ; 89 : 155 -163) Mots clés : Ganglion sentinelle, Ly m p h o s c i n t i grap h i e, Carcinome epïdermoide, Cavité orale. Date de soumission : décembre 2004 Date d'acceptation : octobre 2005 Auteur correspondant : Dr David Lussato S e rvice central de Biophysique et de Médecine N u cl é a i re Centre hospitalo-unive rs i t a i re de la Ti m o n e, ABSTRACT Objectives: To prospectively evaluate radiolocaliza-tion of sentinel lymph nodes in N0 squamous cell car-cinoma of the oral cavity. Material and methods: Between January 2002 and May 2004, 21 consecutive patients with T1/T2 N0 squamous cell oral cancer underwent preoperative lymphoscintigraphy (peritumoral injection of techne-tium-99m colloid) followed by intraoperative gamma-probe SLN localization, SLN removal, neck dissec-tion, and removal of the primary. SLNs were exami-ned using step-serial sectioning and immunohistoche-mistry. Results: All patients had at least one SLN identified, with a total of 41 SLN examined. In 7 patients, SLNs contained occult metastasis. No skip metastases were found in the 14 patients with negat ive SLNs. Sensitivity and negative predictive value were both 100%. Conclusion: These encouraging preliminary findings show that SLN radiolocalization is feasible in patients with N0 oral squamous cell carcinoma and that nega-tive SLN examination predicts absence of cervical node metastases.
