D Brasnu

Hôpital Européen Georges-Pompidou (Hôpitaux Universitaires Paris-Ouest), Lutetia Parisorum, Île-de-France, France

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Publications (398)404.88 Total impact

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    ABSTRACT: Objective: Describe the implementation and preliminary results of the “Experimental Program Personalized care” in patients with Head and Neck cancer. Materials and methods: After being selected a graduate nurse status, called coordination, participated in the development of forms of detection needs and concerns of patients, in collaboration with various health professionals. Results: Between January 2011 and December 2012, 200 new patients with head and neck cancer were included: 62% with advanced cancer and 38% of early stage. No patient refused to participate in this experiment. At least one consultation with a psychiatrist was necessary for 82% of patients with advanced cancer. Social problems were the second axis of the needs of patients. Conclusion: By identifying the needs of patients and organizing their support, this evaluation optimizes not only the therapeutic care for the patient but also the management of human resources within the team.
    Bulletin du cancer 10/2014; 101(10):910-915. DOI:10.1684/bdc.2014.2040 · 0.60 Impact Factor
  • 39th ESMO Congress (ESMO); 09/2014
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    Yaniv Hamzany · Daniel Brasnu · Thomas Shpitzer · Jacob Shvero
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    ABSTRACT: The growing practice of endoscopic surgery has changed the therapeutic management of selected head and neck cancers. Although a negative surgical margin in resection of neoplasm is the most important surgical principle in oncologic surgery, controversies exist regarding assessment and interpretation of the status of margin resection. The aim of this review was to summarize the literature considering the assessment and feasibility of negative margins in transoral laser microsurgery (TLM) and transoral robotic surgery (TORS). Free margin status is being approached differently in vocal cord cancer (1-2 mm) compared with other sites in the upper aerodigestive tract (2-5 mm). Exposure, orientation of the pathological specimen, and co-operation with the pathologist are crucial principles needed to be followed in transoral surgery. Piecemeal resection to better expose deep tumor involvement and biopsies taken from surgical margins surrounding site of resection can improve margin assessment. High rates of negative surgical margins can be achieved with TLM and TORS. Adjuvant treatment decision should take into consideration also the surgeon's judgment with regard to the completeness of tumor resection.
    04/2014; 5(2):e0016. DOI:10.5041/RMMJ.10150
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    ABSTRACT: Introduction La plasmocytose laryngée (PL), est une lésion bénigne rare à plasmocytes matures et polyclonaux, qu’il faut savoir distinguer du plasmocytome extramédullaire. Présentation du cas Nous rapportons l’observation d’une patiente âgée de 59 ans, ayant une dysphonie chronique comme unique symptôme, chez qui une PL isolée à localisation laryngée a été découverte. Discussion Nous discutons la présentation histopathologique, les modalités thérapeutiques, et le pronostic de cette entité. Conclusion La PL est une lésion bénigne et rare, dont le diagnostic est à évoquer devant une infiltration plasmocytaire polyclonale de la sous-muqueuse.
    Annales Francaises d'Oto-Rhino-Laryngologie et de Pathologie Cervico-Faciale 11/2013; 130(5):299–301. DOI:10.1016/j.aforl.2013.02.012
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  • Annales Francaises d'Oto-Rhino-Laryngologie et de Pathologie Cervico-Faciale 10/2013; 130(4):A15. DOI:10.1016/j.aforl.2013.06.036
  • S. Hans · C. Hoffman · A. De corgnol · M. Ménard · D. Brasnu
    Annales Francaises d'Oto-Rhino-Laryngologie et de Pathologie Cervico-Faciale 10/2013; 130(4):A46. DOI:10.1016/j.aforl.2013.06.119
  • C. Badoual · E. Tartour · S. Hans · D. Brasnu · P. Bruneval · P. Ravel
    Annales Francaises d'Oto-Rhino-Laryngologie et de Pathologie Cervico-Faciale 10/2013; 130(4):A106. DOI:10.1016/j.aforl.2013.06.336
  • Annales Francaises d'Oto-Rhino-Laryngologie et de Pathologie Cervico-Faciale 10/2013; 130(4):A17. DOI:10.1016/j.aforl.2013.06.043
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    ABSTRACT: Malignant tumours of the salivary glands (MSGT) are rare and pleomorphic entities. Patients with advanced disease may benefit from targeted therapy; however, specific targets for optimising and personalising treatments are yet to be identified. Immunohistochemistry for C-KIT, EGFR, HER2, MUC1, phospho-mTOR, androgen/estrogens/progesterone receptors and Ki67 was carried out and evaluated in terms of progression-free and overall survival. High throughput molecular screening of key oncogenes was done in 107 patients using routine diagnostic methods and Sequenom technology. Several therapy leads were identified, including high levels of HER2 and androgen receptors in salivary duct carcinomas, C-KIT in myoepithelial carcinomas and EGFR in mucoepidermoid carcinomas. Recurrent mutations involving downstream elements of the EGFR pathway were found in HRAS, notably in tumours with a myoepithelial component, and in other key oncogenes (KRAS/NRAS/PI3KCA/BRAF/MAP2K). On the other hand, <1% of samples had EGFR or HER2 mutations. Several tumour subtypes overexpressed targets of directed therapies suggesting potential therapy leads. Genotyping results suggest activation downstream of EGFR in 18 of the 107 samples that could be associated with low efficacy of EGFR inhibitors. Other molecules, such as PI3K/MEK or mTOR inhibitors, may have anti-tumour activity in this subgroup. The high mutation rate in HRAS highlights a novel key oncogenic event in MSGT.
    Annals of Oncology 08/2013; 24(10). DOI:10.1093/annonc/mdt338 · 7.04 Impact Factor
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    ABSTRACT: Introduction: Laryngeal plasmacytosis (LP) is a rare benign lesion of mature polyclonal plasma cells, which should be differentiated from extramedullary plasmacytoma. Case report: Isolated laryngeal plasmacytosis was discovered in a 59-year-old woman, free of symptoms other than chronic hoarseness. Discussion: Histological presentation, treatment modalities and prognosis are discussed. Conclusion: Laryngeal plasmacytosis is a rare benign lesion that must be considered in case of submucosal polyclonal plasma cell infiltrate.
    European Annals of Otorhinolaryngology, Head and Neck Diseases 07/2013; 130(5). DOI:10.1016/j.anorl.2012.09.011 · 0.82 Impact Factor
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    ABSTRACT: Various arguments support the development of a vaccine targeting human papillomavirus (HPV) for the treatment of HPV-associated head and neck cancer. However, the mucosal localization of this tumor, the HPV-driven downregulation of MHC Class I molecules and various other immunosuppressive mechanisms must be carefully considered to improve the clinical efficacy of such an immunotherapeutic strategy.
    OncoImmunology 06/2013; 2(6):e24534. DOI:10.4161/onci.24534 · 6.27 Impact Factor
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    ABSTRACT: The objective was to assess the feasibility and safety of transoral robotic surgery (TORS)-assisted free flap reconstruction for hypopharyngeal carcinoma after radiation therapy. The study evaluated the feasibility, surgical margins, the need for a tracheotomy, a nasogastric tube as well as surgery-related complications. Two patients underwent TORS-assisted free flap reconstruction after radiation therapy. The resection margins were free of tumor in both patients. A tracheotomy was performed in one patient who had been decannulated on the sixth postoperative day. One patient resumed satisfactory oral feeding in the fourth postoperative month and the second patient on postoperative day 7. No intraoperative complication and one postoperative complication (neck hematoma) were reported. After a follow-up period of 24 and 30 months, no local recurrence was observed. TORS is feasible for hypopharyngeal resection and assisted free flap reconstruction after radiation therapy. It represents a further step in the development of minimally invasive surgery for the treatment of head and neck cancers with laryngeal preservation.
    Archives of Oto-Rhino-Laryngology 05/2013; 270(8). DOI:10.1007/s00405-013-2566-1 · 1.55 Impact Factor
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    ABSTRACT: The human beatbox is the art of reproducing all types of sounds with the mouth while 'adapting' them for better control. To understand how these 'voice virtuosos' juggle with so many different sounds-instrumental, rhythmic, and vocal-at the same time, we have performed a descriptive analysis of three beatboxers by observing their vocal tract behaviour by fiberscopic imaging using an OCM visual scale. From an anatomical-dynamic point of view, beatboxers mobilize all the structures of their laryngopharynx separately. With this first physiological study of the human beatbox, we could observe a well-developed laryngopharyngeal system with extreme articulatory configurations to perform their art.
    Logopedics, phoniatrics, vocology 04/2013; 39(1). DOI:10.3109/14015439.2013.784801 · 0.93 Impact Factor
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    ABSTRACT: Endoscopic laser medial arytenoidectomy for bilateral vocal fold paralysis has the advantage of preserving the structure and the position of the vocal fold, contrary to a transverse cordotomy or total arytenoidectomy. Our objective was to evaluate the functional results of this procedure. This is a prospective non-randomized study. Twenty patients were included: five patients had a tracheotomy preoperatively and 15 patients had dyspnea on exertion. Acoustic voice measurements, spirometric parameters and the voice handicap index 120 (VHI), were evaluated 1 week before surgery and 3 months after. All the five patients with tracheotomy were successfully decannulated. Acoustic records and VHI were available for eight patients. Jitter and shimmer were worse (p = 0.0078), whereas the VHI was not significantly different after surgery. Spirometric records, available for six patients, were not modified. Endoscopic laser medial arytenoidectomy allowed decannulation and subjective improvement of quality of life in patients with bilateral vocal fold paralysis.
    Archives of Oto-Rhino-Laryngology 03/2013; 270(5). DOI:10.1007/s00405-013-2414-3 · 1.55 Impact Factor
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    ABSTRACT: OBJECTIVES/HYPOTHESIS: Minimally invasive surgery has become the standard of care in many organ systems. Head and neck surgery has incorporated transoral surgery, either laser microsurgery or robotic resection, in the management of pharyngeal and laryngeal cancers. To date, the laryngeal procedures have taken the form of partial laryngectomy, as transoral approaches have not allowed reconstruction following total laryngectomy. We present the first series of transoral total laryngectomies. STUDY DESIGN: Multinational, multi-institutional prospective consecutive case series. METHODS: Case series of completed and attempted transoral robotic surgery (TORS) total laryngectomy performed under an institutional review board protocol. The procedure was developed in the cadaver laboratory and applied to selected individuals requiring total laryngectomy for recurrent laryngeal cancer or post-therapeutic organ dysfunction. RESULTS: TORS total laryngectomy was successfully performed in five patients and was unsuccessful in two others. Two of the patients had postoperative fistulae, and all seven are without evidence of recurrent cancer and are swallowing orally without gastrostomy supplementation. CONCLUSIONS: TORS total laryngectomy is feasible and can be taught to other surgeons. Potential benefits of this approach are present for patients undergoing salvage laryngectomy and include improved wound healing and functional results. This procedure further extends the applications of robotic head and neck surgery. Laryngoscope, 2012.
    The Laryngoscope 03/2013; 123(3). DOI:10.1002/lary.23842 · 2.14 Impact Factor
  • Daniel Brasnu
    The Laryngoscope 02/2013; 123(2). DOI:10.1002/lary.23733 · 2.14 Impact Factor
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    ABSTRACT: To present the preliminary results of the qualiit of life and quality of swallowing in a series of 15 patien! treated with oropharyngectomy by transoral robotic-assisted (CTAR) (robot da Vinci, Intuitive Surgical ). A prospective monocentric non-randomized study of 15 patients with cancer of the oropharynx. Were analyzed: demographics, quality of life questionnaires (QLQ-C30 and H&N 35 EORTC) and quality of swallowing questionnairex (MDADI, DHI and EAT 10) with an average of 1 year after the end of the treatment. Fifteen patients (10 males and 5 females), mean age of 65 years (47-73 years) were included. The tumours were classified as: cT1: 4; cT2: 10 cT3: 1. Five of the 15 patients received postoperative chemoradiotherapy as histo-pathological studies showed multiple metastatic cervical lymph nodes +/- capsular rupture. For the analysis of the quality of life and quality of swallowing, the patients were divided into two groups. Group A included patients who underwent CTARs and group B, patients operated by CTAR with adjuvant chemoradiotherapy. At 12 months of the procedure, all patients had a deglutition considered as normal without feeding tube nor tracheostomy. With the three scales used, the quality of swallowing was satisfactory for all patients. It was better for patients in group A than for patients in group B. In terms of quality of life, the EORTC QLQ-C30 scale showed our patients had a high rate of satisfaction scale in "health and overall quality of life". For the EORTC H&N35 questionnaire, mean scores for "specific symptoms" were also low except for the following three items "dry mouths", "sticky saliva" and "sexuality problem". The first two items were statistically more frequent (p = 0.02 and p = 0.001) in group B patients. After transoral robotic-assisted oropharyngectomy, patients have a good quality of life and swallowing. Postoperative chemoradio-therapy compromises the quality of swallowing. Multicentric studies are required to confirm these preliminary results.
    Revue de laryngologie - otologie - rhinologie 01/2013; 134(1):49-56.
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    ABSTRACT: Head and neck cancers positive for human papilloma virus (HPV) have a more favorable clinical outcome than HPV-negative cancers, but it is unknown why this is the case. We hypothesized that prognosis was affected by intrinsic features of HPV-infected tumor cells or differences in host immune response. In this study, we focused on a comparison of regulatory Foxp3+T cells and PD-1+T cells in the microenvironment of tumors that were positive or negative for HPV, in two groups that were matched for various clinical and biological parameters. HPV-positive head and neck cancers were more heavily infiltrated by regulatory T cells and PD-1+ T cells in this group were positively correlated with a favorable clinical outcome. In explaining this paradoxical result, we showed that these PD-1+T cells expressed activation markers and were functional after blockade of the PD-1-PDL-1 axis in vitro. Approximately 50% of PD-1+ tumor-infiltrating T cells lacked Tim-3 expression and may indeed represent activated T cells. In mice, administration of a cancer vaccine increased PD-1 on T cells with concomitant tumor regression. In this setting, PD-1 blockade synergized with vaccine in eliciting antitumor efficacy. Our findings prompt a need to revisit the significance of PD-1-infiltrating T cells in cancer, where we suggest that PD-1 detection may reflect a previous immune responses against tumors that might be reactivated by PD-1/PD-L1 blockade.
    Cancer Research 11/2012; 73(1). DOI:10.1158/0008-5472.CAN-12-2606 · 9.33 Impact Factor
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    ABSTRACT: It is a major clinical challenge to predict which patients, with advanced stage head and neck squamous cell carcinoma, will not exhibit a reduction in tumor size following induction chemotherapy in order to avoid toxic effects of ineffective chemotherapy and delays for instituting other therapeutic options. Further, it is of interest to know to what extent a gene signature, which identifies patients with tumors that will not respond to a particular induction chemotherapy, is applicable when additional chemotherapeutic agents are added to the regimen. To identify genes that predict tumor resistance to induction with cisplatin/5-fluorouracil (PF) or PF and a taxane, we analyzed patient tumor biopsies with whole genome microarrays and quantitative reverse transcriptase-PCR (TLDA) cards. A leave one out cross-validation procedure allowed evaluation of the prediction tool. A ten-gene microarray signature correctly classified 12/13 responders and 7/10 non-responders to PF (92% specificity, 82.6% accuracy). TLDA analysis (using the same classifier) of the patients correctly classified 12/12 responders and 8/10 non-responders (100% specificity, 90.9% accuracy). Further, TLDA analysis correctly predicted the response of 5 new patients and, overall, 12/12 responders and 13/15 non-responders (100% specificity, 92.6% accuracy). The protein products of the genes constituting the signature physically associate with 27 other proteins, involved in regulating gene expression, constituting an interaction network. In contrast, TLDA-based prediction (with the same gene signature) of responses to induction with PF and either of two taxanes was poor (0% specificity, 25% accuracy and 33.3% specificity, 25% accuracy). Successful transfer of the microarray-based gene signature to an independent, PCR-based technology suggests that TLDA-based signatures could be a useful hospital-based technology for determining therapeutic options. Although highly specific for tumor responses to PF induction, the gene signature is unsuccessful when taxanes are added. The results illustrate the subtlety in developing "personalized medicine".
    PLoS ONE 10/2012; 7(10):e47170. DOI:10.1371/journal.pone.0047170 · 3.23 Impact Factor

Publication Stats

4k Citations
404.88 Total Impact Points


  • 2001–2014
    • Hôpital Européen Georges-Pompidou (Hôpitaux Universitaires Paris-Ouest)
      • Service d’ORL et Chirurgie Cervico-Faciale
      Lutetia Parisorum, Île-de-France, France
    • French Institute of Health and Medical Research
      Lutetia Parisorum, Île-de-France, France
  • 1988–2014
    • Université René Descartes - Paris 5
      • Faculté de Médecine
      Lutetia Parisorum, Île-de-France, France
  • 2012–2013
    • Université Paris-Sorbonne - Paris IV
      Lutetia Parisorum, Île-de-France, France
  • 2005–2013
    • French National Centre for Scientific Research
      Lutetia Parisorum, Île-de-France, France
  • 1996–2009
    • Assistance Publique – Hôpitaux de Paris
      Lutetia Parisorum, Île-de-France, France
    • Greenwich Hospital, Connecticut
      Гринвич, Connecticut, United States
  • 2008
    • École Nationale Vétérinaire d'Alfort
      Lutetia Parisorum, Île-de-France, France
  • 1987–2002
    • Centre Hospitalier Sainte Anne
      Lutetia Parisorum, Île-de-France, France
  • 1999
    • University of Paris-Est
      Centre, France
  • 1997
    • University of Angers
      Angers, Pays de la Loire, France
  • 1995
    • Centre hospitalier Laennec de Creil
      Creil, Picardie, France
  • 1989–1995
    • The Australian Society of Otolaryngology Head & Neck Surgery
      Evans Head, New South Wales, Australia
  • 1994
    • Institut de Cancérologie Gustave Roussy
      Villejuif, Île-de-France, France
  • 1992
    • Hospital of the University of Pennsylvania
      • Department of Otorhinolaryngology - Head and Neck Surgery
      Philadelphia, Pennsylvania, United States