[Association of broncho-pulmonary cancers and of cancers of the upper aero-digestive tract (43 cases)].
Explore the source record for details and available documents.
Bronchial Neoplasms↗
Biomedical subjects
B Luboinski
Publications and source records attributed to B Luboinski.
Modes of invasion of cancer of the larynx. A statistical, histological, and radioclinical analysis of 120 cases.
A statistical comparison between histologic and radioclinical data was performed on a series of 120 cases of total laryngectomies in order to study the modes of invasion of laryngeal cancer and to quantify the differences of results as evaluated by pathological and by clinical examinations. The first part of this study deals with the spread of cancer depending on its site of origin; the second part examines spread regardless of the primary location of the laryngeal tumor. The comparative results show that it was difficult to determine the deep invasion of structures such as the preepiglottic space and the cartilages from the radioclinical examination, especially in cases of cancer developed on a laryngocele. This study emphasizes the importance of the histological examination of laryngeal specimens as described here in order to codify the modes of invasion and, as a result, to help the otorhinolarynglologist in the choice of the best treatment.
Carcinoma, Squamous Cell↗
[Treatment of malpighian epitheliomas of the floor of the mouth with gingival involvement].
Within the clinical context of carinomas of the upper respiratory/digestive tract (special underlying features, frequency of multiple localisations), pelvi-gingival tumours pose special problems essentially related to the proximity of the mandible. Over the past 15 years, treatment protocols at the Institut Gustave-Roussy have been progressively oriented towards a surgical solution preceded by short period of chemotherapy and followed by radiotherapy on an "as required" basis. In certain instances (bone resection with defect, especially naterior), such excision surgery results in serious functional and aesthetic impairment and cannot be envisaged in the absence of concomitant reparative surgery. The latter is clearly defined as far as the soft tissues are concerned thanks to the use of facial or thoracic flaps, whilst solutions for restoring bone continuity remain imperfect. The difficulties of covering a bone transplant and the need for postoperative radiotherapy compromise its future. From a tumour standpoint, the results are aggravated essentially by the existence of bone involvement or of histological lymph node invasion. Furthermore, it is closely related to the manifestations of the malignant disease in general. The survival obtained with the current therapeutic protocol is 38% at 3 years and 32% at 5 years.
Bone Transplantation↗
[Permanent transtympanic drain in nonpurulent cryptogenetic ear effusions in children].
Explore the source record for details and available documents.
Adolescent↗
[Laryngeal cancers treated with curative radiation: retreatment of failures with total or partial surgery. Apropos of 88 cases treated at the Institut Gustave-Roussy, Villejuif].
Explore the source record for details and available documents.
Fistula↗
Simultaneous chemoradiotherapy as salvage treatment in locoregional recurrences of squamous head and neck cancer.
This study was designed to determine if long-term palliation could be obtained in pre-irradiated locoregional recurrent squamous head and neck cancer patients, with the administration of simultaneous chemoradiotherapy. Mandatory eligibility criteria were histologically documented squamous head and neck cancer in previously irradiated territory, surgical or brachytherapy salvage unfeasibility, or patient refusal. The protocol consisted of radiotherapy, at a rate of 5 daily fractions of 2 Gy on alternate weeks, with simultaneous continuous intravenous infusion of 5-fluorouracil (5FU) at 800 mg/m2 and oral hydroxyurea (HU) at 1,000-1,500 mg/day for 5 days. Tolerance was good. Acute toxicity was low with no grade > or = III WHO hematologic toxicity observed. Nine patients had grade III mucositis, one had grade IV, three had grade III skin toxicity, and only four patients required a 20% to 30% 5FU dose reduction because of it. Two patients had hand and foot syndrome, and two had asymptomatic 5FU-related cardiac signs (1 ECG, 1 echographic+ECG). Chronic radiotherapy-related effects consisted of Hermitte's sign observed in two patients. Of 34 registered patients, 33 were evaluable for response. An overall rate of 55% (18 patients) of objective responses [complete response (CR) + partial response (PR)] was obtained, with 12 patients (36%) achieving local control of disease. The median survival was 11 months. These data show that palliation could be obtained for the majority of responding patients, and also suggest an improvement in the immediate prognosis with this type of salvage procedure for a selected group of recurrent squamous head and neck cancer patients.
Adult↗
Correlation between nodal density in contrasted scans and response to cisplatin-based chemotherapy in head and neck squamous cell cancer: a prospective validation.
This prospective study was done to validate an earlier retrospective study demonstrating a relationship between complete response to chemotherapy and nodal density as estimated in contrasted computed tomography (CT scans) in head and neck squamous cell carcinoma (HNSCC). CT scans of 36 patients were evaluated by two radiologists blinded to therapeutic outcome. The density of the largest node (> 2 cm) was compared to that of nuchal muscles. A node was classified as hypodense if more than 33% of the nodal surface area consisted of hypodense zones. Density and nodal staging were related: 67% (10 of 15) of patients with N3 disease but only 29% (six of 21) with N1-N2 exhibited isodensity, p < 0.05. Complete response to chemotherapy was noted in 63% (10 of 16) of the isodense group but only in 15% (three of 20) of the hypodense group, p < 0.01. We believe that nodal density can be used for therapeutic decision-making in high nodal volume HNSCC.
Adult↗
Thymidylate synthase activity, folates, and glutathione system in head and neck carcinoma and adjacent tissues.
BACKGROUND: Head and neck squamous cell carcinomas (HNSCC) present variable aggressiveness and chemosensitivity. Because the glutathione (GSH) system and thymidylate synthase (TS) are involved in the resistance to the main drugs used in HNSCC (cisplatin and 5-FU), we studied these systems in tumors and normal mucosae. METHODS: Tumor samples and normal adjacent mucosae were collected from 37 untreated HNSCC patients. GSH and glutathione S-transferase (GST) activity were assayed by spectrophotometry, whereas TS activity and folates were determined by radioassays. RESULTS: Mean GSH levels were higher in tumors (15.2 +/- 8.2 nmol/mg protein) than in mucosae (8.3 +/- 4.1 nmol/mg protein) (p = 0.005, paired t test). GST activity was also higher in tumors (394 +/- 194 nmol/min/mg protein) than in mucosae (261 +/- 132 nmol/min/mg protein) (p = 0.0003). TS activity was markedly higher in tumors (9.2 +/- 21.5 pmol/min/mg protein) compared to that of mucosae (0.9 +/- 1.2 pmol/min/mg protein) (p = 0.0001). Folate levels in tumors and mucosae were similar (1.2 +/- 1.1 and 0.8 +/- 0.9 pmol/mg protein, respectively; p = 0.1, NS). In relation to clinical stage and tumor size, a statistical difference was found in GSH and GST values between tumors and mucosae for stage IV and T3/T4. The increase in tumor TS compared to that of mucosae was significant for all clinical stages, tumor sizes, and nodal involvement. CONCLUSIONS: These data enhance our understanding of the enzymatic systems involved in cisplatin and 5-fluorouracil (5-FU) resistance in HNSCC and normal mucosae and may help to elucidate tumor behavior and interpatient differences in drug sensitivity.
Aged↗
Salvage chemotherapy in recurrent head and neck cancer: the Institut Gustave Roussy experience.
Explore the source record for details and available documents.
Aged↗
[Organ preservation in ORL oncology: myth or reality. The case for laryngeal preservation].
The conservation of a functional larynx is an important goal in the various attempts to improve the treatment of locally-advanced pharyngo-laryngeal cancers. Several axes have been followed: conservative surgery (subtotal laryngectomy), exclusive irradiation (with conventional or non-conventional fractionation), initial chemotherapy (followed by surgery or irradiation) or concomitant chemotherapy-radiotherapy. The numerous studies, including some major randomised trials, dealing with the issue of larynx preservation are reviewed in the present article. A critical comparison of their results and its integration in a consistent approach are difficult, especially because the different options are aimed at different patients. Total laryngectomy and its psychological and social consequences can be avoided in a significant number of patients, although the long term functional outcome is poorly known and the choice of the optimal treatment modality is largely dependent on the expertise and experience of the medical team.
Combined Modality Therapy↗
Aneurysmal bone cysts of the jaws: CT and MR findings.
Two cases of aneurysmal bone cyst of the jaws, one in the mandible and the other in the maxilla, are reported in young girls 7 and 15 years old. One was a primary lesion; the other was associated with fibrous dysplasia. In both cases CT and MR demonstrated characteristic fluid-fluid levels. The diagnosis was confirmed after biopsy and surgical resection of the lesions.
Adolescent↗
[Facial paralysis in children].
Facial paralyses in children may be grouped under headings displaying a certain amount of individuality. Chronologically, first to be described are neonatal facial paralyses. These are common and are nearly always cured within a few days. Some of these cases are due to the mastoid being crushed at birth with or without the use of forceps. The intra-osseous pathway of the facial nerve is then affected throughout its length. However, a cure is often spontaneous. When this desirable development does not take place within three months, the nerve should be freed by decompressive surgery. The special anatomy of the facial nerve in the new-born baby makes this a delicate operation. Later, in all stages of acute otitis, acute mastoiditis or chronic otitis, facial paralysis can be seen. Treatment depends on the stage reached by the otitis: paracentesis, mastoidectomy, various scraping procedures, and, of course, antibiotherapy. The other causes of facial paralysis in children are very much less common: a frigore or viral, traumatic, occur ring in the course of acute poliomyelitis, shingles or tumours of the middle ear. To these must be added exceptional causes such as vitamin D intoxication, idiopathic hypercalcaemia and certain haemopathies.
Adolescent↗
Synovial sarcomas of the head and neck: CT and MR findings.
The authors present three cases of histologically proved synovial sarcoma. CT is useful in assessing erosive or destructive changes in bone, and in demonstrating calcifications. MR characteristics are nonspecific; calcifications within these tumors can be missed on MR. MR can help to assess tumor extension, vascular invasion, and hemorrhage within the tumor.
Adolescent↗
[Salvage esophagoplasty using free jejunal transplant after repeated failure of other esophagoplasties. 25 cases].
Salvage oesophagoplasty using a free jejunal transplant is the ultimate reconstruction possible after repeated failures using the classic procedures of oesophagoplasty. The free jejunal transplant appears to be the best choice. Twenty-five free jejunal transplants were performed by the same surgeon for such reconstructions including 13 cases involving benign lesions and 12 cases of cancer. There were no post-operative death and none of the transplantations was a complete failure although three cases of stenosis and fistulization occurred. Several recommendations can be made: save the existing digestive tract, redissect the residual digestive plasty and pull it up. The residual digestive flap can be examined by opacification or endoscopically in order to evaluate its length. An arteriography of the pediculated plasty gives information on its vascularization. A free jejunal graft can safely cover 25 to 30 cm. When possible, residual plasties should be positioned subcutaneously. The reconstruction of the cervico-thoracic oesophagus usually requires a vascular bypass with a saphene graft. In difficult cases, it may be necessary to remove a part of the sternal manubrium and the head of the clavicular bone in order to avoid compressing the jejunal graft. When the length of the reconstruction is greater than 30 cm, a long jejunal transplant with two pedicules (1 pedicule revascularized from the cervical vessels and the other pedicule from the internal thoracic vessels) is needed. An alternative technique would be a free antebrachial flap (six cases operated with two post-operative deaths at 6 weeks and two fistulas).(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
[Tumors of the mandible. Justification of a second reconstruction after recurrence on the first revascularized bone graft].
The use of free vascularized bone grafts for mandibular reconstruction has led to a consideration of the new entity of recurrent tumour on bone grafts. Exeresis of the mandible was performed in 4 patients with bone tumours: osteosarcoma 1, osteochondroma 1, carcinoma 1 and ameloblastoma 1. A free vascularized bone graft was used for the reconstruction. Tumours recurred with a delay of 10 to 18 months after the initial reconstruction. The frequency of tumoural recurrence can be measured in our series of 46 patients (24 with fibular grafts, 15 with scapular grafts, 4 with radius grafts and 3 with iliac bone grafts). Recurrence rate at our institution was 4.3%. The 2 other cases involved patients from other institutions. The main factor involved in tumoural recurrence is the aggressive nature of the primary tumours, even after extensive initial resection as performed in our patients. Free bone grafts were invaded as were neighbouring tissues. Secondary reconstruction of the mandible was performed in 3 cases with a fibula graft. In the fourth patient, no operation was possible due to the diffuse nature of the invasion and the poor status of the patient's vessels and general health. Local extension, and not the tumour histology, is the main factor in deciding upon reoperation. The explosive nature of recurrences is linked more to the aggressive character of the tumour than to the status of the revascularized free bone graft. Secondary reconstruction is justified after recurrence on bone grafts depending on the complexity of the major resection involving extensive tissue exeresis.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
[Complete reconstruction of the nose using a prefabricated free forearm graft].
The aim of prefabricated free transplants is to create a composite graft including a vascular pedicle with artery and vein, a muscle and its nerve, cellular tissue, bony tissue, cartilage, periosteum, and skin with its sensory nerve. This composite transplant is entirely constructed and modelled around the chosen vascular pedicle beforehand. Once the various materials of the future graft are removed and put in contact with the vascular pedicle, the subsequent neovascularisation should nourish the different elements. The vasculonervous pedicle, with the graft, are transplanted five weeks after preconstruction, revascularized and reinnervated. With these free prefabricated transplants, graft tissue which does not exist in the organism can be created. Cosmetic sequellae can be avoided since the vascular pedicle is chosen beforehand. Ear-nose-throat and plastic surgeons have used local structural preconstruction for many years, especially for ear reconstruction. The work presented here has the original feature of revascularized free transplant. From 1988, we have performed two complete reconstructions of the nose using a free forearm transplant modelled into a nasal pyramid. The classical techniques could not be used. In the first case a radius strut was used to form the nasal crest. In the second a chondrocostal cartilage was used. Transplantation was performed five weeks after preconstruction. In both cases, transplant viability was excellent but the cosmetic and functional results were less than satisfactory and required reoperation.
Adult↗
[Posterior pharyngectomy. Reconstruction using a free antebrachial transplant].
Cancers of the posterior wall of the oro or hypopharynx are rare and do not invade the larynx or the oesophageal orifice. Previously, these cancers were treated with radiotherapy alone, but since 1981 new techniques in reconstruction surgery have allowed a surgical approach. Cancerological non-mutilating exeresis is possible, but reconstruction is difficult since the flap must be very thin to allow normal food intake. In addition, flap reliability is extremely important due to the gravity of cervical salivary fistulation. We treated 15 patients with a lesion of the posterior wall of the pharynx using posterior pharyngectomy and reconstruction with a free antebrachial transplant which was revascularized and reinnervated. In two cases, the operation was performed in patients who had had previous radiotherapy. A branch of the external carotid and the internal jugular vein were used for vascular microanastomoses and reinnervation was obtained using the superficial cervical plexus. The transplant was placed over the prevertebral aponevrosis and sutured to the remaining pharyngeal mucosa. One postoperative death due to heart disease occurred at D + 11. All reconstructions were successful and two salivary fistulas on irradiated tissue closed spontaneously. Postoperative radiotherapy was performed in 11 cases (50-65 Gy) and was well tolerated. These results demonstrate that a highly flexible and thin free forearm transplant is perfectly adapted to reconstruction after posterior pharyngectomy. It is more reliable than local pediculated flaps.
Adult↗
[Multiple free transplants in microsurgery for cervicofacial reconstruction].
Microsurgical techniques open the way for much creativity and originality for cervicofacial reconstruction and tumoral repair. Between 1976 and 1994, we performed 481 free transplants for cervico-facial reconstruction. A recently developed strategy has been the use of multiple free transplants, either simultaneously or successively. Between 1990 and 1994, we operated and reconstructed 9 patients using multiple free cervico-cephalic transplants after multitissular and agressive exeresis for tumoral or traumatic lesions. In 3 cases, the transplants were made simultaneously and in the 6 others successively. Three patients received 3 free transplants and 6 patients had 2. In 8 cases, each of the transplants was micro-anastomosed on different vessels. In one case, the two transplants were anastomosed in series, the most distal portion being connected to the most proximal portion (in comparison with the cervical vessels). One death occurred at 6 weeks due to infectious complications. The final result for the 8 other patients was good both morphologically and functionally. Indications for multiple free transplants include: complex tissue loss, multiple and massive tissue loss of the cervicocephalic region. This situation occurs particularly in case of voluminous tumours invading several structures, in multiple tumours and in firearm wounds. These series of patients allowed a definition of recommended techniques in case of difficulties in these very elaborate surgical procedures and confirmed that if the strategy is correctly planned, it is possible to greatly improve the quality of survival in these patients in terms of aesthetics, morphology and function.
Adolescent↗