Publications by authors named "Renaud Garrel"

46 Publications

Upfront surgery or definitive radiotherapy for p16+ oropharyngeal cancer. A GETTEC multicentric study.

Eur J Surg Oncol 2020 Dec 31. Epub 2020 Dec 31.

University Institute of the Face and Neck, Antoine Lacassagne Centre, Côte D'Azur University, Nice, France.

Background: The aim of this study was to assess the impact of the initial therapeutic strategy on oncologic outcomes in patients with HPV-positive OPSCC.

Methods: All p16-positive OPSCCs treated from 2009 to 2014 in 7 centers were retrospectively included and classified according to the therapeutic strategy: surgical strategy (surgery ± adjuvant radiotherapy and chemotherapy) vs. non-surgical strategy (definitive radiotherapy ± chemotherapy). Univariate, multivariate propensity score matching analyses were performed to compare overall (OS), disease-specific (DSS) and recurrence-free survival (RFS).

Results: 382 patients were included (surgical group: 144; non-surgical group: 238). Five-year OS, DSS and RFS were 89.2, 96.8 and 83.9% in the surgical group and 84.2, 87.1 and 70.4% in the non-surgical group, respectively. These differences were statistically significant for DSS and RFS after multivariate analysis, but only for RFS after propensity score matching analysis.

Conclusion: In p16+ OPSCC patients, upfront surgery results in higher RFS than definitive radiotherapy ± chemotherapy but does not impact OS.
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http://dx.doi.org/10.1016/j.ejso.2020.12.011DOI Listing
December 2020

Oropharyngeal cancer: First relapse description and prognostic factor of salvage treatment according to p16 status, a GETTEC multicentric study.

Eur J Cancer 2021 Jan 14;143:168-177. Epub 2020 Dec 14.

Department of Head and Neck Surgery, Georges Pompidou European Hospital, Paris, France.

Introduction: Although Human Papilloma Virus (HPV)-driven oropharyngeal cancer (OPC) prognosis is significantly better than that of other head and neck cancers, up to 25% of cases will recur within 5 years. Data on the pattern of disease recurrence and efficiency of salvage treatment are still sparse.

Material And Method: Observational study of all recurrent OPCs diagnosed, following a curative intent treatment, in seven French centers from 2009 to 2014. p16 Immunohistochemistry was used to determine HPV status. Clinical characteristics, distribution of recurrence site, and treatment modalities were compared by HPV tumor status. Overall survival was examined using Kaplan-Meier and multivariate Cox regression modeling.

Results: 350 recurrent OPC patients (246 p16-negative and 104 p16-positive patients). The site of recurrence was more frequently locoregional for p16-negative patients (65.4% versus 52.9% in p16-positive patients) and metastatic for p16-positive patients (47.1% versus 34.6% in p16-patients, p = 0.03). Time from diagnosis to recurrence did not differ between p16-positive and p16-negative patients (12 and 9.6 months, respectively, p-value = 0.2), as the main site of distant metastasis (all p-values ≥0.10). Overall and relapse-free survival following the first recurrence did not differ according to p16 status (p-values from log-rank 0.30 and 0.40, respectively). In multivariate analysis, prognosis factors for overall survival in p16-negative patients were distant metastasis (HR 2.11, 95% CI 1.30-3.43) and concurrent local and regional recurrences (HR 2.20, 95% CI 1.24-3.88).

Conclusion: With the exception of the initial site of recurrence, the pattern of disease relapse and the efficiency of salvage treatment are not different between p16-positive and negative OPCs.
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http://dx.doi.org/10.1016/j.ejca.2020.10.034DOI Listing
January 2021

Mucoepidermoid carcinoma of salivary glands: A French Network of Rare Head and Neck Tumors (REFCOR) prospective study of 292 cases.

Eur J Surg Oncol 2020 Nov 21. Epub 2020 Nov 21.

Service d'ORL et Chirurgie Cervico-Faciale, Centre Hospitalier Universitaire La Conception, 147 Boulevard Baille, 13005, Marseille, France; Aix Marseille Univ, Marseille, France; REFCOR (Réseau d'Expertise Français sur Les Cancers ORL Rares), Paris, France. Electronic address:

Background: To describe the characteristics of the largest European study of MEC of salivary glands and to determine the prognostic factors for overall and disease free survival.

Patients And Methods: Patients with MEC were prospectively included in the Réseau d'Expertise Français sur les Cancers ORL Rares (REFCOR, French Network of Rare Head and Neck Tumors) database between 2009 and 2015.

Results: A total of 292 patients were included. Tumors were classified as low grade in 175 cases (60%), intermediate in 39 (13%) and high grade in 78 (27%). Median follow-up was 26 months. The 5-year OS and DFS rates were respectively 83% and 69%. In multivariate analysis, age (p = 0.004), diabetes (p = 0.02) and advanced stage (p = 0.03) were found to have a significant negative impact on OS. Diabetes (p = 0.001), alcohol consumption (p = 0.003) and advanced stage (p = 0.001) were found to have a significant negative impact on DFS. Compare to low grade, high grade tended to have a negative impact on OS (p = 0.05) and had a significant effect on DFS (0.002) while intermediate grade had no significant influence on survival. The surgical treatment had a positive impact on both OS (p = 0.00005) and DFS (p = 0.0005). Postoperative radiotherapy had no impact in multivariate analysis.

Conclusion: Advanced clinical stage, high grade tumor, high age, the impossibility of carrying out a complete surgical resection, and diabetes are the main prognostic factors in this prospective series of patients with MEC. Such findings open new research perspectives on the influence of these components on initial patient care.
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http://dx.doi.org/10.1016/j.ejso.2020.11.123DOI Listing
November 2020

Synchronous primary neoplasia in patients with oropharyngeal cancer: Impact of tumor HPV status. A GETTEC multicentric study.

Oral Oncol 2021 Jan 28;112:105041. Epub 2020 Oct 28.

University Institute of the Face and Neck, Antoine Lacassagne Centre, Côte d'Azur University, Nice, France. Electronic address:

Introduction: Patients with oropharyngeal squamous cell carcinoma (OPSCC) display a significant risk of synchronous primary neoplasia (SPN) which could impact their management. The aims of this study were to evaluate the risk and distribution of SPN in OPSCC patients according to their HPV (p16) status, the predictive factors of SPN and the impact of SPN on therapeutic strategy and oncologic outcomes.

Material And Methods: All OPSCC patients treated from 2009 to 2014 were included in this multicentric retrospective study. Univariate analyses were conducted using Chi-2 and Fisher exact tests. For multivariate analyses, all variables associated with a p ≤ 0.10 in univariate analysis were included in logistic regression models.

Results: Among the 1291 patients included in this study, 75 (5.8%) displayed a SPN which was preferentially located in the upper aerodigestive tract, lung and esophagus. Comorbidity level (p = 0.03), alcohol (p = 0.005) and tobacco (p = 0.01) consumptions, and p16 tumor status (p < 0.0001) were significant predictors of SPN. In multivariate analysis, p16+ status was significantly associated with a lower risk of SPN (OR = 0.251, IC95% [0.133;0.474]). Patients with a SPN were more frequently referred for non-curative treatment (p = 0.02). In patients treated with curative intent, there was no impact of SPN on the therapeutic strategy (surgical vs. non-surgical treatment). We observed no overall survival differences between patients with or without SPN.

Conclusion: P16 tumor status is the main predictive factor of SPN in OPSCC patients. This study provides crucial results which should help adapt the initial work-up and the global management of OPSCC patients.
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http://dx.doi.org/10.1016/j.oraloncology.2020.105041DOI Listing
January 2021

Equivalence Randomized Trial to Compare Treatment on the Basis of Sentinel Node Biopsy Versus Neck Node Dissection in Operable T1-T2N0 Oral and Oropharyngeal Cancer.

J Clin Oncol 2020 Dec 14;38(34):4010-4018. Epub 2020 Oct 14.

Head Neck Surgery Department, Montpellier University Hospital Center, Montpellier, France.

Purpose: Sentinel node (SN) biopsy is accurate in operable oral and oropharyngeal cT1-T2N0 cancer (OC), but, to our knowledge, the oncologic equivalence of SN biopsy and neck lymph node dissection (ND; standard treatment) has never been evaluated.

Methods: In this phase III multicenter trial, 307 patients with OC were randomly assigned to (1) the ND arm or (2) the SN arm (experimental arm: biopsy alone if negative, or followed by ND if positive, during primary tumor surgery). The primary outcome was neck node recurrence-free survival (RFS) at 2 years. Secondary outcomes were 5-year neck node RFS, 2- and 5-year disease-specific survival (DSS), and overall survival (OS). Other outcomes were hospital stay length, neck and shoulder morbidity, and number of physiotherapy prescriptions during the 2 years after surgery.

Results: Data on 279 patients (139 ND and 140 SN) could be analyzed. Neck node RFS was 89.6% (95% CI, 0.83% to 0.94%) at 2 years in the ND arm and 90.7% (95% CI, 0.84% to 0.95%) in the SN arm, confirming the equivalence with < .01. The 5-year RFS and the 2- and 5-year DSS and OS were not significantly different between arms. The median hospital stay length was 8 days in the ND arm and 7 days in the SN arm ( < .01). The functional outcomes were significantly worse in the ND arm until 6 months after surgery.

Conclusion: This study demonstrated the oncologic equivalence of the SN and ND approaches, with lower morbidity in the SN arm during the first 6 months after surgery, thus establishing SN as the standard of care in OC.
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http://dx.doi.org/10.1200/JCO.20.01661DOI Listing
December 2020

Upfront surgery or definitive radiotherapy for patients with p16-negative oropharyngeal squamous cell carcinoma. A GETTEC multicentric study.

Eur J Surg Oncol 2021 Feb 10;47(2):367-374. Epub 2020 Sep 10.

University Institute of the Face and Neck, Antoine Lacassagne Centre, Côte d'Azur University, Nice, France.

Introduction: Therapeutic management of oropharyngeal squamous cell carcinomas (OPSCC) is still debated. Since the role of HPV was demonstrated, few studies have focused on HPV-negative OPSCC. The aim of our study was to assess the impact of therapeutic strategy (surgical vs. non-surgical) on oncologic outcomes in patients with HPV-negative OPSCC.

Material And Method: All p16-negative OPSCCs treated from 2009 to 2014 in 7 tertiary-care centers were included in this retrospective study and were classified according to the therapeutic strategy: surgical strategy (surgery ± adjuvant radiotherapy and chemotherapy) vs. non-surgical strategy (definitive radiotherapy ± chemotherapy). Patients not eligible for surgery (unresectable tumor, poor general-health status) were excluded. Univariate, multivariate and propensity score matching analyses were performed to compare overall (OS), disease-specific (DSS) and recurrence-free survival (RFS).

Results: Four hundred seventy-four (474) patients were included in the study (surgical group: 196; non-surgical group: 278). Five-year OS, DSS and RFS were 76.5, 81.3 and 61.3%, respectively, in the surgical group and 49.9, 61.8 and 43.4%, respectively, in the non-surgical group. The favorable impact of primary surgical treatment on oncologic outcomes was statistically significant after multivariate analysis. This effect was more marked for locally-advanced than for early-stage tumors. Propensity score matching analysis confirmed the prognostic impact of primary surgical treatment for RFS.

Conclusion: Therapeutic strategy is an independent prognostic factor in patients with p16-negative OPSCC and primary surgical treatment is associated with improved OS, DSS and RFS. These results suggest that surgical strategy is a reliable option for advanced stage OPSCC.
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http://dx.doi.org/10.1016/j.ejso.2020.07.034DOI Listing
February 2021

Oral and oropharyngeal cancer surgery with free-flap reconstruction in the elderly: Factors associated with long-term quality of life, patient needs and concerns. A GETTEC cross-sectional study.

Surg Oncol 2020 Dec 20;35:81-88. Epub 2020 Aug 20.

University Cancer Institute of Toulouse - Oncopole, Toulouse, France.

Objectives: To assess the factors associated with long-term quality of life (QoL) and patient concerns in elderly oral or oropharyngeal cancer (OOPC) patients after oncologic surgery and free-flap reconstruction.

Methods: Patients aged over 70 years who were still alive and disease-free at least 1 year after surgery were enrolled in this cross-sectional multicentric study. Patients completed the EORTC QLQ-C30, -H&N35 and -ELD14 QoL questionnaires, and the Hospital Anxiety and Depression Scale (HADS). Patient needs were evaluated using the Patient Concerns Inventory (PCI). Factors associated with these clinical outcomes were determined in univariate and multivariate analysis.

Results: Sixty-four patients were included in this study. Long-term QoL, functioning scales and patient autonomy were well-preserved. Main persistent symptoms were fatigue, constipation and oral function-related disorders. Salivary and mastication/swallowing problems were the main patient concerns. The mean number of patient concerns increased with the deterioration of their QoL. Psychological distress (HADS score ≥ 15) and patient frailty (G8 score < 15) were significantly associated with poor QoL outcomes.

Conclusions: We found a negative correlation between the number of patient concerns and QoL. Dental rehabilitation and psychological and nutritional supportive measures are of critical importance in the multidisciplinary management of elderly OOPC patients.
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http://dx.doi.org/10.1016/j.suronc.2020.08.014DOI Listing
December 2020

Circulating Tumor Cells as a Prognostic Factor in Recurrent or Metastatic Head and Neck Squamous Cell Carcinoma: The CIRCUTEC Prospective Study.

Clin Chem 2019 10 6;65(10):1267-1275. Epub 2019 Aug 6.

Laboratory of Rare Human Circulating Cells (LCCRH), University Medical Center of Montpellier, Montpellier, France;

Background: This prospective multicenter study evaluated the prognostic value of circulating tumor cells (CTCs) in relapsing nonoperable or metastatic head and neck squamous cell carcinoma (rHNSCC) treated by chemotherapy and cetuximab.

Methods: In 65 patients suitable for analyses, peripheral blood was taken at day 0 (D) D, and D of treatment for CTC detection by CellSearch, EPISPOT, and flow cytometry (FCM). Progression-free survival (PFS) was assessed with the Kaplan-Meier method and compared with the log-rank test ( < 0.05).

Results: At D, CTCs were detected with EPISPOT, CellSearch, and FCM in 69% (45/65), 21% (12/58), and 11% (7/61) of patients, respectively. In the patients tested with all 3 methods, EPISPOT identified 92% (36/39), 92% (35/38), and 90% (25/28) of all positive samples at D, D, and D, respectively. Median PFS time was significantly lower in () patients with increasing or stable CTC counts (36/54) from D to D with EPISPOT (3.9 vs 6.2 months; 95% CI, 5.0-6.9; = 0.0103) and () patients with ≥1 CTC detected with EPISPOT or CellSearch (37/51) ( = 0.0311), EPISPOT or FCM (38/54) ( = 0.0480), and CellSearch or FCM (11/51) ( = 0.0005) at D.

Conclusions: CTCs can be detected before and during chemotherapy in patients with rHNSCC. D-D CTC kinetics evaluated with EPISPOT are associated with the response to treatment. This study indicates that CTCs can be used as a real-time liquid biopsy to monitor the early response to chemotherapy in rHNSCC.

Clinicaltrialsgov Identifier: NCT02119559.
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http://dx.doi.org/10.1373/clinchem.2019.305904DOI Listing
October 2019

Prevalence and characteristics of HPV-driven oropharyngeal cancer in France.

Cancer Epidemiol 2019 08 31;61:89-94. Epub 2019 May 31.

Department of Biopathology, University Hospital of Montpellier, France.

Background: France has one of the highest incidence of head and neck cancers in Europe. Despite this, the epidemiological impact of high-risk human papilloma virus (HR-HPV) remains poorly investigated.

Methods: We prospective assessed the proportion of oropharyngeal cancers due to HR-HPV in 15 hospitals throughout France. HPV-status was determined by p16-immunohistochemistry, and by detection of HPV-DNA using in situ hybridization. Cancers were classified as HPV-driven if both p16-immunohistochemistry and HPV-DNA assays were positive. Demographical and clinical features were recorded.

Results: 291 patients with palatine-tonsil or tongue-base cancers were recruited from March-2011 to July-2012. Of these, 43.1% of samples were p16-positive and 37.7% were positive for both p16 and HPV-DNA. Prognosis was significantly better in patients with HPV-driven cancers, with smoking negatively impacting patients' oncological outcomes.

Conclusion: In France, more than a third of tonsillar and tongue base cancers are HPV-driven. More research concerning the evolution of HPV-driven cancers over time is needed.
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http://dx.doi.org/10.1016/j.canep.2019.05.007DOI Listing
August 2019

Surgical consensus guidelines on sentinel node biopsy (SNB) in patients with oral cancer.

Head Neck 2019 08 21;41(8):2655-2664. Epub 2019 Mar 21.

Head and Neck Academic Centre, Department of Head and Neck Surgery, University College London Hospital, London, UK.

Background: The eighth international symposium for sentinel node biopsy (SNB) in head and neck cancer was held in 2018. This consensus conference aimed to deliver current multidisciplinary guidelines. This document focuses on the surgical aspects of SNB for oral cancer.

Method: Invited expert faculty selected topics requiring guidelines. Topics were reviewed and evidence evaluated where available. Data were presented at the consensus meeting, with live debate from panels comprising expert, nonexpert, and patient representatives followed by voting to assess the level of support for proposed recommendations. Evidence review, debate, and voting results were all considered in constructing these guidelines.

Results/conclusion: A range of topics were considered, from patient selection to surgical technique and follow-up schedule. Consensus was not achieved in all areas, highlighting potential issues that would benefit from prospective studies. Nevertheless these guidelines represent an up-to-date pragmatic recommendation based on current evidence and expert opinion.
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http://dx.doi.org/10.1002/hed.25739DOI Listing
August 2019

Cetuximab pharmacokinetic/pharmacodynamics relationships in advanced head and neck carcinoma patients.

Br J Clin Pharmacol 2019 06 13;85(6):1357-1366. Epub 2019 Apr 13.

Laboratory of Pharmacology, Institut Claudius Regaud, IUCT-Oncopole, Toulouse, France.

Aims: Cetuximab associated with cisplatin and 5-fluorouracil is used to treat patients with inoperable or metastatic head and neck squamous cell carcinomas (HNSCC) up until disease progression or unacceptable toxicities. To date, no biomarkers of efficacy are available to select patients who will benefit from treatment.

Methods: An ancillary pharmacokinetics (PK) exploration was performed in the context of a prospective study investigating circulating-tumour cells vs progression-free survival (PFS). Cetuximab plasma concentrations were analysed according to a population PK model. Individual exposure parameters were confronted with soluble epidermal growth factor receptor (sEGFR) concentrations, tumour response and PFS.

Results: PK data (28 patients, 203 observations) were best described by a two-compartment model with linear elimination. Performance status (PS) significantly correlated to both cetuximab clearance and central volume of distribution with both parameters increasing by 33.3% (95% CI 1-65.6) for each 1-point increase of PS compared to PS = 0. Univariate analysis showed that patients with higher trough cetuximab concentrations at Day 7 (C ) had better tumour response (P = 0.03) and longer PFS (P = 0.035). However, multivariate analysis revealed that only PS and tumour size at baseline remained significantly associated with PFS. Levels of sEGFR increased during cetuximab treatment but were not associated with PFS in the multivariate analysis.

Conclusions: Our study prospectively indicates that PS is likely a confounding factor in the relationship between cetuximab PK and PFS, patients with a poor PS having lower cetuximab plasma exposure and lower PFS.
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http://dx.doi.org/10.1111/bcp.13907DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6533440PMC
June 2019

Salivary duct carcinoma: Prospective multicenter study of 61 cases of the Réseau d'Expertise Français des Cancers ORL Rares.

Head Neck 2019 03 13;41(3):584-591. Epub 2018 Nov 13.

Réseau d'Expertise Français des Cancers ORL Rares: (REFCOR, French Rare Head and Neck Cancer Expert Network): S. Albert, G. Andry, E. Babin, C. Bach, J.-M. Badet, C. Badoual, A.C. Baglin, A. Banal, B. Barry, E. Baudin, B. Baujat, R.J. Bensadoun, C. Bertolus, J.-P. Bessède, D. Blanchard, C. Borel, A. Bozorg-Grayeli, R. Breheret, P. Breton, L. Brugel, G. Calais, O. Casiraghi, E. Cassagnau, L. Castillo, P. Ceruse, F. Chabolle, D. Chevalier, J.C. Chobaut, O. Choussy, A. Cosmidis, A. Coste, V. Costes, L. Crampette, V. Darrouzet, P. Demez, P. Dessi, B. Devauchelle, G. Dolivet, F. Dubrulle, S. Duflo, X. Dufour, S. Faivre, N. Fakhry, C. Ferron, F. Floret, L. de Gabory, R. Garrel, L. Geoffrois, L. Gilain, A. Giovanni, A. Girod, B. Guerrier, S. Hans, P. Herman, P. Hofman, M. Housset, R. Jankowski, F. Jegoux, M. Juliéron, M.-C. Kaminsky, F. Kolb, J. Lacau St Guily, L. Laccoureye, B. Lallemant, P. Lang, E. Lartigau, J.-P. Lavieille, M. Lefevre, X. Leroy, O. Malard, F. Massip, O. Mauvais, J.-C. Merol, J. Michel, T. Mom, S. Morinière, E. de Monès, G. Moulin, G. Noel, G. Poissonnet, J.-M. Prades, D. de Raucourt, E. Reyt, C. Righini, Y. Marie Robin, F. Rolland, B. Ruhin, N. Sarroul, P. Schultz, E. Serrano, O. Sterkers, V. Strunski, A. Sudaka, M. Tassart, S. Testelin, J. Thariat, A. Timochenko, B. Toussaint, E. Uro Coste, G. Valette, T. Van den Abbeele, A. Varoquaux, F. Veillon, S. Vergez, M. Wassef.

Background: The purposes of this study were to describe the characteristics of a prospective multicenter series of patients with salivary duct carcinoma and to investigate prognostic factors.

Methods: Patients included for salivary duct carcinoma between 2009 and 2016 in the Réseau d'Expertise Français des Cancers ORL Rares (REFCOR) database were selected. Immunohistochemical analyses were performed.

Results: Sixty-one patients were included in this study. The primary site was the parotid gland in 90% of the cases. Fifty-seven percent of the tumors were stage IV, 65% of patients had lymph node involvement, and 10% had metastases. Tumors showed androgen receptor (89%) and human epidermal growth factor receptor 2 (HER2)/neu (36%). Ninety-four percent of patients underwent surgery and 86% had postoperative radiotherapy. Six patients were treated with targeted therapies. The 3-year overall survival (OS) was 74% and the 3-year disease-free survival (DFS) was 44%. Tumor stages III to IV reduced DFS (hazard ratio [HR] 4.3; P = .04). The N2/3 class reduced distant metastasis-free survival (HR 7.3; P = .007).

Conclusion: Salivary duct carcinoma prognosis is poor and is correlated with tumor stage and lymph node classification. Androgen receptor and HER2/neu should be tested as they offer the possibility of targeted therapies.
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http://dx.doi.org/10.1002/hed.25194DOI Listing
March 2019

Oncological and functional outcomes of trans-oral robotic surgery for pyriform sinus carcinoma: A French GETTEC group study.

Oral Oncol 2018 11 25;86:165-170. Epub 2018 Sep 25.

Department of Surgery, University Cancer Institute Toulouse-Oncopole University Hospital of Toulouse, 1 Avenue Irène Joliot-Curie, 31059 Toulouse, France. Electronic address:

Background: Pyriform sinus carcinomas (SCC) present specific functional and oncological issues. The recent advent of trans-oral robotic surgery (TORS), as a conservative procedure, has opened up new perspectives.

Objectives: To present the oncological and functional outcomes of TORS for pyriform sinus SCC.

Materials And Methods: We included, retrospectively, all TORS procedures for pyriform sinus SCC performed between 2009 and 2017 in eight French tertiary referral centers. We excluded lesions involving the pyriform sinus that had developed from the oropharynx, larynx, or other anatomic sub-sites of the hypopharynx.

Results: We included 57 TORS procedures. Median hospital stay was 10 days. A preventive tracheotomy was performed in seven cases (12%), and all were successfully decannulated. Oral re-feeding was possible for 93%, after a median of 5 days. The main surgical complications were hemorrhages (three cases), all successfully handled, although 2 patients with heavy comorbidities died from blood loss in the days after. Adjuvant therapy was proposed in 31 cases (54%), including two cases of salvage surgery (total pharyngolaryngectomy). After a median follow-up of 23 months, overall and disease-free survival were, respectively, 84% and 74% at 24 months, and 66% and 50% at 48 months. At the end of follow-up, organ preservation rate was 96%. None of the surviving patients needed a tracheotomy and oral diet was possible for 96%.

Conclusion: The functional and oncological outcomes of TORS for pyriform sinus cancer are encouraging, and this procedure can be considered safe for selected early or moderately advanced cases as a conservative treatment.
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http://dx.doi.org/10.1016/j.oraloncology.2018.09.014DOI Listing
November 2018

A posttraumatic cervical hematoma with emphysema.

J Trauma Acute Care Surg 2018 Oct;85(4):823-824

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http://dx.doi.org/10.1097/TA.0000000000002026DOI Listing
October 2018

Impact of HPV-associated p16-expression and other clinical factors on therapeutic decision-making in patients with oropharyngeal cancer: A GETTEC multicentric study.

Eur J Surg Oncol 2018 12 25;44(12):1908-1913. Epub 2018 May 25.

Institut Universitaire de la Face et du Cou, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France. Electronic address:

Objectives: To analyze the impact of tumor p16 status and other clinical factors on the therapeutic decision-making process in patients with oropharyngeal squamous cell carcinoma (OPSCC).

Methods: We conducted a multicenter retrospective study (GETTEC collaborative study group) enrolling all OPSCC patients with a determined p16-status considered eligible for surgery between 2009 and 2014. The impact of p16-status and other clinical factors on the therapeutic decision was evaluated in multivariate analysis.

Results: A total of 476 patients were enrolled in the study, including 244 cases (51%) of p16-positive OPSCC. Overall, 223 (47%) patients underwent primary surgery, and 184 (83%) of them received postoperative radiotherapy ± chemotherapy. More patients with p16-positive OPSCC tended to undergo non-surgical treatment than did patients with p16-negative OPSCC (p = 0.10). Multivariate analysis showed that 5 factors significantly influenced therapeutic management of the patients: T-stage ≥ 3 (towards a non-surgical strategy; p < 0.001), N-stage ≥ 2a (non-surgical strategy; p = 0.02), tumor involvement of the glosso-tonsillar sulcus (surgical strategy; p = 0.002), tumor extension to the oral cavity (surgical strategy; p < 0.009) and the center of care (p < 0.001). The rate of patients directed towards a surgical strategy varied between 9% and 74% depending on the center.

Conclusion: There was a non-significant trend to recommend patients with p16-positive OPSCC for non-surgical treatment. Center of care, tumor stage and tumor anatomical subsite and extensions were the main determinants of the treatment choice.
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http://dx.doi.org/10.1016/j.ejso.2018.05.022DOI Listing
December 2018

Magnetic Resonance Imaging of Parotid Gland Tumors: Dynamic Contrast-Enhanced Sequence Evaluation.

J Comput Assist Tomogr 2017 Jul/Aug;41(4):541-546

From the *Department of Radiology, University Hospital Center, Hopital Carémeau, Nîmes; †Department of Radiology, Institut du Cancer de Montpellier, Clinique du Val d'Aurelle; ‡Department of Neuroradiology, University Hospital Center, Hôpital Gui de Chauliac; §Department of Medical Informatics, Clinique Beausoleil, Montpellier Cedex; ∥Department of Radiology, Clinique du Parc, Castelnau-le-lez; Departments of ¶Radiology and #Otorhinolaryngology, Clinique Beausoleil; and **Department of Otorhinolaryngology, University Hospital Center, Hôpital Gui de Chauliac, Montpellier Cedex, France.

Objective: The aim of the study was to evaluate dynamic contrast-enhanced magnetic resonance (MR) imaging in the characterization of parotid gland tumors.

Methods: Fifty-five parotid lesions in 55 patients were retrospectively included. Two observers interpreted 2 reading protocols derived from all MR imaging in 2 distinct sessions, independently and blinded. Benign versus malignant distinction was carried out for protocol 1 (without contrast administration) and protocol 2 (with dynamic contrast-enhanced sequence). Histopathological results after surgical resection were used as the criterion standard. Diagnostic accuracy was compared between protocols using McNemar test. A P values of less than 0.05 indicated significant difference.

Results: There was no intraobserver statistical discordance between protocols for both observers (P = 0.27 and P = 1). Interobserver reliability showed moderate agreement for protocol 1 (κ = 0.591; 95% confidence interval [CI], 0.376-0.806) and 2 (κ = 0.463, 95% CI, 0.226-0.701). Intraobserver reliability showed moderate agreement for observer 1 (κ = 0.507; 95% CI, 0.279-0.736) and 2 (κ = 0.477; 95% CI, 0.241-0.712).

Conclusions: Magnetic resonance imaging protocol including dynamic sequence for the characterization of parotid gland lesion yielded nonsignificant increases in sensitivity, specificity, or positive predictive values, and negative predictive values over noninjected protocol.
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http://dx.doi.org/10.1097/RCT.0000000000000553DOI Listing
August 2017

Atypical presentations of sinonasal inverted papilloma: Surgical management and influence on the recurrence rate.

Am J Rhinol Allergy 2016 Mar-Apr;30(2):149-54

Department of Ear, Nose and Throat and Head and Neck Surgery, University Hospital Gui de Chauliac, University of Montpellier, Montpellier, France.

Background: Sinonasal inverted papilloma (SNIP), classically, is a unilateral benign tumor of the nasal lateral wall. Numerous variations have been observed, depending on location, bilateral presentation, or association with nasal polyposis.

Objective: The aim of this work was to describe atypical presentations of SNIPs with their management specificities and to assess their influence on the recurrence rate in a large case series.

Methods: A retrospective single center study of 110 patients treated for SNIP. Atypical inverted papillomas were identified according to the following criteria: (1) unusual location (frontal, posterior, anterior), (2) bilateral involvement, and (3) association with nasal polyposis. Surgical management was detailed, and the influence of each atypical group on recurrence was assessed by using Kaplan-Meier survival curves and the log-rank test.

Results: Distribution of atypical presentations was as follows: frontal sinus localization (10.9%); posterior localization, including sphenoid sinus (9%); nasal anterior localization (3.6%); bilateral involvement (3.6%); and nasal polyposis association (10%). The surgical approach was endoscopic (74.5%), external (5.5%), or combined endoscopic and external (20%). Except for nasal anterior localization, all the groups were associated with a higher recurrence rate, without reaching statistical significance.

Conclusion: Recurrence rates for these atypical presentations arise from their specific surgical challenges. The choice of the surgical technique is guided by tumor location and extension, and by the surgeon's experience; the main objective is a complete resection. The endoscopic endonasal approach is the most frequent procedure.
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http://dx.doi.org/10.2500/ajra.2016.30.4288DOI Listing
December 2016

Robot-assisted transaxillary thyroidectomy: surgical technique.

Eur Ann Otorhinolaryngol Head Neck Dis 2015 Jun 13;132(3):153-6. Epub 2015 May 13.

Service d'ORL et Chirurgie Cervico-Faciale, CHU, Hôpital Gui-de-Chauliac, Université Montpellier 1, 80, avenue Augustin-Fliche, 34295 Montpellier cedex, France.

Robot-assisted transaxillary thyroid surgery avoids the need for a neck incision. It consists of thyroid lobectomy and isthmectomy for moderately large unilateral benign nodules. The surgical imperatives are the same as for conventional surgery, but with differences in terms of patient positioning, surgical incision, equipment, surgical technique and indications. The purpose of this article is to describe the equipment, patient positioning and surgical technique of exclusive robot-assisted transaxillary total thyroid lobectomy and isthmectomy.
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http://dx.doi.org/10.1016/j.anorl.2015.04.002DOI Listing
June 2015

Adult sinonasal soft tissue sarcoma: analysis of 48 cases from the French Sarcoma Group database.

Laryngoscope 2015 Mar 3;125(3):615-23. Epub 2014 Sep 3.

Département de pathologie, Centre hospitalo-universiatire Gui de Chauliac.

Objective: The aim of this study was to determine the frequency of primary sinonasal adult sarcoma, identify histological subtypes, and analyze prognostic factors.

Study Design: Retrospective review.

Method: Forty-eight adult sinonasal sarcomas included in the French Sarcoma Group database (Conticabase) were reviewed.

Results: The most frequent tumor types were alveolar rhabdomyosarcoma (33.3%), embryonal rhabdomyosarcoma (14,6%), unclassified sarcoma (14.6%), and leiomyosarcoma (12.5%). All round cell tumors were rhabdomyosarcomas. The 5-year overall survival (OS), metastasis-free survival (MFS), and local recurrence-free survival (LRFS) rates were 62.3%, 73%, and 88.8%, respectively. Histotype was a prognostic factor for OS, MFS, and LRFS, with the worst prognosis associated with rhabdomyosarcomas, regardless of the subtype. The tumor grade influenced the OS and MFS. Surgery was a predictive factor for a complete response.

Conclusions: These results suggest that sinonasal tract should be considered as an unfavorable site for rhabdomyosarcoma. Moreover, surgery should always be considered in treatment.
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http://dx.doi.org/10.1002/lary.24910DOI Listing
March 2015

Anterior mediastinal tracheostomy as salvage operation.

Ann Thorac Surg 2014 Sep 16;98(3):1026-33. Epub 2014 Jul 16.

General Thoracic Surgery Department, Hospital Clinic, Universidad de Barcelona, Barcelona, Spain. Electronic address:

Background: This study aimed to assess early and long-term results after anterior mediastinal tracheostomy (AMT) as a salvage operation for recurrent neck malignancies.

Methods: Between October 2006 and February 2013, 12 patients (mean age, 57 years) underwent AMT. All patients had experienced stomal recurrence, with or without esophageal involvement, after laryngectomy. All patients had undergone previous radiotherapy (50.3 ± 6.2 [43-60] Gy) and previous surgical treatment: total laryngectomy (n = 11) and thyroidectomy (n = 2).

Results: The mean length of resected trachea was 3.7 ± 2.7 (2.5-6) cm. Resection was complete in 10 patients. All patients required relocation of the remaining trachea below the innominate artery and myocutaneous flap for coverage/stoma construction. AMT was associated with esophagectomy (n = 4) and supraaortic trunk resection (innominate artery, n = 2; carotid artery, n = 3). Seven patients required resection of the pharyngoesophageal region, and 4 patients underwent reconstruction, including primary closure of a pharyngeal remnant (n = 1) and gastric pull-up (n = 3). There was 1 operative death (8.3%) resulting from an infectious process leading to bypass fistulization. Major complications were partial tracheal necrosis (n = 3), pharyngeal fistula (n = 1), pneumonia (n = 4), and flap dehiscence (n = 2). Length of hospital stay was 30 ± 22.8 (13-86) days. Actuarial overall 5-year survival was 58.3%, and median estimated disease-free survival was 53 (31-75) months.

Conclusions: Our experience with AMT as salvage therapy has shown acceptable long-term results if complete resection is achieved. This procedure is not risk free, and very careful patient selection is required because of a tortuous postoperative course, especially in combined pharyngeal-esophageal and vascular reconstruction.
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http://dx.doi.org/10.1016/j.athoracsur.2014.04.103DOI Listing
September 2014

Feasibility and Efficacy of an Addiction Treatment Program in Patients With Upper Aerodigestive Tract Cancer.

Subst Use Misuse 2014 Jan 6;49(1-2):103-109. Epub 2013 Aug 6.

e 5 Service ORL, Hôpital Gui de Chauliac , Montpellier, France.

Background: Continuing to smoke or to drink after the treatment of an upper aerodigestive tract (UADT) cancer is known to worsen the prognosis. We assessed the feasibility and efficacy of an addiction treatment program integrated into the cancer treatment.

Method: In four units devoted to UADT tumors, we proposed an addiction treatment to all patients still drinking or smoking at the end of the cancer treatment; the abstinence rate was assessed 6 and 12 months later.

Results: One hundred and sixteen patients were included. Among the 73 patients still drinking and/or smoking at the end of the cancer treatment, 46.6% accepted an addiction treatment. In the latter, abstinence rate was increased, 52.2% versus 31.03% ( p = .07) at M12. In patients both drinking and smoking, addiction treatment doubled the rate of abstinence of both products (31% vs. 14%).

Conclusion: Offering addiction treatment to patients with UADT cancer improves abstinence rate and helps maintain long-term withdrawal.
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http://dx.doi.org/10.3109/10826084.2013.821660DOI Listing
January 2014

Transoral robotic surgery for the treatment of T1-T2 carcinoma of the larynx: preliminary study.

Laryngoscope 2013 Oct 5;123(10):2485-90. Epub 2013 Aug 5.

Department of Head and Neck Surgery, University Hospital of Nîmes, Sud de France; University of Montpellier, Sud de France.

Objectives/hypothesis: To determine the feasibility and the preliminary oncological results of transoral robotic surgery (TORS) for the treatment of early stage laryngeal tumors.

Study Design: Retrospective single center study.

Methods: We reviewed the medical records of 23 patients who underwent TORS for the treatment of T1 or T2 laryngeal squamous cell carcinoma between August 2009 and March 2012.

Results: Laryngeal tumors were involving the glottis (13 cases) and the supraglottis (10 cases). They were classified T1 N0 in 16 cases, T2 N0 in four cases, and T2 N+ in three cases. The median TORS operative time was 60 minutes (ranging from 30 to 118 minutes). The median hospitalization time was 7.5 days. Histopathological examination of the resected tumors confirmed 14 cases in which the margins were clear, four cases in which the surgical margins were close (less than 1 mm), one case in which the margins were microscopically positive, and in four cases margins status were not able to be recorded. A tracheostomy was carried out for three patients, and 11 patients got a nasogastric feeding tube postoperatively. The local recurrence rate was 8.7% (2/ 23 cases), and in both cases the recurrence occurred in the anterior commissure area only. The overall larynx preservation rate was 95,7% (22/ 23 cases).

Conclusion: In this preliminary study, we demonstrated that laryngeal TORS is feasible and may result in oncological results comparable with other treatment strategies, including laser CO2 surgery. This innovative approach needs to be evaluated through randomized multi-institutional trial.

Level Of Evidence: 4.
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http://dx.doi.org/10.1002/lary.23994DOI Listing
October 2013

Management of the neck in the setting of definitive chemoradiation: is there a consensus? A GETTEC study.

Ann Surg Oncol 2012 Jul 9;19(7):2311-9. Epub 2012 Mar 9.

Department of Radiotherapy, Center Antoine-Lacassagne, IUFC, Nice, France.

Background: The management of the neck remains controversial in the definitive chemoradiation setting of advanced N2-3 head and neck squamous cell carcinoma. Most published data favor omission of neck dissection (ND) after complete response for N2-3 or selective ND for residual disease

Methods: We studied the patterns of care in the French-Belgian Groupe d'Etude des Tumeurs de la Tête Et du Cou (GETTEC) through a questionnaire-based survey.

Results: Eighteen percent of institutions never performed up-front ND, 20% rarely, 40% sometimes, 14% often, and 8% systematically. Induction chemotherapy was indicated in 30% of the cases, and most ND were performed either between induction and radiation or after chemoradiation for residual disease. Response to chemoradiation was assessed by computed tomographic scan and positron emission tomography in 72% of cases. Selective ND was more common than radical ND.

Conclusions: Omission of ND based on computed tomographic scan and positron emission tomography-based complete response to chemoradiation is the most common strategy for advanced nodal disease among centers. However, neck management strategies vary among institutions, and some institutions continue advocating systematic ND before irradiation. The new treatment options and the changing epidemiology, namely docetaxel-based induction chemotherapy and human papilloma virus-related head and neck squamous cell carcinoma having better response profiles and prognosis, are adding to the nonconsensual approach. The best therapeutic index in terms of neck management remains to be defined in this evolving context.
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http://dx.doi.org/10.1245/s10434-012-2275-9DOI Listing
July 2012

Prophylactic percutaneous endoscopic gastrostomy in patients with advanced head and neck tumors treated by combined chemoradiotherapy.

J Pain Symptom Manage 2011 Oct 7;42(4):548-56. Epub 2011 Apr 7.

Department of Gastro-Nutrition, Val d'Aurelle Cancer Institute, Montpellier, France.

Context: Few studies have evaluated outcomes of combined chemoradiotherapy for Stage III-IV head and neck squamous cell carcinoma in terms of the use of nutritional support by means of percutaneous endoscopic gastrostomy (PEG).

Objectives: To compare nutritional status and treatment interruption because of acute toxicity in patients with advanced head and neck tumors who were treated by combined chemoradiotherapy and received or did not receive prophylactic PEG tubes.

Methods: This was a retrospective study that evaluated data obtained from a cancer center in Montpellier, France. A total of 139 consecutive patients treated for Stage III-IV head and neck squamous cell carcinoma from January 1, 1998 to June 30, 2003 were evaluated in terms of nutritional status before and after therapy, treatment interruption because of toxicity, and duration of hospitalization.

Results: Seventy-eight of the 139 patients (58%) did not receive prophylactic PEG feeding, and 61 patients (44%) received PEG feeding. Pretreatment nutritional status was worse in the PEG group. Compared with the initial nutritional status, nutritional status at the end of treatment was unchanged in the PEG group and much worse in the group that did not receive the PEG (P<0.05). Cumulative incidence of treatment interruption because of toxicity was significantly lower in the PEG group than in the no-PEG group (100 and 236 days of interruption, respectively, P=0.03) and hospitalization was significantly shorter (P=0.003).

Conclusion: Prophylactic PEG sustains nutritional status and reduces the cumulative incidence of treatment interruption caused by toxicity and duration of hospitalization. A randomized study is warranted to validate these results.
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http://dx.doi.org/10.1016/j.jpainsymman.2011.01.009DOI Listing
October 2011

Recurrent pleomorphic adenoma: results of surgical treatment.

Ann Surg Oncol 2010 Dec 20;17(12):3308-13. Epub 2010 Jul 20.

Department of Head and Neck Surgery, CHU, Montpellier, France.

Background: Recurrent parotid pleomorphic adenoma surgery increases the risk of facial nerve injury, and there is also a risk of ulterior recurrence.

Methods: Postoperative results from 62 consecutive patients operated for recurrent pleomorphic adenoma were analyzed. It was the first recurrence for 49 patients (79%), the second or more for 13 patients (21%).

Results: Total parotidectomy was performed in 69.4% of cases. Skin resection was performed in 47 patients (75.8%). Resection of a facial nerve branch was performed in seven patients (11.3%). Pathologic examination findings revealed carcinoma ex pleomorphic adenoma in 10/62 cases (16.1%) and microscopic multinodular disease in 39 patients (62.9%). Nine patients had preoperative facial palsy, 95% had postoperative facial paralysis ≥ grade II (House-Brackmann scale), and 11.3% still had ≥ grade III facial palsy after 1 year. Six patients developed another recurrence after our intervention (9.68%). Moreover, carcinoma was discovered after a new intervention in 40% of these patients. Initial partial parotid surgery [hazard ratio (HR) = 8.477, P = 0.008], microscopic multinodular recurrent disease (HR = 11.717, P = 0.005), and ≥ 1 recurrence number (HR = 10.608, P = 0.01) were associated with increased risk of ulterior recurrence.

Conclusion: Surgery is recommended in pleomorphic adenoma recurrence because of the high rate of carcinoma ex pleomorphic adenoma (16.1%). Nevertheless, a definitive facial paralysis ≥ grade III rate of 11.3% is reported after multiple nerve dissection. New recurrence after surgery is less frequent if the initial treatment for pleomorphic adenoma is total parotidectomy.
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http://dx.doi.org/10.1245/s10434-010-1173-2DOI Listing
December 2010

Neck restaging with sentinel node biopsy in T1-T2N0 oral and oropharyngeal cancer: Why and how?

Otolaryngol Head Neck Surg 2010 Apr;142(4):592-7.e1

Head and Neck Surgery Department, Gui de Chauliac Hospital, Montpellier University Hospital Center, Montpellier, France.

Objective: To evaluate the lack of accuracy in neck staging with the classical technique (i.e., neck dissection and routine histopathology) with the sentinel node (SN) biopsy in oral and oropharyngeal T1-T2N0 cancer.

Study Design: Cross-sectional study with planned data collection.

Setting: Tertiary center care.

Subjects And Methods: In 50 consecutive patients, the pathological stage of sentinel node (pSN) was established after analyzing SN biopsies (n = 148) using serial sectioning and immunohistochemistry. Systematic selective neck dissection was performed. The pN stage was established with routine histopathologic analysis of both the non-SN (n = 1075) and the 148 SN biopsies.

Results: The sensitivity and negative predictive value of pSN staging were 100 percent. Conversely, if one considers pSN staging procedure as the reference test for micro- and macro-metastasis diagnosis, the sensitivity of the classical pN staging procedure was 50 percent (9/1; 95% CI 26.9-73.1) and its negative predictive value was 78 percent (95% CI 61.9-88.8). Fifteen patients (30%) were upstaged, including nine cases from pN0 to pSN >or= 1 and six cases from pN1 to pSN2. Two of the pN0-pSN1 upstaged patients died with relapsed neck disease.

Conclusion: The SN biopsy technique appeared to be the best staging method in cN0 patients and provided evidence that routinely undiagnosed lymph node invasion may have clinical significance.
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http://dx.doi.org/10.1016/j.otohns.2009.12.016DOI Listing
April 2010

Prognostic value of a three-grade classification in primary epithelial parotid carcinoma: result of a histological review from a 20-year experience of total parotidectomy with neck dissection in a single institution.

Eur J Cancer 2010 Jan;46(2):323-31

Head and Neck Surgery Department, Gui de Chauliac Hospital, Montpellier University Hospital Center, France.

Background: The tumour grading of primary parotid cancers (PPCs) remains controversial.

Methods: A 20-year standardised single centre treatment has been assessed retrospectively. The histological review of 155 consecutively treated parotid malignancies identified 96 suitable cases for univariate and multivariate survival analyses.

Results: Treatment involved total parotidectomy, neck dissection and post-operative radiotherapy in, respectively, 91.7%, 83.3% and 70.4% of cases. The 5-year overall survival, disease-specific and recurrence-free survival rates were 79.4%, 83.5% and 70.8%, respectively. Univariate analysis confirmed the classical prognostic factors, i.e. age>60 years, male gender, facial palsy, hardness of the tumour, clinical stage, tumour grade, facial nerve invasion and lymph node metastases. Multivariate analysis identified a three-grade classification just after the clinical stage as the most important prognostic factor.

Conclusion: This study identifies the prognostic significance of intermediate grade tumours.
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http://dx.doi.org/10.1016/j.ejca.2009.10.012DOI Listing
January 2010

[Adenocarcinomas of nasal cavities and paranasal sinuses: Diagnostic pitfalls in sinonasal glandular lesions].

Ann Pathol 2009 Sep 16;29(4):286-95. Epub 2009 Sep 16.

Service d'anatomie et cytologie pathologique, hôpital Gui-de-Chauliac, CHU de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France.

Among primitive adenocarcinoma of nasal cavity and paranasal sinus, the 2005 WHO classification distinguishes two main categories: intestinal type adenocarcinoma (ITAC) and low-grade non-intestinal adenocarcinoma, entities with different clinical and epidemiological characteristics. Low-grade adenocarcinoma shows a respiratory type phenotype (CK20-/CK7+/CDX2-/villin-) and ITACs, an intestinal type profile (CK20+/CK7-/CDX2+/villin+). Because of histological, ultrastructural and phenotypical similarities between ITAC and colorectal adenocarcinomas, several studies have discussed a possible common pathway in carcinogenesis. But the review of literature shows conflicting results, suggesting different pathways of pathogenesis. Differential diagnoses of sinonasal intestinal-type adenocarcinoma are mainly respiratory epithelial adenomatoid hamartomas, inverted schneiderian papillomas, salivary glands-type carcinoma and more rarely metastasis of adenocarcinoma.
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http://dx.doi.org/10.1016/j.annpat.2009.07.007DOI Listing
September 2009