Abstract: BACKGROUND: Selecting patients for phase I trials in order to investigate cytotoxic agents is challenging, since there is no clear and reliable guidance to estimate life expectancy among these patients. We retrospectively assessed prognostic factors in cancer patients screened for Phase1 trials between October 1997 and October 2002. METHODS: 148 consecutive patients, screened for inclusion in phase I trials investigating cytotoxic agents, were included in the present study. 70 out of them actually received phase I trial regimens. Univariate and multivariate analysis were undertaken to determine the prognostic factors for overall survival (OS) from the date of screening. RESULTS: The median OS of the 148 patients was 5.7 months. Ninety-two percent of them had PS </= 1. The Cox model identified serum albumin <38 g/l [HR 2.51 (1.51-4.18), p = 0.0001] and lymphocyte count <700/mm(3) [HR 2.27 (1.13-4.62), p = 0.024] as independent prognostic for overall survival. All patients presenting both prognostic factors died within 90 days. CONCLUSIONS: We propose a simple model, easily obtained at the bedside, which can discriminate patients who are likely to be alive at 3 months and thus could be included in a phase 1 anti-cancer trial. This model now needs to be validated on an independent cohort.
Abstract: The development of molecular targeted therapies requires some specific methodological approaches. Dose-limiting toxicities are rare in phase I studies the maximal tolerated dose is rarely established. On the contrary, the biological active dose is often determined as the dose inducing biological effect on the target without significant clinical toxicity. Several designs of phase II are described (selection phase II, randomized phase II, stratified phase II...). All of them are indicated in specific situations. The discontinuation treatment studies and the validation of biomarkers (as surrogate endpoints or as classifiers) are the two main particularities of phase III studies designed for the assessment of molecular targeted therapies.
Abstract: The clinical impact of surgical site infections (SSI) and postoperative pneumonia (PP) after head and neck cancer surgery has been assessed in the past, but little is known about their economic impact. The present study was designed to evaluate costs related to SSI and PP after head and neck cancer surgery with opening of mucosa. The incidence of SSI and PP was measured in a prospective cohort of 261 patients who had undergone head and neck cancer surgery. The additional direct medical costs related to these infections from the hospital perspective were determined based on postoperative length of stay. The mean direct hospital costs for patients with and without SSI or PP were compared. Of the 261 patients, 81 (31%), 21 (8%) and 13 (5%) developed SSI, PP or both, respectively. The additional lengths of stay attributable to SSI, PP or both were 16, 17 and 31 days, respectively, and additional direct medical costs related to these conditions were 17,000, 19,000 and 35,000 Euros. Nosocomial infections after head and neck cancer surgery significantly increase patients' length of stay and therefore generate additional direct medical costs. These results support the application of preventive interventions to reduce nosocomial infections in this setting.
Abstract: The aim of this study was to determine the risk factors for the mortality during the first 30 days after a major head and neck cancer surgery. Two hundred and sixty one consecutive surgical procedure were prospectively studied at Oscar Lambret Cancer Centre within a 36-months period. Twenty variables were recorded for each patient. The significant risk factors for postoperative mortality were assessed by univariate and multivariate analysis. Overall 30-days mortality rate was 3.83% [95% CI 3.13-4.53]. In univariate analysis identified four risk factors: female gender (odd ratio 4.25 [95% CI 1.03-17.56]), age equal or superior than 70 (odd ratio 5.06 [95% CI 1.35-18.36]), current alcohol addiction (odd ratio 3.65 [1.02-13.06]) and laryngeal location (odd ratio 4.23 [CI 95% 1.18-3.38]). In multivariate analysis only female gender and laryngeal location remained significant. The incidence of postoperative mortality was 1.63% for patients without risk factor and was 6.41% for those with one or two risk factors. This model identifies easily high-risk patients for major head and neck cancer surgery. A multicenter validation is necessary.
Abstract: BACKGROUND: Early catheter-related infection is a serious complication in cancer treatment, although risk factors for its occurrence are not well established. The authors conducted a prospective study to identify the risk factors for developing early catheter-related infection. METHODS: All consecutive patients with cancer who underwent insertion of a central venous catheter were enrolled and were followed prospectively during 1 month. The study endpoint was occurrence of early catheter-related infection. RESULTS: Over 10,392 catheter-days of follow-up, 14 of 371 patients had early catheter-related infections (14 patients in 10,392 catheter-days or 1.34 per 1000 catheter-days). The causative pathogens were gram positive in 11 of 14 patients. In univariate analysis, the risk factors for early catheter-related infection were aged <10 years (P = .0001), difficulties during insertion (P < 10(-6)), blood product administration (P < 10(-3)), parenteral nutrition (P < 10(-4)), and use >2 days (P < 10(-6)). In multivariate analysis, 3 variables remained significantly associated with the risk of early catheter-related infection: age <10 years (odds ratio [OR], 18.4; 95% confidence interval [95% CI], 1.9-106.7), difficulties during insertion procedure (OR, 25.6; 95% CI, 4.2-106), and parenteral nutrition (OR, 28.5; 95% CI, 4.2-200). CONCLUSIONS: On the day of insertion, 2 variables were identified that were associated with a high risk of developing an early catheter-related infection: young age and difficulties during insertion. The results from this study may be used to identify patients who are at high risk of infection who may be candidates for preventive strategies.
Abstract: Pesticides are numerous. The occupational exposure to pesticide increases the risk of non-Hodgkin's lymphoma and hairy cells leukaemia. Numerous studies suggest an increasing of incidence of children cancer in connection with parental pesticide exposure. But, most of epidemiological studies are not conclusive but of the difficulty to measure the exposure to pesticides. The future epidemiological studies may include toxicological analysis in order to measure the exposure.
Abstract: BACKGROUND: Cancer-associated hypercalcemia (CAH) is the most frequent metabolic disorder in cancer patients. We retrospectively reviewed the outcome and prognostic factors for patients with CAH being treated with standard intravenous disphosphonates. MATERIALS AND METHODS: Two hundred sixty patients were reviewed. Overall survival and prognostic factors were analyzed. Relative risks (RR) for early death (within 60 days) were assessed (Fischer exact test and logistic regression model). RESULTS: Median survival was 64 days (range, 12-1,955+). Multivariate analysis identified the following factors as poor survival predictors: serum corrected calcium >2.83 mmol/l [hazard ratio (HR) = HR 2.21], albuminemia <35.5 (HR 2.41), squamous cell carcinoma (HR 2.64), bone metastasis (HR 1.44), and liver metastasis (HR 2..22). One hundred twenty-one patients died within 60 days. For those patients, the logistic regression model identified four independent predicting factors for early death: calcemia >2.83 mmol/l (RR 5.07), hypoalbuminemia (RR 7.42), liver metastasis (RR 4.34), and squamous cell carcinomas (RR 2.21). DISCUSSION: Despite intravenous diphosphonate, CAH is still associated with poor outcome. Simple bedside parameters may estimate the risk of early deaths.
Abstract: Hospital stays constitute the main component of costs of cancer treatment. We conducted a prospective study to identify the determinants of the length of stay (LOS) after head and neck cancer surgery (HNCS). Patients who underwent major HNCS with opening of mucosa and with curative intent were enrolled. Data were collected for patient characteristics, type of tumour, surgical procedures and postoperative outcome. LOS defined as the interval between the day of admission for surgery until hospital discharge or death was determined by the Kaplan-Meier method. Independent determinants of LOS were identified using a Cox model. All 260 patients were included. Median LOS was 26 days (range, 3-178). In the multivariate model, four variables remained associated with increased LOS: American Society of Anaesthesiologist's score equal to 3 (hazard ratio 1.62 [1.23-1.99]), duration of surgical procedure >220min., (HR=1.37 [1.22-1.56]), SSI (HR=2.09 [2.02-2.54]), occurrence of SSI caused by multi-resistant pathogen (HR=2.92 [2.78-3.77]) and occurrence of PP (HR=2.09 [1.78-2.81]). The present results highlighted the long duration of LOS after head and neck cancer surgery. Two variables (duration of surgical procedure and occurrence of nosocomial infections) were associated with LOS and might be improved by appropriate strategies.
Abstract: OPINION STATEMENT: Angiosarcomas (AS) are a heterogeneous group of rare and aggressive malignancies. The best treatment of localized AS includes wide resection following by adjuvant radiation therapy as possible. The current standard treatment of metastatic AS remains a doxorubicin-based regimen. This treatment provides a median progression-free survival and a median overall survival of about 4 and 8 months, respectively. Numerous case reports and retrospective studies have suggested that taxanes (paclitaxel or docetaxel) may provide some objective responses. The French Sarcoma Group has conducted a phase II clinical trial, which states the benefit of weekly paclitaxel in patients with unresectable or metastatic AS. After 2 cycles, the non-progression rate was 78% and complete histological responses were observed in 3 out of 30 cases. Further clinical studies are needed to confirm clinic impact of weekly paclitaxel on survival and to assess the role of taxanes in the multidisciplinary treatment of AS.
Abstract: The structured report (SR) summarizing the multidisciplinary decision making for referred cancer patient is a new opportunity to ameliorate communication between GPs and cancer specialists. The aim of this study was to investigate how GPs value this structured report. We carried out a questionnaire-audit on SR GPs assessment. The SR had included: the list of committee participants, short summary of clinical history and characteristics, tumour location and size, TNM classification, precise histological diagnosis, practice guidelines used, possibility of clinical trial, identification of specialist in charge of patient, and a short conclusion. The enrolled patients were treated for soft tissue sarcoma, melanoma or carcinoma with unknown primary. The response rate was 47% (52/110). 79% of GPs are satisfactory with the structured report. The analysis of responses suggest 3 amelioration axes: (i) accompany the report with a short summary of guidelines used, (ii) describe clearly the potential cancer treatment side effects and suggest some treatments of those side-effects, (iii) and send this structured report more rapidly during the clinical pathway. This SR appears clearly an opportunity of communication amelioration between care providers. This SR is appreciated by GPs. But, it is necessary to include more practical information.
Abstract: Squamous cell carcinomas (SCC) localized at the lateral buccopharyngeal junction are frequent occurrences in our experience. This anatomical site gives the tumor ample space to spread in different directions, making tumor management all the more difficult. We focused our study on this localization to underline their specificities and evaluate our practices. In the Department of Head and Neck Oncology at the Centre Oscar Lambret, 57 patients with lateral bucco-pharyngeal junction SCC were treated from 1995 to 2000. Epidemiological data were extracted from the medical chart. Description of the tumor was based on clinical and imaging data. Treatment modalities frequently combined surgery, radiotherapy and chemotherapy. Protocol was adapted with the health status and the aggressiveness of the disease. Follow-up and survival rates are outlined below. Fifty men and seven women with a mean age of 57 years constitute the patient population. Forty-nine out of 57 presented a history of smoking, and 44 out of 46 presented a history of alcoholism. Patient overall clinical status, social and family background were also discussed. Thirty-one of fifty-seven tumors were categorized as T1 or T2. Forty-five out of fifty-seven presented limited lymph-node involvement. Tumor extension, growth pathology and degree of differentiation were described. Twenty-eight out of fifty-seven had undergone primary surgery. Primary radiotherapy with or without chemotherapy was delivered to the others. The modality of the different treatments and their results were specified. The 3-year disease-free survival rate was 52.7% and the 3-year overall survival rate was 48.2%. The mean survival rate was 3 years. Univariate analysis was performed on all occasions. Gender (P = 0.008), surgery first versus non-surgical treatment first (P = 0.03), spread beyond the midline (P = 0.03), and small tumors T1 T2 versus T3 T4 (P = 0.003) were predictive factors of overall survival. A Multivariate analysis showed that the type of treatment (surgery first versus no primary surgery P = 0.006), and the T (T1, T2 versus T3, T4 P = 0.005) were the two predictive factors of the overall survival. Because of the small size of the population studied, the retrospective nature of the study and the scarcity of the publications on the subject, results must be carefully interpreted. For example, surgery must be proposed whenever deemed possible. It is in an independent factor in our series. All the statuses linked to the population type, tumor extension and tumor differentiation are also discussed.
Abstract: After treatment of primary soft tissue sarcoma, a third of patients will develop local or distant (lung in 90% of cases) recurrence. For an individual patient, the issue of cancer recurrence is a binary event. However, when developing surveillance strategies for large groups of patients, knowledge of the risks (tumor biology, natural history of the disease), the benefits (potential efficacy of salvage therapy) and diagnosis test performances is necessary to formulate a rationale and resource effective follow-up algorithm.
Abstract: Soft tissue sarcomas are uncommon heterogeneous group of tumour derived from mesenchym. The most common location is the lower extremity, but they can occur in the upper extremity, and abdominal and chest walls. The first radiological evaluation may include plain films and ultrasonography in viewing to assess the probability of soft tissue sarcomas. MRI with contrast is the main modality to evaluate these lesions and choose which part of tumour must be biopsied. Computer tomography (CT) is secondary used to perform core needle biopsy and detect lung metastases. The role of PET begins to be more clear in case of need global assessment before radical surgery. A multidisciplinary approach is essential to perform rational treatment planning and avoid partial surgery.
Abstract: Advanced soft-tissue sarcomas are usually resistant to cytotoxic agents such as doxorubicin and ifosfamide. Antitumor activity has been observed for gemcitabine and docetaxel combination. We conducted a retrospective study on 133 patients (58 males/75 females) with unresectable or metastatic soft-tissue sarcoma. The median age at diagnosis was 51.7 (18-82), with 76 patients with leiomoyosarcoma and 57 patients with other histological subtypes. The initial localizations were limb (44), uterine (32), retroperitoneal (23) and organs or bone (34). Patients received 900 mg/m2 of gemcitabine (days 1 and 8) over 90 min plus 100 mg/m2 of docetaxel (day 8), intravenously every 21 days. Gemcitabine/docetaxel combination was well tolerated with an overall response of 18.4% and with no clear statistical difference between leiomyosarcomas and other histological subtypes (24.2% versus 10.4% (p=0.06)). No difference was found between uterine soft-tissue sarcomas versus others. The median overall survival was 12.1 months (1-28). Better overall survival was correlated with leiomyosarcoma (p=0.01) and with the quality of the response, even for patients with stable disease (p<10(-4)). No statistical difference was found for the initial localization. Response to treatment and overall survival were better for patients in World Health Organization (WHO) performance status classification (PS) 0 at baseline versus patients in WHO PS-1, 2 or 3 (p=0.023 and p<10(-4), respectively). Gemcitabine/docetaxel combination was tolerable and demonstrated better response and survival for leiomyosarcoma, especially for patients in WHO PS-0 at baseline. For the other histological subtypes, the response was not encouraging, but the survival for patients in response or stable suggests further investigation.
Abstract: BACKGROUND: Primary mucosal melanomas of the head and neck (MMHN) are rare and carry a poor outcome. The impact of different treatments on survival is not yet clearly established. METHODS: Twenty patients treated from 1991 to 2004 at a single referral center were retrospectively reviewed. RESULTS: Primary sites were oral mucosa in 14 cases, paranasal sinuses in three cases, and nasal cavities in three cases. The sex ratio was equal to 1, and the median age at diagnosis was 63 years (range, 17-77 y). At presentation, one patient had lymph node metastases, one patient had distant metastases, and one patient had both. Surgery was performed with curative intent in 19 cases (and achieved clear margins in 14 cases). Postoperative radiation therapy was delivered in four cases. The actuarial 2-year and 5-year survival rates were 13/19 and 7/16. The risk factors for death were male gender (RR = 9.3 [1.2-72], P = .024) and positive margins (RR = 21 [1.9-47], P = .013). In addition, we observed three metachromous cancers (one breast cancer, one kidney cancer and one lymphoma) during the follow-up period. CONCLUSION: The present study suggests that obtaining clear margins must be the goal in the treatment of MMNH.
Abstract: Systematic follow-up of patients after initial treatment of cancer is stressful with heavy cost. The aim of such follow-up is to detect asymptomatic lesions in viewing to increase global survival and quality of life. For an individual patient, the issue of cancer recurrence is a binary event. However, when developing surveillance strategies for large groups of patients, knowledge of the risks (tumor biology, natural history of the disease), the benefits (potential efficacy of salvage therapy) and diagnosis test performances is necessary to formulate a rationale and resource effective follow-up algorithm. The Bayes'nomogram is useful to assess diagnosis test. Soft tissue sarcoma is a example of such demonstration.
Abstract: BACKGROUND: In the north of France, a delay in primary consultation has been noted among patients with head and neck cancer. This group is often correlated with lower socioeconomic status and a lack of medical information. Therefore, the choice to seek consultation is often influenced by symptoms such as pain and change in the size of tumors in the neck. We studied this delay in seeking consultation, focusing on psychosocial variables such as professional and social background, the involvement of a spouse/partner, and the presence of anxiety and depression. METHODS: Two rating scales were administered to 50 patients with large tumors (T3/T4) and 50 patients with small tumors (T1/T2), and the results were compared. These rating scales were as follows: (1) a 17-item questionnaire assessing sociodemographic data, presenting symptoms, factors generating the consultation, and reasons for delay; and (2) the Hospital Anxiety and Depression Scale (HADS). RESULTS: Both groups were predominantly male and working-class. Significant differences were observed in time since symptom onset and in conscious delay in seeking medical attention. The group with large tumors was characterized by lower involvement of a spouse/partner, conscious delay before first consultation, greater social isolation, fewer medical visits, and lower HADS anxiety scores. The group with small tumors sought consultation sooner and was characterized by greater involvement of a spouse/partner, correlated with significant anxiety. Depression was not a factor influencing delay within either group. CONCLUSIONS: The interpersonal relationship with a spouse/partner seemed to be essential in the dynamics surrounding consultation. Anxiety, rather than socioeconomics status, was a discriminating factor in the delay in seeking consultation.
Abstract: The goal of this prospective study was to determine risk factors for wound infections (WI) for patients with head and neck cancer who had undergone surgical procedures with opening of upper aerodigestive tract mucosa in multimodal therapeutic approaches. Two hundred and sixty consecutive surgical procedures were studied at Oscar Lambret Cancer Center over a 36-month period. Twenty-five variables were recorded for each patient. Statistical evaluation used chi2 test analysis (categorical data) and Mann-Whitney test (continuous variables). Multivariate analysis was performed with logistic regression model. The overall rate of WI was 45% (117/260). Univariate analysis indicated that five variables were significantly related to the likelihood of WI: male sex (p = 0.03), previous chemotherapy (p = 0.009), duration of previous hospital stay (p = 0.013), hypopharyngeal location (p = 0.003), post-laryngectomy tracheostoma (p < 0.001). Multivariate analysis identified only one major risk factor for WI: post-laryngectomy tracheostoma (Odd Ratio 1.9 [95% CI 1.3-3]; 33% versus 64%; p = 0.001). Despite antibiotic prophylaxis, WI occurrence is high. This study identified one major risk factor, post-laryngectomy tracheostomy. Long-term curative antibiotherapy must be evaluated in cancer head and neck surgery requiring post-laryngectomy tracheostoma.
Abstract: Recent data issuing the prognostic impact of hypercalcemia on outcome of aerodigestive tract cancers are spare. To assess the prognosis and the survival of head and neck cancer patients with hypercalcemia, we reviewed 136 recent successive cases, including also oesophageal and lung cancers. Data were collected from a retrospective database (July 2002-January 2004). Hypercalcemia was defined by calcemia level above 2.55 mmol/l. Univariate analysis for prognosis was performed with Mann-Whitney test (continuous variables) and Odd Ratio with 95% confidence interval (categorical variables). The primary locations were : oropharynx and oral cavity (79, 58%), hypopharynx (13, 9.5%), larynx (10, 7.3%), oesophagus (17, 12.5%) and lung (17, 12.5%). There were 23 females and 123 males, with a median age of 53 (18-86). The incidence of bone metastasis was low: 20/136, 14.5%. At cancer diagnosis, 32 hypercalcemia were observed. With a median follow-up of 88 days (2-553), we observed 98 deaths (overall mortality=72%). The median overall survival was 35 days (2-553+). The pejorative prognostic factors were: male gender (OR=2.64 CI 95% 1.07-6.82), age inferior to 50 (OR=2.67 CI 95% 1.23-5.8), presence of distant metastasis (OR=4.45 CI 95% 1.8-11.01), elevation of alkaline phosphatases (OR=7 CI 95% 2.73-17.9) and need of hospitalization for intravenous hydratation (OR=5.11 CI 95% 1.99-13.17). We observed 39 recurrences of hypercalcemia. The predictive factors for recurrence of hypercalcemia were: age superior to 50 (OR=4.61 CI 95% 2.02-10.52), male gender (OR=38.22 CI 95% 12.2-89), calcemia level superior to 2.7 mmol/l (OR=3.08 CI 95% 1.42-6.64) and absence of diphosphonates (bisphosphonates: OR=2.16 CI 95% 1.01-4.63). Despite use of diphosphonates (infusions of pamidronate), hypercalcemia is associated with very poor prognosis. Tumour location and level of calcemia had no prognostic value.
Abstract: OBJECTIVE: The aims of our retrospective study were to study first the causes of 245 febrile episodes in cancer patients and then the value of procalcitonin (PCT) and C-reactive protein (CRP) in differentiating infections from paraneoplastic fever. METHOD: The causes of fever were studied in 245 consecutive cases observed between January and December 2002, and PCT and CRP diagnostic value in 155 cases (114 infections and 41 paraneoplastic fever). RESULTS: The two main causes of fever were infection (121 cases) and paraneoplastic fever (43 cases); 77 infections were microbiologically documented. Cocci gram positive caused 41 out of 77 documented infections. Paraneoplastic fever was more frequent in metastatic disease ( p=6.10(-6)). CRP and PCT serum levels at admission did not differ significantly in the infection group and paraneoplastic fever group (respectively p=0.39 and p=0.14 with Mann-Whitney test). The PCT and CRP levels had poor prognostic value in infection (respectively 0.04 and 0.0003 with Mann-Whitney test). CONCLUSION: Causes of fever are very numerous in cancer patients (more than 75 different causes in this study). Bacterial infection is the most frequent cause. PCT and CRP failed to discriminate infection, but both had pejorative prognostic value in infected patients.
Abstract: INTRODUCTION: Ocular melanoma is associated with extended risk of metastases, mainly liver metastases. Nevertheless, the late and ultra-late recurrence (respectively 10 and 15 years after initial treatment) are exceptional events. EXEGESIS: We describe hereafter two cases. In the first case, the treatment is palliative chemotherapy with death 12 months after metastasis diagnosis. In the second case, the patient underwent two resections of metastases (lung and liver). This patient had excellent quality of live, and survived 11 months later after palliative surgery. DISCUSSION: Follow-up of ocular melanoma patients should include liver enzymes and ultrasonography of liver in the long run.
Abstract: BACKGROUND: The goal of this prospective study was to determine the incidence of wound infections (WI) after clean uncontaminated head and neck cancer procedures and after emergency tracheotomies. METHODS: Two hundred twelve clean procedures without tracheotomy or opening of mucosa (neck dissections, large skin resections, thyroidectomies, parotid gland resections, and explorative cervicotomies) were studied at Oscar Lambret Cancer Center over a 24-month period. RESULTS: WI rate was 6.6% (14 of 212). In a univariate analysis, only one variable was significantly related to the likelihood of WI: previous anticancer chemotherapy. All but one patient who had had previous chemotherapy demonstrated WI (14 of 15). CONCLUSIONS: After previous chemotherapy, WI rate in clean uncontaminated head and neck surgery was as high as 90%. In this case, antibiotic prophylaxis should be evaluated.
Abstract: PROPOSE: We describe clinical and pathological aspects and survival of 12 recent of radio-induced soft tissue sarcoma. METHOD: We performed a single center case-control study, with 23 control matched by grade (according to Federation nationale des centres de lutte contre le cancer Grading) and by location. Survival comparison used Log Rank test. RESULTS: The development of these 12 cases was a result of 12 previous cancer treatment (including 4 breast cancers and 2 cervix cancers) with radiotherapy (median dose of 58 Grays). The median latency period was 10 years. There were nine women and three men. The median age was 68.5 years. The main location was chest wall (5 cases). The two main histologic subtypes were malignant histiocytofibromas (6 cases) and angiosarcomas (3 cases). Five cases were high grade. Treatments were performed with curative intent in 9 cases, including complete resection in six cases. Clinical and pathological aspects and treatments of controls were similar, but postoperative radiotherapy was most frequent and malignant histiocytofibroma was less common. Median overall survival (47 months vs. 30 months, P = 0.6), median metastatic disease-free survival (37 vs. 15 m., P = 0.6) and median locoregional disease-free survival (14 vs. 24 m., P = 0.07) were similar for cases and control. CONCLUSION: This study suggests that prognosis of radio-induced soft-tissue sarcomas is similar as other soft tissue sarcoma of same grade and same location.
Abstract: Adult head and neck soft tissue sarcomas (AHNSTS) are rare, and data concerning treatment results are spare. To assess clinico-pathological characteristics, management prognostic factors, and survival of AHNSTS, we reviewed our experience of 28 recent successive new cases. Data were collected from a retrospective database (1997-2002). Aggressive fibromatosis, dermatofibrosarcoma, Kaposi sarcoma, chondrosarcoma and osteogenic sarcoma were excluded. Univariate analysis for prognostic factors was performed with chi2 test with Yates correction. The median age was 45.7 years (range: 18-86). The male/female ratio was 15/13. The most common subtypes was rhabdomyosarcoma (seven cases). Twenty-two patients presented with previous inadequate resection performed elsewhere before admission. The most common location was neck muscles (11 cases). Nineteen patients had surgery (complete resection in 13 cases). Associated treatments were neoadjuvant chemotherapy, adjuvant chemotherapy and postoperative radiotherapy in respectively, 4, 3 and 10 cases. The 2-year overall survival was 56%. Rhabdomyosarcomas (p = 0.005) and inadequate resection (p = 0.04) were associated with poor outcome. Large resection of AHNSTS in a multimodality approach may afford the best chance of disease control.
Abstract: Use of antibiotic prophylaxis (AP) in clean breast cancer surgery is still controversial. We assessed the efficacy of preoperative AP in a prospective study of 171 clean breast cancer procedures following previous anticancer chemotherapy. From June 1998 to July 2001, we analyzed 171 procedures. In 133 cases. AB with cefuroxime was performed. Wound infection rate was 3 out of 171 procedures (WI rate of 2/131 with AP compared with 1/37 without AP, p = 1.0). This study suggests that AP is not systematically required in breast cancer surgery following previous anticancer chemotherapy.
Abstract: OBJECTIVE: We evaluated the incidence, risk factors and consequences of wound infection (WI) following major head and neck cancer surgery in an open non-comparative study. PATIENTS AND METHODS: The study group, comprising 95 patients who underwent clean-contaminated procedures with opening of the upper aerodigestive tract for biopsy-proven squamous cell cancer, were studied over a 1-year period. Antibiotic prophylaxis was amoxicillin and clavulanic acid. More than 20 variables were prospectively recorded for each patient. The mean follow-up was 30 months. MAIN RESULTS: The overall WI rate was 50.5% (48/95). Most pathogens isolated from samples were gram-negative rods. In univariate analysis, we found three risk factors for WI: alcohol consumption (P = 0.07), a hypopharyngeal location (P = 0.02) and laryngectomy stoma (P = 0.01). WI were associated with postoperative fever (P = l.5 x 10(-11)), postoperative antibiotic therapy (P = 1.5 x 10(-5)) and postoperative death (P = 0.043). Patients without WI had a median postoperative hospital stay of 15 days compared with 29 days for those with WI (P < 0.001). Healing of WI was achieved after a median time of 48 days. WI delayed postoperative radiation therapy in 21 out of 33 evaluable patients. But overall survival, and local and metastatic failures were similar with and without WI. CONCLUSIONS: WI are associated with a heavy postoperative morbidity, but have no prognostic impact on cancer control.
Abstract: Little is known about epidemiology of adults soft tissue and visceral sarcomas (ASTS). The frequency of previous cancers and associated genetic diseases has been analyzed out of 493 ASTS, treated between 1997 and 2002 at Oscar Lambret Cancer Center. Median age is 51, sex ratio is close to 1. Liposarcomas and malignant fibrous histiocytofibromas are the two main types (respectively 104 and 86 cases). Upper and lower limbs are the two main locations (respectively 176 and 75 cases). Fifteen patients had associated genetic disease, including 12 cases of Recklinghausen diseases. 7 out of those 15 patients have neurosarcoma. 30 patients have previous cancers, including 7 breast cancers, 3 lymphomas and 3 chronic lymphocytic leukemias. Four out of those 30 patients have two different previous cancers. 13 patients have radiation-induced sarcomas, after an average 10-year-period, and an average dose of 53 Gy. Undifferenciated sarcomas are the main histologic type (8/13), followed by angiosarcomas (2/13). Radiation-induced sarcomas are located in the chest wall (7/13), in pelvis (2/13) and head and neck (2/13). Those sarcomas are high grade (10 grade III tumours). ASTS epidemiology is complex with different risk factors depending on histologic type.
