Detection and quantification of focal uptake in head and neck tumours: 18F-FDG PET/MR versus PET/CT

Purpose: Our objectives were to assess the quality of PET images and coregistered anatomic images obtained with PET/MR, to evaluate the detection of focal uptake and SUV, and to compare these findings with those of PET/CT in patients with head and neck tumours. Methods: The study group comprised 32 consecutive patients with malignant head and neck tumours who underwent whole-body 18F-FDG PET/MR and PET/CT. PET images were reconstructed using the attenuation correction sequence for PET/MR and CT for PET/CT. Two experienced observers evaluated the anonymized data. They evaluated image and fusion quality, lesion conspicuity, anatomic location, number and size of categorized (benign versus assumed malignant) lesions with focal uptake. Region of interest (ROI) analysis was performed to determine SUVs of lesions and organs for both modalities. Statistical analysis considered data clustering due to multiple lesions per patient. Results: PET/MR coregistration and image fusion was feasible in all patients. The analysis included 66 malignant lesions (tumours, metastatic lymph nodes and distant metastases), 136 benign lesions and 470 organ ROIs. There was no statistically significant difference between PET/MR and PET/CT regarding rating scores for image quality, fusion quality, lesion conspicuity or anatomic location, number of detected lesions and number of patients with and without malignant lesions. A high correlation was observed for SUVmean and SUVmax measured on PET/MR and PET/CT for malignant lesions, benign lesions and organs (ρ = 0.787 to 0.877, p < 0.001). SUVmean and SUVmax measured on PET/MR were significantly lower than on PET/CT for malignant tumours, metastatic neck nodes, benign lesions, bone marrow, and liver (p < 0.05). The main factor affecting the difference between SUVs in malignant lesions was tumour size (p < 0.01). Conclusion: In patients with head and neck tumours, PET/MR showed equivalent performance to PET/CT in terms of qualitative results. Comparison of SUVs revealed an excellent correlation for measurements on both modalities, but underestimation of SUVs measured on PET/MR as compared to PET/CT

Rôle de la panendoscopie dans la recherche de cancers synchrones et métachrones de la sphère ORL.

Head and neck cancer result from excessive tobacco and alcohol consumption. The survival has not improved in the last decades despite better loco-regional control, mainly because of secondary cancers. Head and neck cancer is associated to a high rate of synchronous esophageal and lung tumors and an annual 4% rate of new metachronous malignancies. The role of panendoscopy is evolving: a flexible esophagoscopy with Lugol's iodine staining should be performed and a chest CT-scan should replace bronchoscopy. During follow-up, metachronous malignancy should be searched for in the head and neck region; investigation beyond the head and neck is questionable since prognosis is poor

Traitement des carcinomes épidermoïdes ORL chez la personne âgée

We compared the treatment modalities as well as the oncologic outcome between young elderly (65-79 years old), elderly (>80 years old) and the reference population (<65 years old.) We reviewed 1047 patients treated between 2002 and 2012. Tumor sites, TNM stages, type of treatment, and the oncologic results are compared with survival statistics. The elderly group was associated with an increase in palliative treatment, more women and advanced T stages. For the 947 patients treated with curative intent, 5 year recurrence free survival was comparable. The overall-survival decreases with the age because of intercurrent deaths. Nevertheless, the treatment efficacy is similar. In conclusion, an advanced age is associated with worse survival, without a decrease in loco-regional control. The chronological age should not be used as a predictive factor for treatment response

Rhinophotothérapie et rhinosinusite chronique: une étude en double aveugle, randomisée et contrôlée par placebo

La rhinosinusite chronique (CRS) est une maladie à forte prévalence qui détériore considérablement la qualité de vie des patients. Le diagnostic de CRS est basé sur la présence d'une combinaison de symptômes relativement communs, et la présence d'anomalies à l'endoscopie nasale ou au CT-Scan des sinus. Le traitement repose sur la pulvérisation endo-nasale de stéroïdes topiques, le rinçage des fosses nasales au sérum physiologique, la prise orale de stéroïdes et d'antibiotiques. La chirurgie fonctionnelle endonasale est réservée pour les 50 % de patients qui ne répondent pas au traitement conservateur. Nous avons évalué dans une étude originale en double aveugle, contrôlée par placebo le bénéfice de la rhinophotothérapie sur les patients souffrant de CRS

The superficial musculoaponeurotic system flap in the prevention of Frey syndrome: A meta-analysis

Evaluate the difference of the incidence in clinical Frey syndrome in studies comparing classical parotidectomy and parotidectomy with superficial musculoaponeurotic system (SMAS) flap elevation and suturing through meta-analysis methodology

Synovial sarcoma of the hypopharynx in a pediatric patient: Case report

Introduction: Synovial sarcoma (SS) is uncommon high grade soft tissue sarcoma, accounting for less than 10% of all head and neck sarcomas. Also, about 10% of SS occur within the Head & Neck. In the pediatric population, SS is an extremely rare head & neck malignancy. Presentation of case: We present a case of sixteen years old boy diagnosed with SS situated of the hypopharynx treated by surgical excision and post operative radio-chemotherapy. Discussion: This anatomical location brings additional functional challenges (swallowing, phonation, respiration), especially in the pediatric population. Pre-operative and even post-operative histopathological diagnosis of SS remains difficult. Optimal treatment of Head & Neck SS has to balance functional and oncologic aspects. Conclusion: SS is an extremely rare head & neck malignancy in pediatric population. It has multifaceted challenges including pre and post-operative histopathological diagnosis and optimal modality of treatment. Clinical judgment, especially in the pediatric population, needs to balance tumor free margins and organ preservation in head and neck region

Open Maximal Mucosa-Sparing Functional Total Laryngectomy

BackgroundTotal laryngectomy after (chemo)radiotherapy is associated with a high incidence of fistula and therefore flaps are advocated. The description of a transoral robotic total laryngectomy prompted us to develop similar minimally invasive open approaches for functional total laryngectomy.MethodsA retrospective study of consecutive unselected patients with a dysfunctional larynx after (chemo)radiation that underwent open maximal mucosal-sparing functional total laryngectomy (MMSTL) between 2014 and 2016 is presented. The surgical technique is described, and the complications and functional outcome are reviewed.ResultsThe cohorts included 10 patients who underwent open MMSTL. No pedicled flap was used. Only one postoperative fistula was noted (10%). All patients resumed oral diet and experienced a functional tracheo-esophageal voice.ConclusionMMSTL could be used to perform functional total laryngectomy without a robot and with minimal incidence of complications

Comparison of the incidence of osteoradionecrosis with conventional radiotherapy and intensity-modulated radiotherapy

Modern techniques of radiotherapy are supposed to decrease the incidence of osteoradionecrosis of the mandible (ORNM). The purpose of this study was to compare the incidence of ORNM after intensity-modulated radiotherapy (IMRT) in comparison to conventional 3D conformal radiotherapy techniques (conventional RT)