Cryothérapie des récidives loco-régionales des carcinomes rares des voies aéro-digestives supérieures : revue de la littérature, série de cas et analyse de la faisabilité en ORL

Médecine. Oto-rhino-laryngologie. Chirurgie cervico-facialeRésumé : les cancers rares des voies aéro-digestives supérieures ne représentent que 10% des carcinomes de la tête et du cou. Si la prise en charge initiale passe par une exérèse chirurgicale et bien souvent une radiothérapie adjuvante, les récidives locorégionales représentent souvent une véritable impasse thérapeutique. Après de multiples traitements, les possibilités curatrices sont quasi-nulles. La cryothérapie pourrait représenter un nouvel axe thérapeutique curatif pour les patients actuellement orientés vers une prise en charge palliative. Nous avons mené une étude de cohorte rétrospective au sujet de 4 cas traités par cryothérapie pour une récidive locorégionale, au sein du Centre Hospitalier Universitaire de Strasbourg. L'objectif principal était d'évaluer la faisabilité de cette technique de prise en charge novatrice n'ayant quasiment jamais été exploitée en Oto-Rhino-Laryngologie. Les résultats sur la survie globale et le contrôle local sont également décrits. Cette étude montre la faisabilité de la technique dans le traitement des récidives locorégionales en chirurgie cervico-faciale. Il s'agit d'une technique innovante et sûre pour des cas bien sélectionnés. En outre, elle peut être réalisée en association avec les autres traitements disponibles, en vue d'accroître le contrôle locorégional. De prochaines études sont nécessaires afin d'évaluer l'intérêt de la cryothérapie en Oto-Rhino-Laryngologie dans des indications moins restrictives, et notamment comme alternative à une chirurgie délabrante.Summary : rare neoplasms of the upper aerodigestive tract represent only 10% of Head and Neck carcinomas. If the initial management involves surgical excision and adjuvant radiotherapy, locoregional recurrences often represent a true therapeutic challenge. After multiple treatments, the curative possibilities are almost null. Cryotherapy could represent a new curative therapeutic axis for patients currently oriented towards palliative care. We conducted a retrospective cohort study on 4 cases treated by cryotherapy for locoregional recurrence, in the University Hospital Center of Strasbourg. The main objective was to evaluate the feasibility of this innovative management technique that has almost never been used in Oto-Rhino-Laryngology. Results on overall survival and local control are also described. This study shows the feasibility of the technique in the treatment of locoregional recurrences in cervicofacial surgery. This is an innovative and safe technique for well selected cases. In addition, it can be performed in combination with other available treatments, in order to increase locoregional control. Further studies are needed to evaluate the interest of cryotherapy in Oto-Rhino-Laryngology in less restrictive indications, and especially as an alternative to dilapidated surgery

Mindfulness Improves Otolaryngology Residents’ Performance in a Simulated Bad-News Consultation: A Pilot Study

Introduction: Delivering bad news is a stressful moment for both patient and clinician. As poor bad-news consultation quality may lead to misunderstandings, lack of treatment adherence, acute or even post-traumatic stress in patients, training interventions to improve communication skills and stress-management are necessary. Mindfulness is a recognised stress-management strategy that has shown its efficacy in reducing stress in both health professionals and students. We then supposed that a short mindfulness meditation session performed just before a simulated breaking bad-news consultation to patients with laryngeal cancer may help ear, nose and throat (ENT) residents to master their stress and improve their management of this consultation. This study aims at showing how a short mindfulness meditation performed before a simulated bad-news consultation may improve performance in its realisation by ENT residents.Materials and methods: We enrolled 53 ENT residents, randomised in 2 groups. The first group completed a 5-minute mindfulness session while the other group listened to a control track. Thereafter, every resident completed an 8-minute simulated bad-news consultation with a standardised patient. Two blinded expert assessors evaluated their performance on a 25-point grid (BNC-OSAS). Residents self-assessed their stress before and after the intervention and simulated patients rated their perception of physician's empathy.Results: The performance was significantly better in the mindfulness group than in the control group (m = 19.8, sd = 3.2 and m = 17.4, sd = 3.7 respectively, F(1,45)=5.27, p = 0.026, d = 0.67), especially in the communication and knowledge subdomains. There was no significant difference in perceived stress between the 2 groups. Empathy perceived by simulated patients was positively correlated to residents' performance.Conclusion: A short mindfulness meditation is effective for improving ENT residents' performance in a simulated bad-news consultation. These results encourage further assessments of this method with objective measures of physiological stress. More research is required concerning the feasibility and efficacy of mindfulness before daily clinical activities such as stressing bad-news consultation

Percutaneous Cryoablation for Recurrent Head and Neck Tumors

Purpose: To report techniques and results of 16 cryoablation procedures in 11 patients treated for recurrent head and neck cancer. Methods and materials: This retrospective study reviewed 11 consecutive patients with head and neck cancer recurrence after primary treatment by surgery and radiotherapy, treated with cryoablation between 2016 and 2020. Efficacy was measured by local control rate evaluated on MRI or/and PET. Tumor characteristics, number of cryoprobes, thermoprotective measures and complications were documented. Results: Sixteen cryoablation procedures were performed in 11 patients with head and neck cancer recurrence after surgery or radiotherapy, deemed ineligible for classic salvage treatment. Among 11 patients, four were treated for an epidermoid carcinoma, four for an adenocarcinoma and three for other types: 1 muco-epidermoid carcinoma, 1 adenoid cystic carcinoma and 1 esthesioneuroblastoma, 10/11 patients had prior surgery, 7/11 patients had prior chemotherapy and 3/11 patients had prior radiotherapy. Median number of cryoprobes was 4, [IQR, 3-6 cryoprobes], thermoprotective measures to protect surrounding organs were required for 10/16 procedures. After cryoablation, local control rate was 45.4% at a mean follow-up of 11.7 months (range 3-34 months). Among the 16 cryoablation procedures, four resulted in complications, two were considered major complications: one septic shock on inhalation pneumopathy during extubation, requiring intensive care; and one dysphonia due to a recurrent nerve injury. Conclusion: Cryoablation as a salvage treatment for recurrence of head and neck tumors after surgery and/or radiotherapy is an effective option, especially for patients that cannot benefit from salvage surgery. Keywords: Cryoablation; Head and neck cancer; Image guided; Percutaneous treatment