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Resume Le cancer differencie de la thyroide (CDT) est un cancer habituellement de bon pronostic. Les recidives locoregionales, survenant dans 15–20 % des cas, sont surtout ganglionnaires et sont traitees chirurgicalement. Les metastases a distance sont observees dans 5 % des cas et sont surtout pulmonaires, plus rarement osseuses. Lorsque les metastases captent suffisamment l’iode (environ 60 % des cas), elles peuvent etre detruites par des activites repetees d’I131. La thyroglobuline (Tg), evaluee sous traitement hormonal ou sous stimulation par la TSH, est le marqueur tumoral du CDT. Lorsque le taux de Tg s’eleve, des examens d’imagerie fonctionnelle (scintigraphie a l’iode 131, TEP-FDG, scintigraphie osseuse) et anatomiques (echographie cervicale, TDM thoracique, IRM osseuse) peuvent etre indiques pour mettre en evidence des lesions residuelles/recidivantes. Ces dernieres annees ont ete marquees par la mise sur le marche de nouveaux equipements hybrides integrant une gamma camera et un scanner X (TEMP/TDM) et par l’implantation generalisee sur le territoire francais de tomographes a emission de positons couples a un scanner X (TEP/TDM). Ces equipements, qui permettent de correler directement les images fonctionnelles et anatomiques, ameliorent considerablement l’interpretation de la scintigraphie planaire ou de la TEP seule. L’imagerie hybride permet de localiser precisement les foyers scintigraphiques et, le plus souvent, de verifier immediatement s’ils se projettent sur des lesions d’allure tumorale. L’objectif de cet article est de faire le point en 2010 sur la place de la TEMP/TDM et TEP/TDM dans la prise en charge des patients presentant un CDT.

La prise en charge des patients atteints d’un cancer des voies aerodigestives superieures est parfois difficile dans un contexte de mutilation par la tumeur ou les traitements, les sequelles nombreuses, dans un environnement fragilise par l’intoxication alcoolo-tabagique.

The aim of the present article is to demonstrate the relevance of revascularized free scapular flap in mandibular reconstruction in oncological cervicofacial salvage surgery. We will discuss the advantages and the disadvantages, indications and contraindications, together with possible complications and sequelae for this type of surgical flap.Retrospective study of 93 revascularized free scapular flaps used to reconstruct segmental substance defects in the mandible from April 1997 to October 2009 (in 91 patients). All patients benefited from 10 months to 12 years follow-up surgical and functional results. Functional assessment following anatomic site restoration focused on the quality of feeding and deglutition.The anatomical success rate was 94.63% (5 complete necroses out of 93 flaps). Results were considered to be good (normal or close to normal function for feeding and deglutition) in the majority of patients (83% at 6 months, 91% at 18 months). On the donor site: Functional sequelae were moderate when post-operative reeducation was correctly performed.Vascularized free scapular flap bone graft is very interesting for the reconstruction of mandibular discontinuity, composite (soft tissue and cutaneous resection) or exclusively osseous defects (not in excess of 13 cm), secondary to oncologic or osteoradionecrotic resections.

Consider whether surgery alone in the treatment of early cancers of the hypopharynx can give identical or better results in terms of survival and local control than radiotherapy.Forty-five patients were operated on during the years 1991-2004. Surgical treatment consisted in a resection by the transoral approach in four patients and 41 patients had a partial pharyngolaryngectomy. An elective neck dissection was performed on 43 patients.The 1-, 3-, and 5-year overall survival rates were 100, 95, and 75%. The 1-, 3-, and 5-year locoregional control rates were 93, 88, and 82% and were influenced by the presence of dysplasia on surgical margins (p=0.027). The oncological occurrences observed were five local recurrences, two nodal recurrences, ten second primary cancers, and two metastases. Five locoregional failures out of seven were controlled after a second treatment.Surgery alone gives completely satisfactory results in terms of survival and locoregional control. In case of recurrence, this makes it possible to operate on patients in nonirradiated areas with lower morbidity and mortality and better results. These results must be confirmed by a randomized trial.

In presenting a case of laryngeal schwannoma, the authors emphasize the difficulties in diagnosing this rare pathology and review treatment options. The recent literature concerning this benign tumour is reviewed.The authors present a case of laryngeal schwannoma in a 29 year old man, revealed by exertional inspiratory dyspnea.The patient was treated by a conservative surgery with no recurrence after two years follow-up.CT scan and magnetic resonance imaging provide essentiel data on the spread of this benign tumour. The possibility of malignant change and recurrence warrant long-term follow-up.

With 10,882 estimated new cases in 1995 in France, lip, oral cavity and pharynx tumours rank 4th, representing 8.1% of all cancers in men. They are less frequent in women, with a sex ratio of 7. Based on the French cancer registries data which cover 13% of the metropolitan territory in 2000, both incidence and mortality increased until early 1980s to decrease thereafter. The main hypothesis proposed to explain the French leadership world-wide for these tumours deals with alcohol and tobacco consumption. Important differences observed between several areas within Europe, for some subsites, in connection with age or sex, are pointing toward the need of new studies about environment and/or genetics. Until now, comparisons between countries were made at the level of lip, oral cavity and pharynx category as a whole or by large subgroups. In this work we attempt to establish more accurate statistics, in order to comply with the situation of this cancer in France. Present results should encourage the scientific community to conduct site specific epidemiological studies.

From December 1987 to February 1998, 270 patients underwent a total laryngectomy with voice restoration by a voice prosthesis. The analysis is focused on the 62 live patients with a 5 year follow-up. Tracheoesophageal speech had a success rate of 81% after 1 year and 73% after 5 years. The daily use of the voice prosthesis is only 68% after 1 year and 61% after 5 years. During the 5 year follow up (for all patients) 16 (26%) presented an enlarged fistula with leakage around the fistula and 17 (27%) needed a removal of the prosthesis.Tracheoesophageal speech with a voice prosthesis appears interesting for laryngectomized patients with: a high success rate, the quality and precocity of the voice obtained. However, it requires extensive care and the results deteriorate with time.

The possibility to perform flow cytometry was examined in a series of 167 patients with primary untreated head and neck carcinoma referred to our Institution from February 1989 to January 1992. In all cases, flow cytometry was carried out on frozen tumour samples. The Cox model was used including age, tumour size, nodal status on clinical assessment, topography, treatment, malignancy grade, S phase fraction and ploidy as independent variables and overall survival as dependent variable. In this study, ploidy could be assessed in only 73% of cases and S phase fraction and G2M in 65% of the population studied. No correlation could be evidenced between ploidy or SPF with other clinical, pathologic characteristics or clinical outcome. We conclude that flow cytometry should remain a research tool until the method has proved to be relevant in clinical routine, and until the yield of the technique can be improved.

129 patients, who had oral cavity or oropharyngeal carcinoma underwent excision with intraoperative histopathologic examination. Thanks to this method, the number of satisfying resections has increased from 25% to 75%. Whatever the quality of the surgical excision may be, postoperative radiotherapy improves the prognosis.

When malignant tumours of the oral cavity are of a small size, they are asymptomatic during a long time, and it is difficult to detect them. A method permitting to discover them more easily during the examination would be a precious rescue. In this aim, we have tested the oral coloration with toluidine-blue in 50 patients with a high risk of malignant tumour. This coloration has allowed to reveal cancer in 3 patients whereas no tumour was found at previous clinical examination.

From the data collected in the Cancer Registry of Calvados, a screening program for neoplastic lesions of the whole upper digestive and respiratory tract was performed in a canton where esophageal cancer incidence is very high. 137 men underwent this examination for mouth, pharyngo-larynx and esophagus. None neoplastic lesion was revealed but histologic and cytologic swabs showed some abnormalities that are now being studied.

The authors performed 29 surgical interventions of this type (24 primary and 5 secondary implantations). The treatment protocols, especially, the radio-chemotherapeutic protocols, were not changed and the radiotherapeutic tolerance of these prosthetic implants was particularly outstanding. This method may find wide application as well after single total laryngectomy as after circular total pharyngeal laryngectomy with restoration by gastric transplant. Speech is generally produced as early as the 12th day and we may assert that it is much better than esophageal speech, the whole indications and results being considered. These are being discussed and sustained support by the therapeutic team appears to be necessary.