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Patients with Roux en Y gastric bypass (RYGBP) who undergo total thyroidectomy may be at increased risk for recalcitrant symptomatic hypocalcemia.All patients who underwent total thyroidectomy with a history of preceding RYGBP from 2007 to 2012 were identified retrospectively. Cases were matched 2:1 for age, gender, and BMI to a control group undergoing total thyroidectomy without previous RYGBP during the same study period.Age and body mass index were equivalent between cases (n = 14) and controls (n = 23). A comparison between groups demonstrated that cases had a significantly higher incidence of symptomatic hypocalcemia resulting in paresthesia and tetany (38% vs. 0%; P0 .01), received intravenous calcium more often (18% vs. 0%; P0.01), and had longer hospital stays (2.2 vs. 1.2 days, P = 0.02) than controls.Physicians and surgeons need to be aware of this complication and take measures to identify and prevent it, and patients should be informed. In this patient population, calcium levels should be closely monitored and early calcium and vitamin D spplementation should be initiated preemptively.

One of the most important complications during thyroid surgery is injury to the recurrent laryngeal nerve (RLN) which leads to dysfunction and palsy of the vocal folds. Adequate knowledge about the location of the RLN supported by neuromonitoring can help the operating surgeon to prevent this complication. Visualization of the nerve alone seems not enough. An estimation of the function of the RLN is very important. Recently, the use of neuromonitoring has been increasingly employed to predict and document nerve function at the end of thyroidectomy. The aim of the study was to verify the usefulness of neuromonitoring in identifying the recurrent laryngeal nerve and to predict postoperative outcome in patients undergoing thyroid surgery for different indications. Between March 2009 and October 2010, 91 patients (26 men, 65 women; mean age 53 (range 26-83) underwent thyroidectomy. Intraoperative neuromonitoring (IONM) was registered for 91 patients. Eighty-four total thyroidectomies and seven lobectomies were performed with IONM. Eight unilateral postoperative transient paresis were identified without any permanent paralysis. Intraoperative neuromonitoring has an excellent specificity and negative predictive value in which an unchanged positive signal is highly predictive of intact nerve function. Intraoperative neuromonitoring during thyroid surgery is a reliable tool for early recurrent laryngeal nerve localization and identification, certainly in complicated thyroid operations. The probability is high for correctly predicting an intact postoperative nerve function by neuromonitoring.

Annales Francaises d'Oto-Rhino-Laryngologie et de pathologie cervico-faciale - Vol. 130 - N° 1 - p. 4-7

Resume Objectifs Dans notre societe vieillissante, le nombre de seniors avec une tumeur des voies aerodigestives est croissant. Le but de cette etude etait d’evaluer l’adequation d’une therapeutique agressive administree a but curatif chez ces personnes âgees. Patients et methodes De maniere retrospective, de 2005 a 2007, les patients âges de plus de 70 ans et ayant presente une tumeur des voies aerodigestives superieures localisee au niveau de la cavite buccale, du pharynx et du larynx, pris en charge primairement dans nos services, ont ete evalues, apres un suivi de 36 mois. Les donnees demographiques, l’evaluation des facteurs de comorbidite, les modalites therapeutiques ainsi que leur morbidite et mortalite associees ont ete evaluees. Resultats Trente-deux hommes et 12 femmes avec un âge median de 77 ans (extremes de 70 a 88 ans) ont ete traites avec intention curative. La majorite des patients presentaient un ou plusieurs facteurs de comorbidite. Sept patients avaient pour antecedent une ischemie du myocarde, 15 patients une bronchopathie chronique obstructive, dix patients un diabete non insulinodependant. Dix-sept patients avaient une hypertension arterielle medicalement traitee. Quatre patients avaient une insuffisance renale chronique, deux patients une cirrhose. Neuf patients ont ete traites par radiotherapie exclusive. Dix-huit patients ont ete traites par radiochimiotherapie concomitante. Quatorze patients ont beneficie d’une chirurgie suivie d’un traitement adjuvant par radiochimiotherapie concomitante. Trois patients ont ete traites par une chirurgie de rattrapage. Parmi les 44 patients, 12 deces ont ete observes, dont sept associes a une recidive, deux a des complications secondaires au traitement, un a un infarctus, un a une peritonite et un a une pneumonie. Apres un suivi de 36 mois, 32 des 44 patients etaient en vie. Conclusion Les tumeurs des voies aerodigestives superieures representent une pathologie grave, qui souvent exige une attitude agressive. Tous les patients âges aptes medicalement doivent beneficier du traitement optimal ; l’âge chronologique ne doit pas servir de facteur d’exclusion. En revanche, la connaissance des facteurs de comorbidite du patient permettra de decider idealement la therapeutique.

Resume Introduction Le diagnostic d’un second primitif pulmonaire est generalement associe a un mauvais pronostic chez les patients ayant presente initialement un carcinome epidermoide des voies aerodigestives superieures (VADS). Methodes De janvier 2000 a juin 2008, 39 patients ayant eu une tumeur cervicofaciale et ayant developpe un second primitif pulmonaire ont ete inclus. Resultats Quatorze secondes primitifs pulmonaires ont ete classes comme synchrones et 25 comme metachrones. Le stade du second primitif pulmonaire etait correle au stade du primitif cervicofacial ( p = 0,0496). Les patients avec une tumeur pulmonaire metachrone ont presente une survie globale prolongee par rapport aux patients avec une tumeur pulmonaire synchrone (92,9 mois vs 15,7 mois ; HR 0,323 ; 95 % IC 0,042–0,559, p = 0,0045). Dans le sous-groupe de 11 patients diagnostiques avec une tumeur plus de cinq ans apres le primitif pulmonaire cervicofacial, le pronostic etait meilleur (128,1 mois vs 29,7 mois ; HR 0,288 ; 95 % IC 0,053–0,353 ; p Discussion Dans notre etude, au contraire des donnees publiees dans la litterature, de maniere plus specifique, une survie et un pronostic favorable ont pu etre determine dans un sous-groupe de patients ayant eu un primitif des VADS et qui ont developpe dans le suivi un second primitif pulmonaire plus de 12 mois apres le diagnostic du premier primitif et, encore plus specifiquement, dans le groupe de patients ayant developpe le second primitif pulmonaire plus de cinq ans apres le diagnostic du primitif des VADS. Conclusion Un second primitif pulmonaire diagnostique chez un patient ayant presente un carcinome epidermoide des VADS est decrit, sans nuance, comme est une entite agressive, associee a un mauvais pronostic. Cependant, les tumeurs pulmonaires metachrones et surtout les tumeurs pulmonaires diagnostiquees plus de cinq ans apres le primitif cervicofacial sont clairement associees a un meilleur pronostic.

Chemoradiation ( CRT) is a valuable treatment option for(pharyngo)laryngeal squamous cell cancer and a palliative cure in advanced oral cancers. However, toxicity is scarcely reported. Therefore, efficacy, acute and toxic effects of chemoradiation for advanced head and neck squamous cell carcinomas were evaluated, using retrospective study.Previously untreated patients with stage III-IV head and neck squamous cell carcinomas were included. Radiotherapy consisted of 70 Gy/7 weeks/35 fractions. All patients received concurrent Cisplatin 40 mg/m2 weekly.The most common acute toxic effects were dysphagia and mucositis. Dysphagia and xerostomia remained problematic during follow-up. Loco regional disease control was respectively 91% and 98% after 6 months. The median overall survival (calculating starting form the end of the treatment) was 33 months (range 0-111months). The 5-year disease specific survival was 41%.The results indicated that concurrent chemoradiotherapy for advanced head and neck squamous cell carcinoma is associated with high locoregional control and disease-specific survival. However, significant acute and long-term toxic effects occur, and organ preservation appears not necessarily equivalent to preservation of function in pharyngolaryngeal cancers.

Summary Introduction The present study sought to determine the necessity and prognostic impact of superior mediastinum (SM) dissection in advanced upper aerodigestive tract squamous cell carcinoma (SCC). Methods A retrospective review was made of the records of 31 patients who had undergone (pharyngo-) laryngectomy for advanced SCC. Statistical analysis examined correlations between the presence of SM lymph node metastasis and clinical factors, with a significance threshold of P Results Positive cervical and/or SM lymph nodes were found in 20 cases, including six with isolated positive SM nodes. Positive SM nodes were found in none of the patients with laryngeal SCC, versus six of the 13 patients with hypopharyngeal SCC, where they were associated with tumors greater than 35 mm. Presence of paratracheal lymph node metastasis showed a strong but not statistically significant association with the primary site (larynx vs. hypopharynx: P = 0.08). Conclusions In the present series, advanced laryngeal carcinoma was never associated with positive SM nodes, whereas advanced hypopharyngeal carcinoma showed a trend in favor of paratracheal lymph node involvement.

The 1997 International staging system (ISS) classification separated stage III non-small cell lung cancer (NSCLC) into stages IIIA and IIIB. In a previous study including unresectable NSCLC initially treated with chemotherapy, we analysed survival according to tumour (T) and node (N) stages and derived a classification into stages IIIbeta (T3-4N3) and IIIalpha (other TN stage III) that had a better discrimination on survival distribution. The aim of this study was to validate these results in a further set of patients. Patients with unresectable stage III NSCLC included in a phase III trial assessing the role of increased dose chemotherapy (SuperMIP: mitomycin 6 mg/m2, ifosfamide 4.5 g/m2, cisplatin 60 mg/m2, carboplatin 200 mg/m2) in comparison to standard chemotherapy MIP (mitomycin 6 mg/m2, ifosfamide 3 g/m2, cisplatin 50 mg/m2), before thoracic irradiation (60 Gy in 30 fractions over 6 weeks) were the subject of this study. Survival distributions were assessed by the method of Kaplan-Meier. Survival comparisons were made by the log-rank test. Multivariate analyses using Cox regression models, included all potential prognostic factors for survival with a P-value0.2 in univariate analysis. According to the 1997 International staging system classification, 328 eligible patients were included in the study. There was no imbalance between the two arms. Five parameters were significantly associated (Por = 0.05) with survival in univariate analysis: European lung cancer working party (ELCWP) staging (IIIalpha[n = 294 pts] versus IIIbeta [n = 46]), Karnofsky index, weight loss, platelet count and haemoglobin level. These variables as well as the 1997 ISS staging, white blood cell (WBC) count, LDH and sodium levels were included in a multivariate analysis. Two models were constructed, including either the ELCWP or the 1997 ISS. In model 1 (ISS included), Karnofsky index (HR 0.69; 95% confidence interval (CI) 0.47-1.00; P = 0.05) and haemoglobin (HR 1.49; 95% CI 1.11-1.99; P = 0.007) were found significant. In model 2, including ELCWP staging, two variables were associated with survival: ELCWP staging (HR 1.68; 95% CI 1.20-2.35; P = 0.002) and haemoglobin (HR 1.54; 95% CI 1.15-2.07; P = 0.01).In initially unresectable stage III NSCLC treated by chemotherapy and radiotherapy, we validated the results of our previous study. The classification into stages IIIbeta (T3-4N3M0) and IIIalpha (other TN stage III) better discriminates the patients in term of survival than the 1997 ISS classification.

Resume Introduction. – Le melanome est caracterise par sa tendance a metastaser. Sur le tractus digestif, les sites les plus frequemment envahis sont par ordre decroissant l'intestin grele, l'estomac et le colon. Le traitement chirurgical des metastases digestives de melanome est mal connu et son interet est discute. Patients et methodes. – Les dossiers de dix patients (6 femmes et 4 hommes) operes d'une metastase digestive de melanome entre 1980 et 2001 ont ete revus afin de preciser les resultats du traitement chirurgical. Resultats. – Les metastases gastro-intestinales etaient symptomatiques chez huit patients (douleurs abdominales 3 fois, syndrome occlusif 3 fois, masse abdominale et ictere obstructif une fois chacun). Deux patients avaient une anemie. Le diagnostic a ete evoque par l'imagerie sept fois et l'endoscopie trois fois. Tous les patients ont ete operes par laparotomie pour resection de metastases localisees au niveau de l'intestin grele quatre fois, sur la vesicule biliaire deux fois, l'estomac deux fois, et le colon deux fois. Une resection complete a supprime les symptomes dans neuf cas. Dans un cas, la resection etait incomplete mais a fait disparaitre les symptomes de facon satisfaisante. Un patient est decede a J3 ; chez les autres patients, la survie mediane etait de 18 mois (extremes 3–120 mois). Conclusion. – Chez un patient ayant un antecedent de melanome, des symptomes digestifs doivent faire realiser des explorations morphologiques a la recherche d'une metastase gastro-intestinale. Le traitement chirurgical de ces metastases est le plus souvent palliatif mais, dans de rares cas, autorise une survie prolongee.

Total thyroidectomy or hemithyroidectomy together with a total laryngectomy (TL) or pharyngo laryngectomy (TPL) for (pharyngo) laryngeal cancer often renders the patient hypothyroid and commits them to life-long thyroid hormone replacement. To determine the incidence of thyroid gland invasion (TG) in patients undergoing TL or TPL with total thyroidectomy (TThy) or lobectomy (HThy) for advanced laryngeal or hypo pharyngeal cancer and to assess predicative factors. Retrospective analysis of 35 patients from 2007 to 2010. Specimens were examined to determine the incidence of TG invasion and relevant predicative factors such as histological grade and subglottic extension. Pre-operative imaging was reviewed to assess for radiological evidence of TG invasion. TL and TThy was performed in 13 patients. TL and HThy was performed in four patients and TPL and TThy was performed in 18 patients. Surgery was performed for primary and recurrent cancer in 29 and six patients, respectively. Histological evidence of invasion of the TG was found in three patients. Relationship was found between TG invasion and subsite of primary carcinoma and the presence of subglottic extension. No relationship was found between TG invasion and patient’s sex, stage of primary disease at surgery, degree of differentiation. In addition, no significant relationship was found between the presence of TG invasion and recurrent disease. Invasion of the TG in patients undergoing a TL or TPL is a rare event and limits the need for a TTHy in most cases.

Summary Introduction Second primary lung cancer (SPLC) is generally of poor prognosis in patients presenting with head and neck cancer. Methods Between January 2000 and June 2008, 39 patients with head and neck squamous-cell carcinoma (HNSCC) patients diagnosed with SPLC were included. Results Fourteen SPLC were classified as synchronous and 25 as metachronous. SPLC and HNSCC staging correlated ( P = 0.0496). Patients with metachronous tumor showed longer median overall survival than those with synchronous tumor (92.9 months versus 15.7 months; Hazard ratio (HR), 0.323; 95% CI, 0.042–0.559; P = 0.0045). In the subgroup of 11 patients with SPLC diagnosed more than 5 years after HNSCC, prognosis was better (128.1 versus 29.7 months; HR, 0.288; 95% CI, 0.053–0.353; P Discussion In the present study, in contrast to the literature, improved prognosis and survival were found in the subgroup in which SPLC developed more than 12 months after initial HNSCC diagnosis, and even more specifically in that in which SPLC developed more than 5 years after initial HNSCC diagnosis. Conclusion SPLC in HNSCC is generally described as unequivocally aggressive and of poor prognosis. Metachronous SPLC, however, especially when diagnosed more than 5 years after HNSCC, was clearly associated with better prognosis.

Radiation therapy alone, or combined with chemotherapy, are both used for cancer in the head and neck. This can lead to damage of tissue cells and vasculature. Surgery in such compromised tissues has increased complication rates, because wound healing with angiogenesis and fibroplasias requires normal cell growth conditions. Hyperbaric oxygen therapy raises oxygen levels in hypoxic tissue, stimulates angiogenesis and fibroplasia. In this report, we review the clinical value of hyperbaric oxygen therapy for major wounds that had shown no signs of healing as well as fistulas after salvage surgery in patients treated with (chemo)radiation of the head and neck regions.In this retrospective study, 16 patients with soft-tissue wounds without signs of healing after salvage surgery, after radiation, and most after chemotherapy were treated in the head and neck regions with hyperbaric oxygen therapy. The patients were treated by HBO2, 2.5 bars 90 minutes daily, usually 20 treatments.The healing processes seemed to be initiated and accelerated by HBO2. Fourteen of the 16 patients healed completely. There were no life-threatening complications.Radiotherapy and combined chemoradiation therapy leads to damage of tissue cells and vasculature. Salvage surgery in such tissues has an increased complications rate, because wound healing requires angiogenesis and fibroplasias, all of which are jeopardized. Hyperbaric oxygen therapy raises oxygen levels in hypoxic tissue, stimulates angiogenesis and fibroplasias and is an effective and powerful treatment for postoperative wounds in oral, pharyngeal and laryngeal carcinomas surgery.

Summary Objectives Carotid blowout syndrome is a rare but devastating complication in patients with head and neck malignancy, and is associated with high morbidity and mortality. Bleeding from the carotid artery or its branches is a well-recognized complication following treatment or recurrence of head and neck cancer. It is an emergency situation, and the classical approach to save the patient's life is to ligate the carotid artery. But the surgical treatment is often technically difficult. Endovascular therapies were recently reported as good alternatives to surgical ligation. Methods Retrospective review of three cases of acute or threatened carotid hemorrhage managed by endovascular therapies. Results Two patients presented with acute carotid blowout, and one patient with a sentinel bleed. Two patients had previously been treated with surgery and chemo radiation. One patient was treated by chemo radiation. Two had developed pharyngocutaneous fistulas, and one had an open necrosis filled wound that surrounded the carotid artery. In two patients, stent placement resolved the acute hemorrhage. In one patient, superselective embolization was done. Mean duration follow-up was 10.2 months. No patient had residual sequelae of stenting or embolization. Conclusion Management of carotid blow syndrome is very critical and difficult. A multidisciplinary approach is very important in the management of carotid blow syndrome. Correct and suitable management can be life saving. An endovascular technique is a good and effective alternative with much lower morbidity rates than surgical repair or ligation.

To determine the functional disabilities and overall quality of life of patients operated for advanced (Stages III-IV) or recurrent squamous cell carcinomas (SCCA) after radiation therapy of the (pharyngo)larynx.From 1984 to 1997, 135 patients were consecutively treated for SCCA of the (pharyngo)larynx. There were 118 men and 17 women with a mean age of 60 years. The University of Washington QOL questionnaire (UW-QOL) (Deleyiannis et al) was administered to 19 long term survivors. Self-administered scale consisting of nine domains affected by treatment for head and neck cancer: pain, physical appareance, global activity, entertainement, employment, chewing, swallowing, speech and shoulder function. For each patient, a total score and weighted score were determined. Descriptive statistics were used.9/19 patients reported that compared with one year prior to the diagnosis of cancer their general health was the same. Pain resolved in 78%; the physical appearance was juged not modified in 52% of the cases. Chewing and swallowing functions were respected in 94% of the cases. These functions were considered as very important in 53% and 68% respectively. Five patients are still at work; 11 patients retired. Work was considered as very important for 9/19 patients. Speech rehabilitation permitted a modified but well understandable communication in 63% of the cases. This function was considered by 88% of the patients as very important. Finally, 73% of the patients (14/19) reported having a good to excellent overall QOL.Though disabling, pharyngolaryngectomies do not necessarily translate into worse overall QOL; ultimate disabilities are widely variable. Many factors such family, friends, personal leisure, activities, employement, cultural habits were important and depending on each patient in enjoyement of life's estimation.

Necrotizing fasciitis of the head and neck is a rare polymicrobial infection, rapidly progressing with a potentially fatal outcome, without early recognition and treatment. Odontogenic infection spreading to the lower neck or anterior chest is an important clinical feature. CT-scan and MRI can be useful in case of doubt. As the relative mild external clinical signs can mask the severe underlying necrosis, the difference in outcome is due to the rapidity of diagnosis and surgical intervention. Surgery consists of complete debridement of all necrotic tissues, repeated as needed and associated with an early tracheotomy. Antibiotherapy is based on the organisms most frequently involved. Hyperbaric oxygen therapy and vacuum-assisted closure could have a role after initiation of intravenous antibiotics and surgical debridement. We report a case of a 23-year old man with a necrotizing fasciitis from a dental origin, necessitating an extensive and repeated surgery, a tracheotomy and antibiotherapy; he developed severe complications such as multisystem organ failure, pericardial effusion and cardiorespiratory arrest.

We report the case of a patient treated by neck dissection for a cervical recurrence from a head and neck cancer. The histopathologic study of the lymph nodes evidenced the presence of a occult metastases of differentiated thyroid carcinoma. We discuss the treatment of these patient, with review of the literature. Management of thyroid carcinoma found incidentally during treatment of squamous cell carcinoma of the head and neck is still debatable, and all patients must be evaluated individually with regard to its benefit.

The management of squamous cell carcinoma in undetermined primary tumours in the head and neck region (approximately 5.5% of patients) is controversial.The present report examines the outcomes for 14 patients after an initial treatment strategy directed principally at the side of the neck that is clinically involved. The distribution of nodal status was as follows: 1 N1, 8 N2A, 4 N2B, and 1 N3.Initial treatment included a modified neck dissection in 12 cases and radical neck dissection in 2 cases, plus postoperative radiation in 10 cases. Radiotherapy was directed at the ipsilateral side of the neck alone. Concomitant radiochemotherapy was given in 2 cases. The rate of disease control on the ipsilateral side was 12/14. Two patients were treated by chemotherapy but died of their disease. The failure rate on the contralateral side was 2/14. These two patients were successfully salvaged. During follow-up, a primary tumour was detected in one case. At the end of the follow-up, 10 patients were alive.Modified radical neck dissection combined with postoperative radiation with or without chemotherapy could be considered in N1-N3 lymph node status. Despite generally advanced disease at presentation, patients presenting with cervical metastasis from an unknown primary carcinoma have a reasonable survival expectation and aggressive treatment is warranted. Careful follow-up is required for effective salvage treatment.

Malignant primary lymphoma of the thyroid gland is a rare disease. The principal clinical sign is a rapidly growing goiter, leading to signs of compression, raising the question of differential diagnosis with anaplastic cancer. Multimodality therapy with surgery, radiotherapy, and chemotherapy appears to be of value. We retrospectively reviewed the management and outcomes of five consecutives patients with thyroid lymphoma.

Distant metastases in head and neck cancer are often to the lung, and rarely to the skin sites.To ascertain that a skin metastasis indicates a poor prognosis, a review was conducted of patients with head and neck cancer.Three out of seven patients had evidence of local recurrence at the time of development of the skin metastases, and three out of seven had evidence of distant metastases. The average survival time was 1 month after the development of skin metastases.Skin metastases may represent the first clinical evidence of impending recurrence or distant metastasis. The development of skin metastasis is associated with a poor prognosis. Current treatment options are limited in their efficacity.

Tracheotomy was initially described as a means to relieve acute upper airway obstruction. Indications for its use have changed and developed over time.During the 1960's, tracheotomy was promoted as a treatment for ventilator-dependent patients but the complications reported in the 1970's and early 1980's both reduced its accepted indications and led to it being proposed later. During the last 20 years advances in intensive care medicine and a reduction in the rate of complications associated with the procedure have encouraged intensivists again to propose tracheotomy at an earlier stage.Over the last 10 years, a new technique, percutaneous dilatational tracheotomy has gained widespread acceptance because of its simplicity of execution, its low cost and the low rate of postoperative complications that has been observed.Although the ideal time to perform a tracheotomy has not yet been established, the benefits of this approach compared to prolonged laryngeal intubation, the low morbidity associated with modern surgical tracheotomy and the development of percutaneous techniques support the use of this procedure in the management of patients requiring prolonged ventilatory support.

The recent publication of many randomised trials about (neo)adjuvant chemotherapy in resectable non-small cell lung cancer (NSCLC) has prompted our group to update a prior meta-analysis of the literature. Randomised studies published in French and English between 1965 and June 2004 were included in this analysis. A qualitative assessment of each trial was first performed using the European lung cancer working party (ELCWP) and the Chalmers' scales. In absence of statistically significant quality difference between positive and negative trials, a quantitative aggregation (meta-analysis) of the individual results was performed. Two trials for which data were available on ASCO virtual meeting website were also included in the meta-analysis. Twenty-five studies eligible for this analysis assessed chemotherapy as induction (n = 6) or adjuvant to surgery (n = 19). No quality difference was detected between positive and negative trials according to the two scores, whatever all trials were combined or only adjuvant chemotherapy studies were considered. The overall meta-analysis showed that the hazard ratio (HR) of the combined results was 0.66 (95% CI 0.48-0.93) in favour of the addition of induction chemotherapy to a standard surgical procedure and 0.84 (95% CI 0.78-0.89) in favour of adjuvant chemotherapy. The effect was significant for adjuvant chemotherapy in stages I and II with a HR of 0.88 (95% CI 0.83-0.94). It was not statistically significant in stage III although the trend was in favour of chemotherapy whatever adjuvant (HR = 0.85; 95% CI 0.69-1.04) or (neo)adjuvant (HR = 0.65; 95% CI 0.41-1.04) chemotherapy was tested. In conclusion, our meta-analysis shows the efficacy of adjuvant chemotherapy in stages I and II resected NSCLC. More data are needed to confirm such a role for induction chemotherapy. Further trials should separate stage III disease from earlier stages.

We report a case of prostate carcinoma metastatic to the mandible that had been initially suspected as being a primary tumor of the parotid. The initial symptom was hard swelling in the left parotid region. No pathologic fracture was diagnosed. The metastatic lesion was diagnosed 4 years after diagnosis of the carcinoma of the prostate. This is a very interesting event because of its unusual localization.

Small cell lung carcinoma (SCLC) initially presents with regional and/or distant metastases in the majority of patients. The mediastinum usually shows bulky involvement with massive lymph node metastases. Superior vena cava obstruction syndrome is found in more than 10% of all cases, and other complications, such as dysphagia or dysphonia, are not rare. In two-thirds of the cases, there is hematogenous dissemination, with metastases to the liver, adrenals, bone marrow or brain. When the neoplasm cannot be treated in a single irradiation field, the disease is called extensive, according to the definition of the Veterans Administration Lung Cancer Study Group, and treatment is based on chemotherapy. When the neoplasm is ipsilateral and can be included in a single irradiation field, it is called limited and the therapeutic approach is based on a combination modality of chemotherapy and irradiation (Pignon et al. 1992).

Most of the time, biological parameters are evaluated on tissues obtained on surgical samples of the primary tumour. New approaches in non small cell lung cancer (NSCLC) treatment consist to administer neoadjuvant chemotherapy or anti-EGF-R (epidermal growth factor receptor) drug.We assessed the expression of EGF-R by immunohistochemistry on biopsy samples and on the paired resected tumours in 27 patients.The mean percentage of EGF-R positive neoplastic cells was 11% in surgical specimens compared to 28% in biopsy specimens (p=0.02) although a good correlation (R=0.67; p=0.0001) between biopsies and surgical specimens was observed. Furthermore, the positivity (cut-off1% cells) rate was not statistically different between biopsies (55%) and tumours (48%) (p=0.63). In term of positivity rate, we found 85% concordant results between biopsies and resected tumours, 4% false negative and 11% false positive on biopsies in comparison with the resected tumours. The positive and negative predictive value of the biopsies were respectively 80% and 92%.The evaluation of EGF-R by immunohistochemistry on biopsies may provide reliable information about non small cell lung cancer EGF-R status.

Metastases of melanoma are frequent. On the gastro-intestinal tract, commonest localizations are small bowel, stomach and colon. Surgical treatment of digestive metastases from melanoma is not well known and its value is still debated.Medical records of 10 patients (six female and four male) operated for metastatic melanoma to gastro-intestinal tract were reviewed to determine results of surgery.Gastro-intestinal metastases were symptomatic in eight patients (abdominal pain in three, bowel obstruction in three, abdominal mass and obstructive jaundice in one each). Two patients had anemia. Diagnosis has been suggested by imaging in seven patients and endoscopy in three. All patients were operated on by laparotomy for resection of metastases located on small bowel in four patients, gallbladder in two, stomach in two and colon in two. Complete resection suppressed symptoms in nine cases. In one patient, resection was incomplete but provided satisfying symptomatic relief. One patient died at day 3; in other patients, median survival was 18 months (range: 3-120).In a patient with previous history of melanoma, digestive symptoms indicate morphological explorations due to suspicion of metastases to gastro-intestinal tract. Surgical treatment of these metastases is usually palliative but, in some cases, allows long-term survival.

Thyroid cancer rarely metastasizes to the pelvis. We report a case where the metastasis was found two years before the thyroid cancer. Treatment included initial surgery with resection of the metastatic tumor and reconstruction of the acetabulum with bone cement, and secondly total thyroidectomy, node dissection and I131. Surgical treatment of locoregional recurrence had no influence on the clinical course leading to the patient's death. Early diagnosis of unique metastasis of a thyroid cancer is important in terms of prognosis and quality of life. This case is exceptional due to the unique bone metastasis and treatment options for acetabular metastases. Therapeutic options should be adapted according to algorithms reported in the literature.

The case of a 40-year-old black man, who developed a very unusual tumour-like lymphoid hyperplasia involving primarily the subcutaneous tissue, is reported. The lesion, which arose at a site of tribal scarifications, displayed a deceptive morphology that closely resembled subcutaneous panniculitis-like T-cell lymphoma (SPTCL). An accurate diagnosis could only be made following detailed immunohistochemical and molecular studies. Although SPTCL has been thought to represent a very specific clinicopathologic entity, the present case illustrates that its histological appearance can, however, be closely mimicked by reactive and benign conditions.

This study was performed to evaluate the use of cervical ultrasonography and ultrasound-guided fine-needle aspiration for pretherapeutic staging of oesophageal cancer. 50 patients with a thoracic-oesophageal cancer (upper third = 8, middle = 36, lower = 6), previously untreated, underwent cervical ultrasonography to detect supraclavicular lymph node metastases (LN). An ultrasound fine-needle aspiration biopsy was attempted in 12 cases of suspected LN. 26 patients were operated on, of which 13 had surgical exploration of the neck. All patients were followed after treatment with special attention to the supraclavicular area. 14 patients (28%) were ultrasonography positive, 5 of 8 in the upper third, 9 of 42 in the two other thirds. Of the 12 patients where a fine-needle biopsy was attempted, 9 showed neoplastic cells (75%). 5 patients had cervical metastatic LN at surgery, and 5 other patients demonstrated supraclavicular LN metastases during the follow-up. There was one false positive and six false negatives from cervical ultrasonography and two false negatives of UGFAB (ultrasound-guided fine-needle aspiration biopsy). The sensitivity and the specificity of the cervical ultrasonography were 68 and 97%, respectively. The pretherapeutic staging was modified: 7 patients initially stage II-III were regraded to stage IV. Cervical ultrasonography is a reliable method of assessment of supraclavicular LN in thoracic oesophageal carcinoma.