Melanoma: Lacau St Guily J

Bensadoun RJ, Allavena C, Chauvel P, Dassonville O, Demard F, Dieu-Bosquet L, Lacau St Guily J, Ettore F, Gory-Delabaere G, Marcy PY, Reyt E, Anonymous00028, Anonymous00029, Anonymous00030, Anonymous00031, Anonymous00032, Anonymous00033. · Centre Antoine Lacassagne, Nice, France. · Bull Cancer. · Pubmed #12957805 links to  free full text

Abstract: CONTEXT: The "Standards, Options and Recommendations" (SOR) project, which started in 1993, is a collaboration between the Federation of French Cancer Centers (FNCLCC), the 20 French Regional Cancer Centers, and specialists from French public universities, general hospitals and private clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and the outcome of cancer patients. OBJECTIVES: To update clinical practice guidelines for the management of patients with salivary gland malignant tumors previously validated in 1997. These recommendations cover diagnosis, classification, treatment and follow-up of patients with these tumors. METHODS: The methodology is based on a literature review and critical appraisal by a multidisciplinary group of experts who define the CPG s according to the definitions of the Standards, Options and Recommendations project. Once the guidelines has been defined, the document is submitted for review by independent reviewers. RESULTS: This article is a summary version of the full document presenting the updated clinical practice guidelines with algorithms. The main questions addressed by the expert group in this update concern the place of fine needle aspiration biopsy in preoperative diagnosis, the place of cervical lymph node area surgical treatment, the place of postoperative irradiation and neutron therapy in the treatment of unresectable tumors and also the place of medical imaging, especially RMI, for the diagnosis of these tumors.

Bensadoun RJ, Allavena C, Chauvel P, Dassonville O, Demard F, Dieu-Bosquet L, Lacau St Guily J, Ettore F, Gory-Delabaere G, Marcy PY, Reyt E, Anonymous00452, Anonymous00453, Anonymous00454, Anonymous00455, Anonymous00456, Anonymous00457. · Centre Antoine-Lacassagne, Nice. · Cancer Radiother. · Pubmed #12914861 No free full text.

Abstract: CONTEXT: The "Standards, Options and Recommendations" (SOR) project, which started in 1993, is a collaboration between the Federation of French Cancer Centers (FNCLCC), the 20 French Regional Cancer Centers. and specialists from French public universities,general hospitals and private clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and the outcome of cancer patients. OBJECTIVES: To update clinical practice guidelines for the management of patients with salivary gland malignant tumors previously validated in 1997. These recommendations cover diagnosis, treatment and follow-up of patients with these tumors. METHODS: The methodology is based on a literature review and critical appraisal by a multidisciplinary group of experts who define the CPGs according to the definitions of the Standards, Options and Recommendations project. Once the guidelines have been defined, the document is submitted for review by independent reviewers. RESULTS: This article presents the updated clinical practice guidelines concerning irradiation of patient with salivary gland tumors. The main recommendations are: 3 dimensional conformal radiotherapy (with or without intensity modulation) or 2D irradiation can be used; for surgical complete resected patients, postoperative photon radiotherapy should not be used in case of low grade stage I and 11 tumors(standard, level of evidence B2) but should be used for high grade stage II, II and IV tumors and for low grade stage III and IV tumors(standard, level of evidence B2). Neutron therapy should not be used in all of these cases (standard, level of evidence D); for patients presenting an incomplete macroscopic or microscopic surgical residual disease, postoperative irradiation must be delivered(standard). Neutron or photon therapy can be either delivered (options); for non operable patients neutron or photon therapy can be either delivered (options, level of evidence B2); for unresectable tumors or in case of recurrent neoplasms, exclusive neutron therapy or surgical tumor reduction combined with postoperative photon beam irradiation can be proposed (options, level of evidence C).

Morinière S, Périé S, Lacau St Guily J. · Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, University Francois Rabelais, Bretonneau Hospital, 4 Bd Tonnellé, 37044, Tours Cedex 1, France. · Eur Arch Otorhinolaryngol. · Pubmed #17534637 No free full text.

Abstract: Our aim was to report our experience in the management of malignant primary and non-primary parotid neoplasms and to compare the clinical presentations, the treatment modalities and the outcomes in these two groups. We performed a retrospective review of the clinical and surgical data contained in patient files. Between January 1995 and December 2004, 60 patients with malignant parotid tumors were admitted to our department. Two groups were isolated: a group of 42 patients with primary parotid malignancies (group 1) and a group of 18 patients with non-primary parotid malignancies (intra-parotid metastasis and parotid lymphoma), (group 2). We compared the preoperative data, the surgical procedures performed total parotidectomy (TP) versus superficial parotidectomy (SP), the need for sacrificing the facial nerve and postoperative facial nerve function in the two groups. Actuarial survival rates were calculated using the Kaplan-Meier method in combination with the Log Rank test for comparison of the results in the two groups. Preoperative clinical facial nerve impairment was significantly more frequent in group 1 (33%) as compared to group 2 (6%) (P = 0.023). A SP was performed in 15 patients in group 2 while a TP was performed in 37 patients in group 1. The facial nerve was completely or partially sacrificed in 17 cases in group 1 and in only one case in group 2 (P = 0.03). One month after surgery, 18 patients in group 1 had persistent facial nerve dysfunction compared to only one patient in group 2 (P = 0.004). In group 1, the overall 1, 3 and 5-year survival rates were, respectively, 94, 76 and 69%. In group 2, the respective survival rates were 84, 62 and 40% (P = 0.4). This study outlines the differences in clinical presentation, surgical management and outcomes in the two main groups of malignant parotid tumors. The prognosis of facial nerve function was better in non-primary parotid malignancies. SP was the standard surgical option in group 2 patients while a TP was performed in the majority of the patients in group 1. Except when melanoma or lymphoma were present (which require specific treatment), adjuvant radiotherapy had the same indications in both groups when the tumors were high-grade, AJCC stages III and IV or when they had positive margins or lymph node and facial nerve involvement.