This retrospective study was, to our knowledge, the largest ever reported in the literature. This series confirmed the risk factor of this lesion as well as the lesion's influence on the survival rate. Surgery is the most important part of the treatment. Local recurrences were responsible for the poor prognosis of this lesion.

Full-dose reirradiation combined with chemotherapy was feasible in patients with inoperable HNC. The incidence and severity of late toxicity was markedly increased in comparison to that observed after the first irradiation. Median survival was better than that generally obtained using palliative chemotherapy alone. A small proportion of patients were long-term disease-free survivors.

BACKGROUND Primary head and neck mucosal melanoma (HNMM) has a poor prognosis with a low local control rate and frequent distant metastases. The objective of the current study was to determine the impact of postoperative radiotherapy on local control and survival. METHODS One hundred forty‐two patients with primary HNMM treated between 1979 and 1997 were reviewed. Of these, 69 patients with confirmed primary mucosal melanoma, absence of metastatic disease, and definitive management by surgery with or without postoperative radiotherapy and follow‐up at the Institut Gustave‐Roussy (Villejuif) were selected. The site of primary HNMM was sinonasal in 46 patients, oral in 19 patients, and pharyngolaryngeal in 4 patients. Twenty‐two patients (32%) had a locally advanced tumor (T3–T4) and 17 patients had regional lymph node metastases after pathologic examination (pN > 0). Thirty patients underwent surgery alone and 39 received postoperative radiotherapy. Patients with locally advanced tumors had received postoperative radiotherapy more frequently than those with small tumors (P = 0.02). RESULTS Thirty‐seven patients (54%) experienced local disease recurrence and 47 patients (68%) developed distant metastasis. The overall survival rates were 47% at 2 years and 20% at 5 years. In the Cox multivariate analysis, patients with early T‐classification tumors who received postoperative radiotherapy had a better local disease‐free survival (P = 0.004 and P = 0.05, respectively) compared with patients with late T‐classification tumors who did not receive postoperative radiotherapy. Patients with advanced T‐classification and pN > 0 stage had a shorter distant metastasis disease‐free survival compared with patients with early T‐classification and pN < 0 stage. Patients with advanced T‐classification tumors had a shorter overall survival compared with patients with early T‐classification tumors (P = 0.003). CONCLUSIONS The prognosis of patients with HNMM was poor. Patients had a high rate of distant metastasis and a low rate of local control. The current study suggested that postoperative radiotherapy increased local control even for patients with small tumors. Cancer 2005. © 2004 American Cancer Society.

Forty patients were treated or followed up for aesthesioneuroblastoma between 1980 and 1995 at Institut Gustave Roussy, France. There were three T1; seven T2, 15 T3 and 15 T4 lesions. The cervical metastatic rate at presentation was 18 per cent. Distant metastases were detected by bone marrow biopsy and bone scan in three patients at presentation. Treatment modalities included surgery alone in eight patients, radiotherapy alone in three patients, combined modality surgery plus radiotherapy in 11 patients, chemotherapy alone in two patients, chemotherapy plus radiotherapy in 10 patients, and multimodality therapy chemotherapy plus surgery plus radiotherapy in six patients.The five-year survival rate was 51 per cent. Multimodality treatment offered better survival (63 per cent at five years) and disease-free interval (54 months). Overall local, regional, and distant failure rates were 58 per cent, 15 per cent and 40 per cent respectively. Distant metastases commonly occurred in bone (82 per cent). Cervical metastasis was an unfavourable prognostic indicator (0 per cent survival at two years).In conclusion, aesthesioneuroblastoma is sensitive to chemotherapy and radiotherapy. Multimodality therapy should be used initially.

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Patients with head and neck cancer represent 11% of the malignant tumours diagnosed in French males (Ménégoz et al, 1998). While most small tumours can be cured, a majority of the tumours are advanced and despite progress in surgery and radiotherapy, the prognosis remains poor. In the past years, systemic chemotherapy has been used in an attempt to improve the results of loco-regional treatment. Clinical trials have shown a high response rate with a combination of Cisplatinum (CDDP) and 5 Fluoro-Uracil (5FU) in head and neck carcinoma sites (Decker et al, 1983;Weaver et al, 1985;Calais et al, 1988).In 1986, we decided to investigate the efficiency of neoadjuvant chemotherapy in a single tumour site: the oropharynx with survival as the main study end-point, and event-free survival as a secondary endpoint. MATERIALS AND METHODSAll patients with a biopsy-proven squamous cell carcinoma of all sites of the oropharynx except for the posterior wall and the anterior surface of epiglottis, classified as T2 to T4, N 0 to N 2b , and M 0 (UICC-AJC, 1986) were eligible if curative treatment, either radiotherapy or surgery, was considered feasible. Patients older than 69, younger than 18 or in whom chemotherapy was contraindicated, or who had previously been treated, or with multiple tumours were excluded. Patients were randomized by telephone to receive either neoadjuvant chemotherapy or no chemotherapy. Randomization was stratified on the centre and on the local treatment which was either surgery followed or not by radiotherapy, or radiotherapy alone.The treatment planned consisted, in the study arm, of 3 chemotherapy cycles followed, if possible, by surgery and systematic radiotherapy, or if surgery was impossible by radiotherapy alone. Post-randomization consent was obtained from each patient in accordance with the law in use in France at the time of the trial.A total of 318 patients treated in 6 centres were included in the trial between 1986 and 1992. ChemotherapyChemotherapy consisted of Cisplatin (100 mg/m 2 ) given in a 1-hour i.v. infusion on day 1 followed by a 24-hour i.v. infusion of fluorouracil (1000 mg/m 2 /day) for 5 days. This treatment was repeated on day 22 unless tumour progression exceeded 25%, and repeated on day 43 only if tumour regression had been observed. 2-3 weeks after the end of chemotherapy, local treatment (surgery and/or radiotherapy) was performed. SurgeryThe operative procedure in both groups consisted of a commando procedure i.e. oropharyngeal composite resection with segmental Summary The objective of the study was to evaluate the effect of neoadjuvant chemotherapy on the survival of patients with oropharyngeal cancer. Patients with a squamous cell carcinoma of the oropharynx for whom curative radiotherapy or surgery was considered feasible were entered in a multicentric randomized trial comparing neoadjuvant chemotherapy followed by loco-regional treatment to the same locoregional treatment without chemotherapy. The loco-regional treatment consisted either of surgery plus radiotherapy or...

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The proportion of patients with HNSCC who have serum p53-Abs is smaller than that of patients exhibiting tumor cell accumulation of p53 protein. The presence of p53-Abs is significantly associated with increased risks of relapse and death.