Évaluation du handgrip préradiochimiothérapie des patients présentant un cancer des voies aérodigestives supérieures

IntroductionThe updated diagnosis criteria for adult undernutrition introduced assessment of muscle mass and/or muscle function. As undernutrition is a factor in the interruption of radio-chemotherapy treatments for head and neck cancer, we evaluated the association between pre-therapeutic muscle function according to handgrip strength and treatment interruptions.Materials and methodsAncillary study of an observational, mono-centric, prospective cohort evaluating the benefit of systematic, global and early supportive care in patients with head and neck cancer before radio-chemotherapy concomitant. Were included patients for whom radio-chemotherapy concomitant was being considered for radical treatment of head and neck cancer and who had a pre-therapeutic handgrip test.ResultsThirty-nine patients were included from July 2019 to February 2020. Nine patients were undernourished and three had pathological handgrip strength. Handgrip test permitted to reclassify three patients as undernourished. Radiotherapy discontinuation was significantly associated with a pathological pre-therapeutic handgrip strength (P = 0.0359). No association was found for discontinuation of chemotherapy (P = 1).ConclusionPre-therapeutic handgrip test for patients with head and neck cancers is of interest on the oncological treatments choice regarding toxicities risk that may lead to treatment discontinuation.     

Efficacité et tolérance des gastrostomies percutanées radiologiques en cancérologie des voies aérodigestives supérieures

Nutritional care is essential for upper aerodigestive tract cancer patients. In the hospital, percutaneous radiologic gastrostomy is performed using “introducer” method. The objective of this study was to assess the efficacy and tolerability of gastrostomy inserted to patients suffering from upper aerodigestive tract cancer. A retrospective study about data collection has been done on gastrostomy insertions from January 1st, 2018 to December 31st, 2018 to patients suffering of upper aerodigestive tract cancer in the Otorhinolaryngology department. Thirty-seven patients in total received a gastrostomy whose indication was prophylactic in the majority of the cases (78%). Seventeen patients (46%) lost weight (mean [min; max]: ?2,5 kg [?0,1; ?5,7]) and nine (24%) gained weight (3,2 kg [0,5; 6,9]) in the interval between the gastrostomy insertion and two months after the end of treatments. The mean duration of gastrostomy was 146 days [42; 367]. On average, patients resumed eating 42 days [9; 91] after the end of treatments. Complications affected five patients (13%): peristomal leaking, porosity and deflation of the balloon, abdominal contractures and a hemorrhagic shock at the moment of the insertion. Gastrostomy insertion is a major asset to limit weight loss. Furthermore, the tolerability was found to be similar to the one from the literature for any type of gastrostomy (curative and preventive).     

Traitement antibiotique des pneumonies communautaires de l'adulte – apport des nouvelles molécules ; place des traitements de durée abrégée ; données pharmaco-économiques

There have been relatively few well-designed clinical trials comparing new antibiotics; mainly quinolones with enhanced in vitro activity against Streptococcus pneumoniae – and valid comparators. Quinolones are at least as efficient as comparators. But trials are of limited value in choice assistance for the empirical treatment of community-acquired pneumonia, since they are not stratified according to the severity of pneumonia and risk factors. The potential toxicity and ecological damage do jnot favor a large utilization of quinolones.