Although unintentional weight loss (UWL) and depressive symptoms are critical outcomes following diagnosis and treatment for head and neck cancer (HNC), there is a limited understanding of how they influence one another over time. As part of a large, prospective study on HNC outcomes, growth curve modeling was used to evaluate 564 patients’ trajectories of depressive symptoms and percentage UWL and analyze longitudinal associations between these variables across the first year following HNC diagnosis. The hypothesized temporal precedence model was not supported—pretreatment depressive symptoms predicted neither total percentage weight loss at 6 months (t(561) = -1.50, p = .13), nor rates of curvilinear change in percentage weight loss over time (t(561) = 1.38, p = .17). The opposite temporal precedence model also lacked support—early weight loss predicted neither level of depressive symptoms at 6 months (t (432) = 0.24, p = .81), nor rates of linear change in depressive symptoms over time (t (432) = 1.31, p = .19). Instead, a pattern of concurrent covariation emerged—changes in depressive symptoms over time were associated with concurrent changes in UWL (t (1148) = 2.05, p = .041) and changes in UWL over time were associated with concurrent changes in depressive symptoms (t (556) = 2.43, p = .015). That is, to the extent that depressive symptoms increased on a monthly basis, patients lost incrementally more weight than was lost due to the passage of time, and to the extent that weight loss increased on a monthly basis, depressive symptoms also increased. Together, these bidirectional results depicted an ongoing transactional interplay between depressive symptoms and UWL across time, such that changes in either variable resulted in deviations from the average trajectory of the other variable. Patient-reported pain and eating abilities emerged as potential mechanisms through which these variables influence one another. The results have important clinical implications, indicating that ongoing screening and treatment for depression and weight loss throughout the first year after HNC could benefit patients’ psychological and nutritional outcomes alike.

Malignant vascular tumors of the head and neck are rare neoplasms with variable clinical presentation, wide age distribution, and variable clinical courses. The heterogeneous presentation of angiosarcomas and epithelioid hemangioendothelioma often leads to misdiagnosis and unsuitable treatment. While risk factors for angiosarcomas are previous radiation, chronic lymphedema, and exposure to arsenic, thorium oxide, or vinyl chloride, there are only limited and retrospective data available on prognostic factors in EHE. In both angiosarcomas and EHE, surgery is the mainstay of treatment. There is limited evidence regarding the role of radiotherapy in EHE, although EHE is considered relatively radiosensitive. In angiosarcomas, adjuvant radiotherapy is recommended according to retrospective case series. A standard medical therapy for metastasized malignant vascular tumors is lacking. Chemotherapy, which is effective in angiosarcoma, is mostly ineffective in EHE. Targeted therapy, antiangiogenetic drugs and immunotherapy have been studied as new treatment options. The goal of this review is to summarize the current data regarding malignant vascular tumors along with their diagnosis and management.

Les thérapies anticancéreuses basées sur des principes physiques (radiofréquences, ultrasons, laser, électroporation...) ont considérablement augmenté lors de la dernière décennie. Leurs objectifs sont de détruire directement les cellules cancéreuses, de favoriser l'entrée ciblée de molécules thérapeutiques ou encore de stimuler le système immunitaire du patient afin d'éliminer la tumeur. Le plasma froid suscite l'intérêt dans le domaine de l'oncologie grâce à sa capacité à générer des espèces réactives oxygénées (ROS) et azotées (RNS) qui peuvent être génotoxiques et cytotoxiques pour les cellules cancéreuses. Deux approches d'utilisation du plasma sont étudiées : soit l'exposition directe de cellules au jet plasma, soit l'exposition indirecte via l'utilisation d'un Milieu Activé par Plasma (PAM). Le PAM étant plus facile à délivrer par injection dans la tumeur, c'est cette approche qui est choisie lors de ces travaux. Le travail de thèse présenté consiste à étudier l'effet génotoxique et cytotoxique du PAM, obtenu après exposition du milieu au jet de plasma d'hélium, sur des tumeurs in vitro et in vivo. Pour les études in vitro, nous avons choisi d'utiliser un modèle 3D : le sphéroïde (MCTS - MultiCellular Tumor Spheroid). Ce modèle présente des caractéristiques proches du modèle in vivo grâce à son organisation en sphéroïde. Les MCTS présentent en effet des gradients de pénétration d'oxygène, de nutriments et de prolifération cellulaire. La première partie de la thèse concerne l'identification et la quantification des espèces générées dans le PAM. Les méthodes d'analyses utilisées sont la résonance paramagnétique électronique, la fluorimétrie, la colorimétrie, la chromatographie en phase liquide et la spectrométrie de masse. Ces analyses ont mis en évidence que la toxicité du PAM était due à plusieurs facteurs : d'un côté la génération de ROS et RNS mais aussi à la dégradation des nutriments pour les cellules contenues dans le milieu via par exemple l'oxydation et la nitrosylation des acides aminés. La deuxième partie est dédiée à l'étude des effets du PAM sur les MCTS HCT-116 (cancer du côlon).[...] / Cancer therapies based on physical principles (radiofrequency, ultrasound, laser, electroporation...) have considerably increased in the last decade. Their objectives are to directly destroy cancer cells, to favor the targeted entry of therapeutic molecules or to stimulate the patient's immune system in order to eliminate the tumor. Cold plasma still arouses interest in the field of oncology through its ability to generate reactive oxygen species (ROS) and nitrogen species (RNS) which can be genotoxic and cytotoxic for cancer cells. Two approaches to the use of plasma are studied: either direct exposure of cells to the plasma jet, or indirect exposure via the use of a Plasma Activated Medium (PAM). The PAM being easier to deliver by injection into the tumor, this approach was chosen in this work. The work presented consists in studying the genotoxic and cytotoxic effects of PAM resulting from exposure of the medium to the helium plasma jet on in vitro and in vivo tumors. For in vitro studies, we chose to use a 3D model: the spheroid (MCTS - MultiCellular Tumor Spheroid). This model has similar characteristics to the in vivo model thanks to its spheroidal organization. The spheroids have indeed gradients of oxygen penetration, nutrients and cell proliferation. The first part of the thesis concerns the identification and quantification of the species generated in PAM. The analytical methods used are paramagnetic electronic resonance, fluorimetry, colorimetry, liquid chromatography and mass spectrometry. These analyses revealed that the toxicity of PAM was due to several factors: on the one hand to the generation of ROS and RNS and on the other hand to the degradation of cell nutrients contained in the medium via, for example, the oxidation and nitrosylation of the amino acids. The second part is dedicated to the study of the effects of PAM on HCT-116 (colon cancer) spheroids[...]