ENT Cancers Research Articles

Nouveaux marqueurs développés pour le dépistage des cancers liés aux HPV

AbstractHigh-risk human papillomaviruses (HPV-HR) are viruses with a mucosal tropism whose persistence is responsible for the development of cancers. HPV-HR is found in almost 100 % of cervical cancers, 80 % of anal cancers, 50 % of genital cancers and 30 % of ENT cancers. HPV-HR oncoproteins E6 and E7, viral genome integration and epigenetic mechanisms all play a part in setting up the carcinogenic process. Biological markers associated with the presence of pre-cancerous or cancerous lesions include HPV-HR typing, pl6/Ki67 double immunostaining, viral or cellular gene methylation analysis, viral genome integration and serology directed against viral oncoproteins. However, not all these markers have the same performance, and this varies according to the type of cancer. For cervical cancer, HPV-HR typing plays a central role in screening, while other biomarkers, notably methylation, still need to be evaluated and automated before they can find their place in the screening algorithm. In the case of anal cancer, HPV16 typing has recently been incorporated into the screening algorithm, while methylation and serology have yet to benefit from clinical validation to confirm their value. HPV-related ENT cancers do not currently benefit from relevant screening biomarkers. The new biomarkers that have been developed often have very good sensitivity, but insufficient specificity to be used as part of a screening strategy.

Cancers ORL chez les enfants et adolescents au service d’ORL du CHNU de FANN (A propos de 65 cas)

introduction: Every year, more than 400,000 cancers are diagnosed in children and adolescents aged 0-19 [1,3]. In the specific case of head and neck cancer in pediatric patients, the worldwide prevalence is still unknown [7]. New data are therefore needed to improve their management.objectives: To analyse the epidemiological aspects of ENT cancers in patients aged 0-18 years.patients and methods: This was a retrospective, descriptive, single-centre study. It concerned children aged 0-18 years hospitalized for ENT cancer between 1 June 2010 and 30 June 2020. The term «ENT cancer» was used to designate cancers of the VADS, ear, main salivary glands and thyroid, as well as malignant adenopathies of primary appearance and cervico-facial lymphomas.results: A total of 65 patients were identified, representing a frequency of 1.94%. The sex ratio (M/F) was 1.40. The mean age was 13 years, with extremes of 2 and 18 years. 78.46% of patients were over 10 years old. The average consultation time was 7 months, with extremes of 1 month and 60 months, and 63.92% of patients consulted before 6 months. Cervical masses accounted for 69.23% of consultations. No previous history was found in 80% of our patients. The cavum was found in 40% of cases and the hypopharynx in 21.54%. Squamous cell carcinoma was found in 49.23% of cases and lymphoma in 13.85%. Patients presenting at stage T3 or T4 represented 61.54% of cases. Excisional surgery was performed in 6.16% of cases and chemotherapy in 24.61%. 50.77% of patients were lost to follow-up and 43.08% died after an average follow-up of 10 months. Conclusion: ENT cancers in children and adolescents are rare but have a poor prognosis. Improving our technical facilities and raising public awareness could eventually improve the prognosis.

Primary oto-rhino-laryngological cancers: Epidemiological, clinical and therapeutic aspects about 231 cases in Senegal

Objective: establish the epidemiological, clinical and therapeutic profile of primary cancers of the oto-rhino-laryngological (ENT) sphere in a reference oncology service in Senegal. Methods: This is a retrospective descriptive study, conducted at the Joliot Curie Institute of Aristide le Dantec hospital over a 30 months period from January 1, 2020 to June 30, 2022. Results: 231 ENT cancers were collected in our study, with a mean age of 51 years [11; 93]. Females predominated with a sex ratio of 0.88. Alcoholism was noted in 15.1% of cases. Smoking was noted in 23.8%. Alcohol smoking predominated in laryngeal cancer. The oral cavity was the most frequent site (44.6%). The histological nature of the cancers was dominated by squamous cell carcinoma (93.5%). Stages III and IV were in the majority: 62.8% and 23.8% of cases respectively. Neoadjuvant surgery was performed in 11.9% of cases. Chemotherapy was used in 65.1% of cases (including 90.2% for induction). Radiotherapy was used in 42.9% of cases and associated with chemotherapy in 90.7% of cases. Conclusion: ENT cancers are common in Senegal and diagnosed at all ages. Females predominate. The most common cancers are those of the oral cavity. They are discovered at a locally advanced stage and are treated with induction chemotherapy followed by concomitant chemoradiotherapy.

Long term disease-free survival in locoregional, metastatic and/or recurrent UCNT.

e18023 Background: Undifferentiated Carcinoma of Nasopharyngeal Type (UCNT) is a rare and aggressive type of head and neck cancer related to the Epstein Barr virus (EBV), genetic (HLA B5 in Algeria) and environmental factors. It is the most frequent histological variant of ENT cancers. It has geographically selective epidemiologic features unrelated to external carcinogens, and is known to be radiosensitive and chemosensitive. Methods: Seventy-one patients with biopsy-proven UCNT presenting to a single oncology unit between 2015 and 2022 were assessed for their long-term response to treatment. The sex ratio of cases was 3M: 1F; thirty-one patients (43%) were under the age of 50; 11 (15%) under the age of 35; and among these, there were two 19 year old males. The initial median World Health Organization (WHO) performance status was 1.6. These patients with locoregional (LR), recurrent (REC) and/or metastatic (MTS) UCNT were treated with monthly cycles of platinum-based chemotherapy of cisplatin (CDDP) 75 mg/m2 IV or Carboplatine AUC-4 and Docetaxel 75 mg/m2 IV followed by fluorouracil (5FU) 1000 mg/m2/day continuous IV infusion days 1 to 4 (TPF) in locally advanced disease, and with cisplatin (CDDP) 75 mg/m2 day 1 or Carboplatine AUC-5; and fluorouracil (5FU) 1000 mg/m2/d continuous IV infusion days 1 to 4 (PF) in recurrent and/or metastatic cases. The choice of systemic therapy was individualized based on patient characteristics including performance status, goals of therapy. Results: Those LR or MTS patients who were still alive without evidence of disease after 36+ months were categorized as complete responders (CRs). A subgroup of CRs was identified who had failed prior chemotherapy. MTS patients with less than three distant osseous sites underwent additional radiation therapy. Conclusions: Encouraging results for this particular type of head and neck cancer confirm the chemosensitivity of UCNT, and the observation of long-term responders makes curability a real consideration.

Estimation of Oncologic Surgery Case Volume Before and After the COVID-19 Pandemic in France

COVID-19 has had a major effect on health care activities, especially surgery. At first, comparisons were proposed using 2019 activities as the highest standard. However, while such an approach might have been suitable during the first months of the pandemic, this might no longer be the case for a longer period. To examine approaches that may better assess the use of cancer surgeries. In a cross-sectional design, the nationwide French hospital facility data (Medicalised Information System Program) were used to assess cancer surgery for 6 cancer site categories in adults from January 1, 2010, to December 31, 2021. Estimated cancer surgery activity during the COVID-19 pandemic. Three models were proposed to assess the expected number of surgical procedures between 2020 and 2021 and make a comparison with those observed in earlier years. In France, cancer removal surgeries account for approximately 7000 hospitalizations per year for liver cancer; 4000 for pancreatic cancer; 7700 for ovarian cancer; 1300 for esophagus cancer; 23 000 for ear, nose, and throat (ENT) cancer; 78 000 for breast cancer; and 16 600 for thoracic cancers. For most cancer sites, the number of surgical procedures increased from 2010 to 2019: liver, 14%; pancreas, 38%; ovary, 14%; esophagus, 18%; breast, 8%; and thoracic, 29%. Assuming stability, these values underestimate the gap in activity observed in 2020-2021. For other procedures, a decrease was observed: stomach, -10%, and ENT, -6%. Assuming stability, these values overestimate the gap in activity observed in 2020-2021. At the end of 2021, according to the model, the gap in activity observed in 2020-2021 was estimated at between -1.4% and 1.7% for breast, -6.6% and -7.3% for thoracic, -3.1% and -2.5% for ovarian, -4.2% and -1.7% for pancreas, -6.7% and 5.9% for stomach, and -13.0% and -13.9% for esophageal cancers. For ENT, liver, and urologic cancers, because the trend was different before and after 2015, it was necessary to opt for modeling using only the most recent period. The cumulative gap in activity observed in 2020-2021 was estimated at -1.0% for ENT cancers, -5.3% for liver cancers, and -2.9% for urologic cancers. The findings of this study suggest that short- and medium-term trends must be considered to estimate COVID-19 cancer surgery activities. Breast cancer is the site for which the activity showed the smallest decrease during the pandemic, with almost full recovery in 2021.

Prevalence of cancer-treatment induced arrhythmias and conduction disorders: Experience of a Moroccan cardio-oncology unit

Therapeutic advances in cancer management have improved patients’ prognosis. Nevertheless, these treatments come with a price including cardiac toxicity. Arrhythmias were reported as a side effect of several chemotherapeutic drugs but still remain a rare complication. The aim of this study was to assess the prevalence of cancer-treatment induced arrhythmias and conduction disorders in our unit. We conducted a prospective longitudinal study in the cardio-oncology unit of Casablanca from January 2017 to December 2019 where all the patients, all types of cancer confounded, were followed-up according to the ESC 2016 guidelines, with clinical, electrical, biological and echocardiographic evaluation of cardiac tolerance to cardiotoxic cancer-treatments. Out of a total number of 1318 patients (mean age= 53 ± 9 yo, 91.2% female), the most frequent neoplasy was breast cancer in 84.6%, followed by ENT, kidney and colon cancers (6,2%, 3,1%, 1,8%). 77.6% received a chemotherapy based on anthracyclines (AC60 protocol in 62,8% and FEC100 protocol in 37,2%), 69,7% on cyclophosphamide, 39,8% on 5-Flurouracil (5FU), 56,1% on taxanes and 17.3% on cisplatin. 53.7% breast cancer patients were under HER2 inhibitors and 56.8% had radiotherapy. A total of 107 patients developed cardiotoxicity (8,1%) with 13 cases of arrhythmias (12,1%). Atrial fibrillation (AF) was found in 5 patients (4 under anthracyclines and 1 under cisplatin), sinusal bradychardia in 2 patients, ventricular hyperexcitability in 1 patient under 5-FU. Conduction disorders in our serie were prolonged QT interval in 4 patients under anthracyclines and cyclophosphamide, and 1 complete atrioventricular block in 1 patient under anthracyclines and taxanes. Arrhythmias and conduction disorders secondary to chemotherapeutic drugs are a rare but possible complication, hence the importance of clinical and electrical evaluation of patients under cardiotoxic treatments.

Diagnostic, pronostic et traitement des carcinomes nasosinusiens (hors mélanomes, sarcomes et lymphomes)

Sinonasal carcinomas account for 3% of ENT cancers. They are subdivided into squamous cell carcinomas (50%), adenocarcinomas [20%, mostly of intestinal type (ITAC)], and more rarely, adenoid cystic carcinomas, olfactory neuroblastomas (=esthesioneuroblastomas), neuroendocrine carcinomas or undifferentiated sinonasal carcinomas (SNUC). The 5-year survival rates are, in descending order, 72% for neuroblastomas, 63% for adenocarcinomas, 50-60% for large-cell neuroendocrine carcinomas, 53% for squamous cell carcinomas, 25-50% for adenoid cystic, 35% for small-cell neuroendocrine carcinomas and 35% for SNUC and newly discovered histologies. Surgery is the main treatment; endoscopic approaches reduce the morbidity with equivalent tumour control. Intensity-modulated radiation therapy (IMRT) is almost systematic. Nodal involvement is rare in ethmoidal adenocarcinomas and adenoid cystic carcinomas; it is intermediate and may justify prophylactic radiotherapy for N0 necks in SNUC, neuroblastoma, squamous cell carcinomas and sinonasal neuroendocrine carcinomas. IMRT or proton therapy is the mainstay of treatment of unresectable disease. Radiotherapy optimization by carbon ion therapy for adenoid cystic carcinomas, or by chemotherapy for all carcinomas with IMRT or proton therapy, is investigated within clinical trials in France. Neoadjuvant chemotherapy is reserved for rapidly progressive disease or histologies with a high metastatic potential such as neuroendocrine carcinomas or SNUC. Given their histologic and molecular specificities and different relapse patterns, an expertise of the REFCOR network, with REFCORpath review, is likely to correct diagnoses, rectify treatments, with an impact on survival.

Intra-arterial chemotherapy of ENT cancers

The key element that has determined us to initiate a study concerning the benefits of intra-arterial chemotherapy is the fact that, despite progress regarding therapy, the ENT cancer prognosis is poor, especially in stages that have regional invasion, with a higher risk of therapeutic failure. ENT cancer treatment has raised many questions, the present therapeutic standard being simultaneous radio-chemotherapy with cisplatin, a quality regional control being obtained by hyper-fractionated radiotherapy, targeted on the tumour volume. The technical inconveniences that, in some cases, make impossible the accomplishment of a correct treatment, have determined us to make a retrospective analysis of the studies published in medical journals, with the aim of discerning a therapeutic method that has a role in increasing the loco-regional control of the disease. The studies speak about intra-arterial chemoinfusion with cisplatin, alongside radiotherapy, demonstrating with certainty the superiority of this method versus administrating the drug intravenously, in terms of local tumour control and tolerability. Because the benefits regarding the survival rate and the disease-free period have not reached the statistically significant level, intra-arterial chemoinfusion of cisplatin, alongside radiotherapy, remains a subject that is open to further studies. The efficacy of intra-arterial chemoinfusion of cisplatin hasn’t been studied in the case of a relapse, remaining still a subject that is worthy of being approached, seeing as this method was shown to be efficient regarding the safety profile, having a good tolerability and also having a good activity profile, leading to increase in the quality of life and an increase in survival through a local tumour control that is superior than in the case of intravenous administration of the drug.

Pleuropulmonary metastases originating from extra-thoracic neoplasia

Les poumons reçoivent la totalité du drainage veineux du corps expliquant la grande fréquence des métastases pleuro-pulmonaires de plusieurs cancers. L'objectif était d'étudier les manifestations radio-cliniques des métastases pleuro-pulmonaires des cancers extra-thoraciques. Nous rapportons une étude rétrospective de patients porteurs de métastase pleuro-pulmonaire colligés dans notre service entre janvier 2006 et décembre 2014. 76 dossiers ont été étudiés. La moyenne d'âge était de 50 ans (extrêmes allant de 21 ans jusqu'à 89 ans) avec une prédominance masculine dans 57,8% des cas. La symptomatologie clinique était faite principalement de toux (32,8% des cas), de dyspnée (23,7% des cas) et d'hémoptysie (11,2% des cas). Les cancers primitifs à l'origine des différentes métastases pleuro-pulmonaires retrouvés dans notre série sont dominés respectivement par le cancer du sein dans 27,6% des cas, les cancers digestifs dans 15,8% des cas, les cancers génitaux dans 9,2% des cas, les sarcomes dans 7,8% des cas, le cancer rénal dans 5,2% des cas, le cancer de la vessie dans 5,2% des cas, le cancer de la prostate dans 3,9% cas, les cancers ORL dans 3,9% des cas, les cancers thyroïdiens dans 3,9% des cas, le cancer de la peau dans 2,6% des cas et le cancer primitif d'origine indéterminée dans 14,4% des cas. Plusieurs aspects radiologiques des métastases pleuro-pulmonaires ont été retrouvés dans notre série, ils peuvent être isolés ou en association. L'aspect radiologique le plus fréquent est celui du lâcher de ballon présent dans 52,6% des cas, suivi des pleurésies présentes dans 34,2% des cas, des micronodules diffus présents dans 23,6% des cas et un nodule unique présent dans 3,94% des cas. Les cancers secondaires pleuro-pulmonaires sont fréquents. Ils viennent en 3ème position après les métastases ganglionnaires et hépatiques et ils sont retrouvés dans 30% des autopsies de patients porteurs d'une néoplasie.

PP080-MON: Evolution of the Prevalence of Malnutrition and its Treatment in Patients with Cancer

Rationale: This study aimed to compare the prevalence of malnutrition and nutritional care between two one-day surveys, Nutricancer 1 (N1) [1] and Nutricancer 2 (N2), completed respectively in 2005 and 2012. Methods: In N1 and N2 the characteristics of the cancer, treatment, performance status (PS), body weight and BMI were evaluated in patients present that day in hospital. Malnutrition was defined as BMI 5% in 1 month or 10% in 6 months. Patients filled questionnaires regarding the nutritional care. Results: In N1 and N2, respectively, 1.903 and 2.197 patients (59±13 vs 62±13 yrs) were studied. The main locations of cancer were haematology (20% vs 10%), GI (17% vs 32%), ENT (19% vs 13%), breast (12% vs 15%) or lung (13% vs 10%). The cancer was metastatic in 44% vs 55% of patients and the PS was >2 in 23% vs 15%. In N1 and N2 the prevalence of malnutrition was similar (39%). It was respectively, 67% vs 54% for pancreas, 60% vs 53% for upper GI tract, 49% vs 42% for ENT, 45% vs 41% for lung, 39% vs 35% for colon/rectum, 34% vs 46% for haematology and 20% vs 21% for breast (NS). In 2005 and 2012, respectively, 55% vs 69% of patients reported having nutritional support (59% vs 86% for malnourished and 28% vs 58% for non-malnourished patients; P< 0.05). Dietary advice (68% vs 89%, P< 0.05) and oral nutritional support (44% vs 50%, P< 0.05) improved significantly; enteral nutrition decreased (25% vs 17%, P< 0.05) and parenteral nutrition remained stable (18% vs 16%, NS). Improvement of nutritional support was greater (P< 0.05) for ENT (72% vs 85%), haematology (51% vs 63%) and lung cancers (50% vs 70%). Conclusion: In 7 yrs in France, the prevalence of malnutrition remained stable in cancer patients but the use of dietary advice and nutritional supplements increased. These encouraging results suggest an awareness of the nutrition problem in oncology.

Les pathologistes et le réseau d’expertise français sur les cancers ORL rares : le REFCORpath

Aerodigestive tract tumors are very diverse, either in terms of location, or histologically. Also, this heterogeneity poses particular problems for the histological diagnosis but also for the establishment of the most appropriate treatment. Thus, the network REFCOR (réseau d'expertise français sur les cancers ORL rares/French expert network on rare ENT cancers) was created to better understand these issues, by proposing an epidemiological and diagnostic approach with research collaborations. This network is dedicated to all primary malignant tumors of the salivary glands, ear, nasal cavity and sinuses and all head and neck malignancies other than conventional squamous cell carcinoma. The REFCORpath network consists of expert pathologists and offers, through a network of scanned images, a second opinion or even a third.

21 High energy lasers enable a paradigm shift in surgery with cost reduction pattern could be history of prostate therapy

Although the concept photodynamic therapy has been recognised for over a century, it is only over the last 25 years that it has been used in Great Britain. The first applications in the UK were in 1981 by John Carruth, who treated patients with advanced ENT and skin cancers. The following year, he and Stephen Bown set up the British Medical Laser Association (BMLA). Since that time, the use of PDT in the UK has slowly expanded in all fields of medicine and surgery. In 1986, Bown set up the National Medical Laser Centre (NMLC) and later collaborated with Liverpool gastroenterologist, Neville Krasner, in animal studies on rat colon. In 1997, Keyvan Moghissi founded the Yorkshire Laser Centre (YLC) and began treating patients with advanced inoperable bronchial and oesophageal cancers. Stan Brown in Leeds set up the Centre for Photobiology and Photodynamic Therapy at the University of Leeds, working in close collaboration with the Yorkshire Cancer Research Centre. Other pioneers include Hugh Barr in Gloucester, Colin Hopper in London, Grant Fullarton in Glasgow and Roger Ackroyd, Malcolm Reed and Nicky Brown in Sheffield. PDT has now been used in the UK in the treatment of skin, oral, ENT, oesophageal, lung, bladder and gynaecological malignancies.

20 Microspot CO2, pulse dye laser, KTP for laryngeal surgery in benign lesions: when and how?

Although the concept photodynamic therapy has been recognised for over a century, it is only over the last 25 years that it has been used in Great Britain. The first applications in the UK were in 1981 by John Carruth, who treated patients with advanced ENT and skin cancers. The following year, he and Stephen Bown set up the British Medical Laser Association (BMLA). Since that time, the use of PDT in the UK has slowly expanded in all fields of medicine and surgery. In 1986, Bown set up the National Medical Laser Centre (NMLC) and later collaborated with Liverpool gastroenterologist, Neville Krasner, in animal studies on rat colon. In 1997, Keyvan Moghissi founded the Yorkshire Laser Centre (YLC) and began treating patients with advanced inoperable bronchial and oesophageal cancers. Stan Brown in Leeds set up the Centre for Photobiology and Photodynamic Therapy at the University of Leeds, working in close collaboration with the Yorkshire Cancer Research Centre. Other pioneers include Hugh Barr in Gloucester, Colin Hopper in London, Grant Fullarton in Glasgow and Roger Ackroyd, Malcolm Reed and Nicky Brown in Sheffield. PDT has now been used in the UK in the treatment of skin, oral, ENT, oesophageal, lung, bladder and gynaecological malignancies.

A STUDY ON CLINICAL FEATURES OF ENT CANCERS AT HUE UNIVERSITY HOSPITAL AND HUE CENTRAL HOSPITAL

Background: The study made to determine the epidemiologic and clinical features of cancers in ENT. Patients and method: Study 103 patients of ENT cancers by cross-sectional and descriptive methods. Results: - Male patients (78.6%) are more numerous than female patients (21.4%). Adults (98.1%) are more numerous than children (1.9%). - Age range more than 45 years (73.8%), living in rural and mountainous area (70.9%), urban area (29.1%), manual labor profession (48.6%). - The percentage of smokers (69.9%) and alcoholics (57.3%). - Hospitalization in the first 6 months of disease (75.8%), diseased time more than 1 year (2.8%). - Reasons of hospitalization following in order: Pain at tumor area (47.5%), dysphagy (44.7%), laryngeal syndrome (41.8%), headache (37.9%), otologic syndrome (31.1%), nasosinusal syndrome (29.1%), cervical nodes (25.2 %)...- Order of ENT cancers: nasopharyngeal cancer (33.0%), laryngeal cancer (24.3%), hypopharyngeal cancer (19.4%), nasosinusal cancer (11.7%), tonsillar cancer (9, 7%), otologic cancer (1.9%). - Metastasis to lymphatic nodes of superior carotide group (28.2%) is most frequent. - Squamous cell carcinoma (88.4%) is most common. Conclusion: ENT cancers in Hue having epidemiologic and clinical features similar to those of other regions in the country. Result of treatment will be better if cancers are diagnosed early and treated properly.

Cancers ORL et génomique

ENT cancers in France - with the fourth rank after the breast, colon and prostate localizations - represent on important problem of public health. Survival at five years reaches a maximum in spite of undeniable therapeutic progress, in particular with the targeted treatments associated to conventional cytotoxic drugs. The studies in progress still make it possible to hope for new predictive and prognostic biological markers, but the complexity of these parameters, as well as the needs for heavy and expensive equipment to explore them, require a unification of the efforts and means. It is the major objective of the cooperative program PACOR.

History of photodynamic therapy in Great Britain

Although the concept photodynamic therapy has been recognised for over a century, it is only over the last 25 years that it has been used in Great Britain. The first applications in the UK were in 1981 by John Carruth, who treated patients with advanced ENT and skin cancers. The following year, he and Stephen Bown set up the British Medical Laser Association (BMLA). Since that time, the use of PDT in the UK has slowly expanded in all fields of medicine and surgery. In 1986, Bown set up the National Medical Laser Centre (NMLC) and later collaborated with Liverpool gastroenterologist, Neville Krasner, in animal studies on rat colon. In 1997, Keyvan Moghissi founded the Yorkshire Laser Centre (YLC) and began treating patients with advanced inoperable bronchial and oesophageal cancers. Stan Brown in Leeds set up the Centre for Photobiology and Photodynamic Therapy at the University of Leeds, working in close collaboration with the Yorkshire Cancer Research Centre. Other pioneers include Hugh Barr in Gloucester, Colin Hopper in London, Grant Fullarton in Glasgow and Roger Ackroyd, Malcolm Reed and Nicky Brown in Sheffield. PDT has now been used in the UK in the treatment of skin, oral, ENT, oesophageal, lung, bladder and gynaecological malignancies.

Effects of the Radio-Therapeutic Treatment of ENT Cancers on Quality of Life, the ORCO National Observatory

Effects of the Radio-Therapeutic Treatment of ENT Cancers on Quality of Life, the ORCO National Observatory

Developing an operational typology of patients hospitalised in palliative care units.

The objective of this study was to develop an operational typology of patients hospitalised in palliative care units (PC units) and to characterize these populations. Prospective data were collected in four PC units over three-week periods, generating a sample of 139 cases. Five classes of patient were identified and described via a factorial analysis and a classification: metastatic cancers requiring significant psychological attention, terminally ill patients, ENT cancers, neurological diseases and elderly patients. A more detailed study revealed differences between metastatic cancers, younger patients, very dependent patients and the other patients. We present the sociodemographic, clinical and cost per patient profiles of each class of patient. Having access to a broader sample of PC units and of patients would allow for a more complete typology.