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Primary pulmonary salivary gland-type tumors are rare and characterized by a specific clinicopathological manifestation. They are proximal tumors affecting young subjects and not associated with smoking. For optimal management, it is important to distinguish them from other bronchopulmonary tumors, with which they don't share either biology or treatment and outcome. We conducted a retrospective study, including all primary malignant salivary gland-type tumors of the lung, over a period of 32 years, from January 1987 to December 2019. We collected data from the medical records of 10 patients: 5 men and 5 women (sex ratio 1). The average age of our patients was 47.4 years. In all cases radiological examinations showed proximally located nodular tumor ranging in size from 1 to 5.8 cm. Histological examination objectified mucoepidermoid carcinoma (6 out of 10 cases). All patients had localized or locally advanced tumors, with the exception of one case of metastatic mucoepidermoid carcinoma. Pulmonary salivary gland-type tumors correspond to a heterogeneous group of tumours. They are not very aggressive but are associated with a high frequency of recurrences and late metastases, requiring long-term monitoring. [ABSTRACT FROM AUTHOR]

La balnéopuvathérapie est une technique de photochimiothérapie, consistant en l'immersion d'une zone cutanée dans un bain contenant un psoralène topique dilué à faible concentration, suivie d'une irradiation par des ultraviolets A. La kératodermie palmoplantaire est une affection le plus souvent inflammatoire chronique évoluant par poussées. Elle peut devenir handicapante et son traitement est difficile. Notre but était de démontrer l'efficacité de la balnépuvathérapie, en traitement de seconde intention dans les kératodermies palmoplantaires résistant à un traitement local bien conduit. [ABSTRACT FROM AUTHOR]

Giant cell tumors of the synovial tendon sheaths (GCTSTS) are a localized form of hemopigmented villonodular synovitis. They mainly affect the hands. This study aims to analyse the epidemiology, clinical and therapeutic characteristics of GCTSTS, to assess the results of surgical treatment and to identify risk factors for recurrences. We conducted a retrospective data collection from medical records of 50 patients with GCTSTS of the hand between 1992 and 2016 in the Department of Orthopaedics at the Hospital of Sahloul (Sousse-Tunisia). The clinical and epidemiological features of GCTSTS have been specified. The average age of patients was 33 years (9-69 years), the sex ratio was 0,6. Constant swelling (100%), joints inter-phalangeal mobilization trouble (6%) and digital pain (18%) were the most frequent reason for consultation. All tumors were located at the level of the digital region, especially at the level of the index (42%). It occurred on the palm of the hand in 66% of cases. All patients underwent surgery; macroscopically GCTTS appeared as an encapsulated polylobed and yellowish brown tumor, extending into the flexor tendons sheath(4 cases) and under the extensor tendon (2 cases). We noted a single case of recurrent cancer (2%) which was treated surgically. The functional results were good in all cases. The diagnosis of GCTTS should be evoked when there is evidence of digital swelling. Their management is based on surgery which is difficult and should be performed correctly to avoid recurrences. [ABSTRACT FROM AUTHOR]

Genetic or epidemiological tests can be used to determine a person's risk of developing a new or recurrent familial breast cancer. Not only cognitive but factors such as anxiety influence understanding of and confidence in the results, decision-making, and satisfaction with testing. Emotion plays a strong role in the perception of risk information but is frequently underemphasized in the medical communication. We discuss and put into context several reflections that explore the whole setting and course of life after being labeled as a person at high risk. [ABSTRACT FROM AUTHOR]

Résumé: Objectifs de l’étude: Évaluation des résultats d’une radiothérapie de rattrapage à visée curative dans le cadre du traitement des rechutes pelviennes isolées de cancers du col utérin. Patientes et méthodes: Quatorze patientes atteintes d’une rechute pelvienne d’un cancer du col utérin ont été prises en charge dans notre service de 1982 à 2009. Cinq rechutes étaient centropelviennes, quatre vaginales et cinq ganglionnaires pelviennes. Quatre patientes ont eu une exérèse chirurgicale première de la rechute. Les 14 patientes ont reçu une radiothérapie pelvienne de dose médiane de 55Gy en fractionnement classique. Une chimiothérapie concomitante a été administrée à 13 patientes. Une curiethérapie vaginale de complément de bas débit de dose médiane de 20Gy a été réalisée chez trois patientes. Le recul médian était de 39mois. Résultats: La tolérance de la radiothérapie était acceptable avec 29 % de cas de toxicité aiguë digestive ou urinaire de grade 3. Le contrôle tumoral a été obtenu chez dix patientes (71 %). Quatre patientes ont présenté une poursuite évolutive locorégionale. Au moment de l’analyse, trois patientes étaient décédées de leur cancer. Les taux de survie globale à deux et cinq ans étaient respectivement de 84 % et 74 %. Huit patientes ont souffert d’effets secondaires tardifs, sévères dans trois cas (21 %). Conclusion: Dans notre expérience, une chimioradiothérapie permet d’obtenir un taux élevé de rémission chez les patientes atteintes d’une rechute pelvienne isolée d’un cancer du col utérin. Celle-ci n’est réalisable qu’en l’absence de radiothérapie externe pelvienne lors du traitement initial de la tumeur ou en cas de rechute tumorale localisée en dehors du volume précédemment irradié. [ABSTRACT FROM AUTHOR]

Résumé: Objectif de l’étude: Les carcinomes canalaires in situ avec micro-invasion représentent une entité rare et distincte de cancer du sein. Grâce au dépistage de tumeur de plus en plus précocement, leur incidence est en augmentation. Cependant, il n’existe à ce jour aucun consensus concernant leur prise en charge. Cette étude présente les caractéristiques cliniques, les modalités thérapeutiques et le suivi des patientes traitées sur dix ans à l’institut Claudius-Regaud, incluant une relecture anatomopathologique. Patientes et méthodes: Les dossiers de l’ensemble des patientes prises en charge à l’institut Claudius-Regaud (Toulouse, France), pour un carcinome canalaire in situ avec micro-invasion sur une période de 10ans ont été rétrospectivement analysés. Le matériel histologique disponible a été relu. Résultats: Soixante-trois patientes étaient éligibles à cette étude, une extension ganglionnaire a été constatée chez deux au moment diagnostic (3 %). Toutes les patientes ont bénéficié d’une prise en charge chirurgicale initiale conservatrice (n =37) ou par mastectomie (n =25). L’évaluation ganglionnaire a été réalisée chez 52 patientes (82 %) par curage, exérèse du ganglion sentinelle ou les deux pour respectivement 10, 37 et 5 patientes. Après relecture, les contingents micro-invasifs exprimaient les récepteurs hormonaux et le gène HER2 dans respectivement 60 % et 33 % des cas. La relecture histologique a retrouvé un taux non négligeable (9 %) de discordance entre le statut hormonal et HER2 du foyer de micro-invasion par comparaison au composant in situ qui l’entoure. Après un suivi médian de 61 mois, les taux de survie globale et spécifique à cinq ans étaient respectivement de 98 % et 89 %. Durant le suivi, deux patientes ont été atteintes d’une rechute invasive, dont une a entraîné le décès. Conclusion: Le risque initial d’extension ganglionnaire justifie une évaluation ganglionnaire axillaire chirurgicale systématique. Le niveau d’expression des récepteurs hormonaux et du gène HER2 par le composant micro-invasif est important. Le taux de discordance entre les composants micro-invasif et in situ de chaque tumeur implique une recherche de l’expression des récepteurs hormonaux et HER2 sur les foyers de micro-invasion. [ABSTRACT FROM AUTHOR]

Résumé: L’adénome pléomorphe parotidien est la tumeur bénigne la plus fréquente des glandes salivaires. La difficulté de sa prise en charge est liée à un risque de récidive élevé. Les complications de celles-ci sont, soit iatrogènes en cas de nécessité de reprises chirurgicales (paralysie faciale), soit intrinsèques, le risque de transformation maligne augmentant avec le nombre de rechutes locales. Cet article reprend les critères histologiques et radiologiques des récidives et revient sur les modalités chirurgicales de prise en charge. Pour améliorer le taux de contrôle local, la radiothérapie adjuvante (de première intention ou en situation de récidive) peut être délivrée mais reste à l’heure actuelle controversée : il s’agit d’une tumeur bénigne, dans une population jeune, et le risque de cancer radio-induit est redouté. Nous avons recensé les études où l’irradiation adjuvante était proposée afin d’essayer de mieux définir sa place dans les stratégies thérapeutiques ainsi que ses modalités. Des facteurs pronostiques ont été identifiés par certains auteurs. Les incertitudes demeurent, d’autres études sont nécessaires. [ABSTRACT FROM AUTHOR]

Résumé: Objectifs: Évaluer la valeur pronostique en termes de contrôle locorégional des sous-types moléculaires et du Ki67 dans les cancers du sein indemnes d’envahissement ganglionnaire (pN0) après mastectomie et leur valeur prédictive concernant l’irradiation adjuvante. Patientes et méthodes: Étude rétrospective des dossiers de 699 patientes prises en charge entre 2001 et 2008 pour un cancer du sein de stade pN0 après mastectomie–lymphadénectomie axillaire. L’étude immuno-histochimique des récepteurs aux œstrogènes, à la progestérone et de HER2 a permis de définir quatre sous-types moléculaires : luminaux A et B, HER2+ et triple négatif. Une analyse multifactorielle selon le modèle de Cox a été utilisée pour déterminer le risque de rechute locorégionale associé au Ki67 et aux différents sous-types après ajustement sur les facteurs clinicopathologiques classiques. Résultats: Avec un suivi médian de 56 mois, 17 patientes ont été atteintes d’une rechute locorégionale. À cinq ans, les probabilités de survies sans rechute locorégionale et globale dans la population générale étaient respectivement de 97 % et 94,7 %, sans différence significative entre les sous-groupes avec (n =191) et sans irradiation (n =508). Aucun sous-type moléculaire n’était associé à un risque accru de rechute locorégionale. Un Ki67 de plus de 20 % était le seul facteur pronostique péjoratif indépendant de survie sans rechute locorégionale (hazard ratio : 4–18 ; intervalle de confiance à 95 % : 1,11–15,77 ; p <0,0215). Aucun sous-groupe de patientes ne semblait bénéficier d’une irradiation adjuvante. Conclusion: Contrairement aux différents sous-types moléculaires, un Ki67 de plus de 20 % a permis d’identifier un sous-groupe à haut risque de rechute locorégionale parmi les patientes atteintes d’un cancer du sein de stade pN0 après mastectomie. Le bénéfice d’une irradiation adjuvante dans ces tumeurs proliférantes pourrait faire l’objet d’une étude prospective. [ABSTRACT FROM AUTHOR]

Résumé: La tumeur à cellules granuleuses ou tumeur d’Abrikossoff est une tumeur rare, ubiquitaire, d’évolution majoritairement bénigne. Les formes malignes représentent 1 à 3 % des cas. La localisation vulvaire est exceptionnelle. Nous rapportons l’observation d’une patiente âgée de 28ans qui était atteinte d’une localisation vulvaire d’une tumeur d’Abrikossoff. Initialement considérée comme bénigne, elle a été traitée par chirurgie locale exclusive. Cinq mois plus tard, cette tumeur connaissait une transformation maligne ; la tumeur mesurait 14cm avec la présence des mitoses éparses non systématisées, exprimait PS100 à 100 % et le Ki 67 à 20 %. Du fait du caractère malin et de l’exérèse économique du néoplasme, la patiente a reçu une radiothérapie adjuvante dans le lit tumoral et les ganglions inguinaux 50Gy. Après 20 mois, la patiente a été atteinte d’une rechute locale et pulmonaire en lâcher de ballons, renforçant ainsi le diagnostic de malignité. Elle a reçu deux lignes de chimiothérapie, 5-fluoro-uracile et cisplatine, et paclitaxel et carboplatine sans aucune réponse. Suite à l’échec de la chimiothérapie, la patiente a été mise sous traitement médical symptomatique. Cette observation incite à préconiser un traitement chirurgical agressif des sites tumoraux identifiés et surtout à exercer une surveillance clinique et radiologique rapprochée de toute tumeur à cellules granuleuses. [ABSTRACT FROM AUTHOR]

Résumé: La chimiothérapie est fondamentale dans la prise en charge des carcinomes épithéliaux de l’ovaire aussi bien pour les stades précoces (traitement uniquement chirurgical dans de rares cas) qu’avancés et dans pratiquement toutes les étapes évolutives de la maladie. Le schéma de référence associe carboplatine-paclitaxel par voie intraveineuse. La voie intrapéritonéale a également prouvé son efficacité en première ligne dans les stades avancés après une chirurgie complète mais doit être réservée à des équipes entraînées en raison de ses contraintes techniques et des toxicités dont elle peut être responsable. En cas de rechute ou de progression les modalités de la chimiothérapie dépendent principalement de l’intervalle libre entre ce diagnostic et la dernière injection de platine. Le bévacizumab a prouvé son efficacité en prolongeant la survie sans progression en 1er ligne de traitement en association avec la chimiothérapie puis en maintenance ainsi que dans les rechutes ou progressions aussi bien sensibles que résistantes aux platines. Enfin, une meilleure connaissance de la biologie des cancers de l’ovaire permet d’envisager dans l’avenir des thérapeutiques personnalisées guidées par les caractéristiques spécifiques de chaque patiente et de chaque tumeur. [ABSTRACT FROM AUTHOR]

Metabolomics deals with the large scale detection, identification and quantification of the metabolites that are present in a biological system. As a result of its downstream output of global cellular networking, the metabolome can reflect the true cellular phenotype and, therefore, offers a new paradigm for biomarker discovery in oncology. Many predictive biomarkers have yet been found for cancer screening, tumour relapse, treatment response, and toxicity of anticancer agents. Yet, few of them have been accepted clinically. This promising approach needs, therefore, besides overcoming some technical limits, to standardize candidates biomarkers development process. [ABSTRACT FROM AUTHOR]

Résumé: Objectif: La prise en charge des récidives des cancers de l’ovaire repose sur la chimiothérapie intraveineuse associée ou non à une chirurgie de cytoréduction. La chimiohyperthermie intrapéritonéale (CHIP) est parfois proposée en complément d’une chirurgie complète. Le but de cette étude est d’évaluer la faisabilité, la morbidité et la survie de la CHIP associée à une cytoréduction chirurgicale complète dans le cadre de la prise en charge de patientes présentant une première récidive d’un cancer de l’ovaire. Patientes et méthodes: Entre 2005 et 2010, 27 patientes ont été opérées pour une récidive d’un cancer de l’ovaire. Parmi elles, 17 patientes (63 %) ont bénéficié d’une CHIP. Résultats: Seize patientes (94 %) étaient en résection complète en fin d’intervention. Aucune patiente n’est décédée en postopératoire. Deux patientes ont eu des complications peropératoires : une plaie vésicale et une section de l’uretère. Huit patientes ont présenté des complications postopératoire dont 3 de grade 3 ou supérieur (deux défaillances d’organe et une reprise chirurgicale). Quinze patientes ont présenté une récidive avec une médiane de survie sans progression de 11,9mois (IC 95 % [5,4–32,9]) depuis la CHIP. La médiane de survie globale depuis le diagnostic était de 107,8 mois. Discussion et conclusion: Ces résultats montrent que l’association de la CHIP, à une cytoréduction complète pour les récidives de cancer de l’ovaire, présente une morbidité et une survie acceptables. Les résultats de l’étude française multicentrique en cours (CHIPOR) sont attendus afin de généraliser cette prise en charge. [ABSTRACT FROM AUTHOR]

Regional lymph node involvement, especially in axilla, remains the most important prognostic factor in breast cancer, both for locoregional relapse (LRR) and survival. Locoregional radiotherapy (RT) reduces LRR rates by 50-70% and increases survival by 7-9%, as confirmed by EBCTCG. metaanalysis. The main LRR risk factors are: tumor site, number of axillary involved nodes, high grade, age under 40, and some molecular profiles, such as triple negative and Her-2 overexpressed tumors. The global LRR prognosis is unfavorable, with approximately 50% of metastatic evolution at 5 years. The supraclavicular relapse risk, both after mastectomy and breastconserving surgery, is reduced to under 2% with RT. Internalmammary nodes (IMN) are involved in 3-16% and 10-43% among pN0 and pN+ tumors, respectively. The specific RT impact on IMN is difficult to assess but recent studies seem to confirmthe importance of this treatment in case of high LRR risk. Globally, the axillary node involvement occurs in 30-35% of recent breast cancer series including a large proportion of screened tumors. The development of sentinel node biopsy (SNB) allows a very important reduction of axillary dissection (AD) sequelae. If SNB is negative, local control is equivalent to AD. When SNB is positive (micrometastases or even macrometastases), some studies question the usefulness of systematic complementary AD. In these cases, axillary RT seems a possible option, with several techniques. [ABSTRACT FROM AUTHOR]

Concerning the desire of pregnancy after breast cancer, several issues have to be discussed with the patient, such as risk of cancer recurrence or optimal time between cancer and future pregnancy. Potential obstetrical complications, long-term teratogenicity of anti-cancer drugs or breast feeding are other points that have to be discussed. The aim of this review of literature is to provide answers to the numerous questions that may be encountered in this highly difficult situation. Planning a pregnancy in breast cancer patients seems to be possible with, first, a multidisciplinary approach, an anticipation of the side effects of chemotherapy and second, a close and specialized obstetrical monitoring. [ABSTRACT FROM AUTHOR]

Résumé: Objectif: L’objectif de cette revue est de connaître le lien existant entre le cancer du sein et la vitamine D, qu’elle soit synthétisée par la peau ou apportée par l’alimentation ou par une supplémentation. Matériel et méthodes: Les articles pris en compte ont été extraits de la base de données Pubmed de 1998 à 2012. Les mots clés utilisés ont été : ű 25-hydroxyvitamin D Ƈ, ű breast cancer recurrence Ƈ, ű breast cancer risk Ƈ, ű serum levels of vitamin D Ƈ, ű vitamin D intake Ƈ. Au total, 37 articles ont été retenus. Résultats: L’exposition solaire, via la synthèse de vitamine D, est associée à une diminution du risque de cancer du sein. Une telle baisse semble également probable pour les apports alimentaires ainsi que pour la supplémentation en vitamine D à raison d’une dose supérieure à 400UI/j. Une relation inverse entre le taux sanguin de 25-hydroxyvitamine D (25-OH-D) et le risque de cancer du sein a inconstamment été retrouvée. L’augmentation de la 25-OH-D sérique semble être associée à une diminution du risque de récidive du cancer du sein. Conclusion: Des recommandations concernant une supplémentation en vitamine D pourraient être établies, mais nécessitent d’être étoffées par des recherches complémentaires. [ABSTRACT FROM AUTHOR]

Summary: Introduction: Adnexial carcinomas are a group of rare and aggressive malignant skin tumors. Management of these tumors is not well codified. Patients and method: The authors present a retrospective and single-center study of six cases. Surgery was performed between November 2005 and February 2008. Result: Pathological study revealed two syringoideccrine carcinomas, one microcystic adnexal carcinoma, two tricholemmal carcinomas, and one extra-ocular sebaceous neoplasm. In five cases, complete excision was guided by extemporaneous examination. In five cases, reconstructive surgery involved loco-regional skin flaps: two Abbé flaps, one Webster flap, one lifting lip flap, one submental flap, and one LLL flap. One case of relapse occurred, at 40months. Several particular characteristics of these tumors are shown in this study. They often follow a non-specific and discrete clinical course, are deeply infiltrated with a perineural tropism in some forms, and are preferentially located in the mid-face. Risks of incomplete excision and relapse are high. Conclusion: Complete excision is absolutely necessary in the management of these tumors, especially if reconstructive surgery is performed. Extemporaneous examination was in our experience a good option, particularly in the case of large labial or eyelid excisions. [ABSTRACT FROM AUTHOR]

It is now proven that preoperative chemotherapy (CT) and chemoradiation (CRT) increase R0 resection rate and overall survival. Moreover, CRT results in about 30% pathologic complete response. Indeed two randomized trials showed that survival was similar after definitive CRT or after CRT and surgery in locally advanced esophageal squamous cell cancer, despite more frequent local recurrences. In one of these trials (FFCD 9102), only clinical responders were randomized between surgery and no surgery, therefore clinical nonresponders could be operated on without delay. Indeed, survival of randomized patients and nonrandomized operated patients was not different. Evidence of benefit of surgery is poorer in case of delayed recurrence. Only small non-randomized studies tackled the issue: R0 resection rates ranged from 50 to 87%, 5-year survival rates from 0 to 33% and operative mortality from 12.5 to 25%. A radical change in the strategy against locally advanced esophageal cancer is upcoming: to start therapy with curative CRT and perform surgery only in non-responders and in case of operable loco-regional delayed relapse. Before recommending this strategy, the benefit of delayed salvage resection should be assessed in a prospective strategic randomized trial, currently in preparation by the FFCD and the FRENCH. [ABSTRACT FROM AUTHOR]

With the emergence of new targeted therapies against cancer and the increasing number of treatment options, the challenge for the clinician is to assess the risk/benefit ratio of a choice and prognosis for each patient. Interest in serum biomarkers of melanoma progression fits into this framework. In fact, many serum biomarkers were assessed in melanoma, but their clinical significance remains a matter of debate. In this article, a review of these serum biomarkers of melanoma is detailed and discussed in terms of their practical utility. The low sensitivity and reduced specificity of these markers are serious limitations to their routine use in the early stages (AJCC stage I and II). However, in the later stages (AJCC stage III and IV), the use of some of them can help to follow the patient carefully since elevated serum levels are shown to precede a recurrence. None of them can set a personalized therapeutic strategy. Microarray technology and proteomics research will surely bring new candidates in the near future for a more precise definition of individual prognosis and prediction of treatment outcome, and identify patients who could benefit from a new adjuvant therapeutic approach. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: The botryomycoma is a benign tumor that develops as a response to a local trauma. Generally, it occurs in the fingers, the face and the oral cavity. It is often easily recognized. However, the diagnosis between this tumor and other oral tumors, whether benign or malignant, may be difficult in some cases. We report a particular case of a botryomycoma that occurred with no history of a trauma at an earlier age in the tongue, which is an unusual site for this tumor. Case report: A 7-month-old infant presented with a polypoid and sessile swelling on the dorsal side of the tongue. This tumor gradually increased in size since birth. Clinically, the appearance of this mass with the gathered vessels inside was similar to that of a benign vascular tumor. A possibly malignant nature was not excluded. A complete resection under general anesthesia was performed. The histologic examination confirmed the diagnosis of pyogenic granuloma. Discussion: Pyogenic granuloma is a rare benign tumor which is most likely to occur between the age of 11 and 40. The most frequent location encountered for oral cavity is the gingiva. The tongue is rarely a site for its occurrence. Cutaneous pyogenic granuloma may have different aspect from mucosal type and thus may make the diagnosis difficult. Treatment consists on surgical excision and removal of etiological factors that may be source of recurrence. [Copyright &y& Elsevier]

Abstract: Objective: To evaluate the percentage of regional recurrence (RR) in patients with triple-negative (TN) N0 breast cancer in order to consider the interests of a systematic adjuvant nodal irradiation. Patients and methods: Between February 1996 and June 2009, 249 patients were treated for TN breast cancer in Léon-Bérard center (Lyon, France). All patients received first surgical treatment followed or not by chemotherapy or radiotherapy. We excluded patients with metastasis at diagnosis, patients who were initially irradiated regional lymph node, patients which ER, PR and/or HER2 status was not known and patients who didn’t have standard treatment. Ultimately, 100 patients were included. Results: Two patients (2%) developed regional recurrence (1 sub and supraclavicular recurrence and 1 supraclavicular recurrence). The median follow-up was 34 months (95% CI: 29,2 to 37,4). The survival rate at 3 years was 98% (95% CI: 90–99). Our study showed no differences in terms of RR between TN cancers and not TN cancers for a median followed up of 34 months. Conclusion: The results of our study do not suggest that patients with TN breast cancer should receive systematic nodal adjuvant radiotherapy. [Copyright &y& Elsevier]

Abstract: Postoperative radiotherapy is a cornerstone of the local treatment in breast cancer. It has been proved with high level of evidence that it decreases local relapse and improves survival of patients. However, radiotherapy comes with healthy tissue toxicity, heart and lung in particular. With constant improvement of radiation techniques, several methods have been developed to decrease the dose to the heart and the lungs. Sometimes, respiratory maneuvers can help, due to patient''s anatomy: the radiotherapy is gated with patient''s breath. The Deep Inspiration Breath Hold technique is the most popular and there are several ways to perform it. This note will describe the different systems with published data in order to help the radiation oncologist in the daily practice. [Copyright &y& Elsevier]

Summary: Background: Basal cell carcinoma is the most common type of skin cancer in humans. Objectives: The aim of our study was to determine the histologic risk factors involved in recurrence of basal cell carcinomas of the face. Patients and methods: We conducted a retrospective study of patients with primary basal cell carcinoma (BCC) of the face treated between March 2003 and December 2005. We analyzed the size of lateral and deep margins of tumor, histologic subtype, perineural invasion, and ulcerations. Clinical follow-up was observed until June 2011. Results: We note that 184 cases of BCC were included. Eleven recurrences occurred during the follow-up, i.e. 6%. The population was divided into two groups according to histologic safety margins (1mm for all basal cell carcinomas, 0.8mm for nodular and 2 mm for aggressive-growth (AG-BCC) subtypes). There was a significant difference between groups in regards to cancer recurrence. Tumor size above 2 cm and presence of perineural invasion increased the risk of recurrence. Discussion: Low histological safety margins appear to be critical on tumor recurrence. Depending on the tumor characteristics, and the patient, we advocate a re-excision in cases of histological safety margins inferior to 0.8mm for the nodular subtypes and 2 mm for aggressive subtypes. Tumor size, and perineural invasion should be taken into consideration so as to make a well-informed decision between re-excision and a watching strategy in critical cases. [Copyright &y& Elsevier]

Abstract: The quality of surgical margins in lumpectomy are strong criteria to define risk of locoregional recurrence when conservative treatment is undertaken. Intraoperatively, the limits of adequate resection are sometimes difficult to define. This is why some teams propose the realization of systematic cavity margins during the excision of lumpectomy during the same operation. We expose the potential benefits of this type of practice using data from the literature. [Copyright &y& Elsevier]

Chronic myeloid leukemia (CML) is a malignant disorder in which the immune system has been described as important for the graft versus leukemia effect after stem cell transplantation. With imatinib at a dose of 400 mg, the current treatment of chronic phase CML does not eradicate the leukemic stem cells. Most of the patients in molecular response remain with leukemic stem cells responsible for relapse if the treatment is discontinued. Recent studies have suggested that interferon may be useful in order to eradicate the quiescent stem cells. The second-generation inhibitors like dasatinib, nilotinib or bosutinib do not eliminate either the stem cells; this leads to the conclusion that either there is a persistence of leukemic stem cells or there is a general phenomenon with TKI. The mechanisms of resistance include high activities of Bcr-Abl and CrkLPhospho, a weak expression ofOCT-1 and high levels of proteins ABCB1 and ABCG2. However, two scientific groups have recently demonstrated the value of interferon alpha as a molecule that may stimulate the turnover and proliferation of hematopoietic stem cells in vivo. This new approach to understanding the mechanism of action of interferon alpha on hematopoietic stem cells supports the use of combination therapy of TKI plus interferon. [ABSTRACT FROM AUTHOR]

Second-generation tyrosine-kinase inhibitors enable an earlier and higher quality molecular response to be achieved than with imatinib in patients suffering from CML in chronic phase at diagnosis. This implies that in the future a larger number of patients will be candidates for the discontinuation of treatment. However, the majority of patients maintain a detectable residual disease despite their CMR4.5 status.Moreover, in the STIMstudy, more than half the patients who stopped Imatinib after 2 years of CMR, had a molecular relapse. Indeed, it has been shown that quiescent Philadelphia-positive cells recover upon ceasing tyrosine-kinase inhibitors (TKIs). The association of other molecules with TKI, acting by routes other than AbI inhibition, appears to be an interesting and logical option in the goal of eradicating the disease. Several research avenues exist. SMO, CXCR4, STAT5 inhibitors and PEG-IFN act by specific mechanisms which will be detailed here. The PEG-IFN and imatinib combination has shown very promising results, and TKI2 and PEGIFN tests are in progress. No data testing combinations of TKI2 and other molecules on a series of patients has been published to date. We will discuss here the rationale, the issues of this type of therapy and the perspectives in the treatment of CML. [ABSTRACT FROM AUTHOR]

Abstract: Postoperative radiotherapy remains essential in breast cancer in 2012. After conserving surgery, it reduces local recurrence risks from 50 to 70%, both for ductal carcinoma in situ and invasive cancers. This was confirmed in several randomized trials and three meta-analyses. The boost increases local control in invasive cancers, but its role should be better defined in ductal carcinoma in situ. Among the latter, there is no clearly identified subgroup for which radiotherapy could be avoided. Local recurrence risk factors are now well-identified both for ductal carcinoma in situ and invasive cancers, with an inclusion, for the latter, of new molecular subgroups. After mastectomy, radiotherapy reduces local recurrence rates from 60 to 70%, especially among patients with axillary nodal involvement, with, in parallel, a 7 to 9% increased survival rate. In order to reduce the waiting list and to avoid under treatment, especially in the elderly, several hypofractionated radiotherapy schemes have been developed for several years. Three randomized trials confirmed similar results to classical radiotherapy. For ten years, several techniques of partial breast irradiation have been developed, with various doses and treated volumes. The optimal indications should be defined according to the new international guidelines. [Copyright &y& Elsevier]

Abstract: Adjuvant radiotherapy is a standard component of breast cancer treatment. The addition of radiotherapy after breast conserving surgery has been shown to reduce local recurrence rate and improve long-term survival. Accurate delineation of target volumes and organs at risk is crucial to the quality of treatment planning and delivered accomplished with innovate technologies in radiation therapy. This allows the radiation beam to be shaped specifically to each individual patient''s anatomy. Target volumes include the mammary gland and surgical bed in case of breast conserving surgery, the chest wall in case of mastectomy, and if indicated, regional lymph nodes (axillary, supra- and infraclavicular and internal mammary). Organs at risk include lungs, thyroid, brachial plexus, heart, spinal cord and oesophagus. The aim of this article is to encourage the use of conformal treatment and delineation of target volumes and organs at risk and to describe specifically the definition of these volumes. [Copyright &y& Elsevier]

Abstract: Many clinical studies have showed the key role of radiotherapy in anticancer treatment strategy. Radiations are delivered alone or in combination with systemic therapies. In recent years, the main goal of all clinical developments has focused on improving clinical benefit, with an increased tumour control and a higher normal tissue protection. This research was designed to reduce local recurrences, to increase recurrence-free or overall survival and to decrease acute and late effects. Technological and biological evolutions (or revolutions) accompanied clinicians to improve clinical benefit, namely with strong progress in radiology and better understanding of radiobiology, particularly at the molecular level. Differences in tumour and normal tissues radiosensitivity are nowadays integrated in daily clinical practice of radiation oncologists. The current report details the last 5-year developments of clinical and translational research in radiation oncology, especially the role of French teams in the development of personalized treatment. [Copyright &y& Elsevier]

Abstract: Radiofrequency is a thermal ablative technique that is most often used percuteanously under image guidance. Thermal damage is obtained through frictional heating of a high frequency current. The maximal volume of destruction obtained in one radiofrequency delivery is around 4cm and consequently, best indication for treatment are tumours below 3cm. When compared, radiofrequency and surgical removal for tumours below 25mm in diameter demonstrated a rate of incomplete resection/ablation of 6% and 7.3% respectively. Median survival after the first radiofrequency of a liver metastasis of CRC is reported to be 24 to 52 months with a 5 years overall survival of 18 to 44%. The median overall survival increases from 22 to 48 months depending on the use of radiofrequency ablation as rescue treatment after failure of others, or as a first line treatment. For patients with a single tumour, less than 4cm, the survival rates at 1, 3, and 5 years are respectively 97%, 84% and 40%, with a median survival of 50 months. Follow-up imaging requires to use contrast-enhanced CT or MRI, looking for local recurrences evidenced by local foci of enhancement at the periphery of the ablation zone. [Copyright &y& Elsevier]

Abstract: Surgical treatment of cancer is usually necessary but it can paradoxically aggravate the patient outcome by increasing the risk of recurrence. Many perioperative factors have been shown to contribute to the dissemination of the tumor: surgery itself, stress, inflammation, pain, anaesthetic drugs, blood transfusion, etc. The type of anaesthesia chosen in the cancer patient could then be crucial and influence the evolution of the disease. Experimental, preclinical and retrospective studies have suggested that a regional anesthesia associated or not with a general anesthesia for carcinologic surgery might reduce the risk of cancer recurrence. This text reviews the factors promoting the recurrence of tumors after carcinologic surgery and the potential possibilities of protection associated with the type of anaesthesia chosen. [Copyright &y& Elsevier]

Summary: Introduction: Although fibromatosis is considered as benign tumor, it can have significant morbidity, particularly when it occurs in the head and neck. Their propensity for infiltrative local growth with encroachment on vital structures and their tendency to recur make fibromatoses of the head and neck extremely challenging lesions. Case report: We report the case of a 10-year-old boy with desmoid fibromatosis of the upper lip. For this patient, the medical treatment has been decided to avoid a mutilating surgery. He had a good result with chemotherapy using methotrexate and vinblastine. Discussion: According to the literature, surgery is the most common treatment of fibromatosis in the head and neck region. However, particularly in children, alternative modes of therapy must be considered because of the high recurrence rate and to avoid mutilating operations. Chemotherapy using methotrexate and vinblastine may be a reasonable choice. [ABSTRACT FROM AUTHOR]

Summary: Introduction: Primary malignant schwannomas are rare neoplasms of nerve sheath origin, especially in the location of the head and neck where few cases are described in the literature. Report case: We report the case of a 65-year-old male diagnosed with malignant shwannoma in the left cheek. The patient underwent surgery with wide local excision, reconstruction were made later by skin graft. Discussion: The treatment of choice is radical excision of the lesion with wide margins. In fact, to reduce local tumor recurrence, the use of adjuvant radiation or chemotherapy is still controversial. [ABSTRACT FROM AUTHOR]

Abstract: Purpose of the study: The objective of this study was to compare prospectively the delineations of tumour bed after breast conserving surgery from two techniques for defining the target volume. Patients and methods: Sixteen patients treated by lumpectomy with development of surgical clips were included. For each patient, four radiation oncologists delineated the clinical target volume (CTV boost) following its own method (technique 1) or using a predefined methodology (technique 2), the diameter to be applied around each clip relative to the risk of local recurrence. Factors taken into account to adjust the volume were tumour size, age, surgical margins and the presence of extensive ductal carcinoma. We then analyzed the factors varying the volume and variation of delineation for each method by calculating the concordance index: Kappa index and overlap. Results: For all 16 patients, the volume delineated was nearly identical: 29.65cm3 with technique 1 and 33.54cm3 with technique 2 (P =0.6). The correlation was higher with technique 2 over technique 1, with KI from 0.146 to 0.285 (P =0.0001) and an OV of 0.302 to 0.458 (P =0.0002). Conclusion: Our study shows that within the same institute, there is a great variability in CTV delineation boost, even in the presence of surgical clips. A standardized approach to adjusting the volume of relapse risk factors has improved the consistency. [Copyright &y& Elsevier]

Abstract: Purpose: To assess the clinical outcome of the involved-node radiotherapy (INRT) concept with the use of deep-inspiration breath-hold (DIBH) technique in patients with localized supra-diaphragmatic Hodgkin lymphoma. Patients and methods: All were patients with stage I–II Hodgkin lymphoma and they were treated with chemotherapy prior to irradiation. Radiation treatments were delivered using the involved-node radiotherapy concept according to the European Organization for Research and Treatment of Cancer Guidelines and a spirometer dedicated to DIBH radiotherapy was used for every patient. Results: Twenty-seven patients with Hodgkin lymphoma (26 patients with primary Hodgkin lymphoma, one with refractory disease), treated from November 2004 to October 2010, were retrospectively analysed. The median age was 27 years (range 16 to 54). Seventeen (63%) patients had stage I–IIA and 10 (37%) had stage I–IIB disease. All patients received two to six cycles of adriamycin, bleomycin, vinblastine and dacarbazine. The median radiation dose to patients was 30,6Gy (range: 19,8–40). Protection of various organs at risk was satisfactory. Median follow-up, 3-year progression-free and 3-year overall survival were 38 months (range: 7–70), 96% (95%CI: 79–99%) and 95% (95%CI: 75–99%), respectively. Recurrence occurred in one patient (mediastinal in-field relapse). There was one grade 3 acute toxicity (transient pneumonitis). Conclusions: Our results suggest that patients with localized Hodgkin lymphoma can be safely and efficiently treated using deep-inspiration breath technique and the involved-node radiotherapy concept. Longer follow-up is needed to assess late toxicity, especially for the heart and the coronary arteries. [Copyright &y& Elsevier]

Patients who have undergone a radical prostatectomy may have to face high risk of recurrence. This recurrence is due to occult metastatic disease at the time of diagnosis. Results of prospective randomized trials on high risk patients have shown a metastatic free survival, progression-free survival and local control benefits with adjuvant radiotherapy. Patients without immediate adjuvant radiation therapy but having subsequent evidence of recurrent disease are candidates for salvage radiation therapy. Hormonal treatment is proposed in this indication. The encouraging results of modern chemotherapy for advanced disease allow to test this therapy in an earlier phase of biological recurrence. This article will discuss the decision criteria for the use of these treatments and the ongoing trials in adjuvant or salvage situations. [ABSTRACT FROM AUTHOR]

Abstract: Colorectal surgery for endometriosis is increasingly performed, but its assessment is still incomplete, especially regarding its impact on quality of life, the recurrence rate and subsequent fertility. Segmental resection is the technique most often performed and best evaluated with a proven efficacy but associated with significant morbidity. Alternatives to segmental resection consisting of shaving rectal resection, discoid resection or superficial resection have recently been proposed to provide equivalent efficacy while decreasing morbidity. To date, data are insufficient to clarify the respective indications of segmental resection and alternatives. Only randomized trials will resolve the existing controversy. [Copyright &y& Elsevier]

Bone metastases are common complications of several cancers, among which breast and prostate cancer are the most osteotropic. Different factors produced by the bone microenvironment draw cancer cells to invade the bone marrow where they seed in specific regions termed the premetastatic niche and the osteoblastic niche. Cancer cells then acquire bone-like properties to adapt and thrive in the bone microenvironment (osteomimicry). The inhibition of these mechanisms may offer new therapeutic perspectives, preventing bone metastasis formation inpatients at high risk of relapse in bone. [ABSTRACT FROM AUTHOR]

Despite the improvement in surgical management for ovarian carcinoma, it remains the most aggressive gynaecologic cancer with the ability to kill patients. Finding new treatments that can improve survival rate is an urgent need for these patients. Antiangiogenics with bevacizumab in association with chemotherapy has demonstrated their capability to decrease the risk of relapse and death for high-risk patients. Parp inhibitors seem to confirm their capabilities in efficiently treating high-grade serous carcinoma, notably for patients with BRCA mutations. Finally, other pathways are on clinical trials to confirm their importance in the treatment of ovarian carcinoma (folates inhibitors, PI3K inhibitors, c-MET inhibitors...). [ABSTRACT FROM AUTHOR]

L'activité physique (AP) s'intègre dans les soins de support en améliorant les possibilités fonctionnelles de l'organisme et la qualité de vie des patientes. Il s'agit du seul facteur modifiant de façon établie la fatigue des patients cancéreux. L'AP modifie la survie en diminuant le taux de rechute des cancers du sein et l'impact des comorbidités. Les mécanismes d'action de l'exercice physique sur la maladie cancéreuse sont décrits. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: The aim of this study is to establish the feasibility of the management of recurrent pelvic cancers by robot-assisted laparoscopy, and particularly the feasibility of robot-assisted laparoscopy anterior pelvic exenteration, from a single center series of seven patients. Patients and methods: From February 2007 to April 2010, all patients cared for recurrent pelvic cancer have been included (n =7). Five patients have been cared for a cervical cancer recurrence, one patient for recurrent VAIN 3, and one patient for squamous cell carcinoma of the vaginal vault after hysterectomy for cervical carcinoma in situ. All patients were benefited from robot-assisted laparoscopy: two had surgery such as anterior pelvic exenteration with Miami Pouch urinary reconstruction, and five had colpectomy with or without lymph node removal, including one with vaginal preparation first before vaginal cuff resection. Data were collected prospectively identifying treatment history, intraoperative data, immediate outcomes, pathological findings, and long-term outcomes. Results: From February 2007 to April 2010, 195 patients underwent robot-assisted laparoscopy at the Institut Paoli-Calmettes. Among them, seven patients had pelvic cancer recurrence. The median age was 53 years (44 to 67). The median BMI was 25 (19.7 to 35.3). The median Karnofsky index was 100 (80–100). The median operative time was 210min (90 to 300) for colpectomy, 480 min for pelvectomy, 240min (90–480) for the serie. The mean duration of the installation of the robot, all procedures combined, is estimated at 22.5 min (±4.8min). There was no conversion to laparotomy, the median blood loss was 340ml (100 to 800). One patient was transfused with two red blood cells. There was a surgical complication (wound of the inferior mesenteric artery). There were no early postoperative complications and the median hospital stay was 6 days (3–24). There was a late postoperative complication: a patient who underwent anterior pelvic exenteration had impaired wound healing, with scarring requiring led by the VAC system. On pathological findings, the average number of nodes removed in the pelvic was 8.5 (±2) on the left, and 4 (±1.4) on the right. Three patients had involved margins; it was an anterior pelvic exenteration and two colpectomy. There was no hospital mortality, neither post-operative mortality at D30 and D90. After a median follow up of 22 months (9–34), the recurrence rate was 71% (5 patients out of 7), and one patient died 10 months after the intervention of a pulmonary embolism. Discussion and conclusion: The surgical management of recurrent cervical cancer by laparoscopy-assisted robot is feasible for selected indications, and could be proposed as an alternative to laparotomy. Monitoring data in this series raise the question of the validity of conservative treatment in cases of recurrent pelvic cancer. The possibilities in terms of urinary and vaginal reconstruction remain to be defined. The impact of this surgical approach on oncological data must be confirmed. [Copyright &y& Elsevier]