Search

Résumé: Les métastases génitales sont très rarement révélatrices d’un cancer du sein ; elles siègent exceptionnellement au niveau du col utérin. Ces localisations atypiques sont plus fréquentes lorsqu’il s’agit d’un cancer du sein multimétastatique ou d’un type histologique lobulaire infiltrant. L’association concomitante d’un cancer lobulaire infiltrant et canalaire infiltrant dans le cadre d’un cancer du sein bilatéral synchrone reste également une entité rare. Nous rapportons l’observation d’une patiente présentant un cancer du sein bilatéral synchrone, de types histologiques différents, révélé par des métrorragies causées par une métastase au niveau du col de l’utérus. [ABSTRACT FROM AUTHOR]

Résumé: Objectif: Évaluer les résultats de la radiothérapie chez les patients atteints de carcinomes épidermoïdes du larynx avec atteinte sous-glottique. Patients et méthodes: Entre 1998 et 2012, 56 patients ont reçu une radiothérapie ou une radiochimiothérapie (63 %) sans ou avec chimiothérapie d’induction (37 %) dans notre établissement. Résultats: Le suivi médian était de 74mois. À cinq ans, les probabilités de survie globale, de survie sans progression et de survie spécifique étaient respectivement de 64 % (intervalle de confiance à 95 % [IC 95 %] : 48–90 %), 45 % (IC 95 % : 28 %–61 %) et 88 % (IC 95 % : 78 %–98 %), respectivement. Les probabilités de contrôle locorégional et de contrôle à distance à cinq ans étaient de 69 % (IC 95 % : 56–83) et 95 % (IC 95 % : 89–100). Il n’y avait pas de différence de survie globale ni de contrôle locorégionale en fonction des traitements reçus (radiothérapie/chimioradiothérapie contre chimiothérapie puis radiothérapie/chimioradiothérapie) ou en cas d’atteinte sous-glottique primitive. Un indice de performance de 1 ou plus et la présence d’adénopathie cervicale au moment du diagnostic étaient des facteurs pronostiques défavorables de survie globale en analyse multifactorielle (hazard ratio [HR] [IC 95 %], respectivement de 6,5 [1,3–34 ; p =0,03] et 11 [1,6–75 ; p =0,02]). La probabilité de contrôle locorégional des cancers de stades T3-T4 était plus basse (HR : 3,1 ; IC 95 % : 1,1–9,2, p =0,04) en analyse unifactorielle mais aucun facteur pronostique n’a été retrouvé dans l’analyse multifactorielle. Aucune différence de probabilité de contrôle locorégional n’a été observée en fonction du premier traitement reçu (p =0,3). La probabilité de préservation laryngée à cinq ans était de 88 % (IC 95 % : 78–98) pour l’ensemble des patients et 58 % en cas de cancer de stade T3. Les probabilités de préservation laryngée à cinq ans étaient de 91 % (IC 95 % : 79–100) et 83 % (IC 95 % : 66–100), respectivement chez les patients qui n’ont pas et ont reçu une chimiothérapie néoadjuvante. Conclusion: Cette analyse suggère que les résultats obtenus pour les cancers du larynx avec atteinte sous-glottique par la radiothérapie avec ou sans chimiothérapie seraient comparables à ceux obtenus pour les autres tumeurs laryngées. Des protocoles de préservation laryngée pourraient donc être proposés en cas d’atteinte sous-glottique, dans certains cas sélectionnés. D’autres études sont nécessaires pour préciser ces données préliminaires. [ABSTRACT FROM AUTHOR]

Résumé: Objectif: La colpohystérectomie élargie est l’un des traitements standards actuels des cancers du col précoces. L’objectif de ce travail est de déterminer le taux et les facteurs prédictifs d’invasion paramétriale dans les cancers débutants du col traités par hystérectomie radicale afin d’identifier un groupe de patientes à bas risque, potentiellement candidates à une chirurgie à moindre morbidité. Méthode: Nous avons conduit une revue de la littérature des études rétrospectives et prospectives récentes et présenté les études randomisées en cours sur la faisabilité d’une chirurgie non élargie aux paramètres. Résultats: Le taux d’invasion paramétriale pour des cancers du col débutant de moins de 2cm, sans embole, sans envahissement ganglionnaire, avec une profondeur d’invasion stromale inférieure à 10mm varie entre 0 et 1,96 %. Conclusion: Ces résultats suggèrent qu’une hystérectomie simple extrafasciale associée à une lymphadénectomie pelvienne est peut-être suffisante dans ce contexte. Actuellement, il n’existe pas encore d’étude randomisée permettant de valider cette hypothèse et donc de modifier les pratiques actuelles. L’élargissement aux paramètres reste donc le standard dans la prise en charge chirurgicale des cancers du col précoces. [ABSTRACT FROM AUTHOR]

Résumé: Objectifs: Les métastases intra-mammaires (MIM) des cancers d’origine extra-mammaire sont peu fréquentes. L’objectif de cette revue de littérature était d’actualiser les connaissances et d’expliciter les erreurs diagnostiques. Patients et méthodes: La revue de la littérature via PubMed a permis de sélectionner 54 articles parus en anglais entre 2003 et 2012. Résultats: Les mélanomes (138 cas, 29,8 %) étaient plus fréquemment à l’origine des 463 cas de MIM, suivis des cancers pulmonaires, gynécologiques, digestifs et hématologiques. Les MIM surviennent chez la femme (92,2 %) vers 50ans, de manière métachrone (84,2 %). Cliniquement, elles sont généralement rondes, indolores, sans rétraction cutanée et associées à des adénopathies (33 %). À l’imagerie, elles sont plus souvent uniques. Le diagnostic, parfois évoqué par l’étude morphologique de la tumeur, est confirmé par l’immuno-histochimie. Les métastases systémiques sont fréquentes, entraînant une survie courte. Discusssion: La prévalence des primitifs n’est pas responsable à elle seule de la fréquence des MIM, comme le montre les mélanomes. La théorie de ű la graine et du sol Ƈ de Paget peut l’expliquer, certaines cellules tumorales ne pouvant s’implanter que dans certains organes. La vascularisation du sein paraît être également un facteur important. Cliniquement, les MIM peuvent être confondues avec des tumeurs bénignes. Néanmoins, un antécédent de cancer et des lésions multiples doivent faire suspecter la malignité. À l’imagerie, les signes sont peu spécifiques. Les caractéristiques morphologiques ne permettent pas d’affirmer le diagnostic avec certitude. L’immuno-histochimie est fondamentale, comme la comparaison avec l’histologie de la tumeur primitive. La prise en charge est essentiellement palliative. [ABSTRACT FROM AUTHOR]

Introduction. Salivary gland metastases are rare. When such event occurs, it mainly involves the parotid gland. When it concerns the submandibular gland, it is even rarer. Observation. In this case report, we will describe a case of submandibular gland in a patient where the primary tumor was located on the right breast. Discussion. We will discuss about the cases reported on the English literature about metastasis to the submandibular gland from a non-head and neck primary tumor. [ABSTRACT FROM AUTHOR]

To reduce the morbidity of complementary axillary lymph node dissection and the reoperation rate after sentinel lymph node (SN) biopsy, the use of predictive models of metastatic non-SN in case of positive SN can be useful. Before being used in routine, these models have to be validated in independent populations based on discrimination and calibration. However, the main issue is their clinical utility based not only on the low false negative rate but also on its potential to discriminate patients with a low risk of non-SN involvement. This article is intended to recall the different types of predictive models used, their definition and to present and compare different published models to estimate the risk of invasion of non-SN in case of positive SN. [ABSTRACT FROM AUTHOR]

Axillary lymph node dissection (ALND) for micro- or macrometastases in sentinel node is questioned by recent trial results. We reported some results of the following questions: 1) What is the non-sentinel node rate in case of involved sentinel node? 2)What is the impact of ALND omission on axillary recurrence, 3) on survival rate and 4) on adjuvant treatment indication? Inclusion in prospective randomised trial is recommended because the sufficient level of evidence is not demonstrated to propose ALND omission in routine practice. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Multidisciplinary meeting (MDM) should ensure a homogeneous management of the patients by following breast cancer guidelines. Are these guidelines really applied in MDM decisions? Patients and methods: We reviewed the last 200 cases of patients operated in our department for breast cancer. We searched for each case if MDM had been consulted, at which step of the management and if the decision was in accordance with our guidelines. Results: Mean age of the 200 patients was 56 (range 27–87)years old and 145 of them (72,5%) had an invasive breast cancer. All cases were presented to the MDM, 148 (74%) preoperatively and 200 (100%) postoperatively. Only four decisions did not follow our guidelines. In three cases, the decision was explained within the MDM report and in one case, the decision was not explained but could be understood. Discussion and conclusion: We found a significant relation between MDM decisions and our guidelines. However, complex cases require adapting the guidelines to the particularity and the wishes of the patients. [Copyright &y& Elsevier]

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: The natural history of ductal carcinoma in situ (DCIS) is not fully elucidated, but it is recognized that DCIS is the true precursor of invasive carcinoma. Studies could show that DCIS is as heterogeneous as invasive ductal carcinoma, yet, they were unable to predict which DCIS will progress to invasion. Several biomarkers were also demonstrated to have a certain prognostic value. However, except for estrogen receptors and HER2, biomarkers are not yet widely used in clinical practice since their predictive value has not proven to be better than the grade and the classical classifying systems of DCIS. Identifying biomarkers for risk of invasiveness in DCIS could be of great value to help high risk patients through the management of their disease and to avoid overtreatment in low risk patients. [Copyright &y& Elsevier]

It is well established that cancer increases the risk of venous thrombosis. Conversely, the mechanisms involved in haemostasis play a major role in the tumour development, facilitating tumour proliferation and altering the microenvironment, with major consequences in terms of the metastatic process. It is therefore mandatory to take the measure of this double bond between cancer and haemostasis. The clinicianwill be aware that venous thromboembolism is difficult to diagnose in cancer patients. At all stages of care, preventive and curativemeasures will be implemented, based on current recommendations and, if applicable, the standards which have been developed. With the French Group Thrombosis and Cancer (GFTC), a dynamics has been boosted in order to implement 'RCP-thrombose'. [ABSTRACT FROM AUTHOR]

The article offers information on a study on intercellular adhesion Regulation during epithelial morphogenesis. It informs that stable chemical and mechanical barriers are generated by epithelium between physiological compartments and can be remodeled during wound healing, embryogenesis and tumor progression. It also informs that relationship and the coupling in adhesive forces and cortical tension was studied in the study.

The article offers information on the use of matrikines in new anticancer therapeutic strategy. It informs that matrikines are extracellular matrix-derived peptides which regulate cell activity and capable to control tumor invasion and metastasis dissemination. It has been found that during hypoxia proteases secreted by the stromal cells degrade the stromal extracellular matrix which further releases various matrikines.

Treatment of advanced non-smallcell lung cancer is usually based on several lines of therapy separated by treatment-free intervals, in which each new line is started when tumor progression is detected. The maintenance strategy consists of continuing an appropriate, well-tolerated treatment immediately after the end of first-line chemotherapy, in order to maintain the initial therapeutic benefit and to avoid rapid clinical deterioration that would rule out further treatment. Maintenance can use either a non-platinum component of induction chemotherapy defining 'continuation maintenance' or initiation of a new agent consisting in 'switch maintenance'. Clinical trials show that maintenance therapy with pemetrexed or erlotinib provides a significant clinical benefit in terms of disease control and survival. Maintenance therapy is an important option in first-line treatment of non-small cell lung cancer but more reliable criteria is needed to identify the patientsmost likely to benefit from either continuation or switch maintenance. [ABSTRACT FROM AUTHOR]

Angiogenesis constitutes a major process in cancer progression, especially by promoting the growth of malignant cells and dissemination of metastases. The development of anti-angiogenic targeted therapies has made significant progress over the last decade. Since the discovery of bevacizumab, numerous therapies have been designed. Among them, small molecules that inhibit the tyrosine-kinase activity of pro-angiogenic receptors such as VEGFR, are the most studied today. Current research focuses on the development of new targeted-therapies, able to inhibit the activity of several receptors at the same time and with a greater affinity. This article reviews the data on anti-angiogenic targetedtherapies, from available molecules to drugs still in the process of development. [ABSTRACT FROM AUTHOR]

Abstract: Patients who survive a cancer occurring during childhood or young adulthood, treated with radiation, are at a very high risk of chronic sequelae and secondary tumours. To reduce this radioinduced morbidity and mortality, efforts are put on reducing the burden of the treatments and a long-term monitoring of these patients is progressively organized. We present a general review of the literature about the risk factors for developing a secondary breast cancer, which is the most frequent secondary tumour in this population. We suggest that contouring the prepubescent breast as an organ at risk may help predict the risk and reduce the dose to the breasts using modern radiotherapy techniques. [Copyright &y& Elsevier]

Abstract: Purpose: Superior sulcus non-small cell lung cancer represents less than 5% of all lung cancers and is a challenge for the physicians because of clinical presentation, treatments related toxicities and poor prognosis. The aim of this preliminary retrospective report is to present outcomes of patients affected by a superior sulcus non-small cell lung cancer, treated by high dose radiotherapy (>60Gy) with or withour chemotherapy. Patients and methods: All adult inoperable or unresectable patients (≥18years) with a clinical and radiological diagnosis of superior sulcus non-small cell lung cancer treated in our department by radiotherapy with or without chemotherapy were retrospectively analysed. Primary endpoint was the local control. Overall survival, metastasis free survival and toxicity rates were also analysed and reported. Results: From January 1999 to June 2009, 12 patients were treated by exclusive high-dose radiochemotherapy. Median age was 53years (range: 33–64years); mean follow-up time was 20months (range: 2–75months). Mean local control, overall survival and metastasis free survival were 20.2, 22 and 20months, respectively. At the time of this analysis, seven patients died of cancer and three of them presented only a metastatic disease progression. One patient died of acute cardiac failure 36months after the end of radiochemotherapy and was disease free. Treatment was well tolerated and any acute and/or late G3-4 toxicity was recorded (NCI-CTC v 3.0 score). Conclusion: This analysis confirms the interest of exclusive high-dose radiochemotherapy in treating inoperable superior sulcus non-small cell lung cancer patients, in achieving good local control and overall survival rates. [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]

For decades, therapeutic management of advanced-stage hepatocellular carcinoma (HCC) was hampered by marginal and limited benefit of conventional chemotherapy. HCC is a highly vascularised tumor, in which angiogenesis plays a major role in all stages of the disease, and resulted in a rational use of antiangiogenic therapies. Moreover, several tyrosine-kinase receptors have been implicated in the proliferation and invasion of HCC, including vascular endothelial growth factor receptor (VEGFR) and platelet-derived growth factor receptor (PDGFR). Recently, the approval of sorafenib, a multikinase inhibitor, as an efficient therapy for advanced-stage HCC sparked an interest in evaluating new antiangiogenic therapies in the initial and advanced stages of the disease. Currently, several molecules are investigated in preclinical studies and clinical trials with disparate results, with the hope to identify new efficient therapies, thereby opening new prospects and raising several questions and challenges. [ABSTRACT FROM AUTHOR]

Abstract: Despite significant progress in the treatment of glioblastoma, the prognosis of these radioresistant, invasive and hypoxic tumours remain dark. The constant relapse after treatment of this tumour is in part due to its intra-cellular but also micro-environmental radioresistance, largely controlled by growth factors and their receptors. The complexity of the biology of these tumours and the presence of numerous cross-talks between the pathways of these different growth factors can be in part responsible for the negative results obtained in clinical trials associating radiotherapy and targeted drugs designed without previous in vitro and in vivo studies validating the proof of concept of a specific target as key factor of radioresistance. In the aim to optimize the treatment of glioblastoma and to reduce the risks of failure of new trials, several laboratories and clinical departments are developing translational research in radiotherapy and radiobiology, validating in vitro and then in orthotopic xenografts interesting targets, then studying the radiosensitizing effect of targeted drugs directed against these proteins, studying the mechanisms of action and resistance of these drugs, validating these proteins as predictive factors of response to radiotherapy in the patients, and then designing clinical trials, integrating metabolic or functional imaging and surrogate markers to better understand the mechanism of action of these associations. We describe in this article the main translational research axis developed for radiosensitizing glioblastoma, which our lab and department have pursued for several years. [Copyright &y& Elsevier]

Abstract: In spite of the great advances made on the knowledge of cancer etiology and the significant breakthroughs in terms of treatment, complete remission is obtained in only around half of cancer patients. In fact, therapies that appear successful for some cancers are totally unfruitful for others, and some cancer types still remain incurables. In order to develop new therapies suitable to these tenacious cancers, we need to renew our view on cancer and to revise some old paradigms and “false friends” that can hide unexpected new therapeutic targets. A good example of these paradigms is the role of the cell stress response in tumor progression. Indeed, a number of studies has been devoted to the pivotal tumor suppressor function of some players of this response, of which the p53 protein is the best example. Nevertheless, during tumor progression and metastasis, the cancer cell faces many stresses imposed by tumor microenvironment and its survival will be conditioned by an efficient cell stress response. This review is consecrated to the role played by a pivotal actor of the cell stress response, the p8 protein, during carcinogenesis. We will recapitulate the data available on its different cell functions and the assets p8 confer to the cancer cell in terms of growth, drugs resistance and metastasis formations. [Copyright &y& Elsevier]

Abstract: Purpose: To evaluate the feasibility of helical tomotherapy intensity-modulated radiotherapy for the treatment of axial and paraspinal tumours. Patients and methods: Fourteen consecutive patients with axial and paraspinal tumours at the Bergonié Institute between June 2007 and June 2009 were analysed. Various localisations were observed: four paravertebral tumours, five primitive vertebral tumours and six iliosacral or sacral tumours. Results: The dose prescribed to the median of the planning target volume (PTV) varied from 45 to 68Gy depending on histology. The maximum dose delivered to the PTV (Dnear max or D2%) was 60.6Gy (range 46.3–69.1). In the five cases where the tumour was located close to the spinal cord, the median value of Dnear max was 40.1Gy (range 37.8–45.4). In the seven where the tumour was situated close to the cauda equina, the median value of Dnear max was 46.5Gy (range 39.2–60). For two cases in whom the sciatic nerve was the nervous structure at risk, the Dnear max was 64.4 and 67Gy. Six patients were in complete remission, six patients suffered a relapse at a median follow-up of 14.5 months (4–24), two died following local tumour progression and metastasis, tumoral stabilisation had been obtained in two patients. Treatment was well tolerated and was never interrupted in all patients. Conclusions: Results from this preliminary series are encouraging, particularly concerning the good tolerance of this new intensity-modulated radiotherapy presently more available than proton therapy. [Copyright &y& Elsevier]

Abstract: After normal tissue exposure to radiation therapy, late side effects can occur and may reduce patients’ quality of life due to their progressive nature. Late toxicities occurrence is the main limiting factor of radiotherapy. Various biological disorders related to irradiation are involved in the development of late toxicities including fibrosis. The present review will focus on the recent physiopathological and molecular mechanisms described to be involved in the development of late radio-induced toxicities, that provide therapeutic perspective for pharmacomodulation. [Copyright &y& Elsevier]

Abstract: Objectives: Multicentricity is not listed as a major prognostic parameter in invasive breast carcinoma, and is not by itself an indication of systemic adjuvant treatment. Furthermore, evaluating the size of these tumors is discussed. The aims of this study are to evaluate prognostic value of multicentricity, and to compare different way for measuring multicentric breast carcinomas. Patients and methods: Between 2001 and 2008, 1458 patients having breast invasive carcinoma were included in Tenon Hospital, Paris, France; 16% had a multicentric cancer. We have compared impact of multicentricity on lymph node (LN) involvement, and compared 3 ways for measuring these cancers. Results: LN involvement was significantly associated with multicentricity. We found an over-risk of 20% for LN involvement in patients having multicentric cancer, whatever the size of the tumors. Considering the diameter of the largest focus is the best way for measuring these cancers. Discussion and conclusion: We did not find a subgroup of patients at low risk of LN involvement when having a multicentric breast cancers. These results lead us to extend indications of adjuvant chemotherapies in all multicentric breast cancer. These results should be validated by randomized prospective studies. [Copyright &y& Elsevier]

Abstract: Purpose: Temozolomide has significantly improved the outcome of patients with glioblastoma. However, the optimal duration of continuation treatment after chemoradiation remains uncertain. This retrospective analysis aims at assessing the feasibility, the tolerance, and the potential benefit of prolonging adjuvant temozolomide more than six months, which is the reference protocol. Patients and methods: Forty-six patients were included in the analysis. Median age at diagnosis was 61years old (range 40 to 77). Forty-five patients received a conformal external beam radiation with concurrent temozolomide-based chemotherapy. Then, 37 patients received adjuvant chemotherapy with temozolomide. The treatment was continued until progression or toxicity. Results: During the adjuvant phase, no treatment discontinuation for toxicity was necessary. Eight patients required dose adaptation because of toxicity. Thirty-two patients presented tumor progression during the adjuvant phase. Overall median survival was 12.3months (range 11–13.2months) and progression-free survival (PFS) was 7.6months (range 5.6–9.6months). Conclusion: These results suggest feasibility of delivering temozolomide beyond the six months of the standard protocol, with mild toxicity and survival data at least comparable to those from literature. Prospective assessments are ongoing. [Copyright &y& Elsevier]

Abstract: Purpose: To determine whether exclusive radiotherapy could be a therapeutic option after complete clinical response (cCR) to neoadjuvant chemotherapy (NCT) for early breast cancers (EBC). Patients and methods: Between 1985 and 1999, 1477 patients received néoadjuvante chemotherapy for early breast cancer considered to be too large for primary conservative surgery. Of 165 patients with complete clinical response, 65 were treated by breast surgery (with radiotherapy) and 100 by exclusive radiotherapy. Results: The two groups were comparable in terms of baseline characteristics, except for larger initial tumor sizes in the exclusive radiotherapy group. There were no significant differences in overall, disease-free and metastasis-free survivals. Five-year and 10-year overall survivals were 91 and 77% in the no surgery group and 82 and 79% in the surgery group, respectively (P =0.9). However, a non-significant trend towards higher locoregional recurrence rates (LRR) was observed in the no surgery group (31 vs. 17% at 10 years; P =0.06). In patients with complete responses on mammography and/or ultrasound, LRR were not significantly different (P =0.45, 10-year LRR: 21 in surgery vs. 26% in exclusive radiotherapy). No significant differences were observed in terms of the rate of cutaneous, cardiac or pulmonary toxicities. Conclusion: Surgery is a key component of locoregional treatment for breast cancers that achieved complete clinical response to neoadjuvant chemotherapy. [Copyright &y& Elsevier]

Invasive micropapillary carcinoma (IMC) of the breast is a rare variant of the invasive ductal carcinoma; it is characterized by a unique histology and an extremely high-incidence of lymph node metastases (95%). Histologically, IMC of the breast has been well described but it remains insufficiently recognized in clinical practice. Carcinomas with an IMC histology show abundant invasive epithelial nests surrounded by a clear area, within a fine reticular to collagenous stroma. Recognizing this entity is crucial in predicting lymph node metastases, even if it only constitutes a small component of more ordinary breast carcinoma, regardless of the overall tumour size. We report a case of breast carcinoma with a partial micropapillary component occurring in a 29-year-old woman with positive lymph nodes. [ABSTRACT FROM AUTHOR]

Abstract: Radiation tolerance for bone tissue has been mostly evaluated with regard to bone fracture. Main circumstances are mandibula osteoradionecrosis, hip and costal fracture, and patent or radiologic fractures in the treated volume. After radiation therapy of bone metastasis, the analysis of related radiation fracture is difficult to individualize from a pathologic fracture. Frequency of clinical fracture is less than 5% in the large series or cohorts and is probably underevaluated for the asymptomatic lesions. Women older than 50years and with osteoporosis are probably the main population at risk. Dose–effect relations are difficult to qualify in older series. Recent models evaluating radiations toxicity on diaphysa suggest an important risk after 60Gy, for high dose–fraction and for a large volume. [ABSTRACT FROM AUTHOR]

Abstract: The liver is a large abdominal organ in the right hypondrium. Because of its anatomical situation, it is near many abdominal PTVs as well as some lower thoracic PVTs. The liver could also be at the same time the target (for irradiation of liver metastases or primary liver tumours) and organ at risk (OAR). Radiation-induced liver disease (RILD) is radiobiologically the normal tissue complication probability (NTCP), i.e., the clinical event limiting the total dose that could be delivered. This review describes radiobiological criteria justifying the NTCP data, and recommendations for conformal 3D radiotherapy and stereotactic liver irradiation. [ABSTRACT FROM AUTHOR]

La prise en charge des cancers du sein est en pleine évolution. Suite aux progrès dans la prise en charge des cancers du sein localisés, le nombre de patientes métastatiques tend à diminuer, et les caractéristiques des maladies en rechute se trouvent modifiées. Différents soustypes de cancers du sein ont pu être identifiés et associés à des mécanismes moléculaires spécifiques et des cibles thérapeutiques potentielles. Les nouvelles thérapies en cours de développement nécessitent d’identifier les mécanismes de sensibilité/résistance qui, sans doute, devront être évalués lors de l’évolution de la maladie pour unemeilleure adéquation des traitements. Ce ne sont là que quelques-uns des nombreux challenges pour unemeilleure prise en charge des patientes atteintes de cancer du sein métastatique dans les années à venir. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: Assessment of prognostic value of pretherapeutic 18F-FDG PET/CT (PET). Patients and methods: Retrospective study of 53 patients with invasive uterine cervix carcinoma. Each patient has been evaluated with pretherapeutic whole-body FDG PET/CT and pelvic MRI. Minimal follow-up lasted for 1 year. On PET/CT, we have visually analyzed metabolism of primary tumor, pelvic and para-aortic lymph nodes in comparison with surrounding structures. We have compared prognostic factors as pretherapeutic haemoglobin rate, FIGO staging, MRI and PET/CT data using Mann-Whitney univariate analysis and Cox multivariate analysis. Results: Para-aortic lymph node abnormal uptake on PET/CT was the only independent predictor of progression-free survival. Pelvic lymph node involvement on PET/CT was the only independent predictor of overall survival. MRI did not provide any additional information. Discussion and conclusion: Lymph node involvement visually assessed by 18F-FDG PET/CT was the most significant prognostic factor for overall and progression-free survival. [Copyright &y& Elsevier]

Abstract: The idea that pelvic cancers can be treated by laparoscopy is now commonly admitted among gynaecological surgeons. Literature shows a lower morbidity than laparotomy, with similar prognostic results. Metastatic invasion of para-aortic lymph nodes is a major prognostic factor in gynaecological malignancies. It modifies the therapeutic plan and requires retroperitoneal lymphadenectomy in many indications. Laparoscopy is an interesting technical procedure in this situation: it allows both staging and curative surgery. Two laparoscopic ways are eligible: transperitoneal lymphadenectomy and retroperitoneal lymphadenectomy. [Copyright &y& Elsevier]

Abstract: Extensive proteolytic remodeling processes constitute a critical step during tumor progression. The endocytic receptor low-density lipoprotein receptor-related protein-1 (LRP-1), by its function in the clearance of multiple extracellular proteases involved in metastatic spreading, has long been considered as a putative tumor suppressor. Moreover, the receptor is likely to control the peritumoral microenvironment by internalization of growth factors and matricial proteins and could therefore participate to the control of signaling events involved in survival and proliferation of cancer cells. Nevertheless, recent data lead to reconsider the initially attributed antitumor properties of LRP-1. A more complex model seems to emerge in which LRP-1 could constitute a sensor of pericellular environment and regulate the membrane proteome dynamics. By its control of focal adhesions composition and turn-over, regulation of the cytoskeleton organization and integrin endocytic recycling, LRP-1 appears as a crucial actor of the epithelial-mesenchymal transition, thereby reinforcing the aggressive phenotype of malignant cells. LRP-1 partitioning into rafts and association with tissue-type and tumor grade specific intracellular scaffold proteins appear crucial to determine its function in tumor progression. Those emerging aspects present numerous promising perspectives in oncology and allow envisaging the development of innovative strategies of control of tumor progression through the targeting of LRP-1. [Copyright &y& Elsevier]

Abstract: Since its introduction in clinical practice in the 1990''s, positron emission tomography (PET), usually with 18F-fluoro-2-deoxy-D-glucose (18F-FDG), has become an important imaging modality in patients with cancer. For cervix carcinoma, FDG-PET is significantly more accurate than computed tomography (CT) and is recommended for loco-regional lymph node and extrapelvic staging. The metabolic dimension of the technique provides additional prognostic information. Ongoing studies now concentrate on more advanced clinical applications, such as the planning of radiotherapy, the response evaluation after the induction of therapy, the early detection of recurrence. Technical innovations, such as PET cameras with better spatial resolution and hybrid positron emission tomography/computed tomography (PET-CT), available now on the whole territory, provide both anatomic and metabolic information in the same procedure. From the point of view of biological metabolism, new radiopharmaceutical probes are being developed. Those hold promise for future refinements in this field. This article reviews the current applications of FDG-PET in patients with cervix cancer. [Copyright &y& Elsevier]

Abstract: Cancer prevention has to be based on robust biological and epidemiological data, therefore its reappraisal becomes mandatory in view of recent progress in the understanding of carcinogenesis. The first phase of the carcinogenic process, that of initiation, is generally associated with mutation; however the role of extrinsic mutagens is less critical than was thought two decades ago. During intracellular oxygen metabolism, reactive oxygen species (ROS) are made which are potent mutagens. Defense mechanisms against these intrinsic mutagens include scavenger and enzymatic systems which destroy them (catalase, superoxide dismutase). When the radiation dose is low, DNA repair is very effective as well as the elimination of cells with unrepaired or misrepaired DNA. Therefore a small increase in the number of ROS, such as that caused by a small dose of radiation has most probably no significant effect on the risk of DNA damage. These conclusions are consistent with the concept of a practical threshold. The second phase, that of promotion, appears to be the key one. During the promotion phase, initiated cells must acquire new properties (immortalization, release of angiogenic factors, resistance to hypoxia, etc.) in order to become precancerous. This evolution is due to the accumulation in the genome of 6 to 10 new alteration defects. In the clone of initiated cells, the occurrence in one cell of a mutation or an epigenetic event gives birth to a subclone. There is a Darwinian type competition between the subclones and those with the more rapid growth because dominant (the acceleration of the growth rate can be due to shorter cell cycles or to an alleviation of cell proliferation exerted by the neighboring cells or the microenvironment). In the dominant subclones new genomic events provoke the appearance of new subclones growing more rapidly and having greater autonomy. The process is very slow because the specific genetic events that favour this evolution seldom occur. Promoting factors are agents that either perturb intercellular signalling or stimulate cell proliferation (e.g. hormones) or increase cell mortality: mechanical or chemical irritation (e.g. alcohol, bacteria, viruses) thereby inducing compensatory cell proliferation. Thus, gradually precancerous cells become able to divide more rapidly with greater autonomy. This phase ends when a subclone of cells has acquired the capacity of autonomous proliferation. The third phase is that of progression during which cells proliferate regularly without any stimulation. In one of the cells of one of the precancerous lesions (e.g. polyps) a cell acquires the capacity of invading surrounding tissue or to metastasize. The whole carcinogenic process is very slow, extending over several decades, because the specific mutations seldom occur and the probability of an accumulation of several specific mutations in the same cell or cell lineage is very small. It can be accelerated by intense stimulation of cell proliferation or genetic instability. Ionizing radiations act firstly as a mutagen, however when the dose is high they also kill a significant proportion of cells and by a homeostatic mechanism they induce cell proliferation and clonal amplification. It has been claimed that even the smallest dose of radiation can induce a cancer. This concept is associated with the LNT model and it is not based on scientific evidence. It has fuelled a fear of radiation which had detrimental consequences. Conversely the high efficacy of defense mechanisms against radiocarcinogenesis, particularly when the tissue is not disorganized, can explain the lack of carcinogenic effect of contamination by small doses of radium or thorium which has been observed on radium dial painters or in patients injected with thorotrast. The study of second cancers in patients treated by radiotherapy could provide important information and should be actively pursued with two aims: reduce the incidence of second cancers; to better understand radiocarcinogenesis and the relation between dose and carcinogenic effect. [Copyright &y& Elsevier]

We conducted a retrospective study including 517 patients with invasive breast cancer classified pT1 less than 20mm. We estimated the relevance of bone scan in the screening of metastases at the time of primary presentation, as well as the costs incurred by such a screening. Postoperative systematic bone scan did not detect the two cases of synchronous bone metastases in this population. No bone metastasis was detected in groups with the highest metastatic risks (low profitability for all pT1 classified cancers). Bone scan's rate of false positive was high (17%). The global cost was estimated at 110,770 euros, that was 215 euros per patient (208 to 232 euros in the risk groups). [Copyright &y& Elsevier]

Carcinomas of unknown primary (CUP) site are a heterogeneous group of tumours with widely variable natural histories and poor survival rates. In a minority of patients, the clinical presentation similar to that of known primar cancers at an equivalent stage has resulted in the identification of subsets of patients with favourable clinical and pathological features. Their recognition is of major importance since specific management may prolong survival. For the vast majority of patients with CUP however, the identification of reliable prognostic indicators has proven challenging. A number of studies with multivariate analyses identified poor performance status, liver metastases, abnormal serum lacticodehydrogenase levels, and low serum albumin as main recurrent adverse prognostic factors. Adequate knowledge of prognostic factors may help oncologists in refining the daily management of patients, assessing the results and designing clinical research studies. [ABSTRACT FROM AUTHOR]

Abstract: The imaging of gliomas, as well as diffuse infiltrative gliomas or as more recently individualized entities, has been profoundly modified these last years. Correlated with the classic morphological MRI, numerous new sequences have appeared that allowed a more metabolic approach of the tumors, such as diffusion, perfusion – related to angiogenesis – and spectroscopy – reflecting metabolic data. Their development in daily practice allows to precise the diagnostic, to definite the more active areas (correlated with the hyperperfused or more metabolic active areas in relation with the Ki67 index) and so optimize the biopsy and/or evaluate the evolution of the lesion. When associated, they allow also and perhaps especially to precise the diagnostic, particularly with other tumoral masses such as lymphomas or metastases that can present misleading patterns, but also with other more benign lesions such as abcesses. Always critically analysed, and reevaluated along the time if necesary, they can sometimes help the histological diagnosis, but never can be used in place of it. [Copyright &y& Elsevier]

Copyright of Revue de Stomatologie & de Chirurgie Maxillo-Faciale is the property of Masson SPA and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: At cellular level, signalization pathway activated by ErbB receptors participate to the proliferation, migration and differenciation of many cellular types. Observed alterations are mutations, overexpressions with or without gene amplification or abnormal stimulation by their ligands. The most frequently observed mutation is an extracellular deletion aiming to activate tyrosine kinase activity without ligand. Strategies to target the EGFr receptor include antisens oligonucleotids, antibodies directed to extracellular component of tyrosine kinase receptor. Only monoclonal antibodies and TKI have been developed in clinical research, mainly for oesophageal and rectal carcinomas. Solid tumor proliferation is under control of tumoral mechanisms and the interaction between tumor and microenvironment. In particular, angiogenesis is important during invasive and metastasis phases. The major role of Vasculoendothelial Growth Factor (VEGF) in angiogenesis is useful for tumor growth, which has been demonstrated by many convergent studies. Radiosensitivation or reversion of radioresistance could be obtained by inhibition of VEGF pathway. Antibodies directed against this molecule have been introduced in GI tract malignancies for the treatment of pancreatic and colic carcinomas. [Copyright &y& Elsevier]

Abstract: Angiogenesis is a crucial requirement for tumorogenesis, providing oxygen and nutrient supply necessary for tumor growth and metastasis. This is a complex phenomenon regulated by many factors that can now be targeted by novel anti-cancer therapies. Antiangiogenic approaches have shown positive results in clinical trials and are now approved as standard of care in medical oncology. Many clinical trials are evaluating antiangiogenic agents in association with radiotherapy. This review aims to summarize the knowledge useful to the understanding of these novel therapies and their potential in combination with radiotherapy. [Copyright &y& Elsevier]