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1. Determinants of the access to remote specialised services provided by national sarcoma reference centres

Author

Céleste Lebbé, Justine Gantzer, Antoine Italiano, Jean-Yves Blay, C. Dalban, Sylvain Causeret, François Le Loarer, Pauline Soibinet, Isabelle Ray-Coquard, Sophie Piperno-Neumann, Fabrice Fiorenza, Louis-Romée Le Nail, Jean-Christophe Ruzic, Esma Saada-Bouzid, Sixtine De Percin, Sharmini Varatharajah, François Gouin, Axel Le Cesne, Maria Rios, Charles Honoré, Yohan Fayet, Christine Chevreau, P. Dubray-Longeras, Paul Michelin, François Bertucci, Marie Karanian, Simone Mathoulin-Pélissier, Françoise Ducimetière, Loic Chaigneau, Florence Duffaud, Raphaël Tetreau, Abel Cordoba, Emmanuelle Bompas, Sylvie Chabaud, Nicolas Penel, Mickaël Ropars, Fadila Farsi, Centre Léon Bérard [Lyon], Université Claude Bernard Lyon 1 (UCBL), Université de Lyon, Health Service and Performance Research (HESPER), Université de Lyon-Université de Lyon, Institut du Cancer de Montpellier (ICM), Institut Gustave Roussy (IGR), Département de chirurgie viscérale [Gustave Roussy], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Université de Tours (UT), Centre Régional de Lutte contre le cancer Georges-François Leclerc [Dijon] (UNICANCER/CRLCC-CGFL), UNICANCER, Department of Medical Oncology, Institut Curie, Paris 75248, France, Institut Curie [Paris], CIC Bordeaux, Université Bordeaux Segalen - Bordeaux 2-Institut National de la Santé et de la Recherche Médicale (INSERM), Bordeaux population health (BPH), Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), Département de Pathologie [CHU Lyon-Sud - HCL], Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Institut Bergonié [Bordeaux], Hôpital JeanMinjoz, Institut de Cancérologie de Strasbourg Europe (ICANS), Institut Paoli-Calmettes, Fédération nationale des Centres de lutte contre le Cancer (FNCLCC), Centre de Recherche en Cancérologie de Marseille (CRCM), Aix Marseille Université (AMU)-Institut Paoli-Calmettes, Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)-Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), CHU Pontchaillou [Rennes], Université de Rennes (UR), Centre de Lutte contre le Cancer Antoine Lacassagne [Nice] (UNICANCER/CAL), UNICANCER-Université Côte d'Azur (UCA), Université Côte d'Azur (UCA), Centre Régional de Lutte contre le Cancer Oscar Lambret [Lille] (UNICANCER/Lille), Université de Lille-UNICANCER, Centre Hospitalier Universitaire de La Réunion (CHU La Réunion), Centre Régional de Lutte contre le Cancer François Baclesse [Caen] (UNICANCER/CRLC), Normandie Université (NU)-UNICANCER-Tumorothèque de Caen Basse-Normandie (TCBN), Centre Jean Perrin [Clermont-Ferrand] (UNICANCER/CJP), Service de médecine interne [CHU Dupuytren], CHU Dupuytren, Cancer Research and Personalized Medicine - CARPEM [Paris], Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Immunologie humaine, physiopathologie & immunothérapie (HIPI (UMR_S_976 / U976)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), Centre Hospitalier Universitaire de Reims (CHU Reims), Service de Radiologie [CHU Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU), Institut de Cancérologie de Lorraine - Alexis Vautrin [Nancy] (UNICANCER/ICL), Département cancer environnement (Centre Léon Bérard - Lyon), Association pour l'Utilisation du Rein Artificiel Région Lyonnaise (AURAL), University of Lille, Institut de Cancérologie de l'Ouest [Angers/Nantes] (UNICANCER/ICO), Hôpital de la Timone [CHU - APHM] (TIMONE), Aix Marseille Université (AMU), Institut Universitaire du Cancer de Toulouse - Oncopole (IUCT Oncopole - UMR 1037), Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT)-Université de Toulouse (UT)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES), Université Lille Nord de France (COMUE)-UNICANCER, UNICANCER-Tumorothèque de Caen Basse-Normandie (TCBN)-Normandie Université (NU), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Descartes - Paris 5 (UPD5)-Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-CHU Necker - Enfants Malades [AP-HP], Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP), CHU Toulouse [Toulouse]-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Régional Universitaire de Tours (CHRU TOURS), Université de Tours, Université Côte d'Azur (UCA)-UNICANCER, Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Institut National de la Santé et de la Recherche Médicale (INSERM), and Malbec, Odile

Subjects
Adult, Male, Cancer Research, medicine.medical_specialty, Adolescent, Databases, Factual, Spatial inequalities, [SDV]Life Sciences [q-bio], Context (language use), Medical Oncology, Cancer inequalities, Health Services Accessibility, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Multidisciplinary approach, Reference networks, Genetics, medicine, Humans, Rare cancers, 030212 general & internal medicine, Healthcare Disparities, Cancer care accessibility, RC254-282, Survival analysis, Aged, Quality of Health Care, Patient Care Team, business.industry, Research, Remote Consultation, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, Cancer, Sarcoma, Middle Aged, medicine.disease, 3. Good health, [SDV] Life Sciences [q-bio], Social deprivation, Oncology, 030220 oncology & carcinogenesis, Family medicine, Cohort, Female, France, business
Abstract

BackgroundSpatial inequalities in cancer management have been evidenced by studies reporting lower quality of care or/and lower survival for patients living in remote or socially deprived areas. NETSARC+ is a national reference network implemented to improve the outcome of sarcoma patients in France since 2010, providing remote access to specialized diagnosis and Multidisciplinary Tumour Board (MTB). The IGéAS research program aims to assess the potential of this innovative organization, with remote management of cancers including rare tumours, to go through geographical barriers usually impeding the optimal management of cancer patients.MethodsUsing the nationwide NETSARC+ databases, the individual, clinical and geographical determinants of the access to sarcoma-specialized diagnosis and MTB were analysed. The IGéAS cohort (n = 20,590) includes all patients living in France with first sarcoma diagnosis between 2011 and 2014. Early access was defined as specialised review performed before 30 days of sampling and as first sarcoma MTB discussion performed before the first surgery.ResultsSome clinical populations are at highest risk of initial management without access to sarcoma specialized services, such as patients with non-GIST visceral sarcoma for diagnosis [OR 1.96, 95% CI 1.78 to 2.15] and MTB discussion [OR 3.56, 95% CI 3.16 to 4.01]. Social deprivation of the municipality is not associated with early access on NETSARC+ remote services. The quintile of patients furthest away from reference centres have lower chances of early access to specialized diagnosis [OR 1.18, 95% CI 1.06 to 1.31] and MTB discussion [OR 1.24, 95% CI 1.10 to 1.40] but this influence of the distance is slight in comparison with clinical factors and previous studies on the access to cancer-specialized facilities.ConclusionsIn the context of national organization driven by reference network, distance to reference centres slightly alters the early access to sarcoma specialized services and social deprivation has no impact on it. The reference networks’ organization, designed to improve the access to specialized services and the quality of cancer management, can be considered as an interesting device to reduce social and spatial inequalities in cancer management. The potential of this organization must be confirmed by further studies, including survival analysis.

Published
2021
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2. Treatment of primary and metastatic peritoneal tumors in the Covid-19 pandemic. Proposals for prioritization from the RENAPE and BIG-RENAPE groups

Author

Frédéric Marchal, Catherine Arvieux, B. Paquette, Naoual Bakrin, Diane Goéré, Marc Pocard, Peggy Dartigues, Julio Abba, Charles Honoré, Denis Pezet, Olivia Sgarbura, R. Lo Dico, P. Rousset, Jérémie H. Lefevre, Maximiliano Gelli, Frédéric Guyon, Abdelkader Taibi, Clarisse Eveno, Sylvaine Durand-Fontanier, Benoit You, J. Fontaine, Olivier Bouché, Jean-Baptiste Delhorme, Olivier Glehen, Karine Abboud, C. Nadeau, Vahan Kepenekian, L. Gladieff, Jean-Jacques Tuech, Laurent Villeneuve, Ciblage thérapeutique en Oncologie (EA3738), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon, Institut Universitaire du Cancer de Toulouse - Oncopole (IUCT Oncopole - UMR 1037), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-CHU Toulouse [Toulouse]-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Grenoble, Service de Chirurgie digestive, endocrinienne et générale [CHU Limoges], CHU Limoges, Hopital Saint-Louis [AP-HP] (AP-HP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Institut de Cancérologie de Lorraine - Alexis Vautrin [Nancy] (UNICANCER/ICL), UNICANCER, Centre hospitalier universitaire de Poitiers (CHU Poitiers), Service de Chirurgie Digestive [CHRU Besançon], Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Service de Chirurgie Digestive et Hépatobiliaire [CHU Clermont-Ferrand], CHU Estaing [Clermont-Ferrand], CHU Clermont-Ferrand-CHU Clermont-Ferrand, Hôpital Lariboisière-Fernand-Widal [APHP], Institut du Cancer de Montpellier (ICM), Service de chirurgie digestive [CHU Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), and Normandie Université (NU)

Subjects
medicine.medical_specialty, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Pneumonia, Viral, Disease, 030230 surgery, Care provision, 03 medical and health sciences, Peritoneal Neoplasm, 0302 clinical medicine, Intensive care, Health care, medicine, Pseudomyxoma peritonei, Humans, Pandemics, Curative care, Peritoneal Neoplasms, Chemotherapy, business.industry, Health Priorities, General surgery, COVID-19, General Medicine, medicine.disease, 3. Good health, 030220 oncology & carcinogenesis, business, Coronavirus Infections
Abstract

The Covid-19 pandemic is profoundly changing the organization of healthcare access. This is particularly so for peritoneal neoplastic diseases, for which curative treatment mobilizes substantial personnel, operating room and intensive care resources. The BIG-RENAPE and RENAPE groups have made tentative proposals for prioritizing care provision. A tightening of the usual selection criteria is needed for curative care: young patients with few or no comorbidities and limited peritoneal extension. It is desirable to prioritize disease conditions for which cytoreduction surgery with or without associated hyperthermic intraoperative peritoneal chemotherapy (HIPEC) is the gold-standard treatment, and for which systemic chemotherapy cannot be a temporary or long-term alternative: pseudomyxoma peritonei, resectable malignant peritoneal mesotheliomas, peritoneal metastases of colorectal origin if they are resectable and unresponsive to systemic chemotherapy after up to 12 courses, first-line ovarian carcinomatosis if resectable or in interval surgery after at most six courses of systemic chemotherapy. Addition of HIPEC must be discussed case by case in an expert center. The prioritization of indications must consider local conditions and the phase of the epidemic to allow optimal peri-operative care.

Published
2020
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3. Surgical Margins and Adjuvant Therapies in Malignant Phyllodes Tumors of the Breast: A Multicenter Retrospective Study

Author

Jean-Yves Blay, Sophie Piperno-Neumann, Mehdi Brahmi, Fabien Reyal, Marick Laé, Clémentine Owen, Nicolas Penel, Sébastien Salas, Thibaud Valentin, S. Thezenas, Emmanuelle Bompas, Camille Chakiba, Charles Honoré, Isabelle Ray-Coquard, A. Michot, Nelly Firmin, Mathias Neron, Esma Saada-Bouzid, Christophe Sajous, François Bertucci, Hôpital Universitaire Carémeau [Nîmes] (CHU Nîmes), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Centre Léon Bérard [Lyon], Institut du Cancer de Montpellier (ICM), Département d'Oncologie Médicale [Institut Curie, Paris], Institut Curie [Paris], Department of Medical Oncology [Saint-Cloud], Institut Curie [Saint-Cloud], Centre de Lutte Contre le Cancer Henri Becquerel Normandie Rouen (CLCC Henri Becquerel), Département d'oncologie médicale, Institut Bergonié [Bordeaux], UNICANCER-UNICANCER, UNICANCER, Université de Lille, Département d'hématologie [Gustave Roussy], Institut Gustave Roussy (IGR), Département de chirurgie viscérale [Gustave Roussy], CHU Tenon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre de Recherche en Cancérologie de Marseille (CRCM), Aix Marseille Université (AMU)-Institut Paoli-Calmettes, Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)-Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Hôpital de la Timone [CHU - APHM] (TIMONE), Medical Oncology Department [Nice], Centre de Lutte contre le Cancer Antoine Lacassagne [Nice] (UNICANCER/CAL), UNICANCER-Université Côte d'Azur (UCA)-UNICANCER-Université Côte d'Azur (UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA), Institut de Cancérologie de l'Ouest [Angers/Nantes] (UNICANCER/ICO), Centre de Recherche en Cancérologie de Lyon (UNICANCER/CRCL), Centre Léon Bérard [Lyon]-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Département d'oncologie Médicale, and CRLCC Val d'Aurelle - Paul Lamarque

Subjects
Adult, medicine.medical_specialty, Adolescent, medicine.medical_treatment, Breast Neoplasms, [SDV.CAN]Life Sciences [q-bio]/Cancer, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Surgical oncology, Phyllodes Tumor, medicine, Humans, Survival rate, Mastectomy, ComputingMilieux_MISCELLANEOUS, Aged, Retrospective Studies, Aged, 80 and over, Chemotherapy, business.industry, Margins of Excision, Retrospective cohort study, Chemoradiotherapy, Adjuvant, Middle Aged, medicine.disease, Prognosis, Combined Modality Therapy, Surgery, Radiation therapy, Survival Rate, Oncology, 030220 oncology & carcinogenesis, 030211 gastroenterology & hepatology, Female, Sarcoma, Neoplasm Recurrence, Local, business, Chemoradiotherapy, Follow-Up Studies
Abstract

The optimal threshold of surgical margins for breast malignant phyllodes tumors (MPTs) and the impact of adjuvant chemotherapy and radiotherapy were investigated.We conducted a multicenter nationwide retrospective study of all MPT cases with central pathological review within the French Sarcoma Group. Endpoints were local recurrence-free survival (LRFS), metastasis-free survival (MFS), and overall survival (OS) rates.Overall, 212 patients were included in the study. All non-metastatic patients underwent primary surgical treatment, including 58.6% of conservative surgeries. An R0 resection was achieved in 117 patients (59.4%: 26.9% of patients with 1-2 mm margins, 12.2% of patients with 3-7 mm margins, 20.3% of patients with ≥ 8 mm margins). Ninety-four patients (45%) underwent a second surgery (SS) to obtain R0 margins, with a final mastectomy rate of 72.6%. Radiotherapy and chemotherapy were performed in 91 (43.1%) and 23 patients (10.9%), respectively, but were not associated with better outcomes. Mastectomy was significantly associated with better LRFS (p 0.001). Margins of 0, 1, or 2 mm with SS were associated with better MFS (hazard ratio [HR] 0.3, p = 0.005) and OS (HR 0.32, p = 0.005) compared with margins of 0-1-2 mm without SS. Wider margins ( 8 mm) were not superior to margins of 3-7 mm (3-7 mm vs. 8 mm; HR 0.81, p = 0.69). Age (HR 2.14, p = 0.038) and tumor necrosis (HR 1.96, p = 0.047) were found to be poor prognostic factors and were associated with MFS.This study suggests that 3 mm margins are necessary and sufficient for surgical management of MPTs, and emphasizes the importance of SS to obtain clear margins in case of 0-1-2 mm margins. No impact of adjuvant chemotherapy or radiotherapy was detected in this study.

Published
2020
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4. Can we cure patients with abdominal Desmoplastic Small Round Cell Tumor? Results of a retrospective multicentric study on 100 patients

Author

François Quenet, Christine Chevreau, J.-Y. Blay, Matthieu Faron, G. Ferron, Daniel Orbach, A. Le Cesne, E Nassif, S. Carrere, Antoine Italiano, François Bertucci, Jean-Baptiste Delhorme, Olivier Mir, Marc Pocard, Emmanuelle Bompas, Charles Honoré, Olivier Glehen, AIRPARIF - Surveillance de la qualité de l'air en Île-de-France, Department of Surgical Oncology Institut Claudius Regaud, Service d'Oncologie Médicale [Centre hospitalier Lyon Sud - HCL], Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Institut Bergonié [Bordeaux], UNICANCER, Centre de Recherche en Cancérologie de Marseille (CRCM), Aix Marseille Université (AMU)-Institut Paoli-Calmettes, Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)-Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Carcinose Angiogenèse et Recherche Translationnelle, Angiogenese et recherche translationnelle (CART U965), Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut de Recherche en Cancérologie de Montpellier (IRCM - U1194 Inserm - UM), CRLCC Val d'Aurelle - Paul Lamarque-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Centre de Recherche en Cancérologie de Lyon (UNICANCER/CRCL), Centre Léon Bérard [Lyon]-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Institut Claudius Regaud, Institut Gustave Roussy (IGR), Sarcome, Département de médecine oncologique [Gustave Roussy], Institut Gustave Roussy (IGR)-Institut Gustave Roussy (IGR), Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Paoli-Calmettes, and Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)-Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)-Aix Marseille Université (AMU)

Subjects
Male, 0301 basic medicine, MESH: Combined Modality Therapy, Desmoplastic small-round-cell tumor, Survival, medicine.medical_treatment, [SDV]Life Sciences [q-bio], 0302 clinical medicine, MESH: Child, MESH: Peritoneal Neoplasms, Child, Peritoneal Neoplasms, MESH: Middle Aged, Systemic chemotherapy, Female sex, Cytoreduction Surgical Procedures, MESH: Follow-Up Studies, Middle Aged, Prognosis, Combined Modality Therapy, 3. Good health, Survival Rate, Oncology, MESH: Young Adult, Child, Preschool, 030220 oncology & carcinogenesis, Female, Hyperthermic intraperitoneal chemotherapy, Cure, Adult, medicine.medical_specialty, Poor prognosis, Adolescent, MESH: Survival Rate, education, [SDV.BC]Life Sciences [q-bio]/Cellular Biology, MESH: Prognosis, Young Adult, 03 medical and health sciences, medicine, Overall survival, Humans, Chemotherapy, MESH: Cytoreduction Surgical Procedures, MESH: Patient Selection, MESH: Hyperthermia, Induced, Retrospective Studies, MESH: Adolescent, MESH: Humans, business.industry, Patient Selection, MESH: Child, Preschool, MESH: Adult, MESH: Retrospective Studies, Hyperthermia, Induced, medicine.disease, MESH: Desmoplastic Small Round Cell Tumor, MESH: Male, Surgery, 030104 developmental biology, Chemotherapy, Cancer, Regional Perfusion, Conventional PCI, Desmoplastic small round cell tumor, MESH: Chemotherapy, Cancer, Regional Perfusion, business, MESH: Female, Follow-Up Studies
Abstract

Despite being associated with a very poor prognosis, long-term survivors across all series of Desmoplastic Small Round Cell Tumor (DSRCT) have been reported.To analyze patients 'characteristics associated with a prolonged survival after DSRCT diagnosis.All consecutive patients treated for DSRCT in nine French expert centers between 1991 and 2018 were retrospectively analyzed. Patients with a follow-up of less than 2 years were excluded and cure defined as being disease-free at least 5 years.100 pts were identified (median age 25 years, 89% male). 27 had distant metastases at diagnosis and 80 pts underwent upfront chemotherapy (CT). 71 pts were operated, 20 pts without prior CT). Surgery was macroscopically complete (CC0/1) in 50 pts. Hyperthermic intraperitoneal Chemotherapy (HIPEC) was administered during surgery in 15 pts 54 pts had postoperative CT and 26 pts had postoperative whole abdomino-pelvic RT (WAP-RT). After a median follow-up of 103 months (range 23-311), the median overall survival (OS) was 25 months. The 1- year, 3-year and 5-year OS rates were 90%, 35% and 4% respectively. 5 patients were considered cured after a median disease-free interval of 100 months (range 22-139). Predictive factors of cure were female sex (HR = 0.49, p = 0.014), median PCI12 (HR = 0.32, p = 0.0004), MD Anderson stage I (HR = 0.25, p 0.0001), CC0/1 (HR = 0.34, p 0.0001), and WAP-RT (HR = 0.36, p = 0.00013). HIPEC did not statistically improve survival.Cure in DSRCT is possible in 5% of patients and is best achieved combining systemic chemotherapy, complete cytoreductive surgery and WAP-RT. Despite aggressive treatment, recurrence is common and targeted therapies are urgently needed.

Published
2019
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5. Iterative cytoreductive surgery with or without hyperthermic intraperitoneal chemotherapy for colorectal peritoneal metastases: A multi‐institutional experience

Author

Marcello Deraco, Loreen Maerz, Mathew A. Kozman, Nayef A. Alzahrani, Cécile Brigand, Charles Honoré, Denis Pezet, Vic J. Verwaal, David L. Morris, Oliver M. Fisher, Dario Baratti, Frédéric Dumont, Yutaka Yonemura, Karine Abboud, Shigeki Kusamura, Mark Pocard, Paul H. Sugarbaker, Ignace H. J. T. de Hingh, Frédéric Marchal, Pompiliu Piso, Olivier Glehen, Sarah J. Valle, Edward A. Levine, Brendan Moran, Dianne Goere, Winston Liauw, Washington Cancer Institute, Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hospices Civils de Lyon (HCL), Département de chirurgie viscérale [Gustave Roussy], Institut Gustave Roussy (IGR), Hôpital de Hautepierre [Strasbourg], Department of Surgery, National Cancer Institute [Bethesda] (NCI-NIH), National Institutes of Health [Bethesda] (NIH)-National Institutes of Health [Bethesda] (NIH), University Medical Center of Regensburg, Centre de Recherche en Automatique de Nancy (CRAN), Université de Lorraine (UL)-Centre National de la Recherche Scientifique (CNRS), Materials Department, UCSB, Chirurgie digestive, Centre Hospitalier Universitaire de Clermont-Ferrand, Microbes, Intestin, Inflammation et Susceptibilité de l'Hôte - Clermont Auvergne (M2iSH), Institut National de la Recherche Agronomique (INRA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Clermont Auvergne (UCA)-Centre de Recherche en Nutrition Humaine d'Auvergne (CRNH d'Auvergne), Hôpital Nord, Hôpital nord, Institut de RadioAstronomie Millimétrique (IRAM), Centre National de la Recherche Scientifique (CNRS), Centre National de la Recherche Scientifique (CNRS)-Université de Lorraine (UL), CHU Clermont-Ferrand, Microbes, Intestin, Inflammation et Susceptibilité de l'Hôte (M2iSH), Université Clermont Auvergne [2017-2020] (UCA [2017-2020])-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre de Recherche en Nutrition Humaine d'Auvergne (CRNH d'Auvergne)-Institut National de la Recherche Agronomique (INRA), Institut National de la Recherche Agronomique (INRA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Clermont Auvergne [2017-2020] (UCA [2017-2020])-Centre de Recherche en Nutrition Humaine d'Auvergne (CRNH d'Auvergne), and Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] (CHU ST-E)

Subjects
Male, colorectal peritoneal carcinomatosis (CRPC), animal diseases, 0302 clinical medicine, hyperthermic intraperitoneal chemotherapy (HIPEC), iterative cytoreductive surgery (iCRS), Medicine, Prospective Studies, Lymph node, Peritoneal Neoplasms, Mortality rate, General Medicine, Cytoreduction Surgical Procedures, Middle Aged, Prognosis, Combined Modality Therapy, 3. Good health, Peritoneal carcinomatosis, Survival Rate, medicine.anatomical_structure, Oncology, 030220 oncology & carcinogenesis, 030211 gastroenterology & hepatology, Hyperthermic intraperitoneal chemotherapy, Female, Cytoreductive surgery, Colorectal Neoplasms, Adult, medicine.medical_specialty, Adolescent, colorectal peritoneal carcinomatosis (CRPC) hyperthermic intraperitoneal chemotherapy (HIPEC) iterative cytoreductive surgery (iCRS) prognostic factors survival, survival, 03 medical and health sciences, Young Adult, Peritoneal Carcinomatosis Index, Humans, Aged, Retrospective Studies, business.industry, prognostic factors, Mean age, [SDV.BBM.BM]Life Sciences [q-bio]/Biochemistry, Molecular Biology/Molecular biology, Hyperthermia, Induced, [SDV.MP.BAC]Life Sciences [q-bio]/Microbiology and Parasitology/Bacteriology, Surgery, Chemotherapy, Cancer, Regional Perfusion, Conventional PCI, Neoplasm Recurrence, Local, business, Follow-Up Studies
Abstract

International audience; Background and Objectives: The aims of this multi‐institutional study were to assess the feasibility of iterative cytoreductive surgery (iCRS)/hyperthermic intraperitoneal chemotherapy, iCRS in colorectal peritoneal carcinomatosis (CRPC), evaluate survival, recurrence, morbidity and mortality outcomes, and identify prognostic factors for overall survival.Methods: Patients with CRPC that underwent an iCRS, with or without intraperitoneal chemotherapy, from June 1993 to July 2016 at 13 institutions were retrospectively analyzed from prospectively maintained databases.Results: The study comprised of 231 patients, including 126 females (54.5%) with a mean age at iCRS of 51.3 years. The iterative high‐grade (3/4) morbidity and mortality rates were 23.4% and 1.7%, respectively. The median recurrence‐free survival was 15.0 and 10.1 months after initial and iCRS, respectively. The median and 5‐year survivals were 49.1 months and 43% and 26.4 months and 26% from the initial and iCRS, respectively. Independent negative predictors of survival from the initial CRS included peritoneal carcinomatosis index (PCI) > 20 ( P = 0.02) and lymph node positivity ( P = 0.04), and from iCRS, PCI > 10 ( P = 0.03 for PCI 11‐20; P 20), high‐grade complications ( P = 0.012), and incomplete cytoreduction ( P

Published
2019
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6. Quelle prise en charge optimale pour un sarcome du cordon spermatique en 2018 ?

Author

P. Meeus, François Quenet, R. Tetreau, C. Llacer, J.-B. Delhorme, M. Fau, Dimitri Tzanis, Eberhard Stoeckle, Gsf-Geto, N. Firmin, Charles Honoré, Gauthier Decanter, S. Carrere, B. Meunier, D. Cupissol, S. Bonvalot, Gwenael Ferron, CCSD, Accord Elsevier, Institut du Cancer de Montpellier (ICM), Institut Gustave Roussy (IGR), Institut Curie [Paris], Hôpital de Hautepierre [Strasbourg], Institut de Cancérologie de Lorraine - Alexis Vautrin [Nancy] (UNICANCER/ICL), UNICANCER, Centre Régional de Lutte contre le Cancer Oscar Lambret [Lille] (UNICANCER/Lille), Université de Lille-UNICANCER, Institut de Recherche en Cancérologie de Montpellier (IRCM - U1194 Inserm - UM), CRLCC Val d'Aurelle - Paul Lamarque-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Institut Bergonié [Bordeaux], Centre Léon Bérard [Lyon], Institut Universitaire du Cancer de Toulouse - Oncopole (IUCT Oncopole - UMR 1037), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Pontchaillou [Rennes], and Université de Toulouse (UT)-Université de Toulouse (UT)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Institut National de la Santé et de la Recherche Médicale (INSERM)

Subjects
Gynecology, medicine.medical_specialty, Soft tissue sarcoma, Pluridisciplinarité, business.industry, Urology, [SDV]Life Sciences [q-bio], 030232 urology & nephrology, Quality, Sarcome du cordon spermatique, 3. Good health, [SDV] Life Sciences [q-bio], 03 medical and health sciences, Sarcome des tissus mous, 0302 clinical medicine, Mulidisciplinarity, Medicine, Surgery, business, Chirurgie, Spermatic cord sarcoma, Qualité
Abstract

Spermatic cord sarcomas are rare tumors for which the most important is the initial diagnostic procedure. They are frequently misdiagnosed after surgery for inguinal hernia, inguinal lymphadenectomy or testicular malignancy. Any clinical suspicion has to lead to perform imaging with MRI and a core needle biopsy in order to obtain an accurate preoperative diagnosis. Liposarcoma and leiomyosarcoma are the most common histological subtypes in elderly adults, rhabdomyosarcoma in children or in young adults. A CT scan will precede the treatment in order to look for distant metastasis and abdominal involvement. The therapeutic strategy as well as the surgical planning are then adapted to the histological, morphological and prognostic factors. Surgery is the cornerstone for the treatment of spermatic cord sarcoma. The minimum requirements for the surgical procedure are a wide excision of the tumor en bloc with radical orchidectomy, excision of the ipsilateral scrotum and high spermatic cord ligation. It could be enlarged to the anterior abdominal wall and adjacent organs some required a soft tissue flap. Spermatic cord sarcoma and trunk wall sarcoma have the same prognosis for which local recurrence could significantly decrease survival. Consequently, surgeon in charge with these tumors has to be familiar with soft tissue sarcoma and the management of these patients must be carried out under the supervision of a multidisciplinary team within the Netsarc network., Le sarcome du cordon spermatique est une pathologie rare pour laquelle la prise en charge initiale est d’importance primordiale. Le diagnostic est souvent découvert a posteriori après une chirurgie pour cure de hernie inguinale, pour suspicion de cancer du testicule ou après exérèse d’une adénopathie inguinale. Toute suspicion clinique doit donc faire l’objet d’une imagerie par résonance magnétique (IRM) et d’une biopsie percutanée sous contrôle radiologique dans le but d’obtenir un diagnostic préopératoire précis. Les histologies les plus fréquentes sont le liposarcome et le léiomyosarcome chez l’adulte âgé, le rhabdomyosarcome chez l’enfant et l’adulte jeune. Un bilan d’extension intra-abdominal et à distance par scanner précédera le traitement. La stratégie thérapeutique de même que la planification chirurgicale sont ensuite adaptées aux paramètres histologiques, morphologiques et pronostiques. La chirurgie est la pierre angulaire du traitement des sarcomes du cordon spermatique. Le geste minimal requis est l’exérèse de la tumeur en bloc avec la réalisation d’une orchidectomie totale, l’exérèse du cordon spermatique et la ligature des vaisseaux spermatiques à l’orifice inguinal profond. Elle peut être élargie à la paroi abdominale et aux organes de voisinage et nécessiter si besoin une reconstruction par lambeau. Le pronostic des sarcomes du cordon spermatique est équivalent à celui des sarcomes du tronc dont l’évolutivité locale est péjorative pour la survie des patients. De fait, l’exérèse doit être réalisée par un chirurgien ayant l’expertise des problématiques liées à la chirurgie des sarcomes au sein d’un centre spécialisé du réseau Netsarc.

Published
2019
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