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Your search keyword '"Département de chirurgie gynécologique [Gustave Roussy]"' showing total 11 results
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11 results on '"Département de chirurgie gynécologique [Gustave Roussy]"'

1. Long-term oncological safety of sentinel lymph node biopsy in early-stage cervical cancer: A post-hoc analysis of SENTICOL I and SENTICOL II cohorts

Author

Jean Lévêque, Virginie Fourchotte, Laurent Magaud, Eric Leblanc, Marc Baron, Philippe Morice, Benedetta Guani, Denis Querleu, Patrice Mathevet, Emile Daraï, Vincent Balaya, Henri Marret, Fabrice Lecuru, INSERM, Université de Lille, Protéomique, Réponse Inflammatoire, Spectrométrie de Masse (PRISM) - U1192, Centre Hospitalier Universitaire Vaudois [Lausanne] [CHUV], Institut Gustave Roussy [IGR], CHU Strasbourg, Institut Curie [Paris], CHU Tenon [AP-HP], Centre de Lutte Contre le Cancer Henri Becquerel Normandie Rouen [CLCC Henri Becquerel], Hôpital Bretonneau, Centre Hospitalier Universitaire [Rennes], Centre Hospitalier Lyon Sud [CHU - HCL] [CHLS], Centre Hospitalier Universitaire Vaudois [Lausanne] (CHUV), Institut Gustave Roussy (IGR), Département de chirurgie gynécologique [Gustave Roussy], Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Centre Régional de Lutte contre le Cancer Oscar Lambret [Lille] (UNICANCER/Lille), Université de Lille-UNICANCER, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre de Lutte Contre le Cancer Henri Becquerel Normandie Rouen (CLCC Henri Becquerel), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), CHU Pontchaillou [Rennes], and Hospices Civils de Lyon (HCL)

Subjects
Adult, medicine.medical_specialty, Multivariate analysis, SENTICOL, Sentinel lymph node, Urology, Uterine Cervical Neoplasms, Oncologic outcomes, Disease-Free Survival, Cohort Studies, Young Adult, Risk Factors, Post-hoc analysis, Biopsy, medicine, Humans, Prospective Studies, Stage (cooking), Pelvic lymphadenectomy, Aged, Neoplasm Staging, Proportional Hazards Models, Aged, 80 and over, Cervical cancer, Risk level, medicine.diagnostic_test, Sentinel Lymph Node Biopsy, business.industry, Obstetrics and Gynecology, Middle Aged, medicine.disease, Oncology, Female, Disease-free survival, France, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

International audience; Objectives: To compare oncologic outcomes of patients with early-stage cervical cancer and negative nodes who underwent sentinel lymph node biopsy alone (SLNB) versus pelvic lymphadenectomy (PL).Methods: An ancillary analysis of two prospective multicentric trials on SLN biopsy for cervical cancer (SENTICOL I and II) was conducted. Only patients with early-stage cervical cancer (IA to IIA FIGO stage), bilateral detection of SLN, negative SLN after ultrastaging and negative non-SLN after final pathologic examination were included. Risk-factors of recurrence and disease-specific mortality were determined by Cox proportional hazard models.Results: Between January 2005 and July 2012, 259 node-negative patients were analyzed: 87 in the SLNB group and 172 in the PL group. The median follow-up was 47 months [4-127]. During the follow-up, 21 patients (8.1%) experienced recurrences, including 4 nodal recurrences (1.9%), and 9 patients (3.5%) died of cervical cancer. Disease-free survival (DFS) and disease-specific survival (DSS) were similar between SLNB and PL groups, 85.1% vs. 80.4%, p = 0.24 and 90.8% vs. 97.2%, p = 0.22 respectively. By Cox multivariate analysis, SLNB compared to PL was not associated with DFS (HR = 1.78, 95%CI = [0.71-4.46], p = 0.22) neither with DSS (HR = 3.02, 95%CI = [0.69-13.18], p = 0.14). Only pathologic risk level according to the Sedlis criteria was an independent predictor of DFS and DSS.Conclusions: Omitting full pelvic lymphadenectomy for patients with bilateral negative SLN does not seem to be associated with an increased risk of recurrence in this series. Survival non-inferiority needs to be confirmed by prospective trials.

Published
2022
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2. FDG-PET/CT and Para-Aortic Staging in Endometrial Cancer. A French Multicentric Study

Author

Camille Sallée, Antoine Tardieu, Pierre Collinet, Jérémie Belghiti, Maxime Legros, Eric Lambaudie, Tristan Gauthier, François Margueritte, Sebastien Gouy, Jacques Monteil, Frédéric Guyon, Service de Gynécologie-Obstétrique [CHU Limoges], CHU Limoges, Institut Gustave Roussy (IGR), Département de chirurgie gynécologique [Gustave Roussy], Service de chirurgie gynécologique et mammaire [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Sorbonne Université - Faculté de Médecine (SU FM), Sorbonne Université (SU), Institut Paoli-Calmettes, Fédération nationale des Centres de lutte contre le Cancer (FNCLCC), Centre de Recherche en Cancérologie de Marseille (CRCM), Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Paoli-Calmettes, Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)-Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)-Aix Marseille Université (AMU), Hôpital Jeanne de Flandres, Université de Lille, Droit et Santé-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Institut Bergonié [Bordeaux], UNICANCER, Service de médecine nucléaire [CHU Limoges], Ciblage individuel et prévention des risques de traitements immunosupresseurs et de la transplantation (IPPRITT), CHU Limoges-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST), Université de Limoges (UNILIM)-Université de Limoges (UNILIM), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), 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), Service de Chirurgie et Cancérologie Gynécologique et Mammaire [CHU Pitié-Salpêtrière], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Gestionnaire, Hal Sorbonne Université, and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)

Subjects
medicine.medical_specialty, medicine.medical_treatment, [SDV]Life Sciences [q-bio], high risk, Article, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, 0302 clinical medicine, Medicine, para-aortic, Mri scan, Lymph node, Hysterectomy, business.industry, Endometrial cancer, General Medicine, medicine.disease, Predictive value, FDG-PET/CT, 3. Good health, [SDV] Life Sciences [q-bio], carbohydrates (lipids), medicine.anatomical_structure, Multicenter study, 030220 oncology & carcinogenesis, endometrial cancer, lymphadenectomy, Lymphadenectomy, Fdg pet ct, Radiology, business
Abstract

Background: FDG-PET/CT is a noninvasive examination that could be helpful for the management of endometrial cancer. The aim of this study was to evaluate the performance of FDG-PET/CT in assessing para-aortic lymph-node involvement in high-risk endometrial cancer. Methods: We performed a retrospective multicenter study including all patients who had a high-risk endometrial cancer with a preoperative FDG-PET/CT and a para-aortic lymphadenectomy (PAL) between 2009 and 2019. The main objective was to evaluate the overall performance of FDG-PET/CT. The secondary objectives were to evaluate its performances according to the histological type and according to FDG-PET/CT date (before or after hysterectomy), and to compare its overall performance with that of the MRI scan. Results: We included 200 patients from six different centers. After the false positive FDG-PET/CT was reread by nuclear physicians, FDG-PET/CT had a sensitivity of 61.8%, a specificity of 89.7%, a positive predictive value of 69.4%, a negative predictive value of 86.1%, and an AUC of 0.76. There were no statistically significant differences in the performances according to either histological type and or FDG-PET/CT date. The sensitivity of FDG-PET/CT was better than that of MRI (p &lt, 0.01), but the specificity was not (p = 0.82). Conclusion: Currently, FDG-PET/CT alone cannot replace PAL for the lymph node evaluation of high-risk endometrial cancers. It seems essential to reread it in multidisciplinary meetings before validating the therapeutic management of patients, particularly in the case of isolated para-aortic involvement.

Published
2021
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3. False negative rate at 18F-FDG PET/CT in para-aortic lymphnode involvement in patients with locally advanced cervical cancer: impact of PET technology

Author

Amandine Maulard, Catherine Genestie, Marie Terroir, Sebastien Gouy, Alexandra Leary, Patricia Pautier, Serena Grimaldi, Cyrus Chargari, Veronika Seebacher, Désirée Deandreis, Philippe Morice, Anna Ilenko, Malbec, Odile, Département de chirurgie gynécologique [Gustave Roussy], Institut Gustave Roussy (IGR), Université Paris-Sud - Paris 11 (UP11), Radiothérapie Moléculaire et Innovation Thérapeutique (RaMo-IT), Institut Gustave Roussy (IGR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay, Département de radiothérapie [Gustave Roussy], Institut de Recherche Biomédicale des Armées (IRBA), Médecine nucléaire, Département d'imagerie médicale [Gustave Roussy], Institut Gustave Roussy (IGR)-Institut Gustave Roussy (IGR), Pathologie morphologique, Département de biologie et pathologie médicales [Gustave Roussy], Biomarqueurs prédictifs et nouvelles stratégies moléculaires en thérapeutique anticancéreuse (U981), Université Paris-Sud - Paris 11 (UP11)-Institut Gustave Roussy (IGR)-Institut National de la Santé et de la Recherche Médicale (INSERM), Département de médecine oncologique [Gustave Roussy], Università degli studi di Torino = University of Turin (UNITO), Imagerie thérapeutique (radiologie interventionnelle), and University of Turin

Subjects
Cancer Research, [SDV]Life Sciences [q-bio], Cervical cancer, FDG, LACC, Para-aortic lymph node, PET/CT, TOF, Adenocarcinoma, Adult, Aged, Aorta, Carcinoma, Squamous Cell, Chemoradiotherapy, False Negative Reactions, Female, Humans, Laparoscopy, Lymph Node Excision, Lymph Nodes, Middle Aged, Neoplasm Staging, Pelvis, Positron Emission Tomography Computed Tomography, Retrospective Studies, Uterine Cervical Neoplasms, Young Adult, Fluorodeoxyglucose F18, Radiopharmaceuticals, medicine.medical_treatment, 030218 nuclear medicine & medical imaging, 0302 clinical medicine, Medicine, Stage (cooking), medicine.diagnostic_test, lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens, 3. Good health, [SDV] Life Sciences [q-bio], Oncology, Positron emission tomography, 030220 oncology & carcinogenesis, medicine.drug, lcsh:RC254-282, 03 medical and health sciences, Genetics, Fluorodeoxyglucose, PET-CT, business.industry, Carcinoma, Magnetic resonance imaging, medicine.disease, Squamous Cell, Lymphadenectomy, business, Nuclear medicine
Abstract

Background The identification of factors responsible for false negative (FN) rate at 18F- Fluorodeoxyglucose (FDG) Positron Emission Tomography /Computed Tomography (PET/CT) in para-aortic (PA) lymph nodes in the presurgical staging of patients with locally advanced cervical cancer (LACC) is challenging. The aim of this study was to evaluate the impact of PET/CT technology. Methods A total of 240 consecutive patients with LACC (International Federation of Gynecology and Obstetrics, FIGO, stage IB2-IVA) and negative Magnetic Resonance Imaging (MRI) and/or Computed Tomography (CT) and negative 18F-FDG PET/CT in the PA region, undergoing laparoscopic PA lymphadenectomy before chemoradiotherapy were included. The FN rate in patients studied with Time of flight (TOF) PET/CT (TOF PET) or non-Time of flight PET/CT (no-TOF PET) technology was retrospectively compared. Results Patients presented with FIGO stage IB (n = 78), stage IIA-B (n = 134), stage III (n = 18) and stage IVa (n = 10), squamous cell carcinoma (n = 191) and adenocarcinoma (n = 49). 141/240 patients were evaluated with no-TOF PET/CT and 99/240 with TOF PET/CT. Twenty-two patients (9%) had PA nodal involvement at histological analysis and considered PET/CT FN findings. The FN rate was 8.5% for no-TOF PET and 10% for TOF PET subgroup respectively (p = 0.98). Ninety patients (38%) presented with pelvic node uptakes at PET/CT. The FN rate in the PA region was 18% (16/90) and 4% (6/150) in patients with and without pelvic node involvement at PET/CT respectively (19 vs 3% for no-TOF PET and 17 vs 5% for TOF PET subgroup). Conclusions In LACC, FN rate in PA lymph nodes detection is a clinical issue even for modern PET/CT, especially in patients with pelvic uptake. Surgical lymphadenectomy should be performed in case of negative PET/CT at PA level in these patients, while it could be discussed in the absence of pelvic uptake.

Published
2021
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4. Clinical Activity of Sunitinib and Regorafenib in Endometriosis

Author

Philippe Morice, Paul Berveiller, Stanislas Ropert, Olivier Mir, Institut Gustave Roussy (IGR), Oncologie gynécologique, Département de médecine oncologique [Gustave Roussy], Institut Gustave Roussy (IGR)-Institut Gustave Roussy (IGR), Hôpital Privé d'Antony, Département de chirurgie gynécologique [Gustave Roussy], centre hospitalier intercommunal de Poissy/Saint-Germain-en-Laye - CHIPS [Poissy], Gamètes, implantation, gestation (GIG), and Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)

Subjects
Oncology, medicine.medical_specialty, 030219 obstetrics & reproductive medicine, business.industry, Sunitinib, Endometriosis, [SDV.BDLR]Life Sciences [q-bio]/Reproductive Biology, General Medicine, [SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, medicine.disease, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, chemistry, 030220 oncology & carcinogenesis, Internal medicine, Regorafenib, medicine, business, ComputingMilieux_MISCELLANEOUS, medicine.drug
Abstract

International audience

Published
2019
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5. Management of epithelial cancer of the ovary, fallopian tube, primary peritoneum. Long text of the joint French clinical practice guidelines issued by FRANCOGYN, CNGOF, SFOG, GINECO-ARCAGY, endorsed by INCa. (Part 2 systemic, intraperitoneal treatment, elderly patients, fertility preservation, follow-up)

Author

Mojgan Devouassoux-Shisheboran, Blandine Courbiere, Marcos Ballester, G. Ferron, Claire Falandry, Sofiane Bendifallah, C. Sénéchal-Davin, Catherine Uzan, Chantal Touboul, Patricia Pautier, Naoual Bakrin, Fabrice Lecuru, François Planchamp, Marie-Aude Lefrère-Belda, L. Ouldamer, Sebastien Gouy, François Golfier, Nathalie Chabbert-Buffet, Eric Lambaudie, Laure Fournier, Christine Rousset-Jablonski, Fabrice Narducci, Cyrille Huchon, P. Alfonsi, Emile Daraï, F Guyon, Laurence Gladieff, C. Bourgin, Pierre-Adrien Bolze, Benoit You, V. Lavoué, A. Lemoine, Eric Leblanc, Fabrice Bonnet, Cherif Akladios, Nicolas Pouget, P. Collinet, T. de la Motte Rouge, I.L. Ray-Coquard, Alexandra Leary, Isabelle Thomassin-Naggara, Chemistry, Oncogenesis, Stress and Signaling (COSS), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-CRLCC Eugène Marquis (CRLCC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de gynécologie et obstétrique [CHI Poissy-Saint Germain], CHI Poissy-Saint-Germain, CHU Strasbourg, Hôpital Saint-Luc-Saint-Joseph, service anesthésie-réanimation, Hôpital Saint-Luc-Saint-Joseph, Service d’Urologie [CHU Lyon Sud], Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Groupe Hospitalier Diaconesses Croix Saint-Simon, CHU Tenon [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), 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), Hôpital Jeanne de Flandres, CHRU de Lille, Institut méditerranéen de biodiversité et d'écologie marine et continentale (IMBE), Centre National de la Recherche Scientifique (CNRS)-Institut de recherche pour le développement [IRD] : UMR237-Aix Marseille Université (AMU)-Avignon Université (AU), Centre Eugène Marquis (CRLCC), Hospices Civils de Lyon (HCL), Institut Claudius Regaud, 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), Département de chirurgie gynécologique [Gustave Roussy], Institut Gustave Roussy (IGR), Institut Bergonié [Bordeaux], UNICANCER, Institut Paoli-Calmettes, Fédération nationale des Centres de lutte contre le Cancer (FNCLCC), Oncologie gynécologique, Département de médecine oncologique [Gustave Roussy], Institut Gustave Roussy (IGR)-Institut Gustave Roussy (IGR), Centre Régional de Lutte contre le Cancer Oscar Lambret [Lille] (UNICANCER/Lille), Université Lille Nord de France (COMUE)-UNICANCER, Département d’Hématologie Clinique [CHU Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Institut Curie [Paris], Centre Léon Bérard [Lyon], Centre Hospitalier Intercommunal de Créteil (CHIC), Centre de Recherche Saint-Antoine (CR Saint-Antoine), Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Université de Rennes (UR)-CRLCC Eugène Marquis (CRLCC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Avignon Université (AU)-Aix Marseille Université (AMU)-Institut de recherche pour le développement [IRD] : UMR237-Centre National de la Recherche Scientifique (CNRS), Université de Lille-UNICANCER, Centre de Recherche Saint-Antoine (CRSA), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Jonchère, Laurent, Institut National de la Santé et de la Recherche Médicale (INSERM)-CRLCC Eugène Marquis (CRLCC)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), and Centre Hospitalier Régional Universitaire de Tours (CHRU TOURS)

Subjects
endocrine system diseases, medicine.medical_treatment, Carboplatin, chemistry.chemical_compound, 0302 clinical medicine, Fertility preservation, Stage (cooking), Peritoneal Neoplasms, Aged, 80 and over, Ovarian Neoplasms, 030219 obstetrics & reproductive medicine, Obstetrics and Gynecology, Fertility Preservation, female genital diseases and pregnancy complications, 3. Good health, Bevacizumab, medicine.anatomical_structure, Tubal cancer, Chemotherapy, Adjuvant, 030220 oncology & carcinogenesis, Hyperthermic intraperitoneal chemotherapy, Female, France, medicine.drug, Adult, medicine.medical_specialty, Paclitaxel, [SDV.CAN]Life Sciences [q-bio]/Cancer, Guidelines, 03 medical and health sciences, [SDV.CAN] Life Sciences [q-bio]/Cancer, Ovarian cancer, medicine, Fallopian Tube Neoplasms, Humans, Chemotherapy, Aged, business.industry, Hyperthermia, Induced, medicine.disease, Primary peritoneal cancer, Surgery, Reproductive Medicine, chemistry, business, Fallopian tube
Abstract

International audience; Adjuvant chemotherapy by carboplatin and paclitaxel is recommended for all high-grade ovarian and tubal cancers (FIGO stages I-IIA) (grade A). After primary surgery is complete, 6 cycles of intravenous chemotherapy (grade A) are recommended, or a discussion with the patient about intraperitoneal chemotherapy, according to her risk-benefit ratio. After complete interval surgery for FIGO stage III, hyperthermic intraperitoneal chemotherapy (HIPEC) can be proposed, in accordance with the modalities of the OV-HIPEC trial (grade B). In cases of postoperative tumor residue or in FIGO stage IV tumors, chemotherapy associated with bevacizumab is recommended (grade A).

Published
2019
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6. Management of epithelial cancer of the ovary, fallopian tube, and primary peritoneum. Long text of the Joint French Clinical Practice Guidelines issued by FRANCOGYN, CNGOF, SFOG, and GINECO-ARCAGY, and endorsed by INCa. Part 1 Diagnostic exploration and staging, surgery, perioperative care, and pathology

Author

Laurence Gladieff, Blandine Courbiere, Christine Rousset-Jablonski, Cyrille Huchon, Fabrice Lecuru, I.L. Ray-Coquard, Laure Fournier, Mojgan Devouassoux-Shisheboran, Chantal Touboul, Eric Lambaudie, Isabelle Thomassin-Naggara, Sebastien Gouy, Marie-Aude Lefrère-Belda, G. Ferron, Eric Leblanc, Benoit You, L. Ouldamer, V. Lavoué, C. Bourgin, Alexandra Leary, A. Lemoine, Francis Bonnet, C. Sénéchal-Davin, Emile Daraï, P. Collinet, Fabrice Narducci, P. Alfonsi, Naoual Bakrin, Marcos Ballester, Catherine Uzan, T. de la Motte Rouge, François Golfier, Nathalie Chabbert-Buffet, Pierre-Adrien Bolze, Cherif Akladios, Nicolas Pouget, Patricia Pautier, F Guyon, Claire Falandry, Sofiane Bendifallah, François Planchamp, Chemistry, Oncogenesis, Stress and Signaling (COSS), Institut National de la Santé et de la Recherche Médicale (INSERM)-CRLCC Eugène Marquis (CRLCC)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), CHU Tenon [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Institut méditerranéen de biodiversité et d'écologie marine et continentale (IMBE), Avignon Université (AU)-Aix Marseille Université (AMU)-Institut de recherche pour le développement [IRD] : UMR237-Centre National de la Recherche Scientifique (CNRS), Centre Eugène Marquis (CRLCC), Institut Claudius Regaud, Département de chirurgie gynécologique [Gustave Roussy], Institut Gustave Roussy (IGR), Institut Bergonié [Bordeaux], UNICANCER, Institut Paoli-Calmettes, Fédération nationale des Centres de lutte contre le Cancer (FNCLCC), Oncologie gynécologique, Département de médecine oncologique [Gustave Roussy], Institut Gustave Roussy (IGR)-Institut Gustave Roussy (IGR), Centre Régional de Lutte contre le Cancer Oscar Lambret [Lille] (UNICANCER/Lille), Université Lille Nord de France (COMUE)-UNICANCER, Institut Curie [Paris], Centre Léon Bérard [Lyon], Centre de Recherche Saint-Antoine (CR Saint-Antoine), Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Institut Carnot CALYM [Pierre-Benite], Université de Rennes (UR)-CRLCC Eugène Marquis (CRLCC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Université de Lille-UNICANCER, Centre de Recherche Saint-Antoine (CRSA), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), and Institut Carnot Lymphome (CALYM)

Subjects
Thorax, medicine.medical_specialty, medicine.medical_treatment, Ovary, [SDV.CAN]Life Sciences [q-bio]/Cancer, Guidelines, Perioperative Care, 03 medical and health sciences, 0302 clinical medicine, Ovarian cancer, Biomarkers, Tumor, Fallopian Tube Neoplasms, Humans, Minimally Invasive Surgical Procedures, Medicine, Chemotherapy, Neoplasms, Glandular and Epithelial, Neoplasm Metastasis, Peritoneal Neoplasms, Pelvis, Neoplasm Staging, Ovarian Neoplasms, 030219 obstetrics & reproductive medicine, business.industry, Obstetrics and Gynecology, medicine.disease, Primary peritoneal cancer, Magnetic Resonance Imaging, 3. Good health, Surgery, Omentectomy, medicine.anatomical_structure, Reproductive Medicine, Tubal cancer, 030220 oncology & carcinogenesis, Abdomen, Female, Laparoscopy, France, Tomography, X-Ray Computed, business, Fallopian tube
Abstract

International audience; An MRI is recommended for an ovarian mass that is indeterminate on ultrasound. The ROMA score (combining CA125 and HE4) can also be calculated (grade A). In presumed early-stage ovarian or tubal cancers, the following procedures should be performed an omentectomy (at a minimum, infracolic), an appendectomy, multiple peritoneal biopsies, peritoneal cytology (grade C), and pelvic and para-aortic lymphadenectomies (grade B) for all histologic types, except the expansile mucinous subtypes, for which lymphadenectomies can be omitted (grade C). Minimally invasive surgery is recommended for early-stage ovarian cancer, when there is no risk of tumor rupture (grade B). For FIGO stages III or IV ovarian, tubal, and primary peritoneal cancers, a contrast-enhanced computed tomography (CT) scan of the thorax/abdomen/pelvis is recommended (grade B), as well as laparoscopic exploration to take multiple biopsies (grade A) and a carcinomatosis score (Fagotti score at a minimum) (grade C) to assess the possibility of complete surgery (i.e., leaving no macroscopic tumor residue). Complete surgery by a midline laparotomy is recommended for advanced ovarian, tubal, or primary peritoneal cancer (grade B). For advanced cancers, para-aortic and pelvic lymphadenectomies are recommended when metastatic adenopathy is clinically or radiologically suspected (grade B). When adenopathy is not suspected and when complete peritoneal surgery is performed as the initial surgery for advanced cancer, the lymphadenectomies can be omitted because they do not modify either the medical treatment or overall survival (grade B). Primary surgery (before other treatment) is recommended whenever it appears possible to leave no tumor residue (grade B).

Published
2019
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7. Management of epithelial cancer of the ovary, fallopian tube, and primary peritoneum. Short text of the French Clinical Practice Guidelines issued by FRANCOGYN, CNGOF, SFOG, and GINECO-ARCAGY, and endorsed by INCa

Author

Nicolas Pouget, Francis Bonnet, Blandine Courbiere, Emile Daraï, François Planchamp, C. Sénéchal-Davin, Fabrice Lecuru, T. de la Motte Rouge, Pierre-Adrien Bolze, L. Ouldamer, Isabelle Thomassin-Naggara, I. Ray-Coquard, François Golfier, Nathalie Chabbert-Buffet, Laure Fournier, Laurence Gladieff, P. Collinet, Sebastien Gouy, Chantal Touboul, C. Bourgin, Benoit You, Catherine Uzan, Christine Rousset-Jablonski, Alexandra Leary, Cyrille Huchon, Patricia Pautier, Marie-Aude Lefrère-Belda, Naoual Bakrin, Cherif Akladios, Marcos Ballester, Vincent Lavoué, Sofiane Bendifallah, Claire Falandry, G. Ferron, Fabrice Narducci, P. Alfonsi, F Guyon, Eric Lambaudie, Eric Leblanc, A. Lemoine, Mojgan Devouassoux-Shisheboran, Chemistry, Oncogenesis, Stress and Signaling (COSS), Université de Rennes (UR)-CRLCC Eugène Marquis (CRLCC)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Pontchaillou [Rennes], CHU Strasbourg, Hôpital Saint-Joseph [Marseille], Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL), Institut méditerranéen de biodiversité et d'écologie marine et continentale (IMBE), Avignon Université (AU)-Aix Marseille Université (AMU)-Institut de recherche pour le développement [IRD] : UMR237-Centre National de la Recherche Scientifique (CNRS), Hôpital de la Conception [CHU - APHM] (LA CONCEPTION), Centre Eugène Marquis (CRLCC), Institut Claudius Regaud, 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), Service de Radiologie [CHU 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), Département de chirurgie gynécologique [Gustave Roussy], Institut Gustave Roussy (IGR), Institut Bergonié [Bordeaux], UNICANCER, Institut Paoli-Calmettes, Fédération nationale des Centres de lutte contre le Cancer (FNCLCC), Oncologie gynécologique, Département de médecine oncologique [Gustave Roussy], Institut Gustave Roussy (IGR)-Institut Gustave Roussy (IGR), Service d'anatomo-pathologie [CHU HEGP], 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), Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Centre Léon Bérard [Lyon], Service de Pneumologie [CHI Créteil], CHI Créteil, CHU Tenon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre de Recherche Saint-Antoine (CRSA), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Institut National de la Santé et de la Recherche Médicale (INSERM)-CRLCC Eugène Marquis (CRLCC)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre de Recherche Saint-Antoine (CR Saint-Antoine), Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Saint-Antoine [AP-HP], and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)

Subjects
medicine.medical_specialty, Bevacizumab, medicine.medical_treatment, Antineoplastic Agents, [SDV.CAN]Life Sciences [q-bio]/Cancer, Guidelines, [SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Ovarian cancer, medicine, Fallopian Tube Neoplasms, Humans, Minimally Invasive Surgical Procedures, Chemotherapy, 030212 general & internal medicine, Stage (cooking), Peritoneal Neoplasms, Ovarian Neoplasms, 030219 obstetrics & reproductive medicine, business.industry, Carcinoma, Obstetrics and Gynecology, medicine.disease, Primary peritoneal cancer, Carboplatin, female genital diseases and pregnancy complications, 3. Good health, medicine.anatomical_structure, Reproductive Medicine, chemistry, Tubal cancer, Abdomen, Female, Hyperthermic intraperitoneal chemotherapy, Surgery, France, Radiology, business, medicine.drug, Fallopian tube
Abstract

International audience; An MRI is recommended for an ovarian mass that is indeterminate on ultrasound. The ROMA score (combining CA125 and HE4) can also be calculated (Grade A). In presumed early-stage ovarian or tubal cancers, the following procedures should be performed an omentectomy (at a minimum, infracolic), an appendectomy, multiple peritoneal biopsies, peritoneal cytology (grade C), and pelvic and para-aortic lymphadenectomies (Grade B) for all histologic types, except the expansile mucinous subtypes, for which lymphadenectomies can be omitted (grade C). Minimally invasive surgery is recommended for early-stage ovarian cancer, when there is no risk of tumor rupture (grade B). Adjuvant chemotherapy by carboplatin and paclitaxel is recommended for all high-grade ovarian and tubal cancers (FIGO stages I-IIA) (grade A). For FIGO stage III or IV ovarian, tubal, and primary peritoneal cancers, a contrast-enhanced computed tomography (CT) scan of the thorax/abdomen/pelvis is recommended (Grade B), as well as laparoscopic exploration to take multiple biopsies (grade A) and a carcinomatosis score (Fagotti score at a minimum) (grade C) to assess the possibility of complete surgery (i.e., leaving no macroscopic tumor residue). Complete surgery by a midline laparotomy is recommended for advanced ovarian, tubal, or primary peritoneal cancers (grade B). For advanced cancers, para-aortic and pelvic lymphadenectomies are recommended when metastatic adenopathy is clinically or radiologically suspected (grade B). When adenopathy is not suspected and when complete peritoneal surgery is performed as the initial surgery for advanced cancer, the lymphadenectomies can be omitted because they do not modify either the medical treatment or overall survival (grade B). Primary surgery (before other treatment) is recommended whenever it appears possible to leave no tumor residue (grade B). After primary surgery is complete, 6 cycles of intravenous chemotherapy (grade A) are recommended, or a discussion with the patient about intraperitoneal chemotherapy, according to her risk-benefit ratio. After complete interval surgery for FIGO stage III disease, hyperthermic intraperitoneal chemotherapy (HIPEC) can be proposed, in accordance with the modalities of the OV-HIPEC trial (grade B). In cases of postoperative tumor residue or in FIGO stage IV tumors, chemotherapy associated with bevacizumab is recommended (grade A).

Published
2019
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8. Management of epithelial ovarian cancer. Short text drafted from the French joint recommendations of FRANCOGYN, CNGOF, SFOG, GINECO-ARCAGY and endorsed by INCa

Author

Sofiane Bendifallah, Patricia Pautier, Nicolas Pouget, Sebastien Gouy, Catherine Uzan, Eric Lambaudie, Naoual Bakrin, Vincent Lavoué, François Planchamp, Fabrice Bonnet, Lobna Ouldamer, Emile Daraï, Christine Rousset-Jablonski, C. Sénéchal-Davin, Isabelle Thomassin-Naggara, A. Lemoine, Cyrille Huchon, Marcos Ballester, Claire Falandry, Isabelle Ray-Coquard, François Golfier, Nathalie Chabbert-Buffet, Benoit You, Laurence Gladieff, F Guyon, Pierre Collinet, Marie-Aude Lefrère-Belda, Pierre-Adrien Bolze, G. Ferron, Eric Leblanc, Thibault De La Motte Rouge, Alexandra Leary, Laure Fournier, Mojgan Devouassoux-Shisheboran, Blandine Courbiere, Cherif Akladios, Fabrice Narducci, P. Alfonsi, Cyril Touboul, Fabrice Lecuru, C. Bourgin, Chemistry, Oncogenesis, Stress and Signaling (COSS), Institut National de la Santé et de la Recherche Médicale (INSERM)-CRLCC Eugène Marquis (CRLCC)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), CHU Strasbourg, Hôpital Saint-Joseph [Marseille], Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL), Centre de Recherche Saint-Antoine (CR Saint-Antoine), Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Institut méditerranéen de biodiversité et d'écologie marine et continentale (IMBE), Avignon Université (AU)-Aix Marseille Université (AMU)-Institut de recherche pour le développement [IRD] : UMR237-Centre National de la Recherche Scientifique (CNRS), Centre Eugène Marquis (CRLCC), Institut Claudius Regaud, 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), Service de Radiologie [CHU 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), Département de chirurgie gynécologique [Gustave Roussy], Institut Gustave Roussy (IGR), Institut Bergonié [Bordeaux], UNICANCER, Institut Paoli-Calmettes, Fédération nationale des Centres de lutte contre le Cancer (FNCLCC), Oncologie gynécologique, Département de médecine oncologique [Gustave Roussy], Institut Gustave Roussy (IGR)-Institut Gustave Roussy (IGR), Service d'anatomo-pathologie [CHU HEGP], 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), Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Centre Léon Bérard [Lyon], Université de Rennes (UR)-CRLCC Eugène Marquis (CRLCC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre de Recherche Saint-Antoine (CRSA), and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)

Subjects
0301 basic medicine, Cancer Research, medicine.medical_specialty, Bevacizumab, medicine.medical_treatment, Cancer de l’ovaire, Recommandations, [SDV.CAN]Life Sciences [q-bio]/Cancer, Cancer du péritoine primitif, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Laparotomy, medicine, Cancer de la trompe, Radiology, Nuclear Medicine and imaging, Stage (cooking), Chirurgie, ComputingMilieux_MISCELLANEOUS, Gynecology, business.industry, Hematology, General Medicine, medicine.disease, female genital diseases and pregnancy complications, Carboplatin, 3. Good health, 030104 developmental biology, medicine.anatomical_structure, Oncology, chemistry, 030220 oncology & carcinogenesis, Fallopian tube cancer, Lymphadenectomy, Ovarian cancer, business, Chimiothérapie, medicine.drug, Fallopian tube
Abstract

Faced to an undetermined ovarian mass on ultrasound, an MRI is recommended and the ROMA score (combining CA125 and HE4) can be proposed (grade A). In case of suspected early stage ovarian or fallopian tube cancer, omentectomy (at least infracolonic), appendectomy, multiple peritoneal biopsies, peritoneal cytology (grade C) and pelvic and para-aortic lymphadenectomy are recommended (grade B) for all histological types, except for the expansive mucinous subtype where lymphadenectomy may be omitted (grade C). Minimally invasive surgery is recommended for early stage ovarian cancer, if there is no risk of tumor rupture (grade B). Adjuvant chemotherapy with carboplatin and paclitaxel is recommended for all high-grade ovarian or Fallopian tube cancers, stage FIGO I-IIA (grade A). In case of ovarian, Fallopian tube or primitive peritoneal cancer of FIGO III-IV stages, thoraco-abdomino-pelvic CT scan with injection (grade B) is recommended. Laparoscopic exploration for multiple biopsies (grade A) and to evaluate carcinomatosis score (at least using the Fagotti score) (grade C) are recommended to estimate the possibility of a complete surgery (i.e. no macroscopic residue). Complete medial laparotomy surgery is recommended for advanced cancers (grade B). It is recommended in advanced cancers to perform para-aortic and pelvic lymphadenectomy in case of clinical or radiological suspicion of metastatic lymph node (grade B). In the absence of clinical or radiological lymphadenopathy and in case of complete peritoneal surgery during an initial surgery for advanced cancer, it is possible not to perform a lymphadenectomy because it does not modify the medical treatment and the overall survival (grade B). Primary surgery is recommended when no tumor residue is possible (grade B). After a complete first surgery, it is recommended to deliver 6 cycles of intravenous (grade A) or to propose intraperitoneal (grade B) chemotherapy, to be discussed with patient, according to the benefit/risk ratio. After a complete interval surgery for a FIGO III stage, the hyperthermic intra peritoneal chemotherapy (HIPEC) can be proposed in the same conditions of the OV-HIPEC trial (grade B). In case of tumor residue after surgery or FIGO stage IV, chemotherapy associated with bevacizumab is recommended (grade A).

Published
2019
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9. Gynecologic cancers in pregnancy: guidelines based on a third international consensus meeting

Author

Paul Berveiller, K. Van Calsteren, Ingrid A. Boere, Tineke Vandenbroucke, Michael J. Halaska, Charlotte Maggen, Matteo Lambertini, P. Poortmans, Robert Fruscio, Christianne A.R. Lok, Monica Fumagalli, M. van Gerwen, Frédéric Amant, M.M. van den Heuvel-Eibrink, Annette Hasenburg, Elyce Cardonick, Ignacio Zapardiel, A.L.V. Johansson, P. Morice, Flora Zagouri, Fedro A. Peccatori, Medical Oncology, Amant, F, Berveiller, P, Boere, I, Cardonick, E, Fruscio, R, Fumagalli, M, Halaska, M, Hasenburg, A, Johansson, A, Lambertini, M, Lok, C, Maggen, C, Morice, P, Peccatori, F, Poortmans, P, Van Calsteren, K, Vandenbroucke, T, van Gerwen, M, van den Heuvel-Eibrink, M, Zagouri, F, Zapardiel, I, Catholic University of Leuven - Katholieke Universiteit Leuven (KU Leuven), Service de gynécologie et obstétrique [CHI Poissy-Saint Germain], CHI Poissy-Saint-Germain, Gamètes, implantation, gestation (GIG), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Erasmus University Medical Center [Rotterdam] (Erasmus MC), Università degli Studi di Milano-Bicocca [Milano] (UNIMIB), Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, University Hospital Kralovské Vinohrady, University Medical Center [Mainz], Karolinska Institutet [Stockholm], Ospedale Policlinico San Martino [Genoa], Netherlands Cancer Institute (NKI), Antoni van Leeuwenhoek Hospital, Département de chirurgie gynécologique [Gustave Roussy], Institut Gustave Roussy (IGR), European Institute of Oncology [Milan] (ESMO), Université Paris sciences et lettres (PSL), University Hospitals Leuven [Leuven], VU University Medical Center [Amsterdam], Princess Máxima Center for Pediatric Oncology [Utrecht, Netherlands], University of Athens Medical School [Athens], Hospital Universitario La Paz, Obstetrics, and Faculty of Economic and Social Sciences and Solvay Business School

Subjects
0301 basic medicine, medicine.medical_specialty, Cognitive, Genital Neoplasms, Female, International Cooperation, [SDV.CAN]Life Sciences [q-bio]/Cancer, Cancer, Chemotherapy, Cognitive, Gynecologic, Offspring, Pregnancy, [SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, 03 medical and health sciences, Genital Neoplasms, Female/therapy, Gynecologic, Offspring, 0302 clinical medicine, SDG 3 - Good Health and Well-being, Pregnancy, Health care, medicine, Prenatal Exposure Delayed Effects/etiology, Humans, Chemotherapy, Radiation treatment planning, Intensive care medicine, Societies, Medical, Cancer, Pregnancy Complications, Neoplastic/therapy, Vaginal delivery, business.industry, Hematology, medicine.disease, Prognosis, 3. Good health, Cancer registry, Long-term care, 030104 developmental biology, Oncology, 030220 oncology & carcinogenesis, Prenatal Exposure Delayed Effects, Practice Guidelines as Topic, Female, Practice Guidelines as Topic/standards, business, Breast feeding, Pregnancy Complications, Neoplastic
Abstract

We aimed to provide comprehensive protocols and promote effective management of pregnant women with gynecological cancers. New insights and more experience have been gained since the previous guidelines were published in 2014. Members of the International Network on Cancer, Infertility and Pregnancy (INCIP), in collaboration with other international experts, reviewed existing literature on their respective areas of expertise. Summaries were subsequently merged into a manuscript that served as a basis for discussion during the consensus meeting. Treatment of gynecological cancers during pregnancy is attainable if management is achieved by collaboration of a multidisciplinary team of health care providers. This allows further optimization of maternal treatment, while considering fetal development and providing psychological support and long-term follow-up of the infants. Nonionizing imaging procedures are preferred diagnostic procedures, but limited ionizing imaging methods can be allowed if indispensable for treatment plans. In contrast to other cancers, standard surgery for gynecological cancers often needs to be adapted according to cancer type and gestational age. Most standard regimens of chemotherapy can be administered after 14 weeks gestational age but are not recommended beyond 35 weeks. C-section is recommended for most cervical and vulvar cancers, whereas vaginal delivery is allowed in most ovarian cancers. Breast-feeding should be avoided with ongoing chemotherapeutic, endocrine or targeted treatment. More studies that focus on the long-term toxic effects of gynecologic cancer treatments are needed to provide a full understanding of their fetal impact. In particular, data on targeted therapies that are becoming standard of care in certain gynecological malignancies is still limited. Furthermore, more studies aimed at the definition of the exact prognosis of patients after antenatal cancer treatment are warranted. Participation in existing registries (www.cancerinpregnancy.org) and the creation of national tumor boards with multidisciplinary teams of care providers (supplementary Box S1, available at Annals of Oncology online) is encouraged. ispartof: ANNALS OF ONCOLOGY vol:30 issue:10 pages:1601-1612 ispartof: location:England status: published

Published
2019
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10. Should Systematic Infrarenal Para-aortic Dissection Be the Rule in the Pretherapeutic Staging of Primary or Recurrent Locally Advanced Cervix Cancer Patients With a Negative Preoperative Para-aortic PET Imaging?

Author

Fabrice Narducci, Philippe Morice, Ninad Katdare, Alejandra Martinez, Lucie Bresson, Sebastien Gouy, Denis Querleu, Gwenael Ferron, Eric Leblanc, Centre Régional de Lutte contre le Cancer Oscar Lambret [Lille] (UNICANCER/Lille), Université Lille Nord de France (COMUE)-UNICANCER, Institut Gustave Roussy (IGR), Département de chirurgie gynécologique [Gustave Roussy], Institut Claudius Regaud, Université de Lille-UNICANCER, and SALZET, Michel

Subjects
Adult, medicine.medical_specialty, [SDV]Life Sciences [q-bio], medicine.medical_treatment, Uterine Cervical Neoplasms, Kidney, Inferior mesenteric artery, 03 medical and health sciences, Young Adult, 0302 clinical medicine, medicine.artery, Image Processing, Computer-Assisted, Para-Aortic Bodies, Medicine, Humans, Kidney surgery, Longitudinal Studies, Prospective Studies, Stage (cooking), Laparoscopy, Aged, Neoplasm Staging, Cervical cancer, Aortic dissection, 030219 obstetrics & reproductive medicine, medicine.diagnostic_test, business.industry, Obstetrics and Gynecology, Middle Aged, medicine.disease, Prognosis, 3. Good health, Surgery, [SDV] Life Sciences [q-bio], Dissection, Oncology, 030220 oncology & carcinogenesis, Positron-Emission Tomography, Carcinoma, Squamous Cell, Lymph Node Excision, Lymphadenectomy, Female, Radiology, Neoplasm Recurrence, Local, business, Tomography, X-Ray Computed, Follow-Up Studies
Abstract

BackgroundExtended-field chemoradiation is the usual management of patients with locally advanced cervical cancer (LACC) and para-aortic node metastases (PA pN1). It is efficient but not without morbidity. Assessment of PA lymph node positivity by PA lymphadenectomy is the most accurate method to select the candidates for this treatment. Hence, to clarify the dissection pattern, we wanted to test the true incidence of isolated/skip node metastasis, above the level of the inferior mesenteric artery (IMA).Materials and MethodsAll patients with LACC and negative magnetic resonance imaging and positron emission tomography–computed tomography imaging at the PA level were offered a laparoscopic staging encompassing a diagnostic laparoscopy followed, if negative, by an extraperitoneal PA lymphadenectomy. All nodes were removed from both common iliac bifurcations up to the left renal vein. Node groups, below and above the IMA, were separately sent to the pathologist for definitive examination.ResultsFrom January 2010 to December 2013, 196 stage IB1 with pelvic pN1, IB2, to IVA LACC patients from 2 cancer centers who fulfilled the criteria were included in this institutional review board–approved study after informed consent. Thirty patients (15%) had PA pN1. Only 1 patient had positive nodes exclusively located above the IMA (3.3% of the pN1 group; 95% confidence interval, 0%–9.7%). Complications were observed in 15 (7.6%) of 196 patients.ConclusionsGiven the very low rate of skip metastases above the IMA and the potential additional morbidity of a systematic extended dissection, a bilateral ilioinframesenteric dissection seems to be an acceptable pattern of PA lymphadenectomy in LACC patients.

Published
2015
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11. Surgical Complexity Impact on Survival After Complete Cytoreductive Surgery for Advanced Ovarian Cancer

Author

Christophe Pomel, Sebastien Gouy, Mathieu Luyckx, Charlotte Ngo, Denis Querleu, Emile Daraï, Gwenael Ferron, Jean-Marc Classe, Frédéric Guyon, Eric Leblanc, Alejandra Martinez, Thomas Filleron, Institut Universitaire du Cancer de Toulouse - Oncopole (IUCT Oncopole - UMR 1037), 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), 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), Centre Régional de Lutte contre le Cancer Oscar Lambret [Lille] (UNICANCER/Lille), Université Lille Nord de France (COMUE)-UNICANCER, Institut Gustave Roussy (IGR), Département de chirurgie gynécologique [Gustave Roussy], Cliniques Universitaires Saint-Luc [Bruxelles], CHU Tenon [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Institut de Cancérologie de l'Ouest [Angers/Nantes] (UNICANCER/ICO), UNICANCER, Institut Bergonié [Bordeaux], Centre Jean Perrin [Clermont-Ferrand] (UNICANCER/CJP), SALZET, Michel, 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), Université de Lille-UNICANCER, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), UCL - (SLuc) Centre du cancer, UCL - (SLuc) Service de gynécologie et d'andrologie, UCL - SSS/IREC/PEDI - Pôle de Pédiatrie, 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
Adult, medicine.medical_specialty, Paclitaxel, [SDV]Life Sciences [q-bio], Carboplatin, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Surgical oncology, Cytoreduction Surgical Procedures, Antineoplastic Combined Chemotherapy Protocols, surgical complexity impact, medicine, cytoreductive surgery, Humans, Stage (cooking), Radical surgery, Survival rate, Aged, Neoplasm Staging, Aged, 80 and over, Ovarian Neoplasms, Univariate analysis, 030219 obstetrics & reproductive medicine, business.industry, Middle Aged, medicine.disease, Prognosis, 3. Good health, Surgery, Tumor Burden, [SDV] Life Sciences [q-bio], Survival Rate, ovarian cancer, Treatment Outcome, Oncology, chemistry, 030220 oncology & carcinogenesis, Female, France, Ovarian cancer, business
Abstract

International audience; Introduction: The direct relationship between surgical radicality to compensate biologic behavior and improvement of patient outcome at the time of primary or interval cytoreduction remains unclear.Objective: The aim of this study was to evaluate the impact of disease extension and surgical complexity on survival after complete macroscopic resection for stage IIIC-IV ovarian cancer.Materials and methods: Medical records from seven referral centers in France were reviewed to identify all patients who had complete cytoreductive surgery for stage IIIC-IV epithelial ovarian, fallopian, or primary peritoneal cancer. All patients had at least six cycles of carboplatin and paclitaxel combination therapy.Results: From the 374 consecutive patients with complete cytoreduction who were included in this study, stage, grade, upper abdominal disease, surgical complexity, and carcinomatosis extent were significantly associated with disease-free survival (DFS) at univariate analysis. Stage IV and the need for ultra-radical procedures were significantly associated with lower overall survival (OS). On multivariate analysis, radical surgery, including more than two visceral resections, was significantly associated with decreased DFS and OS.Conclusions: Patients who need complex surgical procedures involving two or more visceral resections in order to achieve successful complete cytoreduction have worse outcome than patients with less extensive procedures. The negative impact of surgical complexity was not significant in patients who underwent upfront procedures. Tumor volume and extension were associated with decreased DFS in patients undergoing a primary surgical approach. This adds to the evidence that, even though complete cytoreduction is currently the objective of surgery, tumor load remains an independent poor prognostic factor and probably reflects a more aggressive behavior.

Published
2015
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