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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. Long term follow-up of a large series of stage-II/III atypical proliferative serous ovarian tumors

Author

Amandine Maulard, Catherine Genestie, Matthieu Faron, Sophie Maria, Alexandra Leary, Sebastien Gouy, Philippe Morice, Patricia Pautier, Cyrus Chargari, Institut Gustave Roussy (IGR), Centre de recherche en épidémiologie et santé des populations (CESP), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay, Département de chirurgie viscérale [Gustave Roussy], Département de chirurgie gynécologique [Gustave Roussy], Oncologie gynécologique, Département de médecine oncologique [Gustave Roussy], Institut Gustave Roussy (IGR)-Institut Gustave Roussy (IGR), Département de radiothérapie [Gustave Roussy], Pathologie morphologique, Département de biologie et pathologie médicales [Gustave Roussy], 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, and CCSD, Accord Elsevier

Subjects
0301 basic medicine, Adult, Prognostic factor, medicine.medical_specialty, Adolescent, Long term follow up, [SDV]Life Sciences [q-bio], Ovary, Stage ii, Gastroenterology, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Internal medicine, Overall survival, Medicine, Humans, Atypical proliferative serous tumor, Neoplasm Invasiveness, Aged, Cell Proliferation, Neoplasm Staging, Retrospective Studies, Ovarian Neoplasms, business.industry, Obstetrics and Gynecology, Large series, Middle Aged, Invasive implants, Prognosis, Survival Analysis, 3. Good health, Cystadenocarcinoma, Serous, Conservative treatment, [SDV] Life Sciences [q-bio], Serous fluid, 030104 developmental biology, medicine.anatomical_structure, Oncology, 030220 oncology & carcinogenesis, Extraovarian low-grade serous carcinoma, Female, Neoplasm Recurrence, Local, business, Follow-Up Studies, Noninvasive implants
Abstract

International audience; Background: The aim of this study was to assess prognostic factors and implications on further management in a large series of stage-II or III Atypical Proliferative Serous Tumors (APST) with a long-term follow-up.Patients and methods: Patients with APSTs and peritoneal implants treated in, or referred to, our institution were retrospectively reviewed. Prognostic factors on invasive recurrence, disease-free (DFS) and overall survival (OS) were analyzed.Results: Between 1971 and 2017, 212 patients were identified and followed (33 having invasive implants). After a median follow-up of 115 months, 70 recurrences were observed, 28 of them under the form of invasive disease. DFS at 5 years and 10 years was 73% and 62% respectively. The use of a conservative treatment (HR = 5.5[3.33-9.08], p < .0001), the presence of ≥3 peritoneal sites with implants (HR = 1.65[1.01-2.72], p = .045) were unfavorable prognostic factors for DFS. The presence of ≥3 peritoneal sites with implants (HR = 3.02[0.96-9.53], p = .049) and the presence of stromal microinvasion (HR = 3.19[1.12-9.1], p = .022) were unfavorable prognostic factors for OS. Non-conservative surgery (HR = 7[2.35-20.87], p = .0002), invasive implants (HR = 5.37[1.29-22.26], p = .013), and ≥ 3 peritoneal sites with implants (HR = 3.56 [1.11-11.39], p = .024) were identified as predictors of recurrence in the form of an invasive disease. Invasive implants were not associated with DFS (HR = 1.39[0.77-2.51], p = .27), nor OS (HR = 1.76[0.57-5.47], p = .32).Conclusion: After a long-term follow-up, type of peritoneal implants is no longer a prognostic factor for OS. Implants ≥3 peritoneal sites seem to impact significantly OS and then require a specific follow-up in this subgroup of patients.

Published
2020
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5. 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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6. Ovarian and peritoneal psammocarcinoma: Results of a multicenter study on 25 patients

Author

Jean-Baptiste Delhorme, Jordan Ohayon, Sébastien Gouy, Gerlinde Averous, Catherine Genestie, Léopold Gaichies, Olivier Glehen, Jean-Marc Guilloit, Denis Pezet, Francois Quenet, Gwenaël Ferron, Cécile Brigand, Philippe Morice, Charles Honoré, Julio Abba, Karine Abboud, Mohammad Alyami, Catherine Arvieux, Naoual Bakrin, Gisèle Balagué, Vincent Barrau, Houda Ben Rejeb, Jean-Marc Bereder, Isabelle Berton-Rigaud, Frédéric Bibeau, Isabelle Bonnefoy, Dominique Bouzard, Ivan Bricault, Sébastien Carrère, Cécile de Chaisemartin, Madleen Chassang, Anne Chevallier, Thomas Courvoisier, Peggy Dartigues, Anthony Dohan, Julien Dubreuil, Frédéric Dumont, Clarisse Eveno, Marie Faruch-Bilfeld, Juliette Fontaine, Laure Fournier, Johan Gagniere, Delphine Geffroy, Laurent Ghouti, François-Noël Gilly, Laurence Gladieff, Diane Goéré, Aymeric Guibal, Frédéric Guyon, Bruno Heyd, Christine Hoeffel, Constance Hordonneau, Sylvie Isaac, Peggy Jourdan-Enfer, Rachid Kaci, Reza Kianmanesh, Catherine Labbé-Devilliers, Joëlle Lacroix, Bernard Lelong, Agnès Leroux-Broussier, Yoann Lherm, Réa Lo Dico, Gérard Lorimier, Caroline Malhaire, Frédéric Marchal, Pascale Mariani, Emilie Mathiotte, Pierre Meeus, Eliane Mery, Simon Msika, Cédric Nadeau, Pablo Ortega-Deballon, Guillaume Passot, Olivier Pellet, Patrice Peyrat, Nicolas Pirro, Marc Pocard, Flora Poizat, Jack Porcheron, Anaïs Poulet, François Quenet, Patrick Rat, Pierre Rousselot, Pascal Rousset, Hélène Senellart, Martine Serrano, Vincent Servois, Olivia Sgabura, Andrea Skanjeti, Magali Svrcek, Raphaël Tetreau, Emilie Thibaudeau, Yann Touchefeu, Jean-Jacques Tuech, Séverine Valmary-Degano, Delphine Vaudoyer, Stéphane Velasco, Véronique Verriele-Beurrier, Laurent Villeneuve, Romuald Wernert, Franck Zinzindohoue, Département de chirurgie générale et digestive [CHU Strasbourg], Centre Hospitalier Universitaire de Strasbourg (CHU de Strasbourg ), Institut Gustave Roussy (IGR), Département de chirurgie gynécologique [Gustave Roussy], Service d'anatomie pathologique [CHU Pitié-Salpêtrière], Université Pierre et Marie Curie - Paris 6 (UPMC)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Université de Caen Normandie - UFR Santé (UNICAEN Santé), Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU), Hôpital Nord, Hôpital nord, 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), CHU Grenoble, Hôpitaux Universitaires de Strasbourg, Centre de Lutte contre le Cancer Antoine Lacassagne [Nice] (UNICANCER/CAL), UNICANCER-Université Côte d'Azur (UCA), Laboratoire d'anatomo-pathologie, CRLCC Val d'Aurelle - Paul Lamarque, Département de chirurgie, Institut Paoli-Calmettes, Fédération nationale des Centres de lutte contre le Cancer (FNCLCC), COMUE Université Côte d'Azur (2015-2019) (COMUE UCA), Centre hospitalier universitaire de Poitiers (CHU Poitiers), Département de biologie et pathologie médicales [Gustave Roussy], Department of Body and Interventional Imaging, Hôpital Lariboisière, Paris, France., Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université de Lille, Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), CHU Toulouse [Toulouse], 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), Chirurgie digestive et hépatobiliaire, CHU Estaing [Clermont-Ferrand], CHU Clermont-Ferrand-CHU Clermont-Ferrand, Ciblage thérapeutique en Oncologie (EA3738), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon, Hospices Civils de Lyon (HCL), Département de chirurgie générale [Gustave Roussy], Centre Régional de Lutte contre le Cancer François Baclesse [Caen] (UNICANCER/CRLC), Normandie Université (NU)-UNICANCER-Tumorothèque de Caen Basse-Normandie (TCBN), Service de chirurgie viscérale et digestive - Unité de transplantation hépatique, Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Centre Hospitalier Universitaire de Reims (CHU Reims), Service de Radiologie, Service de pathologie, Service de Chirurgie Générale, Digestive et Endocrine [CHU Reims], Institut de Cancérologie de l'Ouest [Angers/Nantes] (UNICANCER/ICO), UNICANCER, Service de Radiologie [CLCC Baclesse], Normandie Université (NU)-UNICANCER-Tumorothèque de Caen Basse-Normandie (TCBN)-Normandie Université (NU)-UNICANCER-Tumorothèque de Caen Basse-Normandie (TCBN), Centre de recherches (CRT), Société Lafarge, Service de Chirurgie d'Oncologie Digestive [CHU Lariboisière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Paul Papin(Angers), Hôpital Henri Mondor, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Centre de Recherche en Automatique de Nancy (CRAN), Université de Lorraine (UL)-Centre National de la Recherche Scientifique (CNRS), Institut Curie [Paris], Centre Léon Bérard [Lyon], Institut Claudius Regaud. Department of pathology, Hôpital Louis Mourier - AP-HP [Colombes], Department of Gynecology and Obstetrics, Lipides - Nutrition - Cancer (U866) (LNC), Université de Bourgogne (UB)-Institut National de la Santé et de la Recherche Médicale (INSERM)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement-Ecole Nationale Supérieure de Biologie Appliquée à la Nutrition et à l'Alimentation de Dijon (ENSBANA), Service de Chirurgie Digestive (AP-HM), Université de la Méditerranée - Aix-Marseille 2, Hôpital Lariboisière, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7), Service de Biopathologie [CHRU Montpellier], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Chirurgie digestive, Centre Hospitalier Universitaire de Saint-Etienne, Laboratoire Joliot Curie, École normale supérieure - Lyon (ENS Lyon)-Centre National de la Recherche Scientifique (CNRS), CRLC Val d'Aurelle-Paul Lamarque, Service de Chirurgie Digestive, Cancérologique, Générale, Endocrinienne et Urgences (CHU de Dijon), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Laboratoire d'Anatomie Pathologique, CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN), Department of Radiology, Centre René Gauducheau, CRLCC René Gauducheau, Université de Lyon, (le programme) Cartes d'identité des tumeurs (CIT), Ligue Nationales Contre le Cancer (LNCC), Institut du Cancer de Montpellier (ICM), Centre de Recherche en Cancérologie Nantes-Angers (CRCNA), Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM)-Hôtel-Dieu de Nantes-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hôpital Laennec-Centre National de la Recherche Scientifique (CNRS)-Faculté de Médecine d'Angers-Centre hospitalier universitaire de Nantes (CHU Nantes), Laboratoire d'éthique médicale et médecine légale (LEM), Université Paris Descartes - Paris 5 (UPD5), Service de Pathologie, Centro de Investigaciones Oceanograficas e Hidrograficas (CIOH), DIMAR, Ministerio de Defensa Nacional, Colombie, Unité de Méthodologie en Recherche Clinique, Université de Lyon-Université de Lyon-Hospices Civils de Lyon (HCL), Service de chirurgie digestive, générale et cancérologique [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), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] (CHU ST-E), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), École normale supérieure de Lyon (ENS de Lyon)-Centre National de la Recherche Scientifique (CNRS), UNICANCER-Tumorothèque de Caen Basse-Normandie (TCBN)-Normandie Université (NU), UNICANCER-Tumorothèque de Caen Basse-Normandie (TCBN)-Normandie Université (NU)-UNICANCER-Tumorothèque de Caen Basse-Normandie (TCBN)-Normandie Université (NU), Centre National de la Recherche Scientifique (CNRS)-Université de Lorraine (UL), and Université Paris Diderot - Paris 7 (UPD7)-Hôpital Lariboisière-Fernand-Widal [APHP]

Subjects
Hyperthermic Intraperitoneal Chemotherapy, Intraperitoneal chemotherapy, chemistry.chemical_compound, 0302 clinical medicine, Infusions, Parenteral, Peritoneal Neoplasms, Ovarian Neoplasms, Univariate analysis, 030219 obstetrics & reproductive medicine, General Medicine, Cytoreduction Surgical Procedures, Middle Aged, Neoadjuvant Therapy, Progression-Free Survival, 3. Good health, Survival Rate, medicine.anatomical_structure, Oncology, Chemotherapy, Adjuvant, 030220 oncology & carcinogenesis, Female, France, Peritoneum, Pancreas, Adult, medicine.medical_specialty, Adolescent, Ovary, Antineoplastic Agents, Psammocarcinoma, 03 medical and health sciences, Young Adult, medicine, Humans, Aged, business.industry, [SDV.BBM.BM]Life Sciences [q-bio]/Biochemistry, Molecular Biology/Molecular biology, [SDV.MP.BAC]Life Sciences [q-bio]/Microbiology and Parasitology/Bacteriology, Carboplatin, Surgery, chemistry, Multicenter study, Conventional PCI, Neoplasm Grading, business, Neoplasms, Cystic, Mucinous, and Serous, Rare disease
Abstract

International audience; Purpose: Psammocarcinoma (PK) is a rare disease of unknown origin. We aimed to report the characteristics, management and survival of patients operated on for PK within the French Network for Rare Peritoneal Malignancies (RENAPE) expert centers.Patients and methods: All consecutive cases of PK operated within all 26 RENAPE centers between 1997 and 2018 were retrospectively analyzed.Results: Twenty-five patients were identified. The median age was 53 years [range 17–78]. None of the patients had extra peritoneal metastases at diagnosis. A median of 6 cycles of carboplatin-based systemic chemotherapy was delivered in 52% preoperatively (n = 13) and 56% postoperatively (n = 14); associated with placlitaxel for 12 patients. All patients were operated on. The median PCI was 23 [0–33]. Eighty-four percent had a complete cytoreductive surgery through digestive (n = 7), spleen (n = 3), pancreas (n = 1) resections and/or multiple peritonectomies (n = 11). Five patients (20%) had intraperitoneal chemotherapy. Morbidity (Dindo-Clavien ≥3) was 12%. No postoperative death occurred. After a median follow-up of 42 months (range [2–194]), the median overall (OS) and progression-free (DFS) survival times were respectively 128 months and 31 months. Eighteen patients recurred (72%), mainly in the peritoneum (n = 16). Four of them (22%) were reoperated. The 5 and 10-year DFS rates were both 20.3%. The 5 and 10-year OS rates were 62% and 51.7%, respectively. A complete cytoreductive surgery was associated with a better OS and DFS in a univariate analysis.Conclusion: Complete cytoreductive surgery is the cornerstone of the PK's management as a primary treatment. Recurrence remains common and new adjuvant strategies seem needed.

Published
2019
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7. 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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8. 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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9. 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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10. 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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11. Tumeurs épithéliales de l’ovaire : les personnes âgées. Article rédigé sur la base de la recommandation nationale de bonnes pratiques cliniques en cancérologie intitulée « Conduites à tenir initiales devant des patientes atteintes d’un cancer épithélial de l’ovaire » élaborée par FRANCOGYN, CNGOF, SFOG, GINECO-ARCAGY sous l’égide du CNGOF et labellisée par l’INCa

Author

Claire Falandry, Sebastien Gouy, Laboratoire de Biologie Moléculaire de la Cellule (LBMC), École normale supérieure de Lyon (ENS de 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), Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Institut National de la Recherche Agronomique (INRA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM), Département de chirurgie gynécologique [Gustave Roussy], Institut Gustave Roussy (IGR), École normale supérieure - Lyon (ENS Lyon)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hospices Civils de Lyon (HCL), Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université Claude Bernard Lyon 1 (UCBL), and Université de Lyon-Institut National de la Recherche Agronomique (INRA)

Subjects
03 medical and health sciences, 0302 clinical medicine, Reproductive Medicine, Ovarian cancer, 030220 oncology & carcinogenesis, [SDV]Life Sciences [q-bio], Obstetrics and Gynecology, Oncogeriatrics, Vulnerable, 030212 general & internal medicine, Morbidity, Prognostic factors, ComputingMilieux_MISCELLANEOUS
Abstract

Resume Dans les cancers ovariens, tubaires et peritoneaux primitifs, les personnes âgees ont une surmortalite liee a la maladie plus agressive (NP4), a un sous-traitement chirurgical et chimiotherapique (NP4) et aux comorbidites (NP4). L’âge avance est a risque plus eleve de morbi-mortalite postoperatoire (NP4). La chirurgie est plus souvent incomplete dans cette population âgee (NP4). L’âge avance constitue un facteur de risque de reduction de la dose intensite de la chimiotherapie adjuvante (NP4) et de chimiotherapie incomplete (NP4). Neanmoins, le benefice d’une chirurgie complete reste identique a celui de la population plus jeune (NP2). L’environnement chirurgical a un impact significatif sur la morbi-mortalite perioperatoire, le taux de cytoreduction complete et la survie globale (NP4). L’evaluation fonctionnelle preoperatoire permet d’identifier les patientes a risque de complications postoperatoires (NP4). Le risque perioperatoire depend de trois variables, le score ASA, l’âge et le score de complexite de la chirurgie (NP4). Il est recommande de realiser la chirurgie de cytoreduction dans un centre realisant plus de 20 chirurgies pour cancer avance par an (grade C) et sur la base d’une expertise geriatrique analysant les performances fonctionnelles et physiques (grade C). Sous reserve des comorbidites et de la possibilite d’une chirurgie complete, il est recommande de realiser une chirurgie complete chez les personnes âgees (Grade B). La balance benefices/risques de la chirurgie doit etre evaluee au cas par cas pour les populations les plus a risque (NP4) definies par : (i) âge ≥ 80 ans, en particulier si albuminemie ≤ 37 g/L ; (ii) âge ≥ 75 ans et stade FIGO IV ;(iii) âge ≥ 75 ans, stade FIGO III et ≥ 1 comorbidite. Il est recommande une evaluation onco-geriatrique avant la prise en charge d’une personne âgee atteinte d’un cancer de l’ovaire, tubaire ou peritoneal primitif (grade C). Le score GVS (Geriatric Vulnerability Score) permet d’identifier les patientes âgees vulnerables (NP2). Chez les patientes âgees non vulnerables, il est recommande de realiser une chimiotherapie intraveineuse identique a celle des patientes plus jeunes (i.e. bitherapie a base de sels de platine) (grade B). Chez les patientes âgees vulnerables, differents protocoles de chimiotherapies adaptees ont ete evalues de maniere prospective dans le cadre d’essais non comparatifs, et semblent realisables au prix de toxicites specifiques et non specifiques : carboplatine en monotherapie (NP2), carboplatine AUC2 + paclitaxel 60 mg/m2 3 semaines/4 (NP2), carboplatine AUC 4-5 + paclitaxel 135 mg/m2/3 semaines (NP2), carboplatine AUC5/3 semaines + paclitaxel 60 mg/m2/semaine (NP3). En l’absence de donnees comparatives, aucune recommandation ne peut etre formulee dans cette population. La chimiotherapie premiere diminue la complexite du geste operatoire et la morbi-mortalite perioperatoire lors de la chirurgie d’intervalle (NP1). Elle est une bonne alternative apres 70 ans en cas de comorbidites et/ou de carcinose peritoneale etendue necessitant une chirurgie initiale complexe (NP4).

Published
2019
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12. Partie 2 rédigée à partir de la synthèse de la recommandation nationale de bonnes pratiques cliniques intitulée « Conduites à tenir initiales devant des patientes atteintes d’un cancer épithélial de l’ovaire » élaborée par FRANCOGYN, CNGOF, SFOG, GINECO-ARCAGY et labélisée par l’INCa. (Traitement systémique et intrapéritonéal, personnes âgées, préservation de la fertilité et suivi)

Author

Sofiane Bendifallah, Fabrice Narducci, P. Alfonsi, Isabelle Thomassin-Naggara, Laurence Gladieff, Mojgan Devouassoux-Shisheboran, Claire Falandry, Alexandra Leary, L. Ouldamer, F Guyon, C. Bourgin, François Planchamp, Laure Fournier, Vincent Lavoué, Francis Bonnet, Cherif Akladios, Naoual Bakrin, Chantal Touboul, C. Sénéchal-Davin, Marie-Aude Lefrère-Belda, Fabrice Lecuru, Nicolas Pouget, Blandine Courbiere, Catherine Uzan, François Golfier, Nathalie Chabbert-Buffet, T. de la Motte Rouge, I. Ray-Coquard, P. Collinet, Benoit You, Pierre-Adrien Bolze, Eric Lambaudie, Eric Leblanc, Christine Rousset-Jablonski, Emile Daraï, Cyrille Huchon, Patricia Pautier, A. Lemoine, Sebastien Gouy, G. Ferron, Marcos Ballester, 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), Risques cliniques et sécurité en santé des femmes et en santé périnatale (RISCQ), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), 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 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), CRLCC Eugène Marquis (CRLCC), Institut Claudius Regaud, Institut Gustave Roussy (IGR), Département de chirurgie gynécologique [Gustave Roussy], 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 de Lille-UNICANCER, Institut Curie [Paris], Centre Léon Bérard [Lyon], 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), 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), and Université Lille Nord de France (COMUE)-UNICANCER

Subjects
medicine.medical_specialty, Intra peritoneal, Bevacizumab, endocrine system diseases, Adjuvant chemotherapy, medicine.medical_treatment, Cancer de l’ovaire, [SDV.CAN]Life Sciences [q-bio]/Cancer, Cancer du péritoine primitif, Olaparib, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Medicine, Cancer de la trompe, Stage (cooking), Chirurgie, Gynecology, Chemotherapy, 030219 obstetrics & reproductive medicine, business.industry, Obstetrics and Gynecology, Carboplatin, female genital diseases and pregnancy complications, 3. Good health, Reproductive Medicine, chemistry, 030220 oncology & carcinogenesis, business, Stage iv, Chimiothérapie, medicine.drug
Abstract

National audience; Adjuvant chemotherapy with carboplatin and paclitaxel is recommended for all high-grade ovarian or Fallopian tube cancers, stage FIGO I-IIA (grade A). 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). For BRCA mutated patient, Olaparib is recommended (grade B).

Published
2019
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13. 50P Early breast cancer in women aged 35 years or younger: A French population-based case control-matched analysis

Author

C. Faure, Monique Cohen, M.-P. Chauvet, G. Houvenaeghel, A. De Nonneville, P. Guimbergues, J-M Classe, Eva Jouve, A.-S. Azuar, A. Gonçalves, Chafika Mazouni, O. Dufour, Emile Daraï, 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), Institut Paoli-Calmettes, Fédération nationale des Centres de lutte contre le Cancer (FNCLCC), CRLCC René Gauducheau, Hôpital Guillaume-et-René-Laennec [Saint-Herblain], Centre Léon Bérard [Lyon], Institut Gustave Roussy (IGR), Département de chirurgie gynécologique [Gustave Roussy], Centre Régional de Lutte contre le Cancer Oscar Lambret [Lille] (UNICANCER/Lille), Université de Lille-UNICANCER, Institut Claudius Regaud, CHU Tenon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Hopital de Grasse, Centre Jean Perrin [Clermont-Ferrand] (UNICANCER/CJP), and UNICANCER

Subjects
Pediatrics, medicine.medical_specialty, Oncology, business.industry, Medicine, [SDV.CAN]Life Sciences [q-bio]/Cancer, Hematology, Population based, business, Early breast cancer
Abstract

International audience; BackgroundThere is a scarcity of data exploring prognostic factors in young patients with breast cancer (BC), and the independent negative impact of age by itself is still debated. We aimed to assess shared and intrinsic prognostic factors in a large cohort of patients aged 35 years or younger, compared to a control group aged from 36 to 50.MethodsPatients ≤50 years old were retrospectively identified from a large cohort of 23 134 early BC patients who underwent primary surgery in 18 academic centers between 1990 and 2014. Multivariate Cox analysis aiming to identify factors associated with disease-free and overall survival (DFS and OS) were built for the total cohort, and then for the ≤35 years cohort only. To further assess the independent impact of age on DFS and OS, 1 to 3 case control analysis was performed by matching ≤35 and 36 to 50 according to histology, grade, tumor size, lymphovascular invasion (LVI), nodal status, endocrine receptors (ER), endocrine therapy (ET) and chemotherapy (CT).ResultsOn 6 481 patients included, 556 were aged ≤35 years, and 5 925 from 36 to 50. Compared to the 36-50 group, age ≤35 was significantly associated with larger tumors, higher grade, ER negativity, macroscopic lymph node involvement, LVI, and higher rates of mastectomy and chemotherapy use. In multivariate analysis, age ≤35 was associated with worse DFS (HR 1.59, 95% CI 1.35-1.88; p

Published
2021
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14. 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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15. Prospective Assessment of First-Year Quality of Life After Pelvic Exenteration for Gynecologic Malignancy: A French Multicentric Study

Author

G. Ferron, P. Morice, Frédéric Marchal, I. Jaffré, Michel Rivoire, Eric Lambaudie, G. Houvenaeghel, Denis Querleu, Eberhard Stoeckle, F. Foucher, Pierre Meeus, Sebastien Gouy, Thomas Filleron, J-M Classe, Pierre-Emmanuel Colombo, N. Chopin, Vincent Lavoué, Fabrice Narducci, Jean Levêque, Eva Jouve, Philippe Rouanet, Frédéric Guyon, Alejandra Martinez, J. L. Verheaghe, Eric Leblanc, A. Mourregot, Institut Claudius Regaud, Centre de Recherches en Cancérologie de Toulouse (CRCT), Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT)-Université de Toulouse (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), CRLCC Val d'Aurelle - Paul Lamarque, Centre Léon Bérard [Lyon], Institut Paoli-Calmettes, Fédération nationale des Centres de lutte contre le Cancer (FNCLCC), Institut de Cancérologie de l'Ouest [Angers/Nantes] (UNICANCER/ICO), UNICANCER, CHU Pontchaillou [Rennes], Centre Régional de Lutte contre le Cancer Oscar Lambret [Lille] (UNICANCER/Lille), Université de Lille-UNICANCER, Département de chirurgie gynécologique [Gustave Roussy], Institut Gustave Roussy (IGR), Institut Bergonié [Bordeaux], Institut de Cancérologie de Lorraine - Alexis Vautrin [Nancy] (UNICANCER/ICL), 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), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Université Lille Nord de France (COMUE)-UNICANCER, CRLCC Institut Claudius Regaud, Institut de cancérologie de l'Ouest - Nantes (ICO Nantes), CRLCC Paul Papin-CRLCC René Gauducheau, CRLCC Oscar Lambret, Institut Bergonié - CRLCC Bordeaux, and Institut de Cancérologie de Lorraine - Alexis Vautrin (ICL)

Subjects
medicine.medical_treatment, 0302 clinical medicine, MESH: Pelvic Exenteration, MESH: Genital Neoplasms, Female, Quality of life, Surgical oncology, MESH: Postoperative Period, Surveys and Questionnaires, Medicine, Postoperative Period, Prospective Studies, Prospective cohort study, MESH: Aged, 030219 obstetrics & reproductive medicine, MESH: Middle Aged, MESH: Follow-Up Studies, Middle Aged, Prognosis, humanities, 3. Good health, Oncology, 030220 oncology & carcinogenesis, Female, medicine.symptom, Psychosocial, Adult, medicine.medical_specialty, Genital Neoplasms, Female, [SDV.CAN]Life Sciences [q-bio]/Cancer, Anorexia, MESH: Prognosis, 03 medical and health sciences, Body Image, Humans, MESH: Surveys and Questionnaires, MESH: Body Image, Aged, MESH: Humans, Pelvic exenteration, business.industry, General surgery, MESH: Quality of Life, MESH: Adult, MESH: Prospective Studies, Pelvic Exenteration, Surgery, Gynecologic malignancy, Quality of Life, Sexual function, business, MESH: Female, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, Follow-Up Studies
Abstract

International audience; BACKGROUND:Pelvic exenteration remains one of the most mutilating procedures, with important postoperative morbidity, an altered body image, and long-term physical and psychosocial concerns. This study aimed to assess quality of life (QOL) during the first year after pelvic exenteration for gynecologic malignancy performed with curative intent.METHODS:A French multicentric prospective study was performed by including patients who underwent pelvic exenteration. Quality of life by measurement of functional and symptom scales was assessed using the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 (version 3.0) and the EORTC QLQ-OV28 questionnaires before surgery, at baseline, and 1, 3, 6, and 12 months after the procedure.RESULTS:The study enrolled 97 patients. Quality of life including physical, personal, fatigue, and anorexia reported in the QLQ-C30 was significantly reduced 1 month postoperatively and improved at least to baseline level 1 year after the procedure. Body image also was significantly reduced 1 month postoperatively. Global health, emotional, dyspnea, and anorexia items were significantly improved 1 year after surgery compared with baseline values. Unlike younger patients, elderly patients did not regain physical and social activities after pelvic exenteration.CONCLUSIONS:Therapeutic decision on performing a pelvic exenteration can have a severe and permanent impact on all aspects of patients' QOL. Deterioration of QOL was most significant during the first 3 months after surgery. Elderly patients were the only group of patients with permanent decreased physical and social function. Preoperative evaluation and postoperative follow-up evaluation should include health-related QOL instruments, counseling by a multidisciplinary team to cover all aspects concerning stoma care, sexual function, and long-term concerns after surgery.

Published
2018
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16. 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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17. 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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18. [Nodal strategies: A constant evolution of ideas].

Author

Evrard S and Morice P

Subjects
Humans, Lymph Node Excision, Neoplasm Staging, Programmed Cell Death 1 Receptor physiology, Sentinel Lymph Node Biopsy, Tumor Escape, Lymph Nodes surgery, Lymphatic Metastasis diagnosis, Lymphatic Metastasis physiopathology
Published
2020
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