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From the analysis of our series and a review of the literature, we have done a summary of the clinicopathologic patterns and treatment of squamous cell carcinoma of the breast. It usually presents as a large palpable mass in a woman over 50 years old. There are no specific iconographic features, but a relative frequency of presentation as abscess or cyst. The overall and disease-free survivals are worse than other histological types of breast cancer. These neoplasms have a basal-like and triple negative profile and they respond poorly to standard treatment of breast carcinomas. They are usually treated by radical surgery. Optimal chemotherapy regimens is not yet determined and platin based chemotherapy could offer an effective alternative as the developpement of specific targeted therapies (anti Her1) could do.

Background: Lymph node evaluation in the management of DCIS has been completely abandoned as a result of the documented low incidence of nodal metastases ( Trial design: Patients with extensive microcalcifications on mammography and DCIS diagnosed by VAMB treated by mastectomy were included in the study. The SLN procedure was performed and intraoperative evaluation on frozen sections was carried out. If the SLN was positive an ALND was performed during the same intervention. If the SLN procedure failed or was negative an ALND was not performed. Radiography of the mastectomy specimen was performed to assist the pathologist in confirming the DCIS diagnosis, to evaluate the size and to determine concordance rates between initial VAMB diagnosis and histological analyses. Results: Fourteen French cancer centers took part in this protocol over 2 years (May 2008-December 2010). 228 patients were enrolled, including 197 DCIS on VAMB. The SLN was identified in 193 cases (98%) but one case was not documented at histology leaving 192 valid cases for analysis. Distribution of SLN results and histological lesions found on mastectomy specimens in the series ALND was not performed for non-invasive disease and negative SLN (n=114) and invasive or micro-invasive disease and negative SLN (n=51). This meant that ALND was avoided for 67.1% of the patients with invasive disease (51/76, 95%CI[56.5−77.7]), or 26.6% of patients overall (95%CI [20.3−32.8]), whereas these patients would have previously received ALND without the use of the SLN procedure. We observed 39.6% (76/192) of discordance between VAMB results and definitive results from histology analysis after mastectomy across all patients. Conclusions: SLN is a useful procedure for patients with DCIS diagnosed by VAMB treated by mastectomy and presenting extensive microcalcifications on mammography. For patients for whom microinvasive or invasive carcinoma is later identified on the mastectomy specimen, the use of this procedure makes it possible to spare over a quarter of them from ALND and the associated morbidity. Biological analyses are currently underway to determine predictive factors of invasive disease associated with DCIS. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P4-18-02.

Du fait du depistage du cancer du sein generalise en France depuis 2004, les cancers du sein in situ representent 15 a 20 % des nouveaux cancers du sein. Ces recommandations elaborees par l’Institut national du cancer et la Societe francaise de senologie et pathologie mammaire definissent les meilleures strategies de prise enchargede ces lesions. La mammographie et l’echographie bilaterale sont les examens d’imagerie de reference. Les indications de l’IRM mammaire sont limitees. Letraitement de reference des cancers canalaires in situ, quand il est realisable, comporte une tumorectomie et une radiotherapie. Les marges saines doivent etre au minimum de 2 mm. Le curage ganglionnaire n’a pas d’indication, et la place du ganglion sentinelle est precisee. Pour les cancers lobulaires in situ, les recommandations s’appuient sur la classification LIN (OMS 2003). La surveillance recommandee des cancers du sein in situ traites comporte au minimum un examen clinique et une mammographie annuels completes le plus souvent d’une echographie.

PurposeSeveral models have been developed to predict nonsentinel lymph node (non-SN) status in patients with breast cancer with sentinel lymph node (SN) metastasis. The purpose of our investigation was to compare available models in a prospective, multicenter study.Patients and MethodsIn a cohort of 561 positive-SN patients who underwent axillary lymph node dissection, we evaluated the areas under the receiver operating characteristic curves (AUCs), calibration, rates of false negatives (FN), and number of patients in the group at low risk for non-SN calculated from nine models. We also evaluated these parameters in the subgroup of patients with micrometastasis or isolated tumor cells (ITC) in the SN.ResultsAt least one non-SN was metastatic in 147 patients (26.2%). Only two of nine models had an AUC greater than 0.75. Three models were well calibrated. Two models yielded an FN rate less than 5%. Three models were able to assign more than a third of patients in the low-risk group. Overall, the Memorial Sloan-Kettering Cancer Center nomogram and Tenon score outperform other methods for all patients, including the subgroup of patients with only SN micrometastases or ITC.ConclusionOur study suggests that all models do not perform equally, especially for the subgroup of patients with only micrometastasis or ITC in the SN. We point out available evaluation methods to assess their performance and provide guidance for clinical practice.

From March 2003 to April 2004, 77 physicians throughout France prospectively recruited 1289 ductal carcinoma in situ (DCIS) patients and collected data on diagnosis, patient and tumour characteristics, and treatments. Median age was 56 years (range, 30–84). Ductal carcinoma in situ was diagnosed by mammography in 87.6% of patients. Mastectomy, conservative surgery alone (CS) and CS with radiotherapy (CS+RT) were performed in 30.5, 7.8 and 61.7% of patients, respectively. Thus, 89% of patients treated by CS received adjuvant RT. Sentinel node biopsy (SNB) and axillary dissection (AD) were performed in 21.3 and 10.4% of patients, respectively. Hormone therapy was administered to 13.4% of the patients (80% tamoxifen). Median tumour size was 14.5 mm (6, 11 and 35 mm for CS, CS+RT and mastectomy, respectively, P

Contexte La mise a jour de ces recommandations a ete elaboree conjointement par la Federation nationale des centres de lutte contre le cancer (FNCLCC) en partenariat avec les secteurs public, prive et l’Institut national du cancer.

Lobular neoplasia (LN) is a risk factor for bilateral breast cancer without consensus as to its appropriate management. The authors report on a retrospective multi-institutional study concerning 52 patients in whom a diagnosis of LN was made after core needle biopsy (CNB) and who subsequently underwent surgical excision. The excision specimens revealed seven cases of invasive carcinoma and three cases of ductal carcinoma in situ, indicating an underestimation of lesions at CNB in 19% of cases, and in particular in those patients with pleomorphic LN, and when clinical, radiological masses were detected. This lesion is increasingly being diagnosed by CNB due to widespread screening. Follow-up surgical excision should be performed in order to examine the whole lesion in the case of masses or when the histologic specimen reveals a pleomorphic subtype. In other cases, annual mammographic surveillance should be undertaken due to the persistent long-term risk of developing bilateral breast cancer.

Summary Objective To study the prognosis of breast cancer in woman younger than 25 years and to compare it with that of other age groups to identify prognostic and histologic factors specific to this group. Method Retrospective study of all cases of infiltrating ductal carcinoma treated at our hospital from January 1977 through July 2005, examining clinical, histologic, and treatment variables as well as 5-year overall survival and 5-years disease-free survival rates. Results The study included 13 women younger than 25 years at diagnosis. Their average age at diagnosis was 23.3 years (CI=1 year). Time from initial signs of disease until diagnosis averaged 6.6 months (CI=2.5). Clinically, the average tumor size was 28.78 mm (CI=6.06), with 46% classified as T1, 31% as T2 and 23% as T4d. We found 92.3% to be invasive ductal carcinoma, with 30% including an in-situ component; 53.8% were SBR grade 3 and 23% included axillary node invasion. Hormone receptors were present in 61.5% of tumors. During the follow-up period, we observed two deaths (with a 5-year overall survival rate, however, of 91%) and 6 recurrences (5-year disease-free survival: 66.5%). Conclusion Prognosis appears unfavorable among young women (younger than 40 years) with breast cancer. In our series,neither prognosis nor clinical or histologic characteristics differed in the subgroup of very young women (younger than 26 years).

Screening mammography contributes to the improvement of breast carcinoma survival through early detection and treatment of non-palpable lesions. Microcalcifications are of fundamental importance in this process. The percentage of malignant lesions found in biopsies for microcalcifications varies from 10% to 40%. The purpose of this study was to evaluate the relationship between clinical and radiologic records and the presence of malignant breast diseases. To establish the basis for the study, 211 mammographic files showing clustered microcalcifications from 204 women were prospectively reviewed and clinical records were retrospectively drawn. Definitive pathologic analysis was available for all. The value for cancer of each criterion was investigated by univariate and multivariate analyses. A first analysis was performed on the entire population and a second one was performed with stratification on morphologic subgroups. There were 99 malignant lesions (47%). In the entire group, no clinical criterion was significant. In the univariate analysis, five radiologic variables were significant: morphologic type(p0.0001), number of calcifications per cluster(p0.0001), linear or triangular distribution(p0.0002), diameter of the area (p0.01),and number of clusters (p = 0.011). In the multivariate analysis, two criteria remained significant: morphologic type 4 (irregularly punctiform) or 5 (vermicular) microcalcifications(Le Gal's classification) (p0.0001) and diameter of the cluster larger than 25 mm (p = 0.032). In subgroups,in the multivariate analysis, the "age60 years" criterion was statistically significant in the group of regular punctiform microcalcifications (type 2); for irregularly punctiform microcalcifications (type 4), "number of microcalcifications20" was significant. The morphologic features of microcalcifications must be the first criterion evaluated. They permit identification of characteristically benign (annular calcifications) or malignant calcifications (vermicular calcifications). For the remainder of the calcification types, other criteria must be taken into account, and their value vary with (according to) the morphologic aspect. These findings have implications for the management of women with microcalcifications and could help breast specialists make treatment decisions.

Since tamoxifen is widely used in breast cancer treatment and has been proposed for the prevention of breast cancer, its endometrial iatrogenic effects must be carefully examined. We have investigated the association between endometrial cancer and tamoxifen use or other treatments in women treated for breast cancer in a case-control study. Cases of endometrial cancer diagnosed after breast cancer (n = 135) and 467 controls matched for age, year of diagnosis of breast cancer and hospital and survival time with an intact uterus were included. Women who had received tamoxifen were significantly more likely to have endometrial cancer diagnosed than those who had not (crude relative risk = 4.9, p = 0.0001). Univariate and adjusted analyses showed that the risk increased with the length of treatment (p = 0.0001) or the cumulative dose of tamoxifen received (p = 0.0001), irrespective of the daily dose. Women who had undergone pelvic radiotherapy also had a higher risk (crude relative risk = 7.8, p = 0.0001). After adjusting for confounding factors, the risk was higher for tamoxifen users (p = 0.0012), treatment for more than 3 years (all p < 0.03) and pelvic radiotherapy (p = 0.012). Women who had endometrial cancer and had received tamoxifen had more advanced disease and poorer prognosis than those with endometrial cancer who had not received this treatment. Our results suggest a causal role of tamoxifen in endometrial cancer, particularly when used as currently proposed for breast cancer prevention. Pelvic radiotherapy may be an additional iatrogenic factor for women with breast cancer. Endometrial cancers diagnosed in women treated with tamoxifen have poorer prognosis. Women who receive tamoxifen for breast cancer should be offered gynaecological surveillance during and after treatment. A long-term evaluation of the risk-benefit ratio of tamoxifen as a preventive treatment for breast cancer is clearly warranted.

La recherche du ganglion sentinelle (GS) dans les carcinomes canalaires in situ (CCIS) du sein est le plus souvent negative avec 2 % d’atteinte ganglionnaire. Cependant, il n’est pas rare en cas mastectomie realisee dans le cadre d’un CCIS diagnostique par macrobiopsie, de decouvrir sur la piece operatoire un carcinome infiltrant ou micro-infiltrant.

Purpose Ductal carcinoma in situ overall prognosis is excellent, but after breast conserving surgery, with or without radiotherapy, local recurrences can lead to locoregional or distant evolution and death. However, there are few data on optimal local recurrences treatment and long-term impact on survival. Patients and methods This study included 195 women treated from 1985 to 1996 by conservative surgery (CS) or conservative surgery followed by radiotherapy (CS + RT), presenting local recurrences, with a 156-month median follow-up. Results Eighty-two out of 195 (42%) local recurrences were non-invasive (in situ) and 113 (58%) invasive. In situ local recurrence was discovered by mammography in 80.5% of the cases versus 47.5% for invasive local recurrence (P = 0.0001). Salvage mastectomy was used in 53% of the cases after conservative surgery and 75% after conservative surgery followed by radiotherapy. The axillary nodal involvement rates were 11.8% and 25.8% among 17 and 62 patients with in situ and invasive local recurrences. Among 113 patients with invasive local recurrences and 82 with in situ local recurrences, 19 (16.8%) and three (3.6%) developed metastases, respectively. Among invasive local recurrences, comedocarcinoma subtype was highly predictive of subsequent metastases (32% versus 4.4%, P Conclusion Invasive local recurrence after ductal carcinoma in situ treatment could be a dramatic event, fully changing long-term prognosis. Early mammographic local recurrence diagnosis (if possible still at non-invasive stage) seems essential to avoid or minimize metastatic risk. Mastectomy remains the safest option but, in some cases, a new conservative approach could be discussed.

From the analysis of our series and a review of the literature, we have done a summary of the clinicopathologic patterns and treatment of squamous cell carcinoma of the breast. It usually presents as a large palpable mass in a woman over 50 years old. There are no specific iconographic features, but a relative frequency of presentation as abscess or cyst. The overall and disease-free survivals are worse than other histological types of breast cancer. These neoplasms have a basal-like and triple negative profile and they respond poorly to standard treatment of breast carcinomas. They are usually treated by radical surgery. Optimal chemotherapy regimens is not yet determined and platin based chemotherapy could offer an effective alternative as the developpement of specific targeted therapies (anti Her1) could do.

Learning Objectives After completing this course, the reader will be able to: Evaluate the therapeutic impact of hysterectomy after chemoradiation therapy in locally advanced cervical cancer.Evaluate the rate of histologic residual disease in patients with complete clinical and radiologic response after chemoradiation therapy. This article is available for continuing medical education credit at CME.TheOncologist.com Background. Concomitant chemoradiation (CRT) (including brachytherapy) is considered the standard management for stage IB2 or II cervical cancer in many countries. Nevertheless, some of them discuss completion surgery (hysterectomy [HT]) after CRT. The aim of this study was to investigate the therapeutic impact of such surgery. Methods. A randomized trial was opened in France in 2003 to evaluate the interest in HT after CRT. Inclusion criteria were: (a) stage IB2 or II cervical cancer without extrapelvic disease on conventional imaging; (b) pelvic external radiation therapy (45 Gy with or without parametrial or nodal boost) with concomitant cisplatin chemotherapy (40 mg/m2 per week) followed by uterovaginal brachytherapy (15 Gy to the intermediate risk clinical target volume); and (c) complete clinical and radiological response 6–8 weeks after brachytherapy. Patients were randomized between HT (arm A) and no HT (arm B). Unfortunately this trial was closed because of poor accrual: 61 patients were enrolled (in 2003–2006) and are reported on here. Results. Thirty one and 30 patients were enrolled, respectively, in arm A and arm B. Twelve patients recurred (five of them died): respectively, eight and four in arm A and arm B. The 3-year event-free survival rates were 72% (standard error [SE], 9%) and 89% (SE, 6%) (not significant [NS]) in arm A and arm B, respectively. The 3-year overall survival rates were 86% (SE, 6%) and 97% (SE, 3%) (NS) in arm A and arm B, respectively. Conclusions. Results of the current trial seem to suggest that completion HT had no therapeutic impact in patients with clinical and radiological complete response after CRT (but this conclusion is limited by the lack of power).

Background After breast conservative treatment (BCT), young age is a predictive factor for recurrence in patients with Ductal Carcinoma In Situ (DCIS) of the breast. The purpose of this study was to evaluate predictive factors for recurrence and outcomes in these younger women (under 40 years) treated for pure DCIS. Methods From 1974 to 2003, 207 cases were collected in 12 French Cancer Centers. Median age was 36.3 years and median follow-up 160 months. Seventy four (35.8%) underwent mastectomy, 67 (32.4%) lumpectomy alone and 66 (31.9%) lumpectomy plus radiotherapy. Results 37 recurrences occurred (17.8%): 14 (38%) were in situ and 23 (62%) invasive. After BCT, the overall rate of recurrence was 27% (33% in the lumpectomy plus radiotherapy group vs. 21% in the lumpectomy alone group). Comedocarcinoma subtype ( p = 0.004), histological size more than 10 mm ( p = 0.011), necrosis ( p = 0.022) and positive margin status ( p = 0.019) were statistically significant predictive factors for recurrence. The actuarial 15-year rates of local recurrence were 29%, 42% and 37% in the lumpectomy alone, lumpectomy and whole breast radiotherapy and lumpectomy + whole breast radiotherapy with additional boost groups respectively. After recurrence, the 10-year overall survival rate was 67.2%. Conclusion High recurrence rates (mainly invasive) after BCT in young women with DCIS are confirmed. BCT in this subgroup of patients is possible if clear and large margins are obtained, tumor size is under 11 mm and necrosis- and/or comedocarcinoma-free.

Background To prospectively determine the feasibility of sentinel lymph node biopsy (SLNB) in preoperatively diagnosed multiple unilateral synchronous invasive breast cancers. Patients and methods The Interest of Axillary Sentinel Lymph Node Biopsy in Multiple Invasive Breast Cancer (IGASSU) study was a prospective multi-institutional study with initial breast surgery, SLNB, and systematic axillary lymph node dissection (ALND). Patients eligible for the IGASSU study had an operable invasive multiple synchronous tumor (MST), defined as two or more physically separate invasive tumors in the same or different quadrant. Results From 1 March 2006 to 31 August 2007, 216 patients were prospectively included from 16 institutions. Of these patients, 211 were assessable. The SLNB-identified rate was 93.4% (197 of 211). The false-negative rate (FNR) was 13.6% (14 of 103) [95% confidence interval (CI) 7% to 20%], and the accuracy was 92.9% (183 of 197) (95% CI 89% to 96%). In a univariate analysis, tumor location (only external location versus other location) was the only clinicopathological factor influencing the FNR [22% (11%–33%) versus 7% (4%–10%)], even then median aggregate histological tumor size was smaller in external tumors [17 mm (range 12–80 mm) versus 34 mm (range 8–90 mm), P = 0.016]. Conclusion With a FNR of 13.6%, we do not recommend SLNB as a routine procedure for MST, even for small tumor.

International audience; BACKGROUND: Axillary lymph node dissection (ALND) is the standard treatment for patients with sentinel node (SN) metastasis, but most of these patients have negative non-sentinel nodes (non-SN). We have developed a scoring system (the Tenon score) to help identify a subgroup of patients who have a low risk of having non-SN metastases and who may thus forgo ALND. Here we validated the Tenon score in an independent cohort of SN-positive patients. PATIENTS AND METHODS: We tested the accuracy of the Tenon score for predicting non-SN status in a prospective multicenter study of 226 SN-positive breast cancer patients. We calculated the false-negative rate, sensitivity, specificity, and positive (PPV) and negative predictive values (NPV). Receiver operating characteristics (ROC) curves were constructed and the areas under the curve (AUC) were calculated as a measure of discriminatory capacity. RESULTS: At least one non-SN was positive in 63 patients (27.9%). One hundred and twenty (53.1%) of the 226 patients had a Tenon score of 3.5 or less. Among these 120 patients, five had at least one positive non-SN. With a score cut-off of 3.5, the negative predictive value was 95.8% and the false-negative rate was 4.2%. Overall, the Tenon score accurately predicted non-SN status, with an AUC of 0.82 (95% confidence interval, 0.77-0.88). CONCLUSION: In this multicenter study of an independent patient population, the Tenon score was accurate and reproducible for predicting non-SN status in breast cancer patients. The simplicity and reliability of the variables on which the Tenon score is based may be an advantage over other scoring systems.

PurposeThree models have been developed to predict four or more involved axillary lymph nodes (ALNs) in patients with breast cancer with one to three involved sentinel lymph nodes (SLNs). Two scores were developed by Chagpar et al (Louisville scores excluding or including method of detection), and a nomogram was developed by Katz et al. The purpose of our investigation was to compare these models in a prospective, multicenter study.Patients and MethodsOur study involved a cohort of 536 patients having one to three involved SLNs who underwent ALN dissection. We evaluated the area under the receiver operating characteristic curve (AUC), calibration (for the Katz nomogram only), false-negative (FN) rate, and clinical utility of the three models. Results were compared with the optimal logistic regression (OLR) model that was developed from the validation cohort.ResultsAmong the 536 patients, 57 patients (10.6%) had ≥ four involved ALNs. The AUC for the Katz nomogram was 0.84 (95% CI, 0.81 to 0.86). The Louisville score excluding method of detection was 0.75 (95% CI, 0.72 to 0.78). The Louisville score including method of detection was 0.77 (95% CI, 0.74 to 0.79). The FN rates were 2.5% (eight of 321 patients), 1.8% (two of 109 patients), and 0% (zero of 27 patients) for the Katz nomogram and the Louisville scores excluding and including method of detection, respectively. The Katz nomogram was well calibrated. Optimism-corrected bootstrap estimate AUC of the OLR model was 0.86. Using this result as a reasonable target for an external model, the performance of the Katz nomogram was remarkable.ConclusionWe validated the three models for their use in clinical practice. The Katz nomogram outperformed the two other models.

Purpose Predictive factors of non-sentinel lymph node (NSN) involvement at axillary lymph node dissection (ALND) have been studied in the case of sentinel node (SN) involvement, with validation of a nomogram. This nomogram is not accurate for SN micrometastasis. The purpose of our study was to determine a nomogram for predicting the likelihood of NSN involvement in breast cancer patients with a SN micrometastasis. Methods We collated 909 observations of SN micrometastases with additional ALND. Characteristics of the patients, tumours and SN were analysed. Results Involvement of SN was diagnosed 490 times (53.9%) with standard staining (HES) and 419 times solely on immunohistochemical analysis (IHC) (46.1%). NSN invasion was observed in 114 patients (12.5%), whereas 62.3% (71) had only one NSN involved and 37.7% (43) two or more NSN involved. In multivariate analysis, significant predictive factors were: tumour size (pT stage ≤10 mm or >11 and ≤20 or >20 mm [odds ratio (OR) 2.1 and 3.43], micrometastases detected by HES or IHC [OR 1.64], presence or absence of lymphovascular invasion (LVI) [OR 1.76], tumour histological type mixed or not [OR 2.64]. The rate and probability of NSN involvement with the model are given for 24 groups, with a representation by a nomogram. Conclusion One group, corresponding to 10.1% of the patients, was associated with a risk of NSN involvement of less than 5%, and five groups, corresponding to 29.8% of the patients, were associated with a risk ≤10%. Omission of ALND could be proposed with minimal risk for a low probability of NSN involvement.

Purpose To determine the optimal injection path for blue dye and radiocolloid for sentinel lymph node (SLN) biopsy in early breast cancer. Patients and Methods A prospective randomized multicentric study was initiated to compare the peritumoral (PT) injection site to the periareolar (PA) site in 449 patients. Results The detection rate of axillary SLN by lymphoscintigraphy was significantly higher (P = .03) in the PA group (85.2%) than in the PT group (73.2%). Intraoperative detection rate by blue dye and/or gamma probe was similar (99.11%) in both groups. The rate of SLN detection was somewhat higher in the PA group than in the PT group: 95.6% versus 93.8% with blue dye (P = .24) and 98.2% versus 96.0% by probe (P = .16), respectively. The number of SLNs detected by lymphoscintigraphy and by probe was significantly higher in the PA group than in the PT group, 1.5 versus 1.2 (P = .001) and 1.9 versus 1.7 (P = .02). The blue and hot concordance was 95.6% in the PA group and 91.5% in the PT group (P = .08). The mean ex vivo count of the SLN was significantly higher in the PA group than in the PT group (P < .0001). Conclusion This study strongly validates the PA injection technique given the high detection rate (99.1%) of SLN and the high concordance (95.6%) between blue dye and the radiotracer, as well as higher significant ex and in vivo counts, improving SLN probe detection.

Background: In 1993 the French National Federation of Cancer Centres (FNCLCC) initiated the Standards, Options and Recommendations (SOR) project. This is a collaboration between the FNCLCC, the 20 French cancer centres, and specialists from French public universities, general hospitals and private clinics, and some specialists learned societies. The main objective is to develop clinical practice guidelines to improve the quality of health care and the outcome of cancer patients. Materials and methods: The SORs are developed using a methodology based on a literature review and critical appraisal by a multidisciplinary group of experts, with feedback from specialists in cancer care delivery. Results: In 1999, the initial SORs for the management of women with cervical cancer were published. At that time the use of chemoradiotherapy was considered as an option. Since this original publication, five randomised trials comparing chemoradiotherapy with radiotherapy have been published, as well as a systematic review and two other clinical practice guidelines. In the light of this additional evidence, it was decided to update the guidelines on chemoradiotherapy in women with cervical cancer. Conclusion: After selection, critical analysis and integration of new evidence, chemoradiotherapy

The " Standards, Options and Recommendations " (SOR) project, started in 1993, is a collaboration between the Federation of French Cancer Centres (FNCLCC), the 20 French cancer centres, and specialists from French public universities, general hospitals and private clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and the outcome of cancer patients. The methodology is based on a literature review and critical appraisal by a multidisciplinary group of experts, with feedback from specialists in cancer care delivery. Objectives : To update the Standards, Options and Recommendations clinical practice guidelines for the management of ductal carcinoma in situ of the breast (DCIS). Methods : The working group identified the questions requiring up-dating from the previous guideline. Medline(r) and Embase(r) were searched using specific search strategies from year 1996 to year 2003. In addition several Internet sites were searched in October 2002. Results : Clinical guidelines have been defined for the management of diagnosis, treatment, follow-up, and treatment of recurrence of DCIS. The issue of hormone replacement therapy has also been addressed in the context of DCIS.

Objective To examine fertility outcomes and determinants of fertility after conservative surgery for women with borderline ovarian tumors. Design Retrospective multicenter study. Setting Thirteen specialized gynecologic units and one cancer center. Patient(s) In a study of women with borderline ovarian tumors, 162 of 360 women underwent conservative surgery; from these 162, we compared epidemiologic, surgical, and histological parameters between 21 women who conceived and 44 women who failed to conceive. Intervention(s) Conservative surgery for borderline ovarian tumors. Main outcome measure(s) Fertility results and outcome. Result(s) Women undergoing conservative treatment were significantly younger and more likely to be nulliparous. Tumor size was significantly smaller in the conservative treatment group. Thirty pregnancies occurred in 21 (32.3%) of the 65 women who wished to conceive after conservative treatment. Twenty-seven pregnancies were spontaneous, whereas three occurred after ovarian stimulation and IUI (one case) or IVF (2 cases). Women who conceived did not differ from women who did not conceive in terms of the tumor recurrence rate or the mean time to recurrence (39.6 ± 28.2 and 22.9 ± 14.9 months, respectively). Age at initial treatment was the only determinant of fertility. Conclusion(s) Despite a high recurrence rate, our results confirm that conservative surgery for women with borderline ovarian tumors is an acceptable option and that fertility is preserved in nearly one third of cases.

The "Standards, Options and Recommendations" (SOR) project, started in 1993, is a collaboration between the Federation of French Cancer Centers (FNCLCC), the 20 French cancer centers and specialists from French public university and general hospitals and private clinics. Its main objective is the development of clinical practice guidelines to improve the quality of health care and outcome for cancer patients. The methodology is based on literature review and critical appraisal by a multidisciplinary group of experts, with feedback from specialists in cancer care delivery.To develop, according to the definitions of the Standards, Options and Recommendations, clinical practice guidelines for the management of invasive cervical cancer patients. Methods : Data were identified by searching Medline and the personal reference lists of members of the expert groups, then submitted for review to independent reviewers.This is a synthesis of the Standards, Options and Recommendations elaborated by a working group of experts. Pretherapeutic assessment, classification, diagnosis, therapeutic modalities (surgery, radiotherapy, radiochemotherapy, chemotherapy), therapeutic strategies by disease stage and follow-up are covered. Algorithms for the management of patients are also included.

The "Standards, Options and Recommendations" (SOR) project, started in 1993, is a collaboration between the Federation of French Cancer Centers (FNCLCC), the 20 French Cancer Centers, and specialists from French Public Universities, General Hospitals and Private Clinics, and some specialists learned societies. The main objective is the development of clinical practice guidelines to improve the quality of health care and the outcome of cancer patients. The SORs are developed using a methodology based on a literature review and critical appraisal by a multidisciplinary group of experts, with feedback from specialists in cancer care delivery.To develop clinical practice guidelines for the management of patients with carcinoma of the endometrium according to the definitions of the Standards, Options and Recommendations project.Data were identified by searching Medline , web sites, and using the personal reference lists of members of the expert groups. Once the guidelines were defined, the document was submitted for review to 63 independent reviewers.The main recommendations for the management of carcinoma of the endometrium are: 1) The diagnosis of carcinoma of the endometrium is based on biopsy and histological examination. However, as first intention, the first elements for diagnosis can be obtain from a hysterography, or particularly, a endovaginal ultrasound examination. Ultrasound allows locoregional metastases to be detected, the CT scan allows the lymph node involvement to be assessed and magnetic resonance imaging allows the myometrium invasion to be evaluated. 2) For the majority of patients, surgery is the initial treatment, both for localised and advanced-stage carcinomas. The excised sample can be used for pathological analysis and tumour staging, using the FIGO (Fédération internationale de gynécologie obstétrique) classification. Surgery for patients with stage I and II carcinomas involves total extrafascial hysterectomy with bilateral salpingo-oophorectomy., In patients with stage III and IV carcinomas radical surgery should be performed, when possible. If this is not possible, then surgery should be as complete as possible and be associated with a complementary treatment. In patients with the most advanced carcinomas, tumour reduction by surgery should be performed. 3) Complementary treatment includes external-beam radiotherapy and brachytherapy. The decision concerning the extent and type of irradiation should be taken taking into consideration the stage and the prognostic factors present. For patients with stage I and II carcinoma, complementary treatment with brachytherapy can be performed, if the myometrium invasion is not deep, or if the carcinoma is grade 2 or 3. Patients with stage III carcinomas can be treated with pelvic or abdominal-pelvic complementary irradiation. In patients that cannot undergo surgery, exclusive radiotherapy can be performed. 4) In the absence of any symptoms, surveillance should include a general clinical and gynaecological examination. All patients with symptoms should undergo an additional work-up.

Introduction: Controversy remains over whether to perform sentinel lymph node biopsy (SLNB) in multiple (multicentric or multifocal) unilateral synchronous breast cancer. Several small retro- or prospective studies, included pre- or post-operative (or both) multiple synchronous tumours (MST) have suggested that the test performance of SLNB is similar to that seen in unifocal disease. The purpose of this study was to evaluate the feasibility and accuracy of SLNB in preoperatively diagnosed invasive MST.Patients and Methods: The Interest of Axillary SLNB in Multiple Invasive Breast Cancer (IGASSU) study was a prospective multi-institutional study with initial breast surgery, SLNB, and systematic level I to II axillary lymph node dissection (ALND). Patients eligible for the IGASSU study had an operable invasive MST, defined as two or more physically separate invasive tumours in the same or different breast quadrant. The diagnosis of invasive MST was confirmed histologically in all patients by core needle biopsy before surgery. Detection of sentinel node was performed by using either blue patent or radiocolloide injection or both. Injection sites were subareolar.Statistical Analysis: Sensitivity (Se), negative predictive value (NPV), accuracy (A), false negative rate (FNR) and their 95%-confidence intervals (95%CI) were calculated with a classical 2x2 contingency table. A univariate analysis using odds ratio calculation was performed to identify the risk factors for false negative results.Results: Between March 1, 2006, and August 31, 2007, 216 patients were prospectively included from 16 institutions. Of these patients, 211 were evaluable. The SLNB identified rate were 93.4% (197/211). A mean number of 2.2 SLN (range, 1 to 8, ± 1.4) was successfully excised. The mean number of resected nodes in ALND was 12 (range, 1 to 39, ± 5.7). The FNR was 13.6% (14/103) [95%CI: 7- 20%], Se was 86 .4% (89/103) [95%CI: 79- 93%], NPV was 87% (94/108) [95%CI: 80-93%], A was 92.9% (183/197) [95%CI: 89- 96%]. For the 14 false-negative SN, all had ≤ 3 involved nodes in ALND. Table 1 shows patterns of management of the axilla.Table 1 ALND+ALND-Non-identified SLNB113Identified SLNB+4544Identified SLNB-1494 In a univariate analysis, tumour location (only external location vs other location) was the only clinico-pathological factor influencing the FNR (22% [11-33%] vs 7% [4-10%]), even then median aggregate histological tumour size was smaller in external tumours (17mm [range, 12-80] vs 34mm [range, 8- 90], p=0.016).Conclusion: With a FNR of 13.6% (95%CI: 7-20%), we do not recommend SLNB as a routine procedure for multiple unilateral synchronous breast cancer, even for small tumour foci. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 305.