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Background Sarcopenia is defined by a loss of skeletal muscle mass with or without loss of fat mass. Sarcopenia has been associated to reduced tolerance to treatment and worse prognosis in cancer patients, including patients undergoing surgery for limited oesophageal cancer. Concomitant chemo-radiotherapy is the standard treatment for locally-advanced tumour, not accessible to surgical resection. Using automated delineation of the skeletal muscle, we have investigated the prognostic value of sarcopenia in locally advanced oesophageal cancer (LAOC) patients treated by curative-intent chemo-radiotherapy. Methods The clinical, nutritional, anthropometric, and functional-imaging (18FDG-PET/CT) data were collected in 97 patients treated between 2006 and 2012 in our institution. The skeletal muscle area was automatically delineated on cross-sectional CT images acquired at the 3rd. lumbar vertebra level and divided by the patient’s squared height (SML3/h2) to obtain the Skeletal Muscle Index (SMI). The primary endpoint was overall survival probability. Results Seventy-six deaths were reported. The median survival time was 27 [95% Confidence Interval 23–40] months for the whole population. Univariate analyses (Cox Proportional Hazard Model) showed decreased survival probabilities in patients with reduced SMI, WHO > 0, Body Mass Index ≤21, and Nutritional Risk Index ≤97.5. Multivariate analyses showed that sarcopenia was the only significant prognostic factor (HR 2.32 [1.24–4.34], p = 0.008). Using Receiver Operating Characteristics curves, the Area Under the Curve (AUC) was 0.73 in males (p = 0.0002], the optimal threshold being 51.5 cm2/m2. In women, the AUC was 0.65 (p = 0.19). Conclusion Sarcopenia is a powerful independent prognostic factor, associated with a rise of the overall mortality in patients treated exclusively by radiochemotherapy for a locally advanced oesophageal cancer. L3 CT images are easily gathered from 18FDG-PET/CT acquisitions.

Objectif de l’etude La prevalence de la denutrition dans les cancers des voies aerodigestives superieures peut empecher la realisation d’une radiotherapie a visee curative. Peu d’etudes ont evalue la correlation entre les volumes d’irradiation et la survenue de toxicite aigue necessitant un recours a une alimentation enterale. L’etude Vol-NECK a evalue l’impact des volumes cible previsionnels sur le recours a une nutrition enterale en cours de radio- ou chimioradiotherapie. Materiel et methode Cette etude prospective unicentrique a inclus 238 patients entre 2015 et 2018. L’ensemble des patients a beneficie d’un protocole nutritionnel avec consultation hebdomadaire et releve de parametres cliniques. Les patients etaient pris en charge par radiotherapie conformationnelle avec modulation d’intensite. Les volumes ciblent previsionnels prophylactiques (50–54 Gy), intermediaires (56–59,4 Gy), hautes doses (60–70 Gy), la somme des volumes cible previsionnels, la dose moyenne dans celle-ci, la dose dans chaque aire ganglionnaire et les organes a risques ont ete analyses. Le critere de jugement principal etait le recours a une sonde nasogastrique en cours de traitement. Resultats Les facteurs ressortant comme statistiquement significatifs pour la pose de sonde nasogastrique etaient la localisation (p = 0,006), avoir ete d’abord opere (p Conclusion Cette etude prospective analysant 238 patients confirme l’importance des volumes traites sur le risque de toxicite. Cela doit permettre d’adapter les recommandations nutritionnelles aux modalites de la radiotherapie.

Ductal carcinoma in situ is defined as breast cancer confined to the ducts of the breast without evidence of penetration of the basement membrane. Local treatment quality represents one of the most prognostic factors as half of recurrences are invasive diseases. The main goal of adjuvant radiotherapy after conservative surgery is to decrease local recurrences and to permit breast conservation with low treatment-induced sequelae. Several randomized trials have established the impact of 50 Gy to the whole breast in terms of local control. Nevertheless, no randomized trial is still available concerning the role of the boost in this disease. In this review, we present updated results of the literature and we detail the French multicentric randomized trial evaluating the impact of a 16 Gy boost after 50 Gy delivered to the whole breast in 25 fractions and 33 days. This protocol will start inclusions in October 2008.

Background Lobular carcinomas in situ (LCIS) represent 1-2% of all breast cancers. Both significance and treatment remain widely debated, as well as the possible similarities with DCIS. Materials and methods Two hundred patients with pure LCIS were retrospectively analyzed in seven centres from 1990 to 2008. Median age was 52 years; 176 patients underwent breast-conserving surgery (BCS) and 24 mastectomy. Seventeen patients received whole breast irradiation (WBRT) after BCS and 20 hormonal treatment (15 by tamoxifen). Results With a 144-month median follow-up (FU), there were no local recurrences (LR) among 24 patients treated by mastectomy. With the same FU, 3 late LR out of 17 (17%) occurred in patients treated by BCS and WBRT (with no LR at 10 years). Among 159 patients treated by BCS alone, 20 developed LR (13%), but with only a 72-month FU (17.5% at 10 years). No specific LR risk factors were identified. Three patients developed metastases, two after invasive LR; 22 patients (11%) developed contralateral BC (59% invasive) and another five had second cancer. Conclusions LCIS is not always an indolent disease. The long-term outcome is quite similar to most ductal carcinomas in situ (DCIS). The main problems are the accuracy of pathological definition and a clear identification of more aggressive subtypes, in order to avoid further invasive LR. BCS + WBRT should be discussed in some selected cases, and the long-term results seem comparable to DCIS.

La recherche des liens entre les facteurs psychosociologiques et le cancer, tant en ce qui concerne l’etiologie de cette maladie que sa prise en charge et son evolution, n’a pas pour l’instant permis d’obtenir de resultats franchement significatifs, et ce malgre l’importance des efforts fournis. Cet article passe en revue les principales conclusions, mais, contrairement aux avis sceptiques qui prevalent dans la litterature medicale, il vise a degager les pistes qui restent a explorer et qui demeurent prometteuses. Parmi elles, des recherches epidemiologiques chez l’enfant sont necessaires, relativement aux evenements de vie propres a cette tranche d’âge et en utilisant une approche systemique. Outre la survie, le confort et la qualite de vie et certaines caracteristiques comme l’anxiete, la depression et le coping, de nouveaux objectifs devraient etre envisages pour evaluer l’impact des psychotherapies sur le cancer, entre autres en etudiant les variations des marqueurs principaux de l’immunite, des rythmes circadiens biologiques, du sommeil ou du cycle activite/repos. Les therapies de groupe semblent avoir un effet principalement en raison des informations (medicales ou autres) dont elles permettent la communication, mais leur efficacite reste discutee. De nouveaux types d’intervention psychosociale devraient donc etre introduits dans les essais, en raison de leurs effets rapides, dont certains prouves sur l’immunite: par exemple l’hypnose. La psychologie clinique semble aussi bien adaptee a ce type d’etude. Les enfants, sous reserve d’une ethique satisfaisante, paraissent une cible privilegiee pour les recherches a venir, mais les essais doivent continuer a inclure des patients de tous âges et, ce, quels que soient le stade et le type de leur maladie. Enfin, sur le plan purement statistique, les analyses multivariees ont tendance a evincer les facteurs psychologiques quand leur pathogeneicite provient de conduites a risque (tabagisme, alcoolisme…) qu’ils favorisent. Les conclusions attribuant la responsabilite des cancers a ces seuls derniers facteurs (tabac, alcool) sont alors erronees. Au minimum, il faut reaffecter au facteur psychologique le poids de son influence sur l’exposition au carcinogene.

Resume Objectif Cette etude analyse les resultats de la « pratique clinique courante » chez 882 patientes traitees pour un carcinome canalaire in situ (CCIS) pur du sein dans 9 centres de lutte contre le cancer francais entre 1985 et 1995. Methode L’âge median etait de 53 ans ; 177 patientes (20 %) ont eu une mastectomie (M), 190 (22 %) une chirurgie conservatrice seule (CS) et 515 (58 %) une CS avec radiotherapie (CS + RT). Resultats Avec un recul median de 7 ans, les taux de recidive locale (RL) etaient de 2 %, 31 % et 13 % dans les groupes M, CS et CS + RT (p 60 ans (non significatif). Dans le groupe CS + RT, ces taux passent a 33 %, 13 % et 8 % (p Conclusion La mastectomie reste le traitement le plus sur des CCIS, assurant un controle local a 7 ans de 98 %. Dans notre etude, apres CS, la RT diminue tres significativement les taux de RL, avec des chiffres comparables a ceux des essais randomises NSABP B-17 et EORTC 10853. Le benefice de la RT est trouve dans tous les sous-groupes, quels que soient les facteurs cliniques ou histologiques consideres, mais son importance est variable. L’âge inferieur a 40 ans et l’exerese incomplete restent les deux facteurs majeurs de RL.

Resume Objectif Cette etude analyse les resultats de la « pratique clinique courante » chez 882 patientes traitees pour un carcinome canalaire in situ (CCIS) pur du sein dans 9 centres de lutte contre le cancer francais entre 1985 et 1995. Methode L’âge median etait de 53 ans ; 177 patientes (20 %) ont eu une mastectomie (M), 190 (22 %) une chirurgie conservatrice seule (CS) et 515 (58 %) une CS avec radiotherapie (CS + RT). Resultats Avec un recul median de 7 ans, les taux de recidive locale (RL) etaient de 2 %, 31 % et 13 % dans les groupes M, CS et CS + RT (p 60 ans (non significatif). Dans le groupe CS + RT, ces taux passent a 33 %, 13 % et 8 % (p Conclusion La mastectomie reste le traitement le plus sur des CCIS, assurant un controle local a 7 ans de 98 %. Dans notre etude, apres CS, la RT diminue tres significativement les taux de RL, avec des chiffres comparables a ceux des essais randomises NSABP B-17 et EORTC 10853. Le benefice de la RT est trouve dans tous les sous-groupes, quels que soient les facteurs cliniques ou histologiques consideres, mais son importance est variable. L’âge inferieur a 40 ans et l’exerese incomplete restent les deux facteurs majeurs de RL.

Purpose We designed a prospective Phase II clinical trial to evaluate the addition of weekly chemotherapy using Docetaxel during standard radiation therapy in patients with Stages III and IV oropharynx carcinoma. Methods A total of 63 patients have been entered in a Phase II multicenter trial. Radiotherapy delivered, with conventional fractionation, 70 Gy in 35 fractions. Patients received during the period of radiotherapy seven cycles of Docetaxel (20 mg/m 2 each week). Results Radiotherapy compliance was good in respect to total dose, treatment duration, and treatment interruption. The rate of Grade 3 and 4 mucositis was 84%. Grade 3 and 4 skin toxicity occurred in 53% of the patients. Hematologic toxicity was infrequent, with only a 5% rate of Grade 3 or 4 neutropenia. Three-year overall actuarial survival and disease-free survival rates were, respectively, 47% (95% CI=39–68%) and 39% (95% CI=30–57%). The local and regional control rate was 64%. Conclusion The adjunction of weekly Docetaxel to conventional radiotherapy is feasible. Mucositis and skin toxicity were the major acute toxic effects. Therapeutic results were similar to those observed with concomitant chemotherapy using platinum and/or 5-FU. Further trials using Docetaxel in combination with other cytotoxic agents are needed.

Resume Introduction. – Le tamoxifene est un anti-estrogene triphenylethylenique de synthese utilise dans le traitement du cancer du sein. Les effets indesirables de ce medicament derive du diethylstilboestrol proviennent de son action agoniste partielle des estrogenes : ces effets « paradoxaux » concernent essentiellement l’uterus avec une augmentation du risque de cancer de l’endometre. Exegese. – Les auteurs rapportent deux cas cliniques de sarcome uterin survenu chez des femmes menopausees prenant du tamoxifene, a la dose conventionnelle de 20 mg/j depuis 38 et 42 mois, comme traitement hormonal adjuvant d’un cancer du sein. Il sˈagissait d’un leiomyosarcome et d’un sarcome stromal, tous les deux asymptomatiques decouverts lors d’un examen echographique transvaginale systematique. Conclusion. – A cote des nombreux adenocarcinomes endometriaux developpes sous tamoxifene, generalement bien differencies et reveles par des metrorragies, des tumeurs plus rares et plus agressives ont ete ponctuellement observees sans distinction d’un lien etiopathogenique particulier. Les modalites de surveillance du tamoxifene ne font pas encore l’objet d’un consensus. Dans les deux cas presentes ici, le sarcome uterin a ete detecte par echographie en l’absence de metrorragies post-menopausiques. Nous restons partisans d’un examen gynecologique avec echographie endovaginale une fois par an chez les patientes prenant du tamoxifene pour cancer du sein.

Resume Objectif de l'etude Analyse retrospective des resultats de la radiotherapie de l'adenocarcinome non metastatique de la prostate a l'exclusion des complications. Patients et methodes Les 610 cas de stade T1-T2 repertories ont ete traites par irradiation externe dans 19 instituts, entre janvier 1983 et janvier 1988. Le recul moyen etait de 10,4 ans, la moyenne d'âge au debut du traitement de 68,5 ans. Resultats Un controle local a 10 ans a ete obtenu pour 86 % des cancers classes T1-T2 (81,4 % dans le cas des T2). Le taux de rechute metastatique etait a 5 et 10 ans respectivement de 25,3 et 30 % (29 et 38,1 % pour les T2). A 10 ans, 62,4 % des tumeurs de stade T1-T2 n'avaient pas recidive; par ailleurs, le taux de survie globale etait de 45,8 % et celui de survie specifique de 70,5 %; 29,9 % des patients etaient vivants sans signe de recidive. Il y avait une correlation entre le stade (TNM), le grade, le statut ganglionnaire pelvien, le controle tumoral local, la presence d'une obstruction ureterale, et la survie. L'irradiation pelvienne, la dose, l'etalement, le traitement hormonal neoadjuvant et la resection transuretrale n'avaient pas d'influence sur le pronostic. Conclusion Il n'y a pas de difference entre les deux etudes francaises (1975–1982 et 1983–1988) sur le plan du recrutement et du pronostic. Les resultats releves dans la litterature sont voisins des notres. Cette etude souligne l'importance des facteurs de pronostic inherents a la tumeur et au malade.

Fragmentation tests of single carbon fibres embedded in small resin specimens are widely used to compare fibre surface treatments or sizes. A limitation of the test is that the matrix must have a high enough ultimate strain for the multiple fracture process to be fully achieved before specimen fractures. The so-called coaxial geometry was introduced in order to extend the method to low strain-to-failure resin systems. In agreement with the Cox theory of the elastic stress transfer, interposition of a ‘high’-modulus material between the fibre and the resin (the ‘low’-modulus material) results in a shorter fragment length, i.e. a better stress transfer.

The fiber/matrix interaction of high modulus (M40) and intermediate modulus (T800) carbon fibers with a bismaleimide resin has been studied by means of three micromechanical techniques involving a single fiber, namely, fragmentation, Raman spectroscopy, and pullout. A number of chemical treatments aimed at improving the fiber/matrix stress transfer at elevated temperature were tested. The stress transfer proved to be reduced by the temperature in the same way for all interfacial conditions. The limitations to the micromechanical characterization of model composites in temperature are emphasized.

A linear shift of carbon-fibre Raman frequencies is created by strain applied to their molecular structure. The magnitude of this shift is the greater, the better organised is the fibre structure—from −7cm −1 /% for the T800HB intermediate modulus fibre to −11 cm −1 /% for the M40B high modulus fibre. Raman spectroscopy is a useful tool for identifying the different interfacial load transfer types from strain profile observation in single-fibre model composites under tensile loading i.e. fibre debonding with (HMS fibre) or without (M40B fibre) friction, and elastic stress transfer well described by the Cox model. The interfacial shear stress distribution, the possible friction coefficient, and the longitudinal thermal residual strain—found to be smaller than the theoretical value—are derived from the strain profiles.

Objectif de l’etude La sarcopenie est un facteur de pronostic defavorable chez les patients operes pour un cancer de l’œsophage. L’influence de la sarcopenie chez les patients pris en charge par chimioradiotherapie n’a jamais ete rapportee. Materiel et methode Les donnees cliniques, nutritionnelles, anthropometriques et d’imagerie fonctionnelle (TEP-scanographie au fluorodesoxyglucose [FDG]) ont ete collectees chez 98 patients pris en charge par chimioradiotherapie pour un cancer de l’œsophage localement evolue entre 2006 et 2012. La surface musculaire squelettique a ete quantifiee sur une coupe scanographique par la surface musculaire squelettique en L3 divisee par la taille au carre (SML3/t2). La sarcopenie etait definie par une surface musculaire squelettique Resultats La TEP-scanographie etait disponible pour 96 des 98 patients, 50 (52 %) etant sarcopeniques. La duree mediane de survie etait de 22 mois chez les 50 patients sarcopeniques (46 deces, 92 %) contre 58 mois chez les 46 patients non sarcopeniques (30 deces, 65 %, p = 0,0013). La sarcopenie etait le seul facteur de risque de deces significatif en analyse unifactorielle (Hazard Ratio [HR] = 2,06 : intervalle de confiance a 95 % [IC95 % : 1,31–3,25]). Un IMC 10 % (HR = 1,2 ; IC95 % : 0,77–2,01) n’etaient pas significativement associes au risque de deces en analyse univariee factorielle. Conclusion La presence d’une sarcopenie est associee a une augmentation du risque de deces chez les patients traites et pris en charge par chimioradiotherapie pour un cancer de l’œsophage localement evolue.

Summary Three methods, namely microphotoelasticimetry, Raman spectroscopy and surface microgrids, are currently used at ONERA on fibre-reinforced polymers to measure the in-situ fibre or matrix deformation. They provide the materials scientist with valuable indications on the early damage growth. Recent results are given and information about the limitations of the methods are indicated.

The residual thermal stress field in the pull-out specimen is calculated in the case of a high properties thermoset system (carbon-bismaleimide). The calculation is performed within the framework of the linear theory of elasticity by means of a finite element method. The specimen is modelled as a three-phase composite (holder-fibre-matrix). The meniscus which forms at the fibre entry is taken into account in order to provide a realistic stress concentration. The latter is far higher than the matrix strength. Evidence that fibre debonding propagates from the fibre end during cooling is then produced.

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.

The interfacial shear strength τd of two carbon/bismaleimide systems has been measured using the pull-out test at different temperatures in the range 20–250°C. The thermal residual stress field appears to have a great influence on the determination of τd. This is analysed both experimentally, through modifications of the pull-out sample (nature of the holder), and theoretically, by means of a finite element calculation, evidencing the complexity of the pull-out sample. A simple argument is used to identify the contribution of the matrix properties to the temperature evolution of τd.

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.

Ductal carcinoma in situ is defined as breast cancer confined to the ducts of the breast without evidence of penetration of the basement membrane. Local treatment quality represents one of the most prognostic factors as half of recurrences are invasive diseases. The main goal of adjuvant radiotherapy after conservative surgery is to decrease local recurrences and to permit breast conservation with low treatment-induced sequelae. Several randomized trials have established the impact of 50 Gy to the whole breast in terms of local control. Nevertheless, no randomized trial is still available concerning the role of the boost in this disease. In this review, we present updated results of the literature and we detail the French multicentric randomized trial evaluating the impact of a 16 Gy boost after 50 Gy delivered to the whole breast in 25 fractions and 33 days. This protocol will start inclusions in October 2008.

Objectifs Evaluer le controle locoregional et la toxicite apres une radiotherapie conformationnelle avec modulation d’intensite (RCMI) chez les patients pris en charge pour un carcinome du canal anal. Patients et methodes Le controle locoregional ainsi que les toxicites (selon la Common Terminology Criteria for Adverse Events v4.0) ont ete evalues chez 15 patients apres RCMI a visee curative pour un carcinome du canal anal entre juin 2013 et octobre 2014. L’âge median etait de 58 ans (46–87), tous etaient atteints d’un carcinome epidermoide, de stade T2 pour 53 %, et avec une atteinte ganglionnaire pour 47 % (selon la classification de l’UICC de 2009). Onze patients ont recu une chimiotherapie concomitante par 5-fluoro-uracile et mitomycine-C et un par de la capecitabine. La radiotherapie a ete delivree par des faisceaux statiques avec modulation d’intensite dans le pelvis puis completee par une arctherapie volumetrique modulee (RapidArc ® ) dans le volume tumoral. Une RCMI avec boost integre a ete realisee chez une patiente âgee traitee par irradiation exclusive. Les donnees cliniques ont ete recueillies prospectivement informatisee sur le logiciel Crossway. Resultats Trois patients ont eu une interruption de traitement de 15 jours et une patiente une interruption de 30 jours pour alteration de l’etat general, cette derniere ayant ete atteinte de la seule recidive (locale). Les autres patients n’ont ete atteints d’aucune recidive apres un suivi median de 13 mois (5–20 mois). La dose moyenne delivree dans le volume pelvien etait de 46 Gy et celle dans le volume tumoral de 62 Gy. Pour la vessie, la dose moyenne etait de 42,7 Gy, le volume recevant 60 Gy (V60) moyen de 3,8 %. La dose moyenne delivree dans le rectum etait de 59,1 Gy et le V60 de 68,2 %. Une toxicite aigue cutanee est survenue chez huit patients sur 15 (53 %), dans trois cas de grade 1, quatre de grade 2 et un de grade 3. Trois patients sur 15 (20 %) ont souffert d’une toxicite rectale aigue, dans deux cas de grade 1 et un de grade 2, trois patients d’une cystite aigue et un d’une toxicite au grele, dans tous les cas de grade 1. Une toxicite tardive rectale de grade 1 est survenue chez un patient (infecte par le virus de l’immundeficience humaine et ayant recu de multiples injections de collagene perineales). Une patiente a eu une colostomie definitive (recidive locale). Conclusion La RCMI en mode sequentiel (faisceaux statiques avec modulation d’intensite au pelvis puis complement par RapidArc ® dans la tumeur) permet dans les carcinomes du canal anal un excellent taux de controle locoregional avec une toxicite acceptable. Ces resultats doivent etre confirmes avec un recul plus long dans un effectif plus grand.

This study assesses the results of "current clinical practice" among 882 women treated in nine French Cancer Centers from 1985 to 1995 for pure ductal carcinoma in situ (DCIS) of the breast.Median age was 53 years (range 21-87); 177 (20%) patients underwent mastectomy (M), 190 (22%) conservative surgery alone (CS) and 515 (58%) conservative surgery with radiotherapy (CS + RT).The crude 7-year local relapse (LR) rates were 2%, 31% and 13% among the M, CS and CS+RT subgroups (p0.0001). All four LR after M were invasive as well as 31 (52%) out of 59 and 40 (61%) out of 66 in the CS and CS+RT groups. Distant metastases occurred in 1%, 3% and 1% of the three treatment groups. No LR factors were found in the M group. Among women treated with CS, the 7-year LR rates were 36%, 31% and 30% among women aged 40 or less, 41 to 60 and 61 or more (NS). For women treated by CS+RT, the LR rates in these age subgroups were 33%, 13% and 8%, respectively (p0.0001). Patients with negative, positive or uncertain margins had 7-year LR rates of 26%, 56% and 29% respectively if treated with CS (p=0.02) and 11%, 23% and 9% if treated with CS+RT (p=0.0008). RT reduced LR rates by 65% in all histological subgroups, but more particularly in comedocarcinoma and mixed cribriform/papillary subgroups. The 7-year rate of contralateral breast cancer was 7%, identical in all subgroups.Mastectomy remains the safest treatment for women with DCIS, with a 98% 7-year control rate. After conservative surgery, RT reduces very significantly LR rates, according to the NSABP B-17 and EORTC 10853 randomized trial results. The RT benefit is present in all clinical/histological subgroups, but its magnitude varies. Young age (40 years) and incomplete excision are the most important LR risk factors.

To assess the long-term outcome for women with ductal carcinoma in situ of the breast treated in current clinical practice by conservative surgery with or without definitive breast irradiation.We analyzed 705 cases of ductal carcinoma in situ treated between 1985 and 1995 in nine French regional cancer centers; 515 underwent conservative surgery and radiotherapy (CS+RT) and 190 CS alone. The median follow-up was 7 years.The 7-year crude local recurrence (LR) rate was 12.6% (95% confidence interval [CI] 9.4-15.8) and 32.4% (95% CI 25-39.7) for the CS+RT and CS groups, respectively (p0.0001). The respective 10-year results were 18.2% (95% CI 13.3-23) and 43.8% (95% CI 30-57.7). A total of 125 LRs occurred, 66 and 59 in the CS+RT and CS groups, respectively. Invasive or microinvasive LRs occurred in 60.6% and 52% of the cases in the same respective groups. The median time to LR development was 55 and 41 months. Nine (1.7%) and 6 (3.1%) nodal recurrences occurred in the CS+RT and CS groups, respectively. Distant metastases occurred in 1.4% and 3% of the respective groups. Patient age and excision quality (final margin status) were both significantly associated with LR risk in the CS+RT group: the LR rate was 29%, 13%, and 8% among women agedor =40, 41-60, andor =61 years (p0.001). Even in the case of complete excision, we observed a 24% rate of LR (6 of 25) in women40 years. Patients with negative, positive, or uncertain margins had a 7-year crude LR rate of 9.7%, 25.2%, and 12.2%, respectively (p = 0.008). RT reduced the LR rate in all subgroups, especially in those with comedocarcinoma (17% vs. 59% in the CS+RT and CS groups, respectively, p0.0001) and mixed cribriform/papillary tumors (9% vs. 31%, p0.0001). In the multivariate Cox regression model, young age and positive margins remained significant in the CS+RT group (p = 0.00012 and p = 0.016). Finally, the relative LR risk in the CS+RT group compared with the CS group was 0.35 (95% CI 0.25-0.51, p = 0.0001). Subsequent contralateral breast cancer occurred in 7.1% and 7.5% of the patients in the CS+RT and CS groups, respectively.Despite the absence of randomization, our results are extremely consistent with the updated National Surgical Adjuvant Breast Project B17 and European Organization for Research and Treatment of Cancer 10853 trials. We also noted that the LR risk was very high in women40 years and/or in the case of incomplete excision.

Objectif Evaluer Le controle locoregional et la xerostomie tardive de l’arctherapie volumetrique modulee chez les patients atteints d’un cancer des voies aerodigestives superieures. Patients et methodes Nous avons evalue le controle locoregional et la xerostomie tardive, par la classification CTCAE V4 (Common Terminology Criteria for Adverse Events version 4), chez 118 patients atteints d’un cancer des voies aerodigestives superieures traite a visee curative de mai 2012 a mai 2013. L’âge moyen des patients etait de 58 ans (38–82) ; 115 (97,5 %) etaient atteints d’un carcinome epidermoide, 43 de l’oropharynx (36,4 %), 25 de la cavite buccale (21,2 %), 23 du larynx (19,5 %), 16 de l’hypopharynx (13,6 %) et huit d’adenopathies de primitif inconnu (6,8 %) ; trois autres cancers etaient d’une histologie non epidermoide. Cent sept cancers (90,7 %) etaient de stade III ou IV et 11 (9,3 %) de stade I ou II (selon la classification de l’Union internationale contre le cancer de 2009). Quatre-vingt patients (67,8 %) ont ete operes et 91 (77 %) ont recu une chimiotherapie concomitante. L’irradiation etait une RCMI avec boost integre, 70/66 Gy ont ete delivres dans les volumes de haut risque, 59,4 et 54 Gy respectivement dans les volumes de risques intermediaire et faible. Resultats Les patients ont ete suivis 18,3 mois en moyenne (10–20). Aucun patient n’a eu son traitement interrompu plus de 2 jours. Une recidive locoregionale est survenue pour sept patients (5,9 %), six fois dans le volume irradie. Une evolution metastatique est survenue pour 24 patients (20,3 %) La dose moyenne recue par la parotide homolaterale a la lesion etait de 23,3 Gy (20,2–66,6) et par la parotide controlaterale de 19,9 Gy (19,8–33,9 Gy). Trente et un pour cent des patients ne souffraient pas de xerostomie tardive, 38 % d’une xerostomie de grade I, 28,6 % de grade II et 2,4 % de grade III. Conclusion L’arctherapie volumetrique modulee permet d’obtenir un bon taux de controle locoregional avec une xerostomie tardive relativement faible a long terme. Ces resultats devront etre confirmes dans le temps.

Until now, less than 5% of the patients with breast ductal carcinoma in situ (DCIS) have been enrolled in clinical trials. Consequently, we have analysed the results of ‘current practice’ among 716 women treated in eight French Cancer Centres from 1985 to 1992: 441 cases (61.6%) corresponded to impalpable lesions, 92 had a clinical size of less than or equal to 2 cm and 70 from 2 to 5 cm; in 113 cases, the size was unspecified. Median age was 53.2 years (range: 21–87 years). 145 patients underwent mastectomy (RS) and 571 conservative surgery (CS) without (136) or with (435) radiotherapy (CS+RT). The mean histological tumour sizes in these three groups were 25.6, 8.2, 14.8 mm, respectively (P

Tamoxifen--a non steroidal triphenylethyl compound--in addition to having antiestrogenic properties may provoke weak estrogenic effects, the well known "paradoxical effects" on the female genital tractus. Concern has been raised about prolonged tamoxifen treatment and subsequent occurrence of endometrial adenocarcinoma; subsequent attention has been drawn through high risk histologic subtypes including poorly differentiated patterns and uterine sarcomas.We report two cases of uterine sarcoma arising in postmenopausal women taking tamoxifen, 20 mg daily during 38 and 42 months, for breast carcinoma: one leiomyosarcoma and one endometrial stromal sarcoma; both cases were asymptomatic and detected by pelvic sonography.Further studies will be required to establish if there is a relationship between long term tamoxifen exposure and highly aggressive types of cancer of the uterine corpus exhibiting adverse histologic features such as uterine sarcomas. There is no consensus regarding uterine surveillance of women receiving tamoxifen. We advocate an annual gynecologic examination plus imaging by means of transvaginal ultrasonography.

Retrospective analysis of the results of radiotherapy in localized prostatic adenocarcinoma. Complications were excluded.Six-hundred-and-ten T1-T2 adenocarcinomas of the prostate were treated with continuous courses of external beam radiation therapy in 19 participating Institutes between January 1983 and January 1988. The mean follow-up was 10.4 years; the mean age of patients at the beginning of radiotherapy was 68.5 years.A 10-year, local control had been achieved in 86% of T1-T2 (81.4% for T2). The 5- and 10-year metastatic relapse rates were 25.3% and 30% (29% and 38.1% for T2), respectively. At 10 years, 62.4% of T1-T2 were recurrence-free; overall survival rate was 45.8% and cause-specific survival rate was 70.5%; 29.9% of T1-T2 patients were alive and disease-free. T category (TNM), pathologic grade, pelvic lymph node status, local tumor control, and obstructive ureteral symptoms were correlated with survival. The influence of pelvic nodes radiation, dose, overall treatment time, previous endocrine treatment, and transuretral resection was not significant for disease-free survival (alive and disease-free) and other endpoints.There was no difference between the French series (1975-1982 and 1983-1988). The results of the literature are comparable to ours. As far as prognostic factors are concerned, this report provides evidence that the explainable variables which influence survival depend on the tumor and patient status.

A micro-mechanical compressive test has been performed in order to study the compressive behaviour of carbon fibres. Fibre failures have been observed under an optical microscope, and the failure strains of two types of carbon fibres, high-strength and high-modulus, have been measured. Fibre micro-buckling, which takes place before the first fibre failure, has been particularly examined. A micro-mechanical analysis based on the Lee–Harris model [1] has been developed to obtain the stresses and strains in both fibre and matrix. Experimental and analytical results point out the high compressive failure strain of the high strength fibres when compared to the composite failure strain. It is therefore concluded that composite failure in compression is not initiated by fibre failure and can be clearly attributed to a combined fibre-matrix mechanism.

Using electron paramagnetic resonance(EPR) and optical absorption measurements, defect creation is studied in irradiated single crystals of lithium aluminate, γ-LiAlO2. The EPR observations show the presence of several paramagnetic defects in γ-LiAlO2 irradiated with 2.5 MeV electrons at 20 K and X-rays at room temperature. The major defect includes an electron trapped near an aluminium nucleus. Optical absorption measurements show four bands in the spectra of γ-LiAlO2 irradiated with 2.5 MeV electrons at 20 K and with 2 MeV He+ ions at room temperature and 77 K. By analogy with other oxides, the most intense band (at 5.25 eV) may be assigned to F+-centres. With that assumption, a configuration is proposed for the F+-centre consistent with the EPR observations.

Between 1973 and 1982, a selected group of 32 patients with anal canal carcinoma received conservative treatment combining external irradiation and 192Iridium implant in a split course. Survival rates at 3 and 5 years are 78 and 61%, respectively. The overall control rate at the primary site is 75%. Tumor response to external irradiation appears to be the major predicting factor of the primary growth control after subsequent interstitial therapy. Two patients (6%) showed severe radionecrosis. The probability to preserve good anal function is 69%. Interstitial irradiation preceded by an external radiotherapy offers a good alternative in the conservative treatment of anal canal carcinoma.