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Pancreatic ductal adenocarcinoma (PAC) is a highly heterogeneous and plastic tumor with different transcriptomic molecular subtypes that hold great prognostic and theranostic values. We developed PACpAInt, a multistep approach using deep learning models to determine tumor cell type and their molecular phenotype on routine histological preparation at a resolution enabling to decipher complete intratumor heterogeneity on a massive scale never achieved before. PACpAInt effectively identified molecular subtypes at the slide level in three validation cohorts and had an independent prognostic value. It identified an interslide heterogeneity within a case in 39% of tumors that impacted survival. Diving at the cell level, PACpAInt identified “pure” classical and basal-like main subtypes as well as an intermediary phenotype and hybrid tumors that co-carried both classical and basal-like phenotypes. These novel artificial intelligence-based subtypes, together with the proportion of basal-like cells within a tumor had a strong prognostic impact.

Resume La prise en charge des malades ayant une tumeur neuroendocrine pancreatique (TNEP) sporadique est multidisciplinaire et souvent multimodale. Le traitement chirurgical a une place centrale car il est le seul traitement potentiellement curatif si la resection est complete. Cette mise au point porte sur les indications operatoires et les differentes techniques chirurgicales (dont la chirurgie d’epargne parenchymateuse) disponibles pour traiter la lesion pancreatique primitive en fonction du terrain, des donnees du bilan preoperatoire, et de l’existence ou non d’une secretion. La place de la surveillance en cas de « petite » TNEP sporadique non fonctionnelle est egalement discutee.

Purpose To compare morphological imaging features and CT texture histogram parameters between grade 3 pancreatic neuroendocrine tumors (G3-NET) and neuroendocrine carcinomas (NEC). Materials and methods Patients with pathologically proven G3-NET and NEC, according to the 2017 World Health Organization classification who had CT and MRI examinations between 2006-2017 were retrospectively included. CT and MRI examinations were reviewed by two radiologists in consensus and analyzed with respect to tumor size, enhancement patterns, hemorrhagic content, liver metastases and lymphadenopathies. Texture histogram analysis of tumors was performed on arterial and portal phase CT images. images. Morphological imaging features and CT texture histogram parameters of G3-NETs and NECs were compared. Results Thirty-seven patients (21 men, 16 women; mean age, 56 ± 13 [SD] years [range: 28-82 years]) with 37 tumors (mean diameter, 60 ± 46 [SD] mm) were included (CT available for all, MRI for 16/37, 43%). Twenty-three patients (23/37; 62%) had NEC and 14 patients (14/37; 38%) had G3-NET. NECs were larger than G3-NETs (mean, 70 ± 51 [SD] mm [range: 18 - 196 mm] vs. 42 ± 24 [SD] mm [range: 8 - 94 mm], respectively; P = 0.039), with more tumor necrosis (75% vs. 33%, respectively; P = 0.030) and lower attenuation on precontrast (30 ± 4 [SD] HU [range: 25-39 HU] vs. 37 ± 6 [SD] [range: 25-45 HU], respectively; P = 0.002) and on portal venous phase CT images (75 ± 18 [SD] HU [range: 43 - 108 HU] vs. 92 ± 19 [SD] HU [range: 46 - 117 HU], respectively; P = 0.014). Hemorrhagic content on MRI was only observed in NEC (P = 0.007). The mean ADC value was lower in NEC ([1.1 ± 0.1 (SD)] × 10−3 mm2/s [range: (0.91 - 1.3) × 10−3 mm2/s] vs. [1.4 ± 0.2 (SD)] × 10−3 mm2/s [range: (1.1 - 1.6) × 10−3 mm2/s]; P = 0.005). CT histogram analysis showed that NEC were more heterogeneous on portal venous phase images (Entropy-0: 4.7 ± 0.2 [SD] [range: 4.2-5.1] vs. 4.5 ± 0.4 [SD] [range: 3.7-4.9]; P = 0.023). Conclusion Pancreatic NECs are larger, more frequently hypoattenuating and more heterogeneous with hemorrhagic content than G3-NET on CT and MRI.

Resume La prise en charge des malades ayant une tumeur neuroendocrine pancreatique (TNEP), secretante ou non, est multidisciplinaire et souvent multimodale. Le traitement chirurgical y a une place centrale car il est le seul traitement potentiellement curateur si la resection est complete. Choisir le projet therapeutique pour une TNEP implique de localiser precisement la tumeur primitive qui est parfois multiple en cas de predisposition genetique, de confirmer le diagnostic de TNEP, de rechercher des metastases principalement hepatiques, et d’en connaitre les principaux facteurs histo-pronostiques. Cette mise au point porte sur la classification histologique OMS 2017 et les principales nouveautes du bilan preoperatoire des TNEP en imagerie conventionnelle et isotopique dont le but est non seulement de permettre une cartographie des lesions (primitives et metastatiques) mais aussi probablement d'en predire l’agressivite.

Un traitement endoscopique est possible pour les tumeurs neuroendocrines (TNE) gastriques, duodenoampullaires et rectales. Il est reserve aux TNE qui sont resecables en totalite avec des marges saines. Les bons candidats a un tel traitement sont les patients ayant des TNE sans critere de malignite, c’est-a-dire avec un risque ganglionnaire nul ou tres faible. D’une maniere generale, il s’agit des TNE bien differenciees, de grade 1 (Ki67 ≤2 %), de stade 1 (T1N0M0) soit envahissant au maximum la sous-muqueuse, de taille ≤10 mm et sans envahissement lymphovasculaire. Quelle que soit la localisation, le bilan d’extension comporte generalement une imagerie en coupes et une echoendoscopie permettant d’eliminer la presence d’adenopathies regionales suspectes. Une chirurgie radicale avec curage ganglionnaire doit etre discutee en presence de facteurs pronostiques pejoratifs. Les TNE gastriques de type 1 sont petites, multiples, developpees sur hypergastrinemie et benignes. Les plus volumineuses peuvent etre traitees par mucosectomie endoscopique. Les TNE gastriques de type 3 (sporadiques) ont un fort potentiel de malignite et doivent etre traitees par resection chirurgicale radicale. Les TNE duodeno-ampullaires sont un groupe heterogene regroupant des TNE non fonctionnelles, des gastrinomes et des somatostatinomes. Leur traitement endoscopique est indique, en l’absence de facteur de mauvais pronostic, de gastrinome ou de localisation periampullaire. La plupart des TNE rectales

Lumbar incisional hernias (LIH) are a rare wall defect, whose surgical management is challenging because no recommendation exists. Moreover, LIH are frequently associated with flank bulging which should be taken into account during LIH surgical repair. We aimed to describe a cohort of patients operated on for LIH using a homogeneous surgical technique and to report surgical outcomes. The records of all consecutive patients operated on in a specialized surgical center between January 2009 and January 2015 were retrospectively reviewed. The same open technique was performed, i.e., using a mesh into the retroperitoneal space posteriorly, placed with the largest overlap inferiorly and posteriorly, and fixed through the controlateral abdominal wall muscles under strong tension to correct the flank bulging. The cohort included 31 patients, of median age 62, who presented two or more comorbidities in 68% of cases. LIH was recurrent in 45% of patients, and was related to nephrectomy in 61% of patients. The mesh was totally extraperitoneal in 65% of patients. The postoperative mortality rate was null. The rate of specific surgical complications was 32.3%, and the rate of overall postoperative morbidity (Clavien-Dindo classification) was 38.7%. After a median follow-up of 27.5 months, the recurrence rate was 6.5% and 9.7% reported chronic pain. The open approach for LIH repair was safe and enabled treating flank bulging simultaneously in all patients. Due to the paucity of adequate scientific studies, this reproducible open method could help moving toward a standardization of LIH surgical management.

The effect of treatment delay on survival in pancreatic ductal adenocarcinoma (PDAC) remains unclear.This study aimed to assess the prognostic impact of time to diagnosis and chemotherapy in advanced PDAC and factors influencing the time intervals.advanced PDAC patients receiving chemotherapy in five centers in the decade 2007-2016 were included. Key time points during care pathway from clinical presentation to beginning of chemotherapy were retrospectively collected. Multivariate Cox proportional hazard model was performed.A total of 409 patients were included (mean age 66.1 ± 10.3 years; 250 metastatic (61%); 139 received FOLFIRINOX chemotherapy (34%). The median overall survival (OS) was 7.2 months. The median times from first symptoms and from first specialist visit to the beginning of chemotherapy were respectively 100 days and 47 days. None of time intervals was significantly associated with OS. Significant prognostic factors were FOLFIRINOX chemotherapy (HR 0.6 [0.5-0.8]; P 0.001), metastasis (HR 1.6 [1.3-2.0]; P = 0.001), WHO PS ≥ 2 (HR 1.6 [1.2-2.1]; P 0.001) and acute pancreatitis as first symptom (HR 2.9 [1.7-4.9]; P 0.001). Jaundice shortened time to diagnosis (P 0.001). Acute pancreatitis (P 0.001) and diabetes (P = 0.01) increased time to treatment.Wait times from clinical presentation to beginning of chemotherapy do not influence survival in advanced PDAC.

Digestive neuroendocrine tumors (NETs) are a group of rare tumors with increasing incidence. Pathological analysis is critical to establish the diagnosis and evaluate tumor grade that relies on differentiation and proliferation index. NETs are mostly diagnosed at an advanced stage because of late occurrence of nonspecific symptoms, and can be associated with hormone hypersecretion. Chromogranin A is the main biochemical marker of NETs. Extension workup relies on conventional imaging (CT-scan, MRI) and isotopic imaging including somatostatin-receptor scintigraphy, which should be soon replaced by positron-emitting scintigraphy. The main prognostic factors include tumor stage, metastatic volume, histological differentiation and grade. Hormonal syndromes and poorly differentiated tumors are the two therapeutic emergencies. The treatment of localized well-differentiated tumors relies on endoscopic or surgical resection depending on the location and aggressiveness. Surgical removal is the only potentially curative treatment of metastatic NETs but is rarely feasible and is associated with almost constant relapse. Other antitumor therapies include somatostatin analogs, systemic chemotherapy, liver trans-arterial chemo-embolization, targeted therapies and peptide-receptor radionuclide therapy. Management strategy relies on primary tumor location, tumor aggressiveness, metastatic volume and the presence of extra-hepatic metastases. It must take into account the risk of cumulated toxicity in patients whose survival is often prolonged.

Introduction Les metastases osseuses (MO) des tumeurs neuro-endocrines de l’intestin moyen (TNEIM) semblent associees a un pronostic pejoratif et peuvent influencer les decisions therapeutiques. La TEP 18F-DOPA possede une excellente sensibilite de detection des TNEIM et est susceptible de detecter un envahissement metastatique osseux precoce, dont l’impact pronostique est inconnu a ce jour. Notre objectif etait d’evaluer l’impact pronostique de la detection des MO en TEP 18F-DOPA dans les TNEIM. Methodes Tous les patients avec TNEIM bien differenciee metastatique ayant realise au moins une TEP 18F-DOPA dans un centre expert entre juin 2011 et juin 2018 etaient retrospectivement inclus. Les MO etaient definies sur des criteres d’imagerie et classees en micro ou macro-envahissement osseux (micro-EO ou macro-EO) selon l’absence ou la presence de symptomes, leur nombre, leur taille et leur avidite a la 18F-DOPA. Les variables associees aux MO etaient identifiees par regression logistique. Les facteurs pronostiques, dont la presence de MO, etaient explores par des modeles de regression de Cox. Resultats Cent cinquante cinq patients etaient inclus, dont 46 ayant des MO (29,7 %). Un syndrome carcinoide (OR = 2,96, p = 0,009) et ≥ 3 organes metastatiques extra-osseux (OR = 4,99, p = 0,002) etaient significativement associes a la presence de MO. Les MO etaient essentiellement condensantes (78 %), peu symptomatiques (8,9 %) et ont eu un impact therapeutique specifique chez 3 patients (6,5 %). La mediane de survie etait de 78,7 mois (IC95 % 15,3–142,2) dans le groupe MO et non atteinte dans le groupe non MO. La presence de MO (HR = 2,67, p = 0,034), un âge plus eleve (HR = 1,07, p = 0,016) et un Ki67 plus eleve (HR = 1,09, p = 0,025) etaient des facteurs pronostiques independants en analyse multivariee. En comparaison au groupe sans MO, un micro-EO n’etait pas associe a un sur-risque de deces (HR 0,97, p = 0,965), contrairement au macro-EO (HR 1,68, p = 0,034). Conclusion Les MO en TEP 18F-DOPA sont frequentes et surviennent dans un contexte de maladie metastatique avancee. La presence de MO est un facteur pronostique pejoratif independant, en particulier s’il s’agit d’un macro-EO. A l’inverse, la presence d’un micro-EO ne semble pas influencer le pronostic et ne devrait probablement pas influencer la prise en charge therapeutique.

The management of patients with sporadic pancreatic neuroendocrine tumors (PNET) is multi-disciplinary and often, multimodal. Surgery has a large part in treatment because it is the only potentially curative therapeutic modality if resection can be complete. The update reviews the operative indications and the different surgical techniques available (including parenchymal-sparing surgery) to treat the primary lesion according to patient status, preoperative work-up and whether the tumor is functioning or not. The place of observation for "small" non-functional sporadic PNET is also discussed.

Summary The management of patients with pancreatic neuroendocrine tumor (PNET), whether hormonally secretory or not, is multidisciplinary and often multimodal. Surgical treatment plays a central role because complete resection is the only potentially curative treatment. The choice of the therapeutic plan for a PNET requires precise localization of the primary tumor (which may sometimes be multiple in case of genetic predisposition), confirmation of the diagnosis of PNET, a search for metastases (mainly hepatic), and identification of the main histoprognostic factors. This update focuses on the WHO 2017 histological classification and recent innovations in the preoperative assessment of PNET using conventional and isotopic imaging. The aim is to not only allow the mapping of primary and metastatic lesions but also to predict tumor aggressiveness.

Aim To explore the survival impact of primary tumor resection (PTR) in patients with metastatic colon cancer (mCC) and unresectable metastases. Methods We retrospectively studied a multicenter cohort of consecutive mCC patients with unresectable metastases receiving first-line chemotherapy. A weighted Cox proportional regression model was used to balance for clinical variables associated with the probability of undergoing PTR, using inverse probability of treatment weighting (IPTW) based on a propensity score. Results Ninety-six patients were included. PTR was performed in 69 (72%). The rates of secondary resection of metastases ( p = 0.02) and bevacizumab administration ( p = 0.02) were higher in the PTR group. Raw median overall survival (OS) was 23.1 months (95%CI[14.6–27.8]) in the PTR group and 22.1 months (95%CI[12.3–23.7]) in the non-PTR group ( p = 0.11). After adjustment on IPTW, OS was 23.1 months (95%CI[17.0–28.7]) in the PTR group and 17.2 months (95%CI[13.5–22.2]) in the non-PTR group (HR 0.68; 95%CI[0.50–0.93]; p = 0.016). This result remained significant on multivariate analysis (HR 0.71; 95%CI[0.50–1.00]; p = 0.05). Conclusion In mCC patients with unresectable metastases receiving chemotherapy, up-front PTR was independently associated with prolonged OS. Patients eligible for secondary metastases resection and/or bevacizumab may benefit the most from PTR. Randomized controlled trials are mandatory.

Resume Les metastases spleniques surviennent dans moins de 1 % de tous les cancers metastatiques et se produisent souvent dans une maladie disseminee. Lorsque le patient peut etre candidat a un traitement agressif de resection chirurgicale, la splenectomie est souvent realisee comme decrit dans la litterature. Cependant, l’aggravation de la morbidite postoperatoire et de la gravite des infections apres une splenectomie est bien connue. Nous rapportons le cas d’une metastase splenique d’un cancer colorectal traite par radiofrequence sous laparoscopie. Nous avons examine les quelques cas rapportes de metastase de la rate (d’origine colorectale ou non) traitees par ablation thermique : radiofrequence ou micro-ondes. Discussion De nombreuses etudes ont demontre la faisabilite, l’innocuite et l’efficacite de l’ablation thermique dans la pathologie benigne de la rate. Mais seulement quelques cas de tumeurs secondaires spleniques traitees par micro-ondes ou radiofrequence ont ete decrits et aucune complication n’a ete signalee contrastant avec la procedure de splenectomie dont le taux de morbidite est compris entre 15 et 27 %. Conclusion Lorsque le traitement curatif des metastases de la rate est possible, l’ablation thermique par radiofrequence ou micro-ondes semble etre une technique faisable et sure, permettant la conservation de la rate avec un taux de morbidite faible. En raison de ces caracteristiques, l’ablation thermique semble etre une procedure ideale pour la resection de metastase splenique et peut etre un outil indispensable dans l’arsenal de la chirurgie splenique moderne.

Summary Splenic metastases develop in less than 1% of all metastatic cancers, and typically occur in a setting of disseminated disease. When isolated splenic metastasis occurs, the patient may be a candidate for aggressive treatment consisting mainly of splenectomy as described in the literature. However, the increased incidence of post-operative morbidity and severe infection after splenectomy are well known. We report a case of splenic metastasis that developed from colorectal cancer and was treated by laparoscopic-guided radiofrequency ablation. We reviewed the few reported cases of splenic metastasis (from colorectal and other primary cancers) treated by thermal ablation using radiofrequency (RF) or microwave (MW) energy sources. Discussion Many studies have proved that thermal ablation for benign splenic pathology is both feasible and safe with no sacrifice in efficacy. However only a few cases of MW or RF treatment of splenic secondary tumor have been described; no complications have been reported with this treatment in contrast to the 15 to 27% morbidity rate for splenectomy. Conclusion When treatment of splenic metastasis is proposed with curative intent, thermal ablation by RF or by MW seems to be a feasible and safe technique resulting in spleen conservation with a low morbidity rate. Because of these features, thermal ablation seems an ideal treatment modality to obliterate splenic metastasis and may be an indispensable tool in the armamentarium of modern splenic surgery.

Pachydermoperiostosis (PDP) is the primary form of hypertrophic osteoarthropathy. It is a very rare disease consisting of pachydermia, digital clubbing and radiologic periostosis. Various digestive symptoms in PDP are seen in 11–49% of patients and juvenile polyps may be found at gastric endoscopy. We report here the history of a patient with PDP who was referred for assessment of severe anemia. Endoscopy of the upper digestive tract showed multiple polyps of the stomach with two huge lesions exhibiting foci of high-grade dysplasia. This observation suggests that PDP can be considered as a precancerous condition of the stomach and systematic screening using endoscopy should be considered in these patients.

Malignant glucagonoma is an exceptional pancreatic endocrine tumour, with frequent dermatologic symptoms, diabetes and degradation of the general health status. Prognosis is unfavourable when liver metastases are present due to the usual inefficiency of chemotherapy. We report here an observation of a patient who was treated for a glucagonoma with multiple liver metastases, migratory necrolytic erythema, dilated cardiomypathy and diabetes that dramatically improved after a dacarbazin-based chemotherapy, allowing subsequent surgical resection of the primary. The patient was still alive and asymptomatic without progressive disease nearly two years after surgery.

Digestive neuroendocrine tumors (NETs) are a group of rare tumors with increasing incidence. Pathological analysis is critical to establish the diagnosis and evaluate tumor grade that relies on differentiation and proliferation index. NETs are mostly diagnosed at an advanced stage because of late occurrence of nonspecific symptoms, and can be associated with hormone hypersecretion. Chromogranin A is the main biochemical marker of NETs. Extension workup relies on conventional imaging (CT-scan, MRI) and isotopic imaging including somatostatin-receptor scintigraphy, which should be soon replaced by positron-emitting scintigraphy. The main prognostic factors include tumor stage, metastatic volume, histological differentiation and grade. Hormonal syndromes and poorly differentiated tumors are the two therapeutic emergencies. The treatment of localized well-differentiated tumors relies on endoscopic or surgical resection depending on the location and aggressiveness. Surgical removal is the only potentially curative treatment of metastatic NETs but is rarely feasible and is associated with almost constant relapse. Other antitumor therapies include somatostatin analogs, systemic chemotherapy, liver trans-arterial chemo-embolization, targeted therapies and peptide-receptor radionuclide therapy. Management strategy relies on primary tumor location, tumor aggressiveness, metastatic volume and the presence of extra-hepatic metastases. It must take into account the risk of cumulated toxicity in patients whose survival is often prolonged.

We report here the observation of a 60-year-old man who had an autoimmune pancreatitis revealed by a jaundice, in whom an insulin-treated diabetes mellitus, which was diagnosed one month before, completely resolved after the administration of prednisolone given to treat this symptomatic pancreatitis. Neither the symptoms, nor the diabetes have relapsed after a 3-year follow-up.

La frequence du cancer gastrique diminue tous les ans ; il est le quatrieme cancer digestif en France avec environ 6 500 cas et 4 400 deces par an [1]. La Modification de l’incidence est differente selon le type histologique et le site tumoral [2, 3]. Ainsi, l’incidence des cancers bien differencies de type « intestinal » selon Lauren et/ou distaux diminue, alors que celle des cancers de type diffus (a cellules independantes) et/ ou proximaux de la jonction œsogastrique (JOG ou cardia) augmente [2, 3]. La survie globale a 10 ans est de l’ordre de 20 % [2–5]. La plupart des cancers gastriques ne sont pas resecables au moment de leur diagnostic et en cas de resection les recidives sont frequentes. Chez ces patients, le traitement repose sur une polychimiotherapie palliative, permettant une amelioration du taux de reponse tumoral par rapport a une monochimiotherapie mais avec un faible benefice en termes de duree de survie [6, 7]. Une meta-analyse a rapporte que la mediane de survie globale d’un an n’a encore jamais ete atteinte dans les etudes de phase III evaluant les polychimiotherapies [7]. Aucun schema de chimiotherapie ne fait l’objet d’un consensus international. Le choix de la chimiotherapie est fonction de l’etat general de l’âge. Le T esaurus National de Cancerologie Digestive (TNCD) proposait en 2011 comme standard une chimiotherapie a base de fluroropyrimidine (5-fuoro-uracile (5-FU) ou capecitabine) associee a un sel de platine (cisplatine ou oxaliplatine), plus ou moins de l’epirubicine ou du docetaxel chez les patients ayant un bon etat general [8].

We report here the observation of a 60-year-old man who had an autoimmune pancreatitis revealed by a jaundice, in whom an insulin-treated diabetes mellitus, which was diagnosed one month before, completely resolved after the administration of prednisolone given to treat this symptomatic pancreatitis. Neither the symptoms, nor the diabetes have relapsed after a 3-year follow-up.

Malignant glucagonoma is an exceptional pancreatic endocrine tumour, with frequent dermatologic symptoms, diabetes and degradation of the general health status. Prognosis is unfavourable when liver metastases are present due to the usual inefficiency of chemotherapy. We report here an observation of a patient who was treated for a glucagonoma with multiple liver metastases, migratory necrolytic erythema, dilated cardiomypathy and diabetes that dramatically improved after a dacarbazin-based chemotherapy, allowing subsequent surgical resection of the primary. The patient was still alive and asymptomatic without progressive disease nearly two years after surgery.

Background The exposure of pharmacy technicians to antineoplastic agents (AAs) has been widely studied, but less is known about risks of exposure and awareness of nurses, nursing auxiliaries and cleaning personnel. Purpose To evaluate the practise and the awareness of oncology nurses (ONs), nursing auxiliaries (NAs) and cleaning personnel (CP) concerning exposure to AA. Materials and Methods Three questionnaires were distributed to ONs, NAs and CP in three oncology wards including one paediatric ward. Participants were asked 10, 11 and 12 questions respectively about their practises and awareness of exposure to AAs. Results For ONs (n = 38), gloves are more often worn when manipulating syringes than when manipulating infusion bags (60.5% vs. 36.8%, p Conclusions Lack of information suggested the necessity of informing the nursing and cleaning personnel on the oncology ward in some fields. A teaching session was arranged by department. No conflict of interest.

Background Most anticancer drugs bring adverse effects (AEs) occurring during treatment-free intervals (TIs) while the patient is at home. A significant difference exists between AEs that really happen at home and those reported to physicians at the time of the subsequent course. Purpose To set up a comprehensive tool for AE reporting by patients and to assess whether it leads to an improvement in patients’ quality of life. Materials and Methods All consecutive patients treated in a day hospital oncological ward (digestive, thoracic, dermatological and haematology) over four courses of chemotherapy were included. A physician-patient logbook of 14 questions (rated from 1 = absence to 4 = strong) was completed daily during the first and third TIs. A global score was calculated for each course and compared to the results of QLQc30 forms. Results Thirty-four patients were included, with a mean age of 59.9 and a male/female ratio of 1.3. A majority of metastatic diseases (67.6%) had a WHO performance status (PS) score of 0/1 (88.2%). Most frequent AEs during the first TI were eating disorders (1.72 ± 0.11) and pain (1.41 ± 0.08). The daily score progressively decreased over subsequent TIs. Mean global score was 1.31 ± 0.06 and 1.14 ± 0.06 after the first and third TI, respectively. The frequency of all side effects decreased between the first and third courses. Eating disorders (1.28 ± 0.10) and neuropathy (1.23 ± 0.08) were the most frequent AEs in the third TI. Results of QLQc30 forms showed an improvement of the quality of life between the first and fourth courses. Most important improvements concerned nausea/vomiting (respectively score 22.1 to 8.3) and loss of appetite (score 31.4 to 21.2). Conclusions A better awareness of AEs of anti-cancer drugs may improve their management. The use of a logbook could be helpful, as its interpretation may be related to an improvement in the quality of life. No conflict of interest.