Carcinosarcomes gynécologiques : revue générale et principes de prise en charge

Carcinosarcoma, also known as mixed mesodermal tumor or malignant mixed Mullerian tumor (MMMT) is a pathological entity combining a sarcomatous and a carcinomatous component. Found in thoracic, digestive, genitourinary, liver or skin locations, the most common location is the female genital tract. In gynecological tumors, carcinosarcoma accounts for about 2-5% of endometrial cancers, and 1% of ovarian cancers. To date, there is no consensus on the therapeutic strategy. It relies mostly on maximum cytoreductive surgery. Adjuvant therapy remains controversial, and few prospective studies investigating its interest. Retrospective studies show the benefits of adjuvant chemotherapy based on platinum in most cases. Radiation therapy has a place in the adjuvant situations of endometrial and cervical carcinosarcoma. A more detailed pathological knowledge, and the use of targeted therapies may be promising in this histological subtype whose prognosis remains very poor. The objective of this study is to present the main principles of carcinosarcoma management in female genital tracts, describing pathological and prognostic features at the same time.     

Les big data,généralités et intégration en radiothérapie

The many advances in data collection computing systems (data collection, database, storage), diagnostic and therapeutic possibilities are responsible for an increase and a diversification of available data. Big data offers the capacities, in the field of health, to accelerate the discoveries and to optimize the management of patients by combining a large volume of data and the creation of therapeutic models. In radiotherapy, the development of big data is attractive because data are very numerous et heterogeneous (demographics, radiomics, genomics, radiogenomics, etc.). The expectation would be to predict the effectiveness and tolerance of radiation therapy. With these new concepts, still at the preliminary stage, it is possible to create a personalized medicine which is always more secure and reliable.     

Spécificités de la prise en charge du CBNPC chez les sujets âgés

Non-small cell lung cancer (NSCLC) is a very common disease of the elderly, and its incidence is expected to increase in Western countries because of the ageing of the population. Despite this, data available to challenge elderly patients with NSCLC are limited compared to younger patients. International recommendations have been published but they are difficult to apply because of the lack of consensual definition of frailties relevant to make decision of treatment and to adapt it. The purpose of this article is to synthesize the published data available to challenge elderly patients with NSCLC at various stages: early, locally advanced and inoperable, and metastatic. We also discuss data about the use of comprehensive geriatric assessment.     

Carcinomes épidermoïdes de l’hypopharynx et du larynx : prise en charge fondée sur les preuves

Squamous cell carcinomas of larynx and hypopharynx can be treated by surgery and/or radiotherapy according to tumor size. For small tumors, the results are similar. For locally advanced tumors, the surgical approach is mutilating and requires a total (pharyngo)laryngectomy. Exclusive chemoradiotherapy has shorow>n its interest at the cost of late sequelae. In order to reduce these effects and mutilation, induction chemotherapy row>ith cisplatin, docetaxel and 5FU for organ preservation becomes the standard treatment but there are no solid studies comparing this approach row>ith the exclusive chemoradiotherapy. And it is not possible to conclude as to the superiority of a scheme in terms of overall survival. ROW>hen chemotherapy is chosen, the modalities of any potentiation of radiation have not been yet established.     

Cancer médullaire de la thyroïde familial isolé

The authors describe the cases of two patients from the same family who presented medullary thyroid carcinoma (MTC). Hormone measurement showed a significantly elevated basal calcitonin. The treatment was total thyroidectomy. Histological findings showed multifocal, bilateral MTC. Direct sequencing identified in both patients a heterozygous germline missense mutation TGC-TTC at codon 634 of exon 11 in the RET gene that causes an animosubstitution of cysteine to phenylalanine. The clinical outcome of the cases is considered to be favourable.     

Critères de prise en charge en médecine physique et de réadaptation et pathologies cancéreuses

Introduction

Physical medicine and rehabilitation (PMR) cares are limited in practice in France. The complexity of treatments and their potential effects on disability, life expectancy, constitute some chronic factors of the cancer diseases. This chronic evolution is more and more indication of PMR interventions to limit deficiency or disability.

Objectives

To present the PMR modalities at different situations of the cancer diseases evolutions.

Methodology

This paper reports the orientation in our outpatient unit, the modalities for cares in PMR, the role of PMR doctors and the different technological or competent needs for cancer patients with deficiency or disability.

Discussion

A new and important reflexion with information, studies and acquired experiences are necessary. Organization of cares, institutions and cooperation must be developed in this specific domain of the rehabilitation for cancer patients with disability.     

Glioblastomes: aspects moléculaires et prise en charge actuelle

Glioblastomas are the kind of malignant gliomas found most frequently in adults. In nearly all glioblastomas there is activation of the receptor tyrosine-kinase pathway and deactivation of the p53 and retinoblastoma tumor suppressor pathways. The methylation status of the MGMT gene promoter is the most importantmolecular prognostic factor and may predict chemosensitivity to alkylating agents. As in other cancers, cancer stem cells have been identified in glioblastomas, where they could be important therapeutic target. Management of glioblastomas involves surgery, radiotherapy and chemotherapy. Concomitant chemoradiotherapy according to Stupp’s regimen is the most important recent therapeutic advance. However, the benefit of chemotherapy for inoperable tumors or in the elderly population remains to be determined. The impact of targeted therapies as part of first line treatment is under evaluation.     

Cancers du col utérin : nouveautés dans la prise en charge en oncologie radiothérapie

During the recent past years, the therapeutic management of locally advanced cervical cancer patients has consistently improved, with the integration of image guided brachytherapy and dose escalation strategies leading to an improvement of local control rates. In parallel, the evolution of external beam radiotherapy techniques and the better control of organs at risk doses in brachytherapy have contributed to decrease the probability of severe normal tissue complication. In case of advanced disease, patients prognosis remains however marked by a high risk of distant failure, and this finding has encouraged the assessment of various research pathways in order to better predict and/or prevent tumor relapse. Major studies are being conducted or have been published, and the place of chemoradiation and brachytherapy has been confirmed as first intent treatment in case of locally advanced disease. Numerous prospective or retrospective data, few of which are reviewed there, have been integrated as part of a strategy aimed at being more and more personalized. Next steps of therapeutic optimization will include the assessment of multiparameters radiological tools, but will also rely on a better understanding of radiobiological pathways involved in local or systemic response to irradiation, and the most promising of those is probably the anti-tumor immune response.     

Cancers de l’ovaire rares : organisation nationale de prise en charge et premiers résultats

Since 2010, under the guidance of INCa, a French Network for Rare Malignant Ovarian Tumours, including three national and twenty regional reference centres bringing together expert clinicians and pathologists, has been set up. Requests from the expert RCP (Multidisciplinary Team Consultation Meeting) and/or the expert histological examination in the rare gynaecological malignant tumours website www.ovaire-rare.org involved 1,265 patients in 2013, including 951 rare malignant ovarian tumours. This tool for managing difficult cases of gynaecological cancer has not only become invaluable for surgeons in their daily practice, but is also an unique database in the world.     

Cancer du sein triple-négatif : caractéristiques histocliniques et moléculaires,prise en charge et perspectives thérapeutiques

Triple-negative breast cancer (TNBC), as defined by the absence of estrogen and progesterone receptor expression, as well as the lack of HER2 overexpression/amplification, corresponds to 15% of breast cancer and represents an aggressive form of the disease. TNBC are frequently confounded with basal subtype in the molecular classification of breast cancer and also share some similarities with BRCA1-mutated tumors. Epidemiological and clinical characteristics are distinct from other subtypes, including a younger age at diagnosis, a higher risk of relapse in spite of increased chemosensitivity, and a higher incidence of lung and brain metastatic relapses. Conventional cytotoxics remain the mainstay of current systemic management but recent evaluation of more targeted therapeutics, including specific cytotoxics (such as the use of platinum salts), PARP and EGFR inhibition, and antiangiogenics have been performed, providing contrasted but rather disappointing results. Recent data indicate that TNBC represent a heterogeneous entity composed of multiple and distinct molecular subtypes, which should deserve specific targeted therapeutics.     

Délais de prise en charge initiale des patients atteints de cancer bronchique traités en radiothérapie

ObjectiveTo describe delays in diagnosis and treatment of lung cancer in patients treated by radiotherapy from the first abnormal imaging to the first day of treatment.Patients and methodsOur retrospective single-center study included all patients treated for primary lung cancer in our center receiving radiotherapy alone or in association to chemotherapy or surgery, between 1st May and 15th September 2011.ResultsWe included 40 patients. Mean age was 65.3 years and sex ratio was 4 (32 males). In 72.5% (n=29) of the cases, the objective of the treatment was palliative. Median delay between the first abnormal imaging to the first day of treatment was 75.5 days (CI 95%[63.6-134.4]). Median diagnostic delay to obtain a pathological proof was 38 days (CI 95%[27.9-100]). Median therapeutic delay to start treatment was 31 days (CI 95%[24.6-38.5]). When considering radiotherapy, median delay between multidisciplinary staff decision and first radiotherapy session was 26 days (CI 95%[22.4-33.3]).ConclusionThe study of the delays in diagnosis and treatment is the first step to reduce them. Detailed analysis helps to propose some measures to improve these delays.