Chimioradiothérapie préopératoire du cancer du rectum : expérience d’un centre

PurposeIn recent decades, the management of rectal cancer has been significantly improved by optimizing the surgical treatment with the total mesorectal excision and the development of neoadjuvant radiotherapy with or without chemotherapy. In this study, we investigated the impact of changes in practice over a period of 15 years in an expert centre.Patients and methodsA monocentric study was conducted retrospectively on cT3-resectable T4 patients who received chemoradiotherapy for a locally advanced rectal adenocarcinoma between 1993 and 2008. We studied sphincter preservation, pathological complete response (ypT0), survival, and toxicities by different concomitant chemotherapy and treatment period.ResultsAmong the 179 patients who had a chemoradiotherapy, 56.4% were received concomitant 5-fluoro-uracil-leucovorin, 28.5% with concomitant capecitabine, and 15.1% with concomitant oxaliplatin and capecitabine. The average dose of radiotherapy was 45 Gy (25 × 1.8 Gy). Five-year disease-free survival was 74.3% and overall survival 68.8%. The rate of local recurrence and distant metastases were 6.1 and 23.6%. In multivariate analysis, concomitant chemotherapy oxaliplatin and capecitabine improved the pathological complete response rate (ypT0; capecitabine: 6%, 5-fluoro-uracil-leucovorin: 10.3%, capecitabine-oxaliplatin: 22.2%), but not significantly (P = 0.12) and with more toxicities, and treatment interruptions. Sphincter preservation rate was not improved significantly during the study period (1993–2004 vs. 2005–2008), but disease-free survival improved from 72.2% up to 87.5% (P = 0.03).ConclusionOur results are consistent with those published in the literature. Concomitant chemotherapy with 5-fluoro-uracil or capecitabine remains the standard scheme. Upfront chemotherapy, before chemoradiotherapy, should be investigated with regard to the predominance of metastasis.     

Évaluation du dépistage des cancers de la femme et du dépistage après 75 ans dans le département de la Loire

In France, there is an important interregional disparity concerning participation to cancer screening programs. The aim of this study was to assess oncologic screening practices in Loire, a French rural department, in women and in the elderly (over age 74 years). For this, two surveys were conducted. The first one was regarding screening for breast, cervical and colorectal cancer in women over age 18 years living in Loire. The second survey was regarding onco-geriatric screening through two questionnaires : one for the elderly and the other for general practitioner (GP) of the department, evaluating screening for breast, colorectal, prostate, cervical and lung cancer. One hundred sixty six women were included in the first investigation mean age of 47.6 years. Ninety three point six per cent were screening for breast cancer, 19% received Human Papilloma virus vaccine, 83.1% were screening by Papanicolau smear for cervical cancer and finally, 51.7% were screening for colorectal cancer, among the one entering screening program criteria. In the second survey, 44 patients and 28 GP were included. Thirty-eight point six per cent of patients over 74 years continue screening. Only 11.4% were reluctant to screening and in 80% because of anxiety du to the results. Among GP, 50 % continued screening on two major criteria : life expectancy and performans status. The present study shows heterogeneity of screening in this department both rural and working class and gives us a societo-medical photography.     

Opportunité d’étendre le programme national de dépistage du cancer du sein aux femmes âgées de 40 à 49 ans

RECOMMANDATIONS DE LANAES

Opportunité détendre le programme national de dépistage du cancer du sein aux femmes âgées de 40 à 49 ansActualisation – Mars 2004     

Modalités actuelles du bilan d’un cancer bronchique

Résumé  Le bilan initial en cas de suspicion de cancer bronchique doit répondre à quatre impératifs: apprécier l’état clinique, obtenir une preuve cyto- ou histologique, définir le cTNM, et en cas de résécabilité, l’opérabilité du patient. En quelques années, les modalités de ce bilan ont connu une révolution. Aujourd’hui, la TEP-TDM devrait être réalisée systématiquement lorsque le patient est traité dans une perspective curative. Les dernières recommandations internationales soulignent la nécessité de documenter l’envahissement médiastinal. Les progrès des techniques dites à l’aiguille (TBNA, EUS et EBUS-TBNA) sont très excitants, mais en cas de résultat négatif l’abord chirurgical reste la référence. L’évaluation fonctionnelle avant résection pulmonaire est aussi abordée.      

Ostéosarcome du maxillaire : à propos d’un cas

Osteosarcoma is a malignant bone tumor; its maxillofacial location is relatively rare. Its diagnosis is based essentially on biopsy. The treatment involves surgery and adjuvant therapy. We report a case of maxillary osteosarcoma and discuss the epidemiology, diagnosis, treatment, and follow-up of this tumor.     

Développement d’un ensemble d’indicateurs relatifs à la prise en charge organisationnelle du cancer du sein

Aims

The objective of the study is to develop a set of quality indicators (QIs) measuring the process of care in breast cancer patients and allowing hospitals comparison.

Procedure

The COMPAQH project has designed and tested a set of QIs, derived from clinical practice guidelines, in partnership with professional bodies. Eight QIs evaluating delays and organization, as well as different steps of the process of care, have been defined.

Results

Test was performed on a panel of 60 volunteer hospitals. Large variations in practice were observed on all QIs, encouraging hospitals to promote quality improvement policies. Some indicators appear as strongly linked to the entire process of care of the patients.

Conclusion

The nationwide implementation of these QIs is dependent on the organization of the process of care, making it difficult their generalization to all the institutions. The extension to the entire process of care should allow to include other items of the process and to evaluate their coordination in the entire pathway.     

Présentation d’un outil d’évaluation du déroulement d’un projet de prise en charge en soins palliatifs et en soins de support

Résumé:  Pour répondre aux besoins complexes et multiples d’une population particulière de ?patients lourds?, la mise à disposition et la coordination de professionnels de santé complémentaires s’organisent à domicile ou dans les services d’hospitalisation. Analyser cette prise en charge recouvre aussi bien sa planification au stade de projet, son repérage et son identification au moment de sa mise en œuvre. Son évaluation qualitative et quantitative d’une part, sa déclaration dans le PMSI et sa valorisation par la T2A en hospitalisation d’autre part, permettent d’espérer et/ou d’adapter au mieux les moyens aux objectifs. Cet article présente un outil de recueil de données, élaboré à partir de travaux préexistants et spécifiquement créés pour évaluer le dé roulement d’un projet de prise en charge en soins palliatifs ou de support. Les informations collectées concernent le projet de chaque personne prise en charge (population concernée, sympt?mes et besoins, objectifs de la structure, projets de vie et de soins, moyens mis en œuvre, activités réalisées) et le projet de la structure. Cet outil, une fois testé et validé, pourrait être adapté par les professionnels de santé impliqués dans ce type de prise en charge.      

Radiothérapie à visée curative du carcinome du canal anal : impact défavorable d’une résection préalable. Étude rétrospective de 57 patients traités en intention curative

PurposeTo describe retrospectively the overall survival, the cancer specific survival and the tumor control in an homogeneous series of patients with epidermoid carcinoma of the anal canal treated with definitive radiotherapy; to assess the impact of brachytherapy, chemotherapy and pre-radiotherapy resection on the risk of recurrence.Patients and methodsFrom 1997 to 2007, 57 patients (pts) presenting with an epidermoid carcinoma of the anal canal (T1: 14, T2: 33, T3-4: 10, N0: 31, N1: 19, N2: 3, N3: 4, M0: 57) were treated with definitive radiotherapy by the same radiation oncologist. The treatment included an external beam irradiation (EBRT) given to the posterior pelvis (45 Gy/25 fractions) and, six weeks later, a boost delivered with interstitial brachytherapy (37/57) or external beam irradiation (20/57). Twelve pts had undergone a surgical resection of the tumour before radiotherapy. A belly board was used for EBRT in 13 pts. A concurrent platinum based chemotherapy was done in 42 pts. The mean follow-up was 57 months.ResultsThe overall survival rate at 5 years was 89% with a cause specific survival of 96%. Five patients recurred (5-year rate: 12%: four had local relapse (5-year rate: 8%), four had groin recurrence, and distant metastases were seen in two. In univariate analysis, the risk of relapse was higher in patients who had undergone a pre-radiation excision (p = 0.018), in those who did not receive chemotherapy (p = 0.076) and in those who were irradiated on a belly board (p = 0.049). In multivariate analysis, a pre-radiotherapy resection (p = 0.084) had an inverse impact on the tumour control reaching the level of statistical significance and the use of a belly board was of marginal influence (p = 0.13).ConclusionRadiotherapy and chemoradiation with cisplatine-based chemotherapy cure a vast majority of patients with epidermoid carcinoma of the anal canal. Therapeutic factors that may interfere with the definition of the target volume and the patients’ repositioning may decrease the efficacy of radiotherapy. Pre-radiotherapy surgical resection should be avoided.     

Étude qualitative des facteurs déclenchants et bioculturels à la participation au dépistage organisé du cancer du sein — Bouches-du-Rhône et Charente

Objectives

To qualitatively investigate sociocultural factors that motivate women to participate in a breast cancer screening campaign.

Methodology

An ethnographic methodology involving participant observation was used. This was adapted for medical research: 50 semi-structured interviews were conducted. They were recorded, completely rewritten and then analysed. In Bouches-du-Rhône (3^rd screening campaign), the 25 women interviewed had not participated in the two previous campaigns. In Charente (1st screening campaign), the 25 women interviewed only participated after receiving a reminder invitation.

Results

If the role of mammography screening is accepted, it does not necessarily result in participation. Reasons for non-participation in the initial invitations were: novelty, social and family restrictions, and the management of concomitant health problems. The media, women’s press, the fear of losing social benefits or the lack of charge for the test were participation factors. The various screening methods are still not integrated. There are cultural and environmental variations. In Bouches-du-Rhône, health professionals and daughter’s opinions have a relevant role. Climatic factors are also involved: not participating previously because of the mistral. In Charente, the sociability network, and invitations on a per district basis resulted in better participation. Public-spiritedness was influential: women only came out of politeness to the association organising the campaign.

Conclusion

Participation decisions are still based on a variety of discussions. The general practitioner, especially in Bouches-du-Rhône, has a strategic role. The receipt of an invitation calls for women to be responsible for their own health. Information and the sociability network allow women to get involved in the liminal phase of a propitiary ritual.     

Valeur diagnostique des microcalcifications ACR3 et ACR4 dans le dépistage du cancer du sein

Objective

To evaluate the risk of cancer associated with ACR3 and ACR4 microcalcifications.

Patients and methods

A retrospective study of 96 out of 5204 patients who underwent mammography was conducted for 5 years (January 2008 to December 2012). We confronted cancer lesions with ACR3 and ACR4 microcalcifications.

Results

Cancer was detected in 201 women,with a prevalence of 3.8%. Among the 96 cases of ACR3 and ACR4 microcalcifications detected, 56 cases (58%) were classified as ACR3, and 40 cases (42%) as ACR4. For all ACR3 and ACR4 microcalcifications, it was noted 30% of them represented cancerous lesions against 70% of benign lesions. The sensitivity (Se) was 14.4%, specificity (Sp) was 98.66 %, positive predictive value (PPV) was 30% and negative predictive value (NPV) was 96.63%. For ACR3 microcalcifications, cancerous lesions represented for 11 against 89% of benign lesions. The Se was 3%, Sp was 99%, PPV was 11% and NPV was 96%. For ACR4 microcalcifications, cancerous lesions were noted in 57.5% against 42.5% of benign lesions. The Se was 11.4%, Sp was 99.6%, PPV was 57.5% and NPV was 96.5%.

Conclusion

In our study, the risk of cancer associated with ACR3 microcalcifications was 11% against 57.5% ACR4 microcalcifications.     

Intervention psycho-éducative pour diminuer la fatigue à la suite d’un cancer du sein: fondements, description du contenu et démarche évaluative

Résumé:   À la fin des traitements médicaux initiaux pour un cancer du sein, la fatigue est le symptôme le plus fréquemment rapporté. Plusieurs facteurs associés au maintien de la fatigue sont connus et certains sont modifiables. Des approches thérapeutiques non pharmacologiques, telles que la modification de certains comportements, sont maintenant recommandées. Le premier but de cet article est de résumer les données provenant des écrits scientifiques qui permettent de mieux comprendre la fatigue secondaire au cancer, la trajectoire évolutive de ce phénomène, les principaux facteurs associés et les pistes dintervention les plus intéressantes. Le second but est de décrire le contenu dune intervention psycho-éducative destinée à des femmes qui ont terminé leurs traitements initiaux pour un cancer du sein ainsi que de décrire la démarche évaluative en cours. Lintervention inclut la gestion de stress et lexercice physique. Cette intervention est présentée sous forme de manuel et peut être administrée selon différents formats et par différents intervenants. Une étude en cours teste le format de groupe, animé par deux infirmières. Les résultats viendront sous peu documenter lefficacité de cette intervention qui pourrait être offerte dans le cadre dun programme de prévention secondaire.Travaux réalisés grâce à une subvention du FRSQ.     

Déterminants moléculaires et génétiques d’efficacité et de toxicité du 5-fluoro-uracile

At the present time, 5-FU remains the standard molecule in the treatment of a large number of solid tumours and is the first choice when it comes to gastrointestinal cancers. A large number of markers, indicators of response and safety, have been described for this molecule and its oral form, capecitabine. Although the number of markers with clinically validated relevance remains low, combining both genetic and molecular research at the patient’s bedside with these markers will provide personalised oncological medicine and aims to improve the efficacy/safety balance for these medicinal products. To this end, and at a time where multicentre studies presenting strong evidence are available, 5-Fluorouracil and other fluoropyrimidines should be seen as the molecules of choice, fully benefiting from the progress being made in the area of biomarker-based medicine.     

Retard diagnostique et thérapeutique du cancer du testicule au Sénégal

Introduction

Testicular cancer is a rare disease in black subjects, by disregarding the diagnosis in some cases. We report three cases diagnosed at a metastatic stage.

Patients and methods

We conducted a retrospective study of three cases of testicular cancer. We collected patient age at diagnosis, circumstances of diagnosis, the rate of tumor markers, pathologic results after resection of the tumor and complementary therapies, and morbidity and mortality. Patients have been described based on the summary of their observations.

Results

The average age of our patients was 28 years. All our patients presented at least once without a testicular cancer diagnosis has been discussed. At the histological level, it was in the three cases of non seminomatous germ cell tumors. There were lymph node metastases in our three patients and visceral involvement in two patients. Two patients out of three died during chemotherapy. The third patient had six cycles of chemotherapy with the protocol bleiomycine, etoposide, cisplatin has. Four months after the end of six treatments, he is in complete remission, thoracic and abdomino-pelvic CT scan and tumor markers were normal.

Conclusion

The rarity of testicular cancer in black subjects should not be a reason to disregard them. Late diagnosis often leads to advanced stages with poor prognosis and the need the to use more frequently adjuvant chemotherapy whose cost is not always within reach of patients in our country.