Réduire le temps préanalytique dans le diagnostic anatomopathologique des affections mammaires, utopie ou réalité ?

Surgical pathology diagnosis of a breast lesion is an important stage in the diagnostic process of breast diseases. Quality of the pre-analytical phase is essential to ensure reliable and reproducible diagnoses, and is based on neutral-buffered formalin fixation of tissue specimens. It is important to respect aminimum fixation timewithformalin inorder to guarantee the quality of subsequent morphological, immunohistochemical and cytogenetic studies. We present here an alternative to formalin fixation, based on tissue dehydration, enabling the shortening of technical stages and sign out. Furthermore, this method ensures better nucleic acid preservation, which opens the way for the development of high-throughput molecular testing in breast cancer.     

Les micrométastases : entité biologique et réalité clinique ?

Micrometastases or sub-micrometastases can be detected by standard histopathological method sometimes associated with immunohistochemistry in lymph nodes, bone marrow and blood. The consequence of these small size involvement may be prognostic and therapeutic. Two factors are necessary to assess this kind of involvement: the rate of involvement of non-sentinel lymph node after axillary lymph node dissection and significative difference of survivals. The rate of involvement of non-sentinel lymph node in case of micrometastases or sub-micrometastases is different from the rate of involvement in case of no lymph node metastases (7 to 8%) or in case of macrometases (30 to 50%). Micrometastase is an important factor to determine the rate of involvement of non-sentinel lymph node, the overall or disease free survival and to assess the need of radiotherapy and chemotherapy. In conclusion, micrometastases and sub-micrometastases have a clinical impact even if complementary axillary lymph node dissection is still discussed.     

La radiothérapie en conditions stéréotaxiques des métastases cérébrales en situation complexe

Stereotactic radiation therapy of brain metastases is a treatment recognized as effective, well tolerated, applicable for therapeutic indications codified and validated by national and international guidelines. However, the effectiveness of this irradiation, the evolution of patient care and the technical improvements enabling its implementation make it possible to consider it in more complex situations: proximity of brain metastases to organs at risk; large, cystic, haemorrhagic or multiple brain metastases, combination with targeted therapies and immunotherapy, stereotactic radiotherapy in patients with a pacemaker. This article aims to put forward the arguments available to date in the literature and those resulting from clinical practice to provide decision support for the radiation oncologists.     

Management et souffrance des soignants en oncohématologie

The suffering of caregivers is often observed in haematology and oncology teams. A major Programme Hospitalier de Recherche Clinique was conducted in the north-west of France. Every oncology and haematology ward was contacted. On 64 wards we got 574 questionnaires within 53 different centres. Four major causes of aetiology have been identified, linked to the caregiver, to the speciality of oncohaematology, to the workload and to the organisation and team management. Our group (Afsos) has shown a relationship between participative management and quality of life at work of caregivers. This participative management is now mandatory in France for teams caring for palliative patients (measure 13a of HAS accreditation visit). The perspectives of the results are discussed.     

Quelle est la place de la chirurgie dans la prise en charge des métastases cérébrales en 2020 ?

Brain metastases are the most common intracranial tumors and are associated with a dismal prognosis. The management of patients with brain metastases has become more important because of the increased incidence of these tumours, the better treatment of the systemic disease and the improvement of surgical techniques. The treatment requires multidisciplinary approaches and become complex because of new emerging systemic therapy and advancements in neurosurgery and radiation oncology. The surgical treatment has an indispensable role to obtain a tissue diagnosis, in relieving intracranial effect mass and improving neurological status by improving induced encephalopathy. An understanding of the role and indications of the surgery in patients with metastatic brain lesions is essential for the effective management of this growing population.     

Précarité sociale, cancer et vulnérabilité psychique, lien direct ou indirect ?

The link between psychological vulnerability and cancer is not clearly established. However, there does appear to be a link between cancer and social marginality. Psychological fragility has been shown to be associated with tobacco addiction. Socially vulnerable people are at risk of undergoing screening less frequently and being treated less efficiently. These data could explain the deficit in terms of both monitoring of their pathologies and observed survival rates, compared with those relating to the general population. Such people do not refuse treatment or screening and are often well aware of screening methods and their usefulness, and wish to be treated if they are ill. The main problems relate to organisation and careprovision. Monitoring of such patients is not always possible and the notion of a “life-plan” is often nonexistent, thus preventing adequate management of the disease. Screening programs are not adapted for marginal and socially excluded populations. Solutions can be found but they depend on both social and health policies and the behaviour of every individual professional care-provider.     

Peur de la récidive et/ou progression du cancer et prévention en santé mentale

Patients often mention the return of the cancer and express their anxiety about a possible invasion of their body by the cancer or the spread of the disease in other organs. Particularly, post-treatment, they describe the fear of cancer recurrence (FCR) as a sword of Damocles hanging over their head and threatening their future peace by spreading the notion of uncertainty. Some authors refer to the FCR as a central dimension in many patients, and others point out the problem of pervasive fear of return and/or progression of the disease being one of the most often reported difficulties by cancer survivors. The objective of our work is to present a literature review and propose terms of psychological interventions focused on FCR.     

Bases référentielles de la radiothérapie en conditions stéréotaxiques pour les tumeurs ou métastases bronchopulmonaires,hépatiques,prostatiques, des voies aérodigestives supérieures,cérébrales et osseuses

Since decades, stereotactic radiotherapy has spread out worldwide. Published results are very numerous. To clarify obviousness among all the publications, this recommendation review was written. Voluntarily, authors limited analysis of international best evidence literature on malignant tumors of lung, liver, prostate, head and neck, and metastasis of bone and brain. These data could be used to advance standardization and quality improvement of treatments performed in the nationwide radiotherapy departments and can provide useful guidance for centers worldwide.     

À propos de la mise en place des soins de support en cancérologie: pistes de réflexions et propositions

Résumé  Un groupe de 19 professionnels, impliqués dans les soins de support, ont voulu proposer des postes de réflexion pour l’organisation, la mise en place et l’évaluation des soins de support dans les établissements et les territoires de santé. L’organisation proposée doit pouvoir s’appliquer à tout malade atteint de cancer, quels que soient son age et son lieu de prise en charge, quel que soit le stade de sa malade; elle doit à terme pouvoir concerner tout malade atteint de maladie chronique grave. Elle doit permettre une meilleure prise en charge globale des patients et de leurs proches par: 1) une analyse précise et régulière de leurs besoins; 2) le respect de la continuité des soins; 3) la mise en place de pratiques collaboratives et une transversalité dans les soins. Il ne s’agit pas d’une nouvelle spécialité mais d’une coordination de compétences au service du patient et de ses proches.      

Interventions nutritionnelles et prévention tertiaire des cancers: mythes et réalités

Despite their heterogeneity, numerous studies suggest that lifestyle and diet might be involved in cancer recurrence. Data seems more robust in breast and colon cancer. Recently, two large randomized trials conducted in breast cancer patients confirmed the feasibility of dietary interventions after cancer treatment. Their methodology however remains somewhat flawed. Thus, because of insufficient proof, it remains hazardous to recommend specific interventions in cancer survivors. In particular, there is no evidence to support the use of high-dose micronutrients in order to improve cancer outcomes. The benefits of weight control and regular physical activity, on the other hand, are less debatable. No matter what, it would appear essential that we carry out clinical research with the aim of identifying sub-groups of patients the most likely to benefit from a given dietary intervention.     

Prise en charge symptomatique des métastases cérébrales

Indications and choice of antiepileptic drugs (AED), treatments for cerebral edema and prophylactic and curative treatments of thromboembolic complications of brain metastasis are discussed.