Nausées et vomissements chimio-induits : physiopathologie,prophylaxie et recommandations

Nausea and emesis are one of the most feared secondary effect of chemotherapy. The development of antiemetic therapies has increased after the introduction of cisplatin, a cytotoxin with the highest emetic potential. Chemotherapy-induced nausea and vomiting (CINV) have been classified into acute, delayed and anticipatory based on the time of onset. According to the percentage of nausea and emesis without any antiemetic treatment, chemotherapy is divised into highly, moderate, low and very low emetic potential. The discovery of emetics stimuli neurotransmitters and their receptors has led to the introduction of new molecules which associated with steroids have prevented nausea and vomiting chemotherapy-induced for 70 to 80% of the patients receiving chemotherapy with high emetic potential. Numerous studies have evaluated the various antiemetics and recommendations were issued by learned societies in US and Europe. This text discusses the physiopathology of nausea and vomiting, the development of anti-emetics and the new discovered antiemetics. Finally, a synthesis of the recommandations from the guidelines developed by the Multinational Association of Supportive Care in Cancer (MASCC), the American Society of Clinical Oncology (ASCO), the National Comprehensive Cancer Network (NCCN) and the European Society for Medical Oncology (ESMO) is presented.     

Carcinome hépatocellulaire et traitements antiviraux contre le VHB et le VHC

Hepatitis B virus (HBV) treatment by nucleoside or nucleotide analog (NUC) and Hepatitis C virus (HCV) treatment by interferon-based therapy or by a direct acting antiviral agents (DAAs) combination significantly reduce hepatocellular carcinoma (HCC) occurrence. However, residual residual HCC risk depends on the severity of the underlying liver disease and comorbidities (alcohol or metabolic syndrome). HBV treatments by NUC reduce the risk of HCC recurrence and improve liver function. Sustained virological response (SVR) by interferon-based therapy or more frequently by DAAs combinations reduces HCC occurrence and recurrence. However, the long-term benefit of DAAs combinations needs to be evaluated by long term follow-up.     

Synthèse et conclusion

It is well established that cancer increases the risk of venous thrombosis. Conversely, the mechanisms involved in haemostasis play a major role in the tumour development, facilitating tumour proliferation and altering the microenvironment, with major consequences in terms of the metastatic process. It is therefore mandatory to take the measure of this double bond between cancer and haemostasis. The clinicianwill be aware that venous thromboembolism is difficult to diagnose in cancer patients. At all stages of care, preventive and curativemeasures will be implemented, based on current recommendations and, if applicable, the standards which have been developed. With the French Group Thrombosis and Cancer (GFTC), a dynamics has been boosted in order to implement “RCP-thrombose”.     

Livre et Vidéos

LIVRES ET VIDÉOS

Livre et Vidéos     

Communication entre soignant et soigné: historique, définitions et mesures

This article traces the history of a key concept in cancer care, communication between patients and healthcare providers. First, a history of the concept of communication in oncology is described. Second, the definitions related to this concept and the different approaches to assess communication between patients and healthcare providers are presented. The article demonstrates that a paternalistic relationship between patients and healthcare providers is becoming less popular among patients and a patient-centered approach is an approach to be privileged by the healthcare providers in oncology with their patients. The article also indicates that the observational and perceptual approaches to communication do not have the same goals. They evaluate different perspectives of communication between patients and healthcare providers.     

Politique et qualité de vie

Sans résumé     

Intelligence artificielle et radiothérapie : quelles bases et quelles perspectives ?

Artificial intelligence is a highly polysemic term. In computer science, with the objective of being able to solve totally new problems in new contexts, artificial intelligence includes connectionism (neural networks) for learning and logics for reasoning. Artificial intelligence algorithms mimic tasks normally requiring human intelligence, like deduction, induction, and abduction. All apply to radiation oncology. Combined with radiomics, neural networks have obtained good results in image classification, natural language processing, phenotyping based on electronic health records, and adaptive radiation therapy. General adversial networks have been tested to generate synthetic data. Logics based systems have been developed for providing formal domain ontologies, supporting clinical decision and checking consistency of the systems. Artificial intelligence must integrate both deep learning and logic approaches to perform complex tasks and go beyond the so-called narrow artificial intelligence that is tailored to perform some highly specialized task. Combined together with mechanistic models, artificial intelligence has the potential to provide new tools such as digital twins for precision oncology.     

Les tumeurs gliales et glioneuronales de l'adulte et de l'enfant : principales altérations génétiques et classification histomoléculaire

Glial and glioneuronal tumors in children and adult demonstrate distinctive clinical, neuroradiological and molecular features depending on the pathological subtype and within a same subgroup according to the age. In children, gliomas are mainly located in the infratentorial part of the brain. They are most often benign and circumscribed but infiltrative tumors with dismal prognosis are recorded within the pons (DIGP) or the thalamus. Glioblastomas are very rare in children. In contrast, gliomas in adult mainly occur in the cerebral hemispheres and the most frequent subtype is glioblastoma. Glioneuronal tumors mainly occurred in children and young adults. In addition, although pilocytic astrocytomas, pleomorphic xanthoastrocytomas and gangliogliomas are classified into different subgroups according to the WHO 2007 classification, these tumors demonstrate similar neuroradiological findings: they are cystic with contrast enhancement of a mural nodule. Major advances have been made these last five years in the discovery of some master genes that are involved in gliomagenesis and point out differences between children and adults. In adults, infiltrative gliomas can be classified into two major subgroups depending on the existence or not of IDH mutations. IDH-dependent gliomagenesis encompasses diffuse grade II and grade III (they can also show additional molecular alterations such as TP53 mutation or 1p19q codeletion) and secondary glioblastomas. IDH-independent gliomagenesis include triple negative grade II gliomas, gliomatosis cerebri (grade III) and de novo glioblastomas. Pilocytic astrocytomas, pleomorphic xanthoastrocytomas and gangliogliomas share in common BRAF alterations. However, KIAA1549-BRAF fusion characterizes pilocytic astrocytomas whereas V600E BRAF mutation is mainly recorded in pleomorphic xanthoastrocytomas and gangliogliomas.     

Adénocarcinome du bas œsophage et du cardia. Anatomie et volumes à irradier

The esophagus is divided into four regions: cervical esophagus, intrathoracic esophagus with upper, mid and lower thoracic portion. Cancer may occur on each of these regions. Computed tomography of the thorax and superior abdomen and endoscopic ultrasound are necessary for reliable staging. CT simulation allows accurate definition of tumor volume. GTV includes tumor volume and regional lymph nodes. CTV encompasses GTV plus safety margin and lymph nodes areas considered to harbor potential microscopic disease. The extent of prophylactic lymph node irradiation depends on the anatomic location of the primary tumor.     

Cancers et environnement : explorer les comportements de recherche et les sources d’information des personnes atteintes et non atteintes d’un cancer

Aim

To explore information-seeking behaviors on links between cancers and environment.

Method

Focus groups and individual semi-structured interviews realized, respectively, with individuals without and with personal cancer experience.

Results

The majority of respondents reported informationscanning behaviors. Only half cancer patients searched for information regarding the links between cancers and environment.

Conclusion

Little information is sought on links between cancers and environment.