Endocavitary radiation therapy for rectal adenocarcinoma: 10-year results

Local control, survival, and toxicity in patients treated with endocavitary radiation therapy for rectal cancer were evaluated. Thirty-five patients received a total of 20 to 155 Gy in 1 to 5 fractions with 50 kV x-rays through a treatment proctoscope. Twenty-nine of the 35 patients were treated with curative intent. Median follow-up was 102 months. Local control was achieved in 23 of the 29 patients treated curatively and in 3 of the 6 treated palliatively. Local control for patients treated curatively was 76% at 10 years. No local failures occurred after 21 months. For patients treated curatively, survival was 65% at 5 years and 42% at 10 years. Toxicity within 90 days after treatment was observed in 77% of the patients. Toxicity occurring more than 90 days after treatment was observed in 80%, but only 1 patient needed a colostomy, which was for a perforation after the biopsy of a benign ulcer. In conclusion, radiation therapy resulted in a local control rate of 76% at 10 years in curatively treated patients. Although most patients experience toxicity from this treatment, loss of sphincter function is rare.     

Classification of human astrocytic gliomas on the basis of gene expression: a correlated group of genes with angiogenic activity emerges as a strong predictor of subtypes

The development of targeted treatment strategies adapted to individual patients requires identification of the different tumor classes according to their biology and prognosis. We focus here on the molecular aspects underlying these differences, in terms of sets of genes that control pathogenesis of the different subtypes of astrocytic glioma. By performing cDNA-array analysis of 53 patient biopsies, comprising low-grade astrocytoma, secondary glioblastoma (respective recurrent high-grade tumors), and newly diagnosed primary glioblastoma, we demonstrate that human gliomas can be differentiated according to their gene expression. We found that low-grade astrocytoma have the most specific and similar expression profiles, whereas primary glioblastoma exhibit much larger variation between tumors. Secondary glioblastoma display features of both other groups. We identified several sets of genes with relatively highly correlated expression within groups that: (a). can be associated with specific biological functions; and (b). effectively differentiate tumor class. One prominent gene cluster discriminating primary versus nonprimary glioblastoma comprises mostly genes involved in angiogenesis, including VEGF fms-related tyrosine kinase 1 but also IGFBP2, that has not yet been directly linked to angiogenesis. In situ hybridization demonstrating coexpression of IGFBP2 and VEGF in pseudopalisading cells surrounding tumor necrosis provided further evidence for a possible involvement of IGFBP2 in angiogenesis. The separating groups of genes were found by the unsupervised coupled two-way clustering method, and their classification power was validated by a supervised construction of a nearly perfect glioma classifier.     

Cancer and the law

Health professionals are being impacted by a major reform in 2002. Indeed, after 4 years of dialogues the French parliament has adopted a particularly innovative law of which title "Law in relation to patients rights and to the quality of the Health System" leads us to predict the dimension of the disruptions to come affecting the relation between physicians and patients in its legislative way. This law is directly descended from the "Huriet Law"--voted on December the 20th, 1988--outlining the every day process of clinical research. This constitutes a significant challenge to rethink the medical informations we communicate to patients. The low number of oncologists in France is more than ever affected by this law, despite the will of the health professionals. More time spent with patients could only occur should there be increased human resources.     

The cost of imaging in oncology practice

The purpose of this work was to assess the part of radiology in the total cost of cancer in France. Lot of public and private organisms are in charge to assess the total health cost and their informations are easy to obtain. But there are some obstacles to focus on radiological cancer cost: radiology is performed in various places: private outpatient care practice, private and public hospitals; for same examination, cost varies according on the place were it's performed; we can assess the imaging cost in anticancer centers, but the costs of radiological examinations realised for cancer indications in general hospital are not separated from the cost of those performed for other indications; a same patient can migrate between private and public radiological structures for the same cancer, and we are not able to know the relative cost of each part or the total cost. In summary, we can assess the total cost of private radiology but not the cancer part of this cost. For public structures, we can assess the imaging department cost. Nevertheless this cost is independent of the number of examinations performed, so the paradox is: a same exploration has a different cost according on the place where it's realised. So, we need to create a tool which will permit to obtain a medical assessment of imaging cost. The FNMR (Fédération Nationale des médecins radiologues) try to produce such tool with the OPIM (Observatoire pour l'imagerie). It seems important than public radiologists think about it.     

Standards, Options and Recommendations 2002 for the management of adult patients with intracranial gliomas (summary report)

CONTEXT: The "Standards, Options and Recommendations" (SOR) project, which started in 1993, is a collaboration between the Federation of French Cancer Centers (FNCLCC), the 20 French Regional Cancer Centers, and specialists from French public universities, general hospitals and private clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and the outcome of cancer patients. OBJECTIVE: To define clinical practice guidelines for the management of adult patients with intracranial glioma in collaboration with the Association of French-speaking Neuro-oncologists (Anocef) and the French society of neurosurgeons (SNCLF). These recommendations cover diagnosis, classification, treatment and follow-up of patients with these tumors. METHOD: The methodology is based on a literature review and critical appraisal by a multidisciplinary group of experts who define the CPGs according to the definitions of the Standards, Options and Recommendations project. Once the guidelines has been defined, the document is submitted for review by independent reviewers. RESULTS: This article is a summary version of the full document presenting the clinical practice guidelines with algorithms. The main recommendations concern the place of the surgery, radiotherapy, chemiotherapy, imagery and concomitant medical treatments in the specific treatment strategy of grade III and IV glioma, grade II glioma, gliomatosis cerebri, pilocytic astrocytoma, subependymoma, xanthoastrocytoma, intracranial ependymoma and brain stem glioma.     

Induction chemotherapy for breast carcinoma: predictive markers and relation with outcome

Induction chemotherapy provides an excellent model for evaluation of potential predictive factors. We studied expression of SBR grade, estrogen (ER) and progesterone (PR) receptors, HER2, Ki67 and P53 on core biopsies before and after chemotherapy in a series of 115 patients, who received anthracycline-based induction chemotherapy for primary breast cancer. HER2 overexpression independently predicted response to neoadjuvant anthracycline-based chemotherapy. Patients with HER2-positive status are 4.54 times more likely to have a pathological complete response than those with negative status (p<0.005). HER2, ER and PR status were stable during treatment. P53 and Ki67 significantly increased after treatment (p<0.005 and p<0.0005). SBR grade, proliferation markers, ER evaluated before and after treatment predicted disease-free survival (DFS) in univariate analysis.