Syndrome fibromyalgique, le point de vue du psychiatre

Fibromyalgia syndrome is a common, chronic and disabling condition characterized by widespread pain. Health care utilization leads to high costs. Physicians on the basis of positive and negative criteria make diagnosis. The concept of central sensitivity syndromes seems to be a useful paradigm for fibromyalgia syndrome. Association with psychiatric disorders is relatively common, but there is no specific profile. Comprehensive approach and integrated treatment plan aim to improve the results of care. Multidisciplinary between rheumatologists, algologists and psychiatrists is a priority to elaborate therapeutic framework.     

Toxicity and efficacy of cetuximab associated with several modalities of IMRT for locally advanced head and neck cancer

PurposeIntensity-modulated radiation therapy (IMRT) has shown its interest for head and neck cancer treatment. In parallel, cetuximab has demonstrated its superiority against exclusive radiotherapy. The objective of this study was to assess the acute toxicity, local control and overall survival of cetuximab associated with different IMRT modalities compared to platinum-based chemotherapy and IMRT in the ARTORL study (NCT02024035).Patients and methodThis prospective, multicenter study included patients with epidermoid or undifferentiated nasopharyngeal carcinoma, epidermoid carcinoma of oropharynx and oral cavity (T1–T4, M0, N0–N3). Acute toxicity, local control and overall survival were compared between groups (patients receiving cetuximab or not). Propensity score analysis at the ratio 1:1 was undertaken in an effort to adjust for potential bias between groups due to non-randomization.ResultsFrom the 180 patients included in the ARTORL study, 29 patients receiving cetuximab and 29 patients treated without cetuximab were matched for the analysis. Ten patients (34.5%) reported acute dermal toxicity of grade 3 in the cetuximab group versus three (10.3%) in the non-cetuximab group obtained after matching (P = 0.0275). Cetuximab was not significantly associated with more grade 3 mucositis (P = 0.2563). There were no significant differences in cutaneous or oral toxicity for patients treated with cetuximab between the different IMRT modalities (P = 1.000 and P = 0.5731, respectively). There was no significant difference in local relapse-free survival (P = 0.0920) or overall survival (P = 0.4575) between patients treated with or without cetuximab.ConclusionPatients treated with cetuximab had more cutaneous toxicities, but oral toxicity was similar between groups. The different IMRT modalities did not induce different toxicity profiles.     

Retroperitoneal lymphadenectomy and survival of patients treated for an advanced ovarian cancer: the CARACO trial

The standard management for advanced-stage epithelial ovarian cancer is optimum cytoreductive surgery followed by platinum based chemotherapy. However, retroperitoneal lymph node resection remains controversial. The multiple directions of the lymph drainage pathway in ovarian cancer have been recognized. The incidence and pattern of lymph node involvement depends on the extent of the disease and the histological type. Several published cohorts suggest the survival benefit of pelvic and para-aortic lymphadenectomy. A recent large randomized trial have demonstrated the potential benefit for surgical removal of bulky lymph nodes in term of progression-free survival but failed to show any overall survival benefit because of a critical methodology. Further randomised trials are needed to balance risks and benefits of systematic lymphadenectomy in advanced-stage disease. CARACO is a French ongoing trial, built to bring a reply to this important question. A huge effort for inclusion of the patients, and involving new teams, are mandatory.