Publications by authors named "Emmanuel Barranger"

125 Publications

Clinicopathological characterization of a real-world multicenter cohort of endometrioid ovarian carcinoma: Analysis of the French national ESME-Unicancer database.

Gynecol Oncol 2021 Jul 19. Epub 2021 Jul 19.

Aix-Marseille Univ., CNRS, INSERM, Institut Paoli-Calmettes, Department of Medical Oncology, CRCM, Marseille, France. Electronic address:

Background: Prognostic significance of endometrioid epithelial ovarian cancer (EOC) is controversial. We compared clinical, pathological, and biological features of patients with endometrioid and serous EOC, and assessed the independent effect of histology on outcomes.

Methods: We conducted a multicenter retrospective analysis of patients with EOC selected from the French Epidemiological Strategy and Medical Economics OC database between 2011 and 2016. Our main objective was to compare overall survival (OS) in endometrioid and serous tumors of all grades. Our second objectives were progression-free survival (PFS) and prognostic features.

Results: Out of 10,263 patients included, 3180 cases with a confirmed diagnosis of serous (N = 2854) or endometrioid (N = 326) EOC were selected. Patients with endometrioid histology were younger, more often diagnosed at an early stage, with lower-grade tumors, more frequently dMMR/MSI-high, and presented more personal/familial histories of Lynch syndrome-associated cancers. BRCA1/2 mutations were more frequently identified in the serous population. Endometrioid patients were less likely to receive chemotherapy, with less bevacizumab. After median follow-up of 51.7 months (95CI[50.1-53.6]), five-year OS rate was 81% (95CI[74-85]) in the endometrioid subgroup vs. 55% (95CI[53-57] in the serous subset (p < 0.001, log-rank test). In multivariate analyses including [age, ECOG-PS, FIGO, grade, and histology], the endometrioid subtype was independently associated with better OS (HR = 0.38, 95CI[0.20-0.70], p= 0.002) and PFS (HR = 0.53, 95CI[0.37-0.75], p < 0.001).

Conclusions: Clinicopathological features at diagnosis are not the same for endometrioid and serous EOC. Endometrioid histology is an independent prognosis factor in EOC. These observations suggest the endometrioid population requires dedicated clinical trials and management.
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http://dx.doi.org/10.1016/j.ygyno.2021.07.019DOI Listing
July 2021

[Is preoperative axillary radio-cytology justified after ACOSOG Z001?]

Bull Cancer 2021 Jun 8;108(6):605-613. Epub 2021 May 8.

Centre Antoine-Lacassagne, département de chirurgie sénologique, onco-gynécologique et reconstruction, 33, avenue de Valombrose, 06189 Nice cedex 2, France.

Introduction: Invasive breast cancer without clinical adenopathy (cN0) is currently explored by the sentinel node (GS) technique, except in the case of positive preoperative radio-cytological screening, where axillary curage (CA) remains systematic from the outset. Since the publication of the ACOSOG-Z0011 trial, abstention from CA is possible in patients presenting less than three metastatic GS. As a result, the value of axillary radio-cytological screening is being questioned as it could potentially lead to axillary surgical over-treatment. The objective of this study was to study clinically N0 patients with positive axillary cytology and to compare it to a group of patients with positive GS.

Method: One hundred and forty-seven patients with cN0 pN+ breast cancer treated between 2014 and 2016 were selected retrospectively. Two groups were constituted according to the initial radio-cytological evaluation. A CA was systematically performed.

Results: Thirty-one patients with positive axillary cytology (n=31 vs. n=116) had more metastatic lymph nodes (P=0.01) in the AC, larger (P<0.001), less differentiated (P<0.001) tumours, and shorter recurrence-free survival (P=0.0114). It also appeared that 38.7 % of patients with a positive cytology had at most two metastatic nodes and could, according to the results of ACOSOG, benefit from therapeutic de-escalation.

Conclusion: X-ray cytological screening remains essential in order to select a subgroup of patients with a high lymph node tumour load. Additional studies are necessary in order to be able to offer therapeutic de-escalation to 1/3 of these patients without the risk of under-treatment for the remaining 2/3.
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http://dx.doi.org/10.1016/j.bulcan.2021.02.010DOI Listing
June 2021

[Impact of COVID-19 pandemic on breast and gynecologic cancers management. Experience of the Surgery Department in the Nice Anticancer Center].

Bull Cancer 2021 Jan 26;108(1):3-11. Epub 2020 Nov 26.

Université Côte d'Azur, centre Antoine-Lacassagne, département de chirurgie sénologique et onco-gynécologique, 33, avenue de Valombrose, 06189 Nice cedex, France.

Introduction: During the COVID-19 pandemic, the containment measures and the recommendations of several societies in oncology may have impacted the request for initial care for cancers.

Methods: In this monocentric retrospective study, the number and the characteristics of patients received for a first consultation for a breast or gynecologic tumor were compared between the containment period and a control period. The times from diagnosis to treatment and the type of initial care were compared too.

Results: During the outbreak, 91 patients were seen for a new request, versus 159 during the control period, a decrease of 43.5 %. Patients were older (62.9 versus 60.9 years old) but this difference was not significant. Tumor stage was not modified. Concerning senology, the time from the biopsy to the first consultation was 5.5 days longer during the outbreak (difference statistically insignificant). Among the 51 patients requiring a surgical treatment during the outbreak, 16 (31.48 %) were postponed after the end of the containment measures. After all, the average time from the consultation to the treatment was not modified. No modification of type of treatment was observed.

Discussion: At the height of the pandemic, benefits and risks of the cancer treatment had to be daily balanced against the risk of exposition to the COVID-19. The evaluation of practices for cancer care is essential to understand the real impact of COVID-19 outbreak on global cancer management, so as to get prepared to further crises.
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http://dx.doi.org/10.1016/j.bulcan.2020.10.013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7690308PMC
January 2021

Comparison of 3 γ-probes for simultaneous iodine-125-seed and technetium-99m breast cancer surgery: NEMA standard characterisation with extended processing.

EJNMMI Phys 2020 Jun 5;7(1):37. Epub 2020 Jun 5.

Department of diagnostic radiology and nuclear medicine, Antoine Lacassagne Comprehensive Cancer Center, Université Nice-Côte d'Azur, 33 Avenue de Valombrose, 06189, Nice, France.

Purpose: Iodine-125 (I) seeds can be used as landmarks to locate non-palpable breast lesions instead of implanting metal wires. This relatively new technique requires a nuclear probe usually used for technetium-99m (Tc) sentinel node detection. This study aimed to compare the performances of different probes and valid the feasibility of this technique, especially in the case of simultaneous I-seed and Tc breast cancer surgery.

Methods: Three probes with different features (SOE-3211, SOE-3214 and GammaSUP-II) were characterised according to the NEMA NU3-2004 standards for a Tc source and a I-seed. Several tests such as sensitivity, linearity or spatial resolution allowed an objective comparison of their performances. NEMA testing was extended to work on signals discrimination in case of simultaneous detection of two different sources (innovative figure of merit "Shift Index") and to assess the Tc scatter fraction, a useful parameter for the improvement of the probes in terms of detector materials and electronic system.

Results: Although the GammaSUP-II probe saturated at a lower activity (1.6 MBq at 10 mm depth), it allowed better sensitivity and spatial resolution at the different NEMA tests performed with the Tc source (7865 cps/MBq and 15 mm FWHM at 10 mm depth). With the I-seed, the GammaSUP-II was the most sensitive probe (3106 cps/MBq at 10 mm depth) and the SOE-3211 probe had the best spatial resolution (FWHM 20 mm at 10 mm depth). The SOE-3214 probe was more efficient on discriminating I from Tc in case of simultaneous detection. The SOE probes were more efficient concerning Tc scatter fraction assessments. The SOE-3211 probe, with overall polyvalent performances, seemed to be an interesting trade-off for detection of both I and Tc.

Conclusion: The three probes showed heterogeneous performances but were all suitable for simultaneous Tc sentinel node and I-seed detection. This study provides an objective and innovative methodology to compare probes performances and then choose the best trade-off regarding their expected use.
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http://dx.doi.org/10.1186/s40658-020-00299-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7275111PMC
June 2020

DPD status and fluoropyrimidines-based treatment: high activity matters too.

BMC Cancer 2020 May 18;20(1):436. Epub 2020 May 18.

Centre Antoine-Lacassagne, Oncopharmacology Unit, Université Côte d'Azur, Nice, France.

Background: Dihydropyrimidine dehydrogenase (DPD) status is an indicator of a marked risk for toxicity following fluoropyrimidine (FP)-based chemotherapy. This notion is well-established for low DPD status but little is known about the clinical impact of high DPD activity. This study examined the possible link between high intrinsic lymphocytic DPD activity and overall survival, progression free survival and response to FP-based treatment in patients treated in our institution.

Methods: Lymphocytic DPD activity was assessed in a group of 136 patients receiving FP-based chemotherapy from 2004 to 2016. There were 105 digestive (77.2%), 24 breast (17.6%) and 7 head and neck cancers (5.2%). Cox or logistic regression models were applied with adjustment on all confounding factors that could modify OS, PFS or response. All models were stratified on the three cancer locations. A cut-off for DPD activity was assessed graphically and analytically.

Results: An optimal cut-off for DPD activity at 0.30 nmol/min/mg protein was identified as the best value for discriminating survivals and response. In multivariate analysis, individual lymphocytic DPD activity was significantly related to overall survival (p = 0.013; HR: 3.35 CI95%[1.27-8.86]), progression-free survival (p < 0.001; HR: 3.15 CI95%[1.75-5.66]) and response rate (p = 0.033; HR: 0.33 CI95%[0.12-0.92]) with a marked detrimental effect associated with high DPD activity.

Conclusions: DPD status screening should result in a two-pronged approach with FP dose reduction in case of low intrinsic DPD and, inversely, an increased FP dose for high intrinsic DPD. In a context of personalized FP-based treatment, this innovative strategy needs to be prospectively validated.
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http://dx.doi.org/10.1186/s12885-020-06907-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7236295PMC
May 2020

[Preoperative breast imaging review: Interests and limits of specialized validation in oncology].

Bull Cancer 2020 Mar 27;107(3):295-307. Epub 2020 Feb 27.

Centre Antoine-Lacassagne, service de chirurgie oncologique gynécologique et sénologique, 33, avenue Valombrose, 06189 Nice, France.

Objectives: To evaluate the impact of systematic radiological review by breast specialist radiologist of malignant breast lesion imaging on the therapeutic management of patients.

Materials And Methods: Data collection was performed for patients with histopathologically proved breast cancer or suspicious breast lesion on imaging realized out of our institution. Patients underwent systematic mammary and axillary ultrasound, imaging review and if necessary complementary mammographic images. We analyzed the number of additional breast biopsies and axillary lymph node fine needle aspiration (FNA) with their histopathological results. We assessed their impact by comparing the final surgical treatment to the one planned before review.

Results: Two hundred and seventeen patients were included, with a total of 230 BIRADS 0, 4, 5 or 6 breast lesions. Seventy-six additional breast core biopsies were realized, leading to diagnose 43 additional BIRADS 6 lesions (24 infiltrative carcinomas, 9 DCIS and 10 atypical lesions) in 30 patients (13.82%). Thirty-five additional lymph node FNA were realized with 12 metastatic nodes and 3 false negative samples. Imaging review lead to change surgical treatment in 59 patients (27.19%, P<0.01) with modification in breast surgery in 37 patients, axillary surgery in 8 patients and both sites surgery in 12 patients.

Conclusion: This study shows an impact of systematic radiological review by breast specialist radiologist in therapeutic management of patients treated for malignant breast lesion.
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http://dx.doi.org/10.1016/j.bulcan.2019.11.013DOI Listing
March 2020

Robotic Stereotactic Boost in Early Breast Cancer, a Phase 2 Trial.

Int J Radiat Oncol Biol Phys 2019 02 26;103(2):374-380. Epub 2018 Oct 26.

Department of Radiotherapy, Centre Antoine Lacassagne, Nice, France; Department of Radiation Oncology, Centre François Baclesse, Caen, France - Unicaen - Normandie Universite.

Purpose: To evaluate the feasibility and toxicity of a single-fraction 8-Gy stereotactic boost after whole-breast irradiation in early breast cancer. The primary aim of this phase 2 study was to evaluate cutaneous breast toxicity using National Cancer Institute Common Terminology Criteria for Adverse Events (version 4) 3 months after the boost. Secondary objectives were local control, survival, and patient-reported quality of life using the European Organisation for Research and Treatment of Cancer QLQ-C30 and breast-specific European Organisation for Research and Treatment of Cancer QLQ-BR 23 questionnaires.

Methods And Materials: Patients with invasive ductal or lobular pT1-2 breast cancer treated with lumpectomy with clear margins and pN0 were included. Patients requiring chemotherapy were excluded.

Results: Twenty-eight eligible patients received the planned boost, and 26 had hormonal therapy. The procedure was technically successful without procedural complications. A median of 3 fiducials were tracked, and 115 beams were used. There were 22 acute grade 1 breast skin toxicities, including fibrosis, pain, erythema, or pigmentation. There were 2 acute grade 2 erythemas. Median skin boost dose was inversely correlated with acute skin toxicity (P = .028). QLQ-C30 scores revealed acute dyspnea and arm symptoms without correlation to the boost dose. Breast symptom QLQ-BR23 scores did not deteriorate, although upset with hair loss and systemic side effects of hormonal therapy were observed. After a median follow-up of 38 months, 1 patient had in-boost-field relapse, and there were 5 late grade 1 and 1 grade 2 skin toxicities.

Conclusions: Single-fraction stereotactic boost after conventional whole-breast irradiation in early breast cancer is feasible with minor toxicities. Quality of life and specific breast items showed excellent patient acceptance.
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http://dx.doi.org/10.1016/j.ijrobp.2018.09.020DOI Listing
February 2019

Should Adjuvant Radiation Therapy Be Systematically Proposed for Male Breast Cancer? A Systematic Review.

Anticancer Res 2018 01;38(1):23-31

Department of Radiation Oncology, François Baclesse Anticancer Center, Caen, France

Background: Guidelines for radiotherapy in male breast cancer (MBC) are lacking. Some extrapolate the results from female breast cancer trials, while others advocate systematic adjuvant irradiation. We evaluated clinical practices and outcomes with respect to radiation therapy in MBC treated with locoregional irradiation in the adjuvant setting using a systematic literature review.

Material And Methods: We included studies with data about adjuvant radiotherapy published between 1984 and 2017 and including at least 40 patients.

Results: We found 29 retrospective series, 10,065 men were diagnosed with breast cancer; 3-100% (mean=54%) received adjuvant radiotherapy. Tumor size and nodal involvement were the strongest prognostic factors. Approximatively half of all cases had nodal metastases. Radiation therapy improved locoregional control in six series, overall survival in three and distant metastasis-free survival in one.

Conclusion: MBC is diagnosed at a highly advanced stage and may be linked with poorer outcomes. Adjuvant radiation therapy must, at least, be proposed to men with positive nodes. Despite the large number of cases gathered here, arguments for radiotherapy in other prognostic subgroups (especially in pN0) may exist but are not well supported.
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http://dx.doi.org/10.21873/anticanres.12187DOI Listing
January 2018

Accelerated partial breast irradiation for suitable elderly women using a single fraction of multicatheter interstitial high-dose-rate brachytherapy: Early results of the Single-Fraction Elderly Breast Irradiation (SiFEBI) Phase I/II trial.

Brachytherapy 2018 Mar - Apr;17(2):407-414. Epub 2017 Dec 15.

Department of Radiation Oncology, Antoine Lacassagne Cancer Center, University of Cote d'Azur, Nice, France.

Purpose/objective: To evaluate feasibility and early clinical outcomes of a single fraction of multi-catheter interstitial high-dose rate brachytherapy for accelerated partial breast irradiation (APBI) in the elderly.

Material/methods: From November 2012 to September 2014, 26 patients (≥70) with early breast cancer were enrolled in a prospective phase II trial (NCT01727011). After lumpectomy, intra-operative catheter implant was performed for post-operative APBI (single fraction 16 Gy). Surveillance was achieved at 1, 3 and 6 months after APBI, then twice a year. Acute toxicity was investigated. Early cosmetic outcome was analyzed (patient, radiation oncologist, 2 observers). Local and regional relapse-free survival, cancer specific survival and overall survival were analyzed.

Results: Median age was 77 years [69-89]. Median CTV was 41 cc [22-95]. Acute toxicity was observed in 18 pts (70%) with a total of 44 events: G1: 75.7%; G2: 22.8%; G3: 4.5%. Breast fibrosis (31.8%), puncture site inflammation (13.6%) and skin hyperpigmentation (11.4%) were the most frequent side effects. Cosmetic evaluation at 6 months was excellent/good in 88%, 92%, 85% and 88% for patient, radiation oncologist, observer #1 and #2 respectively. With a median follow-up of 37.2 months [35.6-42.3], side effects were G1: 4 pts (15%) and G2: 1 pt (4%). Three-year Local and regional relapse-free survival, cancer specific survival and overall survival rates were 100%, 100%, 100% and 95.2% respectively.

Conclusions: For elderly early breast cancer, a post-operative multi-catheter interstitial high-dose rate brachytherapy single dose (16 Gy) appears feasible. Acute toxicity is acceptable as well as early cosmetic outcome. Oncologic outcome seems encouraging and allows going forward with new clinical trials focusing on single fraction APBI.
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http://dx.doi.org/10.1016/j.brachy.2017.11.008DOI Listing
January 2019

Comment on: Sentinel Node Biopsy Using Magnetic Tracer Versus Standard Technique: The SentiMAG Multicentre Trial.

Ann Surg Oncol 2017 12 22;24(Suppl 3):593. Epub 2017 Nov 22.

Breast and Gynecological Surgical Oncology Unit, Centre Antoine Lacassagne, University of Nice Sophia-Antipolis, 33 avenue de Valombrose, 06189, Nice Cedex 2, France.

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http://dx.doi.org/10.1245/s10434-017-6191-xDOI Listing
December 2017

Do Lumpectomy Cavity Shaved Margins Really Not Impact Re-excision Rates in Breast Cancer?

Ann Surg Oncol 2017 12 24;24(Suppl 3):585. Epub 2017 Oct 24.

Department of Surgery, Antoine Lacassagne Cancer Center, Nice, France.

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http://dx.doi.org/10.1245/s10434-017-6188-5DOI Listing
December 2017

Accelerated partial breast irradiation for elderly women with early breast cancer: A compromise between whole breast irradiation and omission of radiotherapy.

Brachytherapy 2017 Sep - Oct;16(5):929-934. Epub 2017 Jul 8.

Department of Radiation Oncology, Antoine Lacassagne Cancer Center, University of Cote d'Azur, Nice, France. Electronic address:

Purpose: Regarding adjuvant radiation therapy making decision for elderly women, Albert (2013) published a nomogram predicting the mastectomy-free survival (MFS) rate with or without adjuvant irradiation. Based on this approach, we proposed to investigate the use of accelerated partial breast irradiation (APBI) vs. whole breast irradiation (WBI) or endocrine therapy alone in elderly low-risk breast cancer patients.

Methods And Materials: For each elderly woman treated by conserving surgery and APBI (multicatheter interstitial high-dose-rate brachytherapy), 5- and 10-year MFS rates were calculated. For each treated patient, using the Albert nomogram, we calculated the estimated MFS rates at 5 and 10 years, with and without WBI. Then, we compared the estimated MFS rates after no irradiation and WBI vs. observed MFS rates after APBI.

Results: From 2005 to 2016, 79 patients were treated. Median followup was 96.8 months [68.6-104.9], median age was 77 years [66-89]. Expected 5- and 10-year mastectomy rates calculated with the Albert nomogram without WBI were 2.95% and 7.25%, respectively, leading to a 10-year MFS rate of 92.7%. Expected 5- and 10-year mastectomy rates after WBI were 1.41% and 3.66%, respectively, leading to a 10-year MFS rate of 96.3%. Regarding observed MFS rate, 1 pt (1.3%) experienced a salvage mastectomy. The 10-year MFS rate after APBI was 97.4% vs. 96.3% after WBI (p = 1) and 92.7% after no irradiation (p = 0.27). No toxicity Grade 3 or more was observed.

Conclusions: APBI seems to be an attractive compromise between WBI and no irradiation for elderly women with early stage breast cancer as far as local control, quality of life and cost benefit is concerned.
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http://dx.doi.org/10.1016/j.brachy.2017.06.006DOI Listing
April 2018

Evaluation and Selection of Quality Indicators for the Management of Endometrial Cancer.

Int J Gynecol Cancer 2017 06;27(5):979-986

*Service de Gynécologie Obstétrique; †Sce Gynécologie Hôpital Bichat Claude Bernard, Paris; ‡Sce Gynécologie Centre Antoine Lacassagne, Nice; §Sce Gynécologie, CHU Estaing, Clermont-Ferrand; ∥Pôle d'Obstétrique Gynécologie Reproduction, Hôpital Pellegrin, Centre Aliénor d'Aquitaine, CHU Bordeaux, Bordeaux; ¶Sce de Chirurgie Oncologique 2, Institut Paoli Calmettes, Marseille; #Clinique de Chirurgie Gynécologique Hôpital Jeanne de Flandre, CHRU de Lille, Université Lille Nord de France, Lille; **Sce Gynécologie, Hôpital Le Bocage CHU Dijon, Dijon; ††Sce Gynécologie, Hôpital Tenon Paris, Paris; ‡‡Sce Gynécologie, CHU Antoine Béclére, Clamart; §§Sce Gynécologie CHU Limoges, Limoges; ∥∥Sce Gynécologie, CH Lyon Sud, Lyon; ¶¶Sce Gynécologie, CH Poissy, Poissy; ##Sce Gynécologie, CHRU Bretonneau, Tours; ***Sce Gynécologie Institut Curie; and †††Sce Gynécologie Hôpital Bichat Claude Bernard, Paris, France.

Objective: The aim of this study was to evaluate 36 quality indicators (QIs) for monitoring the quality of care of uterine cancer to be implemented in the EFFECT (effectiveness of endometrial cancer treatment) project.

Methods: The 36 QIs were evaluated in the first 10 patients diagnosed with endometrial cancer and managed in 14 French hospitals in 2011. To assess the status of each QI, a questionnaire detailing the 36 QIs was sent to each hospital, and the information was cross-checked with information from the multidisciplinary staff meeting, surgical reports, and pathological reports. The QIs were evaluated in terms of measurability and improvability. The remaining QIs were evaluated with a multiple correspondence analysis to highlight the interrelationships between qualitative variables describing a population.

Results: Thirteen of the 14 institutions responded to the survey for a total of 130 patients. Twenty-five of the 36 QIs affected less than 80% of the patients. Thirteen QIs were found not to be improvable because they reached more than 95% of the theoretical target. Finally, 5 QIs concerning more than 80% of the patients were found to be improvable. The multiple correspondence analysis finally identified 3 dimensions-outcome, safety, and perioperative management-that included the 5 QIs.

Conclusions: In the present study, 5 of the 36 QIs suggested by the EFFECT project seem to be sufficient to report on the quality of endometrial cancer management. Further studies are needed to correlate the information provided by those 5 questions and the relevant outcomes reflecting quality of care in endometrial cancer.
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http://dx.doi.org/10.1097/IGC.0000000000000980DOI Listing
June 2017

Therapeutic escalation - De-escalation: Data from 15.508 early breast cancer treated with upfront surgery and sentinel lymph node biopsy (SLNB).

Breast 2017 Aug 3;34:24-33. Epub 2017 May 3.

Institut Paoli Calmettes and CRCM, 232 Bd Ste Marguerite, Marseille, France; Aix Marseille Université, Faculté Timone, 25 Boulevard Jean Moulin, Marseille, France.

Introduction: The aim of this study was to examine changes in therapeutic practices for early breast cancer T0-2 N0 managed by upfront surgery and SLNB.

Population: Between 1999 and 2012, 15.508 patients were treated. Four periods were determined: 1999-2003, 2004-2006, 2007-2009 and > 2009. Five tumor subtypes were defined according to hormonal receptors (HR) and Her2: Luminal A (HR + Her2- Grade 1-2), Her2 (Her2+ HR-), Triple-negative (HR- Her2-), Luminal B Her2- (HR + Her2- Grade 3), Luminal B Her2+ (HR + HER2+).

Methods: Rates of axillary lymph node dissection (ALND), adjuvant chemotherapy ± trastuzumab, endocrine treatment, mastectomy and post mastectomy radiotherapy (PMRT) were analyzed according to treatment periods with univariate and multivariate analysis. Overall and disease-free survivals were analyzed according to treatment periods adjusted for HR and then for tumor subtypes.

Results: Rates of ALND, adjuvant chemotherapy and endocrine treatment varied significantly according to treatment periods, for HR positive and negative tumors. ALND rate decreased for all tumor subtypes with a decrease of adjuvant chemotherapy rate for Luminal A tumors and an increase for Luminal B Her2+ and Her2-tumors. Endocrine treatment rate decreased for Luminal A and increased for Luminal B Her2+ tumors. In multivariate analysis, these modifications with time remained significant. Mastectomy and PMRT rates increased. In multivariate analysis, overall and disease-free survivals increased during successive periods.

Conclusion: A global therapeutic de-escalation in ALND and adjuvant systemic treatment, combined with an actual escalation in some specific subsets was demonstrated, but without negative impact on survival.
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http://dx.doi.org/10.1016/j.breast.2017.04.008DOI Listing
August 2017

Surgical treatment of secondary lymphedema of the upper limb by stepped microsurgical lymphaticovenous anastomoses.

Breast Cancer Res Treat 2017 04 12;162(2):219-224. Epub 2017 Jan 12.

Service de chirurgie sénologique et gynécologique, Centre Antoine Lacassagne, 33 avenue de Valombrose, Cedex 2, 06189, Nice, France.

Objective: The incidence of lymphedema following treatment for breast cancer ranges between 10 and 50% after complete axillary dissection and gives rise to severe functional discomfort in patients. Results of lymphaticovenous anastomoses (LVA) in surgical treatment of lymphedema appear to be favorable. However, the available literature on this topic is scarce, often with short follow-up times. The aim of this study is to analyze the results of LVA on 31 patients and to review the existing literature.

Patients And Methods: This study comprised 31 female patients presenting lymphedema of the upper limb following treatment for breast cancer for which surgical treatment was given by microsurgery consisting of three stepped LVA performed in an outpatient setting.

Results: The post-LVA arm circumference was measured at three levels (wrist, forearm, and arm) in 31 female patients. Mean follow-up time was 12.8 months. Reduction in the circumference was 22.5, 21.32, and 30.2%, respectively, in the wrist, forearm, and arm. Functional improvement was observed in the majority (84%) of patients ranging from moderate to substantial. Only 2 patients had no result. The only patients to experience recurrence were those with a high level of lymphedema.

Conclusion: The review of the current literature and the present study revealed modest results in terms of decreased excess volume, although a major improvement in function points to LVA as a useful technique in this indication. Progress in imaging techniques has enhanced the results achieved with this procedure, although further studies on recurrence rates are needed with a follow-up greater than 1 year.
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http://dx.doi.org/10.1007/s10549-017-4110-2DOI Listing
April 2017

Concomitant cervical and transperineal parametrial high-dose-rate brachytherapy boost for locally advanced cervical cancer.

J Contemp Brachytherapy 2016 Feb 28;8(1):23-31. Epub 2016 Jan 28.

Department of Radiation Oncology.

Purpose: There is no consensus for parametrial boost technic while both transvaginal and transperineal approaches are discussed. A prototype was developed consisting of a perineal template, allowing transperineal needle insertion. This study analyzed acute toxicity of concomitant cervical and transperineal parametrial high-dose-rate brachytherapy (HDRB) boost for locally advanced cervical cancer.

Material And Methods: From 01.2011 to 12.2014, 33 patients (pts) presenting a locally advanced cervical cancer with parametrial invasion were treated. After the first course of external beam radiation therapy with cisplatinum, HDRB was performed combining endocavitary and interstitial technique for cervical and parametrial disease. Post-operative delineation (CTV, bladder, rectum, sigmoid) and planification were based on CT-scan/MRI. HDRB was delivered in 3-5 fractions over 2-3 consecutive days. Acute toxicities occurring within 6 months after HDRB were retrospectively reviewed.

Results: Median age was 56.4 years (27-79). Clinical stages were: T2b = 23 pts (69.7%), T3a = 1 pt (3%), T3b = 6 pts (18.2%), and T4a = 3 pts (9.1%). Median HDRB prescribed dose was 21 Gy (21-27). Median CTVCT (16 pts) and HR-CTVMRI (17 pts) were 52.6 cc (28.5-74.3), 31.9 cc (17.1-58), respectively. Median EQD2αβ10 for D90CTV and D90HR-CTV were 82.9 Gy (78.2-96.5), 84.8 Gy (80.6-91.4), respectively. Median EQD2αβ3 (CT/MRI) for D2cc bladder, rectum and sigmoid were 75.5 Gy (66.6-90.9), 64.4 Gy (51.9-77.4), and 60.4 Gy (50.9-81.1), respectively. Median follow-up was 14 months (ranged 6-51). Among the 24 pts with MFU = 24 months, 2-year LRFS rate, RRFS, and OS were 86.8%, 88.8%, and 94.1%, respectively. The rates of acute genitourinary and gastrointestinal toxicities were 36% (G1 dysuria = 8 pts, G2 infection = 2 pts, G3 infection = 2 pts), and 27% (G1 diarrhea = 9 pts), respectively. One patient presented vaginal bleeding at the time of applicator withdrawal (G3-blood transfusion); no bleeding was observed due to the parametrial implant.

Conclusions: Concomitant cervical and transperineal parametrial HDRB boost for locally advanced cervical cancer appears feasible and safe with no specific acute toxicity compare to cervical HDRB alone. Longer follow-up and larger patient cohort will be needed.
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http://dx.doi.org/10.5114/jcb.2016.57535DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4793065PMC
February 2016

Clinical nomogram to predict bone-only metastasis in patients with early breast carcinoma.

Br J Cancer 2015 Sep 22;113(7):1003-9. Epub 2015 Sep 22.

Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.

Background: Bone is one of the most common sites of distant metastasis in breast cancer. The purpose of this study was to combine selected clinical and pathologic variables to develop a nomogram that can predict the likelihood of bone-only metastasis (BOM) as the first site of recurrence in patients with early breast cancer.

Methods: Medical records of patients with non-metastatic breast cancer were retrospectively collected. On the basis of the analysis of patient and tumour characteristics using the Cox proportional hazards regression model, a nomogram to predict BOM was constructed for a 4175-patient-training cohort. The nomogram was validated in an independent cohort of 579 patients.

Results: Among 4175 patients with non-metastatic breast cancer, 314 developed subsequent BOM. Age, T classification, lymph node status, lymphovascular space invasion, and hormone receptor status were significantly and independently associated with subsequent BOM. The nomogram had a concordance index of 0.69 in the training set and 0.73 in the validation set.

Conclusions: We have developed a clinical nomogram to predict subsequent BOM in patients with non-metastatic breast cancer. Selection of a patient population at high risk for BOM could facilitate research of more specific staging approaches or the selective use of bone-targeted therapy.
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http://dx.doi.org/10.1038/bjc.2015.308DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4651124PMC
September 2015

Emotional impact of severe post-partum haemorrhage on women and their partners: an observational, case-matched, prospective, single-centre pilot study.

Eur J Obstet Gynecol Reprod Biol 2015 Oct 7;193:140-3. Epub 2015 Aug 7.

Department of Anaesthesiology and Intensive Care Medicine, Hôpital Lariboisière AP-HP, 2 rue Ambroise Paré, 75010 Paris, France; University Paris Diderot, Paris, France; UMR-942, INSERM, Paris, France.

Objective: This observational, matched-control, prospective, single-centre study sought to estimate the emotional impact of post-partum haemorrhage (PPH) on women and their partners, including its influences on post-traumatic stress disorder (PTSD), postpartum depression and the mother/child relationship.

Study Design: All consecutive women who were admitted for PPH from December 2010 through December 2011 and their partners were screened for eligibility. Emotional impact was assessed using three self-reported questionnaires (Impact of Event Scale-Revised to assess PTSD, Edinburgh Post Natal Depression Scale to assess post-natal depression and Mother-Infant Bonding Scale to assess the relationship between mother and child). Each PPH patient was matched with a control woman for whom the delivery was not complicated by PPH.

Results: The results showed (a) that women with PPH and their partners were more likely to report symptoms related to PTSD compared with controls, (b) that women with PPH were less likely to suffer from postnatal depression and (c) that there was no difference in the mother/child relationship between women with PPH and controls.

Conclusion: PPH is associated with a high incidence of PTSD-related symptoms in both women and their partners. PTSD in the context of PPH is likely an under-recognised phenomenon by health care professionals.
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http://dx.doi.org/10.1016/j.ejogrb.2015.07.020DOI Listing
October 2015

Direct Comparison of Logistic Regression and Recursive Partitioning to Predict Lymph Node Metastasis in Endometrial Cancer.

Int J Gynecol Cancer 2015 Jul;25(6):1037-43

*Department of Obstetrics and Gynaecology, APHP Hôpital Bichat, Paris, France; †Paris Diderot University Paris 07, Paris, France; ‡EA 7285, UVSQ, Poissy, France; §Department of Obstetrics and Gynaecology, CHU Reims, Reims, France; ∥Department of Obstetrics and Gynaecology, APHP Hôpital Lariboisiere, Paris, France; ¶INSERM UMR-S 1018, Université Paris-Sud, Institut Gustave-Roussy, Villejuif, France; #Department of Obstetrics and Gynaecology, CHIC, Créteil, France; **Department of Obstetrics and Gynaecology, APHP Hôpital Tenon, Paris, France; and ††Department of Gynaecology Institut Curie, Paris, France.

Objective: The purpose was to compare logistic regression model (LRM) and recursive partitioning (RP) to predict lymph node metastasis in early-stage endometrial cancer.

Methods/materials: Three models (1 LRM and 2 RP, a simple and a complex) were built in a same training set extracted from the Surveillance, Epidemiology, and End Results database for 18,294 patients who underwent hysterectomy and lymphadenectomy for stage I or II endometrial cancer. The 3 models were validated in a same validation set of 499 patients. Model performance was quantified with respect to discrimination (evaluated by the areas under the receiver operating characteristics curves) and calibration.

Results: In the training set, the areas under the receiver operating characteristics curves were similar for LRM (0.80 [95% confidence interval [CI], 0.79-0.81]) and the complex RP model (0.79 [95% CI, 0.78-0.80]) and higher when compared with the simple RP model (0.75 [95% CI, 0.74-0.76]). In the validation set, LRM (0.77 [95% CI, 0.75-0.79]) outperformed the simple RP model (0.72 [95% CI, 0.70-0.74]). The complex RP model had good discriminative performances (0.75 [95% CI, 0.73-0.77]). Logistic regression model also outperformed the simple RP model in terms of calibration.

Conclusions: In these real data sets, LRM outperformed the simple RP model to predict lymph node metastasis in early-stage endometrial cancer. It is therefore more suitable for clinical use considering the complexity of an RP complex model with similar performances.
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http://dx.doi.org/10.1097/IGC.0000000000000451DOI Listing
July 2015

Effect of Neoadjuvant Chemotherapy on the Surgical Treatment of Patients With Locally Advanced Breast Cancer Requiring Initial Mastectomy.

Clin Breast Cancer 2015 Oct 18;15(5):e231-5. Epub 2015 Mar 18.

Département de chirurgie oncologique, Centre Antoine Lacassagne, Nice, France.

Background: The aim of this study was to assess the rate of breast-conserving surgery (BCS) after neoadjuvant chemotherapy (nCT) in patients for whom mastectomy (MT) was, initially, the only conceivable surgical option.

Patients And Methods: Between 2007 and 2012, 168 patients from a single center received nCT. Among these patients, we focused on the ones who received nCT (n = 119, [70.8%]) to decrease tumor size and thus to potentially allow a conservative surgical treatment. For these patients, MT was initially the only possible surgical treatment.

Results: Among the 119 patients included, 118 presented with an invasive ductal carcinoma. The mean tumor size before nCT, measured using magnetic resonance imaging, was 41.6 mm (range, 15-110 mm) and 25.3 mm (range, 0-90 mm) after nCT. Eighty-six patients (72.3%) underwent BCS, and oncoplastic techniques were used in 29 patients (33.6%). Only 4.3% (5 patients) of patients who were treated with BCS needed additional surgery because of positive surgical margins. The median follow-up was 41.1 months (95% confidence interval [CI], 35.2-48.3). Five-year overall survival after BCS and MT were 77% (95% CI, 63-92) and 77% (95% CI, 63-95) respectively. Five-year disease-free survival after BCS and MT were 74% (95% CI, 64-86) and 59% (95% CI, 40-89) (not significant), respectively.

Conclusion: nCT for selective patients with "chemosensitive" breast tumor leads to a significant "MT to BCS" conversion rate. The type of surgery does not seem to affect the patient's overall and disease-free survival rates. Oncoplastic procedures can help to extend BCS after nCT.
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http://dx.doi.org/10.1016/j.clbc.2015.03.001DOI Listing
October 2015

Is there a role for a handheld gamma camera (TReCam) in the SNOLL breast cancer procedure?

Q J Nucl Med Mol Imaging 2019 Mar 31;63(1):56-61. Epub 2015 Mar 31.

Breast and Gynecological Surgical Oncology Unit, Centre Antoine Lacassagne, University of Nice-Sophia-Antipolis, Nice, France.

Background: Sentinel node and occult lesion localization (SNOLL) calls for a combination of two specific procedures: intraoperative detection of sentinel lymph node (SLN) and radio-guided occult lesion localization (ROLL). The safety and benefits of radio-guided localization in the surgical treatment of non-palpable breast cancer have been confirmed. The aim of this study was to evaluate the potential role for an intra-operative handheld tumor resection gamma camera (TReCam) in SNOLL procedures.

Methods: Fifteen patients were enrolled. The SNOLL procedure was performed in all patients with conventional lymphoscintigraphy (LS). TReCam was used to obtain nuclear imaging in the operating theater. Concordance between LS and TReCam images, duration of use and assessment of difficulties in data acquisition with TReCam were reported.

Results: Concordance for tumor localization between single-detector gamma probe and TReCam was excellent (15/15). The number of radioactive SLNs visualized between LS and TReCam was equivalent in 53.3% of cases (8/15). TReCam was considered to be very easy-to-use (12/15) or easy-to-use (3/15). Average duration of acquisition with TReCam was 4 minutes and 45 seconds for the SLN procedure, and 2 minutes and 10 seconds for lumpectomy.

Conclusions: This study suggests that TReCam is easy-to-use and does not increase operative time. Its exact role in radio-guided surgery needs to be clearly defined in a larger study. However, its usefulness and benefits in radio-guided breast surgery seem to be promising.
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http://dx.doi.org/10.23736/S1824-4785.17.02789-3DOI Listing
March 2019

Intrathecal Trastuzumab Halts Progression of CNS Metastases in Breast Cancer.

J Clin Oncol 2016 06 29;34(16):e151-5. Epub 2014 Dec 29.

Université Paris Diderot, Unité Mixte de Recherche S728; Institut National de la Santé et de la Recherche Médicale U728; Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France.

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http://dx.doi.org/10.1200/JCO.2012.44.8894DOI Listing
June 2016

Response to the article by Rodríguez et al: "effectiveness of an absorbable fibrin sealant patch to reduce lymphoceles formation after axillary lymphadenectomy for breast cancer: a matched-pair analysis." Am J Surg 2014.

Am J Surg 2015 Feb 20;209(2):426-7. Epub 2014 Aug 20.

Department of Gynecology - Obstetrics, Bobigny University, AP-HP, Hôpital Jean-Verdier, Avenue du 14-Juillet, 93143 Bondy, France.

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http://dx.doi.org/10.1016/j.amjsurg.2014.06.028DOI Listing
February 2015

Response to the article by Evangelista et al.: Use of a portable gamma camera for guiding surgical treatment in locally advanced breast cancer in a post-neoadjuvant therapy setting. Breast Cancer Res Treat 2014.

Breast Cancer Res Treat 2014 Nov 25;148(1):231-2. Epub 2014 Jul 25.

Department of Gynecology-Obstetrics, Bobigny University, AP-HP, Hôpital Jean-Verdier, avenue du 14-Juillet, 93143, Bondy, France.

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http://dx.doi.org/10.1007/s10549-014-3062-zDOI Listing
November 2014

Response to the article by Thill et al.: "The Central-European SentiMag study: sentinel lymph node biopsy with supermagnetic iron oxide (SPIO) vs. radioisotope". The Breast 2014.

Breast 2014 Jun 8;23(3):297. Epub 2014 Apr 8.

Breast and Gynecological Surgical Oncology Unit, Centre Antoine Lacassagne, University of Nice Sophia-Antipolis, 33 Avenue de Valombrose, 06189 Nice Cedex 2, France.

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http://dx.doi.org/10.1016/j.breast.2014.03.005DOI Listing
June 2014

Untreated highly viraemic pregnant women from Asia or sub-Saharan Africa often transmit hepatitis B virus despite serovaccination to newborns.

Liver Int 2015 Feb 28;35(2):409-16. Epub 2014 Apr 28.

Service de Médecine Interne A (Pr J.F. Bergmann), Hôpital Lariboisière, Paris, France.

Background & Aims: Mother-to-child (MTC) hepatitis B virus (HBV) transmission has been mainly studied in Asia. The geographical origins of women and HBV genotypes differ in Europe. The aims were to determine the rate and risk factors of MTC HBV transmission from women with high HBV DNA loads in a maternity hospital in Paris, France.

Methods: Retrospective study of HIV-negative, HBs Ag-positive pregnant women with HBV DNA loads above 5 Log10 I.U/ml who were not given lamivudine or tenofovirDF during pregnancy between 2004 and 2011.

Results: Among 11 417 pregnant women, 437 (4%) showed a positive HBs Ag. Among these women, 52 had HBV DNA loads above 5 Log10 I.U/ml: 41, 10 and 1 born in Asia, sub-Saharan Africa and Europe respectively. Among the 52 women, 40 were eligible for the analysis: no antiviral therapy during pregnancy; children over 9 months old. Twenty-eight (70%) women were assessed, corresponding to 41 childbirths. Eleven children (27%) had positive HBs Ag, 14 (34%) had positive HBc and HBs Ab, 16 (39%) had positive HBs Ab only. The risk of having positive HBs Ag, according to maternal HBV DNA loads, was 14% for HBV DNA loads less or equal to 8 Log10 I.U/ml, 42% for HBV DNA loads over 8 Log10 I.U/ml, P = 0.04, but not related to the women's origin, HBV genotype.

Conclusions: This study confirms that serovaccination does not fully protect newborns from MTC HBV transmission, when maternal HBV DNA loads exceed 5 Log10 I.U/ml, regardless of the women's origin or HBV genotype.
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http://dx.doi.org/10.1111/liv.12561DOI Listing
February 2015

A suggested modification to FIGO stage I endometrial cancer.

Gynecol Oncol 2014 May 12;133(2):192-6. Epub 2014 Mar 12.

Department of Obstetrics and Gynaecology, APHP Hôpital Bichat, Paris, France; Paris Diderot University, Paris 07, France; UMR S 938, CdR St Antoine UPMC University, Paris 06, France; EA 7285, UVSQ, Montigny-le-Bretonneux, France. Electronic address:

Objective: FIGO stage I endometrial cancers are divided into two substages, regardless of the presence or absence of lymphovascular space invasion (LVSI). The aim of this study was to investigate whether stratification based on the LVSI status would better predict mortality.

Methods: Using a multicentric database, we identified patients who underwent endometrial cancer operations between 2000 and 2010. The staging performance was quantified with respect to discrimination.

Results: The study cohort included 508 patients (198 with LVSI-positive tumors and 310 with LVSI-negative tumors). The survival difference between the stage I patients with LVSI-positive and LVSI-negative tumors was highly significant (81% and 97%, respectively P=.009), whereas the difference between the stage I patients with tumors invading greater or less than half of the myometrium was not (87% and 96%, respectively P=0.09). The 5-year OS rates for the patients with LVSI-negative tumors invading less than half of the myometrium, with LVSI-negative tumors invading more than half of the myometrium and with LVSI-positive invading more than or less than half of the myometrium were 98%, 95%, and 81%, respectively (P=.03). Separating the LVSI-negative and LVSI-positive tumors would improve discrimination (concordance index, 77% vs. 75%, respectively, using the actual staging system).

Conclusion: A LVSI-positive status has a significantly worse prognosis. In this study, the distinction by LVSI status appears to be more relevant than the distinction between stages IA and IB for predicting survival in stage I endometrial cancer. This difference in prognosis would favor restaging these two entities.
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http://dx.doi.org/10.1016/j.ygyno.2014.03.009DOI Listing
May 2014

[Breast cancer surgery].

Rev Prat 2013 Dec;63(10):1395-9

Oncochirurgie générale, gynécologique et mammaire, Centre Antoine-Lacassagne, 06189 Nice cedex 2, France.

The surgery for breast cancer is frequently the first step in a multi-disciplinary care. It allows for local control, but also to establish crucial prognostic factor indicating potential adjuvant therapy. The current trend s towards de-escalation of surgical treatment for reducing the functional and aesthetic morbidity. At the local level, this de-escalation has been made possible by performing most often breast conservative surgery because of the development of oncoplastic techniques, but also because of neoadjuvant chemotherapy. At the axillary level, the reduction of morbidity has been made possible by the advent of the sentinel node biopsy which is more and more indicated year after year.
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December 2013

Individual xenograft as a personalized therapeutic resort for women with metastatic triple-negative breast carcinoma.

Breast Cancer Res 2014 Feb 11;16(1):401. Epub 2014 Feb 11.

A localized left breast ductal invasive triple-negative breast carcinoma (TNBC) was diagnosed in a 44-year-old woman. After surgery, she was treated with chemotherapy and radiation therapy in accordance with national guidelines. At the end of treatment, she had local and metastatic relapse with multiple sub-diaphragmatic lymph nodes.
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http://dx.doi.org/10.1186/bcr3615DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3979114PMC
February 2014
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