Publications by authors named "Julia Salleron"

141 Publications

High-dose-rate brachytherapy for facial skin cancer: Outcome and toxicity assessment for 71 cases.

Brachytherapy 2021 Mar 5. Epub 2021 Mar 5.

Department of Brachytherapy, Institut de Cancérologie de Lorraine, Vandoeuvre-les-Nancy, France.

Purpose: In France, the reference technique for skin cancer was low-dose-rate brachytherapy (BT) delivered via iridium wire. At the end of their commercialization in 2015 we have replaced them by high-dose-rate (HDR) BT via interstitial catheters. We assessed efficacy and tolerance as soon as this technique was implemented.

Methods And Materials: Patients received 7 Gy on the first day, followed by 8 × 4 Gy over the next 4 days for exclusive BT and 9 × 4 Gy over 5 days for post-operative BT.

Results: Sixty-six patients of median age 81 years received a total of 58 primary BT and 13 post-operative BT for non-melanoma facial skin cancers. Implantation was without difficulty. Median follow up was 15.3 months. Two patients died of intercurrent diseases before first follow up. For the others, 98.5% showed complete response and 3% local recurrence after a median of 20.5 months. Four patients had grade 3 acute dermatitis and three patients had grade 3 mucositis. All the Grade 3 toxicities were resolved within 3 months. A late significant hypopigmentation occurred in 4 patients.

Conclusions: HDR BT is efficient and well-tolerated with good cosmetic results. HDR catheters are similar with iridium wires in terms of technical difficulty.
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http://dx.doi.org/10.1016/j.brachy.2021.01.009DOI Listing
March 2021

Differences in clinical and imaging characteristics between p16-positive non-smokers and p16-positive smokers or p16-negative patients in oropharyngeal carcinoma.

Sci Rep 2021 Feb 8;11(1):3314. Epub 2021 Feb 8.

Institut de Cancérologie de Lorraine, 6 Avenue de Bourgogne, 54519, Vandœuvre-lès-Nancy, France.

The eighth edition of the TNM classifies oropharyngeal squamous cell carcinomas (OSCCs) depending on p16 status. Some imaging features are reportedly associated more frequently with p16-positive (P16+) OSCC than p16-negative (p16-) OSCC. However, classical risk factors such as tobacco use were not specifically considered when assessing these imaging features. We aimed to evaluate whether P16+ OSCCs have different epidemiological, clinical, prognostic and imaging features depending on smoking status, and to compare P16+ and p16- groups. A retrospective study of data from 85 patients with P16+ OSCC (41 non-smokers, 44 smokers) and 36 with p16- OSCC from 2011 to 2020 was carried out, assessing epidemiological data, clinical aspects of the tumour and presence of adenopathy. Staging was assessed according to the seventh and eighth editions of the TNM. Compared with P16+ OSCC non-smokers, P16+ OSCC smokers had tumours that were less well-defined (36.6% vs 77.8%, p < 0.001), more ulcerated (85.4% vs 44.4%, p < 0.001) and more necrotic (53.7% vs 25%, p = 0.012). There was also less downstaging from N2 or N3 of the seventh edition of the TNM to N1 of the eighth edition for smokers than non-smokers (22.7% vs 43.9%, p = 0.042). Compared with p16- tumours, more P16+ tumours had well-defined contours (55.8% vs 22.2%, p = 0.001), were exophytic (89.6% vs 72.2%, p = 0.023), less necrotic (40.3% vs 80.6%, p < 0.001), less ulcerated (97.2% vs 66.2%, p = 0.006) and involved less muscle tissue (26.0% vs 47.2%, p = 0.027).P16+ OSCCs of smokers show clinical, imaging and prognostic differences with P16+ OSCCs of non-smokers.
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http://dx.doi.org/10.1038/s41598-021-82999-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7870833PMC
February 2021

Estimating the risks and benefits before salvage surgery for recurrent head and neck squamous cell carcinoma.

Eur J Surg Oncol 2021 Jan 29. Epub 2021 Jan 29.

Department of Surgical Oncology, Head and Neck Unit, Institut de Cancérologie de Lorraine, Université de Lorraine, F-54519, Vandœuvre-lès-Nancy, France; University of Lorraine, CNRS, CRAN, F-54000, Nancy, France.

Introduction: The risks associated with salvage surgery of head and neck squamous cell carcinoma (SCC) in a previously irradiated field needs to be balanced against the expected survival benefits. We want to identify preoperative predictive factors for overall and disease-specific survival (OS/DSS) and for the development of serious (Clavien-Dindo, CD≥III) complications following salvage surgery for radiorecurrent SCC to help surgeons, patients, and caregivers in the decision-making process in this setting.

Materials And Methods: The records of 234 patients presenting to the Lorraine Cancer Institute with locoregional radiorecurrent SCC were reviewed. The primary endpoint was OS, secondary endpoints were DSS, OS without tracheostomy/gastrostomy, and the risk of CD≥III complications. Multivariate analyses were carried out to explore preoperative factors associated with survival and the risk of postoperative complications.

Results: With a median follow-up time of 19 months, 5-year OS since the first salvage surgery was 28.3%, 5-year DSS was 38.9%. 2- and 5-year functional OS were 45.6% and 27.2%. rcT-rcN, and WUNHCI ≥4 were both independent significant preoperative predictors of OS and DSS. 30-days postoperative complications occurred in 44.4% of patients (28 CD I, 24 CD II, 34 CD III, 11 CD IV, 7 CD V). A salvage procedure involving T+N plus the presence of a WUHNCI ≥4 was the only independent predictor of CD≥III complications.

Conclusion: When discussing with the patients and the caregivers salvage surgery for recurrent head and neck SCC, a careful evaluation of the preoperative comorbidities by the WUHNCI tool can reliably predict the expected risks and benefits from the procedure.
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http://dx.doi.org/10.1016/j.ejso.2021.01.022DOI Listing
January 2021

Efficacy of extracranial stereotactic body radiation therapy (SBRT) added to standard treatment in patients with solid tumors (breast, prostate and non-small cell lung cancer) with up to 3 bone-only metastases: study protocol for a randomised phase III trial (STEREO-OS).

BMC Cancer 2021 Feb 4;21(1):117. Epub 2021 Feb 4.

Academic Radiation Oncology & Brachytherapy Department, Lorraine Institute of Cancerology - Alexis-Vautrin Comprehensive Cancer Center, 6 avenue de Bourgogne, 54519, Vandœuvre-lès-Nancy, France.

Background: Stereotactic Body Radiation Therapy (SBRT) is an innovative modality based on high precision planning and delivery. Cancer with bone metastases and oligometastases are associated with an intermediate or good prognosis. We assume that prolonged survival rates would be achieved if both the primary tumor and metastases are controlled by local treatment. Our purpose is to demonstrate, via a multicenter randomized phase III trial, that local treatment of metastatic sites with curative intent with SBRT associated of systemic standard of care treatment would improve the progression-free survival in patients with solid tumor (breast, prostate and non-small cell lung cancer) with up to 3 bone-only metastases compared to patients who received systemic standard of care treatment alone.

Methods: This is an open-labeled randomized superiority multicenter phase III trial. Patients with up to 3 bone-only metastases will be randomized in a 1:1 ratio.between Arm A (Experimental group): Standard care of treatment & SBRT to all bone metastases, and Arm B (Control group): standard care of treatment. For patients receiving SBRT, radiotherapy dose and fractionation depends on the site of the bone metastasis and the proximity to critical normal structures. This study aims to accrue a total of 196 patients within 4 years. The primary endpoint is progression-free survival at 1 year, and secondary endpoints include Bone progression-free survival; Local control; Cancer-specific survival; Overall survival; Toxicity; Quality of life; Pain score analysis, Cost-utility analysis; Cost-effectiveness analysis and Budget impact analysis.

Discussion: The expected benefit for the patient in the experimental arm is a longer expectancy of life without skeletal recurrence and the discomfort, pain and drastic reduction of mobility and handicap that the lack of local control of bone metastases eventually inflicts.

Trials Registration: ClinicalTrials.gov NCT03143322 Registered on May 8th 2017. Ongoing study.
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http://dx.doi.org/10.1186/s12885-021-07828-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7863429PMC
February 2021

Expression of immune response biomarkers (PD‑L1, p16, CD3+ and CD8+ TILs) in recurrent head and neck squamous cell carcinoma within previously irradiated areas.

Oncol Rep 2021 Mar 7;45(3):1273-1283. Epub 2021 Jan 7.

Department of Medical Oncology, Lorraine Institute of Oncology, University of Lorraine, F‑54519 Vandœuvre‑lès‑Nancy, France.

The immune landscape of head and neck squamous cell carcinoma in pretreated areas remains poorly documented. We aimed to assess the tumor microenvironment for biomarkers of antitumor immune responses in tumors in previously irradiated areas compared with de novo tumors. This retrospective monocentric study analyzed 100 paraffin‑embedded surgical samples of invasive head and neck squamous cell carcinoma (oral cavity, oropharynx, larynx, hypopharynx) from patients who underwent surgery between January 2010 and November 2017. We compared the immune microenvironment in 50 de novo tumors and 50 tumors recurring within irradiated areas. We used immunohistochemistry to assess p16 status, CD3+/CD8+ tumor‑infiltrating lymphocytes (TILs), and programmed death‑ligand 1 (PD‑L1) expression on tumor and immune cells in stromal and intratumoral components. CD3+ TIL counts were significantly lower in intratumoral and stromal components (P=0.003 and P=0.020, respectively) in the irradiated area cohort; there was no significant difference between CD8+ TIL counts in the two cohorts. The percentage of tumors with PD‑L1+ tumor cells (tumor proportion score ≥1%) was significantly lower within the irradiated area cohort than the de novo cohort (56.0% vs. 86.0%, P<0.001). There were also significantly fewer tumors with PD‑L1+ immune cells in the irradiated area cohort. Predominantly, tumors from the irradiated area cohort had microenvironments classified as 'adaptive immune resistance'. There was persistence of cytotoxic cells in tumors in the irradiated areas but lower PD‑L1 expression and CD3+ TIL counts than in the de novo tumors. This offers an initial hypothesis to explain why these lesions are less responsive to immunotherapy, even though they may still have antitumor capacities. Assessment of immune response biomarkers in patients treated with immunotherapy in randomized trials is required.
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http://dx.doi.org/10.3892/or.2021.7928DOI Listing
March 2021

Evaluation of Pre-Therapeutic Assessment in Endometrial Cancer Staging.

Diagnostics (Basel) 2020 Dec 4;10(12). Epub 2020 Dec 4.

Surgery Department, Institut de Cancérologie de Lorraine, 6, Avenue de Bourgogne, 54519 Vandoeuvre-les-Nancy, France.

Objective: The aim of this retrospective cohort study is to evaluate the concordance between the preoperative MRI and histology data with the final histopathological examination.

Method: This is a retrospective observational study of 183 patients operated for endometrioid cancer between January 2009 and December 2019 in the surgical oncology department of the Lorraine Cancer Institute (ICL) in Vandœuvre-lès-Nancy. The patients included are all women operated on for endometrioid-type endometrial cancer over this period. The exclusion criteria are patients for whom the pre-therapy check-up does not include pelvic MRI and those who have not had first-line surgery. The final anatomopathological results were compared with preoperative imaging data and with endometrial biopsy data.

Results: For the myometrial infiltration, the sensitivity of MRI was of 37% and the specificity of 54%. To detect nodal metastases, the sensitivity of MRI was of 21% and the specificity of 93%. We observed an under estimation of the FIGO classification ( = 0.001) with the MRI in 42.7% of cases (n = 76) and an overestimation in 24.2% of cases (n = 43). There was a concordance in 33.1% of cases (n = 59). We had a poor agreement between the MRI and final histopathological examination with an adjusted kappa (κ) of 0.12 [95% IC (0.02; 0.24)]. There was a moderate concordance on the grade between the pretherapeutic biopsy and the final histopathological examination on excised tissue with an adjusted kappa of 0.52 [95% IC 0.42-0.62)]. Endometrial biopsy underestimated the tumor grade in 28.9% of cases (n = 50) ( < 0.001), overestimated the tumor grade in 6.9% of cases (n = 12) and we observed a concordance in 64.2% of cases (n = 111).

Conclusion: The pre-operative assessment of endometrial cancer is inconsistent with the results obtained on final histopathological examination. A study with a systematic review should be done to assess the performance of MRI, only in expert centers, in order to consider a a specific care management for endometrial cancer patients: patients who have had an MRI in an outpatient center should have their imaging systematically reviewed, with the possibility of a new examination in case of incomplete sequences, by expert radiologists, and discussed in multidisciplinary concertation meeting in expert centers, before any therapeutic decision. The sentinel node biopsy must be used for low and intermediate risk endometrial cancer.
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http://dx.doi.org/10.3390/diagnostics10121045DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7761973PMC
December 2020

Optimizing the treatment of liver metastases from uveal melanomas with transarterial chemoembolization using melphalan and calibrated microspheres.

Bull Cancer 2020 Dec 9;107(12):1274-1283. Epub 2020 Nov 9.

University Hospital Archet 2, Department of Diagnostic and Interventional Radiology, 151 Route de Saint-Antoine, 06200 Nice, France. Electronic address:

Introduction: Patients with liver metastasis from uveal melanoma have a poor prognosis. Efficacy and safety of hepatic transarterial chemoembolization (TACE) using melphalan and microspheres was evaluated.

Materials And Methods: Monocentric retrospective study of all consecutive patients treated by TACE using melphalan and 250μm calibrated microspheres between 2004 and 2016. Radiological response was assessed according to RECIST 1.1, modified (m)-RECIST and EASL on contrast-enhanced computed tomography (CT) or magnetic resonance imaging (MRI). The primary endpoint was overall survival (OS). Liver metastasis response, hepatic, extrahepatic and global progression free survival (PFS) complications were evaluated with the common terminology criteria for adverse events version 4.0 (CTCAE 4.0) and survival factors were secondary endpoints.

Results: Thirty-four patients underwent 138 TACE (4; 4.1 sessions; range 1-9). Median OS was 16.5 months (mean 21.6 months). Liver metastasis response combining partial and complete response was 42.4%, 97%, 97% with RECIST 1.1, mRECIST, EASL, respectively. There were 58 severe (CTCAE≥3) but manageable complications in 28 patients, except for 1 toxic death.

Conclusion: For patients with liver metastases from uveal melanoma ineligible for local treatments, TACE using melphalan may be performed as first line therapy in metastatic miliary disease from uveal melanomas with careful supportive care.
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http://dx.doi.org/10.1016/j.bulcan.2020.09.010DOI Listing
December 2020

Fluorescence Emitted by Papanicolaou-Stained Urothelial Cells Improves Sensitivity of Urinary Conventional Cytology for Detection of Urothelial Tumors.

World J Oncol 2020 Oct 15;11(5):204-215. Epub 2020 Oct 15.

Service d'Urologie, Universite de Lorraine, CNRS UMR 7039 CRAN, Centre Hospitalier Regional Universitaire, 54035 Nancy Cedex, France.

Background: Urinary conventional cytology (UCCy) is easy to perform, but its low sensitivity, especially for low-grade urothelial neoplasms (LGUNs), limits its indications in the management of patients at risk of bladder cancer. The authors aim at obtaining a complementary test that would effectively increase the sensitivity of UCCy on voided urines by analyzing fluorescence of Papanicolaou-stained urothelial cells with no change of method in slide preparation.

Methods: In this retrospective study of 155 patients, 91 Papanicolaou-stained voided urines were considered satisfactory under fluorescence microscopy (FMi). The results of FMi were compared with UCCy (using transmission microscopy) and correlated to cystoscopy, histology and follow-up data.

Results: The results are given for all patients and for two groups of them according to the patients' main complaints (group 1: 33 patients followed up for a previously treated bladder tumor; group 2: 58 patients with persistent urinary symptoms). Overall negative predictive value (NPV) and sensitivity of FMi were 100% vs. 73.7% and 64.3% respectively for UCCy (P = 0.0001). Sensitivity of FMi for LGUN was unexpectedly high with a value of 100% vs. 46.2% for UCCy (P = 0.0002). FMi was significantly superior to UCCy for detecting urothelial tumors in every group of patients and would allow a better characterization of atypical urothelial cells (AUCs) defined by the Paris System for Reporting Urine Cytology (TPS).

Conclusions: Because of its sensitivity and NPV of 100%, FMi could complement UCCy to screen voided urines allowing a better detection of primary urothelial tumors or early recurrences of previously treated urothelial carcinoma. Moreover, this "dual screening" would allow completing efficiently cystoscopy to detect flat dysplasia, carcinoma (CIS) and extra bladder carcinoma.
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http://dx.doi.org/10.14740/wjon1305DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7575278PMC
October 2020

EyeSi Surgical Simulator: validation of a proficiency-based test for assessment of vitreoretinal surgical skills.

Acta Ophthalmol 2020 Oct 3. Epub 2020 Oct 3.

Department of Ophthalmology, Nancy University Hospital, Vandœuvre-lès-Nancy, France.

Purpose: To develop and investigate an evidence-based performance test for assessment of vitreoretinal surgical skills on the EyeSi Surgical Simulator.

Methods: Ten junior residents without any surgical experience, eight senior residents with prior experience in cataract surgery and five vitreoretinal surgeons were included in the study. The test consisted of seven modules and was completed twice by all groups during a single session. Validity evidence was evaluated using Messick's validity framework. Senior residents completed four additional test sessions and were retested 3 months after to assess skill acquisition and retention.

Results: Content was aligned with vitreoretinal surgical skills as evaluated by expert surgeons. Response process was ensured through standardized instruction and data collection. The test showed satisfactory internal consistency with Cronbach's α = 0.76 (internal structure) and significant discriminative ability between the residents and the experienced surgeons (relation to other variables). A pass/fail level was determined at 596 using the contrasting groups' method. Consequences of applying this standard resulted in no false positive and no false negative. Senior residents significantly improved their simulator skills over time, reaching a plateau at the fifth iteration and equalling expert performance (p = 0.420). This level of competency was retained during the post-3-month retention testing (p = 0.062).

Conclusion: We established a performance test with solid evidence for assessment of vitreoretinal surgical skills on the EyeSi Simulator and determined a benchmark criterion that may be used for future implementation of proficiency-based training for novices.
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http://dx.doi.org/10.1111/aos.14628DOI Listing
October 2020

Evaluation of 3 molecular-based assays for microsatellite instability detection in formalin-fixed tissues of patients with endometrial and colorectal cancers.

Sci Rep 2020 10 2;10(1):16386. Epub 2020 Oct 2.

Service de Biologie Moléculaire des Tumeurs, Institut de Cancérologie de Lorraine, CNRS UMR 7039 CRAN-Université de Lorraine, 6 avenue de Bourgogne CS 30519, 54519, Vandœuvre-lès-Nancy Cedex, France.

Microsatellite instability (MSI) status is routinely assessed in patients with colorectal and endometrial cancers as it contributes to Lynch syndrome initial screening, tumour prognosis and selecting patients for immunotherapy. Currently, standard reference methods recommended for MSI/dMMR (deficient MisMatch Repair) testing consist of immunohistochemistry and pentaplex PCR-based assays, however, novel molecular-based techniques are emerging. Here, we aimed to evaluate the performance of a custom capture-based NGS method and the Bio-Rad ddPCR and Idylla approaches for the determination of MSI status for theranostic purposes in 30 formalin-fixed paraffin embedded (FFPE) tissue samples from patients with endometrial (n = 15) and colorectal (n = 15) cancers. All samples were previously characterised using IHC and Promega MSI Analysis System and these assays set as golden standard. Overall agreement, sensitivity and specificity of our custom-built NGS panel were 93.30%, 93.75% and 92.86% respectively. Overall agreement, sensitivity and specificity were 100% with the Idylla MSI system. The Bio-Rad ddPCR MSI assay showed a 100% concordance, sensitivity and specificity. The custom capture-based NGS, Bio-Rad ddPCR and Idylla approaches represent viable and complementary options to IHC and Promega MSI Analysis System for the detection of MSI. Bio-Rad ddPCR and Idylla MSI assays accounts for easy and fast screening assays while the NGS approach offers the advantages to simultaneously detect MSI and clinically relevant genomic alterations.
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http://dx.doi.org/10.1038/s41598-020-73421-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7532161PMC
October 2020

Non-technical skills in robotic surgery and impact on near-miss events: a multi-center study.

Surg Endosc 2020 Sep 23. Epub 2020 Sep 23.

Department of Urology, CHRU Nancy Brabois University Hospital, 5 Rue du Morvan, 54500, Vandoeuvre-Lès-Nancy, France.

Background: Robotic surgery requires a set of non-technical skills (NTS), because of the complex environment. We aim to study relationship between NTS and near-miss events in robotic surgery.

Methods: This is an observational study in five French centers. Three robotic procedures were observed and filmed by one of expert trainers in NTS. They established and scored a non-technical skills in robotic surgery (NTSRS) score, that included eight items, each scored from 1 to 5, to assess the whole surgical teams. The surgical teams also self-assessed their work. The number of near-miss events was recorded and classified as minor, or major but no harm incidents, independently by two surgeons. Correlations were Spearman coefficients.

Results: Of the 26 procedures included, 15 were prostatectomy (58%), 9 nephrectomy (35%), and 2 pyeloplasty (7.7%). Half of procedures (n = 13) were performed by surgeons with extensive RS experience (more than 150 procedures). Per procedure, there was a median (quartiles) of 9 (7; 11) near-miss events. There was 1 (0; 2) major near-miss events, with no harm. The median NTSRS score was 18 (14; 21), out of 40. The number of near-miss events was strongly correlated with the NTSRS score (r = - 0.92, p < 0.001) but was not correlated with the surgeon's experience. The surgeons for fifteen (58%) procedures, and the bed-side surgeons for 11 (42%) procedures, felt that there was no need for an improvement in the quality of their NTS. None of the surgeons gave a negative self-evaluation for any procedure; in three procedures (12%), the bed-side surgeons self-assessed negatively, on ergonomics.

Conclusion: Occurrence of near-miss events was reduced in teams managing NTS. Specific NTS surgical team training is essential for robotic surgery as it may have a significant impact on risk management.
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http://dx.doi.org/10.1007/s00464-020-07988-5DOI Listing
September 2020

Added-value of advanced magnetic resonance imaging to conventional morphologic analysis for the differentiation between benign and malignant non-fatty soft-tissue tumors.

Eur Radiol 2021 Mar 3;31(3):1536-1547. Epub 2020 Sep 3.

Service d'imagerie Guilloz, Hôpital Central, Centre Hospitalier Régional Universitaire de Nancy, 29 avenue du Maréchal de Lattre de Tassigny, 54035, Nancy cedex, France.

Objectives: To evaluate the added value of DWI, qualitative proton MR spectroscopy (H-MRS) and dynamic contrast-enhanced perfusion (DCE-P) to conventional MRI in differentiating benign and malignant non-fatty soft tissue tumors (NFSTT).

Methods: From November 2009 to August 2017, 288 patients with NFSTT that underwent conventional and advanced MRI were prospectively evaluated. The study was approved by the local ethics committee. All patients signed an informed consent. A musculoskeletal (R1) and a general (R2) radiologist classified all tumors as benign, malignant, or indeterminate according to morphologic MRI features. Then, DWI, H-MRS, and DCE-P data of indeterminate tumors were analyzed by two additional radiologists (R3 and R4). Advanced techniques were considered individually and in combination for tumor benign-malignant differentiation using histology as the gold standard.

Results: There were 104 (36.1%) malignant and 184 (63.9%) benign tumors. Conventional MRI analysis classified 99 tumors for R1 and 135 for R2 as benign or malignant, an accuracy for the identification of malignancy of 87.9% for R1 and 83.7% for R2, respectively. There were 189 indeterminate tumors for R1. For these tumors, the combination of DWI and H-MRS yielded the best accuracy for malignancy identification (77.4%). DWI alone provided the best sensitivity (91.8%) while the combination of DCE-P, DWI, and H-MRS yielded the best specificity (100%). The reproducibility of the advanced imaging parameters was considered good to excellent (Kappa and ICC > 0.86). An advanced MRI evidence-based evaluation algorithm was proposed allowing to characterize 28.1 to 30.1% of indeterminate non-myxoid tumors.

Conclusion: The prioritized use of advanced MRI techniques allowed to decrease by about 30% the number of non-myxoid NFSTT deemed indeterminate after conventional MRI analysis alone.

Key Points: • When morphological characterization of non-fatty soft tissue tumors is possible, the diagnostic performance is high and there is no need for advanced imaging techniques. • Following morphologic analysis, advanced MRI techniques reduced by about 30% the number of non-myxoid indeterminate tumors. • DWI is the keystone of advanced imaging techniques yielding the best sensitivity (91.8%). Optimal specificity (> 90%) is obtained by a combination of advanced techniques.
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http://dx.doi.org/10.1007/s00330-020-07190-0DOI Listing
March 2021

Pre-operative axillary ultrasound with fine-needle aspiration cytology performance and predictive factors of false negatives in axillary lymph node involvement in early breast cancer.

Breast Cancer Res Treat 2020 Oct 31;183(3):639-647. Epub 2020 Jul 31.

Institut de Cancérologie de Lorraine, Department of Surgical Oncology, Université de Lorraine, 54519, Vandoeuvre-lès-Nancy, France.

Purpose: Breast cancer is the most common cancer among females worldwide. Axillary lymph node involvement is an important prognostic factor in pre-operative evaluation. The aim of this study was to evaluate the sensitivity and accuracy of AUS during the initial breast cancer diagnosis and the contribution of ultrasound with guided FNAC (AUS + FNAC) in cases of suspicious node.

Methods: A retrospective study was conducted at the Lorraine Cancer Institute between 1 January and 31 December 2015. It included patients with early breast cancer, all of whom received AUS. If axillary node involvement was suspected, FNAC was performed. Sentinel lymph node biopsy (SLNB) and/or axillary lymph node dissection (ALND) were performed depending on FNAC results.

Results: In total, 292 patients were included. 88 patients (30.1%) had a suspicious lymph node on ultrasound and had FNAC, of whom 53 tested positive for axillary node involvement (60.2%). Among the 35 patients who tested negative with FNAC, 15 had axillary metastatic involvement. Performance of AUS + FNAC was better than that of AUS alone, with sensitivity, specificity, positive predictive and negative predictive values of approximately 44.5%, 100%, 100% and 72.4%, respectively, and accuracy of approximately 77.4%. Luminal A subgroup, axillary involvement of less than two positive nodes or nodal tumor of less than 7 mm are independent factors of false negative rate.

Conclusions: AUS performance would seem to be improved by FNAC, with a false negative rate of approximately 26%. It may be possible to reduce the false negative rate of AUS if its contributing factors are taken into consideration, along with the impact of specific echographic signs as revealed by experienced radiologists.
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http://dx.doi.org/10.1007/s10549-020-05830-zDOI Listing
October 2020

Locoregional control, progression-free survival and morbidity rates in N3 head and neck cancer patients with low primary tumour burden: A 301-patient study.

Clin Otolaryngol 2020 Nov 16;45(6):877-884. Epub 2020 Sep 16.

Radiation oncology, Centre François Baclesse / ARCHADE, Caen, France.

Objectives: In patients with N3 head and neck squamous cell carcinoma (HNSCC), N3 disease is associated with high regional relapse and metastatic risks. Patients with resectable N3 disease have better prognosis although their metastatic risk may be similar as in patients with unresectable disease. Neoadjuvant chemotherapy has been associated with lower metastatic rates, but N3 patients may die of rapid locoregional progression. We assessed outcomes with the three modalities in patients with low primary burden to better assess the specific prognosis of N3 disease.

Methods: This retrospective multicentric study included T0-2 N3 HNSCC patients. Outcomes and morbidity in upfront neck dissection (uND) vs non-surgical groups were analysed and oncological outcomes and morbidity compared between patients undergoing chemoradiation or neoadjuvant chemotherapy in patients with initially unresectable N3 nodes.

Results: Of 301 patients, 142 (47%) underwent uND, 68 (23%) neoadjuvant chemotherapy and 91 (30%) chemoradiation. The 24- and 60-month incidence of locoregional relapse was 23.2% [18.3%; 28.4%] and 27.4% [21.8%; 33.3%]; it was lower in patients undergoing uND (P = .006). In patients with non-surgical treatments, success rates were 57.8% [49.4%; 66.3%] after chemoradiation and 38.1% [29.6%; 46.7%] after neoadjuvant chemotherapy (P = .001). Overall morbidity was more frequent in patients undergoing uND (68.8%) (P < .001).

Conclusion: uND improved locoregional control but increased morbidity and showed no survival benefit. Success rates were better after chemoradiation versus neoadjuvant chemotherapy. Neoadjuvant chemotherapy did not reduce metastatic rates but non-responders to chemoradiation had poor PFS and survival rate, suggesting that predictive criteria are warranted.
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http://dx.doi.org/10.1111/coa.13615DOI Listing
November 2020

Intrapericardial instillation of bleomycin prevents recurrence of malignant pericardial effusions: Series of 46 cases and comprehensive literature review.

Bull Cancer 2020 Jul - Aug;107(7-8):756-762. Epub 2020 Jun 5.

Institut de cancérologie de Lorraine, Department of Medical Oncology, Vandœuvre-lès-Nancy, France.

Introduction: Malignant pericardial effusion is a severe complication of lung and breast cancer. The median survival is less than 4 months and recurrences occurs in about 40% of cases. Systemic chemotherapy and/or local treatments are necessary, even if there is no consensus.

Methods: We collected data from patients in our center from 1997 to 2016 who received at least one intrapericardial instillation of bleomycin (60mg). At the same time, we conducted a review of the relevant literature on the subject.

Results: We included 46 patients in the analysis. Median survival was 2.6 months [95% CI: 1.7; 4.7]. Overall survival was 49% [33%; 63%] at 3 months and 28% [15%; 42%] at 6 months. In the lung cancer subgroup, overall survival was 18% [3%; 44%] at 3 months. In the breast cancer subgroup, overall survival was 73% [44%; 89%] at 3 months and 46% [21%; 69%] at 6 months.

Discussion: The best response rates in the literature are obtained with local instillation of bleomycin or cisplatin. Malignant pericardial effusions in breast cancer patients had a better prognosis. This is certainly related to the prognosis of the underlying disease. We have not found an increase in overall survival with intrapericardial chemotherapy injections, but preventing recurrence of malignant pericardial effusions is a benefit in itself, thus avoiding a lethal complication.
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http://dx.doi.org/10.1016/j.bulcan.2020.04.010DOI Listing
August 2020

Quality of life, anxiety, and postoperative complications of patients undergoing breast cancer surgery as ambulatory surgery compared to non-ambulatory surgery: A prospective non-randomized study.

J Gynecol Obstet Hum Reprod 2021 Feb 11;50(2):101779. Epub 2020 May 11.

Département de Chirurgie, Institut de Cancérologie de Lorraine, Université de Lorraine Avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy, France; CRAN, UMR 7039, Université de Lorraine, CNRS Vandœuvre-lès-Nancy, France.

Purpose: According to the latest recommendations a minimally invasive approach should be used to manage breast cancer and a global policy for minimizing costs encourages shorter periods of hospitalization. The aim of this study was to investigate the impact of length of hospitalization on quality of life, anxiety and depression and postoperative complications.

Methods: This is a prospective observational study of 412 female patients with breast cancer requiring a first mastectomy or lumpectomy to assess the impact of the length of hospitalization on quality of life (using the European Organization for Research and Treatment of Cancer Quality of Life QLQ30 and BR23 questionnaires) at postoperative day 14 (D+14), levels of anxiety at d-1 and D+1 (according to the Hospital Anxiety and Depression scale) and postoperative state at D+21.

Results: Our study included 244 patients that had ambulatory surgery and 124 that had non-ambulatory surgery. Global health status was significantly better for ambulatory surgery patients (adjusted p-value=0.014). There were no significant differences between the two groups for levels of anxiety, pain, lymphoceles and postoperative complications. No cases of nausea and vomiting requiring medical treatment were reported for either group.

Conclusions: Breast cancer surgery can be performed using ambulatory surgery with no significant differences compared to non-ambulatory surgery in terms of quality of life, perioperative anxiety, and postoperative complications. Indeed, our study suggests that ambulatory surgery improves patient outcome. It should be determined whether the mode of hospitalization has any long-term impact on the patient, as a shorter hospitalization period would allow decreasing waiting times.
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http://dx.doi.org/10.1016/j.jogoh.2020.101779DOI Listing
February 2021

COMPARATIVE EFFECTIVENESS OF PROTON BEAM VERSUS PHOTODYNAMIC THERAPY TO SPARE THE VISION IN CIRCUMSCRIBED CHOROIDAL HEMANGIOMA.

Retina 2021 Feb;41(2):277-286

Service de Radiothérapie, Centre François Baclesse/ARCHADE-Normandie Université, Caen, France; and.

Purpose: The aim of this study was to compare the functional and anatomical effectiveness of photodynamic therapy (PDT) versus proton beam therapy (PBT) in a real-life setting for the treatment of circumscribed choroidal hemangioma.

Methods: A total of 191 patients with a diagnosis of circumscribed choroidal hemangioma and treated by PBT or PDT were included for analyses.

Results: The 119 patients (62.3%) treated by PDT were compared with the 72 patients treated by PBT. The final best-corrected visual acuity did not differ significantly between the two groups (P = 0.932) and final thickness was lower in the PBT compared with the PDT group (P = 0.001). None of the patients treated by PBT needed second-line therapy. In comparison, 53 patients (44.5%) initially treated by PDT required at least one other therapy and were associated with worse final best-corrected visual acuity (P = 0.037). In multivariate analysis, only an initial thickness greater than 3 mm remained significant (P = 0.01) to predict PDT failure with an estimated odds ratio of 2.72, 95% confidence interval (1.25-5.89).

Conclusion: Photodynamic therapy and PBT provide similar anatomical and functional outcomes for circumscribed choroidal hemangioma ≤3 mm, although multiple sessions are sometimes required for PDT. For tumors >3 mm, PBT seems preferable because it can treat the tumor in only 1 session with better functional and anatomical outcomes.
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http://dx.doi.org/10.1097/IAE.0000000000002843DOI Listing
February 2021

Postoperative Radiation Therapy in Patients with Extracranial Chondrosarcoma: A Joint Study of the French Sarcoma Group and Rare Cancer Network.

Int J Radiat Oncol Biol Phys 2020 07 11;107(4):726-735. Epub 2020 Apr 11.

Department of Radiation Oncology, Centre Baclesse/ARCHADE-Normandie Université, Caen, France; Laboratoire de Physique Corpusculaire, Caen, France; Unicaen-Normandie Université, Caen, France. Electronic address:

Purpose: Postoperative radiation therapy (poRT) of intracranial/skull base chondrosarcomas (CHSs) is standard treatment. However, consensus is lacking for poRT in extracranial CHS (eCHS) owing to their easier resectability and intrinsic radioresistance. We assessed the practice and efficacy of poRT in eCHS.

Methods And Materials: This multicentric retrospective study of the French Sarcoma Group/Rare Cancer Network included patients with eCHS who were operated on between 1985 and 2015. Inverse propensity score weighting (IPTW) was used to minimize poRT allocation biases.

Results: Of 182 patients, 60.4% had bone and 39.6% had soft-tissue eCHS. eCHS were of conventional (31.9%), myxoid (28.6%; 41 extraskeletal, 11 skeletal), mesenchymal (9.9%), or other subtypes. En-bloc surgery with complete resection was performed in 52.6% and poRT in 36.8% of patients (median dose, 54 Gy). Irradiated patients had unfavorable initial characteristics, with higher grade and incomplete resection. Median follow-up time was 61 months. Five-year incidence of local relapse was 10% with poRT versus 21.6% without (P = .050). Using the IPTW method, poRT reduced the local relapse risk (hazard ratio, 0.27; 95% confidence interval, 0.14-0.52; P < .001). Five-year disease-free survival (DFS) was 71.8% with poRT and 64.2% without (P = .680). Using the IPTW method, poRT improved DFS (hazard ratio, 0.51; 95% confidence interval, 0.30-0.85; P = .010). The benefit of poRT on local relapse and DFS was confirmed after exclusion of the extraskeletal subtype. There was no difference in overall survival. Prognostic factors of poorer DFS in multivariate analysis were deeper location, higher grade, incomplete resection, and no poRT.

Conclusions: poRT should be offered in patients with eCHS and high-grade or incomplete resection, regardless of the histologic subtype.
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http://dx.doi.org/10.1016/j.ijrobp.2020.03.041DOI Listing
July 2020

Radiomics Method for the Differential Diagnosis of Radionecrosis Versus Progression after Fractionated Stereotactic Body Radiotherapy for Brain Oligometastasis.

Radiat Res 2020 05 11;193(5):471-480. Epub 2020 Mar 11.

CNRS UMR 7365 IMoPA, Université de Lorraine, Biopôle, Vandoeuvre-Lès-Nancy, France.

Stereotactic radiotherapy (SRT) is recommended for treatment of brain oligometastasis (BoM) in patients with controlled primary disease. Where contrast enhancement enlargement occurs during follow-up, distinguishing between radionecrosis and progression presents a critical challenge. Without pathological confirmation, decision-making may be inappropriate and delayed. Quantitative imaging features extracted from routinely performed examinations are of interest in potentially addressing this problem. We explored the added value of the radiomics method for the differential diagnosis of these two entities. Twenty patients who received SRT for BoM, from any primary location, were included (8 radionecrosis, 12 progressions, pathologically confirmed). We assessed the clinical relevance of 1,766 radiomics features, extracted using IBEX software, from the first T1-weighted postcontrast magnetic resonance imaging (MRI) after SRT showing a lesion modification. We evaluated seven feature-selection methods and 12 classification methods in terms of respective predictive performance. The classification accuracy was measured using Cohen's kappa after leave-one-out cross-validation. In this work, the best predictive power reached was a Cohen's kappa of 0.68 (overall accuracy of 85%), expressing a strong agreement between the algorithm prediction and the histological gold standard. Prediction accuracy was 75% for radionecrosis, and 91% for progression. The area under a curve reached 0.83 using a bagging algorithm trained with the chi-square score features set. These findings indicated that the radiomics method is able to discriminate radionecrosis from progression in an accurate, early and noninvasive way. This promising study is a proof of concept, preceding a larger prospective study for defining a robust model to support decision-making in BoM. In summary, distinguishing between radionecrosis and progression is challenging without pathology. We built a classification model based on imaging data and machine learning. Using this model, we were able predict progression and radionecrosis in, respectively, 91% and 75% of cases.
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http://dx.doi.org/10.1667/RR15517.1DOI Listing
May 2020

[Recourse of patients to their general practitioner in unplanned hospitalization in oncology management: A prospective study in an oncology institute].

Bull Cancer 2020 Feb 5;107(2):191-199. Epub 2020 Feb 5.

Institut de cancérologie de Lorraine, service interdisciplinaire de soins de support pour le patient en oncologie (SISSPO), 6, avenue de Bourgogne-CS 30519, 54519 Vandœuvre-lès-Nancy cedex, France.

Introduction: Cancer management is a public health issue in France. Its incidence is stabilizing even decreasing, but the prevalence increases. Public policies give at the general practitioner (GP) a central role in oncological care: it must be present at all stages of the disease, from screening to post-cancer.

Methods: One-year prospective monocentric study in a cancer institute. Distribution of a questionnaire to unplanned hospitalized patients and collection of socio-demographic and medical data in their files.

Results: Fifty-four percent of the study patients did not consult their GP for the health problem that motivated hospitalization. Sixty-nine percent of patients surveyed believe that GP is not the primary care physician for the management of complications and adverse effects of oncology treatments. A large majority of patients have metastatic cancer while only 40 % followed by the support care team.

Discussion: GP's are not yet integrated into the active management of cancer for study patients. The symptoms that GP's say they can easily manage are the most frequent reasons for hospitalization.
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http://dx.doi.org/10.1016/j.bulcan.2019.11.005DOI Listing
February 2020

[Tolerance of Tamoxifen as an adjuvant therapy and long-term follow up of 55 premenopausal breast cancer women, cared for at the Institut de cancérologie de Lorraine, treated with Tamoxifen].

Bull Cancer 2019 Dec;106(12S1):S75-S100

Département du Parcours Sein, Institut de cancérologie de Lorraine, 6, avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy, France.

Introduction: Objectives: the purpose of this study is to assess TAM safety in terms of side effects and hormonal status, the persistence of the treatment over a five years time-frame and to report the remote follow-up data.

Methods: Fifty five patients were included patients between January 2001 and November 2002 at the Institut de cancérologie de Lorraine. The subjects were aged 50 years or less, premenopausal at diagnosis and treated with adjuvant TAM therapy at a daily dose of 20 mg, for an expected duration of 5 years, at a daily. After 2 years, prospective evaluation was completed and monitoring of ovarian function was performed as usual in the institution (1x/year). All data were retrospectively evaluated in 2019.

Results: In these 55 patients, the cumulative incidences of cysts and hot flushes 5 years after treatment were 68.5 % and 77.6 %, respectively. Of the 33 patients with chemoreactive amenorrhea, half had cycles which resumed within a median of 9 months. In the 10 patients without chemotherapy-induced amenorrhea, 4 had a cycle stop. Of these, 3 patients had cycles that, resumed within 1, 4 and 8 months. 34 patients (61.3 %) had taken Tamoxifen for at least 5 years. After 15 years of treatment, overall and progression-free survival was 90.7 % and 67.4 %, respectively.

Conclusion: The observation of the tolerance to the treatment for 5 years and beyond, contributes to the quality of information delivered to future patients starting the treatment, allowing a better understanding and in the long term a better observance.
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http://dx.doi.org/10.1016/S0007-4551(20)30050-3DOI Listing
December 2019

[Breast cancer management before 40 years: what change in one decade? A retrospective study at the "Institut de cancérologie de Lorraine": 2002-2012].

Bull Cancer 2019 Dec;106(12S1):S60-S74

Institut de cancérologie de Lorraine Alexis-Vautrin, Parcours sein, 6, avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy cedex, France.

Introduction: Breast cancer of young women has medico-psychological issues, particularly in the perspective of "after cancer" period. The objective of the study was to analyze the changes in management, in a decade including the publication of Cancer Plans I and II.

Methods: This retrospective unicentric study involved two populations of women aged 40 and treated at the "Institut de cancérologie de Lorraine" in 2002-2004 (P1) and 2012-2014 (P2). Epidemiological-demographic, histological, diagnostic and therapeutic sequences were analyzed.

Results: 216 patients were included. The mean age was 35.7 years (range 22-40), with no significant epidemiological difference, except for an increased rate of obesity in P2. Preoperative biopsies became almost systematic and the pre-therapeutic care plan rate increased over the decade from 3.8% to 8% (p < 0.001). The rate of breast-conserving treatment remained stable. The sentinel lymph node rate increased from 4.4% in P1 to 31.9% in P2 (p < 0.001), while the rate of lymph node dissection decreased (p < 0.001) between the two periods. Resort to breast nurses, psycho-oncologists, fertility experts and oncogenetic consultations has also increased.

Conclusion: There is an improvement in the care and management of young women under 40 because of the first Cancer Plans. A study about the impact on the prognosis and a reflection to improve the experience of illness for these women are to lead.
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http://dx.doi.org/10.1016/S0007-4551(20)30049-7DOI Listing
December 2019

Oncologic and visual outcomes after postoperative proton therapy of localized conjunctival melanomas.

Radiat Oncol 2019 Dec 27;14(1):239. Epub 2019 Dec 27.

Department of Ophthalmology, Pasteur 2 Teaching Hospital, Nice, France.

Introduction: conjunctival melanomas have high local relapse rates. Oncologic and visual outcomes can be improved with proton therapy and no-touch surgery.

Material And Methods: a monocentric retrospective study of consecutive patients treated with surgery and proton therapy for conjunctival melanoma was conducted. Proton therapy was performed to a total dose of 45 Grays physical dose delivered in eight fractions over two weeks.

Results: Ninety-two patients were included. The mean age was 63-year-old. 65.2% of patients had primary acquired melanosis. The mean tumor thickness and diameter was 2.5 mm and 7.0 mm respectively. The clinical stage was T1 in 71.6% of cases, with a quadrangular involvement of more than 90° in 69% of cases. Conjunctival melanomas were of epithelioid cell-type in 40% of cases. Mean follow-up was 4.7 years. Five-year local failure rate was 33.2%. Of 25 local recurrences, 14 were marginal/out-of-field, 4 in-field, others were undetermined. First surgery at expert center resulted in 24.3% of local failure at 5 years versus 38.7% if performed elsewhere (p = 0.41). Salvage exenteration was performed in 13 patients. Tumor stage and quadrangular involvement were significant factors for local failure. Five-year progression-free survival and cause-specific death rates were 61.5 and 3.6%. Stage and epithelioid type were associated with poorer progression-free survival. Trophic toxicity occurred in 22.9% of patients and was treated locally, with grafts in 7 patients. Glaucoma and cataract occurred in 13 and 22 patients respectively. Prognostic factors for visual deterioration were age, tumor extent (multifocality, quadrangular involvement > 180°) and cryotherapy.

Conclusions: 5-year local failure rate after postoperative proton therapy for conjunctival melanoma was of 33.2%. Radiation-induced complications were overall manageable.
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http://dx.doi.org/10.1186/s13014-019-1426-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6935064PMC
December 2019

Clinical evaluation of a device providing simultaneous white-light and fluorescence video streams as well as panoramic imaging during fluorescence assisted-transurethral resection of bladder cancer.

J Opt Soc Am A Opt Image Sci Vis 2019 Nov;36(11):C62-C68

The current clinical study is aimed at evaluating the clinical relevance of an innovative device (called CyPaM2 device) that for the first time provides urologists with (i) a panoramic image of the bladder inner wall within the surgery time, and with (ii) a simultaneous (bimodal) display of fluorescence and white-light video streams during the fluorescence assisted-transurethral resection of bladder cancers procedure. The clinical relevance of this CyPaM2 device was evaluated on 10 patients according to three criteria (image quality, fluorescent lesions detection relevance, and ergonomics) compared with a reference medical device. Innovative features displayed by the CyPaM2 device were evaluated without any possible comparison: (i) simultaneous bimodal display of white-light and fluorescence video streams, (ii) remote light control, and (iii) time delay for the panoramic image building. The results highlight the progress to achieve in order to obtain a fully mature device ready for commercialization and the relevance of the innovative features proposed by the CyPaM2 device confirming their interest.
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http://dx.doi.org/10.1364/JOSAA.36.000C62DOI Listing
November 2019

[Factors limiting outpatient management in breast surgery].

Bull Cancer 2019 Dec 15;106(12):1115-1123. Epub 2019 Oct 15.

Université de Lorraine, institut de cancérologie de Lorraine, département de chirurgie, 6, avenue de Bourgogne, 54511 Vandoeuvre-les-Nancy, France; Université de Lorraine, CNRS Vandoeuvre-les-Nancy, CRAN, UMR 7039, Vandoeuvre-les-Nancy, France.

Introduction: Breast cancer surgery associates interventions of short duration and low morbidity, mostly accessible for outpatient management.

Methods: We performed a descriptive, retrospective, monocentric study involving 1735 patients operated between 1st of July 2015 and the 31st of December 2017 of a mammary or axillary lymph node procedure. A comparative study was carried out, involving 2 groups of patients treated either on an outpatient or conventional hospitalization mode, in order to find the main medico-social factors that could constitute barriers to this ambulatory modality.

Results: In total, 992 patients were treated in outpatient surgery and 743 in conventional surgery. The mean age of the ambulatory group was 56.9 years (±11.2), versus 65.9 years (±13.5) in the conventional hospitalization group. Thirteen stays (1.3%) had to be converted into conventional hospitalization. The main factors limiting outpatient management are age≥70 years, BMI≥25, isolation of the patient, total mastectomy, and drainage.

Conclusion: Because of social, medical or psychological constraints, the rate of outpatient breast surgery remains in our practice, stable in recent years at 56%. Some ways of improvement can be envisaged, but it is likely that this rate will only increase in a very gradual manner in the years to come.
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http://dx.doi.org/10.1016/j.bulcan.2019.08.018DOI Listing
December 2019

Somatic substitution signature as an innovative tool in lung cancer diagnosis.

Sci Rep 2019 10 10;9(1):14561. Epub 2019 Oct 10.

Service de Biopathologie, Institut de Cancérologie de Lorraine, F-54519, Vandœuvre-lès-Nancy, France.

Diagnosis of lung cancer can sometimes be challenging and is of major interest since effective molecular-guided therapies are available. Compounds of tobacco smoke may generate a specific substitutional signature in lung, which is the most exposed organ. To predict whether a tumor is of lung origin or not, we developed and validated the EASILUNG (Exome And SIgnature LUNG) test based on the relative frequencies of somatic substitutions on coding non-transcribed DNA strands from whole-exome sequenced tumors. Data from 7,796 frozen tumor samples (prior to any treatment) from 32 TCGA solid cancer groups were used for its development. External validation was carried out on a local dataset of 196 consecutive routine exome results. Eight out of the 12 classes of substitutions were required to compute the EASILUNG signature that demonstrated good calibration and good discriminative power with a sensitivity of 83% and a specificity of 72% after recalibration on the external validation dataset. This innovative test may be helpful in medical decision-making in patients with unknown primary tumors potentially of lung origin and in the diagnosis of lung cancer in smokers.
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http://dx.doi.org/10.1038/s41598-019-51155-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6786985PMC
October 2019

Predictive factors of axillary positive sentinel lymph node biopsy in extended ductal carcinoma in situ treated by simple mastectomy at once.

J Gynecol Obstet Hum Reprod 2020 Mar 25;49(3):101641. Epub 2019 Sep 25.

Institut de Cancérologie de Lorraine, Department of Surgical Oncology, Université de Lorraine, F-54519 Vandoeuvre-lès-Nancy, France; Université de Lorraine, CNRS UMR7039, CRAN, F-54000 Nancy, France.

Background: The incidence of positive sentinel lymph node biopsy (SLNB) in ductal carcinoma in situ (DCIS) ranged from 0 to 14%. The main hypothesis would be the presence of an invasive contingent on the final histology. The objective was to identify predictive factors of sentinel lymph node positivity in the management of extended ductal carcinoma in situ treated by simple mastectomy.

Methods: This was a retrospective study carried out at the Lorraine Cancer Institute from January 2003 to December 2017. Women with DCIS on core-needle biopsy whose management consisted of simple mastectomy and SLNB procedure were included.

Results: 188 patients were analyzed. Preoperatively, 18 patients (9.6%) had DCIS with microinvasion, while the others had pure DCIS. Eight patients (4.2%) had positive sentinel lymph node biopsy, the majority of which were single micrometastases. Predictive factor of node invasion was microinvasion on biopsy (p<0.01). Only in cases of pure DCIS, the percentage of positive SLNB was reduced to 2.9%. Invasive carcinoma was found in the majority of patients with positive axillary SLNB procedure (75%, n=6), compared to 16.7% (n=30) without SLNB involvement (p<0.01).

Conclusions: The low rate of positive sentinel node biopsy in pure ductal carcinoma in situ suggests that in the absence of microinvasion, the sentinel procedure would seem less appropriate. New techniques for identifying sentinel lymph node biopsy could report axillary staging after definitive histologic results.
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http://dx.doi.org/10.1016/j.jogoh.2019.101641DOI Listing
March 2020

Surgery or Radiotherapy of the Primary Tumor in T1-2 Head and Neck Squamous Cell Carcinoma with Resectable N3 Nodes: A Multicenter GETTEC Study.

Ann Surg Oncol 2019 Oct 1;26(11):3673-3680. Epub 2019 Jul 1.

ENT, Service ORL, Chirurgie cervico-maxillo-faciale et audiophonologie, CHU de Poitiers, 2 rue de la Milétrie, 86000, Poitiers, France.

Background: The prognosis of advanced nodal (N3) squamous cell carcinoma of the head and neck (HNSCC) is poor. We investigated whether surgery or radiotherapy of early (T1-2) primary stage HSNCC is preferable to limit the overall morbidity after upfront neck dissection (uND) for N3 disease.

Methods: This retrospective multicentric Groupe d'Étude des Tumeurs de la Tête Et du Cou study included patients undergoing uND and surgery or radiotherapy of their primary. Prognostic factors were evaluated using propensity score matching to account for biases in performing surgery depending on primary site and stage.

Results: Of 189 T1-2, N3 HNSCC patients, 70 (37.0%) underwent uND: 42 with surgery of their primary and 28 with radiotherapy only. Radiotherapy alone was more frequent in patients with hypopharyngeal primaries. All local (N = 3) and regional (N = 10) relapses (included 2 locoregional relapses) occurred within the first 2 years. There were 16 distant metastatic failures. Five-year locoregional relapse and survival incidences were 15.7% and 66.5% and were similar regardless of the treatment of the primary. The overall morbidity rate was 65.2% and was similar after weighting by the inverse propensity score (p = 0.148). The only prognostic factor for morbidity was the radicality of the uND. Prolonged parenteral feeding was not more frequent in patients only irradiated to their primary (p = 0.118). Prolonged tracheostomy was more frequent after surgery of the primary.

Conclusions: In patients with T1-2, N3 HNSCC undergoing uND, radiotherapy and surgery of the primary yield similar oncological outcomes. Morbidity was related to the extent of neck dissection.
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http://dx.doi.org/10.1245/s10434-019-07589-0DOI Listing
October 2019

10-Year Locoregional Control with Postoperative External Beam Radiotherapy in Patients with Locally Advanced High-Risk Non-Anaplastic Thyroid Carcinoma De Novo or at Relapse, a Propensity Score Analysis.

Cancers (Basel) 2019 Jun 19;11(6). Epub 2019 Jun 19.

Baclesse Cancer Center/ARCHADE, 14000 Caen, France.

(1) Background: To assess the role of postoperative external beam radiotherapy (pEBRT) on locoregional failure (LRF) for patients with locally advanced high-risk non-anaplastic thyroid carcinoma (naTC) at primary event or relapse. (2) Methods: Between 1995 and 2015, postoperative naTC patients with a theoretical indication for EBRT were included based on criteria that were common to American-British-French current guidelines, i.e., pT3-4, pN+, gross or microscopic residual disease. Inverse probability of treatment weighting (IPTW) after multiple imputation was used to reduce selection biases. (3) Results: Of 254 naTC patients, 216 patients underwent pEBRT (106 de novo, 110 at relapse, median dose 60 Gy) and 38 underwent surgery only. pEBRT patients had more gross residual disease, a major prognostic factor ( = 0.027) but less perineural invasion ( = 0.008) or lymphovascular emboli ( = 0.009). pEBRT patients more frequently underwent radioiodine therapy ( = 0.026). The 10-year cumulative incidence of LRF was 56% (95% CI, 32-74%) in operated patients, and 23% (95% CI, 17-30%) in pEBRT patients. After IPTW method, pEBRT reduced the risk of LRF (hazard ratio 0.30; 95% CI [0.18-0.49], < 0.001), but had no impact on OS. In the pEBRT group, non-Intensity Modulated RadioTherapy (IMRT) plans and interruption of the radiotherapy were associated with poorer survival, while extended versus limited field strategy and dose were not. (4) Conclusions: In naTC patients who have pT3-4, pN+ disease or R1-2 resection, pEBRT improved LRF. Limited-field IMRT is preferred.
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http://dx.doi.org/10.3390/cancers11060849DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6628348PMC
June 2019

[Systematic second opinion review of outside imaging in breast cancer diagnosis: An added value].

Bull Cancer 2019 Apr 15;106(4):316-327. Epub 2019 Mar 15.

Institut de cancérologie de Lorraine, département du Parcours Sein, 54000 Nancy, France.

Introduction: The systematic second opinion review in cancer centers after breast cancer detection is currently under development. The purposes were the evaluation of review's consequences, in particularly of the axillary staging and the evolution of the delays.

Methods: A retrospective study was conducted on patients who consulted a clinician at Cancer Center of Lorraine in Nancy from January 1st, 2016 to December 31th, 2016. We analyzed from their medical charts: the outside exams, the initial therapeutic plan, the second opinion review, the additional exams, the multidisciplinary consultation conclusions, the first treatment, the multidisciplinary consultation after surgery.

Results: In all, 251 patients were analyzed. Second opinion review discrepancies were seen in 72.5%. As a result, 43.4% of all patients had new breast-axillary biopsies. New malignancies lesions were identified in 19.9% of patients. Modifications in therapeutic plan were recommended in 19.9% of patients (including patients with and without new malignancies lesions diagnosed). Before a second opinion review, 9.8% of axillary ultrasound lead to a positive fine-needle biopsy. The additional exams identified 9.6% additional lesions. After a positive sentinel lymph node excision biopsy, the multidisciplinary consultation recommended a revision surgery of axillary lymph node dissection for 27% of patients with axillary ultrasound performed in our cancer center, and for 70% of patients without ultrasound (P=0.023).

Discussion: The systematic second opinion at cancer center allows the detection of new malignancies lesions and significant modifications in the therapeutic plan. A systematic evaluation of axillary ultrasound in cancer center could be considered.
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http://dx.doi.org/10.1016/j.bulcan.2019.01.019DOI Listing
April 2019