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Saint-Martin-Boulogne, France

Abdelnour-Mallet M.,Groupe Hospitalier Pitie Salpetriere | Tezenas Du Montcel S.,Unite de Biostatistique et Information Medicale | Tezenas Du Montcel S.,University Pierre and Marie Curie | Cazzolli P.A.,ALS Care Project | And 16 more authors.
Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration | Year: 2013

There is an unmet need for validated tools to measure sialorrhea in amyotrophic lateral sclerosis, especially to evaluate treatments. We assessed the inter-/intra-rate reviewer reliability of two scales: the Oral Secretion Scale (OSS), specifically developed for ALS patients, and the Sialorrhea Scoring Scale (SSS), initially developed for Parkinson's disease patients. Sialorrhea was rated in 69 ALS consecutive patients by four evaluators: two neurologists, one nurse and one speech therapist. Inter-rater reliability was evaluated by the light kappa coefficient and intra-rater reliability by the weighted kappa coefficient. We also compared patients' and caregivers' answers. Results demonstrated that the two scales present a high inter-/intra-rater reliability: weighted kappas were 0.85 for both scales and light kappas 0.89 for the OSS and 0.88 for the SSS. Both scales also showed a good intra-profession reliability (OSS kappa = 0.84; SSS kappa = 0.79) and agreement between patients' and caregivers' answers. The SSS showed a higher responsiveness compared to OSS. In conclusion, both Oral Secretion Scale and Sialorrhea Scoring Scale are reliable tools to measure sialorrhea in ALS patients. Because of the wide range of salivation degrees, SSS may be more sensitive as a tool to evaluate treatments in patients with severe hypersialorrhea. © 2013 Informa Healthcare. Source

Tai P.,University of Saskatchewan | Assouline A.,Center Clinique Of La Porte Of Saint Cloud | Joseph K.,University of Alberta | Lian J.D.,Windsor Cancer Center | And 2 more authors.
Nowotwory | Year: 2011

There is limited information in the literature regarding salvage treatment of MCC (Merkel cell carcinoma) yet this is one of the most commonly asked clinical questions for this malignancy. This multicentre study which we report gathered 145 cases recruited from January 1987 through December 1997, 72 of which progressed or recurred after the initial treatment. A total of 22 chemo-naïve patients had salvage chemotherapy. Most had partial or complete responses. The choices of second and third line chemotherapy were discussed. Twenty-one patients had excellent response to multi-modality salvage treatment without recurrence at the time of death. 7/21 became long-term survivors of 64-130 months after recurrence. Source

Tai P.,Saskatchewan Cancer Agency | Assouline A.,Center Clinique Of La Porte Of Saint Cloud | Joseph K.,University of Alberta | Stitt L.,Clinical Research Unit | Yu E.,University of Western Ontario
Clinical Lung Cancer | Year: 2013

Background: Previous clinical studies have generally reported that prophylactic cranial irradiation (PCI) was given to patients with a complete response (CR) to chemotherapy and chest radiotherapy in limited-stage small-cell lung cancer (SCLC). It is not clear if those with incomplete response (IR) would benefit from PCI. Patients and Methods: The Saskatchewan experience from 1981 through 2007 was reviewed. Patients were treated with chest radiotherapy and chemotherapy with or without PCI (typical doses: 2500 cGy in 10 fractions over 2 weeks, 3000 cGy in 15 fractions over 3 weeks, or 3000 cGy in 10 fractions over 2 weeks). Results: There were 289 patients treated for curative intent, 177/289 (61.2%) of whom received PCI. For the whole group of 289 patients, PCI resulted in significant overall survival (OS) and cause-specific survival (CSS) benefit (P =.0011 and 0.0005, respectively). The time to symptoms of first recurrence at any site with or without PCI was significantly different: 16.9 vs. 13.2 months (P =.0006). PCI significantly delayed the time to symptoms of first recurrence in the brain: 20.7 vs. 10.6 months (P <.0001). The first site of metastasis was the brain for 12.5% and 45.5% patients with CR with and without PCI, respectively (P =.02) and in 6.1% and 27.6% of patients with IR with and without PCI, respectively (P =.05). For the 93 patients with IR, PCI did not confer OS or CSS benefit (P =.32 and 0.39, respectively). Conclusions: Patients with IR benefited from PCI, with a reduced rate of and a delayed time for the development of brain metastases, although without significant OS or CSS benefit. PCI could be considered for all patients with limited-stage SCLC responding to chemoradiation. © 2013 Elsevier Inc. All rights reserved. Source

Barral M.,Institute Gustave Roussy | Auperin A.,Institute Gustave Roussy | Hakime A.,Institute Gustave Roussy | Cartier V.,Institute Gustave Roussy | And 5 more authors.
CardioVascular and Interventional Radiology | Year: 2016

Objective: To evaluate prognostic factors associated with local control and disease-free-survival (DFS) of oligometastatic breast cancer patients treated by percutaneous thermal ablation (PTA). Materials and Methods: Seventy-nine consecutive patients (54.5 ± 11.2 years old) with 114 breast cancer metastases (28.9 ± 16.1 mm in diameter), involving the lungs, the liver, and/or the bone, were treated using PTA with a curative intent. The goal was to achieve a complete remission in association with systemic chemotherapy and hormonal therapy. We retrospectively evaluated the prognostic factors associated with 1- and 2-year local control and the 1- and 2-year DFS rates. Results: The 1- and 2-year local control rates were 83.0 and 76.1 %, respectively. Tumor burden was associated with a poorer outcome for local control after PTA (HR 1.027 by additional millimeter, p = 0.026; >4 cm HR 3.90). The 1- and 2-year DFS rates were 54.2 and 30.4 %, respectively. In multivariate analysis, triple-negative histological subtype and increased size of treated metastases were associated with a poorer DFS (HR 2.22; 95 % CI [1.13–4.36]; p = 0.02 and HR 2.43; 95 % CI [1.22–4.82]; p = 0.011, respectively). Conclusion: PTA is effective for local control of breast cancer oligometastases. Tumor burden >4 cm and triple-negative histological subtype are associated with a poorer outcome. © 2016, Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE). Source

Mery B.,Institute Of Cancerologie Lucien Neuwirth | Falk A.T.,Center Antoine Lacassagne | Assouline A.,Center Clinique Of La Porte Of Saint Cloud | Trone J.-C.,Institute Of Cancerologie Lucien Neuwirth | And 12 more authors.
International Urology and Nephrology | Year: 2015

Introduction: There are only scarce data on the optimal management of patients who present with a bladder carcinoma and who are aged 90 years and older. Patients and methods: We retrospectively reviewed records from radiotherapy departments from two university hospitals, two private centers and one public center to identify patients who underwent radiotherapy for bladder cancer over the past decade and who were aged 90 years or older. From 2003 to 2013, 14 patients aged 90 years or older receiving RT for bladder malignant tumors were identified. Results: Mean age was 92.7 years. Ten patients (71 %) had a general health status altered (PS 2–3) at the beginning of RT. A total of 14 RT courses were delivered, including six treatments (43 %) with curative intent and eight treatments (57 %) with palliative intent. Palliative intent mainly encompassed hemostatic RT (36 %). At last follow-up, two patients (14 %) experienced complete response, one patient (7 %) experienced partial response, three patients (21 %) had their disease stable, and three patients (21 %) experienced tumor progression, of whom two patients with the progression of symptoms. There was no reported high-grade acute local toxicity in 14 patients (100 %). One patient experienced delayed grade 2 toxicity with pain and lower urinary tract symptoms. At last follow-up, seven patients (50 %) were deceased. Cancer was the cause of death for five patients. Conclusion: Hypofractionated radiotherapy remains feasible for nonagenarians with bladder cancer. Further investigations including analysis of geriatric comorbidities and impact of treatments on quality of life should be conducted. © 2015, Springer Science+Business Media Dordrecht. Source

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