Center Clinique Of La Porte Of Saint Cloud

Sainte-Foy-lès-Lyon, France

Center Clinique Of La Porte Of Saint Cloud

Sainte-Foy-lès-Lyon, France

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Vu K.,Maisonneuve Rosemont Hospital | Tai P.,Allan Blair Cancer Center | Assouline A.,Center Clinique Of La Porte Of Saint Cloud | Krzisch C.,Center Hospitalier University Damiens
Current Cancer Therapy Reviews | Year: 2016

Canada and France do not have a lot of sunshine but skin cancer is still the most common tumor. The majority of the population is white. The pattern of care for skin cancers is similar to the delivery of care for other cancers. No extra resources are allocated to skin cancer. Generally the general practitioners are the first care providers for skin cancers. Excision or biopsy of the skin lesion establishes the diagnosis. If residual disease is present, further treatments are provided by general practitioners, dermatologists, general or plastic surgeons and radiation oncologists. If adjuvant or definitive treatments are required, patients are referred to cancer services to consider radiotherapy, chemotherapy, targeted therapy or immunotherapy. Both Canada and France have waiting lists for referrals. © 2016 Bentham Science Publishers.


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.


Assouline A.,Center Clinique Of La Porte Of Saint Cloud | Assouline A.,Groupe Hospitalier Pitie Salpetriere | Levy A.,University Paris - Sud | Abdelnour-Mallet M.,Service Evaluation Pharmaceutique et Bon Usage SEPBU | And 10 more authors.
International Journal of Radiation Oncology Biology Physics | Year: 2014

Purpose This study aimed to evaluate the efficiency and the tolerance of radiation therapy (RT) on salivary glands in a large series of amyotrophic lateral sclerosis (ALS) patients with hypersalivation. Methods and Materials Fifty ALS patients that had medically failure pretreatment were included in this prospective study. RT was delivered through a conventional linear accelerator with 6-MV photons and 2 opposed beams fields including both submandibular glands and two-thirds of both parotid glands. Total RT dose was 10 Gy in 2 fractions (n=30) or 20 Gy in 4 fractions (n=20). RT efficacy was assessed with the 9-grade Sialorrhea Scoring Scale (SSS), recently prospectively validated as the most effective and sensitive tool to measure sialorrhea in ALS patients. Results At the end of RT, all patients had improved: 46 had a complete response (92% CR, SSS 1-3) and 4 had a partial response (8% PR, SSS 4-5). A significant lasting salivary reduction was observed 6 months after RT completion: there was 71% CR and 26% PR, and there was a significant SSS reduction versus baseline (P<10-6). There was no grade 3 to 4 toxicity, and most side effects (34%) occurred during RT. Nine patients (18%) underwent a second salivary gland RT course, with a 3-months mean delay from the first RT, resulting in a SSS decrease (-77%). Both RT dose regimens induced a significant SSS decrease with no significant toxicity. There were, however, more patients with CR/PR in the 20-Gy protocol (P=.02), and 8 of 9 patients (89%) receiving a second RT course had previously been treated within the 10-Gy protocol. Conclusion Radiation therapy of 20 Gy in 4 fractions is an efficient and safe treatment for ALS patients with sialorrhea. A shorter RT course (10 Gy in 2 fractions) may be proposed in patients in poor medical condition. © 2014 Elsevier Inc.


Tai P.,Allan Blair Cancer Center | Joseph K.,Cross Cancer Center | Assouline A.,Center Clinique Of La Porte Of Saint Cloud | Au J.,Queen Elizabeth Hospital | Yu E.,Canada
Current Respiratory Medicine Reviews | Year: 2014

Mesothelioma is an often fatal cancer arising from the lining of pleura, peritoneum, pericardium and tunica vaginalis (of the testis). In the past decade, investigators have met with limited or minimal success in demonstrating improvements in survival compared to supportive care or observation. Radical surgery such as extrapulmonary pleurectomy is associated with perioperative mortality rates of 6-30% by different institutions, compared to 3% with extended pleurectomy and decortication. Talc pleurodesis is preferred over video-assisted thorascopic partial pleurectomy in the setting of pleural effusion due to fewer complications and shorter hospital stay. To spare normal tissues, radiotherapy with IMRT (intensity-modulated radiation therapy) technique should be used in all cases. Reirradiation with proton particles for recurrent disease is being investigated. The ongoing PIT (Prophylactic Irradiation of Tracts) study will explore the effectiveness of radiotherapy to prevent or delay recurrent nodules on the chest wall following invasive chest wall intervention. The literature on this question is varied and inconclusive. Pemetrexed-cisplatin is currently the standard as first line therapy for malignant pleural mesothelioma in accordance with a phase III study showing improved quality of life and survival. In 2012, a new promising biomarker, fibulin-3 was reported in all mesothelioma sites. Fibulin-3 is a superior prognosticator compared with mesothelin and can be used to monitor tumor response. Mesothelin, the cell-surface glycoprotein, has become the primary target for immunotherapy. SS1P is a recombinant antimesothelin immunotoxin which induces a durable response in all mesotheliomas. © 2014 Bentham Science Publishers.


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).


Abdelnour-Mallet M.,Groupe Hospitalier Pitie Salpetriere | Tezenas Du Montcel S.,Groupe Hospitalier Pitie Salpetriere | 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.


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.


PubMed | London Health Sciences Center, University of Saskatchewan, University of London, University of Alberta and 2 more.
Type: Journal Article | Journal: Cureus | Year: 2015

To assess the effect of prognostic factors and their impact on survival in male and female breast cancer.Medical records for men and women diagnosed with breast cancer referred to the cancer center for treatment were reviewed. Patients with distant metastatic diseases were excluded. Data on prognostic factors including age, nodal status, resection margin, use of hormonal therapy, chemotherapy with and without hormone and radiation therapy (RT), survival, and recurrence were analyzed. Survival estimates were obtained using Kaplan-Meier methodology. The Cox regression interaction was used to compare male and female differences in prognostic factors. Male breast cancer (MBC) and female breast cancer (FBC) were matched according to propensity scores and survival compared using Cox regression.From 1963-2006, there were 75 MBC and 1,313 FBC totaling 1,388 breast cancers.The median age of the cohort was 53 (range: 23-90) years.Median follow-up was 90 (range: 0.4-339) months. Prognostic factors of patients were balanced among the groups after adjusting for propensity scores. A Cox model adjusting for propensity scores showed that overall survival(OS) (HR= 2.52 (1.65, 3.86), P<0.001) and distant disease recurrence-free survival (DDRFS)(HR= 2.39 (0.75, 3.04), P=0.003) were significantly different for MBC and FBC. Analyses that stratified by propensity scorequintiles had similar findings: OS HR=2.41 (1.67, 3.47), P<0.001); DDRFS HR=2.89 (1.81, 4.60), P<0.001). When MBC and FBC were matched (1:3) by propensity scores, differences between MBC and FBC were again observed in OS (HR=1.94, 95%CI:1.18-3.19, P=0.009) and DDRFS (HR=2.79, 95%CI:1.36-5.75, P=0.005) with MBC at a higher risk of death and disease recurrence compared to FBC .This large series showed that MBC and FBC survivals are not similar, with MBC having a worse outcome. The finding of this study needs confirmation from a complete prospective database.


PubMed | Center Clinique Of La Porte Of Saint Cloud
Type: Journal Article | Journal: Rare tumors | Year: 2011

The review covers the current recommendations for Merkel cell carcinoma (MCC), with detailed discussion of many controversies. The 2010 AJCC staging system is more in-line with other skin malignancies although more complicated to use. The changes in staging system over time make comparison of studies difficult. A wide excision with margins of 2.5-3 cm is generally recommended. Even for primary


PubMed | Center Clinique Of La Porte Of Saint Cloud and Institute Gustave Roussy
Type: Journal Article | Journal: Cardiovascular and interventional radiology | Year: 2016

To evaluate prognostic factors associated with local control and disease-free-survival (DFS) of oligometastatic breast cancer patients treated by percutaneous thermal ablation (PTA).Seventy-nine consecutive patients (54.511.2years old) with 114 breast cancer metastases (28.916.1mm 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.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; >4cm 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).PTA is effective for local control of breast cancer oligometastases. Tumor burden >4cm and triple-negative histological subtype are associated with a poorer outcome.

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