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rue Saint Pierre, France

Metellus P.,Center hospitalo University La Timone | Metellus P.,Aix - Marseille University | Metellus P.,French Institute of Health and Medical Research | Tallet A.,Groupe de reflexion sur la prise en charge | And 15 more authors.
Cancer/Radiotherapie | Year: 2015

Brain metastases management has evolved over the last fifteen years and may use varying strategies, including more or less aggressive treatments, sometimes combined, leading to an improvement in patient's survival and quality of life. The therapeutic decision is subject to a multidisciplinary analysis, taking into account established prognostic factors including patient's general condition, extracerebral disease status and clinical and radiological presentation of lesions. In this article, we propose a management strategy based on the state of current knowledge and available therapeutic resources. © 2015.

Le Rhun E.,Neuro oncologie | Le Rhun E.,Center Oscar Lambret | Le Rhun E.,French Institute of Health and Medical Research | Dhermain F.,Groupe de reflexion sur la prise en charge | And 11 more authors.
Cancer/Radiotherapie | Year: 2015

The incidence of brain metastases is increasing because of the use of new therapeutic agents, which allow an improvement of overall survival, but with only a poor penetration into the central nervous system brain barriers. The management of brain metastases has changed due to a better knowledge of immunohistochemical data and molecular biological data, the development of new surgical, radiotherapeutic approaches and improvement of systemic treatments. Most of the time, the prognosis is still limited to several months, nevertheless, prolonged survival may be now observed in some sub-groups of patients. The main prognostic factors include the type and subtype of the primitive, age, general status of the patient, number and location of brain metastases, extracerebral disease. The multidisciplinary discussion should take into account all of these parameters. We should notice also that treatments including surgery or radiotherapy may be proposed in a symptomatic goal in advanced phases of the disease underlying the multidisciplinary approach until late in the evolution of the disease. This article reports on the ANOCEF (French neuro-oncology association) guidelines. The management of brain metastases of breast cancers and lung cancers are discussed in the same chapter, while the management of melanoma brain metastases is reported in a separate chapter due to different responses to the brain radiotherapy. © 2015 Société française de radiothérapie oncologique (SFRO).

Lamine F.,Tunis el Manar University | Kanoun F.,Tunis el Manar University | Chihaoui M.,Tunis el Manar University | Saveanu A.,Hopital de la Conception | And 5 more authors.
Pituitary | Year: 2012

Agenesis of internal carotid artery (ICA) is an unusual finding in subjects with congenital Combined Pituitary hormone deficiency (CPHD) with only nine cases being reported to date but to our best knowledge none of them was genetically investigated. A 10-years old girl presented with severe growth failure (height 103 cm) with substantial bone age delay (3 years). She had no history of perinatal insults or familial CPHD. There was no evidence of mental retardation or craniofacial dysmorphism or ophtalmological abnormalities. She was first diagnosed with GH and TSH deficiency. Cerebral magnetic resonance imaging (MRI) showed hypoplastic anterior pituitary, flat sella turcica, absent pituitary stalk with ectopic posterior pituitary as well as agenesis of the left ICA and the left carotid canal. Genomic analysis of pituitary transcription factor HESX1, LHX4 and OTX2 showed no mutations. Treatment with GH and thyroxine was started. The patient remained free of neurovascular symptoms for 5 years but she presented at the age of 15 years with delayed puberty related to an evolving gonadotropin deficiency. ICA agenesis associated with CPHD is unusual and is often asymptomatic in children. Since the CPHD with pituitary stalk interruption cannot be due to HESX1, LHX4 or OTX2 mutation in our case, other pathogenetic mechanisms may be responsible for CPHD associated with unilateral ICA agenesis. © 2012 Springer Science+Business Media, LLC.

Cerdan F.,British Petroleum | Gabriel S.,Center hospitalo University La Timone | Sebag F.,Center hospitalo University La Timone | Fakhry N.,Center hospitalo University La Timone | And 5 more authors.
Medecine Nucleaire | Year: 2013

Objective: Paraganglioma (PGL) and pheochromocytoma (PCC) are neuroendocrine tumors most often benign associated with hereditary syndromes in about 30% of cases. This study aims to define the impact of tumor location and patient genotype on the clinical value of 18F-FDopa PET by assessing in detail the false negative occurrences. Patients and methods: A retrospective study was conducted on a cohort of 53 cases with non-metastatic sporadic or inherited PGL/PCC (SDHx or VHL related syndromes), investigated with 18F-FDopa PET. Results: Overall detection sensitivity of 18F-FDopa PET was 88%. Seventy-three lesions were found using this technique, including 49 head-and-neck PGL (HNP), two thoracic PGL (1 sympathetic and 1 parasympathetic), eight extra-adrenal retroperitoneal PGL and 15 PCC. The 10 missed lesions were seven extra-adrenal abdominal PGL (2 SDHB, 2 SDHD), two HNP (1 sporadic, 1 SDHD) and one PCC (1 SDHD). Conclusion: 18F-FDopa PET is a sensitive technique for the evaluation of non-metastatic head and neck and adrenal PGLs. Exploration of extra-adrenal retroperitoneal PGL associated with SDHB or SDHD syndrome is the main limitation of this technique, encouraging the use of alternative functional imaging modalities like FDG-PET. Negativity of 18F-FDopa PET in the initial assessment of a PGL should prompt to search for a SDHx mutation. © 2013 Elsevier Masson SAS.

Jacquier A.,French National Center for Scientific Research | Jacquier A.,Center hospitalo University La Timone | Kober F.,French National Center for Scientific Research | Bun S.,French National Center for Scientific Research | And 3 more authors.
NMR in Biomedicine | Year: 2011

To quantify noninvasively myocardial blood flow (MBF) and MBF reserve in isoflurane-anesthetized rats using the Look-Locker flow-alternating inversion recovery gradient-echo arterial spin labeling technique (LLFAIRGE-ASL), and to compare the results with the fluorescent microsphere (FM) technique. Male Wistar rats (weight=200-240g, n=21) were anesthetized with 2.0% isoflurane. Hemodynamic parameters were recorded. In seven rats, MBF was assessed on a Bruker Biospec 4.7T MR system using an ECG- and respiration-gated LLFAIRGE-ASL (pixel size=234×468μm 2, TE=1.52ms) at rest and during adenosine infusion (140μg/kg/min). A mixture of 200 000 FM was injected into a second group of rats at rest and during adenosine infusion (n=7 each), under similar physiologic conditions. Hearts and skeletal muscle samples were processed for fluorescence spectroscopy. Two-tailed unpaired, paired Student's t-test and ANOVAwere used to compare groups. MBF measured with LLFAIRGE-ASL was 5.2±1.0mL/g/min at rest and 13.3±3.0mL/g/min during adenosine infusion. Results obtained with fluorescent microspheres yielded 5.9±2.3mL/g/min (nonsignificant vs. LLFAIRGE-ASL, p=0.9) at rest and 13.1±2.1mL/g/min (nonsignificant vs. LLFAIRGE-ASL, p=0.4) during adenosine infusion. Myocardial blood flow reserve measured using LLFAIRGE-ASL and FM were not significantly different (2.5±0.6 vs. 2.4±0.9, respectively; p=0.8). Hemodynamic parameters during the experiments were not different between the groups. The myocardial blood flow reserve determined under isoflurane anesthesia was 2.5±0.6, which was not different from the value obtained with FM. LLFAIRGE-ASL provided MBF maps with high spatial resolution in rats under isoflurane anesthesia. LLFAIRGE-ASL is a noninvasive measure to assess myocardial blood flow reserve and provides an interesting tool for cardiovascular research. Copyright © 2011 John Wiley & Sons, Ltd. This study shows that Look-Locker flow-sensitive alternating inversion recovery gradient-echo (LLFAIRGE-ASL) allows quantification of myocardial blood flow (MBF) reserve in freely breathing rats under isoflurane. Using both techniques LLFAIRGE and fluorescent microspheres (FM), and under similar physiologic conditions, we measured the MBF reserve to be approximately 2.5. There were no significant differences in MBF measures obtained with LLFAIRGE and FM, at rest and under adenosine. © 2011 John Wiley & Sons, Ltd.

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