Joué-lés-Tours, France
Joué-lés-Tours, France

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Renaud C.J.,National University of Singapore | Francois M.,CHU Bretonneau | Francois M.,Center Hospitalier | Nony A.,Polyclinique | And 2 more authors.
Nephrology Dialysis Transplantation | Year: 2012

Background. Witholding treatment in asymptomatic/pauci-symptomatic high-grade central vein stenosis (CVS), i.e. those not causing debilitating painful extremity oedema, the benefits of which have been shown in only one study in grafts, is debatable. The aim of our study was to assess the short-and long-term benefits of such a strategy in mainly autogenous fistulas. Methods. We retrospectively compared the outcomes of 53 untreated asymptomatic/pauci- symptomatic and 50 symptomatic high-grade CVS treated by dilation with or without stenting between January 1998 and August 2010 at a single center. Central vein and access patency was estimated by Kaplan-Meier analysis. Results. Mean age, central catheter use and location of stenosis (brachiocephalic vein) in asymptomatic/pauci-symptomatic and symptomatic CVS were significantly different at 69 versus 75 years, 28 versus 48% and 74 versus 56%, respectively. Ninety percent of the cases had an autogenous fistula. The mean degree of stenosis was >80%. Fourty percent of asymptomatic/pauci-symptomatic CVS became severely symptomatic after 4 years. Primary central vein patency at 3, 12, 24 and 36 months in asymptomatic/pauci-symptomatic and symptomatic CVS were 87 ± 5 versus 82 ± 6, 77 ± 6 versus 55 ± 9, 71 ± 7 versus 35 ± 9 and 67 ± 7 versus 18 ± 9%, respectively (P = 0.002). Primary access circuit patency rate was not significantly different between the two groups with 66 ± 5 versus 50 ± 4% at 1 year. Secondary central vein and access circuit patency rates at 1 and 3 years were 100 and 93 ± 7 versus 89 ± 5 and 84 ± 7% (P = 0.014). Conclusions. Withholding treatment in asymptomatic/pauci- symptomatic CVS in dialysis fistulas yielded significantly better short-and long-term central vein patency than treatment of symptomatic cases without detrimental effects on overall dialysis circuit. © 2011 The Author.


Gorphe P.,Gustave Roussy | Blanchard P.,Gustave Roussy | Moriniere S.,CHU Bretonneau | Fakhry N.,Aix - Marseille University
European Archives of Oto-Rhino-Laryngology | Year: 2016

The objective of the study is to perform a national survey of practices in early-stage squamous cell carcinoma (SCC) of the oropharynx (base of tongue and tonsils) targeting surgical and non-surgical procedures in France. A questionnaire concerning practices in surgery, radiotherapy, HPV screening, and two clinical cases were sent to all centers participating in the French Head and Neck Oncology Society, and to public hospitals listed as authorized to treat head and neck cancer according to the French National Cancer Institute (INCa). Sixty-four teams comprising almost all the University Hospitals and most of the Comprehensive Cancer Centers completed the survey questionnaire and responded to the clinical cases. Surgical and radiotherapy strategies were used in similar measure for early-stage SCC of the base of the tongue while tonsil lesions were mainly treated with surgery. The main arguments were disease control for the teams offering patients surgery, and functional results for those offering radiotherapy. However, concomitant chemoradiotherapy was chosen more frequently than radiotherapy alone in early-stage SCC of the base of tongue. Age and tobacco–alcohol addiction were decisive criteria in decision making for the majority of the teams. French oncology teams offered surgical and radiotherapy strategies in similar measure to treat early-stage SCC of the oropharynx (base of tongue and tonsils) as well as a high rate of multimodality therapy. Decision making was guided by the desire to achieve oncologic results adapted to the patient and his age, as well as functional preservation taking into account life expectancy. © 2015, Springer-Verlag Berlin Heidelberg.


Coudert B.,Center Georges Francois Leclerc | Pierga J.-Y.,University of Paris Descartes | Mouret-Reynier M.-A.,Center Jean Perrin | Kerrou K.,Hopital Tenon | And 16 more authors.
The Lancet Oncology | Year: 2014

Background: An effective and well tolerated treatment is needed for patients with early HER2-positive breast cancer who do not achieve a pathological complete response after neoadjuvant therapy. The AVATAXHER trial aimed to predict pathological complete response early with the use of PET and to investigate whether the addition of bevacizumab could improve the proportion of patients achieving a pathological complete response in patients unlikely to respond to treatment. Methods: AVATAXHER was a randomised, open-label, non-comparative, multicentre phase 2 study that enrolled women (≥18 years of age) with early-stage HER2-positive breast cancer from 26 oncology centres in France. Patients initially received two cycles of neoadjuvant docetaxel (100 mg/m2 intravenously every 3 weeks) plus trastuzumab (8 mg/kg intravenously every 3 weeks then 6 mg/kg intravenously every 3 weeks for the second course). Before the first and second cycles, [18F]-fluorodeoxyglucose (FDG) PET was done and the change in standardised uptake value was used to predict pathological complete response in each patient. Patients who were predicted to be responders on PET continued to receive standard therapy. Predicted non-responders were randomly assigned (2:1) to receive four cycles of docetaxel (100 mg/m2 intravenously every 3 weeks) and trastuzumab (6 mg/kg intravenously every 3 weeks) plus bevacizumab (15 mg/kg intravenously every 3 weeks; group A) or continue on docetaxel plus trastuzumab alone (group B). Randomisation was open label and was done by an adaptive minimisation method. Although investigators and patients were aware of group assignment, the anatomo-pathologist in charge of centralised review of surgical samples and lymph nodes was masked to treatment assignment. The primary endpoint was centrally assessed pathological complete response according to the Chevallier classification. Efficacy analyses were done in the intention-to-treat population. Safety analyses in this Article were done on all patients who received at least one dose of treatment starting from cycle 3. Survival outcomes are not yet mature. This study is registered with ClinicalTrials.gov (NCT01142778) and EUDRACT (2009-013410-26). © 2014 Elsevier Ltd.


PubMed | Hopital Mere enfant, Marseille University Hospital Center, Besancon University Hospital Center, Institute Gustave Roussy and 8 more.
Type: | Journal: BMC cancer | Year: 2015

The objective of this study is to explore the off-label use of targeted therapies (TTs) for patients with osteosarcoma registered within the French Sarcoma Group--Bone Tumor Study Group (GSF-GETO) national registry.All patients with an osteosarcoma, registered between January 1, 2009 and July 15, 2013 were analyzed.Twenty-nine patients with refractory relapsed osteosarcomas received 33 treatment lines of TTs. The median age at the beginning of treatment was 19 years (range 9-72). The median number of previous lines of chemotherapy was 3 (range 1-8). Before inclusion, 3 patients were in second complete remission, 26 were in progression for metastatic relapse. Twenty-three patients received sirolimus (in combination with cyclophosphamide for 18); 5, sunitinib; 4, sorafenib; and one, pazopanib. Stable disease was observed for 45.5% of patients (95% Confidence Interval (CI) [20-52.8]). The median Progression-Free Survival (PFS) was 3 months (95% CI [2-5.4]) for patients treated by sirolimus and 1.8 months (95% CI [1.3-2.8]) for patients receiving multi-targeted tyrosine kinase inhibitors; 6-month PFS 15%. The median Overall Survival (OS) was 6.8 months (95% CI [4.7-12.1]), and one-year OS was 24%. In a multivariate analysis, PFS was superior for patients receiving sirolimus compared to other TTs (Hazard Ratio (HR)= 2.7, 95% CI [1.05-7.1]). No toxic death was reported. Grade 3 and 4 toxicities were observed in 27 and 6% of cases respectively.Off-label TTs, especially sirolimus, reported benefit in the treatment of refractory osteosarcomas with an acceptable toxicity profile, including in pediatric population.


PubMed | CHU Bretonneau, Gustave Roussy and Aix - Marseille University
Type: Journal Article | Journal: European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery | Year: 2016

The objective of the study is to perform a national survey of practices in early-stage squamous cell carcinoma (SCC) of the oropharynx (base of tongue and tonsils) targeting surgical and non-surgical procedures in France. A questionnaire concerning practices in surgery, radiotherapy, HPV screening, and two clinical cases were sent to all centers participating in the French Head and Neck Oncology Society, and to public hospitals listed as authorized to treat head and neck cancer according to the French National Cancer Institute (INCa). Sixty-four teams comprising almost all the University Hospitals and most of the Comprehensive Cancer Centers completed the survey questionnaire and responded to the clinical cases. Surgical and radiotherapy strategies were used in similar measure for early-stage SCC of the base of the tongue while tonsil lesions were mainly treated with surgery. The main arguments were disease control for the teams offering patients surgery, and functional results for those offering radiotherapy. However, concomitant chemoradiotherapy was chosen more frequently than radiotherapy alone in early-stage SCC of the base of tongue. Age and tobacco-alcohol addiction were decisive criteria in decision making for the majority of the teams. French oncology teams offered surgical and radiotherapy strategies in similar measure to treat early-stage SCC of the oropharynx (base of tongue and tonsils) as well as a high rate of multimodality therapy. Decision making was guided by the desire to achieve oncologic results adapted to the patient and his age, as well as functional preservation taking into account life expectancy.


Avouac J.,University of Paris Descartes | Airo P.,Rheumatology and Clinical Immunology | Meune C.,University of Paris Descartes | Beretta L.,systemIC | And 11 more authors.
Journal of Rheumatology | Year: 2010

Objective. To measure the prevalence of different types of pulmonary hypertension (PH) and to identify patients with systemic sclerosis (SSc) at highest risk in a multicenter European sample, with a metaanalysis of relevant studies. Methods. Consecutive patients with SSc recruited at 11 French and Italian centers underwent detailed evaluations, including Doppler echocardiography, chest computed tomography, pulmonary function tests, and right-heart catheterization (RHC), to detect the presence and causes of PH. A metaanalysis was performed, including data from 4 other studies. Results. Among 206 patients in whom it was suspected, PH was confirmed by RHC in 83 patients (7%). Precapillary PH was found in 64 patients (5%), of whom 42 had pulmonary arterial hypertension (PAH) and 22 had PH secondary to interstitial lung disease (ILD). RHC identified 17 patients (1%) with postcapillary PH secondary to left-heart disease. Patients with DLCO/alveolar volume < 70% were more likely to have precapillary PH (87.5% vs 42%; p < 0.0001). Precapillary and postcapillary PH were associated with advanced age (68 ± 14 vs 59 ± 12 yrs, p < 0.0001, and 74 ± 16 vs 61.5 ± 10 yrs, p < 0.0001, respectively). The metaanalysis of 3818 patients showed a prevalence of precapillary PH of 9% (95% CI 6%-12%) and identified advanced age, longer disease duration, and limited cutaneous disease subset as risk factors for this condition. Conclusion. The prevalence of precapillary PH in our multicenter study of SSc was 5%, and in the metaanalysis 9%. Our observations support use of RHC to confirm the presence of precapillary PH suspected by noninvasive testing. We also identified patients at high risk who should be carefully monitored. The Journal of Rheumatology Copyright © 2010. All rights reserved.


Moriniere S.,University of Tours | Boiron M.,University of Tours | Brunereau L.,CHU Bretonneau | Beutter P.,Bretonneau Hospital | Patat F.,French Institute of Health and Medical Research
Dysphagia | Year: 2011

Recently, we described three components of a normal pharyngeal swallowing sound. The aim of the present study was to identify variations of these components using synchronized acoustic-radiological data in partially laryngectomized (PL) and totally laryngectomized (TL) patients before and after surgery. In this prospective study, from January 2003 to December 2006 we enrolled 14 patients in a PL group and 9 patients in a TL group. A fluoroscopy camera and a microphone were connected to a computer to obtain acoustic-radiological data (25 images/s). The subjects were asked to perform six deglutitions of 10 ml of barium suspension. The average durations of the sound variables were measured before and after surgery. The duration of the preoperative pharyngeal sound was 602 ms in the PL group and 562 ms in the TL group. It was significantly decreased after the TL (296 ms) and was increased after the PL (740 ms). A typical profile of the swallowing sound for each group was obtained. This study allowed us to describe the main variations of the pharyngeal swallowing sound induced by PL and TL. This noninvasive tool could be useful to assess postoperative swallowing function. © 2010 Springer Science+Business Media, LLC.


PubMed | CHU Bretonneau, Toulouse University Hospital Center and Institute Paoli Calmettes
Type: Journal Article | Journal: Archives of gynecology and obstetrics | Year: 2016

We retrospectively studied the different strategies of para-aortic (PA) staging of patients with PA involvement in locally advanced cervical cancer as conducted in eight centers in France and their impact upon survival and management.All patients enrolled in this multicenter study presented with cervical cancer with PA involvement. The diagnosis of PA spread was based on imaging assessment of the PA area and/or pathological examination of harvested PA lymph nodes when staging lymphadenectomy was performed. Imaging modalities comprised positron emission tomography (PET), magnetic resonance imaging and/or computed tomography. Survival outcomes were evaluated retrospectively.One hundred and fifteen women were retrospectively studied. Radiological staging was conducted in 101 (87.8 %) patients. PET was performed in 66 patients (57.4 %). Its FN rate was 22.7 % (15/66) and its sensitivity 77.3 %. Para-aortic lymphadenectomy was conducted in a large proportion of patients (67.8 %). Its indications were not restricted to negative radiological workup. The lymphadenectomy rate was significantly higher in patients with earlier stages (p = 0.02) and lower tumor volume (p = 0.01). Treatment consisted of chemoradiation therapy with extended-field radiotherapy in all patients, followed by intracavitary brachytherapy in 94 cases (81.7 %) and completion surgery in 69 cases (60 %). Patients without para-aortic metastasis on radiological examination were more likely to receive all treatment modalities (p = 0.04).Despite established recommendations, our results point out the tremendous heterogeneity regarding para-aortic assessment. These differences in management are perhaps related to a recommended therapeutic strategy that does not appear to improve the poor prognosis associated with PA involvement.


PubMed | CHU Bretonneau, Bordeaux University Hospital Center, CHU Poitiers and Limoges University Hospital Center
Type: | Journal: Case reports in neurological medicine | Year: 2017

Immune-mediated neuromuscular disorders include pathologies of the peripheral nervous system, neuromuscular junction, and muscles. If overlap syndromes (or the association of almost two autoimmune disorders) are recognized, the simultaneous occurrence of several autoimmune neuromuscular disorders is rare. We describe two patients presenting the simultaneous occurrence of inflammatory neuropathy, myositis, and myasthenia gravis (with positive acetylcholine receptor antibodies). For each patient, we carried out a pathological analysis (nerve and muscle) and an electrophysiological study (and follow-up). To our knowledge, this is the first description of such a triple immune-mediated neuromuscular syndrome. We compared our observations with a few other cases of simultaneous diagnosis of two inflammatory neuromuscular disorders.

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