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L'Esperance S.,Comite de levolution des pratiques en oncologie | Vincent F.,Pavillon Sainte Marie CSSS de Trois Rivieres | Gaudreault M.,Hotel Dieu de Quebec CHU de Quebec | Ouellet J.A.,McGill University | And 3 more authors.
Current Oncology | Year: 2012

Background Metastatic spinal cord compression (MSCC) is an oncologic emergency that, unless diagnosed early and treated appropriately, can lead to permanent neurologic impairment. After an analysis of relevant studies evaluating the effectiveness of various treatment modalities, the Comité de l'évolution des pratiques en oncologie (CEPO) made recommendations on MSCC management. Method A review of the scientific literature published up to February 2011 considered only phase II and III trials that included assessment of neurologic function. A total of 26 studies were identified. Recommendations Considering the evidence available to date, CEPO recommends that • cancer patients with MSCC be treated by a specialized multidisciplinary team. • dexamethasone 16 mg daily be administered to symptomatic patients as soon as MSCC is diagnosed or suspected. • high-loading-dose corticosteroids be avoided. • histopathologic diagnosis and scores from scales evaluating prognosis and spinal instability be considered before treatment. • corticosteroids and chemotherapy with radiotherapy be offered to patients with spinal cord compression caused by myeloma, lymphoma, or germ cell tumour without sign of spinal instability or compression by bone fragment. • short-course radiotherapy be administered to patients with spinal cord compression and short life expectancy. • long-course radiotherapy be administered to patients with inoperable spinal cord compression and good life expectancy. • decompressive surgery followed by long-course radiotherapy be offered to appropriate symptomatic MSCC patients (including spinal instability, displacement of vertebral fragment); and • patients considered for surgery have a life expectancy of at least 3-6 months. © 2012 Multimed Inc. Source


Morneau M.,Direction Quebecoise de Cancerologie MSSS | Foster W.,CHU de Quebec | Lalancette M.,CHU de Quebec | Van Nguyen-Huynh T.,Center Hospitalier Of Luniversite Of Montreal Chum | And 23 more authors.
Gynecologic Oncology | Year: 2013

Objective. Despite the very good prognosis of endometrial cancer, a number of patients with localized disease relapse following surgery. Therefore, various adjuvant therapeutic approaches have been studied. The objective of this reviewis to evaluate the efficacy and safety of neoadjuvant and adjuvant therapies in patientswith resectable endometrial cancer and to develop evidence-based recommendations. Methods. A reviewof the scientific literature published between January 1990 and June 2012was performed. The searchwas limited to published phase III clinical trials andmeta-analyses evaluating the efficacy of neoadjuvant or adjuvant therapies in patients with endometrial carcinoma or carcinosarcoma. A total of 23 studies and five meta-analyses were identified. Results. The selected literature showed that in patients with a low risk of recurrence, post-surgical observation is safe and recommended in most cases. There are several therapeutic modalities available for treatment of endometrial cancers with higher risk of recurrence, including vaginal brachytherapy, external beamradiotherapy, chemotherapy, or a combination of these. Conclusions. Considering the evidence available to date, the CEPO recommends the following: 1) post-surgical observation for most patients with a low recurrence risk; 2) adjuvant vaginal brachytherapy for patients with an intermediate recurrence risk; 3) adjuvant pelvic radiotherapywith orwithout vaginal brachytherapy for patientswith a high recurrence risk; addition of adjuvant chemotherapy may be considered as an option for selected patients (excellent functional status, no significant co-morbidities, poor prognostic factors); 4) adjuvant chemotherapy and pelvic radiotherapy with or without brachytherapy and para-aortic irradiation for patients with advanced disease; 5) hormonal therapy is not recommended in the adjuvant setting. © 2013 Elsevier Inc. All rights reserved. Source


Boily G.,Institute National dExcellence en Sante et en Services Sociaux | Villeneuve J.-P.,Hopital St Luc CHUM | Lacoursiere L.,Hotel Dieu de Levis CSSS Alphonse Desjardins | Chaudhury P.,Royal Victoria Hospital MUHC | And 18 more authors.
HPB | Year: 2015

Background Hepatocellular carcinoma (HCC) is one of the most deadly cancers in the world and its incidence rate has consistently increased over the past 15 years in Canada. Although transarterial embolization therapies are palliative options commonly used for the treatment of HCC, their efficacy is still controversial. The objective of this guideline is to review the efficacy and safety of transarterial embolization therapies for the treatment of HCC and to develop evidence-based recommendations. Method A review of the scientific literature published up to October 2013 was performed. A total of 38 studies were included. Recommendations Considering the evidence available to date, the CEPO recommends the following: (i) transarterial chemoembolization therapy (TACE) be considered a standard of practice for the palliative treatment of HCC in eligible patients; (ii) drug-eluting beads (DEB)-TACE be considered an alternative and equivalent treatment to conventional TACE in terms of oncological efficacy (overall survival) and incidence of severe toxicities; (iii) the decision to treat with TACE or DEB-TACE be discussed in tumour boards; (iv) bland embolization (TAE) not be considered for the treatment of HCC; (v) radioembolization (TARE) not be considered outside of a clinical trial setting; and (vi) sorafenib combined with TACE not be considered outside of a clinical trial setting. © 2014 International Hepato-Pancreato-Biliary Association. Source


Nguyen S.,Laval University | Cloutier F.,Swedish Neuroscience Institute | Philippon D.,Hotel Dieu de Quebec CHU de Quebec | Cote M.,Hotel Dieu de Quebec CHU de Quebec | And 2 more authors.
Auris Nasus Larynx | Year: 2016

Introduction: Preservation of residual hearing in cochlear implantation is a main concern for patients and otologists. New electrode arrays as well as development of minimally invasive technique have allowed the expansion of indication criteria for cochlear implantation. The loss of residual low-frequency hearing is thought to be the result of many factors. Opinions differ in regards with the electrodes array characteristics, the surgical implantation technique and the pharmacological therapy used. Objective: The aim of this research is to analyze the available information pertaining to hearing preservation with cochlear implantation. Results: Both cochleostomy and round window approaches are adequate, but should rely on the anatomic position of the round window membrane. No electrode design had a higher rate of hearing preservation, either a standard or shorter length was used, or a straight or contoured array. The speed of insertion has a significant impact on hearing preservation and vestibular function. A slow insertion should be used for all cochlear implant insertion, hearing preservation or not. However, the optimal speed of insertion is still unclear. Moreover, the use of steroids regardless of the route or the timing, along with intraoperative topical steroids, had a positive impact on hearing preservation. Conclusion: Classic atraumatic insertion maneuvers, very slow and delicate insertion and the use of intraoperative corticosteroids improve hearing outcomes. Whichever the surgeon's preferences, all surgical modifications are aimed at the same goal: protection of the delicate intracochlear structures with preservation of residual low-frequency hearing to improve speech perception abilities. © 2016 Elsevier Ireland Ltd. Source

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