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Saint-Sauveur-en-Rue, France

Filleron T.,Institute Claudius Regaud | Kwiatowski F.,CLCC Jean Perrin
Bulletin du Cancer | Year: 2016

In clinical research, the reference method to evaluate treatment benefit without bias is the randomized trial. Unfortunately, it is not always possible to realize one, as for example in surgery or for particular observational studies. In these cases, Rosenbaum and Rubin introduced in 1983 a new methodology: the calculation of a propensity score. When several treatments are compared, this calculation enables to take into account confusion bias using a score that synthesizes the influence on treatment choice of clinical parameters evaluated before. This article describes how to build this score, to estimate its validity, and how to use it: as a new variable into a multivariate analysis, as a matching criterion, or as a stratification parameter. Examples are given to illustrate each case and point out the limitations of such a methodology. This approach, although innovative and useful, cannot reach the level of evidence of randomized clinical trials: simulations have demonstrated this fact in several situations. On the other hand, it can be compared to standard multivariate analysis which permits in a non-randomized context, to limit evaluation bias of treatments by adjusting on potential confusion factors. Some guidelines are given in the last chapter to help researchers decide whether to use a propensity score or a standard multivariate analysis. © 2015 Société Française du Cancer. Publié par Elsevier Masson SAS. Tous droits réservés. Source

Clough K.B.,The Paris Breast Center Linstitut Du Sein | Acosta-Marin V.,The Paris Breast Center Linstitut Du Sein | Acosta-Marin V.,Centro Clinico Of Estereotaxia Ceclines | Nos C.,The Paris Breast Center Linstitut Du Sein | And 10 more authors.
Annals of Surgical Oncology | Year: 2015

Background: The current retrospective study was intended to obtain up-to-date and comprehensive data on surgical practice for breast cancer throughout France, including neoadjuvant chemotherapy (NAC) and the more recent surgical techniques of oncoplastic surgery (OPS). Methods: In June 2011, e-mail surveys were sent to 33 nationally renowned breast cancer surgeons from French public or private hospitals. The questionnaire focused on all the new cases of breast cancer treated in 2010. It included questions regarding surgical practices, with special emphases on NAC and OPS and other surgical characteristics. Results: The overall response rate for the survey was 72.7 %. The total number of breast cancer cases from the survey was 13,762, which constitutes 26.2 % of the total incidence in 2010. Breast-conserving surgery (BCS) was performed for 71.0 % of the patients, and the results were similar throughout the types of practices. Of these patients, 13.9 % received OPS, either upfront or after NAC. Mastectomy was performed for 29.0 % of the patients, which is consistent with French official numbers. Among all patients, 16.3 % underwent surgery after NAC. Conclusion: To the authors’ knowledge, there are no publications of national figures on NAC or OPS rates to date. They are convinced that this study offers real-life surgical care information on a large population and covers France’s breast cancer surgical landscape. Mastectomy rates in France remain stable and consistent with those in other European countries. However, additional large-scale retrospective studies are required to confirm these figures and further explore NAC and OPS rates as well as surgical practice characteristics. © 2015, Society of Surgical Oncology. Source

Noel G.,CLCC Paul Strauss | Huchet A.,Bordeaux University Hospital Center | Feuvret L.,CHU Pitie Salpetriere | Maire J.P.,Bordeaux University Hospital Center | And 20 more authors.
Journal of Neuro-Oncology | Year: 2012

Purpose of this study was to determine the effect of waiting time for radiotherapy on overall survival of patients with glioblastoma treated in the EORTC-NCIC trial at 18 centers in France. A total of 400 adult patients with glioblastoma who were treated between January 1, 2006 and December 31, 2006 were included. There were 282 patients with "minimum criteria" according to the EORTC-NCIC trial: (i) concurrent chemotherapy with temozolomide; and (ii) age between 18 and 70 years old. Among these patients, 229 were treated with adjuvant temozolomide and were classified as "maximal criteria". One-hundred and eighteen patients were in the "without minimal criteria" group. Waiting time from the first symptom (FS-RT), pathology diagnosis (P-RT), multidisciplinary meeting (MM-RT), surgery (S-RT), and CT scan for delineation (CT-RT) until the start of radiotherapy were recorded. Median follow-up for all patients was 327 days. Overall, median FS-RT, P-RT, MM-RT, CT-RT, and S-RT times were 77, 36, 32, 12, and 41 days, respectively. Median, and 12 and 24-month overall survival were 409 days, and 56.3 ± 2.1 % and 27.6 ± 2.6 %, respectively. Univariate analysis failed to reveal a difference in survival, irrespective of the delay. In multivariate analysis, independent favorable prognostic factors for overall survival were age (p ≤ 0.0001) and type of surgery (p = 0.0006). In this large series treated during the EORTC-NCIC protocol period, waiting time until radiotherapy did not seem to affect patient outcome. © 2012 Springer Science+Business Media, LLC. Source

Peyrode C.,French Institute of Health and Medical Research | Weber V.,French Institute of Health and Medical Research | David E.,University of Nantes | Vidal A.,French Institute of Health and Medical Research | And 9 more authors.
Investigational New Drugs | Year: 2012

Cartilage tumours present ongoing therapeutic challenges due to their chondrogenic extracellular matrix that potentially hampers drug delivery, their low percentage of dividing cells, and their poor vascularity. In this context, and based on the affinity of the quaternary ammonium moiety for proteoglycans (PG), we developed a strategy that uses the quaternary ammonium function to selectively deliver DNA alkylating agents to the cartilage tumour tissue. We engineered the quaternary ammonium derivative of melphalan (Mel-AQ) and assessed its antitumoural activity in vitro and in vivo. In vitro, micromolar concentrations of Mel-AQ inhibited the proliferation of human HEMC-SS chondrosarcoma and Saos-2 osteosarcoma cell lines. Moreover, 24-h incubation with 20 μM Mel-AQ induced a 2.5-fold increase in S population and a 1.5-fold increase in subG0G1 population compared to controls. In vivo, Mel-AQ demonstrated antitumour activity in the orthotopic model of primary Swarm rat chondrosarcoma. When given to chondrosarcoma-bearing rats (three doses of 16 μmol/kg at days 8, 12 and 16 post-implant), Mel-AQ demonstrated an optimal antitumour effect at day 43, when tumour cell growth inhibition peaked at 69%. Interestingly, the treatment protocol was proved well tolerated, since the animals showed no weight loss over the course of the study. This antitumoural effect was assessed in vivo by scintigraphic imaging using 99mTc-NTP 15-5 developed in our lab as a PG-targeting radiotracer, and tumour tissue was analyzed at study-end by biochemical PG assay with Alcian blue staining. Mel-AQ treatment led to a significant decrease in the PG content of tumoural tissue. These experimental results highlighted the promising antitumour potential of Mel-AQ as a PG-targeting strategy for therapeutic management of chondrosarcoma. © Springer Science+Business Media, LLC 2011. Source

Background: Transmission of oncogenetic information (TOI) by probands to their families is of major importance to organize medical prevention in his family. Little is known about the difficulties that the proband faces when he tries to endorse his "duty to warn". Methods: To characterize the barriers to TOI, a survey was performed, previously to the bioethic law of 2011, on a representative sample of 337 counselees seen in the last 10 years at the Centre Jean-Perrin Oncogenetics Department. A questionnaire comprising 97 items was prepared by experts and validated by a group of patients and health professionals. Nineteen Lickert-scale questions specially concerned TOI. Results: Analysis found two dimensions, one of emotions and one concerning communication attitudes. Both dimensions were negatively correlated (r = -0.34, P < 10-7): high emotional levels limited communication attitudes. The probands' history of cancer was the main factor impacting TOI. TOI was more difficult for cancer patients than for healthy counselees (P = 0.025). Delay since consultation and type of cancer risk had no bearing on TOI. Conclusion: Cancer and its treatments seem to deeply affect patient's relatives and limit his capacity to involve his family into the oncogenetic inquiry. Measures are suggested to help expatients improve TOI. © 2014 Société Française du Cancer. Source

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