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Kaidar-Person O.,Rambam Health Care Campus | Roach III M.,University of California at San Francisco | Crehange G.,Georges Francois Leclerc Cancer Center
International Journal of Radiation Oncology Biology Physics | Year: 2013

Given the low α/β ratio of prostate cancer, prostate hypofractionation has been tested through numerous clinical studies. There is a growing body of literature suggesting that with high conformal radiation therapy and even with more sophisticated radiation techniques, such as high-dose-rate brachytherapy or image-guided intensity modulated radiation therapy, morbidity associated with shortening overall treatment time with higher doses per fraction remains low when compared with protracted conventional radiation therapy to the prostate only. In high-risk prostate cancer patients, there is accumulating evidence that either dose escalation to the prostate or hypofractionation may improve outcome. Nevertheless, selected patients who have a high risk of lymph node involvement may benefit from whole-pelvic radiation therapy (WPRT). Although combining WPRT with hypofractionated prostate radiation therapy is feasible, it remains investigational. By combining modern advances in radiation oncology (high-dose-rate prostate brachytherapy, intensity modulated radiation therapy with an improved image guidance for soft-tissue sparing), it is hypothesized that WPRT could take advantage of recent results from hypofractionation trials. Moreover, the results from hypofractionation trials raise questions as to whether hypofractionation to pelvic lymph nodes with a high risk of occult involvement might improve the outcomes in WPRT. Although investigational, this review discusses the challenging idea of WPRT in the context of hypofractionation for patients with high-risk prostate cancer. © 2013 Elsevier Inc. Source

Hudry D.,Georges Francois Leclerc Cancer Center | Hudry D.,Paoli Calmettes Institute | Cannone F.,Paoli Calmettes Institute | Houvenaeghel G.,Paoli Calmettes Institute | And 4 more authors.
Surgical Endoscopy and Other Interventional Techniques | Year: 2013

Background Extraperitoneal para-aortic lymphadenectomy (PAL) is used to treat gynecological cancers. This laparoscopic approach was first described using a multiport technique, and more recently, a single-port technique was developed. Our aim was to experimentally compare both approaches-conventional laparoscopy (CL) and singleport laparoscopy (SPL)-via the extraperitoneal laparoscopic approach. Methods From November 2006 to July 2012, extraperitoneal PAL was performed by CL or SPL using the Gel- POINT device (Applied Medical). The surgical outcomes of the 2 groups were statistically analyzed. Results The study involved 69 patients; 36 underwent PAL with CL, and 33 patients underwent PAL with SPL. The mean operative times were 211.2 (range, 132-390) min and 159.6 (range, 120-255) min for the CL and SPL groups, respectively. The mean blood loss was not significantly different between the CL (52.5 mL; range, 0-100 mL) and SPL (40.5 mL; range, 0-100 mL, p = 0.62) groups. The average lymph node count was lower in the CL group (11.1; range, 4-29) compared to the SPL group (15; range, 3-19) (p = 0.03). However, this difference was not confirmed in the multivariate analysis (p = 0.16). The mean hospital stay was lower for the SPL group (2.2 days; range, 1-8 days) than the CL group (3.1 days; range, 1-5 days). In this case, the significant difference found in the univariate analysis (p = 0.02) was confirmed by the multivariate analysis (p = 0.0003). There were no conversions to open technique and no major complications. Conclusions The SPL method appears to be a feasible approach, with surgical outcomes that are not statistically different from the CL method. The cosmetic aspect, the role of SPL in decreasing postoperative pain, and its impact on hospital stay must be confirmed prospectively in larger series. © Springer Science+Business Media New York 2013. Source

Guiu S.,Georges Francois Leclerc Cancer Center | Michiels S.,Jules Bordet Institute | Andre F.,CNRS Gustave Roussy Institute | Cortes J.,Vall dHebron Institute of Oncology | And 9 more authors.
Annals of Oncology | Year: 2012

The 2012 IMPAKT task force investigated the medical usefulness of current methods for the classification of breast cancer into the 'intrinsic' molecular subtypes (luminal A, luminal B, basal-like and HER2). A panel of breast cancer and/or gene expression profiling experts evaluated the analytical validity, clinical validity and clinical utility of two approaches for molecular subtyping of breast cancer: the prediction analysis of microarray (PAM)50 assay and an immuno-histochemical (IHC) surrogate panel including oestrogen receptor (ER), HER2 and Ki67. The panel found the currently available evidence on the analytical validity and clinical utility of Ki67 based on a 14% cut-off and PAM50 to be inadequate. The majority of the working group members found the available evidence on the analytical validity, clinical validity and clinical utility of ER/HER2 to be convincing. The panel concluded that breast cancer classification into molecular subtypes based on the IHC assessment of ER, HER2 and Ki67 with a 14% cut-off and on the PAM50 test does not provide sufficiently robust information to modify systemic treatment decisions, and recommended the use IHC for ER and HER2 for the identification of clinically relevant subtypes of breast cancers. Methods for breast cancer classification into molecular subtypes should, however, be incorporated into clinical trial design. © The Author 2012. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. Source

Khouri C.,Georges Francois Leclerc Cancer Center | Guiu B.,Georges Francois Leclerc Cancer Center | Cercueil J.P.,Georges Francois Leclerc Cancer Center | Chauffert B.,Georges Francois Leclerc Cancer Center | And 3 more authors.
Anti-Cancer Drugs | Year: 2010

The aim of this study was to evaluate the efficacy and safety of combined hepatic arterial infusion (HAI), which is a combination of raltitrexed and oxaliplatin, in refractory colorectal carcinoma with only liver metastases. Seventeen consecutive patients with unresectable metastatic colorectal cancer, after the failure of two lines of systemic chemotherapy, were treated with HAI raltitrexed (3mg/m2 over 1 h) followed by oxaliplatin (130mg/m 2 over 2 h) every 3 weeks between January 2006 and January 2009. All patients presented with the metastatic disease limited to the liver and had failed at least two lines of chemotherapy, which contained oxaliplatin, irinotecan and a fluoropyrimidine. The median number of cycles was six (range 1-15). We observed three complete responses and eight partial responses among assessable patients (overall response rate in intention to treat, 65%; 95% confidence interval, 44.3-87.7%). The median time to progression was 10.5 months and the median survival time was 27.5 months. Toxicity included grade 3-4 neutropenia (in 17%), grade 3-4 thrombopenia (in 17%), and grade 2 abdominal pain (in 47%). In conclusion, the combination regimen of HAI raltitrexed and oxaliplatin is feasible and promising in patients who presented isolated hepatic metastases of colorectal cancer after failure of irinotecan and oxaliplatin treatment. Further evaluation of this combination is required. © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins. Source

Lorgis V.,Georges Francois Leclerc Cancer Center | Chauffert B.,University Hospital Amiens | Gentil J.,Georges Francois Leclerc Cancer Center | Ghiringhelli F.,Georges Francois Leclerc Cancer Center | And 2 more authors.
Anticancer Research | Year: 2012

Background: Metastatic pancreatic carcinoma is an incurable disease and gemcitabine remains the standard of care in first-line chemotherapy. Recently, fluorouracil/leucovorin combined with irinotecan and oxaliplatin (FOLFIRINOX) demonstrated their superiority in first-line therapy. The objective of this study was to determine the efficacy of FOLFIRINOX in either first- and second-line treatment and to compare its efficacy in regard to the location of the primary tumor. Patients and Methods: We performed a retrospective analysis of clinical factors associated with patients' survival using a cohort of 42 patients treated by FOLFIRINOX in either first- or second-line (2006-2011) and a control cohort of 42 patients matched on sex and age without FOLFIRINOX treatment was obtained from a previous period of time (2001-2005). Results: The median follow-up was 10 months. The median overall survival was 10 months for the whole cohort and 10 and 12 months for patients treated at first- and second-line, respectively (p<0.05). In this cohort using a multivariate model, among classical prognosis factors, only primary location in the head was associated with poor outcome. The median overall survival was 8 months for patients with primary location in the head and 14 months for patients with primary location in the corpse or tail (p=0.02). In the gemcitabine cohort, the median follow-up was 8 months. Using a multivariate model, only performance status was associated with outcome. The median overall survival was 9 versus 6.5 months for patients with tumor, of the head versus tail or corpse tumor respectively (p<0.05). Conclusion: This retrospective study suggests the same efficacy of FOLFIRINOX used either in first- or second- line therapy for pancreatic cancer. Importantly, FOLFIRINOX compared favorably to gemcitabine only for patients with tumor of the corpse or tail. Further prospective trials are warranted to evaluate the efficacy of FOLFIRINOX in patients with tumor of the head of the pancreas. Source

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