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Le Touquet – Paris-Plage, France

Ayadi M.,University of Lyon | Ginestet C.,University of Lyon | Gassa F.,University of Lyon | Claude L.,University of Lyon | Mazeron J.-J.,Groupe hospitalier de la Pitie Salpetriere
Bulletin du Cancer | Year: 2010

Stereotactic radiation therapy, consisting in irradiating the tumor with a high dose per fraction, has a therapeutic potential because of excellent local control. This technique requires a high accuracy level in order to minimize the risk of normal tissue toxicity. Initially used for cerebral localization, the stereotactic radiation therapy can be used for lung and liver tumors thanks to personalized immobilization devices, time resolved tomodensitometry for tumor deformation, collimators with small size leaves, advanced dose distribution calculation algorithms and 3D imaging for patient set-up. This article will review the different clinical applications and the different aspects (mechanical, dosimetric and biological) to evaluate before implementing this complex irradiation technique using adapted or dedicated linear accelerators. ©John Libbey Eurotext. Source


Trone J.-C.,Institute Of Cancerologie Lucien Neuwirth | Guy J.-B.,Institute Of Cancerologie Lucien Neuwirth | Mery B.,Institute Of Cancerologie Lucien Neuwirth | Escure J.-L.,Institute Of Cancerologie Lucien Neuwirth | And 8 more authors.
Bulletin du Cancer | Year: 2014

Melanoma of the female genital tract is a rare location (less than 2% of melanomas all sites combined). These cancers have a very poor prognosis, due to the delay in diagnosis. Vulvar location is about 1% of melanomas then the vaginal location, uterine and ovarian. There is no consensus to date regarding their care, due to the rarity of the lesions. Their treatment must however be based on the current data concerning gynaecological cancers as well as standard management of cutaneous melanoma. The treatment is often based on conservative surgery, because radical resection does not improve survival. For the vulva and vagina, reconstructive surgery is possible. Treatment is sometimes supplemented by chemotherapy or radiotherapy, which could improve local control. The interest in the use of targeted therapy in these locations is not well known because of their rarity, but the study of genes c-Kit and BRAF provides new prospects for treatment. The objective of this review is to describe and report the current state of knowledge about gynaecologic melanomas. Copyright © 2007 John Libbey Eurotext - All rights reserved. Source


Multiple sclerosis is a complex disease of the central nervous system involving inflammation, demyelinisation, remyelinisation and axonal degeneration. Based on a real case report, we will review different treatments in multiple sclerosis. Improvement in targeting the inflammatory component of the disease allows an early treatment to prevent relapses and long term disability, but sometimes with serious adverse events. Therapeutic decision must be taken individually based on an accurate evaluation of the risk-benefit balance. Source


Spano J.-P.,Groupe hospitalier de la Pitie Salpetriere | Falandry C.,University of Lyon | Chaibi P.,Groupe Hospitalier de la Pitie Salpetriere Charles Foix | Freyer G.,Center Hospitalier Of Lyon Sud
Oncologist | Year: 2011

The incidence of breast cancer is two to three times higher in women aged≥65 years than in the whole population, whereas their mortality rate is threefold to fourfold higher. Targeted therapies allow significantly longer disease-free survival times. Nevertheless, in an elderly population, these treatments need to be prescribed with caution. This paper reviews the treatments of breast cancer in the elderly, and the issues of targeted therapies and their toxicities. Patients with human epidermal growth factor receptor (HER)-2+ breast cancer benefit from trastuzumab; although cardiotoxic effects are observed in<5% of pa-tients when given alone, they affect ~25% of patients when combined with anthracyclines. Bevacizumab leads to a longer progression-free survival time and lower risk for progression in patients with metastatic breast cancer when added to paclitaxel or docetaxel. Although generally well tolerated, it is associated with a higher risk for arterial thromboembolism and hypertension. Lapatinib is approved for the treatment of advanced or metastatic breast cancer in patients not responding to trastuzumab, combined with capecitabine chemotherapy. The most frequent side effects concern the gastrointestinal system and dermatologic symptoms. The life expectancy of breast cancer patients should be taken into account to determine the appropriateness of treatments. The quality of life of elderly cancer patients must be assessed with an appropriate tool. Older patients exhibit greater vulnerability, suggesting identification and exclusion of patients at high cardiac risk. Future recommendations for the treatment of elderly women with breast cancer should include a multidisciplinary approach and a global geriatric assessment before treatment with anti-HER-2 therapy or bevacizumab. Source


Clement S.,University Paris - Sud | Gargiulo M.,University of Paris Descartes | Gargiulo M.,Institute Of Myologie | Feingold J.,Groupe hospitalier de la Pitie Salpetriere | And 3 more authors.
Revue Neurologique | Year: 2015

Huntington's disease was the first adult onset neurological disease for which presymptomatic genetic testing became possible. It served as a model for the approach which constituted a radical change in medical practice and provided an important framework for multi-step, multidisciplinary, counselling for at risk persons. We will review the historical context of guidelines and good clinical practices, the experiences of our team which covers more than 20 years of presymptomatic testing for Huntington's disease in France, and explore the impact of the new French legislation for the future of presymptomatic testing of diseases for which neither preventive measures nor curative treatments are yet available. © 2015, Elsevier Masson SAS. All rights reserved. Source

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