Hopitaux Universitaires Of Genve

La Chaux-de-Fonds, Switzerland

Hopitaux Universitaires Of Genve

La Chaux-de-Fonds, Switzerland
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Toscas J.I.,Instituto Oncologico Teknon | Linero D.,Instituto Oncologico Teknon | Rubio I.,Instituto Oncologico Teknon | Hidalgo A.,Servei de Radiodiagnstic | And 6 more authors.
Radiotherapy and Oncology | Year: 2010

Purpose: To assess the potential dosimetric advantages and drawbacks of photon beams (modulated or not), electron beams (EB), and protons as a boost for the tumor bed in deep-seated early-stage breast cancer. Material and methods: Planning CTs of 14 women with deep-seated tumors (i.e., ≥4 cm depth) were selected. The clinical target volume (CTV) was defined as the area of architectural distortion surrounded by surgical clips. The planning treatment volume (PTV) was the CTV plus 1 cm margin. A dose of 16 Gy in 2 Gy fractions was prescribed. Organs at risk (OARs) were heart, lungs, breasts, and a 5-mm thick skin segment on the breast surface. Dose-volume metrics were defined to quantify the quality of concurrent treatment plans assessing target coverage and sparing of OAR. The following treatment techniques were assessed: photon beams with either static 3D-conformal, dynamic arc (DCA), static gantry intensity-modulated beams (IMRT), or RapidArc (RA); a single conformal EB; and intensity-modulated proton beams (IMPT). The goal for this planning effort was to cover 100% of the CTV with ≥95% of the prescribed dose and to minimize the volume inside the CTV receiving >107% of the dose. Results: All techniques but DCA and EB achieved the planning objective for the CTV with an inhomogeneity ranging from 2% to 11%. RA showed the best conformity, EB the worst. Contra-lateral breast and lung were spared by all techniques with mean doses <0.5 Gy (zero for protons). The ipsi-lateral lung received a mean dose <10% of that prescribed with photon beams and <2% with IMPT, increasing to 17% with EB. The heart, in left-sided breast tumors, received also the highest dose with EB. The skin was best protected with RA with a mean dose of 5.4 Gy and V15Gy = 2.4%. Conclusions: Boosting the tumor bed in early-stage breast cancer with optimized photon or proton beams may be preferred to EB especially for deep-seated targets. The marked OAR (i.e., ipsi-lateral breast, lung, heart, and skin surface) dose-sparing effect may allow for a potential long-term toxicity risk reduction and better cosmesis. DCA or RA may also be considered alternative treatment options for patients eligible for accelerated partial breast irradiation trials. © 2010 Elsevier Ireland Ltd. All rights reserved.

Guittier M.-J.,University of Applied Sciences and Arts Northwestern Switzerland | Guittier M.-J.,Hopitaux Universitaires Of Genve | Othenin-Girard V.,University of Applied Sciences and Arts Northwestern Switzerland
Gynecologie Obstetrique Fertilite | Year: 2012

Occipito-posterior presentation represents 10 to 34% of cephalic presentations in early labor. Spontaneous rotation during labor to occipito-anterior mode occurs in most cases, but 5 to 8% of fetuses will persist in posterior position for the expulsive phase of delivery. Previous research has shown that this presentation carries an increased risk of unusually long labor, maternal and fetal exhaustion, instrument-assisted delivery, severe perineal injury, and cesarean section. The diagnosis of posterior variety is usually made quite late at the end of dilation. Several researchers have reported the benefits of determining presentation during labor by transabdominal ultrasonography. Some obstetrical techniques to correct these presentations at complete dilation have also been described. In the case of diagnosis of posterior variety, the usual attitude is expectant management. Postural techniques to promote physiological labor and delivery have been documented in the literature. De Gasquet has described a very precise technique to facilitate fetal rotation, but its effectiveness has never been assessed scientifically. A Cochrane review on the topic has shown that similar positions are well accepted by women and reduce back pain. On the other hand, the sample size of included studies appeared inadequate to assess their interest for use in childbirth, in general, and for adverse outcomes associated with posterior presentation varieties in particular. Attempts to correct the fetal malposition during the expansion phase would allow to reduce adverse outcomes during the expulsive phase of delivery. Further research is necessary to assess the efficacity of specific maternal positions during labor for the correction of fetal posterior presentation. © 2012 Elsevier Masson SAS.

Cai L.,University of Lausanne | Cai L.,Sun Yat Sen University | Stauder M.C.,Mayo Medical School | Zhang Y.-J.,Sun Yat Sen University | And 12 more authors.
International Journal of Radiation Oncology Biology Physics | Year: 2012

Purpose: Primary bone lymphoma (PBL) represents less than 1% of all malignant lymphomas. In this study, we assessed the disease profile, outcome, and prognostic factors in patients with Stages I and II PBL. Patients and Methods: Thirteen Rare Cancer Network (RCN) institutions enrolled 116 consecutive patients with PBL treated between 1987 and 2008 in this study. Eighty-seven patients underwent chemoradiotherapy (CXRT) without (78) or with (9) surgery, 15 radiotherapy (RT) without (13) or with (2) surgery, and 14 chemotherapy (CXT) without (9) or with (5) surgery. Median RT dose was 40 Gy (range, 4-60). The median number of CXT cycles was six (range, 2-8). Median follow-up was 41 months (range, 6-242). Results: The overall response rate at the end of treatment was 91% (complete response [CR] 74%, partial response [PR] 17%). Local recurrence or progression was observed in 12 (10%) patients and systemic recurrence in 17 (15%). The 5-year overall survival (OS), lymphoma-specific survival (LSS), and local control (LC) were 76%, 78%, and 92%, respectively. In univariate analyses (log-rank test), favorable prognostic factors for OS and LSS were International Prognostic Index (IPI) score ≤1 (p = 0.009), high-grade histology (p = 0.04), CXRT (p = 0.05), CXT (p = 0.0004), CR (p < 0.0001), and RT dose >40 Gy (p = 0.005). For LC, only CR and Stage I were favorable factors. In multivariate analysis, IPI score, RT dose, CR, and CXT were independently influencing the outcome (OS and LSS). CR was the only predicting factor for LC. Conclusion: This large multicenter retrospective study confirms the good prognosis of early-stage PBL treated with combined CXRT. An adequate dose of RT and complete CXT regime were associated with better outcome. © 2012 Elsevier Inc. All rights reserved.

Caubet J.-C.,University of Geneva | Kaiser L.,University of Geneva | Lemaitre B.,University of Geneva | Fellay B.,Cantonal Hospital of Fribourg | And 3 more authors.
Journal of Allergy and Clinical Immunology | Year: 2011

Background: Delayed-onset urticarial or maculopapular rashes are frequently observed in children treated with β-lactams. Many are labeled "allergic" without reliable testing. Objective: Determine the etiology of these rashes by exploring both infectious and allergic causes. Methods: Children presenting to the emergency department with delayed-onset urticarial or maculopapular rashes were enrolled. Acute and convalescent sera were obtained for viral screening along with a throat swab. Subjects underwent intradermal and patch skin testing for β-lactams 2 months after presentation. Anti-β-lactam blood allergy tests were also obtained. All subjects underwent an oral challenge test (OCT) with the culprit antibiotic. Results: Eighty-eight children were enrolled between 2006 and 2008. There were 11 (12.5%) positive intradermal and no positive patch tests. There were 2 (2.3%) positive blood allergy tests. There were 6 (6.8%) subjects with a positive OCT, 2 were intradermal-negative, and 4 were intradermal-positive. No OCT reactions were more severe than the index event. Most subjects had at least 1 positive viral study, 54 (65.9%) in the OCT negative group. Conclusion: In this situation, β-lactam allergy is clearly overdiagnosed because the skin rash is only rarely reproducible (6.8%) by a subsequent challenge. Viral infections may be an important factor in many of these rashes. OCTs were positive in a minority of intradermal skin test-positive subjects. Patch testing and blood allergy testing provided no useful information. OCTs should be considered in all children who develop a delayed-onset urticarial or maculopapular rash during treatment with a β-lactam. © 2010 American Academy of Allergy, Asthma & Immunology.

Miralbell R.,Institute Onclogic Teknon | Miralbell R.,Hopitaux Universitaires Of Genve | Moll M.,Institute Onclogic Teknon | Rouzaud M.,Hopitaux Universitaires Of Genve | And 8 more authors.
International Journal of Radiation Oncology Biology Physics | Year: 2010

Purpose: To evaluate the feasibility, tolerability, and preliminary outcomes in patients with prostate cancer treated according to a hypofractionated dose escalation protocol to boost the dominant tumor-bearing region of the prostate. Methods and Materials: After conventional fractionated external radiotherapy to 64 to 64.4Gy, 50 patients with nonmetastatic prostate cancer were treated with an intensity-modulated radiotherapy hypofractionated boost under stereotactic conditions to a reduced prostate volume to the dominant tumor region. A rectal balloon inflated with 60cc of air was used for internal organ immobilization. Five, 8, and 8 patients were sequentially treated with two fractions of 5, 6, or 7Gy, respectively (normalized total dose in 2Gy/fraction [NTD2Gy] < 100Gy, low-dose group), whereas 29 patients received two fractions of 8Gy each (NTD2Gy > 100Gy, high-dose group). Androgen deprivation was given to 33 patients. Acute and late toxicities were assessed according to the Radiation Therapy Oncology Group/European Organisation for Research and Treatment of Cancer (RTOG/EORTC) scoring system. Results: Two patients presented with Grade 3 acute urinary toxicity. The 5-year probabilities of ≥Grade 2 late urinary and late low gastrointestinal (GI) toxicity-free survival were 82.2% ± 7.4% and 72.2% ± 7.6%, respectively. The incidence and severity of acute or late toxicities were not correlated with low- vs. high-dose groups, pelvic irradiation, age, or treatment with or without androgen deprivation. The 5-year biochemical disease-free survival (b-DFS) and disease-specific survival were 98% ± 1.9% and 100%, respectively. Conclusion: Intensity-modulated radiotherapy hypofractionated boost dose escalation under stereotactic conditions was feasible, and showed excellent outcomes with acceptable long-term toxicity. This approach may well be considered an alternative to high-dose-rate brachytherapy. © 2010 Elsevier Inc.

Zilli T.,Hopitaux Universitaires Of Genve | Jorcano S.,Institute Onclogic Teknon | Rouzaud M.,Hopitaux Universitaires Of Genve | Dipasquale G.,Hopitaux Universitaires Of Genve | And 10 more authors.
International Journal of Radiation Oncology Biology Physics | Year: 2011

Purpose: To evaluate the toxicity and preliminary outcome of patients with localized prostate cancer treated with twice-weekly hypofractionated intensity-modulated radiotherapy (IMRT). Methods and Materials: Between 2003 and 2006, 82 prostate cancer patients with a nodal involvement risk ≤20% (Roach index) have been treated to the prostate with or without seminal vesicles with 56 Gy (4 Gy/fraction twice weekly) and an overall treatment time of 6.5 weeks. Acute and late genitourinary (GU) and gastrointestinal (GI) toxicities were scored according to the Radiation Therapy Oncology Group (RTOG) grading system. Median follow-up was 48 months (range, 9-67 months). Results: All patients completed the treatment without interruptions. No patient presented with Grade ≥3 acute GU or GI toxicity. Of the patients, 4% presented with Grade 2 GU or GI persistent acute toxicity 6 weeks after treatment completion. The estimated 4-year probability of Grade ≥2 late GU and GI toxicity-free survival were 94.2% ± 2.9% and 96.1% ± 2.2%, respectively. One patient presented with Grade 3 GI and another patient with Grade 4 GU late toxicity, which were transitory in both cases. The 4-year actuarial biochemical relapse-free survival was 91.3% ± 5.9%, 76.4% ± 8.8%, and 77.5% ± 8.9% for low-, intermediate-, and high-risk groups, respectively. Conclusions: In patients with localized prostate cancer, acute and late toxicity were minimal after dose-escalation administering twice-weekly 4 Gy to a total dose of 56 Gy, with IMRT. Further prospective trials are warranted to further assess the best fractionation schemes for these patients. © 2011 Elsevier Inc.

Zilli T.,Hopitaux Universitaires Of Genve | Schick U.,Hopitaux Universitaires Of Genve | Ozsahin M.,Hopitaux Universitaires Of Genve | Ozsahin M.,University of Lausanne | And 3 more authors.
Radiotherapy and Oncology | Year: 2012

Purpose: To evaluate the influence of concomitant chemotherapy on loco-regional control (LRC) and cancer-specific survival (CSS) in patients with T1-T2 N0 M0 anal cancer treated conservatively by primary radiotherapy (RT). Materials and methods: Between 1976 and 2008, 146 patients with T1 (n = 29) or T2 (n = 117) N0 M0 anal cancer were treated curatively by RT alone (n = 71) or by combined chemoradiotherapy (CRT) (n = 75) consisting of mitomycin C ± 5-fluorouracil. Univariate and multivariate analyses were performed to assess patient-, tumor- and treatment-related factors influencing LRC and CSS. Results: With a median follow-up of 62.5 months (interquartilerange, 26-113 months), 122 (84%) patients were locally controlled. The five-year actuarial LRC, CSS and overall survival for the population were 81.4% ± 3.6%, 91.9% ± 2.6%, and 75.4% ± 3.9%, respectively. The five-year LRC and CSS for patients treated with RT alone and with CRT were 75.5% ± 6.0% vs. 86.8% ± 4.1% (p = 0.155) and 88.5% ± 4.5% vs. 94.9% ± 2.9% (p = 0.161), respectively. In the multivariate analysis, no clinical or therapeutic factors were found to significantly influence the LRC and CSS, while the addition of chemotherapy was of borderline significance (p = 0.065 and p = 0.107, respectively). Conclusions: In the management of node negative T1-T2 anal cancer, LRC and CSS tend to be superior in patients treated by combined CRT, even though the difference was not significant. Randomized studies are warranted to assess definitively the role of combined treatment in early-stage anal carcinoma. © 2011 Elsevier Ireland Ltd. All rights reserved.

Introduction: Cystic fibrosis is a fatal genetic disorder requiring major therapeutic management. Adolescence is a challenging time for these young patients who are confronted with the new process of managing their illness themselves. Objectives: Better understand how cystic fibrosis adolescents cope with the process of treatment self-management. Results: Three aspects were distinguished: first, different phases inherent in the process of self-management; then bio-psycho-social factors affecting the process; and thirdly the role of the physical therapists in this transfer of responsibility. Conclusion: This study provides healthcare professionals with useful tools for optimizing physical therapy in these adolescents and proposes several pathways for future research. © 2011. Elsevier Masson SAS. All rights reserved.

Aliferis K.,Hopitaux Universitaires Of Genve | Mermoud C.,Hopitaux Universitaires Of Genve | Safran A.B.,Hopitaux Universitaires Of Genve
Journal Francais d'Ophtalmologie | Year: 2011

Introduction: Ophthalmologic follow-up of hydroxychloroquine-treated patients is of major importance because of the risk for potentially irreversible retinal toxicity. The use of the multifocal electroretinogram for the follow-up of such patients has already been reported. We studied the capacity of the multifocal electroretinogram to detect early signs of retinal toxicity. Patients and methods: This study consisted of multifocal electroretinogram analysis of 28 patients treated with hydroxychloroquine for a period of 6-72 months. All patients selected had a normal clinical and paraclinical ophthalmological evaluation. A multifocal electroretinogram according to the international recommendations was obtained. We analyzed the amplitude and the implicit time for kernel 1 responses by quadrant and by ring. Results: For both eyes, in both ring and quadrant analyses, the average implicit times of patients receiving hydroxychloroquine were significantly elevated (p < 0.01). On the other hand, the amplitudes were not significantly attenuated. In a total of 28 patients, seven (25%) presented a significant prolongation of the implicit time and significant amplitude attenuation was found in only one patient. Discussion: Implicit time prolongation in hydroxychloroquine-treated patients has already been reported. However, dissociation between amplitude and implicit time changes has, to our knowledge, never been previously described. This observation is important given that numerous studies focus exclusively on amplitude. Conclusion: The multifocal electroretinogram of patients receiving hydroxychloroquine can present lengthened kernel 1 implicit time, despite otherwise normal ophthalmological evaluation. Further studies are necessary to evaluate the prognostic value of mfERG responses in the early detection of patients presenting a retinotoxicity risk. © 2011 Publié par Elsevier Masson SAS.

Goeau-Brissonnire O.,Ambroise Pare University Hospital | Goeau-Brissonnire O.,University of Versailles | Javerliat I.,Ambroise Pare University Hospital | Javerliat I.,University of Versailles | And 5 more authors.
Annals of Vascular Surgery | Year: 2011

Postoperative wound and graft infections remain a major challenge for vascular surgeons. The bonding of antimicrobial substances on the graft material has been considered for many years, but the demonstration of safety and efficacy of these techniques is far from evident. Among the different proposed options, bonding of rifampin to the grafts has been the most evaluated technique, both experimentally and clinically. The objective of this review was to present and analyze the available data on rifampin-bonding and the possible evolutions of this technique to improve the resistance of vascular prostheses. © Annals of Vascular Surgery Inc.

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