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Grenoble, France

Allemani C.,Analytical Epidemiology Unit | Storm H.,Danish Cancer Society | Voogd A.C.,Eindhoven Cancer Registry | Holli K.,University of Tampere | And 24 more authors.
European Journal of Cancer | Year: 2010

On a population-based sample of 13,500 European breast cancer patients mostly diagnosed in 1996-1998 and archived by 26 cancer registries, we used logistic regression to estimate odds of conservative surgery plus radiotherapy (BCS + RT) versus other surgery, in T1N0M0 cases by country, adjusted for age and tumour size. We also examined: BCS + RT in relation to total national expenditure on health (TNEH); chemotherapy use in N+ patients; tamoxifen use in oestrogen-positive patients; and whether ≥10 nodes were examined in lymphadenectomies. Stage, diagnostic examinations and treatments were obtained from clinical records. T1N0M0 cases were 33.0% of the total. 55.0% of T1N0M0 received BCS + RT, range 9.0% (Estonia) to 78.0% (France). Compared to France, odds of BCS + RT were lower in all other countries, even after adjusting for covariates. Women of 70-99 years had 67% lower odds of BCS + RT than women of 15-39 years. BCS + RT was 20% in low TNEH, 58% in medium TNEH, and 64% in high TNEH countries. Chemotherapy was given to 63.0% of N+ and 90.7% of premenopausal N+ (15-49 years), with marked variation by country, mainly in post-menopause (50-99 years). Hormonal therapy was given to 55.5% of oestrogen-positive cases, 44.6% at 15-49 years and 58.8% at 50-99 years; with marked variation across countries especially in premenopause. The variation in breast cancer care across Europe prior to the development of European guidelines was striking; older women received BCS + RT much less than younger women; and adherence to 'standard care' varied even among countries with medium/high TNEH, suggesting sub-optimal resource allocation. © 2010 Elsevier Ltd. All rights reserved.

Bolla M.,Center Hospitalier University | Hannoun-Levi J.M.,Center Antoine Lacassagne | Ferrero J.-M.,Center Antoine Lacassagne | Maingon P.,Center Georges Franois Leclerc | And 7 more authors.
Radiotherapy and Oncology | Year: 2010

Background and purpose: We evaluate the feasibility of concomitant and adjuvant docetaxel combined with three-dimensional conformal radiotherapy (3D-CRT) and androgen deprivation in high-risk prostate carcinomas. Methods: Fifty men with high-risk localized prostate cancer (16), locally advanced (28) or very high-risk prostate cancer (6) were included. Seventy Gy were delivered on prostate and seminal vesicles in 35 fractions, concurrently with weekly docetaxel (20 mg/m2). Three weeks after the completion of 3D-CRT, docetaxel was given for 3 cycles (60 mg/m2), every 3 weeks. Patients had to receive LHRH agonist during 3 years. Results: The intent to treat analysis shows that four patients out of 15 stopped prematurely the chemotherapy due to grade 3-4 acute toxicity. In the per protocol analysis, 46 patients completed a full-dose chemoradiation regimen representing 413 cycles: five patients experienced a grade 3 toxicity, and 15 patients experienced a grade 2 toxicity. With a median follow-up of 54 months, the 5-year clinical disease-free survival was 66.72% and the 5-year survival was 92.15%. Conclusions: 3D-CRT with androgen deprivation and concurrent weekly docetaxel, followed by three cycles of adjuvant docetaxel may be considered as feasible in high-risk prostate cancer and deserved to be evaluated in a phase III randomized trial. © 2010 Elsevier Ireland Ltd. All rights reserved.

Radoi L.,French Institute of Health and Medical Research | Radoi L.,University of Versailles | Paget-Bailly S.,French Institute of Health and Medical Research | Paget-Bailly S.,University of Versailles | And 21 more authors.
Cancer Causes and Control | Year: 2013

Objective: The association between body mass index (BMI) and the risk of oral cavity cancer, suggested by the few available studies, is controversial because of weight loss preceding cancer diagnosis and possible confounding by tobacco and alcohol consumption. The aim of this study was to evaluate in France, a high-incidence country, the association between the risk of oral cavity cancer and body mass index at interview, 2 years before the interview and at age 30, as well as BMI change. Methods: We used data from a population-based case-control study, the Investigation of occupational and environmental CAuses of REspiratory cancers study, with personal interviews and standardized questionnaires including 689 cases of oral cavity squamous cell carcinoma and 3,481 controls. Odds ratios (ORs) and 95 % confidence intervals (95 % CI) were estimated by unconditional logistic regression and were adjusted for gender, age, area of residence, education, tobacco smoking, and alcohol drinking. Results: ORs were increased in underweight subjects at interview (OR 6.25, 95 % CI 3.74-10.45). No association with underweight 2 years before the interview and at age 30 was found. Overweight and obesity at interview, 2 years before the interview and at age 30 were associated with decreased ORs (ranging from 0.13 to 0.60). BMI gain greater than 5 % between age 30 and 2 years before the interview was inversely associated with oral cavity cancer (OR 0.42, 95 % CI 0.33-0.54). These associations were stronger in men, and in smokers and drinkers. Conclusion: These results add further support to the existence of a reduced risk of oral cavity cancer among overweight and obese people or among people who increased their BMI in adulthood. The underlying mechanisms remain to be clarified. © 2013 Springer Science+Business Media Dordrecht.

Radoi L.,French Institute of Health and Medical Research | Radoi L.,University of Versailles | Paget-Bailly S.,French Institute of Health and Medical Research | Paget-Bailly S.,University of Versailles | And 20 more authors.
European Journal of Cancer Prevention | Year: 2013

The objective was to examine the role of tobacco smoking and alcohol drinking in the incidence of oral cavity cancer by subsite in France, a high-incidence area. We analysed detailed data on lifelong tobacco smoking and alcohol drinking from 772 oral cavity cancer cases and 3555 controls included in a population-based case-control study, the ICARE study. Tobacco smoking increased the risk of oral cavity cancer even for the smaller quantities and durations, whereas alcohol drinking increased this risk only in heavy drinkers who were also ever smokers. The combined effect of smoking and drinking was greater than multiplicative. The floor of the mouth was the subsite that was the most affected by the harmful effects of tobacco and alcohol, whereas the gums were less susceptible. The risk associated with tobacco and alcohol consumption did not differ between intraoral cavity and subsites usually included in the oropharynx (soft palate and base of the tongue). Population-attributable risks for oral cavity cancer were 78.6% for tobacco smoking, 7.3% for alcohol drinking and 80.7% for tobacco and/or alcohol consumption. These results indicate that regular oral check-ups should be targeted at smokers and heavy drinkers, and that prevention efforts should be focused on smoking cessation. © 2013 Wolters Kluwer Health/Lippincott Williams & Wilkins.

Colonna M.,Isere Cancer Registry | Colonna M.,University of Monastir | Bossard N.,Hospices Civils de Lyon | Bossard N.,University Claude Bernard Lyon 1 | And 4 more authors.
International Journal of Cancer | Year: 2010

Cancer mortality in elderly people is described to highlight the mechanisms that could potentially explain observed differences with other age groups. Data from 15 French cancer registries were considered in the search for the 5-year outcome of patients diagnosed during the period 1989-1997. Relative survival, excess mortality hazard, and hazard ratio of mortality were estimated to describe patient outcome according to age. Five cancer sites were selected: colon/rectum, prostate, breast, head/neck, and lung. An excess mortality rate was found in patients aged over 75 at the time of diagnosis. This excess mortality rate was mainly seen during the first months after diagnosis, then it decreased gradually with time. An initial phenomenon of patient selection, a greater disease severity at the time of diagnosis, and less-effective treatments given to elderly patients are the most plausible explanations for the increased risk of cancer-related death in the eldest patients. © 2009 UICC.

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