Toward curative treatment of peritoneal carcinomatosis from nonovarian origin by cytoreductive surgery combined with perioperative intraperitoneal chemotherapy: A multi-institutional study of 1290 patients
Glehen O.,Lyon University Hospital Center |
Gilly F.N.,Lyon University Hospital Center |
Boutitie F.,Biostatistics Service |
Bereder J.M.,Nice University Hospital Center |
And 6 more authors.
Cancer | Year: 2010
Background: Peritoneal carcinomatosis (PC) from nonovarian malignancies long has been regarded as a terminal disease. Over the past decade, new locoregional therapeutic approaches combining cytoreductive surgery with perioperative intraperitoneal chemotherapy (PIC) have evolved that have demonstrated improved survival. Methods: A retrospective, multicenter cohort study was performed in French-speaking institutions to evaluate toxicity and principal prognostic factors after cytoreductive surgery and PIC (hyperthermic intraperitoneal chemotherapy [HIPEC] and/or early postoperative intraperitoneal chemotherapy [EPIC]) for PC from nongynecologic malignancies. Results: The study included 1290 patients from 25 institutions who underwent 1344 procedures between February 1989 and December 2007. HIPEC was performed in 1154 procedures. The principal origins of PC were colorectal adenocarcinoma (N = 523), pseudomyxoma peritonei (N = 301), gastric adenocarcinoma (N = 159), peritoneal mesothelioma (N = 88), and appendiceal adenocarcinoma (N = 50). The overall morbidity and mortality rates were 33.6% and 4.1%, respectively. In multivariate analysis, patient age, the extent of PC, and institutional experience had a significant influence on toxicity. The overall median survival was 34 months; and the median survival was 30 months for patients with colorectal PC, not reached for patients with pseudomyxoma peritonei, 9 months for patients with gastric PC, 41 months for patients with peritoneal mesothelioma, and 77 months for patients with PC from appendiceal adenocarcinoma. Independent prognostic indicators in multivariate analysis were institution, origin of PC, completeness of cytoreductive surgery, extent of carcinomatosis, and lymph node involvement. Conclusions: A therapeutic approach that combined cytoreductive surgery with PIC was able to achieve long-term survival in a selected group of patients who had PC of nonovarian origin and had acceptable morbidity and mortality. The current results indicated that this treatment should be centralized to institutions with expertise in the management of PC. Copyright © 2010 American Cancer Society.
Gevaert S.A.,Ghent University |
De Bacquer D.,Ghent University |
Evrard P.,Catholic University of Leuven |
Convens C.,General Hospital ZNA Middelheim |
And 11 more authors.
EuroIntervention | Year: 2014
Aims: The relationship between the predictive performance of the TIMI risk score for STEMI and gender has not been evaluated in the setting of primary PCI (pPCI). Here, we compared in-hospital mortality and predictive performance of the TIMI risk score between Belgian women and men undergoing pPCI. Methods and results: In-hospital mortality was analysed in 8,073 (1,920 [23.8%] female and 6,153 [76.2%] male patients) consecutive pPCI-treated STEMI patients, included in the prospective, observational Belgian STEMI registry (January 2007 to February 2011). A multivariable logistic regression model, including TIMI risk score variables and gender, evaluated differences in in-hospital mortality between men and women. The predictive performance of the TIMI risk score according to gender was evaluated in terms of discrimination and calibration. Mortality rates for TIMI scores in women and men were compared. Female patients were older, had more comorbidities and longer ischaemic times. Crude in-hospital mortality was 10.1% in women vs. 4.9% in men (OR 2.2; 95% CI: 1.82-2.66, p<0.001). When adjusting for TIMI risk score variables, mortality remained higher in women (OR 1.47, 95% CI: 1.15-1.87, p=0.002). The TIMI risk score provided a good predictive discrimination and calibration in women as well as in men (c-statistic=0.84 [95% CI: 0.809-0.866], goodness-of-fit p=0.53 and c-statistic=0.89 [95% CI: 0.873-0.907], goodness-of-fit p=0.13, respectively), but mortality prediction for TIMI scores was better in men (p=0.02 for TIMI score x gender interaction). Conclusions: In the Belgian STEMI registry, pPCI-treated women had a higher in-hospital mortality rate even after correcting for TIMI risk score variables. The TIMI risk score was effective in predicting in-hospital mortality but performed slightly better in men. The database was registered with clinicaltrials.gov (NCT00727623). © Europa Digital & Publishing 2014. All rights reserved.
PubMed | Jolimont Hospital, Ghent University, Biotronik and New York University
Type: Journal Article | Journal: Pacing and clinical electrophysiology : PACE | Year: 2016
The occurrence and significance of alternans of the ventricular electrogram (VEGM) in patients with an implanted cardioverter-defibrillator (ICD) has been rarely reported.This report describes our observations of VEGM alternans documented in nine patients with an ICD (seven new cases and two previously published cases for comparison).We found seven new cases of near-field VEGM alternans and added two of our previously reported examples. Catecholaminergic polymorphic ventricular tachycardia (CPVT) was diagnosed in one patient based on ICD recordings. Alternans occurred during ventricular tachycardia (VT) in eight patients. A fast sinus tachycardia could not be ruled out in one patient. Stable cycle length alternans was found in five patients. QRS alternans of the left ventricular (LV) electrogram (EGM) was recorded in all five patients who had a device for cardiac resynchronization therapy capable of sensing by the LV channel. These five cases exhibited corresponding alternans of the right ventricular (RV) EGM in three cases, none in one patient, and a questionable recording in another. Alternans of the far-field (FF) VEGM occurred simultaneously with RV EGM alternans in all four patients whose device provided an FF tracing.Ventricular alternans may be more common than realized in ICD patients with VT. The correlation of VEGM alternans with the surface electrocardiogram remains unknown. Although QRS alternans itself as an electrical pattern is generally benign, its cause may not be, as illustrated in our patient with CPVT. Furthermore, associated cycle length alternans or undersensing of the smaller alternans component may complicate ICD therapy.
PubMed | Jolimont Hospital, University of Liège, Ghent University, St Luc University Hospital and Free University of Brussels
Type: Clinical Trial, Phase II | Journal: Anticancer research | Year: 2015
To investigate the efficacy of sunitinib in patients with advanced melanoma and to correlate angiogenic biomarkers with response and survival.We performed a phase II study in patients with advanced pre-treated melanoma. The primary endpoint was tumor response. Blood samples for biomarker analysis including vascular endothelial growth factor (VEGF), and its receptors VEGFR1 and -2, placental growth factor (PlGF) and circulating endothelial cells (CEC) were collected at baseline and during the first cycle.Four out of 39 patients (13%) achieved a partial response and eight (26%) stable disease. Time to progression was at least six months in seven patients. High baseline VEGFR1 levels and high baseline PlGF levels were both associated with a non-significant worse survival (p=0.08 for both).Sunitinib demonstrates limited activity in unselected patients with refractory advanced melanoma, but a minority of patients experienced long-term disease control. Identification of these patients remains a challenge.
PubMed | CHC Saint Joseph, Jolimont Hospital, Catholic University of Louvain, CHU Ambroise Pare and Free University of Colombia
Type: Journal Article | Journal: European journal of nuclear medicine and molecular imaging | Year: 2016
The introduction of targeted drugs has had a significant impact on the approach to assessing tumour response. These drugs often induce a rapid cytostatic effect associated with a less pronounced and slower tumoural volume reduction, thereby impairing the correlation between the absence of tumour shrinkage and the patients unlikelihood of benefit. The aim of the study was to assess the predictive value of early metabolic response (mR) evaluation after one cycle, and its interlesional heterogeneity to a later metabolic and morphological response assessment performed after threecycles in metastatic colorectal cancer (mCRC) patients treated with combined sorafenib and capecitabine.This substudy was performed within the framework of a wider prospective multicenter study on the predictive value of early FDG PET-CT response assessment (SoMore study). A lesion-based response analysis was performed, including all measurable lesions identified on the baseline PET. On a per-patient basis, a descriptive 4-class response categorization was applied based upon the presence and proportion of non-responding lesions. For dichotomic response comparison, all patients with at least one resistant lesion were classified as non-responding.On baseline FDG PET-CT, 124 measurable target lesions were identified in 38 patients. Early mR assessments showed 18 patients (47%) without treatment resistant lesions and 12 patients (32%) with interlesional response heterogeneity. The NPV and PPV of early mR were 85% (35/41) and 84% (70/83), respectively, on a per-lesion basis and 95% (19/20) and 72% (13/18), respectively, on a dichotomized per-patient basis.Early mR assessment performed after one cycle of sorafenib-capecitabine in mCRC is highly predictive of non-response at a standard response assessment time. The high NPV (95%) of early mR could be useful as the basis for early treatment discontinuation or adaptation to spare patients from exposure to non-effective drugs.
Delaunoit T.,Jolimont Hospital
Cancer Management and Research | Year: 2011
Gastric cancer remains a significant health burden worldwide. Most of these Malignancies are diagnosed at an advanced stage and are associated with a grim prognosis.Complete removal of macroscopic and microscopic tumor masses along with regional lymphnodes (R0 surgical resection) represents the treatment of choice in localized, nonmetastatic gastric cancer. Chemotherapy, either alone as a perioperative treatment, or in combination with radiation therapy in an adjuvant setting, improves the clinical outcome for patients with resectable tumors. In patients suffering from metastatic disease, chemotherapy and the so-called targeted therapies play a major role in improving survival and quality of life compared with best supportive care. The emergence of new drugs as well as new administration schedules allow physicians to obtain an objective response of up to 60% and, since the utilization of targeted therapies, overall survival has reached 14 months. In order to situate the standard of care and the latest developments in gastric malignancies better, the pertinent English literature, including major Phase III randomized studies and meta-analyses, has been reviewed. © 2011 Delaunoit.
De Kock M.,Catholic University of Leuven |
Loix S.,Jolimont Hospital |
Lavand'homme P.,Catholic University of Leuven
CNS Neuroscience and Therapeutics | Year: 2013
The old anesthetic ketamine has demonstrated interactions with the inflammatory response. This review intends to qualify the nature and the mechanism underlying this interaction. For this purpose, preclinical data will be presented starting with the initial works, and then, the probable mechanisms will be discussed. A summary of the most relevant clinical data will be presented. In conclusion, ketamine appears as a unique "homeostatic regulator" of the acute inflammatory reaction and the stress-induced immune disturbances. This is of some interest at a moment when the short- and long-term deleterious consequences of inadequate inflammatory reactions are increasingly reported. Large-scale studies showing improved patient's outcome are, however, required before to definitively assert the clinical reality of this positive effect. © 2013 John Wiley & Sons Ltd.
Delaunoit T.,Jolimont Hospital
Acta Gastro-Enterologica Belgica | Year: 2012
Development of screening programs in patients with high risk of developing esophageal cancer, as well as recent advances in diagnostic endoscopic techniques, have allowed clinicians to improve early detection of esophageal malignant tumors. Surgical resection, although currently considered as the standard of care for patients with early stage esophageal cancer, is sometimes contra-indicated. In this subset of patients, endoscopic resection techniques including endoscopic mucosal resections (EMR), thermal or non-thermal laser, or cryoablation are amongst the well-recognized modalities safely and efficiently used by gastroenterologists. However, in some patients, these options are contra-indicated or incomplete, necessitating medical treatments such as chemotherapy and/or radiation therapy. A systematic search of all the English literature regarding non-take away approaches has therefore been performed, based on a MEDLINE search (Pubmed) carried out between January 1990 and March 2011. Future radiation therapy developments will also be pointed out.
Loix S.,Jolimont Hospital |
De Kock M.,St Luc Hospital |
Henin P.,Jolimont Hospital
Acta Anaesthesiologica Belgica | Year: 2011
Inflammation is a major component in keeping the body in homeostasis. However, an overwhelmed inflammatory response may be associated to a loss of this homeostatic status, which may lead to tissue injury or organ dysfunction. A huge number of drugs interacts with the inflammatory response in a positive, negative or "dual" manner. Among these drugs, ketamine seems to have a significant positive effect on the regulation of inflammation. This NMDA-receptor antagonist acts at different levels of inflammation, interacting with inflammatory cells recrutment, cytokins production, and inflammatory mediators regulation. The resultant effect of these interactions confers to ketamine a antiproinflammatory effect by limiting exacerbation of systemic inflammation without affecting local healing processes. This review makes a complete overview of the immunomodulatory properties of this complex anesthetic substance. © Acta Anæsthesiologica Belgica, 2011.
PubMed | Jolimont Hospital
Type: | Journal: Case reports in emergency medicine | Year: 2016
Posterior carpometacarpal (CMC) dislocation is a rare condition. Treatment is usually surgical though no strict consensus can be found upon literature review. If diagnosed early and no associated fractures are found, CMC dislocation could benefit from conservative treatment comprising closed reduction and splint immobilisation. We report the case of a 26-year-old man diagnosed with a posterior dislocation of the third, fourth, and fifth CMC joints after a fall of 1.5 meters, treated by external reduction under procedural sedation and immobilisation with a cast for 6 weeks. Evolution was excellent with no relapse observed during follow-up. Our aim is to increase physician awareness of CMC dislocation so that they seek this injury in the emergency department. Unrecognised CMC dislocation can lead to neurovascular injuries as well as chronic instability and early articular degeneration.