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PubMed | Center Hospitalier Of Meaux, Center hospitalier Auban Moet, Center Hospitalier Of Saint Quentin, Center hospitalier Compiegne Noyon and 5 more.
Type: Journal Article | Journal: Revue des maladies respiratoires | Year: 2016

The Collge des Pneumologues des Hpitaux Gnraux has performed a prospective multicentre epidemiological study which aims to describe the baseline characteristics of all new cases of primary lung cancer histologically or cytologically diagnosed in 2010 and followed-up in the respiratory department of general hospitals. The present publication compares the characteristics of these presentations according to their smoking history.Seven thousand and fifty-one adult patients were included from 104 respiratory departments. A standardized form was completed at diagnosis and a steering committee checked the completeness of inclusion.Only 10.9% of patients were never-smokers and 89.1% ever-smokers (i.e., current or former smokers). Respectively, 3.7%, 10.7% and 85.6% of ever-smokers consumed/had consumed 1-10, 11-20, and >20 pack-years. Mean smoking duration was 37.5 years. Former smokers had stopped smoking on average 14.8 years previously. Only 20.7% of never-smokers reported that they had been exposed to tobacco smoke passively. At diagnosis, statistically significant differences were found between never- and ever-smokers (P<0.0001) for sex (women: 60.8% vs 18.8%), age (mean: 70.7 years vs 64.9 years), stage (IV: 70.8% vs 58.7%), histology (adenocarcinoma: 68.5% vs 42.6%), EGFR mutation exploration (51.4% vs 28.0%) and positivity (37.0% vs 4.6%). Differences between never- and ever-smokers rose with increasing tobacco consumption.This study confirms that differences exist between never- and ever-smoker patients presenting with primary lung cancer and shows the impact of the level of tobacco consumption, in particular on histology.


Jouveshomme S.,Service de Pneumologie et dOncologie Thoracique | Jouveshomme S.,Groupe Hospitalier Saint Joseph | Canoui-Poitrine F.,University Paris Est Creteil | Le Thuaut A.,University Paris Est Creteil | Bastuji-Garin S.,University Paris Est Creteil
Medical Oncology | Year: 2013

Recent phase-III trials show that platinum-based chemotherapy (PBCT) for patients with advanced non-small cell lung cancer and poor performance status (PS) improves survival without increasing toxicity, compared to single-agent chemotherapy (CT). The aim of this study was to asses whether these results are transposable in a community population. About 260 consecutive patients with stage IIIB-IV NSCLC (25 % with PS 2) receiving a PBCT were prospectively included in the study and retrospectively analyzed. No difference was observed between PS 0-1 and 2 patients regarding tumor-control rate, symptom relief, and grade III-V toxicity. Median and 1-year survival of PS 2 patients was 6.2 months and 32 %, respectively. PS 1 and PS 2 patients continuing first-line CT beyond the first course shared the same survival. On the other hand, more PS 2 (31.8 vs. 9.3 % of PS 0-1 patients, p < 0.001) discontinued first-line CT after the first course with a poor clinical outcome. They were more likely to have lost weight and to have a high comorbidity score. PBCT in unselected PS 2 patients achieved survival rates similar to those observed in clinical trials, with no increase in toxicity. PS 2 patients continuing CT beyond the first course shared the same prognosis than PS 1 patients. However, almost one-third of PS 2 patients discontinued CT after the first course. Their prognosis was poor. © 2013 Springer Science+Business Media New York.


PubMed | Service Route, Center hospitalier, hopital University, University dAuvergne and 2 more.
Type: Journal Article | Journal: Revue des maladies respiratoires | Year: 2016

With an aging population and an increase in the prevalence of asthma, this disease is becoming more common in the elderly. Nevertheless, the management of severe asthma can be complex, due to an increased risk of uncontrolled disease in patients over 65years old and partly to the inherent characteristics of old age: comorbidities, underestimation of the role of allergies, poor adherence, difficulties with inhalation devices, etc.We report two cases of women over 75with severe persistent allergic asthma not controlled by high doses of inhaled corticosteroids and long-acting beta-2-agonists in whom treatment with omalizumab was initiated. Following treatment with omalizumab a decrease in the number and severity of exacerbations, improved asthma control and dose reduction or discontinuation of systemic corticosteroids were observed. The tolerance of omalizumab was good in both cases.Omalizumab is to be considered an effective and well-tolerated therapeutic option for elderly patients with inadequately controlled severe allergic asthma.


PubMed | Service de soins palliatifs, Service de radiologie, Equipe de liaison et de soins en addictologie et psychiatrie de liaison, Service de pneumologie et doncologie thoracique and Service doncologie radiotherapie
Type: Journal Article | Journal: Revue des maladies respiratoires | Year: 2016

Miliary brain metastases are a rare form of brain metastatic lesions.We report the case of a 58-year-old patient with lung adenocarcinoma and an EGFR mutation, who had metastatic lesions in the bones, pleura and pericardia at the time of diagnosis. The patient was treated with tyrosine kinase inhibitor. A few months later, he presented with progressive neuropsychiatric symptoms, which were attributed to miliary brain metastases based on the radiological pattern (micronodules, some of which were calcified) and the elimination of alternative possible diagnoses. Despite tumour stability in the thorax and metastatic sites other than the brain, his neurological condition deteriorated, even after cerebral radiotherapy, leading to his death eight months after the diagnosis of lung cancer.Miliary brain metastases are a rare form of brain metastases with unusual clinical presentation. The diagnosis is based on the radiological pattern of cerebral miliary dissemination, with sometimes calcified tumor nodules. Despite its rarity, several cases have been reported in lung adenocarcinoma in the presence of EGFR mutations.


PubMed | Service de chirurgie generale et thoracique, Service de pneumologie et doncologie thoracique and Jean Monnet University
Type: Case Reports | Journal: Revue des maladies respiratoires | Year: 2015

Mounier-Kuhn syndrome or tracheobronchomegaly is a rare congenital condition, the management of which is complex. We report the case of a patient who was treated with interventional endoscopy.We describe the case of a 74-year-old man with a diagnosis of tracheobronchomegaly who was admitted in 2003 with a background of deteriorating respiratory status and the occurrence of postural syncope. He initially received a tracheobronchial silicone Y prosthesis, extended with metal prostheses at the tracheal and bronchial level. This arrangement remained stable until 2011. He then began to develop episodes of asphyxia related to posterior dislocation of the tracheobronchial prosthesis, after breakage of the metallic mesh tracheal prosthesis. A new tracheobronchial prosthesis Y was then placed, custom-made from a 3D model of the airways. This was clinically and functionally effective.This case describes the management of a patient with Mounier-Kuhn syndrome by interventional bronchoscopy, with the adaptation of prosthetic materials, on an individual basis, to the anatomy of the patients airway.


Couraud S.,Service de Pneumologie et dOncologie Thoracique | Couraud S.,University of Lyon | Fournel P.,Institute Of Cancerologie Of La Loire | Moro-Sibilot D.,Grenoble University Hospital Center | And 3 more authors.
Clinical Lung Cancer | Year: 2011

Background: In 2003 the French government initiated a large cancer plan. This program requested the latest edition of local guidelines in each of France's administrative regions. Since their creation, none of these guidelines has been assessed in the conditions of daily clinical practice. Method: A survey was performed to assess physicians' integrated knowledge of local guidelines in the Rhne-Alpes region in France. It included 4 patient cases with accompanying multiple-choice questions. Responses were judged as appropriate or inappropriate according to the 2007 edition of local guidelines. Results: Four hundred one physicians were contacted. The response rate was 56%. Among the responding physicians, 71 were eligible for analysis (those who were board certified in oncology and pulmonology and practiced thoracic oncology only). The rate of physicians who applied guidelines was 55%, 54%, 63%, and 25% for cases 1 to 4, respectively. There were no major differences in the responses between oncologists and pulmonologists. However significant differences were noted between physicians working in public health centers (cases 1 and 2) and those who practiced in private centers (cases 3 and 4) (appropriate response rate, 68% [case 3] vs. 36% [case 1] [P =.0494] for case 1; 28% [case 4] vs. 9% [case 2] (P =.0022)). Finally, no differences in physician responses were found in the administrative departments within the administrative region. Conclusion: The results of the survey illustrate that regional guidelines are not routinely applied in daily clinical practice. This nonapplication of regional guidelines by physicians may be due to either a lack of knowledge of updates to guidelines or a lack of agreement with them. © 2011 Elsevier Inc. All rights reserved.


Leclerc J.,University of Lille Nord de France | Courcot-Ngoubo Ngangue E.,University of Lille Nord de France | Cauffiez C.,University of Lille Nord de France | Allorge D.,University of Lille Nord de France | And 6 more authors.
Biochimie | Year: 2011

The lung is directly exposed to a wide variety of inhaled toxicants and carcinogens. In order to improve our knowledge of the cellular processing of these compounds in the respiratory tract, we investigated the mRNA expression level of 380 genes encoding xenobiotic-metabolizing enzymes (XME), transporters, nuclear receptors and transcription factors, in pulmonary parenchyma (PP), bronchial mucosa (BM) and tumoral lung tissues from 12 patients with non-small cell lung cancer (NSCLC). Using a high throughput quantitative real-time RT-PCR method, we found that ADH1B, CYP4B1, CES1 and GSTP1 are the major XME genes expressed both in BM and PP. Our results also documented the predominant role played by the xenosensor AhR in human lung. The gene expression profiles were different for BM and PP, with a tendency toward increased mRNA levels of phase I and phase II XME genes in BM, suggesting major differences in the initial stages of xenobiotic metabolism. Some of the significantly overexpressed genes in BM (i.e. CYP2F1, CYP2A13, CYP2W1, NQO1...) encode proteins involved in the bioactivation of procarcinogens, pointing out distinct susceptibility to xenobiotics and their toxic effects between these two tissue types. Additionally, interindividual differences in transcript levels observed for some genes may be of genetic origin and may contribute to the variability in response to environmental exposure and, consequently, in the risk of developing lung diseases. A global decrease in gene expression was observed in tumoral specimens. Some of the proteins are involved in the metabolism or transport of anti-cancer drugs and their influence in the response of tumors to chemotherapy should be considered. In conclusion, the present study provides an overview of the cellular response to toxicants and drugs in healthy and cancerous human lung tissues, and thus improves our understanding of the mechanisms of chemical carcinogenesis as well as cellular resistance to chemotherapy. © 2011 Elsevier Masson SAS. All rights reserved.


Leclerc J.,University of Lille Nord de France | Tournel G.,University of Lille Nord de France | Courcot-Ngoubo Ngangue E.,University of Lille Nord de France | Pottier N.,University of Lille Nord de France | And 6 more authors.
Biochimie | Year: 2010

Susceptibility to lung diseases, such as lung cancer and chronic obstructive pulmonary disease, is largely influenced by the metabolic capacity of lung tissues. This capacity is partly determined by the expression profile of the cytochromes P450 (CYPs), a superfamily of enzymes that have relevant catalytic properties toward exogenous and endogenous compounds. Using quantitative real-time RT-PCR, we conducted a comprehensive analysis of the expression profile of the 57 human CYP genes in non-tumoral (bronchial mucosa and pulmonary parenchyma) and tumoral lung tissues of 18 patients with non-small cell lung cancer. This study highlights (i) inter-individual variations in lung expression for some CYPs, (ii) different CYP expression patterns between bronchial mucosa and pulmonary parenchyma, that indicate distinctive susceptibility of these tissues toward the deleterious effects of inhaled chemical toxicants and carcinogens, (iii) high intertumoral variability, that could have major implications on lung tumor response to anti-cancer drugs. © 2010 Elsevier Masson SAS.


Dhalluin X.,Service de Pneumologie et dOncologie Thoracique | Dhalluin X.,University of Lille Nord de France | Scherpereel A.,Service de Pneumologie et dOncologie Thoracique | Scherpereel A.,Lille University of Science and Technology | Scherpereel A.,French Institute of Health and Medical Research
Recent Results in Cancer Research | Year: 2011

Previously considered to be rare, malignant pleural mesothelioma (MPM) is a highly aggressive tumor with an increasing incidence linked to asbestos exposure, its main etiological factor. MPM is also a very important issue because patients have usually a short survival (median <12 months) despite current treatments. Moreover an optimal treatment for MPM is not defined yet, even if ERS/ESTS experts recently provided clear and up-to-date guidelines on MPM management. These guidelines on chemotherapy and radiotherapy for mesothelioma, as well as new therapeutic developments, are presented in this chapter. © 2011 Springer-Verlag Berlin Heidelberg.


Vergnon J.-M.,Service de pneumologie et doncologie thoracique
Revue des Maladies Respiratoires Actualites | Year: 2014

Flexible bronchoscopy is the gold standard technique to diagnose central bronchial cancer. Today, 3 new challenges have to be resolved: i) to detect earlier central cancer to allow a curative local treatment; ii) To explore mediastinal lymph node invasion to improve the staging and the treatment; iii) To diagnose peripheral cancer: this situation. is now common with the higher incidence of adenocarcinomas and with the promotion of screening techniques.This paper analyses the main data on early detection of bronchial cancer (fluorescence bronchoscopy and NBI), on mediastinal staging through conventional TBNA or EBUSTBNA and on per-bronchoscopy sampling of peripheral nodules with radial echography or electromagnetic navigation. To obtain the best sensibility in the diagnosis of cancer, pulmonologists should provide adequate samplings to allow gene mutation. Pathologists should also learn the best strategy to optimize these minimal samplings.A larger diffusion of these new expensive bronchoscopic techniques requires an acceptable reimbursement of these fees by the social insurances. © 2013 Elsevier Masson SAS.

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