The new challenges of palliative treatment of cholangiocarcinoma: Photodynamic therapy, EUS-guided internal biliary fistula [Les nouveaux défis du traitement palliatif du cholangiocarcinome: thérapie photodynamique, dérivation biliaire interne échoguidée]
Bulois P.,Groupe Hospitalier Of Linstitut Catholique Of Lille |
Sergent G.,Service de Radiologie Digestive |
Mordon S.,French Institute of Health and Medical Research
Acta Endoscopica | Year: 2010
Biliary cancer is related to a dismal prognosis. It authorizes the implementation of innovative treatments. We report on two cases. © 2010 Springer Paris.
Chopin-Laly X.,Service de Chirurgie Digestive |
Chopin-Laly X.,University Claude Bernard Lyon 1 |
Walter T.,Federation des Specialites Digestives |
Walter T.,University Claude Bernard Lyon 1 |
And 17 more authors.
Virchows Archiv | Year: 2013
Neuroendocrine tumors (NETs) of the jejunum are rare and usually grouped with either duodenal or ileal NETs. We aimed at better evaluating their characteristics by studying 116 cases of small-bowel NETs for which a precise anatomical location was available. Thirty-four cases were duodenal. Eighty-two were located after the duodenojejunal ligament, including ten cases in the first 50 cm, four cases between 50 and 100 cm, and six cases between 100 and 250 cm. All tumors located after 50 cm from the duodenojejunal ligament were enterochromaffin neoplasms. In contrast, the ten tumors located before this point formed a heterogeneous group. They included two cases of gastrin-expressing tumors in the first 10 cm and one case of enterochromaffin tumor located at 45 cm. The seven remaining cases were large tumors, located between 10 and 50 cm, of intermediate or high histological grade (four out of seven G2 or G3), locally invasive and usually metastatic (five out of seven with liver metastases); their survival was comparable to that of duodenal NETs. Patients with tumors located in the duodenum or the first 50 cm of the jejunum had longer survivals than those with lower jejunal and ileal tumors (p = 0.024). In conclusion, our study underlines the heterogeneity of jejunal NETs and supports the distinction between "upper" and "lower" jejunal tumors, which, for prognostic purposes, might be grouped with, respectively, duodenal and ileal NETs. Our data suggest that the arbitrary limit between upper and lower jejunal tumors might be fixed at 50 cm from the duodenojejunal ligament. © 2013 Springer-Verlag Berlin Heidelberg.
Histologic assessment of treatment effect of preoperative chemoradiation in patients presenting with resectable pancreatic adenocarcinoma [Chimioradiothérapie préopératoire des adénocarcinomes du pancréas: Évaluation anatomopathologique de l'efficacité thérapeutique]
Le Scodan R.,Center Rene Huguenin |
Mornex F.,Center Hospitalier Lyon Sud |
Partensky C.,Service de Chirurgie Digestive |
Mercier C.,Center Hospitalier Lyon Sud |
And 4 more authors.
Cancer/Radiotherapie | Year: 2011
Purpose: Several phase II studies have shown the feasibility of neoadjuvant chemoradiation regimens for resectable localized pancreatic adenocarcinoma. However, there is to date no completed phase III study to validate this approach and treatment effects evaluation still remains an active area of investigation. From the mature results of the SFRO-FFCD 9704 trial, we explored the antitumoral effect of a 5-fluoro-uracil and cisplatin-based preoperative chemoradiation regimen, with a special highlight on the histopathological response and performed a literature review. Patients and methods: Treatment consisted of concurrent radiotherapy (50Gy within five weeks) and chemotherapy with 5-fluoro-uracil (300mg/m2/day, five days/week, weeks 1-5) and cisplatin (20mg/m2/day, days 1-5 and 29-33), followed by surgical resection of the pancreatic tumour in patients without progression. Results: In all, 41 patients were enrolled, 26 patients (63%) underwent surgical resection with curative intent and 21 (80.7%) had R0 resection. A total of 13 of 26 specimens (50%) presented a major pathologic response (≥ 80% of severely degenerative cancer cells), with one complete pathologic response. The local recurrence and two-year survival rates were 4 and 32%, respectively, for the 26 operated patients. Conclusion: Our results suggest that preoperative chemoradiation provides antitumoral effect associated with major histopathological response in 50% of patients and a high R0 resection rate. Evaluation of histopathological response to neoadjuvant chemoradiation may serve as a surrogate marker for treatment efficacy and further research is needed to determine new prognostic and predictive factors of treatment response. © 2010 Société française de radiothérapie oncologique (SFRO).
Filippone A.,University of Chieti Pescara |
Blakeborough A.,Royal Hallamshire Hospital |
Breuer J.,Bayer AG |
Grazioli L.,University of Brescia |
And 17 more authors.
Journal of Magnetic Resonance Imaging | Year: 2010
Purpose: To compare enhancement of liver parenchyma in MR imaging after injection of hepatocyte-specific contrast media. Materials and Methods: Patients (n = 295) with known/ suspected focal liver lesions randomly received 0.025 mmol gadoxetic acid/kg body weight or 0.05 mmol gadobenate dimeglumine/kg body weight by means of bolus injection. MR imaging was performed before and immediately after injection, and in the delayed phase at approved time points (20 min after injection of gadoxetic acid and 40 min after injection of gadobenate dimeglumine). The relative liver enhancement for the overall population and a cirrhotic subgroup was compared in T1-weighted GRE sequences. An independent radiologist performed signal intensity measurements. Enhancement ratios were compared using confidence intervals (CIs). Results: The relative liver enhancement in the overall population was superior with gadoxetic acid (57.24%) versus gadobenate dimeglumine (32.77%) in the delayed-imaging phase. The enhancement ratio between the contrast media was statistically significant at 1.75 (95% CI: 1.46-2.13). In the delayed phase, the enhancement of cirrhotic liver with gadoxetic acid (57.00%) was comparable to that in the overall population. Enhancement with gadobenate dimeglumine was inferior in cirrhotic liver parenchyma (26.85%). Conclusion: In the delayed, hepatocyte-specific phase, liver enhancement after injection of gadoxetic acid was superior to that obtained with gadobenate dimeglumine. © 2010 Wiley-Liss, Inc.
Abdominal CT scan: A comparative study of patient exposure in clinical routine on devices with and without iterative reconstruction [Scanner abdominal: Étude comparative de l'exposition patient en routine clinique sur des appareils avec et sans reconstruction itérative]
Gomes M.,Service de Radiologie Digestive |
Leroy C.,Service de Radiologie Digestive |
Lemaire S.,Service de Radiologie Digestive |
Marmin C.,Service de Radiologie Digestive |
And 2 more authors.
Radioprotection | Year: 2014
Objective: compare the dose delivered to patients and image quality in clinical routine to perform an abdominal CT scan with no iterative reconstruction techniques (IR) relative to an examination conducted on a scanner with IR. Materials and methods: this is a retrospective study of 30 patients who underwent two abdominal examinations: one on a 40-slice scanner (TDM40) without IR and another one on a 256-slice scanner with IR (TDM256). The patients, on medical follow-up for a chronic abdominal disease, had an exam on each scanner using the same protocol comprising an abdominopelvic time portal phase. The length of acquisition, the effective dose and the dose length product (DLP) as well as quantitative and qualitative assessments of the image were compared. Results: the average effective dose per examination was 17.3 mSv with the TDM40 (PDL: 1019 mGy.cm) against 11.1 mSv with the TDM256 (PDL: 654 mGy.cm), hence a reduction of 35.8% (p < 0.001). The length of acquisition and quantification were comparable in both groups. The qualitative assessment was slightly higher on the TDM40 but no examination was considered suboptimal. Conclusion: using a scanner equipped with IR significantly reduces the effective dose while maintaining image quality. © EDP Sciences 2013.