Adherence to guidelines for the treatment of venous thromboembolism in cancer patients: A retrospective analysis of 145 cases [Application des recommandations dans le traitement de la maladie thromboembolique veineuse chez les patients atteints de cancer : Étude rétrospective sur 145 cas]
Belhadj Chaidi R.,Service de medecine interne |
Thollot C.,Unite decho Doppler |
Ferru A.,Service doncologie |
Roblot P.,Service de medecine interne |
Landron C.,Service de medecine interne
Journal des Maladies Vasculaires | Year: 2013
Objectives: To assess adherence to French guidelines for curative treatment of thromboembolism in cancer patients, and to identify factors limiting their implementation. Patients and methods: Retrospective analysis of the medical files of cancer patients diagnosed with deep vein thrombosis (DVT) and/or pulmonary embolism (PE) in one site between January 1st, 2010 and June 30th, 2011. Central venous catheter thrombosis and superficial vein thrombosis were excluded. Results: The series included 145 patients, among whom 113 (78%) had solid tumors (at a metastatic stage in 68% of cases) and 33 (22%) had hematologic malignancies. Low molecular weight heparin (LMWH) was prescribed as long-term treatment (>. 10. days) for 83 patients (57.2%) and a vitamin K antagonist (VKA) for 33 patients (22.7%). Bleeding required treatment modifications or discontinuation in 11 (7.5%) and 10 (6.8%) patients respectively. After 6. months, LMWH, VKA and fondaparinux were prescribed for 28, 27 and six (19.3%, 18.6% et 4.1%) patients respectively. Mean duration of anticoagulation was 176.8. days. Treatment was not affected by a history of venous thromboembolism, the presence of pulmonary embolism or proximal deep vein thrombosis but it was significantly shorter in case of thrombosis limited to muscular veins (115.5 vs 182.3. days, P<. 0.05). Overall, guidelines were fully implemented in only 68 (46.9%) patients, with regards to the choice of pharmacological class and duration of treatment. Conclusion: Adherence to national guidelines is insufficient and actions must be taken to improve the management of venous thromboembolism in cancer patients. © 2013 Elsevier Masson SAS.
Dysautonomic syndrome of the face with Harlequin sign and syndrome: Three new cases and a review of the literature [Syndromes dysautonomiques du visage avec signe et syndrome d'Harlequin: étude de trois cas et revue de la littérature]
Guilloton L.,Service de Neurologie |
Demarquay G.,Service dOncologie |
Quesnel L.,Service de Neurologie |
De Charry F.,Service de Consultation et dExplorations Neurologiques |
And 2 more authors.
Revue Neurologique | Year: 2013
Introduction Harlequin phenomenon is characterized by a strictly unilateral erythrosis of the face with flushing and hyperhydrosis, and controlaterally a pale anhydrotic aspect. This syndrome can occur alone or associated to other dysautonomic phenomena such as Horner syndrome, Adie syndrome or Ross syndrome. Patients and methods We report three cases: two patients presented a Harlequin sign, associated with Horner syndrome for one and Ross syndrome for the second. The etiologic investigation was normal, allowing recognizing the idiopathic nature of the disorder. For the third patient, Harlequin syndrome was observed in a neoplastic context due to breast cancer, metastatic dissemination, and bone metastases involving the right side of the T2 body. Discussion We reviewed the literature: 108 cases have been described. This syndrome occurred alone in 48 patients and was associated with other dysautonomic syndromes such as Horner syndrome in 38 patients, Holmes Adie syndrome in six, and Ross syndrome in six; both Ross and Holmes Adie syndrome were associated five cases and associations were not reported in five patients. The pathophysiological mechanisms of this autonomic cranial neuropathy, the possible etiologies, and therapeutic management were discussed. Conclusion Harlequin phenomenon with flushing and unilateral hyperhydrosis is rare, occurring alone or in combination with other autonomic syndromes of the face. Idiopathic in two-thirds of cases, Harlequin phenomenon does not require specific treatment; sympathectomy may be discussed in the severe cases with a significant social impact. © 2013 Elsevier Masson SAS.
Besse B.,Institute Gustave Roussy |
Planchard D.,Institute Gustave Roussy |
Veillard A.-S.,Institute Gustave Roussy |
Taillade L.,Service dOncologie |
And 7 more authors.
Lung Cancer | Year: 2012
Background: Preliminary results indicated that bortezomib (B) (Velcade*) as a single agent may have activity in pretreated NSCLC patients with similar or lesser toxicity compared to chemotherapy. This phase II study was initiated to determine the efficacy of single-agent B in chemonaïve patients with advanced NSCLC. An early tumor assessment (after 6 weeks of therapy) was performed to allow for rapid and appropriate management of non-responding patients. Methods: Patients received B (1.5mg/m 2) twice a week for 2 consecutive weeks (days 1, 4, 8, and 11) followed by a 10-day rest period. The primary endpoint was non-progression rate (NPR) after 6 weeks of treatment. Secondary endpoints included response rate, progression-free survival (PFS), overall survival (OS), and safety. Exploratory analyses included FDG-PET response at 6 weeks and circulating tumors cell (CTC) assessment at day 1 of each cycle in a subset of patients. Results: 18 patients were enrolled from 06/06 to 02/07 from 3 French institutions. Demographics: male/female 15/3; median age 66 (54-79); PS 0/1/2, 3/12/3; pathology: adenocarcinoma 11, squamous cell carcinoma 5, large-cell carcinoma 2; smoking status never/former/current 1/10/7; stage IIIB/IV 2/16. Seventeen patients received B and 16 were assessable (1 early withdrawal and 1 progression at D26). The most frequent toxicity was fatigue (17 patients). Twelve patients (71%) had at least one grade 3 toxicity: 4 haematological, 1 infection, 5 gastro-intestinal toxicity, 9 fatigue, 1 neuropathy. The non-progression rate was 59% [33-82%] at 6 weeks (10/17 patients). No objective response was seen. With a median follow-up of 12.3 months, the median PFS and OS were 2.4 and 9.8 months respectively. Eleven deaths occurred. No PET response was observed, and CTC were detected only in 1 out of 8 patients evaluated. Conclusions: Although according to the protocol rules the trial should not be stopped, the lack of any objective response either by CT-scan or PET-CT, along with substantial toxicity, did not argue in favor of the current strategy of B as a single agent in the front-line setting of NSCLC. © 2011 Elsevier Ireland Ltd.
Varin R.,University Pierre and Marie Curie |
Varin R.,Laboratoire MERCI |
Mirshahi S.,Research and Development Stago |
Mirshahi P.,University Pierre and Marie Curie |
And 7 more authors.
Thrombosis Research | Year: 2013
Introduction Defective thrombolysis, a thrombotic risk factor, can be attributed to the formation of a compact clot poorly accessible to fibrinolytic enzymes. Venous thrombi, rich in red blood cells (RBCs), and arterial thrombi containing various amounts of RBCS, plasma and whole blood (WB) clot permeability and degradability were compared. The effect of rivaroxaban, a potent direct factor Xa inhibitor, was also evaluated. Materials and Methods Fibrin permeability was determined by flow measurement through the clot. Clot degradability was evaluated by the amount of D-dimer generated by clot perfusion with plasminogen and tissue plasminogen activator. Fibrin clot structure was assessed by confocal microscopy. Results WB clot permeability (KS) and degradability were 6.7- and 38-fold lower, respectively, compared with plasma clots. This is attributed to 1) occlusion of fibrin pores by RBCs and 2) a consistent increase in thrombin generation due to platelets and RBCs inducing formation of a tighter clot. Rivaroxaban added to plasma or WB before clotting, in reducing thrombin generation, led to the formation of a looser clot that is more degradable by fibrinolytic enzymes. Permeability and degradability of whole blood clots formed in the presence of rivaroxaban were very similar to those of plasma clots. Conclusion The resistance to fibrinolysis of WB clots was reduced considerably when clots were formed with rivaroxaban. These results may have implications for the development of antithrombotic agents. © 2012 Elsevier Ltd.
Latorzeff I.,Service de radiotherapie |
Mazurier J.,Service de radiotherapie |
Boutry C.,Service doncologie |
Dudouet P.,Service doncologie |
And 2 more authors.
Cancer/Radiotherapie | Year: 2010
External beam radiotherapy (RT) is used to treat all stages of localized prostate cancer. Using a 3D conformal RT (3DCRT) without any androgen deprivation, a clear dose-effect relationship has been shown in terms of both biochemical control and also unfortunately of rectal and urinary toxicity. Compared to a " standard" 3DCRT, intensity modulated RT (IMRT) improves the dose distribution by mainly providing concave dose distribution and tight dose gradients. Based on large clinical experiences for at least one decade, IMRT is widely used to increase the dose in the prostate and therefore local control, without increasing toxicity. Indeed, toxicity rates observed after high dose delivered in the prostate (80. Gy) with IMRT appear no different than those observed after a standard dose (70. Gy) delivered by a standard 3DCRT. Arc IMRT appears a new promising IMRT modality, decreasing dramatically treatment duration. However, this IMRT-based dosimetric benefit may not be translated into a full clinical benefit, if intra-pelvic prostate motion is not taken in account. Image-guided radiotherapy (IGRT) should be therefore associated with IMRT for a maximal clinical benefit. This article is a literature review showing the interest of both combined approaches. © 2010 Société française de radiothérapie oncologique (SFRO).
Ben Aissa A.,Service dOncologie |
Mach N.,Service dOncologie
Revue Medicale Suisse | Year: 2012
Lung cancer is the leading cause of cancer death in the world, favored by smoking. Nonsmall cell lung cancer is a heterogeneous disease whose prevalence is increasing among women. Epidemiological, hormonal and pathological factors explain tumor differences between men and women. Women have more frequently adenocarcinomas, EGFR mutations and respond better to cancer treatments. In recent decades, many advances have been made, allowing us to move from histological to molecular characterization of lung tumors. Further analysis of gender disparities will help us to understand and improve the management of patients with NSCLC.
Ben Aissa A.,Service dOncologie |
Mach N.,Service dOncologie
Revue Medicale Suisse | Year: 2012
HPV infection, a sexually transmissible disease, causes squamous cell carcinoma in a small fraction of infected individuals, years after exposure. Several cancers both in female and male, such as cervical cancer, anal carcinoma and up to 50% of oropharyngeal tumors are related to serotypes 16 and 18 of HPV. Several studies evaluating vaccination of young women before HPV exposure showed very good protection against cervical dysplasia and carcinoma in situ. Health authorities' guidelines now widely recommend vaccination of female between 11 and 14 years old. Results of recent trials also reveal good protective effect in men, raising the question of immunizing both young women and men. Important medical and socio-economic issues will need to be addressed before implementing such program.
Koessler T.,Service dOncologie |
Roth A.,Service dOncologie |
Cacheux W.,Service dOncologie
Revue Medicale Suisse | Year: 2014
Stomach cancers are diagnosed at an early stage in less than 10% of cases in Europe. They are superficial tumours, involving the mucosa and the submucosa only. Node involvement is the most important prognostic factor for these tumours. To determine the optimal therapeutic strategy, it is necessary to carry out a precise work-up involving an endoscopy, with chemical or virtual colorations and an echoendoscopy. Gastric surgery is the reference treatment. Nowadays, endoscopic tumour resection is a validated curative alternative. High quality medical expertise is needed for those tumours with a good prognosis, after evaluating risk for node involvement, and should be followed by Helicobacter pylori eradication and regular endoscopic surveillance.
Monet A.,Center dImagerie Fonctionnelle |
Merino B.,Center dImagerie Fonctionnelle |
Lupo R.,Service dOncologie
Clinical Nuclear Medicine | Year: 2010
A 67-year-old man underwent whole-body F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) for lymphoma screening. The results demonstrated no evidence of lymphoma recurrence, but a focal increased uptake of F-18 FDG in the prostate. There was no history of urinary symptoms. A biopsy diagnosed a prostatic adenocarcinoma. Incidentally, focal intense FDG uptake in the prostate gland should always require further investigations to confirm the presence of prostate cancer. © 2010 by Lippincott Williams & Wilkins.
Ferrand F.-R.,Service doncologie |
Pavic M.,Service de medecine interne et cancerologie
Revue de Medecine Interne | Year: 2014
The treatment of metastatic prostate cancer since the 1940s is based on the consideration of oncogenic addiction to its androgen receptor (AR). The significant improvement in survival outcomes over the past decade depends not only on the development of effective cytotoxic chemotherapy but also new molecules targeting the AR or decreasing testosterone levels, even in case of castration-resistant cancer. In this review, we summarize the structure and function of the RA, the mechanisms of androgen suppression, the concept of resistance to castration, historical targeted treatment on the AR and those recently marketed as abiraterone acetate and enzalutamide. © 2014 Société nationale française de médecine interne (SNFMI).