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Tessier E, Ruffier d'Epenoux L, Lartigue MF, Chaufour L, Plouzeau-Jayle C, Chenouard R, Guérin F, Tandé D, Lamoureux C, Bémer P, Corvec S. Comparison of the in vitro activities of delafloxacin and comparators against Staphylococcus epidermidis clinical strains involved in osteoarticular infections: a CRIOGO multicentre retrospective study. J Antimicrob Chemother 2024; 79:1045-1050. [PMID: 38507272 DOI: 10.1093/jac/dkae071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 02/29/2024] [Indexed: 03/22/2024] Open
Abstract
OBJECTIVES Staphylococcus epidermidis bone and joint infections (BJIs) on material are often difficult to treat. The activity of delafloxacin has not yet been studied on S. epidermidis in this context. The aim of this study was to assess its in vitro activity compared with other fluoroquinolones, against a large collection of S. epidermidis clinical strains. METHODS We selected 538 S. epidermidis strains isolated between January 2015 and February 2023 from six French teaching hospitals. One hundred and fifty-two strains were ofloxacin susceptible and 386 were ofloxacin resistant. Identifications were performed by MS and MICs were determined using gradient concentration strips for ofloxacin, levofloxacin, moxifloxacin and delafloxacin. RESULTS Ofloxacin-susceptible strains were susceptible to all fluoroquinolones. Resistant strains had higher MICs of all fluoroquinolones. Strains resistant to ofloxacin (89.1%) still showed susceptibility to delafloxacin when using the Staphylococcus aureus 2021 CA-SFM/EUCAST threshold of 0.25 mg/L. In contrast, only 3.9% of the ofloxacin-resistant strains remained susceptible to delafloxacin with the 0.016 mg/L S. aureus breakpoint according to CA-SFM/EUCAST guidelines in 2022. The MIC50 was 0.094 mg/L and the MIC90 was 0.38 mg/L. CONCLUSIONS We showed low delafloxacin MICs for ofloxacin-susceptible S. epidermidis strains and a double population for ofloxacin-resistant strains. Despite the absence of breakpoints for S. epidermidis, delafloxacin may be an option for the treatment of complex BJI, including strains with MICs of ≤0.094 mg/L, leading to 64% susceptibility. This study underlines the importance for determining specific S. epidermidis delafloxacin breakpoints for the management of BJI on material.
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Affiliation(s)
- E Tessier
- Service de Bactériologie et des Contrôles Microbiologiques, CHU Nantes, Nantes, France
| | - L Ruffier d'Epenoux
- Service de Bactériologie et des Contrôles Microbiologiques, CHU Nantes, Nantes, France
- INSERM, INCIT U1302, CHU Nantes, Université de Nantes, Nantes F-44000, France
| | - M F Lartigue
- Service de Bactériologie-Virologie-Hygiène, CHU Tours, Tours, France
- ISP, UMR1282, Université de Tours, INRAe, Tours, France
| | - L Chaufour
- Service de Bactériologie-Virologie-Hygiène, CHU Tours, Tours, France
| | - C Plouzeau-Jayle
- Service de Bactériologie et d'Hygiène hospitalière, CHU Poitiers, Poitiers, France
| | - R Chenouard
- Service de Bactériologie, CHU Angers, Angers, France
| | - F Guérin
- Service de Bactériologie-Hygiène hospitalière & CNR de la résistance aux Antibiotiques (laboratoire associé 'Entérocoques'), CHU Rennes, Rennes, France
| | - D Tandé
- Unité de Bactériologie, Pôle de Biologie-Pathologie CHU Brest, Brest, France
| | - C Lamoureux
- Unité de Bactériologie, Pôle de Biologie-Pathologie CHU Brest, Brest, France
| | - P Bémer
- Service de Bactériologie et des Contrôles Microbiologiques, CHU Nantes, Nantes, France
| | - S Corvec
- Service de Bactériologie et des Contrôles Microbiologiques, CHU Nantes, Nantes, France
- INSERM, INCIT U1302, CHU Nantes, Université de Nantes, Nantes F-44000, France
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2
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Roehrig A, Hirsch TZ, Pire A, Morcrette G, Gupta B, Marcaillou C, Imbeaud S, Chardot C, Gonzales E, Jacquemin E, Sekiguchi M, Takita J, Nagae G, Hiyama E, Guérin F, Fabre M, Aerts I, Taque S, Laithier V, Branchereau S, Guettier C, Brugières L, Fresneau B, Zucman-Rossi J, Letouzé E. Single-cell multiomics reveals the interplay of clonal evolution and cellular plasticity in hepatoblastoma. Nat Commun 2024; 15:3031. [PMID: 38589411 PMCID: PMC11001886 DOI: 10.1038/s41467-024-47280-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 03/21/2024] [Indexed: 04/10/2024] Open
Abstract
Hepatoblastomas (HB) display heterogeneous cellular phenotypes that influence the clinical outcome, but the underlying mechanisms are poorly understood. Here, we use a single-cell multiomic strategy to unravel the molecular determinants of this plasticity. We identify a continuum of HB cell states between hepatocytic (scH), liver progenitor (scLP) and mesenchymal (scM) differentiation poles, with an intermediate scH/LP population bordering scLP and scH areas in spatial transcriptomics. Chromatin accessibility landscapes reveal the gene regulatory networks of each differentiation pole, and the sequence of transcription factor activations underlying cell state transitions. Single-cell mapping of somatic alterations reveals the clonal architecture of each tumor, showing that each genetic subclone displays its own range of cellular plasticity across differentiation states. The most scLP subclones, overexpressing stem cell and DNA repair genes, proliferate faster after neo-adjuvant chemotherapy. These results highlight how the interplay of clonal evolution and epigenetic plasticity shapes the potential of HB subclones to respond to chemotherapy.
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Affiliation(s)
- Amélie Roehrig
- Centre de Recherche des Cordeliers, Université Paris Cité, Sorbonne Université, INSERM, Paris, France
| | - Theo Z Hirsch
- Centre de Recherche des Cordeliers, Université Paris Cité, Sorbonne Université, INSERM, Paris, France
| | - Aurore Pire
- Centre de Recherche des Cordeliers, Université Paris Cité, Sorbonne Université, INSERM, Paris, France
| | - Guillaume Morcrette
- Centre de Recherche des Cordeliers, Université Paris Cité, Sorbonne Université, INSERM, Paris, France
- Department of Pathology, Robert Debré and Necker-Enfants Malades Hospitals, APHP, Paris, France
| | - Barkha Gupta
- Centre de Recherche des Cordeliers, Université Paris Cité, Sorbonne Université, INSERM, Paris, France
| | | | - Sandrine Imbeaud
- Centre de Recherche des Cordeliers, Université Paris Cité, Sorbonne Université, INSERM, Paris, France
| | | | - Emmanuel Gonzales
- Pediatric Hepatology and Liver Transplantation Unit, National Reference Centre for Rare Pediatric Liver Diseases, FILFOIE, ERN RARE LIVER, APHP, Bicêtre University Hospital, University of Paris-Saclay, Le Kremlin Bicêtre, and INSERM UMR_S 1193, Hepatinov, University of Paris-Saclay, Orsay, France
| | - Emmanuel Jacquemin
- Pediatric Hepatology and Liver Transplantation Unit, National Reference Centre for Rare Pediatric Liver Diseases, FILFOIE, ERN RARE LIVER, APHP, Bicêtre University Hospital, University of Paris-Saclay, Le Kremlin Bicêtre, and INSERM UMR_S 1193, Hepatinov, University of Paris-Saclay, Orsay, France
| | - Masahiro Sekiguchi
- Department of Pediatrics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Junko Takita
- Department of Pediatrics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Genta Nagae
- Genome Science Laboratory, Research Center for Advanced Science and Technology (RCAST), the University of Tokyo, Tokyo, Japan
| | - Eiso Hiyama
- Department of Pediatric Surgery, Hiroshima University Hospital, Hiroshima, Japan
- Department of Biomedical Science, Natural Science Center for Basic Research and Development, Hiroshima University, Hiroshima, Japan
| | - Florent Guérin
- Department of Pediatric Surgery, Bicêtre Hospital, APHP, Paris-Saclay University, Orsay, France
| | - Monique Fabre
- Department of Pathology, Hôpital Universitaire Necker-Enfants malades, AP-HP, Paris, France
| | - Isabelle Aerts
- Oncology Center SIREDO, Institut Curie, PSL Research University, Paris, France
| | - Sophie Taque
- Département de Pédiatrie, CHU Fontenoy, Rennes, France
| | - Véronique Laithier
- Department of Children Oncology, Centre Hospitalier Universitaire Besançon, Besançon, France
| | - Sophie Branchereau
- Department of Pediatric Surgery, Bicêtre Hospital, APHP, Paris-Saclay University, Orsay, France
| | - Catherine Guettier
- Department of Pathology Hôpital Bicêtre-AP-HP, INSERM U1193, Paris-Saclay University, Orsay, France
| | - Laurence Brugières
- Gustave Roussy, Université Paris-Saclay, Department of Children and Adolescents Oncology, Villejuif, France
| | - Brice Fresneau
- Gustave Roussy, Université Paris-Saclay, Department of Children and Adolescents Oncology, Villejuif, France
| | - Jessica Zucman-Rossi
- Centre de Recherche des Cordeliers, Université Paris Cité, Sorbonne Université, INSERM, Paris, France.
- Hôpital Européen Georges Pompidou, Assistance Publique Hôpitaux de Paris, Paris, France.
| | - Eric Letouzé
- Centre de Recherche des Cordeliers, Université Paris Cité, Sorbonne Université, INSERM, Paris, France.
- CRCI2NA, Nantes Université, INSERM, CNRS, Nantes, France.
- University Hospital Hôtel-Dieu, Nantes, France.
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3
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Dávila Fajardo R, Scarzello G, Gaze MN, Boterberg T, Cameron A, Fuchs J, Guérin F, Hoskin P, Krasin MJ, Kroon P, Magelssen H, Mercke C, Merks JHM, Paulsen F, Pommier P, Ramos M, Rees H, Rogers T, Schmid M, Seitz G, Slater O, Smeulders N, Stenman J, Terwisscha S, Chargari C, Mandeville HC. Brachytherapy for rhabdomyosarcoma: Survey of international clinical practice and development of guidelines. Radiother Oncol 2024; 195:110273. [PMID: 38588921 DOI: 10.1016/j.radonc.2024.110273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 03/07/2024] [Accepted: 04/04/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND AND PURPOSE The purpose of this study was to address the lack of published data on the use of brachytherapy in pediatric rhabdomyosarcoma by describing current practice as starting point to develop consensus guidelines. MATERIALS AND METHODS An international expert panel on the treatment of pediatric rhabdomyosarcoma comprising 24 (pediatric) radiation oncologists, brachytherapists and pediatric surgeons met for a Brachytherapy Workshop hosted by the European paediatric Soft tissue Sarcoma Study Group (EpSSG). The panel's clinical experience, the results of a previously distributed questionnaire, and a review of the literature were presented. RESULTS The survey indicated the most common use of brachytherapy to be in combination with tumor resection, followed by brachytherapy as sole local therapy modality. HDR was increasingly deployed in pediatric practice, especially for genitourinary sites. Brachytherapy planning was mostly by 3D imaging based on CT. Recommendations for patient selection, treatment requirements, implant technique, delineation, dose prescription, dose reporting and clinical management were defined. CONCLUSIONS Consensus guidelines for the use of brachytherapy in pediatric rhabdomyosarcoma have been developed through multicenter collaboration establishing the basis for future work. These have been adopted for the open EpSSG overarching study for children and adults with Frontline and Relapsed RhabdoMyoSarcoma (FaR-RMS).
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Affiliation(s)
- Raquel Dávila Fajardo
- Department of Radiation Oncology, University Medical Center, Utrecht, the Netherlands; Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; Division Imaging and Oncology, University Medical Center, Utrecht, the Netherlands.
| | | | - Mark N Gaze
- Department of Oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom.
| | - Tom Boterberg
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium.
| | - Alison Cameron
- Bristol Cancer Institute, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom.
| | - Joerg Fuchs
- Department of Pediatric Surgery and Pediatric Urology, University Childreńs Hospital, Tuebingen, Germany
| | - Florent Guérin
- Department of Paediatric Surgery, Paris-Saclay University, Assistance Publique-Hôpitaux de Paris, Bicêtre Hospital, Paris, France
| | - Peter Hoskin
- Department of Oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom.
| | - Matthew J Krasin
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, USA
| | - Petra Kroon
- Department of Radiation Oncology, University Medical Center, Utrecht, the Netherlands; Division Imaging and Oncology, University Medical Center, Utrecht, the Netherlands.
| | | | - Claes Mercke
- Department of Oncology-Pathology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.
| | - Johannes H M Merks
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; Division Imaging and Oncology, University Medical Center, Utrecht, the Netherlands.
| | - Frank Paulsen
- Department of Radiation Oncology, University Hospital, Tuebingen, Germany.
| | - Pascal Pommier
- Department of Radiation Oncology, Centre Leon Berard, Lyon, France.
| | - Monica Ramos
- Department of Radiation Oncology, Vall d'Hebron University Hospital, Barcelona, Spain.
| | - Helen Rees
- Bristol Cancer Institute, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom.
| | - Tim Rogers
- Bristol Cancer Institute, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
| | - Maximilian Schmid
- Medical University of Vienna, Department of Radiation Oncology, Comprehensive Cancer Center, Vienna, Austria.
| | - Guido Seitz
- Department of Pediatric Surgery and Urology, University Hospital Giessen-Marburg, Campus Marburg, Marburg, Germany.
| | - Olga Slater
- Department of Paediatric Oncology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.
| | - Naima Smeulders
- Department of Paediatric Urology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.
| | - Jakob Stenman
- Childhood Cancer Research Unit, Department of Women's and Children's Health, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.
| | - Sheila Terwisscha
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.
| | - Cyrus Chargari
- Department of Radiation Oncology, Gustave Roussy Comprehensive Cancer Center, Villejuif, France.
| | - Henry C Mandeville
- The Royal Marsden Hospital and Institute of Cancer Research, Sutton, United Kingdom
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4
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Calinescu AM, Monluc S, Franchi-Abella S, Habes D, Weber G, Almes MF, Waguet J, Jacquemin E, Fouquet V, Miatello J, Hery G, Baujard C, Gonzales E, Branchereau S, Guérin F. Long-term outcome of combined radiologic and surgical strategy for the management of biliary complications after pediatric liver transplantation. BMC Res Notes 2024; 17:86. [PMID: 38509599 PMCID: PMC10953252 DOI: 10.1186/s13104-024-06735-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 03/06/2024] [Indexed: 03/22/2024] Open
Abstract
OBJECTIVES We aimed to analyze the risk factors for management failure of BC after pediatric liver transplantation (pLT) by retrospectively analyzing primary pLT performed between 1997 and 2018 (n = 620 patients). RESULTS In all, 117/620 patients (19%) developed BC. The median (range) follow-up was 9 (1.4-21) years. Patient survival at 1, 5 and 10 years was 88.9%, 85.7%, 84.4% and liver graft survival was 82.4%, 77.4%, and 74.3% respectively. Graft not patient survival was impaired by BC (p = 0.01). Multivariate analysis identified the number of dilatation courses > 2 (p = 0.008), prolonged cold ischemia time (p = 0.004), anastomosed multiple biliary ducts (p = 0.019) and hepatic artery thrombosis (p = 0.01) as factors associated with impaired graft survival. The number of dilatation courses > 2 (p < 0.001) and intrahepatic vs anastomotic stricture (p = 0.014) were associated with management failure. Thus, repeated (> 2) radiologic dilatation courses are associated with impaired graft survival and management failure. Overall, graft but not patient survival was impaired by BC.
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Affiliation(s)
- Ana M Calinescu
- Paediatric Surgery Unit, Université Paris-Saclay, Assistance Publique-Hôpitaux de Paris, Bicêtre Hospital, 78 Rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France.
- University Center of Pediatric Surgery of Western Switzerland, Geneva University Hospitals, Division of Pediatric Surgery, University of Geneva, 6 Rue Willy Donze, 1205, Geneva, Switzerland.
| | - Sébastien Monluc
- Assistance Publique-Hôpitaux de Paris, Bicêtre Hospital, Epidemiology and Public Health Department, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Stephanie Franchi-Abella
- Assistance Publique-Hôpitaux de Paris, Bicêtre Hospital, Pediatric Radiology Unit, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Dalila Habes
- Assistance Publique-Hôpitaux de Paris, Bicêtre Hospital, Pediatric Hepatology and Pediatric Liver Transplantation Unit, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Gabrielle Weber
- Assistance Publique-Hôpitaux de Paris, Bicêtre Hospital, Pediatric Radiology Unit, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Marion F Almes
- Assistance Publique-Hôpitaux de Paris, Bicêtre Hospital, Pediatric Hepatology and Pediatric Liver Transplantation Unit, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Jerome Waguet
- Assistance Publique-Hôpitaux de Paris, Bicêtre Hospital, Pediatric Radiology Unit, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Emmanuel Jacquemin
- Hépatinov, Inserm U 1193, National Reference Centre for Rare Pediatric Liver Diseases, FSMR FILFOIE, ERN RARE LIVER, Assistance Publique-Hôpitaux de Paris, Bicêtre Hospital, Pediatric Hepatology and Pediatric Liver Transplantation Unit, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Virginie Fouquet
- Paediatric Surgery Unit, Université Paris-Saclay, Assistance Publique-Hôpitaux de Paris, Bicêtre Hospital, 78 Rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France
| | - Jordi Miatello
- Assistance Publique-Hôpitaux de Paris, Bicêtre Hospital, Department of Pediatric and Neonatal Intensive Care, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Geraldine Hery
- Paediatric Surgery Unit, Université Paris-Saclay, Assistance Publique-Hôpitaux de Paris, Bicêtre Hospital, 78 Rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France
| | - Catherine Baujard
- Assistance Publique-Hôpitaux de Paris, Bicêtre Hospital, Anesthesia Department, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Emmanuel Gonzales
- Hépatinov, Inserm U 1193, National Reference Centre for Rare Pediatric Liver Diseases, FSMR FILFOIE, ERN RARE LIVER, Assistance Publique-Hôpitaux de Paris, Bicêtre Hospital, Pediatric Hepatology and Pediatric Liver Transplantation Unit, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Sophie Branchereau
- Paediatric Surgery Unit, Université Paris-Saclay, Assistance Publique-Hôpitaux de Paris, Bicêtre Hospital, 78 Rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France
| | - Florent Guérin
- Paediatric Surgery Unit, Université Paris-Saclay, Assistance Publique-Hôpitaux de Paris, Bicêtre Hospital, 78 Rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France
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5
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McLin VA, Franchi-Abella S, Brütsch T, Bahadori A, Casotti V, de Ville de Goyet J, Dumery G, Gonzales E, Guérin F, Hascoet S, Heaton N, Kuhlmann B, Lador F, Lambert V, Marra P, Plessier A, Quaglia A, Rougemont AL, Savale L, Sarma MS, Sitbon O, Superina RA, Uchida H, van Albada M, Johannes van der Doef HP, Vilgrain V, Wacker J, Zwaveling N, Debray D, Wildhaber BE. Expert management of congenital portosystemic shunts and their complications. JHEP Rep 2024; 6:100933. [PMID: 38234409 PMCID: PMC10792643 DOI: 10.1016/j.jhepr.2023.100933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 09/18/2023] [Accepted: 09/25/2023] [Indexed: 01/19/2024] Open
Abstract
Congenital portosystemic shunts are often associated with systemic complications, the most challenging of which are liver nodules, pulmonary hypertension, endocrine abnormalities, and neurocognitive dysfunction. In the present paper, we offer expert clinical guidance on the management of liver nodules, pulmonary hypertension, and endocrine abnormalities, and we make recommendations regarding shunt closure and follow-up.
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Affiliation(s)
- Valérie Anne McLin
- Swiss Pediatric Liver Center, Gastroenterology, Hepatology and Pediatric Nutrition Unit, Department of Pediatrics, Gynecology and Obstetrics, University of Geneva, Geneva, Switzerland
- ERN RARE LIVER
| | - Stéphanie Franchi-Abella
- Université Paris-Saclay, Faculté de médecine, Le Kremlin-Bicêtre, France
- AP-HP, Centre de référence des maladies rares du foie de l’enfant, Service de radiologie pédiatrique diagnostique et interventionnelle, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- BIOMAPS UMR 9011 CNRS, INSERM, CEA, Orsay, France
- ERN RARE LIVER
- ERN Transplant Child
| | | | - Atessa Bahadori
- Department of Pediatrics, Gynecology and Obstetrics, University of Geneva, Geneva, Switzerland
| | - Valeria Casotti
- ERN Transplant Child
- Pediatric Hepatology, Gastroenterology and Transplant Centre, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Jean de Ville de Goyet
- Pediatric Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, ISMETT UPMC, Palermo, Italy
| | - Grégoire Dumery
- Université Paris-Saclay, Faculté de médecine, Le Kremlin-Bicêtre, France
- AP-HP, Service de gynécologie et d’obstétrique, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Emmanuel Gonzales
- Université Paris-Saclay, Faculté de médecine, Le Kremlin-Bicêtre, France
- ERN RARE LIVER
- ERN Transplant Child
- AP-HP, Centre de référence des maladies rares du foie de l’enfant, FHU Hepatinov, Service d’hépatologie et transplantation hépatique pédiatriques, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- INSERM UMRS_1193, Orsay, France
| | - Florent Guérin
- Université Paris-Saclay, Faculté de médecine, Le Kremlin-Bicêtre, France
- ERN RARE LIVER
- ERN Transplant Child
- AP-HP, Service de chirurgie pédiatrique, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Sebastien Hascoet
- Department of Congenital Heart Diseases, Hôpital Marie Lannelongue, France
- INSERM UMR_S 999, Université Paris, France
| | - Nigel Heaton
- Institute of Liver Studies, Kings College Hospital, London, England
| | - Béatrice Kuhlmann
- Pediatric Endocrinology, Cantonal Hospital Aarau KSA, Aarau, Switzerland
| | - Frédéric Lador
- Service de Pneumologie, University of Geneva, Geneva, Switzerland
| | - Virginie Lambert
- AP-HP, Centre de référence des maladies rares du foie de l’enfant, Service de radiologie pédiatrique diagnostique et interventionnelle, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- Cardiologie congénitale, Institut Mutualiste Montsouris, Paris, France
| | - Paolo Marra
- Department of Radiology, Papa Giovanni XXIII Hospital, School of Medicine and Surgery - University of Milano-Bicocca, Bergamo, Italy
| | - Aurélie Plessier
- ERN RARE LIVER
- Centre de référence des maladies vasculaires du foie, Service d’hépatologie Hôpital Beaujon, Clichy, France
- VALDIG
| | - Alberto Quaglia
- Department of Cellular Pathology, Royal Free London NHS Foundation Trust/UCL Cancer Institute, London, England
| | - Anne-Laure Rougemont
- Swiss Pediatric Liver Center, Division of Clinical Pathology, Diagnostic Department, University of Geneva, Geneva, Switzerland
| | - Laurent Savale
- Université Paris-Saclay, Faculté de médecine, Le Kremlin-Bicêtre, France
- AP-HP, Centre de référence de l’hypertension pulmonaire, Service de pneumologie et soins intensifs respiratoires, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- INSERM UMR_S 999, Hôpital Marie Lannelongue, Le Plessis Robinson, France
- ERN Lung
| | - Moinak Sen Sarma
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Olivier Sitbon
- Université Paris-Saclay, Faculté de médecine, Le Kremlin-Bicêtre, France
- AP-HP, Centre de référence de l’hypertension pulmonaire, Service de pneumologie et soins intensifs respiratoires, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- INSERM UMR_S 999, Hôpital Marie Lannelongue, Le Plessis Robinson, France
- ERN Lung
| | - Riccardo Antonio Superina
- Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, USA
| | - Hajime Uchida
- Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - Mirjam van Albada
- Department of paediatric and congenital cardiology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Hubert Petrus Johannes van der Doef
- Division of paediatric gastroenterology and hepatology, Department of paediatrics, University Medical Center Groningen, Groningen, The Netherlands
| | - Valérie Vilgrain
- ERN RARE LIVER
- VALDIG
- Université Paris Cité, CRI, INSERM, Paris, France
- AP-HP, Département de Radiologie, Hôpital Beaujon. Nord, Clichy, France
| | - Julie Wacker
- Pediatric Cardiology Unit, Department of pediatrics, Gynecology and Obstetrics, University of Geneva, Geneva, Switzerland
- Centre Universitaire Romand de Cardiologie et Chirurgie Cardiaque Pédiatrique, University of Geneva and Lausanne, Switzerland
| | - Nitash Zwaveling
- Department of Pediatric Endocrinology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Dominique Debray
- ERN RARE LIVER
- ERN Transplant Child
- AP-HP, Unité d’hépatologie pédiatrique et transplantation hépatique, Hôpital Necker, Paris, France
- Centre de Référence des maladies rares du foie de l’enfant, FILFOIE, France
| | - Barbara Elisabeth Wildhaber
- ERN RARE LIVER
- Swiss pediatric Liver Center, Division of pediatric surgery, Department of Pediatrics, Gynecology, and Obstetrics, University of Geneva, Geneva, Switzerland
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Coppin R, Martelli H, Chargari C, Sudour-Bonnange H, Orbach D, Vérité C, Pasquet M, Saumet L, Piguet C, Patte C, Guérin F, Faure-Conter C, Fresneau B. Outcome and late effects of patients treated for childhood vaginal malignant germ cell tumors. Pediatr Blood Cancer 2023; 70:e30697. [PMID: 37798818 DOI: 10.1002/pbc.30697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/31/2023] [Accepted: 09/14/2023] [Indexed: 10/07/2023]
Abstract
PURPOSE Vaginal malignant germ cell tumors (MGCT) are rare, occurring in children less than 2 years old and raise the question of the optimal local treatment. METHODS We included children treated for vaginal MGCT according to the French TGM-95/2013 regimen. Patients were classified as standard risk (SR: localized disease and alpha-fetoprotein (AFP) < 10,000 ng/mL) or high risk (HiR: metastatic and/or AFP > 10,000 ng/mL) and were treated, respectively, with three to five VBP (vinblastine-bleomycin-cisplatin) or four to six VIP (etoposide-ifosfamide-cisplatin), followed by conservative surgery and/or brachytherapy in case of post-chemotherapy residuum. RESULTS Fourteen patients were included (median age = 12 months), of which six (43%) were classified as HiR. AFP levels were normalized after first-line chemotherapy in all cases but one. A vaginal post-chemotherapy residuum (median size = 8 mm, range: 1-24 mm) was observed in 13/14 patients, treated by complete resection in seven of 13 (viable cells in three of seven), incomplete resection in four of 13 (viable cells in two of four), with adjuvant brachytherapy in two of 13, and exclusive brachytherapy in two of 13 (viable cells in one of six). Among the six patients with viable disease, four patients received adjuvant chemotherapy. One patient (SR) experienced immediate postoperative relapse despite presenting no viable residual cells and was treated with four VIP cycles and brachytherapy. At last follow-up (median = 4.6 years, range: 0.5-16), all patients were alive in complete remission. Five patients suffered from vaginal sequelae with synechiae and/or stenosis (of whom four had undergone brachytherapy). CONCLUSION Childhood vaginal MGCTs show a highly favorable prognosis with risk-adapted chemotherapy and local treatment of post-chemotherapy residuum (preferably by conservative surgery with partial vaginectomy). Brachytherapy could be an alternative when conservative surgery is not deemed possible or in cases of incomplete resection with residual viable cells.
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Affiliation(s)
- Robin Coppin
- Department of Children and Adolescents Oncology, Gustave Roussy, Paris-Saclay University, Villejuif, France
| | - Helene Martelli
- Department of Pediatric Surgery, Bicêtre Hospital - Assistance Publique-Hôpitaux de Paris - Université Paris Saclay, Le Kremlin-Bicêtre, France
| | - Cyrus Chargari
- Department of Radiation Therapy, Gustave Roussy, Paris-Saclay University, Villejuif, France
| | | | - Daniel Orbach
- SIREDO Oncology Center (Care, Innovation and Research for Children, Adolescents and Young Adults with Cancer) Institut Curie, PSL University, Paris, France
| | - Cecile Vérité
- Department of Pediatric Onco-Hematology, Centre Hospitalier Universitaire, Bordeaux, France
| | - Marlene Pasquet
- Department of Pediatric Onco-Hematology, Centre Hospitalier Universitaire, Toulouse, France
| | - Laure Saumet
- Department of Pediatric Onco-Hematology, Centre Hospitalier Universitaire, Montpellier, France
| | - Christophe Piguet
- Department of Pediatric Onco-Hematology, Centre Hospitalier Universitaire, Limoges, France
| | - Catherine Patte
- Department of Children and Adolescents Oncology, Gustave Roussy, Paris-Saclay University, Villejuif, France
| | - Florent Guérin
- Department of Pediatric Surgery, Bicêtre Hospital - Assistance Publique-Hôpitaux de Paris - Université Paris Saclay, Le Kremlin-Bicêtre, France
| | - Cecile Faure-Conter
- Department of Pediatric Oncology, Institut d'Hemato-Oncologie Pediatrique, Lyon, France
| | - Brice Fresneau
- Department of Children and Adolescents Oncology, Gustave Roussy, Paris-Saclay University, Villejuif, France
- Paris-Saclay University, Paris-Sud University, Epidemiology of Radiation, CESP, INSERM, Villejuif, France
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7
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Lecompte JF, Sarnacki S, Irtan S, Piolat C, Scalabre A, Talon I, Rod J, Panait N, Rodesch G, Luis Huertas AL, Abbo O, Demarche M, Habonimana E, Ballouhey Q, Valteau-Couanet D, Guérin F. Thoracoscopy for Pediatric Thoracic Neurogenic Tumors-A European Multi-Center Study. Cancers (Basel) 2023; 15:5467. [PMID: 38001727 PMCID: PMC10670815 DOI: 10.3390/cancers15225467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/25/2023] [Accepted: 11/03/2023] [Indexed: 11/26/2023] Open
Abstract
OBJECTIVES To assess the efficacy of thoracoscopy and the outcome for children with thoracic neurogenic tumors. METHODS We performed a retrospective review of 15 European centers between 2000 and 2020 with patients who underwent thoracoscopy for a neurogenic mediastinal tumor. We assessed preoperative data, complications, and outcomes. Results were expressed with the median and range values. RESULTS We identified 119 patients with a median age of 4 years old (3 months-17 years). The diameter was 5.7 cm (1.1-15). INRG stage was L1 n = 46, L2 n = 56, MS n = 5, M n = 12. Of 69 patients with image-defined risk factors (IDRF), 29 had only (T9-T12) locations. Twenty-three out of 34 patients with preoperative chemotherapy had an 18 mm (7-24) decrease in diameter. Seven out of 31 patients lost their IDRF after chemotherapy. Fourteen had a conversion to thoracotomy. The length of the hospital stay was 4 days (0-46). The main complications included chylothorax (n = 7) and pneumothorax (n = 5). Long-term complications included Horner's syndrome (n = 5), back pain, and scoliosis (n = 5). Pathology was 53 neuroblastomas, 36 ganglioneuromas, and 30 ganglioneuroblastomas. Fourteen had a postoperative residue. With a median follow-up of 21 months (4-195), 9 patients had a recurrence, and 5 died of disease. Relapses were associated with tumor biology, histology, and the need for chemotherapy (p = 0.034, <0.001, and 0.015, respectively). Residues were associated with preoperative IDRF (excluding T9-T12 only) and the need for preoperative chemotherapy (p = 0.04 and 0.020). CONCLUSION Our results show that thoracoscopy is safe, with good outcomes for thoracic neurogenic tumors in selected cases. Surgical outcomes are related to the IDRFs, whereas oncologic outcomes are related to tumor histology and biology.
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Affiliation(s)
| | - Sabine Sarnacki
- Necker Enfants Malade Hospital, Université Paris-Cité, GHU Centre Assistance Publique-Hôpitaux de Paris (AP-HP), 75015 Paris, France
| | - Sabine Irtan
- Trousseau Hospital, Université Paris-Sorbonne, GHU-Paris Sorbonne Assistance Publique-Hôpitaux de Paris (AP-HP), 75012 Paris, France;
| | | | - Aurélien Scalabre
- Saint-Etienne University Hospital, 42270 Saint-Priest-en-Jarez, France;
| | - Isabelle Talon
- Hopital Hautepierre, CHRU Strasbourg, 67200 Strasbourg, France
| | | | - Nicoleta Panait
- La Timone Hospital, Aix-Marseille University, Assistance Publique-Hôpitaux de Marseille (AP-HM), 13005 Marseille, France
| | - Gregory Rodesch
- Hôpital Universitaire des Enfants Reine Fabiola, 1020 Bruxelles, Belgium
| | | | - Olivier Abbo
- Hôpital des Enfants, CHU de Toulouse, 31300 Toulouse, France;
| | | | | | - Quentin Ballouhey
- Hôpital de la mère et de l’enfant, Centre Hospitalier Universitaire de Limoges, 87000 Limoges, France
| | | | - Florent Guérin
- Bicêtre Hospital, Paris-Saclay University, GHU Paris Saclay Assistance Publique Hôpitaux de Paris (AP-HP), 94270 Le Kremlin Bicêtre, France
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8
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Rutten C, Ackermann O, Lambert V, Durand P, Gonzales E, Kreindel TG, Guérin F, Franchi-Abella S. Pediatric hepatic hemangiomas: spectrum and prognostic significance of initial ultrasound findings. Pediatr Radiol 2023; 53:2446-2457. [PMID: 37773445 DOI: 10.1007/s00247-023-05769-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 09/04/2023] [Accepted: 09/05/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND Hepatic hemangiomas may be associated with serious complications; however, it is unknown whether ultrasound (US) features can predict complications. OBJECTIVE To analyze initial US features of hepatic hemangiomas predictive of complications. MATERIALS AND METHODS This is a single-center retrospective cohort study of clinical, biological, and imaging data of infants with hepatic hemangioma between 2000 and 2018. Patients were categorized as having or not having any complication(s). Associations between initial US features and complications were analyzed through logistic regression. Receiver operating characteristic (ROC) curve analyses were performed to determine optimal cutoff values for continuous variables. Stepwise forward logistic regression was used to construct risk prediction models with training and validation sets. Model calibration and discrimination were evaluated using Hosmer-Lemeshow tests, area under the ROC curve, and overall accuracy. RESULTS Of 112 infants with hepatic hemangioma, 67 (60%) had focal, 32 (28%) had multifocal, and 13 (12%) had diffuse lesions, with complication rates of 51%, 34%, and 92%, respectively, mostly cardiac (54/57, 95%). The US characteristics of the hemangiomas were diverse. Risk factors for complications included diffuse subtype; large tumor volume (focal forms); elevated peak systolic hepatic arterial velocity (PSV); and hepatic vein dilation. For focal forms, initial tumor volume >40 ml and PSV >100 cm/s had >70% sensitivity and specificity, respectively, to predict complications; a model including these variables had 75% overall accuracy in the validation set. For multifocal/diffuse forms, a PSV >115 cm/s had sensitivity and specificity to predict complications of >70%; a model including this variable had 78% overall accuracy in the validation set. CONCLUSION Diffuse subtype, large tumor volume, elevated hepatic arterial PSV, and hepatic vein dilation are risk factors for complications of hepatic hemangiomas.
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Affiliation(s)
- Caroline Rutten
- Department of Pediatric Radiology, Bicêtre Hospital, AP-HP, 78 Rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France
| | - Oanez Ackermann
- Department of Pediatric Hepatology and Liver Transplantation, Bicêtre Hospital, AP-HP, Le Kremlin-Bicêtre, France
- Reference Centre for Vascular Liver Diseases, FSMR Filfoie, European Reference Network On Rare Liver Disorders, Bicêtre Hospital, AP-HP, FHU Hépatinov, Paris-Saclay University, Orsay, France
| | - Virginie Lambert
- Department of Pediatric Radiology, Bicêtre Hospital, AP-HP, 78 Rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France
- Pediatric and Congenital Cardiology, Department of Cardiology, Institut Mutualiste Montsouris, Paris, France
| | - Philippe Durand
- Reference Centre for Vascular Liver Diseases, FSMR Filfoie, European Reference Network On Rare Liver Disorders, Bicêtre Hospital, AP-HP, FHU Hépatinov, Paris-Saclay University, Orsay, France
- Department of Pediatric Intensive Care and Neonatal Medicine, Bicêtre Hospital, AP-HP, Le Kremlin-Bicêtre, France
| | - Emmanuel Gonzales
- Department of Pediatric Hepatology and Liver Transplantation, Bicêtre Hospital, AP-HP, Le Kremlin-Bicêtre, France
- Reference Centre for Vascular Liver Diseases, FSMR Filfoie, European Reference Network On Rare Liver Disorders, Bicêtre Hospital, AP-HP, FHU Hépatinov, Paris-Saclay University, Orsay, France
| | - Tamara G Kreindel
- Department of Pediatric Radiology, Bicêtre Hospital, AP-HP, 78 Rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France
| | - Florent Guérin
- Reference Centre for Vascular Liver Diseases, FSMR Filfoie, European Reference Network On Rare Liver Disorders, Bicêtre Hospital, AP-HP, FHU Hépatinov, Paris-Saclay University, Orsay, France
- Department of Pediatric Surgery, Bicêtre Hospital, AP-HP, Le Kremlin-Bicêtre, France
| | - Stéphanie Franchi-Abella
- Department of Pediatric Radiology, Bicêtre Hospital, AP-HP, 78 Rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France.
- Reference Centre for Vascular Liver Diseases, FSMR Filfoie, European Reference Network On Rare Liver Disorders, Bicêtre Hospital, AP-HP, FHU Hépatinov, Paris-Saclay University, Orsay, France.
- DMU Smart Imaging, BioMaps UMR 9011 CNRS - INSERM - CEA, Le Kremlin-Bicêtre, France.
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9
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Alfares BA, van der Doef HPJ, Wildhaber BE, Casswall T, Nowak G, Delle M, Aldrian D, Berchtold V, Vogel GF, Kaliciński P, Markiewicz-Kijewska M, Kolesnik A, Bernabeu JQ, Hally MM, Larrarte K M, Marra P, Bravi M, Pinelli D, Kasahara M, Sakamoto S, Uchida H, Mali V, Aw M, Franchi-Abella S, Gonzales E, Guérin F, Cervio G, Minetto J, Sierre S, de Santibañes M, Ardiles V, Uno JW, Evans H, Duncan D, McCall J, Hartleif S, Sturm E, Patel J, Mtegha M, Prasad R, Ferreira CT, Nader LS, Farina M, Jaramillo C, Rodriguez-Davalos MI, Feola P, Shah AA, Wood PM, Acord MR, Fischer RT, Mullapudi B, Hendrickson RJ, Khanna R, Pamecha V, Mukund A, Sharif K, Gupte G, McGuirk S, Porta G, Spada M, Alterio T, Maggiore G, Hardikar W, Beretta M, Dierckx R, de Kleine RHJ, Bokkers RPH. Prevalence, management and efficacy of treatment in portal vein obstruction after paediatric liver transplantation: protocol of the retrospective international multicentre PORTAL registry. BMJ Open 2023; 13:e066343. [PMID: 37500271 PMCID: PMC10387733 DOI: 10.1136/bmjopen-2022-066343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/29/2023] Open
Abstract
INTRODUCTION Portal vein obstruction (PVO) consists of anastomotic stenosis and thrombosis, which occurs due to a progression of the former. The aim of this large-scale international study is to assess the prevalence, current management practices and efficacy of treatment in patients with PVO. METHODS AND ANALYSIS The Portal vein Obstruction Revascularisation Therapy After Liver transplantation registry will facilitate an international, retrospective, multicentre, observational study, with 25 centres around the world already actively involved. Paediatric patients (aged <18 years) with a diagnosed PVO between 1 January 2001 and 1 January 2021 after liver transplantation will be eligible for inclusion. The primary endpoints are the prevalence of PVO, primary and secondary patency after PVO intervention and current management practices. Secondary endpoints are patient and graft survival, severe complications of PVO and technical success of revascularisation techniques. ETHICS AND DISSEMINATION Medical Ethics Review Board of the University Medical Center Groningen has approved the study (METc 2021/072). The results of this study will be disseminated via peer-reviewed publications and scientific presentations at national and international conferences. TRIAL REGISTRATION NUMBER Netherlands Trial Register (NL9261).
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Affiliation(s)
- Bader A Alfares
- Department of Radiology, Medical Imaging Center, University Medical Centre Groningen, Groningen, The Netherlands
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Hubert P J van der Doef
- Division of Paediatric Gastroenterology and Hepatology, Department of Paediatrics, University Medical Centre Groningen, Groningen, The Netherlands
| | - Barbara E Wildhaber
- Swiss Paediatric Liver Centre, Division of Child and Adolescent Surgery, Geneva University Hospitals, Geneve, Switzerland
| | - Thomas Casswall
- Department Clinical Interventions and Technology Clintec, Division for Paediatrics, Karolinska Institute, Stockholm, Sweden
| | - Greg Nowak
- Department Clinical Interventions and Technology Clintec, Division for Transplantation Surgery, Karolinska Institute, Stockholm, Sweden
| | - Martin Delle
- Department Clinical Science, Intervention and Technology Clintec, Division for Interventional Radiology, Karolinska Institute, Stockholm, Sweden
| | - Denise Aldrian
- Department of Paediatrics, Medical University of Innsbruck, Innsbruck, Austria
| | - Valeria Berchtold
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Georg F Vogel
- Department of Paediatrics, Medical University of Innsbruck, Innsbruck, Austria
- Institute of Cell Biology, Medical University of Innsbruck, Innsbruck, Austria
| | - Piotr Kaliciński
- Department of Paediatric Surgery and Organ Transplantation, The Children's Memorial Health Institute, Warsaw, Poland
| | | | - Adam Kolesnik
- Cardiovascular Interventions Laboratory, The Children's Memorial Health Institute, Warsaw, Poland
| | - Jesús Q Bernabeu
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, Vall d'Hebron Hospital (HVH), Barcelona, Spain
| | - María Mercadal Hally
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, Vall d'Hebron Hospital (HVH), Barcelona, Spain
| | - Mauricio Larrarte K
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, Vall d'Hebron Hospital (HVH), Barcelona, Spain
| | - Paolo Marra
- Department of Radiology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Michela Bravi
- Department of Paediatric Hepatology, Gastroenterology and Transplantation, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Domenico Pinelli
- Department of Organ Failure and Transplantation, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Mureo Kasahara
- Organ Transplantation Centre, National Center for Child Health and Development, Tokyo, Japan
| | - Seisuke Sakamoto
- Organ Transplantation Centre, National Center for Child Health and Development, Tokyo, Japan
| | - Hajime Uchida
- Organ Transplantation Centre, National Center for Child Health and Development, Tokyo, Japan
| | - Vidyadhar Mali
- Department of Paediatric Surgery, National University Hospital, Singapore
| | - Marion Aw
- Department of Paediatrics, National University Hospital, Singapore
| | | | - Emmanuel Gonzales
- Paediatric Hepatology and Paediatric Liver Transplantation Unit, Hôpital Bicêtre, Paris, France
| | - Florent Guérin
- Paediatric Surgery and Paediatric Liver Transplantation Unit, Hôpital Bicêtre, Paris, France
| | - Guillermo Cervio
- Division of Liver Transplant, Hospital de Pediatría Prof Dr Juan P Garrahan, Buenos Aires, Argentina
| | - Julia Minetto
- Division of Liver Transplant, Hospital de Pediatría Prof Dr Juan P Garrahan, Buenos Aires, Argentina
| | - Sergio Sierre
- Division of Interventional Radiology, Hospital de Pediatría Prof Dr Juan P Garrahan, Buenos Aires, Argentina
| | - Martin de Santibañes
- HPB and Liver Transplant Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Victoria Ardiles
- HPB and Liver Transplant Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Jimmy Walker Uno
- HPB and Liver Transplant Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Helen Evans
- Department of Paediatric Gastroenterology, Starship Children's Health, Auckland, New Zealand
| | - David Duncan
- Department of Paediatric Radiology, Starship Children's Health, Auckland, New Zealand
| | - John McCall
- Liver Transplant Unit, Starship Children's Health, Auckland, New Zealand
| | - Steffen Hartleif
- Paediatric Gastroenterology and Hepatology, University Hospitals Tubingen, Tubingen, Germany
| | - Ekkehard Sturm
- Paediatric Gastroenterology and Hepatology, University Hospitals Tubingen, Tubingen, Germany
| | - Jai Patel
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Marumbo Mtegha
- Department of Paediatrics, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Raj Prasad
- Department of Surgery and Transplantation, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Luiza S Nader
- Department of Paediatrics, Hospital Santo Antonio, Porto Alegre, Brazil
| | - Marco Farina
- Department of Paediatrics, Hospital Santo Antonio, Porto Alegre, Brazil
| | - Catalina Jaramillo
- Department of Paediatrics, Division of Paediatric Gastroenterology, Hepatology and Nutrition, The University of Utah School of Medicine, Salt Lake City, Utah, USA
| | | | - Peter Feola
- Paediatric Interventional Radiology, The University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Amit A Shah
- Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Phoebe M Wood
- Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Michael R Acord
- Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Ryan T Fischer
- Division of Paediatric Gastroenterology and Hepatology, Department of Paediatrics, Children's Mercy Hospital Kansas, Overland Park, Kansas, USA
| | - Bhargava Mullapudi
- Department of Paediatric Surgery, Children's Mercy Hospital Kansas, Overland Park, Kansas, USA
| | - Richard J Hendrickson
- Department of Paediatric Surgery, Children's Mercy Hospital Kansas, Overland Park, Kansas, USA
| | - Rajeev Khanna
- Department of Paediatric Hepatology, Institute of Liver and Biliary Sciences, New Delhi, Delhi, India
| | - Viniyendra Pamecha
- Department Hepatobiliary Surgery and Liver transplantation, Institute of Liver and Biliary Sciences, New Delhi, Delhi, India
| | - Amar Mukund
- Department of Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi, Delhi, India
| | - Khalid Sharif
- Liver Unit, Birmingham Women's and Children's Hospitals NHS Foundation Trust, Birmingham, UK
| | - Girish Gupte
- Liver Unit, Birmingham Women's and Children's Hospitals NHS Foundation Trust, Birmingham, UK
| | - Simon McGuirk
- Department of Interventional Radiology, Birmingham Women's and Children's Hospitals NHS Foundation Trust, Birmingham, UK
| | - Gilda Porta
- Department of Paediatric Hepatology, Hospital Sírio-Libanês, Sao Paulo, Brazil
| | - Marco Spada
- Division of Abdominal Transplantation and Hepatobiliopancreatic Surgery, Ospedale Pediatrico Bambino Gesu, Roma, Italy
| | - Tommaso Alterio
- Gastrointestinal, Liver, Nutrition Disorders Unit, IRCCS Pediatric Hospital Bambino Gesù, Rome, Italy
| | - Giuseppe Maggiore
- Gastrointestinal, Liver, Nutrition Disorders Unit, IRCCS Pediatric Hospital Bambino Gesù, Rome, Italy
| | - Winita Hardikar
- Department of Pediatrics, Royal Children's Hospital Research Institute, Parkville, Victoria, Australia
| | - Marisa Beretta
- Faculty of Health Sciences, Wits Donald Gordon Medical Centre, Johannesburg, South Africa
| | - Rudi Dierckx
- Department of Radiology, Medical Imaging Center, University Medical Centre Groningen, Groningen, The Netherlands
| | - Ruben H J de Kleine
- Division of Hepatobiliary Surgery & Liver Transplantation, Department of Surgery, University Medical Centre Groningen, Groningen, The Netherlands
| | - Reinoud P H Bokkers
- Department of Radiology, Medical Imaging Center, University Medical Centre Groningen, Groningen, The Netherlands
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10
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Guérin F, Martelli H, Rogers T, Zanetti I, van Scheltinga ST, De Corti F, Burrieza GG, Minard-Colin V, Orbach D, van Noesel MM, Karanian M, Fajardo RD, Merks JHM, Ferrari A, Bisogno G. Outcome of patients with undifferentiated embryonal sarcoma of the liver treated according to European soft tissue sarcoma protocols. Pediatr Blood Cancer 2023; 70:e30374. [PMID: 37083216 DOI: 10.1002/pbc.30374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 03/27/2023] [Accepted: 04/04/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND To assess the outcomes of pediatric patients with undifferentiated embryonal sarcoma of the liver (UESL) and treatment including at least surgery and systemic chemotherapy. METHODS This study included patients aged up to 21 years with a pathological diagnosis of UESL prospectively enrolled from 1995 to 2016 in three European trials focusing on the effects of surgical margins, preoperative chemotherapy, use of radiotherapy (RT), and chemotherapy. RESULTS Out of 65 patients with a median age at diagnosis of 8.7 years (0.6-20.8), 15 had T2 tumors, and one had lymph node spread, 14 were Intergroup Rhabdomyosarcoma Study (IRS) I, nine IRS II, 38 IRS III, and four IRS IV. Twenty-eight upfront surgeries resulted in five operative spillages and 11 infiltrated surgical margins, whereas 37 delayed surgeries resulted in no spillages (p = .0119) and three infiltrated margins (p = .0238). All patients received chemotherapy, including anthracyclines in 47. RT was administered in 15 patients. With a median follow-up of 78.6 months, 5-year overall and event-free survivals (EFS) were 90.1% (95% confidence interval [CI]: 79.2-95.5) and 89.1% (95% CI: 78.4-94.6), respectively. Two out four local relapses had previous infiltrated margins and two out of three patients with metastatic relapses received reduced doses of alkylating agents. Infiltrated margins (p = .1607), T2 stage (p = .3870), use of RT (p = .8731), and anthracycline-based chemotherapy (p = .1181) were not correlated with EFS. CONCLUSIONS Multimodal therapy improved the outcome of UESL. Neoadjuvant chemotherapy for pediatric patients increases the probability of complete surgical resection. The role of anthracyclines and RT for localized disease remains unclear.
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Affiliation(s)
- Florent Guérin
- Department of Pediatric Surgery, Université Paris-Saclay, Assistance Publique Hôpitaux de Paris (AP-HP), Bicêtre Hospital, Le Kremlin Bicêtre, France
| | - Hélène Martelli
- Department of Pediatric Surgery, Université Paris-Saclay, Assistance Publique Hôpitaux de Paris (AP-HP), Bicêtre Hospital, Le Kremlin Bicêtre, France
| | - Timothy Rogers
- Department of Pediatric Surgery, University Hospitals Bristol and Weston NHS foundation trust, Bristol, UK
| | - Ilaria Zanetti
- Department of Women's and Children's Health, Hematology Oncology Division, University of Padova, Padua, Italy
| | | | - Federica De Corti
- Department of Women's and Children's Health, Pediatric Surgery Unit, University of Padova, Padua, Italy
| | | | - Véronique Minard-Colin
- Department of Pediatric and Adolescent Oncology, INSERM U1015, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Daniel Orbach
- SIREDO Oncology Center (Care, Innovation and Research for Children, Adolescents and Young Adults with Cancer), Paris Science et Lettres University, Institut Curie, Paris, France
| | - Max M van Noesel
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Marie Karanian
- Department of Biopathology, UNICANCER, Centre Leon Bérard, Lyon, France
| | - Raquel Dávila Fajardo
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Gianni Bisogno
- Department of Women's and Children's Health, Hematology Oncology Division, University of Padova, Padua, Italy
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11
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Fuchs J, Mrad C, Gonzales E, Ndiaye D, Fouquet V, Héry G, Baujard C, Guérin F, Branchereau S. Biliary drainage surgery before or after 3 months of life versus primary liver transplantation in children with biliary atresia: comparative cohort study. BJS Open 2023; 7:7084844. [PMID: 36952250 PMCID: PMC10035563 DOI: 10.1093/bjsopen/zrac175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 12/12/2022] [Accepted: 12/15/2022] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND Early biliary drainage surgery (BDS; Kasai) is associated with longer transplant-free survival in biliary atresia. However, evidence is lacking on whether an age limit can be established at which liver transplantation should be performed as first-line treatment for children with a delayed diagnosis of biliary atresia. The aim of the current study was to compare the outcome of a large cohort of children with biliary atresia who underwent BDS after 90 days of life with those who underwent early BDS (before 90 days) and those who did not receive BDS and were directly referred for primary liver transplantation. METHODS All patients with biliary atresia treated at Bicêtre, Paris-Saclay University Hospital between 1995 and 2017 were analysed in this STROBE-compliant study. Three groups were defined: BDS before 90 days of life (early BDS); BDS after 90 days of life (late BDS); and patients without BDS who were referred for primary liver transplantation (no BDS). Patient characteristics, overall survival, and native liver survival were compared. RESULTS Of 424 children with biliary atresia, 69 patients (16 per cent) were older than 90 days when they underwent BDS. Twenty-five patients had no BDS and were referred for primary liver transplantation (6 per cent). The main reason for not performing BDS was manifest portal hypertension (18/25). Two- and 5-year transplant-free survival were significantly higher in patients with late BDS compared with no BDS (53.5 versus 12.0 per cent respectively for 2-year data and 30.4 versus 4.0 per cent respectively for 5-year data, P < 0.001). Five- and 10-year overall survival did not differ between early BDS (92 and 91 per cent respectively), late BDS (88 and 83 per cent respectively) and no BDS (80 and 80 per cent respectively, P = 0.061). CONCLUSION Age alone should not routinely be considered a contraindication to BDS in patients older than 90 days. Liver transplantation in infancy (less than 12 months) could be avoided in 88 per cent of cases with late diagnosis of biliary atresia and is delayed significantly even when BDS is performed after 3 months. Overall survival is at least equal to patients who are referred for primary liver transplantation.
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Affiliation(s)
- Juri Fuchs
- Department of General, Visceral, Paediatric and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
- Department of Paediatric Surgery, Paris-Saclay University, Assistance Publique-Hôpitaux de Paris, Bicêtre Hospital, Paris, France
| | - Chaima Mrad
- Department of Paediatric Surgery, Paris-Saclay University, Assistance Publique-Hôpitaux de Paris, Bicêtre Hospital, Paris, France
| | - Emmanuel Gonzales
- Department of Paediatric Hepatology, Paris-Saclay University, Assistance Publique-Hôpitaux de Paris, Bicêtre Hospital, Paris, France
| | - Dior Ndiaye
- Department of Paediatric Surgery, Paris-Saclay University, Assistance Publique-Hôpitaux de Paris, Bicêtre Hospital, Paris, France
| | - Virginie Fouquet
- Department of Paediatric Surgery, Paris-Saclay University, Assistance Publique-Hôpitaux de Paris, Bicêtre Hospital, Paris, France
| | - Géraldine Héry
- Department of Paediatric Surgery, Paris-Saclay University, Assistance Publique-Hôpitaux de Paris, Bicêtre Hospital, Paris, France
| | - Catherine Baujard
- Department of Anaesthesiology and Intensive Care, Paris-Saclay University, Assistance Publique-Hôpitaux de Paris, Bicêtre Hospital, Paris, France
| | - Florent Guérin
- Department of Paediatric Surgery, Paris-Saclay University, Assistance Publique-Hôpitaux de Paris, Bicêtre Hospital, Paris, France
| | - Sophie Branchereau
- Department of Paediatric Surgery, Paris-Saclay University, Assistance Publique-Hôpitaux de Paris, Bicêtre Hospital, Paris, France
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Pio L, Guérin F, Martucci C, Martelli H, Gauthier F, Branchereau S. The Use of Cavitron Ultrasonic Surgical Aspirator for High-Risk Neuroblastoma with Image-Defined Risk Factors in Children. Children (Basel) 2023; 10:children10010089. [PMID: 36670640 PMCID: PMC9857095 DOI: 10.3390/children10010089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 12/26/2022] [Accepted: 12/31/2022] [Indexed: 01/03/2023]
Abstract
Aim of the study: The cavitron ultrasonic surgical aspirator (CUSA) has gained popularity in adult surgical oncology, but its application in children is limited to liver surgery and neurosurgical procedures. The complete resection of neuroblastoma with image-defined risk factors (IDRFs) is still considered one of the most difficult procedures to achieve in pediatric surgical oncology, with a high morbidity rate and potential risk of intraoperative mortality. The aim of our study is to describe the application of ultrasonic dissection in neuroblastoma with IDRFs. Methods: A retrospective study was performed, analyzing patients operated on from 2000 to 2018. Patient characteristics, resection completeness, and postoperative surgical and oncology outcomes were analyzed. Main results: Twenty-six patients with high-risk neuroblastoma and IDRFs were operated on in the study period with a CUSA. A complete macroscopic resection was performed in 50% of patients, while the other half was operated on with minimal residual (<5 mL). Six post-operative complications occurred without the need for surgery (Clavien−Dindo < 3). The overall survival was 50%, with a median follow-up of 69.6 months (5.6−140.4). Conclusions: The application of the CUSA in neuroblastoma with IDRFs can be considered an effective and safe alternative technique to achieve a radical resection.
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Affiliation(s)
- Luca Pio
- Department of Surgery, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA
- Paediatric Surgery Department, Hôpital Bicêtre APHP, Paris Saclay University, 91190 Paris, France
- Correspondence:
| | - Florent Guérin
- Paediatric Surgery Department, Hôpital Bicêtre APHP, Paris Saclay University, 91190 Paris, France
| | - Cristina Martucci
- Paediatric Surgery Department, Hôpital Bicêtre APHP, Paris Saclay University, 91190 Paris, France
| | - Helene Martelli
- Paediatric Surgery Department, Hôpital Bicêtre APHP, Paris Saclay University, 91190 Paris, France
| | - Frédéric Gauthier
- Paediatric Surgery Department, Hôpital Bicêtre APHP, Paris Saclay University, 91190 Paris, France
| | - Sophie Branchereau
- Paediatric Surgery Department, Hôpital Bicêtre APHP, Paris Saclay University, 91190 Paris, France
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Rogers T, Zanetti I, Coppadoro B, Martelli H, Jenney M, Minard-Colin V, Terwisscha van Scheltinga SEJ, Skerritt C, Fajardo RD, Guérin F, Kelsey A, Merks JHM, Mandeville H, Guillén G, Glosli H, De Corti F, Bisogno G. Perianal/perineal rhabdomyosarcoma: Results of the SIOP MMT 95, Italian RMS 96, and EpSSG RMS 2005 studies. Pediatr Blood Cancer 2022; 69:e29739. [PMID: 35460336 DOI: 10.1002/pbc.29739] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 03/21/2022] [Accepted: 04/01/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND/OBJECTIVES Rhabdomyosarcoma of the perianal/perineal region (PRMS) is rare, with poor survival and limited understanding of the functional consequences of treatment. DESIGN/METHODS International Society of Pediatric Oncology (SIOP) malignant mesenchymal tumor (MMT) 95, Italian RMS 96, and European paediatric Soft tissue sarcoma Study Group (EpSSG) RMS 2005 studies were interrogated to identify factors that impact survival; in RMS 2005, functional outcomes were analyzed. RESULTS Fifty patients (nonmetastatic) were identified, median age 6.4 years (range: 0.1-19.6): 29 male, 21 female. Tumors were >5 cm in 33 patients. Histopathological subtype was alveolar in 35. Lymph nodes were involved in 23 patients. In RMS 2005, 16/21 (76%) tested alveolar tumors had positive FOXO1 fusion status. Diagnostic biopsy was performed in 37. Primary resection (13) was complete (R0) in one. Delayed primary excision (16) was complete in three. Radiotherapy (RT) in 34/50 patients included external beam (28), brachytherapy (3), and both (3). Nodal RT was given in 16/23 N1 patients (70%). Median follow-up of alive patients (29) was 84.1 months (range: 3.6-221.1). Relapse or progression occurred in 24 patients (48%), 87% were fatal and most events (63%) were locoregional. Five-year event-free survival (EFS) was 47.8 (95% CI: 32.8-61.3), and 5-year overall survival (OS) was 52.6 (95% CI: 36.7-66.2), with age ≥10 years and tumor size >5 cm impacting 5-year EFS and OS (p < .05). Functional outcome data showed bowel, genito-urinary, and psychological issues; fecal incontinence in four of 21 survivors, and urinary symptoms in two of 21. CONCLUSIONS About 60% of patients with nonmetastatic PRMS survive; older patients and those with large tumors have the worst outcomes. Biopsy should be the initial procedure, and definitive local therapy individualized. Quality-of-life and functional studies are needed to better understand the consequences of treatment.
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Affiliation(s)
- Timothy Rogers
- Department of Pediatric Surgery, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Ilaria Zanetti
- Hematology Oncology Division, Department of Women's and Children's Health, Padova University Hospital, Padua, Italy
| | - Beatrice Coppadoro
- Hematology Oncology Division, Department of Women's and Children's Health, University of Padova, Padua, Italy
| | - Hélène Martelli
- Department of Pediatric Surgery, University Paris-Saclay, Bicêtre Hospital, Paris, France
| | - Meriel Jenney
- Department of Pediatric Oncology, University Hospital of Wales, Cardiff, UK
| | | | | | - Clare Skerritt
- Department of Pediatric Surgery, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Raquel Dávila Fajardo
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Florent Guérin
- Department of Pediatric Surgery, University Paris-Saclay, Bicêtre Hospital, Paris, France
| | - Anna Kelsey
- Department of Pathology, Central Manchester University Hospitals, Manchester, UK
| | | | - Henry Mandeville
- The Royal Marsden Hospital and the Institute of Cancer Research, Sutton, UK
| | - Gabriela Guillén
- Department of Paediatric Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Heidi Glosli
- Department of Paediatric Research, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Federica De Corti
- Pediatric Surgery Unit, Department of Women's and Children's Health, Padova University Hospital, Padua, Italy
| | - Gianni Bisogno
- Hematology Oncology Division, Department of Women's and Children's Health, University of Padova, Padua, Italy
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Akkary R, Guérin F, Chargari C, Jochault L, Audry G, Pio L, Minard-Colin V, Haie-Meder C, Martelli H. Long-term urological complications after conservative local treatment (surgery and brachytherapy) in children with bladder-prostate rhabdomyosarcoma: A single-team experience. Pediatr Blood Cancer 2022; 69:e29532. [PMID: 35739611 DOI: 10.1002/pbc.29532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 10/25/2021] [Accepted: 11/22/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Outcome of children with bladder-prostate rhabdomyosarcoma (RMS) has improved with multimodal therapies, including surgery and/or radiotherapy for local treatment. Our aim was to report long-term urological complications after a conservative approach combining conservative surgery and brachytherapy. PATIENTS AND METHODS Eighty-six patients, free of disease, were retrospectively reviewed. Symptoms related to urinary tract obstruction, incontinence, infection, and lithiasis were reported and graded according to the Common Terminology Criteria for Adverse Events (CTCAE) classification. Only symptomatic patients underwent urodynamic studies. Risk factors for complications were analyzed. RESULTS There were 76 males and 10 females. The median follow-up was 6.3 years (18 months to 24 years). Complications occurred after a median follow-up of 5 years (0-21). Twenty-two patients (26%) had long-term urological complications. Urinary tract obstruction was found in 15 patients (17%) and urinary incontinence in 14 patients (16%). Recurrent urinary tract infection occurred in four patients and urinary lithiasis in four (5%). The underlying physiopathology included bladder dysfunction in 15 patients (17%), urethral stenosis in six (7%), and ureterovesical junction stenosis in five (6%). On univariate analysis, posterior bladder wall dissection (p = .001), bladder neck trigone dissection (p = .010), and partial prostatectomy (p = .023) were significantly associated with an increased risk of bladder dysfunction; on multivariate analysis, only age ≤2 years (p = .028) at operation and posterior bladder wall dissection (p = .006) were found to be significant. CONCLUSION The conservative surgical approach combined with brachytherapy for bladder-prostate RMS leads to long-term urological complications in 26% of survivors. Optimizing brachytherapy doses for young children and establishing a clear and long-term follow-up protocol could help to reduce these complications.
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Affiliation(s)
- Rezkalla Akkary
- Department of Pediatric Surgery, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University, Le Kremlin-Bicêtre, France
| | - Florent Guérin
- Department of Pediatric Surgery, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University, Le Kremlin-Bicêtre, France
| | - Cyrus Chargari
- Brachytherapy Unit, Department of Radiation Oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | - Loic Jochault
- Department of Biostatistics, Hôpitaux Civils, Colmar, France
| | - Georges Audry
- Department of Pediatric Surgery, Armand Trousseau Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne University, Paris, France
| | - Luca Pio
- Department of Pediatric Surgery, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University, Le Kremlin-Bicêtre, France
| | | | - Christine Haie-Meder
- Brachytherapy Unit, Department of Radiation Oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | - Hélène Martelli
- Department of Pediatric Surgery, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University, Le Kremlin-Bicêtre, France
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Terlizzi M, Minard V, Haie-Meder C, Espenel S, Martelli H, Guérin F, Chargari C. Implementation of Image-Guided Brachytherapy for Pediatric Vaginal Cancers: Feasibility and Early Clinical Results. Cancers (Basel) 2022; 14:cancers14133247. [PMID: 35805018 PMCID: PMC9265517 DOI: 10.3390/cancers14133247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/30/2022] [Accepted: 06/13/2022] [Indexed: 12/04/2022] Open
Abstract
Simple Summary Brachytherapy is one of the cornerstones of the treatment of pediatric vaginal tumors in combination with surgery and chemotherapy from a conservative perspective. In this retrospective series, we present our experience with 3D pulsed dose rate brachytherapy for the treatment of children with vaginal tumors. Our results show that this treatment has good compliance and provides an excellent local control rate. The toxicity rate is also favorable, with gynecological toxicities being the most frequent. Given the rarity of these diseases, their management should be entrusted to expert centers. Abstract Background: Brachytherapy (BT) has a major role in pediatric cancers of the lower genital tract, as part of a multimodal organ conservative strategy. Scarce data are available on the location of image-guided BT. Methods: Medical records of all consecutive girls treated in our center between 2005 and 2020 for a vaginal tumor with exclusive image-guided PDR-BT were retrospectively examined, with a focus on treatment parameters, patient compliance, and clinical outcome, including analysis of local control, survival and late toxicity rates. Results: Twenty-six patients were identified, with a median age of 25 months. Histological types were rhabdomyosarcoma, malignant germ cell tumor (MGCT) and clear cell adenocarcinoma in 18 (69%), 7 (27%) and 1 (4%) patients, respectively. Ten (33%) patients had prior surgery and 25 (96%) received chemotherapy prior to BT. The median prescribed dose was 60 Gy through pulses of 0.42 Gy. Global compliance was satisfactory, but three (12%) patients required replanning because of applicator displacement. After a median follow-up of 47.5 months, one patient with MGCT referred for salvage treatment of a local recurrence had a local and metastatic relapse. The local control rate probability was 96% at the last follow-up. Late toxicity rates ≥ grade 2 and ≥ grade 3 were reported in 23% and 11%, respectively, with gynecological toxicities being the most frequent side effect. Two patients required dilatation for vaginal stenosis. Conclusions: PDR-BT allowed similar local control compared to the historical low-dose rate technique. An indirect comparison suggests fewer treatment-related toxicities by integrating image guidance and optimization capabilities, but longer follow-up is necessary. Due to the rarity of the disease and the technical aspects of BT in these very young patients, referral to specialized high-volume centers is recommended.
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Affiliation(s)
- Mario Terlizzi
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, 94800 Villejuif, France; (M.T.); (C.H.-M.); (S.E.)
| | - Véronique Minard
- Department of Pediatric and Adolescent Oncology, Gustave Roussy, Université Paris-Saclay, 94805 Villejuif, France;
| | - Christine Haie-Meder
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, 94800 Villejuif, France; (M.T.); (C.H.-M.); (S.E.)
| | - Sophie Espenel
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, 94800 Villejuif, France; (M.T.); (C.H.-M.); (S.E.)
| | - Hélène Martelli
- Department of Pediatric Surgery, Paris-Saclay University, Assistance Publique-Hôpitaux de Paris, Bicêtre Hospital, 94270 Le Kremlin Bicêtre, France; (H.M.); (F.G.)
| | - Florent Guérin
- Department of Pediatric Surgery, Paris-Saclay University, Assistance Publique-Hôpitaux de Paris, Bicêtre Hospital, 94270 Le Kremlin Bicêtre, France; (H.M.); (F.G.)
| | - Cyrus Chargari
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, 94800 Villejuif, France; (M.T.); (C.H.-M.); (S.E.)
- Correspondence:
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16
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Limkin EJ, Guérin F, Espenel S, Terlizzi M, Martelli H, Haie-Meder C, Minard V, Chargari C. Use of an intravaginal spacer in young girls treated with brachytherapy for bladder neck rhabdomyosarcoma: Dosimetric impact for organs at risk sparing and acute tolerance. Cancer Radiother 2021; 26:486-490. [PMID: 34711484 DOI: 10.1016/j.canrad.2021.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 09/16/2021] [Accepted: 09/19/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Interstitial brachytherapy is indicated as part of a conservative strategy for children with bladder and/or prostate rhabdomyosarcoma (RMS), providing high local control probability with acceptable functional results. Vaginal and/or rectal complications were however reported, due to the close proximity to the implanted volume. We investigated the dosimetric impact of a vaginal spacer in terms of rectal and vaginal doses. METHODS AND PATIENTS Medical records of 12 consecutive female patients with bladder neck RMS, median age 32 months (range: 1.3-6 years), were reviewed. Five patients were treated prior to 2017 without a vaginal spacer and seven patients treated after 2017 had their brachytherapy delivered with a vaginal spacer placed at time of implant. RESULTS Minimal doses delivered to the most exposed 2cm3, 1cm3, and 0.5cm3 of the rectum were all statistically significantly lower among patients treated with a vaginal spacer, as compared to those treated without a spacer. Median rectal D2cm3 was 22GyEQD2 versus 38GyEQD2 (P=0.02), D1cm3 was 29GyEQD2 versus 51GyEQD2 (P=0.013), and D0.5cm3 was 32GyEQD2 versus 61GyEQD2 (P=0.017), with and without the vaginal spacer, respectively. The posterior vaginal wall D0.5cm3 dose was also significantly decreased, with median D0.5cm3 of 92GyEQD2 versus 54GyEQD2 (P<0.0001), with and without the spacer, respectively. Acute tolerance was excellent in all patients, with no need for replanning and no acute complication. CONCLUSIONS The use of vaginal spacers in brachytherapy of female pediatric patients with bladder neck RMS resulted in significantly decreased doses to the rectum and the posterior vaginal wall. Though the clinical impact of such dose reduction remains undemonstrated, routine utilization of a vaginal spacer could be a method to decrease long-term morbidity in these patients.
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Affiliation(s)
- E J Limkin
- Department of radiation oncology, Gustave Roussy Cancer Campus, université Paris-Saclay, 94805 Villejuif, France
| | - F Guérin
- Department of pediatric surgery, Kremlin-Bicêtre university hospital, université Paris-Saclay, 94270 Le Kremlin-Bicêtre, France
| | - S Espenel
- Department of radiation oncology, Gustave Roussy Cancer Campus, université Paris-Saclay, 94805 Villejuif, France
| | - M Terlizzi
- Department of radiation oncology, Gustave Roussy Cancer Campus, université Paris-Saclay, 94805 Villejuif, France
| | - H Martelli
- Department of pediatric surgery, Kremlin-Bicêtre university hospital, université Paris-Saclay, 94270 Le Kremlin-Bicêtre, France
| | - C Haie-Meder
- Department of radiation oncology, Gustave Roussy Cancer Campus, université Paris-Saclay, 94805 Villejuif, France
| | - V Minard
- Department of pediatric oncology, Gustave Roussy, université Paris-Saclay, 94805 Villejuif, France
| | - C Chargari
- Department of radiation oncology, Gustave Roussy Cancer Campus, université Paris-Saclay, 94805 Villejuif, France.
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Lambert V, Ladarre D, Fortas F, Hervé P, Gonzales E, Durand P, Ackermann O, Guérin F, Savale L, Pariente D, Riou JY, Lin VM, Franchi-Abella S. Congenital and acquired cardiovascular disorders associated with congenital portosystemic shunt: A disease may hide another…. Archives of Cardiovascular Diseases Supplements 2021. [DOI: 10.1016/j.acvdsp.2021.06.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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18
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Meurant A, Isnard C, Guérin F, Malandain D, Morral y Segura J, Saint-Lorant G, de la Blanchardière A. Sous-utilisation du céfépime dans la prise en charge des entérobactéries du groupe 3. Infect Dis Now 2021. [DOI: 10.1016/j.idnow.2021.06.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Dupond-Athénor A, Peycelon M, Abbo O, Rod J, Haraux E, Scalabre A, Arnaud A, Guérin F, Irtan S. A multicenter review of undescended testis torsion: A plea for early management. J Pediatr Urol 2021; 17:191.e1-191.e6. [PMID: 33388261 DOI: 10.1016/j.jpurol.2020.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 11/27/2020] [Accepted: 12/02/2020] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Torsion of an undescended testis (UT) is a surgical emergency, difficult to diagnose, whose prognosis depends on a quick management. AIM OF THE STUDY To evaluate the management and outcome of these patients. STUDY DESIGN We retrospectively analyzed all cases of UT torsion operated in nine French hospitals between 1997 and 2017. We divided patients in two groups: patients referred less than 6 h after the onset of symptoms (group A) or more than 6 h (group B). MAIN RESULTS We collected 60 cases (17 in group A and 43 in group B). Median age was 2.2 years [IQR = 0.7-7.8] (2.3 y in group A and 2 y in group B, p = 0.76). Eleven patients (10 in group B) had neurological disorders (p = 0.15). The main reason for absence of UT treatment was the absence of surgical consultation in a normal delay (n = 44, 73%). Symptoms were pain (n = 58, 97%), inguinal mass (n = 55, 92%) and vomiting (n = 16, 27%). An inguinal mass with no palpable testis in the ipsilateral hemiscrotum was seen in 55 patients (92%). An ultrasound scan performed in 27 patients led to the diagnosis in 16 patients (59%). At surgery, an orchiectomy was performed in 4 patients (23%) of group A and 24 patients (56%) of group B (p = 0.04). After a median follow-up of 11 months [IQR = 4-23], 11 patients of group A (65%) and 7 patients of group B (16%) had a clinically normal testis (p = 0.03). The salvage rate among patients with conservative treatment was 85% for group A and 37% for group B (p = 0.01). DISCUSSION Our study reveals that although UT torsion is an emergency, 72% of patients are referred more than 6 h after the onset of symptoms. We mostly found classic clinical presentation of UT torsion: a painful inguinal mass with an empty ipsilateral scrotum. Ultrasound was performed in half cases, and even if the result was not significant, it still seemed to be associated with a higher rate of orchiectomy especially in group B because of the delay in care. However, when ultrasound was realized early, it led to diagnosis in all cases. This dilemma poses the problem of the role of imaging in diagnostic management. CONCLUSIONS Early clinical diagnosis in front of a painful inguinal mass with an empty scrotum is essential to improve the salvage rate of testis in UT torsion. Early management of UT should have avoided 68% of testis loss.
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Affiliation(s)
- Adrien Dupond-Athénor
- Sorbonne Université, Department of Pediatric Surgery, APHP Hôpital Armand Trousseau, 26 Avenue du Dr Arnold Netter, 75012, Paris, France.
| | - Matthieu Peycelon
- Department of Pediatric Surgery and Urology, APHP Hôpital Universitaire Robert-Debré, Centres de Référence Maladies Rares, Maladies Endocriniennes Rares de la Croissance (CRMERC), Université de Paris, 48 Bd Sérurier, 75019, Paris, France; Sorbonne Université, INSERM UMR_S933, Maladies Génétiques d'expression Pédiatrique, APHP, Hôpital Armand Trousseau, 26 Avenue du Dr Arnold Netter, 75012, Paris, France.
| | - Olivier Abbo
- Department of Pediatric Surgery, Hôpital des Enfants de Toulouse, CHU Toulouse, 330 Avenue de Grande Bretagne, 31300, Toulouse, France.
| | - Julien Rod
- Department of Pediatric Surgery, University Hospital of Caen, Avenue de la Côte de Nacre, 14000, Caen, France.
| | - Elodie Haraux
- Department of Pediatric Surgery, University Hospital, 1 Rue Du Professeur Christian Cabrol, 80054, Amiens, France.
| | - Aurélien Scalabre
- Department of Pediatric Surgery, University Hospital of Saint-Etienne, Avenue Albert Raimond, 42270, Saint-Priest-en-Jarez, France.
| | - Alexis Arnaud
- Department of Pediatric Surgery, Hôpital Sud, University Hospital, 16 Boulevard de Bulgarie, 35200 Rennes, France.
| | - Florent Guérin
- Department of Pediatric Surgery, Hôpital Bicêtre, AP-HP Paris Saclay, 78 Rue Du Général Leclerc, 94270 Le Kremlin Bicêtre, France.
| | - Sabine Irtan
- Sorbonne Université, Department of Pediatric Surgery, APHP Hôpital Armand Trousseau, 26 Avenue du Dr Arnold Netter, 75012, Paris, France.
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Lambert V, Ladarre D, Fortas F, Durand P, Hervé P, Gonzales E, Guérin F, Savale L, McLin VA, Ackermann O, Franchi-Abella S. Cardiovascular disorders in patients with congenital portosystemic shunts: 23 years of experience in a tertiary referral centre. Arch Cardiovasc Dis 2020; 114:221-231. [PMID: 33281106 DOI: 10.1016/j.acvd.2020.10.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/16/2020] [Accepted: 10/06/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Congenital portosystemic shunts are rare vascular malformations that may have an impact on the heart-lung system. Associated congenital and/or acquired heart diseases are poorly reported. AIMS To analyse cardiovascular disorders within a large congenital portosystemic shunt population, and develop a diagnostic strategy. METHODS Among the 168 consecutive fetuses and children referred for congenital portosystemic shunt (1996-2019), patients presenting with at least one cardiovascular disorder, including congenital heart disease, heart failure, portopulmonary hypertension and/or hepatopulmonary syndrome, were reviewed retrospectively. Cardiovascular disorders were detected using echocardiography and one or more of the following: right-sided heart catheterization; contrast-enhanced transthoracic echocardiography; or lung perfusion radionuclide scan. RESULTS Overall, 46/168 patients with a congenital portosystemic shunt (27.4%) had one or more clinically significant cardiovascular disorders. Congenital heart disease was present in 28 patients, including six with left heterotaxy. Heart failure was present in six fetuses and 21 neonates (eight without congenital heart disease, and 13 with congenital heart disease). In neonates without congenital heart disease, heart function recovered by the age of 3years. Portopulmonary hypertension was identified in 11 patients (mean age at diagnosis: 9years); it was fatal in one patient, and remained stable in five of six patients after congenital portosystemic shunt closure. In six patients, hepatopulmonary syndrome presented as hypoxia (mean age at diagnosis: 5.3years), which reversed after congenital portosystemic shunt closure. CONCLUSIONS Evaluation and monitoring of the cardiopulmonary status of patients with a congenital portosystemic shunt is mandatory to detect and prevent cardiovascular complications. Furthermore, congenital portosystemic shunts must be sought in patients with unexplained cardiovascular disorders, especially when malformations are present.
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Affiliation(s)
- Virginie Lambert
- Paediatric and Congenital Cardiology, Department of Cardiology, Institut Mutualiste Montsouris, 75014 Paris, France; Department of Paediatric Radiology, Bicêtre Hospital, AP-HP, Paris-Saclay, 94275 Le Kremlin-Bicêtre, France.
| | - Delphine Ladarre
- Department of Paediatric Hepatology and Liver Transplantation Unit, Bicêtre Hospital, AP-HP, Paris-Saclay, 94275 Le Kremlin-Bicêtre, France; Centre de Référence des Maladies Vasculaires du Foie (MVF), Filière de Santé des Maladies Rares du Foie de l'Enfant et de l'Adulte (FILFOIE), European Reference Network RARE-LIVER, FHU Hepatinov, Bicêtre Hospital, AP-HP, Paris-Saclay University Hospitals, 94275 Le Kremlin-Bicêtre cedex, France
| | - Feriel Fortas
- Department of Paediatric Intensive Care and Neonatal Medicine, Bicêtre Hospital, AP-HP, Paris-Saclay, 94275 Le Kremlin-Bicêtre, France
| | - Philippe Durand
- Department of Paediatric Intensive Care and Neonatal Medicine, Bicêtre Hospital, AP-HP, Paris-Saclay, 94275 Le Kremlin-Bicêtre, France
| | - Pierre Hervé
- Department of Paediatric Radiology, Bicêtre Hospital, AP-HP, Paris-Saclay, 94275 Le Kremlin-Bicêtre, France
| | - Emmanuel Gonzales
- Department of Paediatric Hepatology and Liver Transplantation Unit, Bicêtre Hospital, AP-HP, Paris-Saclay, 94275 Le Kremlin-Bicêtre, France; Centre de Référence des Maladies Vasculaires du Foie (MVF), Filière de Santé des Maladies Rares du Foie de l'Enfant et de l'Adulte (FILFOIE), European Reference Network RARE-LIVER, FHU Hepatinov, Bicêtre Hospital, AP-HP, Paris-Saclay University Hospitals, 94275 Le Kremlin-Bicêtre cedex, France; INSERM UMR-S 1193, Paris-Saclay, 91400 Orsay, France
| | - Florent Guérin
- Centre de Référence des Maladies Vasculaires du Foie (MVF), Filière de Santé des Maladies Rares du Foie de l'Enfant et de l'Adulte (FILFOIE), European Reference Network RARE-LIVER, FHU Hepatinov, Bicêtre Hospital, AP-HP, Paris-Saclay University Hospitals, 94275 Le Kremlin-Bicêtre cedex, France; Department of Paediatric Surgery, Bicêtre Hospital, AP-HP, Paris-Saclay, 94275 Le Kremlin-Bicêtre, France
| | - Laurent Savale
- Department of Respiratory and Intensive Care Medicine, Bicêtre Hospital, AP-HP, Paris-Saclay, 94275 Le Kremlin-Bicêtre, France; INSERM UMR-999, Marie-Lannelongue Hospital, 92350 Le Plessis-Robinson, France
| | - Valérie A McLin
- Swiss Paediatric Liver Center, Department of Paediatrics, Gynecology and Obstetrics, European Reference Network RARE-LIVER, University Hospitals Geneva and University of Geneva Medical School, 1205 Geneva, Switzerland
| | - Oanez Ackermann
- Department of Paediatric Hepatology and Liver Transplantation Unit, Bicêtre Hospital, AP-HP, Paris-Saclay, 94275 Le Kremlin-Bicêtre, France; Centre de Référence des Maladies Vasculaires du Foie (MVF), Filière de Santé des Maladies Rares du Foie de l'Enfant et de l'Adulte (FILFOIE), European Reference Network RARE-LIVER, FHU Hepatinov, Bicêtre Hospital, AP-HP, Paris-Saclay University Hospitals, 94275 Le Kremlin-Bicêtre cedex, France
| | - Stéphanie Franchi-Abella
- Department of Paediatric Radiology, Bicêtre Hospital, AP-HP, Paris-Saclay, 94275 Le Kremlin-Bicêtre, France; Department of Paediatric Hepatology and Liver Transplantation Unit, Bicêtre Hospital, AP-HP, Paris-Saclay, 94275 Le Kremlin-Bicêtre, France; Centre de Référence des Maladies Vasculaires du Foie (MVF), Filière de Santé des Maladies Rares du Foie de l'Enfant et de l'Adulte (FILFOIE), European Reference Network RARE-LIVER, FHU Hepatinov, Bicêtre Hospital, AP-HP, Paris-Saclay University Hospitals, 94275 Le Kremlin-Bicêtre cedex, France; BioMaps-UMR 8081, University Paris-Saclay, 91400 Orsay, France
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Rogers TN, De Corti F, Burrieza GG, Guérin F, Terwisscha van Scheltinga S, Smeulders N, Craigie R, Jenney M, Kelsey A, Zanetti I, Coppadoro B, De Salvo GL, Bisogno G, Martelli H. Paratesticular rhabdomyosarcoma-Impact of locoregional approach on patient outcome: A report from the European paediatric Soft tissue sarcoma Study Group (EpSSG). Pediatr Blood Cancer 2020; 67:e28479. [PMID: 32573979 DOI: 10.1002/pbc.28479] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 05/14/2020] [Accepted: 05/18/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Paratesticular rhabdomyosarcoma (PT RMS) is rare compared to benign scrotal pathology. Inappropriate first surgery (InFS) required supplementary treatment to maintain excellent outcomes. Initial staging of regional lymph nodes is important. The aim of this study was to determine to what extent the quality of locoregional approach impacted on patient morbidity and survival. DESIGN/METHODS Analysis was performed on all nonmetastatic PT RMS patients enrolled in the European paediatric Soft tissue sarcoma Study Group (EpSSG) RMS 2005 protocol. Aspects assessed were adherence to surgical guidelines and impact of protocol violations, relapse analysis, and survival outcomes. RESULTS Analysis was performed on 237 patients, with median follow up of 67.1 months. Median age was 9.0 years. InFS occurred in 75 of 237 (32%) patients. InFS required intensified chemotherapy (10) and local therapy. After InFS, 61 required primary reexcision and five delayed surgery. Of 26 recurrences, the risk of relapse was higher in patients ≥10 years (21/26) and was mainly locoregional in 16 of 26 recurrences (± metastatic). Sixteen of 26 died with 14 of 16 patients ≥10 years. Nodal relapse neither occurred when N1 nodes were identified at diagnosis, nor after surgical staging. Five-year overall survival (OS) at age <10 years versus ≥10 years was 98.1 and 86.7%, respectively (P = .0013). Event-free survival (EFS) at age <10 years versus ≥10 years was 95.8 and 79.6%, respectively (P = .0004). OS and EFS did not highlight a significant difference in patients undergoing appropriate versus InFS (P = .8479, P = .2780, respectively). CONCLUSIONS InFS required intensified therapy to maintain excellent OS and EFS, so better anticipation of malignancy is required. Surgical staging of the retroperitoneal lymph nodes should be performed in patients ≥10 years old.
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Affiliation(s)
- Timothy N Rogers
- Department of Paediatric Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Federica De Corti
- Pediatric Surgery Unit, Department of Woman's and Child's Health, University Hospital of Padova, Padova, Italy
| | | | - Florent Guérin
- Department of Paediatric Surgery, Bicêtre Hospital, Hôpitaux Universitaires Paris-Sud, Le Kremlin-Bicetre, France
| | | | - Naima Smeulders
- Department of Urology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Ross Craigie
- Department of Paediatric Surgery, Royal Manchester Children's Hospital, Manchester, UK
| | - Meriel Jenney
- Department of Pediatric Oncology, Children's Hospital for Wales Heath Park, Cardiff, UK
| | - Anna Kelsey
- Department of Pediatric Histopathology, Royal Manchester Children's Hospital, Manchester, UK
| | - Ilaria Zanetti
- Hematology Oncology Division, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Beatrice Coppadoro
- Hematology Oncology Division, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Gian Luca De Salvo
- Clinical Trials and Biostatistics Unit, IRCCS Istituto Oncologico Veneto, Padova, Italy
| | - Gianni Bisogno
- Hematology Oncology Division, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Hélène Martelli
- Department of Paediatric Surgery, Bicêtre Hospital, Hôpitaux Universitaires Paris-Sud, Le Kremlin-Bicetre, France
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22
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Guérin F, Franchi Abella S, McLin V, Ackermann O, Girard M, Cervoni JP, Savale L, Hernandez-Gea V, Valla D, Hillaire S, Dutheil D, Bureau C, Gonzales E, Plessier A. Congenital portosystemic shunts: Vascular liver diseases: Position papers from the francophone network for vascular liver diseases, the French Association for the Study of the Liver (AFEF), and ERN-rare liver. Clin Res Hepatol Gastroenterol 2020; 44:452-459. [PMID: 32279979 DOI: 10.1016/j.clinre.2020.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 03/03/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Florent Guérin
- Department of Visceral Pediatric surgery, FHU Hépatinov, Bicêtre Hospital, AP-HP, Paris-Saclay, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France; UMRS-1193, Inserm, Paris-Saclay University, 91400 Orsay, France.
| | - Stéphanie Franchi Abella
- Department of Pediatric Radiology, FHU Hépatinov, Bicêtre Hospital, AP-HP, Paris-Saclay, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - Valérie McLin
- Swiss Pediatric Liver Center, Pediatric Gastroenterology, Hepatology, and Nutrition Unit, Department of Pediatrics, Gynecology and Obstetrics, University of Geneva, Geneva, Switzerland
| | - Oanez Ackermann
- UMRS-1193, Inserm, Paris-Saclay University, 91400 Orsay, France; Department of Pediatric Hepatology, FHU Hépatinov, Bicêtre Hospital, AP-HP, Paris-Saclay, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France; French Network for Rare Liver Diseases (FILFOIE), European Reference Network (ERN) "Rare-Liver" Saint-Antoine Hospital, AP-HP, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
| | - Muriel Girard
- French Network for Rare Liver Diseases (FILFOIE), European Reference Network (ERN) "Rare-Liver" Saint-Antoine Hospital, AP-HP, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France; Department of Pediatric Hepatology, Hôpital Necker - enfants maladies, AP-HP, 149, rue de Sèvres, 75743 Paris cedex 15, France
| | - Jean Paul Cervoni
- Department of Hepatology, Jean Minjoz Hospital, University Hospital of Besançon, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France
| | - Laurent Savale
- Department of Pulmonary Medicine, Bicêtre Hospital, AP-HP, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - Virginia Hernandez-Gea
- Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, Institut de Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona. Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd). Health Care Provider of the European Reference Network onRare Liver Disorders (ERN-Liver), Spain
| | - Dominique Valla
- French Network for Rare Liver Diseases (FILFOIE), European Reference Network (ERN) "Rare-Liver" Saint-Antoine Hospital, AP-HP, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France; Department of Hepatology, DHU Unity, Beaujon Hospital, AP-HP, 100, boulevard du Général-Leclerc, 92118 Clichy, France; Inserm, center for research in inflammation, University of Paris, 75018 Paris, France
| | - Sophie Hillaire
- Department of Internal medicine, Foch Hospital, 40, rue Worth, 92150 Suresnes, France
| | - Danielle Dutheil
- Department of Hepatology, Association of patients with vascular liver diseases (AMVF), Beaujon Hospital, 100, boulevard du Général-Leclerc, 92118 Clichy, France
| | - Christophe Bureau
- Department of Gastroenterology and Hepatology, Rangueil Hospital, University Hospital of Toulouse, 1, avenue du Professeur-Jean-Poulhès, 31400 Toulouse, France
| | - Emmanuel Gonzales
- UMRS-1193, Inserm, Paris-Saclay University, 91400 Orsay, France; Department of Pediatric Hepatology, FHU Hépatinov, Bicêtre Hospital, AP-HP, Paris-Saclay, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France; French Network for Rare Liver Diseases (FILFOIE), European Reference Network (ERN) "Rare-Liver" Saint-Antoine Hospital, AP-HP, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
| | - Aurélie Plessier
- French Network for Rare Liver Diseases (FILFOIE), European Reference Network (ERN) "Rare-Liver" Saint-Antoine Hospital, AP-HP, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France; Department of Hepatology, DHU Unity, Beaujon Hospital, AP-HP, 100, boulevard du Général-Leclerc, 92118 Clichy, France
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23
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Guérin F, Martelli H. [Retroperitoneal lymph node assessment in pediatric paratesticular rhabdomyosarcoma]. Bull Cancer 2020; 107:666-671. [PMID: 32303361 DOI: 10.1016/j.bulcan.2020.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 02/27/2020] [Accepted: 03/16/2020] [Indexed: 10/24/2022]
Abstract
Paratesticular Rhabdomyosarcoma accounts for 7 to 11% of pediatric rhabdomyosarcomas. Children older than 10 years have a worse event-free survival (69 to 80% vs. 87 to 92%) than children younger than 10 years. In this location, the relapses are essentially in the retroperitoneal lymph nodes and are often fatal. In European protocols, the assessment of the retroperitoneal lymph nodes at diagnosis is made by imaging whereas it is performed by retroperitoneal lymph node dissection in the American protocols. This method has been proved to improve event-free survival in the group of patient older than 10 years with a tumour bigger than 5cm. In the next European protocol, when nodes will be enlarged a surgical biopsy will be performed, this will be irrespective of age or size, and when no nodes will be enlarged in patients older than 10 years, retroperitoneal lymph node assessment will be performed. Other techniques of lymph nodes assessment will be tested like sentinel node biopsies or PET-scan.
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Affiliation(s)
- Florent Guérin
- Hôpital Bicêtre, Assistance publique-Hôpitaux de Paris, université Paris-Saclay, chirurgie pédiatrique, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France.
| | - Hélène Martelli
- Hôpital Bicêtre, Assistance publique-Hôpitaux de Paris, université Paris-Saclay, chirurgie pédiatrique, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
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24
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Sonigo G, Battistella M, Beylot-Barry M, Oro S, Franck N, Barete S, Boulinguez S, Dereure O, Bonnet N, Socié G, Brice P, Boccara O, Bodemer C, Adamski H, D’Incan M, Ortonne N, Fraitag S, Brunet-Possenti F, Dalle S, Suarez F, Marcais A, Skowron F, Haidar D, Maubec E, Bohelay G, Laroche L, Mahé A, Birckel E, Bouaziz JD, Brocheriou I, Dubois R, Faiz S, Fadlallah J, Ram-Wolff C, Carlotti A, Bens G, Balme B, Vergier B, Laurent-Roussel S, Deschamps L, Carpentier O, Moguelet P, Hervé G, Comoz F, Le Gall F, Leverger G, Finon A, Augereau O, Bléchet C, Kerdraon R, lamant L, Tournier E, Franck F, Costes-Martineau V, Szablewski V, Taix S, Beschet I, Guérin F, Sepulveda F, Bagot M, De Saint-Basile G, Michonneau D, De Masson A. Étude clinique à long terme et mutations HAVCR2 chez 70 patients atteints de lymphome T sous cutané à type de panniculite. Ann Dermatol Venereol 2019. [DOI: 10.1016/j.annder.2019.09.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Berleur M, Guérin F, Massias L, Chau F, Poujade J, Cattoir V, Fantin B, de Lastours V. Activity of fosfomycin alone or combined with temocillin in vitro and in a murine model of peritonitis due to KPC-3- or OXA-48-producing Escherichia coli. J Antimicrob Chemother 2019; 73:3074-3080. [PMID: 30085154 DOI: 10.1093/jac/dky283] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 06/20/2018] [Indexed: 12/31/2022] Open
Abstract
Background Alternative therapeutic regimens are urgently needed against carbapenemase-producing Enterobacteriaceae. Fosfomycin often remains active against KPC and OXA-48 producers, but emergence of resistance is a major limitation. Our aim was to determine whether the association of temocillin with fosfomycin might be useful to treat KPC- or OXA-48-producing Escherichia coli infections. Methods Isogenic derivatives of E. coli CFT073 with blaKPC-3- or blaOXA-48-harbouring plasmids (named CFT073-KPC-3 and CFT073-OXA-48, respectively) were used. The addition of temocillin to fosfomycin was tested using the chequerboard method and time-kill curves as well as in a fatal peritonitis murine model. Mice were treated for 24 h with fosfomycin alone or in combination with temocillin. Bacterial loads, before and after treatment, were determined in the peritoneal fluid and fosfomycin-resistant mutants were detected. Results Temocillin MICs were 8, 32 and 256 mg/L for CFT073 (WT), CFT073-KPC-3 and CFT073-OXA-48, respectively. Fosfomycin MIC was 0.5 mg/L for all strains. The chequerboard experiments demonstrated synergy for all three strains. In time-kill curves, combining temocillin with fosfomycin was synergistic, bactericidal and prevented emergence of resistance for CFT073-pTOPO and CFT073-KPC-3, but not CFT073-OXA-48. In vivo, for the three strains, bacterial counts were lower in peritoneal fluid with the combination compared with fosfomycin alone (P < 0.001) and inhibited growth of resistant mutants in all cases. Conclusions The combination of fosfomycin and temocillin demonstrated a benefit in vitro and in vivo against E. coli strains producing KPC-3 or OXA-48-type carbapenemases. This combination prevented the emergence of fosfomycin resistance and proved to be more bactericidal than fosfomycin alone.
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Affiliation(s)
- M Berleur
- IAME, UMR1137, INSERM and Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - F Guérin
- CHU de Caen, Service de Microbiologie, Caen, France
| | - L Massias
- AP-HP, Groupe Hospitalier Paris Nord Val de Seine, Pharmacie, Hôpital Bichat, Paris, France
| | - F Chau
- IAME, UMR1137, INSERM and Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - J Poujade
- IAME, UMR1137, INSERM and Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - V Cattoir
- CHU de Rennes, Service de Bactériologie-Hygiène Hospitalière, Rennes, France.,CNR de la Résistance aux Antibiotiques (laboratoire associé "Entérocoques"), Rennes, France.,Université de Rennes 1, Unité Inserm U1230, Rennes, France
| | - B Fantin
- IAME, UMR1137, INSERM and Université Paris Diderot, Sorbonne Paris Cité, Paris, France.,AP-HP, Groupe Hospitalier Paris Nord Val de Seine, Service de médecine interne, Clichy, France
| | - V de Lastours
- IAME, UMR1137, INSERM and Université Paris Diderot, Sorbonne Paris Cité, Paris, France.,AP-HP, Groupe Hospitalier Paris Nord Val de Seine, Service de médecine interne, Clichy, France
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Chargari C, Deutsch E, Blanchard P, Gouy S, Martelli H, Guérin F, Dumas I, Bossi A, Morice P, Viswanathan AN, Haie-Meder C. Brachytherapy: An overview for clinicians. CA Cancer J Clin 2019; 69:386-401. [PMID: 31361333 DOI: 10.3322/caac.21578] [Citation(s) in RCA: 127] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Brachytherapy is a specific form of radiotherapy consisting of the precise placement of radioactive sources directly into or next to the tumor. This technique is indicated for patients affected by various types of cancers. It is an optimal tool for delivering very high doses to the tumor focally while minimizing the probability of normal tissue complications. Physicians from a wide range of specialties may be involved in either the referral to or the placement of brachytherapy. Many patients require brachytherapy as either primary treatment or as part of their oncologic care. On the basis of high-level evidence from randomized controlled trials, brachytherapy is mainly indicated: 1) as standard in combination with chemoradiation in patients with locally advanced cervical cancer; 2) in surgically treated patients with uterine endometrial cancer for decreasing the risk of vaginal vault recurrence; 3) in patients with high-risk prostate cancer to perform dose escalation and improve progression-free survival; and 4) in patients with breast cancer as adjuvant, accelerated partial breast irradiation or to boost the tumor bed. In this review, the authors discuss the clinical relevance of brachytherapy with a focus on indications, levels of evidence, and results in the overall context of radiation use for patients with cancer.
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Affiliation(s)
- Cyrus Chargari
- Department of Radiation Oncology, Gustave Roussy Comprehensive Cancer Center, Villejuif, France
- French Military Health Academy, Paris, France
| | - Eric Deutsch
- Department of Radiation Oncology, Gustave Roussy Comprehensive Cancer Center, Villejuif, France
- Faculty of Medicine, Paris-South University/Paris Saclay, Paris, France
- Molecular Radiotherapy Unit 1030, National Institute of Health and Medical Research (INSERM), Paris, France
| | - Pierre Blanchard
- Department of Radiation Oncology, Gustave Roussy Comprehensive Cancer Center, Villejuif, France
| | - Sebastien Gouy
- Department of Surgery, Gustave Roussy Comprehensive Cancer Center, Villejuif, France
| | - Hélène Martelli
- Department of Pediatric Surgery, Kremlin Bicetre University Hospital, Kremlin Bicetre, France
| | - Florent Guérin
- Department of Pediatric Surgery, Kremlin Bicetre University Hospital, Kremlin Bicetre, France
| | - Isabelle Dumas
- Department of Radiation Oncology, Gustave Roussy Comprehensive Cancer Center, Villejuif, France
| | - Alberto Bossi
- Department of Radiation Oncology, Gustave Roussy Comprehensive Cancer Center, Villejuif, France
| | - Philippe Morice
- Department of Surgery, Gustave Roussy Comprehensive Cancer Center, Villejuif, France
- Paris-South University/Paris Saclay, Paris, France
| | - Akila N Viswanathan
- Department of Radiation Oncology, Johns Hopkins Medicine, Baltimore, Maryland
| | - Christine Haie-Meder
- Department of Radiation Oncology, Gustave Roussy Comprehensive Cancer Center, Villejuif, France
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27
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Guérin F, Rogers T, Minard-Colin V, Gaze MN, Terwisscha S, Van Noesel M, De Corti F, Guillén Burrieza G, De Salvo GL, Kelsey A, Orbach D, Ferrari A, Bergeron C, Bisogno G, Martelli H. Outcome of localized liver-bile duct rhabdomyosarcoma according to local therapy: A report from the European Paediatric Soft-Tissue Sarcoma Study Group (EpSSG)-RMS 2005 study. Pediatr Blood Cancer 2019; 66:e27725. [PMID: 30920113 DOI: 10.1002/pbc.27725] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 03/06/2019] [Accepted: 03/08/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To evaluate the impact of local therapies on the outcome of patients with liver-bile duct rhabdomyosarcoma (LBDRMS). METHODS Data of 30 patients included in the EpSSG-RMS 2005 study were analyzed. RESULTS The median age at diagnosis was 3 years (11 months-8 years). All patients had non-alveolar histology. Fifteen patients had a tumor > 5 cm and six had enlarged regional lymph nodes on imaging. Eight patients (27%) had primary surgery (1 R0). Six of them received external beam radiotherapy (EBRT). All are in first complete remission (CR1) except one (R1, EBRT+ , local relapse, death). Six patients (20%) received EBRT without surgery: one had local relapse and died. Sixteen patients (53%) underwent delayed surgery, with 12 achieving R0 margins, which were higher than those in the primary surgery group (P = 0.003). Three patients with R0 margins received EBRT; one had a metastatic relapse and died. Nine patients with R0 resection did not receive EBRT, three relapsed locally (two deaths). Four R1 patients received additional EBRT without relapses. Local relapse occurred in two among 19 patients with EBRT and three among 11 without EBRT (P = 0.326). At a median follow-up of 61 months (48-84 months), five patients died; all had a tumor size > 5 cm (P = 0.01). The five-year overall survival was 85% (95% CI, 65-94), and event-free survival was 76% (95% CI, 54-89). CONCLUSION This analysis did not show any significant difference in outcome between irradiated and nonirradiated patients. Local relapse in LBDRMS is related to initial tumor size and is often fatal.
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Affiliation(s)
- Florent Guérin
- Department of Paediatric Surgery, Bicêtre Hospital, Hôpitaux Universitaires Paris-Sud, Le Kremlin-Bicetre, France
| | - Timothy Rogers
- Department of Paediatric Surgery, University Hospitals Bristol NHS Foundation trust, Bristol, United Kingdom
| | - Véronique Minard-Colin
- Département d'Oncologie de l'Enfant et de l'Adolescent, Institut Gustave Roussy, Villejuif, France
| | - Mark N Gaze
- Department of Oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Sheila Terwisscha
- Department of Paediatric Surgery, Prinses Máxima Centrum voor Kinderoncologie, Utrecht, the Netherlands
| | - Max Van Noesel
- Department of Paediatric Surgery, Prinses Máxima Centrum voor Kinderoncologie, Utrecht, the Netherlands
| | - Federica De Corti
- Pediatric Surgery Unit, Department of Woman's and Child's Health, University Hospital of Padova, Padova, Italy
| | | | - Gian Luca De Salvo
- Clinical Trials and Biostatistics Unit, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy
| | - Anna Kelsey
- Department of Paediatric Histopathology, Royal Manchester Children Hospital, Manchester, United Kingdom
| | - Daniel Orbach
- SIREDO Oncology Center (Care, Innovation and Research for Children, Adolescents and Young Adults with Cancer), Institut Curie, PSL University, Paris, France
| | - Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Christophe Bergeron
- Institut d'Hématologie et d'Oncologie Pédiatrique, Centre Léon Bérard, Lyon, France
| | - Gianni Bisogno
- Hematology Oncology Division, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Hélène Martelli
- Department of Paediatric Surgery, Bicêtre Hospital, Hôpitaux Universitaires Paris-Sud, Le Kremlin-Bicetre, France
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Guérin F, Charre L, Jasienski S, Duché M, Franchiabella S, Bernard O, Jacquemin E, Agostini H, Gauthier F, Branchereau S. The efficacy of surgical shunts to treat severe portal hypertension after a Kasai procedure for biliary atresia. J Pediatr Surg 2019; 54:531-536. [PMID: 29983186 DOI: 10.1016/j.jpedsurg.2018.06.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 05/28/2018] [Accepted: 06/19/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND To assess the outcome of patients with biliary atresia (BA) who underwent a surgical shunt (SS) for severe portal hypertension (PH) following a Kasai procedure. METHODS We collected and analyzed the data and outcomes of patients with BA who underwent SS for severe PH following a Kasai procedure between 1974 and 2014, focusing on complications related to the procedure, overall survival (OS), and transplant-free survival (TFS). RESULTS SS was performed at a median age of 5.5 years [2-13.5] in 38 patients. Conjugated bilirubin level (cBL) was ≤20 μmol/l in 24 patients at time of SS. Median follow-up was 15 years [1-32]. OS at 5 and 10 years was 91% and 87% respectively. TFS at 5 and 10 years was 84% and 70% respectively. Long-term complications included hepatic encephalopathy in 9 patients, and hepatopulmonary syndrome in 3. At last follow-up, 10/14 patients without LT and 18/ 24 who had a delayed LT at a median delay of 11 years [1.5-22] were alive. CONCLUSION Surgical shunt for severe portal hypertension in biliary atresia may delay the need for liver transplantation. However complications are indications for transplantation. LEVEL OF EVIDENCE Type of study: Therapeutic. Level of evidence III.
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Affiliation(s)
- Florent Guérin
- Department of Paediatric Surgery, Hôpitaux Universitaires Paris-Sud: Bicêtre (AP-HP), Le Kremlin Bicêtre, France.
| | - Lionel Charre
- Department of Paediatric Surgery, Hôpitaux Universitaires Paris-Sud: Bicêtre (AP-HP), Le Kremlin Bicêtre, France; Department of Surgery, Centre Hospitalier René Dubos, Pontoise, France
| | - Stéphanie Jasienski
- Department of Paediatric Surgery, Hôpitaux Universitaires Paris-Sud: Bicêtre (AP-HP), Le Kremlin Bicêtre, France; Department of Paediatric Surgery, Centre Hospitalier de Charleroi, Charleroi, Belgium
| | - Mathieu Duché
- Department of Paediatric Hepatology, Hôpitaux Universitaires Paris-Sud: Bicêtre (AP-HP), Le Kremlin-Bicêtre, France; Department of Paediatric Radiology, Hôpitaux Universitaires Paris-Sud: Bicêtre (AP-HP), Le Kremlin-Bicêtre, France
| | - Stéphanie Franchiabella
- Department of Paediatric Radiology, Hôpitaux Universitaires Paris-Sud: Bicêtre (AP-HP), Le Kremlin-Bicêtre, France
| | - Olivier Bernard
- Department of Paediatric Hepatology, Hôpitaux Universitaires Paris-Sud: Bicêtre (AP-HP), Le Kremlin-Bicêtre, France
| | - Emmanuel Jacquemin
- Department of Paediatric Hepatology, Hôpitaux Universitaires Paris-Sud: Bicêtre (AP-HP), Le Kremlin-Bicêtre, France
| | - Hélène Agostini
- Department of Biostatistics and Clinical Research, Hôpitaux Universitaires Paris-Sud: Bicêtre (AP-HP), Le Kremlin-Bicêtre, France
| | - Frédéric Gauthier
- Department of Paediatric Surgery, Hôpitaux Universitaires Paris-Sud: Bicêtre (AP-HP), Le Kremlin Bicêtre, France
| | - Sophie Branchereau
- Department of Paediatric Surgery, Hôpitaux Universitaires Paris-Sud: Bicêtre (AP-HP), Le Kremlin Bicêtre, France
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Abstract
Congenital portosystemic shunts (CPSS) are rare vascular malformations that create an abnormal connection between portal and systemic veins resulting in complete or partial diversion of the portal flow away from the liver to the systemic venous system. Different anatomic types exist and several classifications have been proposed. They can be associated with other malformations especially cardiac and heterotaxia. The main complications include hepatic encephalopathy, liver tumors, portopulmonary hypertension, and pulmonary arteriovenous shunts. Diagnosis relies on imaging, and prenatal diagnosis is possible. Spontaneous closure of the CPSS is possible in some anatomic forms during the first year of life. When the CPSS remains patent, radiologic or surgical closure of the CPSS may prevent, resolve, or stabilize complications. Interventional radiology plays a key role for both the preoperative evaluation with occlusion test to assess the exact anatomy and to measure portal pressure after occlusion of the CPSS. Endovascular closure is the first option for treatment when possible.
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Affiliation(s)
- Stéphanie Franchi-Abella
- Pediatric Radiology Department, Hôpital Bicêtre, Hôpitaux Universitaire Paris-Sud, Assistance Publique Hôpitaux de Paris, 78 rue du Général Leclerc, 94278, Le Kremlin-Bicêtre, France.
- Pediatric Liver Transplantation Unit, National Reference Centre for Rare Pediatric Liver Diseases and Filfoie, Paris, France.
- Hepatinov, University Paris -Sud, Orsay, France.
- IR4 M-UMR 8081- University Paris -Sud, Orsay, France.
| | - Emmanuel Gonzales
- Pediatric Hepatology, Hôpital Bicêtre, Hôpitaux Universitaire Paris-Sud, Assistance Publique Hôpitaux de Paris, National Centre for Biliary Atresia, Le Kremlin-Bicêtre, France
- Pediatric Liver Transplantation Unit, National Reference Centre for Rare Pediatric Liver Diseases and Filfoie, Paris, France
- Hepatinov, University Paris -Sud, Orsay, France
- INSERM UMR-S1174, Orsay, France
| | - Oanez Ackermann
- Pediatric Hepatology, Hôpital Bicêtre, Hôpitaux Universitaire Paris-Sud, Assistance Publique Hôpitaux de Paris, National Centre for Biliary Atresia, Le Kremlin-Bicêtre, France
- Pediatric Liver Transplantation Unit, National Reference Centre for Rare Pediatric Liver Diseases and Filfoie, Paris, France
- Hepatinov, University Paris -Sud, Orsay, France
| | - Sophie Branchereau
- Pediatric Surgery Department, Hôpital Bicêtre, Hôpitaux Universitaire Paris-Sud, Assistance Publique Hôpitaux de Paris, Le Kremlin-Bicêtre, France
- Pediatric Liver Transplantation Unit, National Reference Centre for Rare Pediatric Liver Diseases and Filfoie, Paris, France
- Hepatinov, University Paris -Sud, Orsay, France
| | - Danièle Pariente
- Pediatric Radiology Department, Hôpital Bicêtre, Hôpitaux Universitaire Paris-Sud, Assistance Publique Hôpitaux de Paris, 78 rue du Général Leclerc, 94278, Le Kremlin-Bicêtre, France
- Pediatric Liver Transplantation Unit, National Reference Centre for Rare Pediatric Liver Diseases and Filfoie, Paris, France
- Hepatinov, University Paris -Sud, Orsay, France
| | - Florent Guérin
- Pediatric Surgery Department, Hôpital Bicêtre, Hôpitaux Universitaire Paris-Sud, Assistance Publique Hôpitaux de Paris, Le Kremlin-Bicêtre, France
- Pediatric Liver Transplantation Unit, National Reference Centre for Rare Pediatric Liver Diseases and Filfoie, Paris, France
- Hepatinov, University Paris -Sud, Orsay, France
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de Lambert G, Chargari C, Minard-Colin V, Haie-Meder C, Guérin F, Martelli H. Testicular transposition in children undergoing brachytherapy for bladder and/or prostate rhabdomyosarcoma. J Pediatr Surg 2018; 53:1428-1431. [PMID: 29753523 DOI: 10.1016/j.jpedsurg.2018.04.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 04/04/2018] [Accepted: 04/08/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND/PURPOSE Fertility preservation is a major goal in treatment of children with cancer. We describe a new technique of testicular transposition (TT) in patients treated with pulse-dose-rate (PDR) brachytherapy as part of the multimodal conservative treatment of bladder neck and/or prostate rhabdomyosarcoma (BP RMS). METHODS Medical records of consecutive patients treated between September 2016 and August 2017 were studied. These patients underwent a TT performed during BP RMS surgery by the same suprapubic incision. The external oblique aponeurosis was not incised. The spermatic cord was mobilized up to the external inguinal ring, and the gubernaculum attachments were severed from the scrotum. The testis was then flipped over with care taken to avoid injury of the vessels or the vas, wrapped in a silicone material and sutured under the abdominal skin with a transfixing stitch facing the anterior superior iliac spine. At the end of brachytherapy, the testis was relocated in the scrotum and during the same general anesthesia, plastic tubes and stents were removed. Surgical outcome and dosimetric parameters were examined. RESULTS Eight patients were identified. Median age was 24 months (range 11-80 months). All had embryonal BP RMS and received chemotherapy according to RMS 2005 protocol prior to local treatment. All patients underwent conservative surgery followed by brachytherapy (60 Gy) and had testicular transposition of one testis. None had surgical complications. After converting doses to biologically equivalent doses in 2-Gy fractions (EQD2), the dose delivered to 75% of the transposed testis was 1.5 GyEQD2 (1-3 GyEQD2), versus 5.4 GyEQD2 (3.9-9.4 Gy EQD2) for the untransposed testis (p < 0.001). CONCLUSION Testicular transposition is feasible in order to potentially preserve fertility and future quality of life in children undergoing brachytherapy for BP RMS. TYPE OF STUDY Level IV Treatment Study: Case Study with no Comparison Group.
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Affiliation(s)
- Guenolee de Lambert
- AP - HP, Bicêtre Hospital, Hôpitaux Universitaires Paris Sud, Department of Pediatric Surgery, Le Kremlin-Bicêtre, 94275, France.
| | - Cyrus Chargari
- Gustave Roussy, Department of Radiotherapy, Villejuif, 94800, France; French Military Health Academy, Ecole du Val-de-Grâce, Paris 75005, France
| | | | | | - Florent Guérin
- AP - HP, Bicêtre Hospital, Hôpitaux Universitaires Paris Sud, Department of Pediatric Surgery, Le Kremlin-Bicêtre, 94275, France
| | - Hélène Martelli
- AP - HP, Bicêtre Hospital, Hôpitaux Universitaires Paris Sud, Department of Pediatric Surgery, Le Kremlin-Bicêtre, 94275, France
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Kohaut J, Guérin F, Fouquet V, Gonzales E, de Lambert G, Martelli H, Jacquemin E, Branchereau S. First liver transplantation for biliary atresia in children: The hidden effects of non-centralization. Pediatr Transplant 2018; 22:e13232. [PMID: 29869366 DOI: 10.1111/petr.13232] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/04/2018] [Indexed: 11/30/2022]
Abstract
The aim of our study was to determine the impact of initial orientation for medical and surgical care of children with BA on procedures and outcomes of the first LT. We retrospectively analyzed charts of children with BA who underwent first LT between 2006 and 2015. Patients were divided into two groups for comparison: a single-center management group (from diagnosis to transplantation) and a secondarily referred group (children referred after failure of KP). We focused analysis on disease severity at transplantation, blood transfusion, and overall survival. One hundred and eighty-five children were included. The median delay between pretransplant check-up and transplantation was shorter in patients secondarily referred. A severe undernutrition was observed in 23.7% of children secondarily referred compared to 11.1% in children with a single-center management (P = .024). At transplantation, INR and factor V level were higher in single-center group patients (respectively, 67% vs 55%, P < .001 and 61% vs 49%, P = .002). The total of red blood cell and fresh frozen plasma administrated during procedure was two times higher in patients secondarily referred. Finally, patients with a single-center management had a higher overall 12 months of survival rate (92.1% vs 83.1%, P = .033). In a country without low-density population issues, the authors advocate an early referring to transplant center to further improving LT outcomes in children with BA.
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Affiliation(s)
- Jules Kohaut
- Department of Pediatric Surgery, Hôpitaux Universitaires Paris-Sud, Bicêtre Hospital, AP-HP, Le Kremlin-Bicêtre, France
- University Paris-Sud, Le Kremlin-Bicêtre, France
| | - Florent Guérin
- Department of Pediatric Surgery, Hôpitaux Universitaires Paris-Sud, Bicêtre Hospital, AP-HP, Le Kremlin-Bicêtre, France
| | - Virginie Fouquet
- Department of Pediatric Surgery, Hôpitaux Universitaires Paris-Sud, Bicêtre Hospital, AP-HP, Le Kremlin-Bicêtre, France
| | - Emmanuel Gonzales
- University Paris-Sud, Le Kremlin-Bicêtre, France
- Department of Pediatric Hepatology, Hôpitaux Universitaires Paris-Sud, Bicêtre Hospital, AP-HP, Le Kremlin-Bicêtre, France
| | - Guénolée de Lambert
- Department of Pediatric Surgery, Hôpitaux Universitaires Paris-Sud, Bicêtre Hospital, AP-HP, Le Kremlin-Bicêtre, France
| | - Hélène Martelli
- Department of Pediatric Surgery, Hôpitaux Universitaires Paris-Sud, Bicêtre Hospital, AP-HP, Le Kremlin-Bicêtre, France
- University Paris-Sud, Le Kremlin-Bicêtre, France
| | - Emmanuel Jacquemin
- University Paris-Sud, Le Kremlin-Bicêtre, France
- Department of Pediatric Hepatology, Hôpitaux Universitaires Paris-Sud, Bicêtre Hospital, AP-HP, Le Kremlin-Bicêtre, France
| | - Sophie Branchereau
- Department of Pediatric Surgery, Hôpitaux Universitaires Paris-Sud, Bicêtre Hospital, AP-HP, Le Kremlin-Bicêtre, France
- University Paris-Sud, Le Kremlin-Bicêtre, France
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de Lambert G, Poirot C, Guérin F, Brugières L, Martelli H. Preservation of future fertility in pediatric patients with cancer. J Visc Surg 2018; 155 Suppl 1:S41-S46. [DOI: 10.1016/j.jviscsurg.2018.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Cornet M, De Lambert G, Pariente D, Planchon JM, Guettier C, Martelli H, Guérin F, Branchereau S. Rhabdoid tumor of the liver: Report of 6 pediatric cases treated at a single institute. J Pediatr Surg 2018; 53:567-571. [PMID: 28966010 DOI: 10.1016/j.jpedsurg.2017.09.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Revised: 08/31/2017] [Accepted: 09/02/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Rhabdoid tumors (RTs) of the liver are rare, aggressive and nonsecreting malignancies occurring mainly during the first year of life. Definition of RT relies on characteristic morphology and on the inactivation of the SMARCB1 tumor suppressor gene. The aim of this study was to analyze clinical data, treatments and outcomes in our patients. PATIENTS AND METHODS 6 cases of patients treated in our institution for RT of the liver between January 2007 and January 2015 are reported. Variables examined included age at diagnosis, tumor stage, treatment and long-term survival. RESULTS Median age at diagnosis was 5months (range: 4-23). Normal for age serum AFP levels was observed in all patients. No patient presented with metastasis at diagnosis. The diagnosis of RT based on the loss of SMARCB1 was made early in 4 patients. The 2 others were initially diagnosed as nonsecreting hepatoblastomas. Median follow-up was 6years (range: 2-9). All patients received chemotherapy, with variable regimens depending on initial diagnosis, followed by surgical resection. Three patients (50%) died of disease. Two of them were mistaken for nonsecreting hepatoblastomas at diagnosis and had recurrence shortly after completion of treatment. The third one presented a cardiac right atrium thrombus. Three patients (50%) are long-term survivors; they received multimodal therapy including chemotherapy according to protocol EpSSG NRSTS consisting of doxorubicin and surgical removal of the tumor performed within 3months after diagnosis. One patient had adjuvant radiotherapy. CONCLUSION According to our results, search of SMARCB1 mutation or alternatively immunohistochemical assay for SMARCB1 in nonsecreting hepatoblastomas is mandatory to exclude RT. Chemotherapy according to EpSSG NRSTS protocol together with a surgical treatment seems justified to improve long-term survival. TYPE OF STUDY Retrospective study. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Marianna Cornet
- Pediatric Surgery Department-Hôpitaux universitaires Paris Sud, Hôpital Bicêtre Assistance Publique Hôpitaux de Paris, Université Paris XI, 78 rue du Général Leclerc, 94275 Le Kremlin Bicêtre, France.
| | - Guénolée De Lambert
- Pediatric Surgery Department-Hôpitaux universitaires Paris Sud, Hôpital Bicêtre Assistance Publique Hôpitaux de Paris, Université Paris XI, 78 rue du Général Leclerc, 94275 Le Kremlin Bicêtre, France
| | - Danièle Pariente
- Pediatric Radiology Department-Hôpitaux universitaires Paris Sud, Hôpital Bicêtre Assistance Publique Hôpitaux de Paris, Université Paris XI, 78 rue du Général Leclerc, 94275 Le Kremlin Bicêtre, France
| | - Julien Masliah Planchon
- Unité de Génétique Somatique-Département de Génétique Humaine et Oncogenèse Institut Curie, 75248 Paris, France
| | - Catherine Guettier
- Anatomo-Cyto-Pathology Department-Hôpitaux universitaires Paris Sud, Hôpital Bicêtre Assistance Publique Hôpitaux de Paris, Université Paris XI, 78 rue du Général Leclerc, 94275 Le Kremlin Bicêtre, France
| | - Hélène Martelli
- Pediatric Surgery Department-Hôpitaux universitaires Paris Sud, Hôpital Bicêtre Assistance Publique Hôpitaux de Paris, Université Paris XI, 78 rue du Général Leclerc, 94275 Le Kremlin Bicêtre, France
| | - Florent Guérin
- Pediatric Surgery Department-Hôpitaux universitaires Paris Sud, Hôpital Bicêtre Assistance Publique Hôpitaux de Paris, Université Paris XI, 78 rue du Général Leclerc, 94275 Le Kremlin Bicêtre, France
| | - Sophie Branchereau
- Pediatric Surgery Department-Hôpitaux universitaires Paris Sud, Hôpital Bicêtre Assistance Publique Hôpitaux de Paris, Université Paris XI, 78 rue du Général Leclerc, 94275 Le Kremlin Bicêtre, France
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Descloux S, Chanudet V, Serça D, Guérin F. Methane and nitrous oxide annual emissions from an old eutrophic temperate reservoir. Sci Total Environ 2017; 598:959-972. [PMID: 28468122 DOI: 10.1016/j.scitotenv.2017.04.066] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 03/14/2017] [Accepted: 04/10/2017] [Indexed: 06/07/2023]
Abstract
Two greenhouse gases -methane (CH4) and nitrous oxide (N2O) - were monitored monthly during one year (2011) at the Eguzon Reservoir in France. The objective of the study was to quantify for the first time in a temperate area the total emissions of these gases through the main emission pathways (diffusion and bubbling from the reservoir, degassing and downstream diffusion). The reservoir was impounded in 1926 and had, in 2011, a eutrophic status promoting high organic matter degradation and nitrification-denitrification, all favouring CH4 and N2O production. CH4 and N2O emissions were dominated by diffusion from the reservoir surface (respectively 78.0% and 92.3%). Ebullition was only observed for CH4 and accounted for 14.0% of total CH4 emissions. Downstream degassing and diffusion represented 8.1% of the total CH4 emissions and 7.7% of the total N2O emissions.
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Affiliation(s)
- S Descloux
- EDF - Hydro Engineering Centre - Environmental and Society Department - Savoie-Technolac, 73373 Le Bourget-du-Lac, France
| | - V Chanudet
- EDF - Hydro Engineering Centre - Environmental and Society Department - Savoie-Technolac, 73373 Le Bourget-du-Lac, France.
| | - D Serça
- Laboratoire d'Aérologie, Université de Toulouse, CNRS, UPS, UMR5560, 14 Av. Edouard Belin, 31400 Toulouse, France
| | - F Guérin
- Université de Toulouse, UPS GET, 14 Avenue E. Belin, F-31400 Toulouse, France; Institut de Recherche pour le Développement; UR 234, GET, 14 Avenue E. Belin, F-31400 Toulouse, France
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Chargari C, Martelli H, Guérin F, Bacorro W, de Lambert G, Escande A, Minard-Colin V, Dumas I, Deutsch E, Haie-Meder C. Pulsed-dose rate brachytherapy for pediatric bladder prostate rhabdomyosarcoma: Compliance and early clinical results. Radiother Oncol 2017; 124:285-290. [DOI: 10.1016/j.radonc.2017.07.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 07/07/2017] [Accepted: 07/10/2017] [Indexed: 11/28/2022]
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Chargari C, Martelli H, Guérin F, Mazeron R, Minard-Colin V, Deutsch E, Haie-Meder C. SP-0224: Brachytherapy for bladder/prostate rhabdomyosarcoma: clinical outcome and functional results. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)30667-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Chargari C, Haie-Meder C, Guérin F, Minard-Colin V, de Lambert G, Mazeron R, Escande A, Marsolat F, Dumas I, Deutsch E, Valteau-Couanet D, Audry G, Oberlin O, Martelli H. Brachytherapy Combined With Surgery for Conservative Treatment of Children With Bladder Neck and/or Prostate Rhabdomyosarcoma. Int J Radiat Oncol Biol Phys 2017; 98:352-359. [PMID: 28463154 DOI: 10.1016/j.ijrobp.2017.02.026] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 02/09/2017] [Accepted: 02/14/2017] [Indexed: 11/24/2022]
Abstract
PURPOSE To report the results of a conservative strategy based on partial surgery combined with brachytherapy in a prospective cohort of children with bladder-prostate rhabdomyosarcoma (BP RMS). METHODS AND MATERIALS We prospectively documented the outcome of children treated in our department between 1991 and 2015 for BP RMS and undergoing a multimodal approach combining conservative surgery (partial cystectomy and/or partial prostatectomy) and perioperative interstitial low-dose-rate or pulse-dose-rate brachytherapy. Before brachytherapy, children had received chemotherapy with modalities depending on their risk group of treatment. RESULTS A total of 100 patients were identified, with a median age of 28 months (range, 5.6 months-14 years). According to the Intergroup Rhabdomyosarcoma Study (IRS) group, 84 were IRS-III, and 12 were IRS-IV tumors. Four patients were treated at relapse. The median number of chemotherapy cycles before local therapy was 6 (range, 4-13). After surgery, 63 patients had a macroscopic tumor residuum. Five patients underwent a brachytherapy boost before pelvic external beam radiation therapy because of nodal involvement, and 95 had exclusive brachytherapy. Median follow-up was 64 months (range, 6 months-24.5 years). Five-year disease-free and overall survival rates were 84% (95% confidence interval 80%-88%) and 91% (95% confidence interval 87%-95%), respectively. At last follow-up most survivors presented with only mild to moderate genitourinary sequelae and a normal diurnal urinary continence. Five patients required a secondary total cystectomy: 3 for a nonfunctional bladder and 2 for relapse. CONCLUSION Brachytherapy is effective as part of a conservative strategy for BP RMS, with a relatively low delayed toxicity as compared with previously published studies using external beam radiation therapy. Longer follow-up is required to ensure that the functional results are maintained over time.
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Affiliation(s)
- Cyrus Chargari
- Brachytherapy Unit, Department of Radiotherapy, Gustave Roussy, Villejuif, France; Institut de Recherche Biomédicale des Armées, Bretigny-sur-Orge, France; French Military Health Service Academy, Ecole du Val-de-Grâce, Paris, France.
| | - Christine Haie-Meder
- Brachytherapy Unit, Department of Radiotherapy, Gustave Roussy, Villejuif, France
| | - Florent Guérin
- Department of Pediatric Surgery, Bicêtre Hospital, Hôpitaux Universitaires Paris Sud, Assistance Publique des Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | | | - Guénolée de Lambert
- Department of Pediatric Surgery, Bicêtre Hospital, Hôpitaux Universitaires Paris Sud, Assistance Publique des Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - Renaud Mazeron
- Brachytherapy Unit, Department of Radiotherapy, Gustave Roussy, Villejuif, France
| | - Alexandre Escande
- Brachytherapy Unit, Department of Radiotherapy, Gustave Roussy, Villejuif, France
| | - Fanny Marsolat
- Brachytherapy Unit, Department of Radiotherapy, Gustave Roussy, Villejuif, France
| | - Isabelle Dumas
- Brachytherapy Unit, Department of Radiotherapy, Gustave Roussy, Villejuif, France
| | - Eric Deutsch
- Brachytherapy Unit, Department of Radiotherapy, Gustave Roussy, Villejuif, France; Faculté de Médecine Paris Sud, Université Paris Sud, Université Paris Saclay, Paris, France
| | | | - Georges Audry
- Department of Pediatric Surgery, Armand-Trousseau Hospital-Hôpitaux Universitaires Paris Est, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Odile Oberlin
- Department of Pediatric and Adolescent Oncology, Gustave Roussy, Villejuif, France
| | - Hélène Martelli
- Department of Pediatric Surgery, Bicêtre Hospital, Hôpitaux Universitaires Paris Sud, Assistance Publique des Hôpitaux de Paris, Le Kremlin-Bicêtre, France; Faculté de Médecine Paris Sud, Université Paris Sud, Université Paris Saclay, Paris, France
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Duché M, Ducot B, Ackermann O, Guérin F, Jacquemin E, Bernard O. Portal hypertension in children: High-risk varices, primary prophylaxis and consequences of bleeding. J Hepatol 2017; 66:320-327. [PMID: 27663417 DOI: 10.1016/j.jhep.2016.09.006] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 09/09/2016] [Accepted: 09/12/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS Primary prophylaxis of bleeding is debated for children with portal hypertension because of the limited number of studies on its safety and efficacy, the lack of a known endoscopic pattern carrying a high-risk of bleeding for all causes, and the assumption that the mortality of a first bleed is low. We report our experience with these issues. METHODS From 1989 to 2014, we managed 1300 children with portal hypertension. Endoscopic features were recorded; high-risk varices were defined as: grade 3 esophageal varices, grade 2 varices with red wale markings, or gastric varices. Two hundred forty-six children bled spontaneously and 182 underwent primary prophylaxis. The results of primary prophylaxis were reviewed as well as bleed-free survival, overall survival and life-threatening complications of bleeding. RESULTS High-risk varices were found in 96% of children who bled spontaneously and in 11% of children who did not bleed without primary prophylaxis (p<0.001), regardless of the cause of portal hypertension. Life-threatening complications of bleeding were recorded in 19% of children with cirrhosis and high-risk varices who bled spontaneously. Ten-year probabilities of bleed-free survival after primary prophylaxis in children with high-risk varices were 96% and 72% for non-cirrhotic causes and cirrhosis respectively. Ten-year probabilities of overall survival after primary prophylaxis were 100% and 93% in children with non-cirrhotic causes and cirrhosis respectively. CONCLUSION In children with portal hypertension, bleeding is linked to the high-risk endoscopic pattern reported here. Primary prophylaxis of bleeding based on this pattern is fairly effective and safe. LAY SUMMARY In children with liver disease, the risk of bleeding from varices in the esophagus is linked to their large size, the presence of congestion on their surface and their expansion into the stomach but not to the child's age nor to the cause of portal hypertension. Prevention of the first bleed in children with high-risk varices can be achieved by surgery or endoscopic treatment, and decreases mortality and morbidity.
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Affiliation(s)
- Mathieu Duché
- Hépatologie Pédiatrique and Centre de Référence National de l'Atrésie des Voies Biliaires, Hôpital Bicêtre, AP-HP and Université Paris-Sud 11, Le Kremlin-Bicêtre 94275, France; Radiologie Pédiatrique, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre 94275, France.
| | - Béatrice Ducot
- Santé Publique et Èpidémiologie, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre 94275, France; Inserm, CESP Centre for Research in Epidemiology and Population Health, U1018, Epidemiology of Reproduction and Children Development Team, 94276 Le Kremlin-Bicêtre, France; Université Paris-Sud 11, UMRS 1018, 94276 Le Kremlin-Bicêtre, France
| | - Oanez Ackermann
- Hépatologie Pédiatrique and Centre de Référence National de l'Atrésie des Voies Biliaires, Hôpital Bicêtre, AP-HP and Université Paris-Sud 11, Le Kremlin-Bicêtre 94275, France
| | - Florent Guérin
- Chirurgie Pédiatrique Hôpital Bicêtre, AP-HP and Université Paris-Sud 11, Le Kremlin-Bicêtre 94275, France
| | - Emmanuel Jacquemin
- Hépatologie Pédiatrique and Centre de Référence National de l'Atrésie des Voies Biliaires, Hôpital Bicêtre, AP-HP and Université Paris-Sud 11, Le Kremlin-Bicêtre 94275, France; Inserm U 1174, Hepatinov, Université Paris-Sud 11, Orsay 91405, France
| | - Olivier Bernard
- Hépatologie Pédiatrique and Centre de Référence National de l'Atrésie des Voies Biliaires, Hôpital Bicêtre, AP-HP and Université Paris-Sud 11, Le Kremlin-Bicêtre 94275, France
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Chargari C, Martelli H, Guérin F, de Lambert G, Mazeron R, Minard-Collin V, Dumas I, Valteau-Couanet D, Haie-Meder C. Place of Brachytherapy as Part of the Multimodal Treatment of Pediatric Bladder-Neck and/or Prostate Rhabdomyosarcoma. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Irtan S, Galmiche-Rolland L, Elie C, Orbach D, Sauvanet A, Elias D, Guérin F, Coze C, Faure-Conter C, Becmeur F, Demarche M, Galifer RB, Galloy MA, Podevin G, Aubert D, Piolat C, De Lagausie P, Sarnacki S. Recurrence of Solid Pseudopapillary Neoplasms of the Pancreas: Results of a Nationwide Study of Risk Factors and Treatment Modalities. Pediatr Blood Cancer 2016; 63:1515-21. [PMID: 27186826 DOI: 10.1002/pbc.25986] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 02/11/2016] [Accepted: 02/26/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Solid pseudopapillary neoplasms of the pancreas (SPPN) can relapse very late, but little is known about risk factors for recurrence and optimal treatment. We aimed to identify risk factors for recurrence and to analyze treatment modalities in all French pediatric cases of SPPN over the past 20 years. MATERIAL AND METHODS Data were collected from pediatric oncologists and surgeons, and also from adult pancreatic surgeons in order to identify late recurrences. RESULTS Fifty-one patients (41 girls) were identified. Median age at diagnosis was 13.1 years [8.7-17.9]. Abdominal pain was the commonest presenting symptom (32/49, 65%). The tumor was located in the pancreatic head in 24 patients (47%). Preoperative biopsy or cytology was performed in 14 cases (28%). All patients were operated with a median of 23 days [0-163] after diagnosis. The rate of postoperative morbidity was 29%. With a median follow-up of 65 months [0.3-221], the overall and event-free survival was 100% and 71%, respectively. Seven patients (13.7%) relapsed with a median of 43 months [33-94] after initial surgery. Six were treated surgically, either alone (n = 3) or with perioperative chemotherapy (n = 2) or hyperthermic intraperitoneal chemotherapy (n = 1). One patient in whom further treatment was not feasible was still alive at last news. Risk factors for recurrence were positive surgical margins (P = 0.03) and age less than 13.5 years at diagnosis (P = 0.03). CONCLUSIONS SPPN recurrence in this pediatric series was a rare and late event that did not undermine overall survival. Complete surgical removal of recurrent tumors appears to be the best option.
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Affiliation(s)
- Sabine Irtan
- Department of Pediatric Surgery, Necker Enfants-Malades Hospital-Université Paris Descartes, Sorbonne Paris Cite, Paris, France
| | - Louise Galmiche-Rolland
- Department of Pathology, Necker Enfants-Malades Hospital-Université Paris Descartes, Sorbonne Paris Cite, Paris, France
| | - Caroline Elie
- Clinical Research Unit/Clinical Investigation Centre, Necker Enfants-Malades Hospital, Paris, France
| | - Daniel Orbach
- Department of Pediatrics, Adolescents, Young Adults, Institut Curie, Groupe Fracture, French Rare Pediatric Tumors Group, Paris, France
| | - Alain Sauvanet
- Department of Hepato-Pancreato-Biliary Surgery, Pôle des Maladies de l'Appareil Digestif (PMAD), AP-HP, Hôpital Beaujon, Clichy, France
| | - Dominique Elias
- Department of Surgical Oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | - Florent Guérin
- Department of Pediatric Surgery, Hôpitaux Universitaires Paris-Sud, Bicêtre Hospital, Université Paris XI, Le Kremlin-Bicêtre, France
| | - Carole Coze
- Department of Pediatric Hematology-Oncology, Aix-Marseille Univ and APHM, Hôpital d' Enfants de La Timone, Marseille, France
| | | | - François Becmeur
- Department of Pediatric Surgery, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Martine Demarche
- Department of Pediatric Surgery, CHR de la Citadelle, Liège, Belgium
| | - René Benoît Galifer
- Department of Pediatric Surgery, Lapeyronie-Arnaud de Villeneuve Hospital, Montpellier, France
| | - Marie Agnès Galloy
- Department of Pediatric Surgery, Children's Hospital Nancy-Brabois University Hospital, Vandoeuvre-lès-Nancy, France
| | - Guillaume Podevin
- Department of Pediatric Surgery, University Hospital, Angers, France
| | - Didier Aubert
- Department of Pediatric Surgery, University Hospital, Besançon, France
| | - Christian Piolat
- Department of Pediatric Surgery, University Hospital, Grenoble, France
| | - Pascal De Lagausie
- Department of Pediatric Surgery, Aix-Marseille Univ and APHM, Hôpital d'Enfants de La Timone, Marseille, France
| | - Sabine Sarnacki
- Department of Pediatric Surgery, Necker Enfants-Malades Hospital-Université Paris Descartes, Sorbonne Paris Cite, Paris, France
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Barraud O, Isnard C, Lienhard R, Guérin F, Couvé-Deacon E, Martin C, Cattoir V, Ploy MC. Sulphonamide resistance associated with integron derivative Tn6326 in Actinotignum schaalii. J Antimicrob Chemother 2016; 71:2670-1. [PMID: 27261268 DOI: 10.1093/jac/dkw197] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- O Barraud
- INSERM, U1092, Limoges F-87000, France Université de Limoges, UMR-S1092, Faculté de Médecine, 2 rue du Dr Marcland, Limoges F-87025, France CHU Limoges, Laboratoire de Bactériologie-Virologie-Hygiène, 2 Av. Martin Luther King, Limoges F-87042, France
| | - C Isnard
- CHU de Caen, Service de Microbiologie, Caen, France Université de Caen Normandie, EA 4655 (équipe 'Antibiorésistance'), Caen, France
| | - R Lienhard
- ADMED Microbiologie, La-Chaux-de-Fonds, Switzerland
| | - F Guérin
- CHU de Caen, Service de Microbiologie, Caen, France Université de Caen Normandie, EA 4655 (équipe 'Antibiorésistance'), Caen, France CNR de la Résistance aux Antibiotiques (laboratoire associé 'Entérocoques et résistances particulières des bactéries à Gram positif'), Caen, France
| | - E Couvé-Deacon
- INSERM, U1092, Limoges F-87000, France Université de Limoges, UMR-S1092, Faculté de Médecine, 2 rue du Dr Marcland, Limoges F-87025, France CHU Limoges, Laboratoire de Bactériologie-Virologie-Hygiène, 2 Av. Martin Luther King, Limoges F-87042, France
| | - C Martin
- INSERM, U1092, Limoges F-87000, France Université de Limoges, UMR-S1092, Faculté de Médecine, 2 rue du Dr Marcland, Limoges F-87025, France CHU Limoges, Laboratoire de Bactériologie-Virologie-Hygiène, 2 Av. Martin Luther King, Limoges F-87042, France
| | - V Cattoir
- CHU de Caen, Service de Microbiologie, Caen, France Université de Caen Normandie, EA 4655 (équipe 'Antibiorésistance'), Caen, France CNR de la Résistance aux Antibiotiques (laboratoire associé 'Entérocoques et résistances particulières des bactéries à Gram positif'), Caen, France
| | - M C Ploy
- INSERM, U1092, Limoges F-87000, France Université de Limoges, UMR-S1092, Faculté de Médecine, 2 rue du Dr Marcland, Limoges F-87025, France CHU Limoges, Laboratoire de Bactériologie-Virologie-Hygiène, 2 Av. Martin Luther King, Limoges F-87042, France
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de Lambert G, Lardy H, Martelli H, Orbach D, Gauthier F, Guérin F. Surgical Management of Neuroendocrine Tumors of the Appendix in Children and Adolescents: A Retrospective French Multicenter Study of 114 Cases. Pediatr Blood Cancer 2016; 63:598-603. [PMID: 26663900 DOI: 10.1002/pbc.25823] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 10/06/2015] [Accepted: 10/06/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND Right hemicolectomy (RHC) in patients with neuroendocrine tumors (NET) of the appendix has been advocated for tumors more than 2 cm, or with mesoappendix/vessel invasion, or with raised mitotic activity. No study demonstrated prolonged survival with RHC over appendectomy alone. The aim of this study was to contribute to define guidelines for secondary surgery in children or adolescents with NET of the appendix. PROCEDURE We contacted all French pediatric surgeons and oncologists by mail, and reviewed the records of patients under 18 with NET of the appendix from 1988 until 2012. RESULTS A total of 114 patients were recorded with a female/male ratio of 1.6. Median age at presentation was 12 years (range: 5-17 years). Ten patients had a tumor more than 2 cm. Twenty patients had evidence of extension into the mesoappendix, including five with blood or lymph vessels' invasion. Solely, one patient had a tumor with a high proliferative index. Incomplete resection was observed in three cases. Eighty-five patients had no criterion for secondary surgery. Twenty-nine patients had criteria for RHC but only 10 underwent surgery. None of the resected specimens showed carcinoid tumor. Three patients had positive lymph nodes. At the last follow-up, all patients were alive and disease free. CONCLUSION Appendectomy alone seems to be curative of these tumors with no influence on life expectancy. Follow-up is not only unnecessary, but its means, whether clinical, radiological or biological, are ineffective.
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Affiliation(s)
- Guénolée de Lambert
- Department of Pediatric Surgery, Hôpital Bicêtre, Hôpitaux Universitaires Paris Sud, Le Kremlin-Bicêtre, France
| | - Hubert Lardy
- Department of Pediatric Surgery, CHRU de Tours, Hôpital Clocheville, Tours, France
| | - Hélène Martelli
- Department of Pediatric Surgery, Hôpital Bicêtre, Hôpitaux Universitaires Paris Sud, Le Kremlin-Bicêtre, France
| | - Daniel Orbach
- Department of Pediatric and Adolescent Oncology, Institut Curie, Paris, France
| | - Frédéric Gauthier
- Department of Pediatric Surgery, Hôpital Bicêtre, Hôpitaux Universitaires Paris Sud, Le Kremlin-Bicêtre, France
| | - Florent Guérin
- Department of Pediatric Surgery, Hôpital Bicêtre, Hôpitaux Universitaires Paris Sud, Le Kremlin-Bicêtre, France
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Alexandre K, Chau F, Guérin F, Massias L, Lefort A, Cattoir V, Fantin B. Activity of temocillin in a lethal murine model of infection of intra-abdominal origin due to KPC-producing Escherichia coli. J Antimicrob Chemother 2016; 71:1899-904. [PMID: 27029848 DOI: 10.1093/jac/dkw066] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 02/17/2016] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVES Temocillin is a 6-α-methoxy derivative of ticarcillin that shows in vitro activity against Enterobacteriaceae producing Klebsiella pneumoniae carbapenemase (KPC). Our objective was to assess in vivo temocillin activity against KPC-producing Escherichia coli. METHODS Isogenic derivatives of the WT E. coli CFT073 producing KPC-2, KPC-3 or OXA-48 were constructed. An experimental murine model of intra-abdominal infection with sepsis was used. Mice were treated subcutaneously with temocillin 200 mg/kg every 2 h for 24 h, reproducing the duration of time that the free serum concentration of temocillin exceeded the MIC in humans with a regimen of 2 g every 12 h or 2 g every 8 h. Blood, peritoneal fluid (PF) and spleen were collected; 24 h survival and sterility rates were assessed. RESULTS Temocillin MICs were 8, 16, 32, and 256 mg/L for the susceptible strain and KPC-2-, KPC-3-, and OXA-48-producing strains, respectively. In mice treated with temocillin, significant bacterial reduction was obtained in PF, blood, and spleen for the susceptible strain and KPC-2- and KPC-3-producing strains (P < 0.001) but not for the OXA-48-producing strain. Sterility rates in PF were 53%, 10%, 0% and 0% (P < 0.001) and sterility rates in blood were 77%, 40%, 3% and 0% (P < 0.001), while survival rates were 97%, 97%, 57%, 0% (P < 0.001) for mice infected with the susceptible strain and KPC-2-, KPC-3- and OXA-48-producing strains, respectively. CONCLUSIONS In a lethal-infection model with bacteraemia from intra-abdominal origin, temocillin retained significant activity in PF, blood and spleen and prevented death in mice by effectively working against KPC-producing E. coli with temocillin MICs ≤16 mg/L.
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Affiliation(s)
- K Alexandre
- INSERM, IAME, UMR 1137, F-75018 Paris, France
| | - F Chau
- INSERM, IAME, UMR 1137, F-75018 Paris, France Université Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, F-75018 Paris, France
| | - F Guérin
- Université de Caen Basse-Normandie, EA 4655 (Équipe "Antibio-résistance"), F-14032 Caen, France CHU de Caen, Service de Microbiologie, F-14033 Caen, France
| | - L Massias
- INSERM, IAME, UMR 1137, F-75018 Paris, France AP-HP, Groupe Hospitalier Paris Nord Val de Seine, Laboratoire de Pharmacologie, F-75018 Paris, France
| | - A Lefort
- INSERM, IAME, UMR 1137, F-75018 Paris, France Université Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, F-75018 Paris, France AP-HP, Groupe Hospitalier Paris Nord Val de Seine, Service de Médecine Interne, F-92210 Clichy, France
| | - V Cattoir
- Université de Caen Basse-Normandie, EA 4655 (Équipe "Antibio-résistance"), F-14032 Caen, France CHU de Caen, Service de Microbiologie, F-14033 Caen, France
| | - B Fantin
- INSERM, IAME, UMR 1137, F-75018 Paris, France Université Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, F-75018 Paris, France AP-HP, Groupe Hospitalier Paris Nord Val de Seine, Service de Médecine Interne, F-92210 Clichy, France
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Serça D, Deshmukh C, Pighini S, Oudone P, Vongkhamsao A, Guédant P, Rode W, Godon A, Chanudet V, Descloux S, Guérin F. Nam Theun 2 Reservoir four years after commissioning: significance of drawdown methane emissions and other pathways. ACTA ACUST UNITED AC 2016. [DOI: 10.1051/hydro/2016001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Martelli H, Borrego P, Guérin F, Boubnova J, Minard-Colin V, Dumas I, Chargari C, Haie-Meder C. Quality of life and functional outcome of male patients with bladder-prostate rhabdomyosarcoma treated with conservative surgery and brachytherapy during childhood. Brachytherapy 2016; 15:306-311. [PMID: 26895712 DOI: 10.1016/j.brachy.2016.01.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 01/14/2016] [Accepted: 01/15/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE The aim of this study was to report the long-term results of a conservative local treatment of male patients with bladder-prostate rhabdomyosarcoma (BPRMS) focusing on their outcome and quality of life (QoL). METHODS AND MATERIALS From 1991 to 2007, 27 male patients were treated by a single team, according to the ongoing European protocols. Surgical procedure was partial cystectomy or partial prostatectomy or both, followed by low-dose-rate interstitial brachytherapy. Three patients died of metastases and two were excluded; 22 patients, who were long-term survivors with their bladder, received a QoL questionnaire derived from the International Workshop on BPRMS. Urodynamic studies were performed when patients had abnormal continence. RESULTS Median age at surgery was 24 months (14 months-11 years). Median followup after surgery was 10 years (5-21 years); 18 male patients (77%) completed the questionnaire at a median age of 13 years (7-25 years); 13 considered themselves as having a normal QoL, with normal urinary continence (9 of 13) or very rare diurnal dribbling (4 of 13). Four male patients had frequent diurnal dribbling requiring protection for three of them and one was submitted to intermittent catheterism for a postoperative neurogenic bladder. Urodynamic studies were performed in 11 patients with urinary disturbance, often revealing detrusor sphincter dyssynergia. All pubertal patients considered themselves as having normal erections. Three sexually active patients reported having satisfying sex and orgasms. Two patients had normal ejaculations. CONCLUSIONS The majority of long-term male survivors (76%) within this cohort considered themselves as having a normal QoL after the combined conservative local treatment of their BPRMS.
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Affiliation(s)
- Hélène Martelli
- Department of Pediatric Surgery, Bicetre Hospital, Hôpitaux Universitaires Paris Sud, Le Kremlin-Bicetre, France.
| | - Paula Borrego
- Department of Pediatric Surgery, CHU de Montpellier, Université de Montpellier 1, Montpellier, France
| | - Florent Guérin
- Department of Pediatric Surgery, Bicetre Hospital, Hôpitaux Universitaires Paris Sud, Le Kremlin-Bicetre, France
| | - Julia Boubnova
- Department of Pediatric Surgery, Hôpital La Timone, APHM, Marseille, France
| | | | - Isabelle Dumas
- Department of Physics, Gustave Roussy, Villejuif, France
| | - Cyrus Chargari
- Department of Brachytherapy, Gustave Roussy, Villejuif, France
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Guérin F, Franchi-Abella S. Re: Hepatocellular nodules resulting from congenital extrahepatic portosystemic shunts can differentiate into potentially malignant hepatocellular adenomas. J Hepatobiliary Pancreat Sci 2016; 22:E51. [PMID: 26768670 DOI: 10.1002/jhbp.290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 10/08/2015] [Indexed: 12/22/2022]
Affiliation(s)
- Florent Guérin
- Department of Paediatric Surgery, Hôpital Bicêtre, Hôpitaux Universitaires Paris-Sud, Assistance Publique Hôpitaux de Paris and University Paris Sud, Paris, France.
| | - Stéphanie Franchi-Abella
- Department of Paediatric Radiology, Hôpital Bicêtre, Hôpitaux Universitaires Paris-Sud, Assistance Publique Hôpitaux de Paris and University Paris Sud, Paris, France
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Vergne A, Guérin F, Lienhard R, Le Coustumier A, Daurel C, Isnard C, Marty N, Poyart C, Cattoir V. In vitro antimicrobial susceptibility of Helcococcus kunzii and molecular analysis of macrolide and tetracycline resistance. Eur J Clin Microbiol Infect Dis 2015; 34:2057-61. [PMID: 26194694 DOI: 10.1007/s10096-015-2451-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 07/03/2015] [Indexed: 11/25/2022]
Abstract
Thanks to the recent advent of matrix-assisted laser desorption/ionisation time-of-flight (MALDI-TOF) technology, Helcococcus kunzii is now easily identifiable and considered as an opportunistic pathogen. However, data about antimicrobial susceptibilities remain very limited. The aim of the study was, then, to assess its in vitro susceptibility to 18 antimicrobial agents and to investigate the genetic basis of macrolide and tetracycline resistance. Thirty-nine human clinical isolates of H. kunzii collected from 2008 to 2013 were studied, as well as the type strain ATCC 51366(T). Minimum inhibitory concentrations (MICs) of penicillin G, amoxicillin, cefotaxime, imipenem, gentamicin, erythromycin, clindamycin, quinupristin-dalfopristin, ciprofloxacin, levofloxacin, tetracycline, tigecycline, vancomycin, teicoplanin, linezolid, daptomycin, cotrimoxazole and rifampin were determined by the microdilution method. Screening for macrolide [erm(A) including erm(TR), erm(B), erm(C), erm(F), erm(T), erm(X), msr(A) and mef(A)] and tetracycline [tet(L), tet(M) and tet(O)] resistance genes was performed, as well as the detection of mutations in 23S rRNA. Except for one strain resistant to cefotaxime, all strains were categorised as susceptible to β-lactams, glycopeptides, linezolid, daptomycin and tigecycline. Whereas ciprofloxacin and gentamicin exhibited limited activity, 95% of strains were categorised as susceptible to levofloxacin. Concerning erythromycin, a bimodal distribution was observed, with 29 'wild-type' strains (MICs from 0.25 to 2 mg/L) and 11 'resistant' strains (MICs ≥ 256 mg/L), including ten harbouring erm(TR). Two isolates exhibited acquired tetracycline resistance (MICs of 16 mg/L) by the production of tet(M). This large study on the in vitro antimicrobial susceptibility of H. kunzii suggests that β-lactams (especially penicillins) should be preferred for the treatment.
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Affiliation(s)
- A Vergne
- Laboratoire de Biologie, CH de Cahors, Cahors, France
| | - F Guérin
- Service de Microbiologie & CNR de la Résistance aux Antibiotiques, CHU de Caen, Caen, France.,Université de Caen Basse-Normandie, EA4655 (équipe "Antibio-résistance"), Caen, France
| | - R Lienhard
- ADMED Microbiologie, La Chaux-de-Fonds, Switzerland
| | | | - C Daurel
- Service de Microbiologie & CNR de la Résistance aux Antibiotiques, CHU de Caen, Caen, France
| | - C Isnard
- Service de Microbiologie & CNR de la Résistance aux Antibiotiques, CHU de Caen, Caen, France.,Université de Caen Basse-Normandie, EA4655 (équipe "Antibio-résistance"), Caen, France
| | - N Marty
- Service de Bactériologie-Hygiène, CHU de Toulouse, Toulouse, France
| | - C Poyart
- Service de Bactériologie & CNR des Streptocoques, GH Cochin-Hôtel Dieu-Broca, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - V Cattoir
- Service de Microbiologie & CNR de la Résistance aux Antibiotiques, CHU de Caen, Caen, France. .,Université de Caen Basse-Normandie, EA4655 (équipe "Antibio-résistance"), Caen, France.
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de Lambert G, Poirot C, Guérin F, Brugières L, Martelli H. La préservation de la fertilité dans les cancers de l’enfant. Bull Cancer 2015; 102:436-42. [DOI: 10.1016/j.bulcan.2015.02.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 02/19/2015] [Indexed: 12/11/2022]
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de La Blanchardière A, Dargère S, Guérin F, Daurel C, Saint-Lorant G, Verdon R, Cattoir V. Non-carbapenem therapy of urinary tract infections caused by extended-spectrum β-lactamase-producing Enterobacteriaceae. Med Mal Infect 2015; 45:169-72. [PMID: 25845927 DOI: 10.1016/j.medmal.2015.03.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 02/06/2015] [Accepted: 03/09/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE We determined the prevalence of ESBL Enterobacteriaceae in urinary tract infections among inpatients, identified risk factors of acquisition, and evaluated the effectiveness of alternatives to carbapenems. METHODS The clinical, microbiological, and therapeutic data as well as the outcomes were recorded for all ESBL-E positive urine samples for three months. RESULTS Thirty-one (4%) of the 762 Enterobacteriaceae positive cultures were ESBL producers. The predisposing conditions for being infected with those strains were: immunodepression (61%), recent hospitalization (52%), recent antibiotic therapy (52%), and urinary catheterization (61%). 19% of infections were community acquired. The seven cases of acute pyelonephritis and five of prostatitis were treated with piperacillin-tazobactam (5), fluoroquinolones (4), ceftazidime (2), or carbapenems (only 1) after specialized advice. Four (33%) patients relapsed at week 10: three were immunodepressed and three presented with bacteremia. CONCLUSIONS Alternatives to carbapenems (especially piperacillin-tazobactam) seem to be a good option for non-bacteremic UTI in immunocompetent patients.
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Affiliation(s)
- A de La Blanchardière
- Service des maladies infectieuses, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex 9, France.
| | - S Dargère
- Service des maladies infectieuses, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex 9, France
| | - F Guérin
- Service de microbiologie, CHU de Caen, Caen, France
| | - C Daurel
- Service de microbiologie, CHU de Caen, Caen, France
| | | | - R Verdon
- Service des maladies infectieuses, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex 9, France
| | - V Cattoir
- Service de microbiologie, CHU de Caen, Caen, France
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