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Arquillière J, Dubois A, Rullier E, Rouanet P, Denost Q, Celerier B, Pezet D, Passot G, Aboukassem A, Colombo PE, Mourregot A, Carrere S, Vaudoyer D, Gourgou S, Gauthier L, Cotte E. Learning curve for robotic-assisted total mesorectal excision: a multicentre, prospective study. Colorectal Dis 2023; 25:1863-1877. [PMID: 37525421 DOI: 10.1111/codi.16695] [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: 01/19/2023] [Revised: 05/19/2023] [Accepted: 06/26/2023] [Indexed: 08/02/2023]
Abstract
AIM Robotic-assisted surgery (RAS) is becoming increasingly important in colorectal surgery. Recognition of the short, safe learning curve (LC) could potentially improve implementation. We evaluated the extent and safety of the LC in robotic resection for rectal cancer. METHOD Consecutive rectal cancer resections (January 2018 to February 2021) were prospectively included from three French centres, involving nine surgeons. LC analyses only included surgeons who had performed more than 25 robotic rectal cancer surgeries. The primary endpoint was operating time LC and the secondary endpoint conversion rate LC. Interphase comparisons included demographic and intraoperative data, operating time, conversion rate, pathological specimen features and postoperative morbidity. RESULTS In 174 patients (69% men; mean age 62.6 years) the mean operating time was 334.5 ± 92.1 min. Operative procedures included low anterior resection (n = 143) and intersphincteric resection (n = 31). For operating time, there were two or three (centre-dependent) LC phases. After 12-21 cases (learning phase), there was a significant decrease in total operating time (all centres) and an increase in the number of harvested lymph nodes (two centres). For conversion rate, there were two or four LC phases. After 9-14 cases (learning phase), the conversion rate decreased significantly in two centres; in one centre, there was a nonsignificant decrease despite the treatment of significantly more obese patients and patients with previous abdominal surgery. There were no significant differences in interphase comparisons. CONCLUSION The LC for RAS in rectal cancer was achieved after 12-21 cases for the operating time and 9-14 cases for the conversion rate. RAS for rectal cancer was safe during this time, with no interphase differences in postoperative complications and circumferential resection margin.
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Affiliation(s)
- J Arquillière
- Department of Digestive and Oncological Surgery, Lyon University Hospital, Lyon-Sud Hospital, Pierre-Bénite, France
| | - A Dubois
- Department of Colorectal Surgery, CHU Estaing, Clermont-Ferrand, France
| | - E Rullier
- Department of Digestive Surgery, Colorectal Unit, Bordeaux University Hospital, Haut-Lévèque Hospital, Pessac, France
| | - P Rouanet
- Department of Colorectal Surgery, Institut Du Cancer De Montpellier, Montpellier, France
| | - Q Denost
- Bordeaux Colorectal Institute, Clinique Tivoli, Bordeaux, France
| | - B Celerier
- Department of Digestive Surgery, Colorectal Unit, Bordeaux University Hospital, Haut-Lévèque Hospital, Pessac, France
| | - D Pezet
- Department of Colorectal Surgery, CHU Estaing, Clermont-Ferrand, France
| | - G Passot
- Department of Digestive and Oncological Surgery, Lyon University Hospital, Lyon-Sud Hospital, Pierre-Bénite, France
- Lyon Center for Innovation in Cancer, CICLY EA 3738, Lyon 1 University, Lyon, France
| | - A Aboukassem
- Department of Colorectal Surgery, CHU Estaing, Clermont-Ferrand, France
| | - P E Colombo
- Department of Colorectal Surgery, Institut Du Cancer De Montpellier, Montpellier, France
| | - A Mourregot
- Department of Colorectal Surgery, Institut Du Cancer De Montpellier, Montpellier, France
| | - S Carrere
- Department of Colorectal Surgery, Institut Du Cancer De Montpellier, Montpellier, France
| | - D Vaudoyer
- Department of Digestive and Oncological Surgery, Lyon University Hospital, Lyon-Sud Hospital, Pierre-Bénite, France
- Lyon Center for Innovation in Cancer, CICLY EA 3738, Lyon 1 University, Lyon, France
| | - S Gourgou
- Biometrics Unit, Montpellier Cancer Institute (ICM), University of Montpellier, Montpellier, France
| | - L Gauthier
- Biometrics Unit, Montpellier Cancer Institute (ICM), University of Montpellier, Montpellier, France
| | - E Cotte
- Department of Digestive and Oncological Surgery, Lyon University Hospital, Lyon-Sud Hospital, Pierre-Bénite, France
- Lyon Center for Innovation in Cancer, CICLY EA 3738, Lyon 1 University, Lyon, France
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2
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Leborne P, Néron M, Colombo PE. An anatomical variation during para-aortic lymphadenectomy. J Visc Surg 2022; 159:528-530. [PMID: 35659774 DOI: 10.1016/j.jviscsurg.2022.05.001] [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] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Failure to identify anatomical variations may contribute to surgical errors or perioperative complications during abdominal and oncological surgery. We report the case of an anatomical variation of the inferior vena cava revealed during para-aortic lymphadenectomy for advanced ovarian cancer. Due to renal insufficiency, preoperative CT-scan was performed without contrast injection and the variation was not clearly detected. Our clinical case underlines the importance of the preoperative diagnosis of anatomical variations and highlights the need to provide young surgeons with adequate technical training in para-aortic lymphadenectomy.
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Affiliation(s)
- P Leborne
- Department of Surgical Oncology, Institut du Cancer de Montpellier (ICM Val d'Aurelle), 208, avenue des Apothicaires, 34298 Montpellier, France
| | - M Néron
- Department of Surgical Oncology, Institut du Cancer de Montpellier (ICM Val d'Aurelle), 208, avenue des Apothicaires, 34298 Montpellier, France
| | - P E Colombo
- Department of Surgical Oncology, Institut du Cancer de Montpellier (ICM Val d'Aurelle), 208, avenue des Apothicaires, 34298 Montpellier, France.
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Houvenaeghel G, Cohen M, Classe JM, Reyal F, Mazouni C, Chopin N, Martinez A, Daraï E, Coutant C, Colombo PE, Gimbergues P, Chauvet MP, Azuar AS, Rouzier R, Tunon de Lara C, Muracciole X, Agostini A, Bannier M, Charaffe Jauffret E, De Nonneville A, Goncalves A. Lymphovascular invasion has a significant prognostic impact in patients with early breast cancer, results from a large, national, multicenter, retrospective cohort study. ESMO Open 2021; 6:100316. [PMID: 34864349 PMCID: PMC8645922 DOI: 10.1016/j.esmoop.2021.100316] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/28/2021] [Accepted: 10/31/2021] [Indexed: 11/17/2022] Open
Abstract
Background We determined the prognostic impact of lymphovascular invasion (LVI) in a large, national, multicenter, retrospective cohort of patients with early breast cancer (BC) according to numerous factors. Patients and methods We collected data on 17 322 early BC patients treated in 13 French cancer centers from 1991 to 2013. Survival functions were calculated using the Kaplan–Meier method and multivariate survival analyses were carried out using the Cox proportional hazards regression model adjusted for significant variables associated with LVI or not. Two propensity score-based matching approaches were used to balance differences in known prognostic variables associated with LVI status and to assess the impact of adjuvant chemotherapy (AC) in LVI-positive luminal A-like patients. Results LVI was present in 24.3% (4205) of patients. LVI was significantly and independently associated with all clinical and pathological characteristics analyzed in the entire population and according to endocrine receptor (ER) status except for the time period in binary logistic regression. According to multivariate analyses including ER status, AC, grade, and tumor subtypes, the presence of LVI was significantly associated with a negative prognostic impact on overall (OS), disease-free (DFS), and metastasis-free survival (MFS) in all patients [hazard ratio (HR) = 1.345, HR = 1.312, and HR = 1.415, respectively; P < 0.0001], which was also observed in the propensity score-based analysis in addition to the association of AC with a significant increase in both OS and DFS in LVI-positive luminal A-like patients. LVI did not have a significant impact in either patients with ER-positive grade 3 tumors or those with AC-treated luminal A-like tumors. Conclusion The presence of LVI has an independent negative prognostic impact on OS, DFS, and MFS in early BC patients, except in ER-positive grade 3 tumors and in those with luminal A-like tumors treated with AC. Therefore, LVI may indicate the existence of a subset of luminal A-like patients who may still benefit from adjuvant therapy. In a study of 17 322 early BC patients, LVI had a significant independent negative prognostic impact on survival. LVI negatively impacted survival in almost every patient category and cancer subtype, with and without AC. LVI did not have a negative survival impact in patients with ER+ grade 3 or with luminal A-like tumors with chemotherapy. Results suggest a possible benefit of AC in LVI-positive luminal A-like patients.
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Affiliation(s)
- G Houvenaeghel
- Department of Surgical Oncology, CRCM, Institut Paoli-Calmettes, Aix-Marseille University, CNRS, INSERM, Marseille, France.
| | - M Cohen
- Department of Surgical Oncology, CRCM, Institut Paoli-Calmettes, Aix-Marseille University, CNRS, INSERM, Marseille, France
| | - J M Classe
- Institut René Gauducheau, Site Hospitalier Nord, St Herblain, France
| | - F Reyal
- Institut Curie, Paris, France
| | - C Mazouni
- Institut Gustave Roussy, Villejuif, France
| | - N Chopin
- Centre Léon Bérard, Lyon, France
| | - A Martinez
- Centre Claudius Regaud, Toulouse, France
| | - E Daraï
- Hôpital Tenon, Paris, France
| | - C Coutant
- Centre Georges François Leclerc, Dijon, France
| | | | | | | | - A S Azuar
- Hôpital de Grasse, Chemin de Clavary, Grasse, France
| | - R Rouzier
- Hôpital René Huguenin, Saint Cloud, France
| | | | | | - A Agostini
- Department of Obstetrics and Gynocology, Hôpital de la Conception, Marseille, France
| | - M Bannier
- Department of Surgical Oncology, CRCM, Institut Paoli-Calmettes, Aix-Marseille University, CNRS, INSERM, Marseille, France
| | - E Charaffe Jauffret
- Department of Pathology, CRCM, Institut Paoli-Calmettes, Aix-Marseille University, Marseille, France
| | - A De Nonneville
- Department of Medical Oncology, CRCM, Institut Paoli-Calmettes, Aix-Marseille University, CNRS, INSERM, Marseille, France
| | - A Goncalves
- Department of Medical Oncology, CRCM, Institut Paoli-Calmettes, Aix-Marseille University, CNRS, INSERM, Marseille, France
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Berta L, Rizzetto F, De Mattia C, Lizio D, Felisi M, Colombo PE, Carrazza S, Gelmini S, Bianchi L, Artioli D, Travaglini F, Vanzulli A, Torresin A. Automatic lung segmentation in COVID-19 patients: Impact on quantitative computed tomography analysis. Phys Med 2021; 87:115-122. [PMID: 34139383 PMCID: PMC9188767 DOI: 10.1016/j.ejmp.2021.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/05/2021] [Accepted: 06/04/2021] [Indexed: 12/04/2022] Open
Abstract
Purpose To assess the impact of lung segmentation accuracy in an automatic pipeline for quantitative analysis of CT images. Methods Four different platforms for automatic lung segmentation based on convolutional neural network (CNN), region-growing technique and atlas-based algorithm were considered. The platforms were tested using CT images of 55 COVID-19 patients with severe lung impairment. Four radiologists assessed the segmentations using a 5-point qualitative score (QS). For each CT series, a manually revised reference segmentation (RS) was obtained. Histogram-based quantitative metrics (QM) were calculated from CT histogram using lung segmentationsfrom all platforms and RS. Dice index (DI) and differences of QMs (ΔQMs) were calculated between RS and other segmentations. Results Highest QS and lower ΔQMs values were associated to the CNN algorithm. However, only 45% CNN segmentations were judged to need no or only minimal corrections, and in only 17 cases (31%), automatic segmentations provided RS without manual corrections. Median values of the DI for the four algorithms ranged from 0.993 to 0.904. Significant differences for all QMs calculated between automatic segmentations and RS were found both when data were pooled together and stratified according to QS, indicating a relationship between qualitative and quantitative measurements. The most unstable QM was the histogram 90th percentile, with median ΔQMs values ranging from 10HU and 158HU between different algorithms. Conclusions None of tested algorithms provided fully reliable segmentation. Segmentation accuracy impacts differently on different quantitative metrics, and each of them should be individually evaluated according to the purpose of subsequent analyses.
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Affiliation(s)
- L Berta
- Department of Medical Physics, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
| | - F Rizzetto
- Department of Radiology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy; Postgraduate School of Diagnostic and Interventional Radiology, Università degli Studi di Milano, via Festa del Perdono 7, 20122, Milan, Italy
| | - C De Mattia
- Department of Medical Physics, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
| | - D Lizio
- Department of Medical Physics, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
| | - M Felisi
- Department of Medical Physics, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
| | - P E Colombo
- Department of Medical Physics, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
| | - S Carrazza
- Department of Physics, Università degli Studi di Milano, via Giovanni Celoria 16, 20133 Milan, Italy; Department of Physics, INFN Sezione di Milano, via Giovanni Celoria 16, 20133 Milan, Italy
| | - S Gelmini
- Department of Physics, Università degli Studi di Milano, via Giovanni Celoria 16, 20133 Milan, Italy
| | - L Bianchi
- Department of Radiology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy; Postgraduate School of Diagnostic and Interventional Radiology, Università degli Studi di Milano, via Festa del Perdono 7, 20122, Milan, Italy
| | - D Artioli
- Department of Radiology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
| | - F Travaglini
- Department of Radiology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
| | - A Vanzulli
- Department of Radiology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy; Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, via Festa del Perdono 7, 20122, Milan, Italy
| | - A Torresin
- Department of Medical Physics, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy; Department of Physics, Università degli Studi di Milano, via Giovanni Celoria 16, 20133 Milan, Italy.
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5
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Berta L, De Mattia C, Rizzetto F, Carrazza S, Colombo PE, Fumagalli R, Langer T, Lizio D, Vanzulli A, Torresin A. A patient-specific approach for quantitative and automatic analysis of computed tomography images in lung disease: Application to COVID-19 patients. Phys Med 2021; 82:28-39. [PMID: 33567361 PMCID: PMC7843021 DOI: 10.1016/j.ejmp.2021.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 12/22/2020] [Accepted: 01/06/2021] [Indexed: 01/17/2023] Open
Abstract
PURPOSE Quantitative metrics in lung computed tomography (CT) images have been widely used, often without a clear connection with physiology. This work proposes a patient-independent model for the estimation of well-aerated volume of lungs in CT images (WAVE). METHODS A Gaussian fit, with mean (Mu.f) and width (Sigma.f) values, was applied to the lower CT histogram data points of the lung to provide the estimation of the well-aerated lung volume (WAVE.f). Independence from CT reconstruction parameters and respiratory cycle was analysed using healthy lung CT images and 4DCT acquisitions. The Gaussian metrics and first order radiomic features calculated for a third cohort of COVID-19 patients were compared with those relative to healthy lungs. Each lung was further segmented in 24 subregions and a new biomarker derived from Gaussian fit parameter Mu.f was proposed to represent the local density changes. RESULTS WAVE.f resulted independent from the respiratory motion in 80% of the cases. Differences of 1%, 2% and up to 14% resulted comparing a moderate iterative strength and FBP algorithm, 1 and 3 mm of slice thickness and different reconstruction kernel. Healthy subjects were significantly different from COVID-19 patients for all the metrics calculated. Graphical representation of the local biomarker provides spatial and quantitative information in a single 2D picture. CONCLUSIONS Unlike other metrics based on fixed histogram thresholds, this model is able to consider the inter- and intra-subject variability. In addition, it defines a local biomarker to quantify the severity of the disease, independently of the observer.
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Affiliation(s)
- L Berta
- Department of Medical Physics, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, Milan 20162, Italy
| | - C De Mattia
- Department of Medical Physics, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, Milan 20162, Italy
| | - F Rizzetto
- Department of Radiology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, Milan 20162, Italy
| | - S Carrazza
- Department of Physics, Università degli Studi di Milano and INFN Sezione di Milano, via Giovanni Celoria 16, Milan 20133, Italy
| | - P E Colombo
- Department of Medical Physics, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, Milan 20162, Italy; Department of Physics, Università degli Studi di Milano and INFN Sezione di Milano, via Giovanni Celoria 16, Milan 20133, Italy
| | - R Fumagalli
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy; Department of Anaesthesia and Intensive Care Medicine, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, Milan 20162, Italy
| | - T Langer
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy; Department of Anaesthesia and Intensive Care Medicine, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, Milan 20162, Italy
| | - D Lizio
- Department of Medical Physics, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, Milan 20162, Italy
| | - A Vanzulli
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, via Festa del Perdono 7, Milan 20122, Italy; Department of Radiology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, Milan 20162, Italy
| | - A Torresin
- Department of Medical Physics, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, Milan 20162, Italy; Department of Physics, Università degli Studi di Milano and INFN Sezione di Milano, via Giovanni Celoria 16, Milan 20133, Italy.
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Carrier G, Colombo PE, Mourregot A. Management of diaphragmatic peritoneal metastasis from recurrent ovarian cancer with pericardial invasion. J Visc Surg 2020; 158:89-91. [PMID: 32553557 DOI: 10.1016/j.jviscsurg.2020.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- G Carrier
- Department of Surgical Oncology, Cancer Institute of Montpellier (ICM), 208, avenue des Apothicaires, 34298 Montpellier, France.
| | - P E Colombo
- Department of Surgical Oncology, Cancer Institute of Montpellier (ICM), 208, avenue des Apothicaires, 34298 Montpellier, France
| | - A Mourregot
- Department of Surgical Oncology, Cancer Institute of Montpellier (ICM), 208, avenue des Apothicaires, 34298 Montpellier, France
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Lécuru F, Bakrin N, Classe JM, Colombo PE, Ferron G, Freyer G, Glehen O, Gouy S, Huchon C, Narducci F, Pocard M, Pomel C, Rouzier R. [CHIP and ovarian cancer]. Gynecol Obstet Fertil Senol 2019; 47:617-618. [PMID: 31252153 DOI: 10.1016/j.gofs.2019.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Indexed: 06/09/2023]
Affiliation(s)
- F Lécuru
- Service de chirurgie cancérologique gynécologique et du Sein, hôpital européen Georges Pompidou, AP-HP, 75015 Paris, France; Faculté de médecine, université Paris Descartes, 75006 Paris, France; UMR S1124, université Paris Descartes, 75006 Paris, France.
| | - N Bakrin
- Chirurgie générale, oncologique et endocrinienne, centre hospitalier Lyon Sud, hospices civils de Lyon, 69495 Pierre-Bénite, France; EMR 3738, faculté Lyon Sud Charles Mérieux, université Lyon 1, 69000 Lyon, France
| | - J M Classe
- Chirurgie oncologique, institut de cancérologie de l'Ouest, 44000 Nantes, France; Faculté de médecine, université de Nantes, 44000 Nantes, France
| | - P E Colombo
- Département de chirurgie, Centre Val d'Aurelle, 34000 Montpellier, France
| | - G Ferron
- Institut universitaire du Cancer, 31100 Toulouse, France
| | - G Freyer
- Service d'onclogie médicale, institut de cancérologie des hospices civils de Lyon, 69000 Lyon, France; Université Lyon 1, 69000 Lyon, France
| | - O Glehen
- Chirurgie générale, oncologique et endocrinienne, centre hospitalier Lyon Sud, hospices civils de Lyon, 69495 Pierre-Bénite, France; EMR 3738, faculté Lyon Sud Charles Mérieux, université Lyon 1, 69000 Lyon, France
| | - S Gouy
- Département de chirurgie, institut Gustave Roussy, 94800 Villejuif, France
| | - C Huchon
- Service de gynécologie et obstétrique, université Versailles-Saint-Quentin en Yvelines, CHI Poissy-St-Germain, 10, rue du champ Gaillard, BP 3082, 78303 Poissy cedex, France; EA 7285 Risques cliniques et sécurité en santé des femmes, université Versailles-Saint-Quentin en Yvelines, 78000 Versailles, France
| | - F Narducci
- Centre Oscar Lambret, 59000 Lille, France
| | - M Pocard
- Unité Inserm U1275, université Paris 7, CAP Paris-Tech : Carcinose Péritoine Paris technologique, hôpital Lariboisière, 2, rue Ambroise Paré, 75475 Paris cedex 10, France; Chirurgie digestive cancérologique, hôpital Lariboisière, Assistance publique des Hôpitaux de Paris, 2, rue Ambroise Paré, 75475 Paris cedex 10, France
| | - C Pomel
- Service de chirurgie oncologique, Centre Jean Perrin, 63011 Clermont-Ferrand, France; Université d'Auvergne, 63011 Clermont-Ferrand, France
| | - R Rouzier
- Département de chirurgie, institut Curie, 92210 Saint-Cloud, France; Université Versailles St Quentin, 78000 Versailles, France
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Affiliation(s)
- G Carrier
- Surgical oncology department, institut du cancer de Montpellier (ICM), 34298 Montpellier, France.
| | - P Rouanet
- Surgical oncology department, institut du cancer de Montpellier (ICM), 34298 Montpellier, France
| | - P E Colombo
- Surgical oncology department, institut du cancer de Montpellier (ICM), 34298 Montpellier, France
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9
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Houvenaeghel G, de Nonneville A, Cohen M, Classe JM, Reyal F, Mazouni C, Chopin N, Martinez A, Daraï E, Coutant C, Colombo PE, Gimbergues P, Chauvet MP, Azuar AS, Rouzier R, Tunon de Lara C, Murraciole X, Agostini A, Gonçalves A, Lambaudie E. Abstract P2-08-08: Isolated ipsilateral local recurrence of breast cancer: Predictive factors and prognostic impact. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p2-08-08] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
Tumour features associated with isolated invasive breast cancer ipsilateral local recurrence (ILR) after breast conservative treatment (BCT) and consequences on overall survival (OS) are still debated. The aim of our study was to examine predictive factors of isolated ILR after BCT with in sano resection and whole breast irradiation as well as the impact of such an ILR on overall survival in a large multi-institutional cohort.
Methods
Patients were retrospectively identified from a large cohort of 23,375 consecutive patients who underwent BCT for invasive breast cancer in 16 cancer centres. End-points were ILR rate and OS. The impact of ILR on OS was assessed through multivariate analysis by logistic regression and Cox model, adjusted on ERs/Grade status (ERs+/Grade 1, ERs+/Grade 2, ERs+/Grade 3 and ERs-) and then on tumour subtypes.
Results
Of 15,570 patients, ILR rate was 3.1%. Cumulative ILR rates differed according to ERs/grade (ERs+/Grade2: HR=1.42, p=0.010; ERs+/Grade3: HR=1.41, p=0.067; ERs-: HR=2.14, p<0.0001), endocrine therapy (HR=2.05, p<0.0001) and age<40-years old (HR=2.28, p=0.005) in multivariate analysis. When multivariate analysis was adjusted on tumour subtype, the latter was the only independent factor. OS-after-ILR was significantly different according to ILR-free intervals (HR=4.96 for ILR-free interval between 2-5-years and HR=9.00 when <2-years, in comparison with ≥5-years).
Impact of free interval time on OS among patients with ILR and among all patients p-valueHRInfSupILRno ILR 1 <2 years0.0172.2551.1594.388 2-5 years0.0012.451.423.89 ≥5 years0.1030.5550.2741.126Tumor subtypesLuminal A G1 1 Luminal A G20.0031.4311.1321.810 Triple negative<0.00012.6992.0553.544 Luminal B ER-<0.00013.1952.4144.229 Luminal B ER+0.021.6081.0762.401 HER2+<0.00012.2791.4523.579
Conclusion
ERs/Grade status, lack of endocrine therapy and tumour subtypes predict isolated ILR risk in patients treated with BCT. Short ILR-free-intervals represent a strong pejorative factor for OS. These results may help selecting initial treatment as well as tailoring ILR systemic chemotherapy.
Citation Format: Houvenaeghel G, de Nonneville A, Cohen M, Classe J-M, Reyal F, Mazouni C, Chopin N, Martinez A, Daraï E, Coutant C, Colombo P-E, Gimbergues P, Chauvet M-P, Azuar A-S, Rouzier R, Tunon de Lara C, Murraciole X, Agostini A, Gonçalves A, Lambaudie E. Isolated ipsilateral local recurrence of breast cancer: Predictive factors and prognostic impact [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-08-08.
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Affiliation(s)
- G Houvenaeghel
- Aix-Marseille Univ, CNRS, INSERM, Institut Paoli-Calmettes, CRCM, Marseille, France; Institut René Gauducheau, Site Hospitalier Nord, St. Herblain, France; Institut Curie, Paris, France; Institut Gustave Roussy, Paris, France; Centre Léon Bérard, Lyon, France; Centre Claudius Regaud, Toulouse, France; Hôpital Tenon, Paris, France; Centre Georges François Leclerc, Dijon, France; Centre Val d'Aurelles, Montpellier, France; Centre Jean Perrin, Clermont Ferrand, France; Centre Oscar Lambret, Lille, France; Hôpital de Grasse, Grasse, France; Hôpital René Huguenin, Saint Cloud, France; Institut Bergonié, Bordeaux, France; Hôpital de la Timone, Marseille, France; Hôpital de la Conception, Service de Gynécologie Obstétrique, Marseille, France
| | - A de Nonneville
- Aix-Marseille Univ, CNRS, INSERM, Institut Paoli-Calmettes, CRCM, Marseille, France; Institut René Gauducheau, Site Hospitalier Nord, St. Herblain, France; Institut Curie, Paris, France; Institut Gustave Roussy, Paris, France; Centre Léon Bérard, Lyon, France; Centre Claudius Regaud, Toulouse, France; Hôpital Tenon, Paris, France; Centre Georges François Leclerc, Dijon, France; Centre Val d'Aurelles, Montpellier, France; Centre Jean Perrin, Clermont Ferrand, France; Centre Oscar Lambret, Lille, France; Hôpital de Grasse, Grasse, France; Hôpital René Huguenin, Saint Cloud, France; Institut Bergonié, Bordeaux, France; Hôpital de la Timone, Marseille, France; Hôpital de la Conception, Service de Gynécologie Obstétrique, Marseille, France
| | - M Cohen
- Aix-Marseille Univ, CNRS, INSERM, Institut Paoli-Calmettes, CRCM, Marseille, France; Institut René Gauducheau, Site Hospitalier Nord, St. Herblain, France; Institut Curie, Paris, France; Institut Gustave Roussy, Paris, France; Centre Léon Bérard, Lyon, France; Centre Claudius Regaud, Toulouse, France; Hôpital Tenon, Paris, France; Centre Georges François Leclerc, Dijon, France; Centre Val d'Aurelles, Montpellier, France; Centre Jean Perrin, Clermont Ferrand, France; Centre Oscar Lambret, Lille, France; Hôpital de Grasse, Grasse, France; Hôpital René Huguenin, Saint Cloud, France; Institut Bergonié, Bordeaux, France; Hôpital de la Timone, Marseille, France; Hôpital de la Conception, Service de Gynécologie Obstétrique, Marseille, France
| | - J-M Classe
- Aix-Marseille Univ, CNRS, INSERM, Institut Paoli-Calmettes, CRCM, Marseille, France; Institut René Gauducheau, Site Hospitalier Nord, St. Herblain, France; Institut Curie, Paris, France; Institut Gustave Roussy, Paris, France; Centre Léon Bérard, Lyon, France; Centre Claudius Regaud, Toulouse, France; Hôpital Tenon, Paris, France; Centre Georges François Leclerc, Dijon, France; Centre Val d'Aurelles, Montpellier, France; Centre Jean Perrin, Clermont Ferrand, France; Centre Oscar Lambret, Lille, France; Hôpital de Grasse, Grasse, France; Hôpital René Huguenin, Saint Cloud, France; Institut Bergonié, Bordeaux, France; Hôpital de la Timone, Marseille, France; Hôpital de la Conception, Service de Gynécologie Obstétrique, Marseille, France
| | - F Reyal
- Aix-Marseille Univ, CNRS, INSERM, Institut Paoli-Calmettes, CRCM, Marseille, France; Institut René Gauducheau, Site Hospitalier Nord, St. Herblain, France; Institut Curie, Paris, France; Institut Gustave Roussy, Paris, France; Centre Léon Bérard, Lyon, France; Centre Claudius Regaud, Toulouse, France; Hôpital Tenon, Paris, France; Centre Georges François Leclerc, Dijon, France; Centre Val d'Aurelles, Montpellier, France; Centre Jean Perrin, Clermont Ferrand, France; Centre Oscar Lambret, Lille, France; Hôpital de Grasse, Grasse, France; Hôpital René Huguenin, Saint Cloud, France; Institut Bergonié, Bordeaux, France; Hôpital de la Timone, Marseille, France; Hôpital de la Conception, Service de Gynécologie Obstétrique, Marseille, France
| | - C Mazouni
- Aix-Marseille Univ, CNRS, INSERM, Institut Paoli-Calmettes, CRCM, Marseille, France; Institut René Gauducheau, Site Hospitalier Nord, St. Herblain, France; Institut Curie, Paris, France; Institut Gustave Roussy, Paris, France; Centre Léon Bérard, Lyon, France; Centre Claudius Regaud, Toulouse, France; Hôpital Tenon, Paris, France; Centre Georges François Leclerc, Dijon, France; Centre Val d'Aurelles, Montpellier, France; Centre Jean Perrin, Clermont Ferrand, France; Centre Oscar Lambret, Lille, France; Hôpital de Grasse, Grasse, France; Hôpital René Huguenin, Saint Cloud, France; Institut Bergonié, Bordeaux, France; Hôpital de la Timone, Marseille, France; Hôpital de la Conception, Service de Gynécologie Obstétrique, Marseille, France
| | - N Chopin
- Aix-Marseille Univ, CNRS, INSERM, Institut Paoli-Calmettes, CRCM, Marseille, France; Institut René Gauducheau, Site Hospitalier Nord, St. Herblain, France; Institut Curie, Paris, France; Institut Gustave Roussy, Paris, France; Centre Léon Bérard, Lyon, France; Centre Claudius Regaud, Toulouse, France; Hôpital Tenon, Paris, France; Centre Georges François Leclerc, Dijon, France; Centre Val d'Aurelles, Montpellier, France; Centre Jean Perrin, Clermont Ferrand, France; Centre Oscar Lambret, Lille, France; Hôpital de Grasse, Grasse, France; Hôpital René Huguenin, Saint Cloud, France; Institut Bergonié, Bordeaux, France; Hôpital de la Timone, Marseille, France; Hôpital de la Conception, Service de Gynécologie Obstétrique, Marseille, France
| | - A Martinez
- Aix-Marseille Univ, CNRS, INSERM, Institut Paoli-Calmettes, CRCM, Marseille, France; Institut René Gauducheau, Site Hospitalier Nord, St. Herblain, France; Institut Curie, Paris, France; Institut Gustave Roussy, Paris, France; Centre Léon Bérard, Lyon, France; Centre Claudius Regaud, Toulouse, France; Hôpital Tenon, Paris, France; Centre Georges François Leclerc, Dijon, France; Centre Val d'Aurelles, Montpellier, France; Centre Jean Perrin, Clermont Ferrand, France; Centre Oscar Lambret, Lille, France; Hôpital de Grasse, Grasse, France; Hôpital René Huguenin, Saint Cloud, France; Institut Bergonié, Bordeaux, France; Hôpital de la Timone, Marseille, France; Hôpital de la Conception, Service de Gynécologie Obstétrique, Marseille, France
| | - E Daraï
- Aix-Marseille Univ, CNRS, INSERM, Institut Paoli-Calmettes, CRCM, Marseille, France; Institut René Gauducheau, Site Hospitalier Nord, St. Herblain, France; Institut Curie, Paris, France; Institut Gustave Roussy, Paris, France; Centre Léon Bérard, Lyon, France; Centre Claudius Regaud, Toulouse, France; Hôpital Tenon, Paris, France; Centre Georges François Leclerc, Dijon, France; Centre Val d'Aurelles, Montpellier, France; Centre Jean Perrin, Clermont Ferrand, France; Centre Oscar Lambret, Lille, France; Hôpital de Grasse, Grasse, France; Hôpital René Huguenin, Saint Cloud, France; Institut Bergonié, Bordeaux, France; Hôpital de la Timone, Marseille, France; Hôpital de la Conception, Service de Gynécologie Obstétrique, Marseille, France
| | - C Coutant
- Aix-Marseille Univ, CNRS, INSERM, Institut Paoli-Calmettes, CRCM, Marseille, France; Institut René Gauducheau, Site Hospitalier Nord, St. Herblain, France; Institut Curie, Paris, France; Institut Gustave Roussy, Paris, France; Centre Léon Bérard, Lyon, France; Centre Claudius Regaud, Toulouse, France; Hôpital Tenon, Paris, France; Centre Georges François Leclerc, Dijon, France; Centre Val d'Aurelles, Montpellier, France; Centre Jean Perrin, Clermont Ferrand, France; Centre Oscar Lambret, Lille, France; Hôpital de Grasse, Grasse, France; Hôpital René Huguenin, Saint Cloud, France; Institut Bergonié, Bordeaux, France; Hôpital de la Timone, Marseille, France; Hôpital de la Conception, Service de Gynécologie Obstétrique, Marseille, France
| | - P-E Colombo
- Aix-Marseille Univ, CNRS, INSERM, Institut Paoli-Calmettes, CRCM, Marseille, France; Institut René Gauducheau, Site Hospitalier Nord, St. Herblain, France; Institut Curie, Paris, France; Institut Gustave Roussy, Paris, France; Centre Léon Bérard, Lyon, France; Centre Claudius Regaud, Toulouse, France; Hôpital Tenon, Paris, France; Centre Georges François Leclerc, Dijon, France; Centre Val d'Aurelles, Montpellier, France; Centre Jean Perrin, Clermont Ferrand, France; Centre Oscar Lambret, Lille, France; Hôpital de Grasse, Grasse, France; Hôpital René Huguenin, Saint Cloud, France; Institut Bergonié, Bordeaux, France; Hôpital de la Timone, Marseille, France; Hôpital de la Conception, Service de Gynécologie Obstétrique, Marseille, France
| | - P Gimbergues
- Aix-Marseille Univ, CNRS, INSERM, Institut Paoli-Calmettes, CRCM, Marseille, France; Institut René Gauducheau, Site Hospitalier Nord, St. Herblain, France; Institut Curie, Paris, France; Institut Gustave Roussy, Paris, France; Centre Léon Bérard, Lyon, France; Centre Claudius Regaud, Toulouse, France; Hôpital Tenon, Paris, France; Centre Georges François Leclerc, Dijon, France; Centre Val d'Aurelles, Montpellier, France; Centre Jean Perrin, Clermont Ferrand, France; Centre Oscar Lambret, Lille, France; Hôpital de Grasse, Grasse, France; Hôpital René Huguenin, Saint Cloud, France; Institut Bergonié, Bordeaux, France; Hôpital de la Timone, Marseille, France; Hôpital de la Conception, Service de Gynécologie Obstétrique, Marseille, France
| | - M-P Chauvet
- Aix-Marseille Univ, CNRS, INSERM, Institut Paoli-Calmettes, CRCM, Marseille, France; Institut René Gauducheau, Site Hospitalier Nord, St. Herblain, France; Institut Curie, Paris, France; Institut Gustave Roussy, Paris, France; Centre Léon Bérard, Lyon, France; Centre Claudius Regaud, Toulouse, France; Hôpital Tenon, Paris, France; Centre Georges François Leclerc, Dijon, France; Centre Val d'Aurelles, Montpellier, France; Centre Jean Perrin, Clermont Ferrand, France; Centre Oscar Lambret, Lille, France; Hôpital de Grasse, Grasse, France; Hôpital René Huguenin, Saint Cloud, France; Institut Bergonié, Bordeaux, France; Hôpital de la Timone, Marseille, France; Hôpital de la Conception, Service de Gynécologie Obstétrique, Marseille, France
| | - A-S Azuar
- Aix-Marseille Univ, CNRS, INSERM, Institut Paoli-Calmettes, CRCM, Marseille, France; Institut René Gauducheau, Site Hospitalier Nord, St. Herblain, France; Institut Curie, Paris, France; Institut Gustave Roussy, Paris, France; Centre Léon Bérard, Lyon, France; Centre Claudius Regaud, Toulouse, France; Hôpital Tenon, Paris, France; Centre Georges François Leclerc, Dijon, France; Centre Val d'Aurelles, Montpellier, France; Centre Jean Perrin, Clermont Ferrand, France; Centre Oscar Lambret, Lille, France; Hôpital de Grasse, Grasse, France; Hôpital René Huguenin, Saint Cloud, France; Institut Bergonié, Bordeaux, France; Hôpital de la Timone, Marseille, France; Hôpital de la Conception, Service de Gynécologie Obstétrique, Marseille, France
| | - R Rouzier
- Aix-Marseille Univ, CNRS, INSERM, Institut Paoli-Calmettes, CRCM, Marseille, France; Institut René Gauducheau, Site Hospitalier Nord, St. Herblain, France; Institut Curie, Paris, France; Institut Gustave Roussy, Paris, France; Centre Léon Bérard, Lyon, France; Centre Claudius Regaud, Toulouse, France; Hôpital Tenon, Paris, France; Centre Georges François Leclerc, Dijon, France; Centre Val d'Aurelles, Montpellier, France; Centre Jean Perrin, Clermont Ferrand, France; Centre Oscar Lambret, Lille, France; Hôpital de Grasse, Grasse, France; Hôpital René Huguenin, Saint Cloud, France; Institut Bergonié, Bordeaux, France; Hôpital de la Timone, Marseille, France; Hôpital de la Conception, Service de Gynécologie Obstétrique, Marseille, France
| | - C Tunon de Lara
- Aix-Marseille Univ, CNRS, INSERM, Institut Paoli-Calmettes, CRCM, Marseille, France; Institut René Gauducheau, Site Hospitalier Nord, St. Herblain, France; Institut Curie, Paris, France; Institut Gustave Roussy, Paris, France; Centre Léon Bérard, Lyon, France; Centre Claudius Regaud, Toulouse, France; Hôpital Tenon, Paris, France; Centre Georges François Leclerc, Dijon, France; Centre Val d'Aurelles, Montpellier, France; Centre Jean Perrin, Clermont Ferrand, France; Centre Oscar Lambret, Lille, France; Hôpital de Grasse, Grasse, France; Hôpital René Huguenin, Saint Cloud, France; Institut Bergonié, Bordeaux, France; Hôpital de la Timone, Marseille, France; Hôpital de la Conception, Service de Gynécologie Obstétrique, Marseille, France
| | - X Murraciole
- Aix-Marseille Univ, CNRS, INSERM, Institut Paoli-Calmettes, CRCM, Marseille, France; Institut René Gauducheau, Site Hospitalier Nord, St. Herblain, France; Institut Curie, Paris, France; Institut Gustave Roussy, Paris, France; Centre Léon Bérard, Lyon, France; Centre Claudius Regaud, Toulouse, France; Hôpital Tenon, Paris, France; Centre Georges François Leclerc, Dijon, France; Centre Val d'Aurelles, Montpellier, France; Centre Jean Perrin, Clermont Ferrand, France; Centre Oscar Lambret, Lille, France; Hôpital de Grasse, Grasse, France; Hôpital René Huguenin, Saint Cloud, France; Institut Bergonié, Bordeaux, France; Hôpital de la Timone, Marseille, France; Hôpital de la Conception, Service de Gynécologie Obstétrique, Marseille, France
| | - A Agostini
- Aix-Marseille Univ, CNRS, INSERM, Institut Paoli-Calmettes, CRCM, Marseille, France; Institut René Gauducheau, Site Hospitalier Nord, St. Herblain, France; Institut Curie, Paris, France; Institut Gustave Roussy, Paris, France; Centre Léon Bérard, Lyon, France; Centre Claudius Regaud, Toulouse, France; Hôpital Tenon, Paris, France; Centre Georges François Leclerc, Dijon, France; Centre Val d'Aurelles, Montpellier, France; Centre Jean Perrin, Clermont Ferrand, France; Centre Oscar Lambret, Lille, France; Hôpital de Grasse, Grasse, France; Hôpital René Huguenin, Saint Cloud, France; Institut Bergonié, Bordeaux, France; Hôpital de la Timone, Marseille, France; Hôpital de la Conception, Service de Gynécologie Obstétrique, Marseille, France
| | - A Gonçalves
- Aix-Marseille Univ, CNRS, INSERM, Institut Paoli-Calmettes, CRCM, Marseille, France; Institut René Gauducheau, Site Hospitalier Nord, St. Herblain, France; Institut Curie, Paris, France; Institut Gustave Roussy, Paris, France; Centre Léon Bérard, Lyon, France; Centre Claudius Regaud, Toulouse, France; Hôpital Tenon, Paris, France; Centre Georges François Leclerc, Dijon, France; Centre Val d'Aurelles, Montpellier, France; Centre Jean Perrin, Clermont Ferrand, France; Centre Oscar Lambret, Lille, France; Hôpital de Grasse, Grasse, France; Hôpital René Huguenin, Saint Cloud, France; Institut Bergonié, Bordeaux, France; Hôpital de la Timone, Marseille, France; Hôpital de la Conception, Service de Gynécologie Obstétrique, Marseille, France
| | - E Lambaudie
- Aix-Marseille Univ, CNRS, INSERM, Institut Paoli-Calmettes, CRCM, Marseille, France; Institut René Gauducheau, Site Hospitalier Nord, St. Herblain, France; Institut Curie, Paris, France; Institut Gustave Roussy, Paris, France; Centre Léon Bérard, Lyon, France; Centre Claudius Regaud, Toulouse, France; Hôpital Tenon, Paris, France; Centre Georges François Leclerc, Dijon, France; Centre Val d'Aurelles, Montpellier, France; Centre Jean Perrin, Clermont Ferrand, France; Centre Oscar Lambret, Lille, France; Hôpital de Grasse, Grasse, France; Hôpital René Huguenin, Saint Cloud, France; Institut Bergonié, Bordeaux, France; Hôpital de la Timone, Marseille, France; Hôpital de la Conception, Service de Gynécologie Obstétrique, Marseille, France
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Forissier V, Tallet A, Cohen M, Classe JM, Reyal F, Chopin N, Mazouni C, Gimbergues P, Daraï E, Colombo PE, Azuar P, Lambaudie E, Houvenaeghel G. Abstract P2-11-17: Is post mastectomy radiotherapy contributive in pN0-1mi breast cancers patients? Results of a French multi-centric cohort. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p2-11-17] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Aim: To assess the value of Post-mastectomy radiation therapy (PMRT) in breast cancer patients with no or minimal lymph nodes involvement.
Materials and methods: We retrospectively analyzed a French multi-centric cohort of 4283 patients treated between 1980 and 2013, by mastectomy and axillary dissection with or without PMRT. Practices were analyzed according 3 treatment periods (1980-1999, 2000-2005; 2006-2013). The value of PMRT on loco-regional recurrence, disease-free survival, breast cancer specific survival and overall survival was assessed in pN0-1mi patients, using multivariate analyses (logistic regression and Cox model). It was subsequently assessed according to the number of clinicopathologic recurrence-risk factors, generating a prognostic index (f-PMRT index), in an attempt to isolate a pN0-1mi patients subgroup deriving benefit from PMRT. We tested the accuracy of the Cambridge-PMRT (c-PMRT) index in the discrimination of patients with significantly different outcomes, as well as the value of PMRT in each c-PMRT prognostic group.
Results: PMRT was considered in more than half pN0-1mi patients of our cohort. Whereas matching pN0-1mi patients according to the number of clinicopathologic recurrence-risk factors led to isolate a higher-risk subpopulation (≥ 3 RR factors), PMRT had no significant impact on patients' outcomes, on multivariate analysis. Whereas the Cambridge-PMRT index had the potential to discriminate 3 patient populations with significantly different outcomes, its use did not help to the decision making for PMRT.
Conclusion: Despite a large cohort, we failed to isolate a subgroup of early breast cancer patients suitable for PMRT, in the absence of lymph node involvement.
Citation Format: Forissier V, Tallet A, Cohen M, Classe J-M, Reyal F, Chopin N, Mazouni C, Gimbergues P, Daraï E, Colombo PE, Azuar P, Lambaudie E, Houvenaeghel G. Is post mastectomy radiotherapy contributive in pN0-1mi breast cancers patients? Results of a French multi-centric cohort [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P2-11-17.
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Affiliation(s)
- V Forissier
- Institut Paoli Calmettes, Marseille, France; Institut Rene Gauducheau, St Herblain, France; Institut Curie, Paris, France; Centre Léon Bérard, Lyon, France; Institut Gustave Roussy, Villejuif, France; Centre Jean Perrin, Clermont Ferrand, France; Hôpital Tenon, Paris, France; ICM Val d'Aurelle, Montpellier, France; Hôpital de Grasse, Grasse, France; Aix Marseille Université, Marseille, France; Centre de Cancérologie de Marseille, Marseille, France
| | - A Tallet
- Institut Paoli Calmettes, Marseille, France; Institut Rene Gauducheau, St Herblain, France; Institut Curie, Paris, France; Centre Léon Bérard, Lyon, France; Institut Gustave Roussy, Villejuif, France; Centre Jean Perrin, Clermont Ferrand, France; Hôpital Tenon, Paris, France; ICM Val d'Aurelle, Montpellier, France; Hôpital de Grasse, Grasse, France; Aix Marseille Université, Marseille, France; Centre de Cancérologie de Marseille, Marseille, France
| | - M Cohen
- Institut Paoli Calmettes, Marseille, France; Institut Rene Gauducheau, St Herblain, France; Institut Curie, Paris, France; Centre Léon Bérard, Lyon, France; Institut Gustave Roussy, Villejuif, France; Centre Jean Perrin, Clermont Ferrand, France; Hôpital Tenon, Paris, France; ICM Val d'Aurelle, Montpellier, France; Hôpital de Grasse, Grasse, France; Aix Marseille Université, Marseille, France; Centre de Cancérologie de Marseille, Marseille, France
| | - J-M Classe
- Institut Paoli Calmettes, Marseille, France; Institut Rene Gauducheau, St Herblain, France; Institut Curie, Paris, France; Centre Léon Bérard, Lyon, France; Institut Gustave Roussy, Villejuif, France; Centre Jean Perrin, Clermont Ferrand, France; Hôpital Tenon, Paris, France; ICM Val d'Aurelle, Montpellier, France; Hôpital de Grasse, Grasse, France; Aix Marseille Université, Marseille, France; Centre de Cancérologie de Marseille, Marseille, France
| | - F Reyal
- Institut Paoli Calmettes, Marseille, France; Institut Rene Gauducheau, St Herblain, France; Institut Curie, Paris, France; Centre Léon Bérard, Lyon, France; Institut Gustave Roussy, Villejuif, France; Centre Jean Perrin, Clermont Ferrand, France; Hôpital Tenon, Paris, France; ICM Val d'Aurelle, Montpellier, France; Hôpital de Grasse, Grasse, France; Aix Marseille Université, Marseille, France; Centre de Cancérologie de Marseille, Marseille, France
| | - N Chopin
- Institut Paoli Calmettes, Marseille, France; Institut Rene Gauducheau, St Herblain, France; Institut Curie, Paris, France; Centre Léon Bérard, Lyon, France; Institut Gustave Roussy, Villejuif, France; Centre Jean Perrin, Clermont Ferrand, France; Hôpital Tenon, Paris, France; ICM Val d'Aurelle, Montpellier, France; Hôpital de Grasse, Grasse, France; Aix Marseille Université, Marseille, France; Centre de Cancérologie de Marseille, Marseille, France
| | - C Mazouni
- Institut Paoli Calmettes, Marseille, France; Institut Rene Gauducheau, St Herblain, France; Institut Curie, Paris, France; Centre Léon Bérard, Lyon, France; Institut Gustave Roussy, Villejuif, France; Centre Jean Perrin, Clermont Ferrand, France; Hôpital Tenon, Paris, France; ICM Val d'Aurelle, Montpellier, France; Hôpital de Grasse, Grasse, France; Aix Marseille Université, Marseille, France; Centre de Cancérologie de Marseille, Marseille, France
| | - P Gimbergues
- Institut Paoli Calmettes, Marseille, France; Institut Rene Gauducheau, St Herblain, France; Institut Curie, Paris, France; Centre Léon Bérard, Lyon, France; Institut Gustave Roussy, Villejuif, France; Centre Jean Perrin, Clermont Ferrand, France; Hôpital Tenon, Paris, France; ICM Val d'Aurelle, Montpellier, France; Hôpital de Grasse, Grasse, France; Aix Marseille Université, Marseille, France; Centre de Cancérologie de Marseille, Marseille, France
| | - E Daraï
- Institut Paoli Calmettes, Marseille, France; Institut Rene Gauducheau, St Herblain, France; Institut Curie, Paris, France; Centre Léon Bérard, Lyon, France; Institut Gustave Roussy, Villejuif, France; Centre Jean Perrin, Clermont Ferrand, France; Hôpital Tenon, Paris, France; ICM Val d'Aurelle, Montpellier, France; Hôpital de Grasse, Grasse, France; Aix Marseille Université, Marseille, France; Centre de Cancérologie de Marseille, Marseille, France
| | - PE Colombo
- Institut Paoli Calmettes, Marseille, France; Institut Rene Gauducheau, St Herblain, France; Institut Curie, Paris, France; Centre Léon Bérard, Lyon, France; Institut Gustave Roussy, Villejuif, France; Centre Jean Perrin, Clermont Ferrand, France; Hôpital Tenon, Paris, France; ICM Val d'Aurelle, Montpellier, France; Hôpital de Grasse, Grasse, France; Aix Marseille Université, Marseille, France; Centre de Cancérologie de Marseille, Marseille, France
| | - P Azuar
- Institut Paoli Calmettes, Marseille, France; Institut Rene Gauducheau, St Herblain, France; Institut Curie, Paris, France; Centre Léon Bérard, Lyon, France; Institut Gustave Roussy, Villejuif, France; Centre Jean Perrin, Clermont Ferrand, France; Hôpital Tenon, Paris, France; ICM Val d'Aurelle, Montpellier, France; Hôpital de Grasse, Grasse, France; Aix Marseille Université, Marseille, France; Centre de Cancérologie de Marseille, Marseille, France
| | - E Lambaudie
- Institut Paoli Calmettes, Marseille, France; Institut Rene Gauducheau, St Herblain, France; Institut Curie, Paris, France; Centre Léon Bérard, Lyon, France; Institut Gustave Roussy, Villejuif, France; Centre Jean Perrin, Clermont Ferrand, France; Hôpital Tenon, Paris, France; ICM Val d'Aurelle, Montpellier, France; Hôpital de Grasse, Grasse, France; Aix Marseille Université, Marseille, France; Centre de Cancérologie de Marseille, Marseille, France
| | - G Houvenaeghel
- Institut Paoli Calmettes, Marseille, France; Institut Rene Gauducheau, St Herblain, France; Institut Curie, Paris, France; Centre Léon Bérard, Lyon, France; Institut Gustave Roussy, Villejuif, France; Centre Jean Perrin, Clermont Ferrand, France; Hôpital Tenon, Paris, France; ICM Val d'Aurelle, Montpellier, France; Hôpital de Grasse, Grasse, France; Aix Marseille Université, Marseille, France; Centre de Cancérologie de Marseille, Marseille, France
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de Nonneville A, Gonçalves A, Cohen M, Reyal F, Classe JM, Giard S, Colombo PE, Muracciole X, Chopin N, Lambaudie E, Houvenaeghel G. Abstract P1-13-04: Impact of hormone receptor status in HER2-Positive early breast cancer in the trastuzumab era: Results of a National multi-institutional study. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p1-13-04] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Recent updated analysis of the HERA (HERceptin Adjuvant) trial indicate that tumor hormone receptor status (HR)remains a major determinant of outcome in HER2-positive (HER2+) early breast cancer (BC) patients, with higher rates of recurrence and death in women with HR-negative (HR-) disease, even after 11 years' median follow-up. Furthermore, data reported from the HERA trial suggest that the timing of recurrences is different, with an initial higher frequency of disease-free survival (DFS) events in patients with HR- disease than those with HR-positive disease (HR+). No evidence of a different trastuzumab efficacy according to the HR of the primary tumor was found. In this study, we examined the impact of HR on outcome in a large, multicenter, “real-world”, retrospective cohort of HER2+ early breast cancer patients
Methods: HER2+ BC were retrospectively identified from a large cohort of 23,375 consecutive patients who underwent primary surgery at 17 French centers between Dec 1987 and Jan 2014. A multivariate Cox model was built including age, tumor size, SBR grade, lymphovascular invasion, lymph node involvement, hormonal receptors status, adjuvant chemotherapy, adjuvant hormone therapy, trastuzumab, radiotherapy and type of surgery.
Results: A total of 1308 cases were identified, including 829 (63%) HR+ and 479 (47%) HR- patients. Median follow-up was 52 months (range 0 to 201). Compared with HR+, HR- patients had significantly smaller tumors (37 vs. 31% ≤ 10mm, p=0.027; information for multifocal tumors was not available), with higher SBR grade (58 vs. 40% grade 3, p<0.001) and had more lymph nodes involvement (41 vs. 32% pN+, p=0.001). HR- patients were more frequently treated by mastectomy (41 vs. 31%, p<0.001), received more trastuzumab (63 vs. 53%, p<0.001) and less radiotherapy (85 vs. 89%, p=0.020). Endocrine therapy was administered in 90% (744) of HR+ patients. No other significant difference in patient, tumor or treatment characteristics was found. HR status impacted DFS, metastasis free-survival (MFS) and BC-Specific survival (BC-SS) (hazard ratios: 0.46 [0.32-0.66]; p<0.001, 0.52 [0.33-0.82]; p=0.004 and 0.56 [0.34-0.90]; p=0.017, respectively), log-rank test) in overall population with higher rates of recurrence and death in women with HR- disease. In multivariate analysis, lymph node involvement and use of trastuzumab but not HR status impacted significantly DFS, MFS and BC-SS. Considering patients by treatment groups (with or without trastuzumab), HR status was not predictive of survival outcomes in the trastuzumab group, as opposed to the group without trastuzumab. Regarding the timing of recurrences, we observed an increased tendency for later relapse in patients with HR+ disease compared with HR- disease, for both DFS and MFS events.
Conclusions: Our results suggest that HR status remains a major determinant of outcome in HER2+ BC, including the timing of recurrence. Yet, this prognostic impact appears to be mitigated by trastuzumab-based adjuvant treatment.
Citation Format: de Nonneville A, Gonçalves A, Cohen M, Reyal F, Classe JM, Giard S, Colombo PE, Muracciole X, Chopin N, Lambaudie E, Houvenaeghel G. Impact of hormone receptor status in HER2-Positive early breast cancer in the trastuzumab era: Results of a National multi-institutional study [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P1-13-04.
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Affiliation(s)
- A de Nonneville
- Aix-Marseille Univ, CNRS, INSERM, Institut Paoli-Calmettes, CRCM, Marseille, France; Institut Curie, Paris, France; Institut René Gauducheau, St Herblain, France; Centre Oscar Lambret, Lille, France; CRLC Val-d'Aurelle, Montpellier, France; Hôpital de la Timone, Marseille, France; Centre Léon Bérard, Lyon, France
| | - A Gonçalves
- Aix-Marseille Univ, CNRS, INSERM, Institut Paoli-Calmettes, CRCM, Marseille, France; Institut Curie, Paris, France; Institut René Gauducheau, St Herblain, France; Centre Oscar Lambret, Lille, France; CRLC Val-d'Aurelle, Montpellier, France; Hôpital de la Timone, Marseille, France; Centre Léon Bérard, Lyon, France
| | - M Cohen
- Aix-Marseille Univ, CNRS, INSERM, Institut Paoli-Calmettes, CRCM, Marseille, France; Institut Curie, Paris, France; Institut René Gauducheau, St Herblain, France; Centre Oscar Lambret, Lille, France; CRLC Val-d'Aurelle, Montpellier, France; Hôpital de la Timone, Marseille, France; Centre Léon Bérard, Lyon, France
| | - F Reyal
- Aix-Marseille Univ, CNRS, INSERM, Institut Paoli-Calmettes, CRCM, Marseille, France; Institut Curie, Paris, France; Institut René Gauducheau, St Herblain, France; Centre Oscar Lambret, Lille, France; CRLC Val-d'Aurelle, Montpellier, France; Hôpital de la Timone, Marseille, France; Centre Léon Bérard, Lyon, France
| | - JM Classe
- Aix-Marseille Univ, CNRS, INSERM, Institut Paoli-Calmettes, CRCM, Marseille, France; Institut Curie, Paris, France; Institut René Gauducheau, St Herblain, France; Centre Oscar Lambret, Lille, France; CRLC Val-d'Aurelle, Montpellier, France; Hôpital de la Timone, Marseille, France; Centre Léon Bérard, Lyon, France
| | - S Giard
- Aix-Marseille Univ, CNRS, INSERM, Institut Paoli-Calmettes, CRCM, Marseille, France; Institut Curie, Paris, France; Institut René Gauducheau, St Herblain, France; Centre Oscar Lambret, Lille, France; CRLC Val-d'Aurelle, Montpellier, France; Hôpital de la Timone, Marseille, France; Centre Léon Bérard, Lyon, France
| | - PE Colombo
- Aix-Marseille Univ, CNRS, INSERM, Institut Paoli-Calmettes, CRCM, Marseille, France; Institut Curie, Paris, France; Institut René Gauducheau, St Herblain, France; Centre Oscar Lambret, Lille, France; CRLC Val-d'Aurelle, Montpellier, France; Hôpital de la Timone, Marseille, France; Centre Léon Bérard, Lyon, France
| | - X Muracciole
- Aix-Marseille Univ, CNRS, INSERM, Institut Paoli-Calmettes, CRCM, Marseille, France; Institut Curie, Paris, France; Institut René Gauducheau, St Herblain, France; Centre Oscar Lambret, Lille, France; CRLC Val-d'Aurelle, Montpellier, France; Hôpital de la Timone, Marseille, France; Centre Léon Bérard, Lyon, France
| | - N Chopin
- Aix-Marseille Univ, CNRS, INSERM, Institut Paoli-Calmettes, CRCM, Marseille, France; Institut Curie, Paris, France; Institut René Gauducheau, St Herblain, France; Centre Oscar Lambret, Lille, France; CRLC Val-d'Aurelle, Montpellier, France; Hôpital de la Timone, Marseille, France; Centre Léon Bérard, Lyon, France
| | - E Lambaudie
- Aix-Marseille Univ, CNRS, INSERM, Institut Paoli-Calmettes, CRCM, Marseille, France; Institut Curie, Paris, France; Institut René Gauducheau, St Herblain, France; Centre Oscar Lambret, Lille, France; CRLC Val-d'Aurelle, Montpellier, France; Hôpital de la Timone, Marseille, France; Centre Léon Bérard, Lyon, France
| | - G Houvenaeghel
- Aix-Marseille Univ, CNRS, INSERM, Institut Paoli-Calmettes, CRCM, Marseille, France; Institut Curie, Paris, France; Institut René Gauducheau, St Herblain, France; Centre Oscar Lambret, Lille, France; CRLC Val-d'Aurelle, Montpellier, France; Hôpital de la Timone, Marseille, France; Centre Léon Bérard, Lyon, France
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Houvenaeghel G, Cohen M, Raro P, De Troyer J, Tunon De Lara C, Guimbergues P, Gauthier T, Faure C, Vaini-Cowen V, Lantheaume S, Regis C, Darai E, Ceccato V, D'Halluin G, Del Piano F, Villet R, Jouve E, Beedassy B, Theret P, Gabelle P, Zinzindohoue C, Opinel P, Marsollier-Ferrer C, Dhainaut-Speyer C, Colombo PE, Di Beo V, Lambaudie E, Tallet A, Boher JM. Abstract P3-01-02: Overview of the pathological results and treatment characteristics in the first 1000 patients randomized in the SERC trial: Axillary dissection versus no axillary dissection in patients with involved sentinel node. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p3-01-02] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Three randomized trials have concluded at non inferiority of omission of complementary axillary lymph node dissection (cALND) for patients with involved sentinel node (SN). However, we can outline strong limitations of these trials to validate this attitude with a high scientific level. We designed the SERC randomized trial to compare outcomes in patients with SN involvement treated with ALND or no further axillary treatment. The aim of this study was to analyze results of the first 1000 patients included.
Patients and Methods: SERC trial is a multicenter non-inferiority phase 3 trial. Multivariate logistic regression analysis was used to identify independent factors associated with adjuvant chemotherapy administration and non-sentinel node (NSN) involvement.
Results : Of the 963 patients included in the analysis set, 478 were randomized to receive cALND and 485 SLNB alone. All patient demographics and tumor characteristics were balanced between the two arms. SN ITC was present in 6.3% patients (57/903), micro metastases in 33.0% (298), macro metastases in 60.7% (548) and 289 (34.2%) were non eligible to Z0011 trial criteria.
Whole breast or chest wall irradiation was delivered in 95.9% (896/934) of patients, adjuvant chemotherapy in 69.5% (644/926), endocrine therapy in 89.6% (673/751) and the proportions were similar in the two arms. The overall rate of positive NSN was 19% (84/442) for patients with cALND. Crude rates of positive NSN according to SN status were 4.5% for ITC (1/22), 9.5% for micro metastases (13/137), 23.9% for macro metastases (61/255) and were respectively 29.36% (64/218), 9.33% (7/75) and 7.94% (10/126) when chemotherapy was administered after cALND, before cALND and for patients without chemotherapy.
Conclusion: The main objective of SERC trial is to demonstrate non inferiority of cALND omission. A strong interaction between timing of cALND and chemotherapy with positive NSN rate was observed.
Citation Format: Houvenaeghel G, Cohen M, Raro P, De Troyer J, Tunon De Lara C, Guimbergues P, Gauthier T, Faure C, Vaini-Cowen V, Lantheaume S, Regis C, Darai E, Ceccato V, D'Halluin G, Del Piano F, Villet R, Jouve E, Beedassy B, Theret P, Gabelle P, Zinzindohoue C, Opinel P, Marsollier-Ferrer C, Dhainaut-Speyer C, Colombo P-E, Di Beo V, Lambaudie E, Tallet A, Boher J-M. Overview of the pathological results and treatment characteristics in the first 1000 patients randomized in the SERC trial: Axillary dissection versus no axillary dissection in patients with involved sentinel node [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P3-01-02.
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Affiliation(s)
- G Houvenaeghel
- Institut Paoli Calmettes, Marseille, France; Institut de Cancérologie de l'Ouest - Site Paul Papin, Angers, France; Polyclinique Urbain V, Avignon, France; Institut Bergonie, Bordeaux, France; Centre Jean Perrin, Clermont Ferrand, France; CHU Limoges, Limoges, France; Centre Léon Bérard, Lyon, France; Clinique d'Aix, Aix-en-Provence, France; Hopital Privé Drome Ardèche - Clinique Pasteur, Guilherand Granges, France; Centre Oscar Lambret, Lille, France; Hôpital Tenon, Paris, France; Institut Jean Godinot, Reims, France; Centre Clinical, Angoulème, France; Hôpitaux du Leman, Thonon, France; Groupe Hospitalier des Diaconesses, Paris, France; Institut Universitaire du Cancer, Toulouse, France; Hôpital Sainte Musse (CHITS), Toulon, France; CHU Amiens-Picardie - Hopital Nord, Amiens, France; Groupe Hospitalier Mutualiste de Grenoble, Grenoble, France; Clinique Clemenville, Montpellier, France; Centre Hospitalier du Pays d'Aix, Aix-en-Provence, France; CHRU Nimes, Nimes, France; GCS Recherche et Innovation, Sainte
| | - M Cohen
- Institut Paoli Calmettes, Marseille, France; Institut de Cancérologie de l'Ouest - Site Paul Papin, Angers, France; Polyclinique Urbain V, Avignon, France; Institut Bergonie, Bordeaux, France; Centre Jean Perrin, Clermont Ferrand, France; CHU Limoges, Limoges, France; Centre Léon Bérard, Lyon, France; Clinique d'Aix, Aix-en-Provence, France; Hopital Privé Drome Ardèche - Clinique Pasteur, Guilherand Granges, France; Centre Oscar Lambret, Lille, France; Hôpital Tenon, Paris, France; Institut Jean Godinot, Reims, France; Centre Clinical, Angoulème, France; Hôpitaux du Leman, Thonon, France; Groupe Hospitalier des Diaconesses, Paris, France; Institut Universitaire du Cancer, Toulouse, France; Hôpital Sainte Musse (CHITS), Toulon, France; CHU Amiens-Picardie - Hopital Nord, Amiens, France; Groupe Hospitalier Mutualiste de Grenoble, Grenoble, France; Clinique Clemenville, Montpellier, France; Centre Hospitalier du Pays d'Aix, Aix-en-Provence, France; CHRU Nimes, Nimes, France; GCS Recherche et Innovation, Sainte
| | - P Raro
- Institut Paoli Calmettes, Marseille, France; Institut de Cancérologie de l'Ouest - Site Paul Papin, Angers, France; Polyclinique Urbain V, Avignon, France; Institut Bergonie, Bordeaux, France; Centre Jean Perrin, Clermont Ferrand, France; CHU Limoges, Limoges, France; Centre Léon Bérard, Lyon, France; Clinique d'Aix, Aix-en-Provence, France; Hopital Privé Drome Ardèche - Clinique Pasteur, Guilherand Granges, France; Centre Oscar Lambret, Lille, France; Hôpital Tenon, Paris, France; Institut Jean Godinot, Reims, France; Centre Clinical, Angoulème, France; Hôpitaux du Leman, Thonon, France; Groupe Hospitalier des Diaconesses, Paris, France; Institut Universitaire du Cancer, Toulouse, France; Hôpital Sainte Musse (CHITS), Toulon, France; CHU Amiens-Picardie - Hopital Nord, Amiens, France; Groupe Hospitalier Mutualiste de Grenoble, Grenoble, France; Clinique Clemenville, Montpellier, France; Centre Hospitalier du Pays d'Aix, Aix-en-Provence, France; CHRU Nimes, Nimes, France; GCS Recherche et Innovation, Sainte
| | - J De Troyer
- Institut Paoli Calmettes, Marseille, France; Institut de Cancérologie de l'Ouest - Site Paul Papin, Angers, France; Polyclinique Urbain V, Avignon, France; Institut Bergonie, Bordeaux, France; Centre Jean Perrin, Clermont Ferrand, France; CHU Limoges, Limoges, France; Centre Léon Bérard, Lyon, France; Clinique d'Aix, Aix-en-Provence, France; Hopital Privé Drome Ardèche - Clinique Pasteur, Guilherand Granges, France; Centre Oscar Lambret, Lille, France; Hôpital Tenon, Paris, France; Institut Jean Godinot, Reims, France; Centre Clinical, Angoulème, France; Hôpitaux du Leman, Thonon, France; Groupe Hospitalier des Diaconesses, Paris, France; Institut Universitaire du Cancer, Toulouse, France; Hôpital Sainte Musse (CHITS), Toulon, France; CHU Amiens-Picardie - Hopital Nord, Amiens, France; Groupe Hospitalier Mutualiste de Grenoble, Grenoble, France; Clinique Clemenville, Montpellier, France; Centre Hospitalier du Pays d'Aix, Aix-en-Provence, France; CHRU Nimes, Nimes, France; GCS Recherche et Innovation, Sainte
| | - C Tunon De Lara
- Institut Paoli Calmettes, Marseille, France; Institut de Cancérologie de l'Ouest - Site Paul Papin, Angers, France; Polyclinique Urbain V, Avignon, France; Institut Bergonie, Bordeaux, France; Centre Jean Perrin, Clermont Ferrand, France; CHU Limoges, Limoges, France; Centre Léon Bérard, Lyon, France; Clinique d'Aix, Aix-en-Provence, France; Hopital Privé Drome Ardèche - Clinique Pasteur, Guilherand Granges, France; Centre Oscar Lambret, Lille, France; Hôpital Tenon, Paris, France; Institut Jean Godinot, Reims, France; Centre Clinical, Angoulème, France; Hôpitaux du Leman, Thonon, France; Groupe Hospitalier des Diaconesses, Paris, France; Institut Universitaire du Cancer, Toulouse, France; Hôpital Sainte Musse (CHITS), Toulon, France; CHU Amiens-Picardie - Hopital Nord, Amiens, France; Groupe Hospitalier Mutualiste de Grenoble, Grenoble, France; Clinique Clemenville, Montpellier, France; Centre Hospitalier du Pays d'Aix, Aix-en-Provence, France; CHRU Nimes, Nimes, France; GCS Recherche et Innovation, Sainte
| | - P Guimbergues
- Institut Paoli Calmettes, Marseille, France; Institut de Cancérologie de l'Ouest - Site Paul Papin, Angers, France; Polyclinique Urbain V, Avignon, France; Institut Bergonie, Bordeaux, France; Centre Jean Perrin, Clermont Ferrand, France; CHU Limoges, Limoges, France; Centre Léon Bérard, Lyon, France; Clinique d'Aix, Aix-en-Provence, France; Hopital Privé Drome Ardèche - Clinique Pasteur, Guilherand Granges, France; Centre Oscar Lambret, Lille, France; Hôpital Tenon, Paris, France; Institut Jean Godinot, Reims, France; Centre Clinical, Angoulème, France; Hôpitaux du Leman, Thonon, France; Groupe Hospitalier des Diaconesses, Paris, France; Institut Universitaire du Cancer, Toulouse, France; Hôpital Sainte Musse (CHITS), Toulon, France; CHU Amiens-Picardie - Hopital Nord, Amiens, France; Groupe Hospitalier Mutualiste de Grenoble, Grenoble, France; Clinique Clemenville, Montpellier, France; Centre Hospitalier du Pays d'Aix, Aix-en-Provence, France; CHRU Nimes, Nimes, France; GCS Recherche et Innovation, Sainte
| | - T Gauthier
- Institut Paoli Calmettes, Marseille, France; Institut de Cancérologie de l'Ouest - Site Paul Papin, Angers, France; Polyclinique Urbain V, Avignon, France; Institut Bergonie, Bordeaux, France; Centre Jean Perrin, Clermont Ferrand, France; CHU Limoges, Limoges, France; Centre Léon Bérard, Lyon, France; Clinique d'Aix, Aix-en-Provence, France; Hopital Privé Drome Ardèche - Clinique Pasteur, Guilherand Granges, France; Centre Oscar Lambret, Lille, France; Hôpital Tenon, Paris, France; Institut Jean Godinot, Reims, France; Centre Clinical, Angoulème, France; Hôpitaux du Leman, Thonon, France; Groupe Hospitalier des Diaconesses, Paris, France; Institut Universitaire du Cancer, Toulouse, France; Hôpital Sainte Musse (CHITS), Toulon, France; CHU Amiens-Picardie - Hopital Nord, Amiens, France; Groupe Hospitalier Mutualiste de Grenoble, Grenoble, France; Clinique Clemenville, Montpellier, France; Centre Hospitalier du Pays d'Aix, Aix-en-Provence, France; CHRU Nimes, Nimes, France; GCS Recherche et Innovation, Sainte
| | - C Faure
- Institut Paoli Calmettes, Marseille, France; Institut de Cancérologie de l'Ouest - Site Paul Papin, Angers, France; Polyclinique Urbain V, Avignon, France; Institut Bergonie, Bordeaux, France; Centre Jean Perrin, Clermont Ferrand, France; CHU Limoges, Limoges, France; Centre Léon Bérard, Lyon, France; Clinique d'Aix, Aix-en-Provence, France; Hopital Privé Drome Ardèche - Clinique Pasteur, Guilherand Granges, France; Centre Oscar Lambret, Lille, France; Hôpital Tenon, Paris, France; Institut Jean Godinot, Reims, France; Centre Clinical, Angoulème, France; Hôpitaux du Leman, Thonon, France; Groupe Hospitalier des Diaconesses, Paris, France; Institut Universitaire du Cancer, Toulouse, France; Hôpital Sainte Musse (CHITS), Toulon, France; CHU Amiens-Picardie - Hopital Nord, Amiens, France; Groupe Hospitalier Mutualiste de Grenoble, Grenoble, France; Clinique Clemenville, Montpellier, France; Centre Hospitalier du Pays d'Aix, Aix-en-Provence, France; CHRU Nimes, Nimes, France; GCS Recherche et Innovation, Sainte
| | - V Vaini-Cowen
- Institut Paoli Calmettes, Marseille, France; Institut de Cancérologie de l'Ouest - Site Paul Papin, Angers, France; Polyclinique Urbain V, Avignon, France; Institut Bergonie, Bordeaux, France; Centre Jean Perrin, Clermont Ferrand, France; CHU Limoges, Limoges, France; Centre Léon Bérard, Lyon, France; Clinique d'Aix, Aix-en-Provence, France; Hopital Privé Drome Ardèche - Clinique Pasteur, Guilherand Granges, France; Centre Oscar Lambret, Lille, France; Hôpital Tenon, Paris, France; Institut Jean Godinot, Reims, France; Centre Clinical, Angoulème, France; Hôpitaux du Leman, Thonon, France; Groupe Hospitalier des Diaconesses, Paris, France; Institut Universitaire du Cancer, Toulouse, France; Hôpital Sainte Musse (CHITS), Toulon, France; CHU Amiens-Picardie - Hopital Nord, Amiens, France; Groupe Hospitalier Mutualiste de Grenoble, Grenoble, France; Clinique Clemenville, Montpellier, France; Centre Hospitalier du Pays d'Aix, Aix-en-Provence, France; CHRU Nimes, Nimes, France; GCS Recherche et Innovation, Sainte
| | - S Lantheaume
- Institut Paoli Calmettes, Marseille, France; Institut de Cancérologie de l'Ouest - Site Paul Papin, Angers, France; Polyclinique Urbain V, Avignon, France; Institut Bergonie, Bordeaux, France; Centre Jean Perrin, Clermont Ferrand, France; CHU Limoges, Limoges, France; Centre Léon Bérard, Lyon, France; Clinique d'Aix, Aix-en-Provence, France; Hopital Privé Drome Ardèche - Clinique Pasteur, Guilherand Granges, France; Centre Oscar Lambret, Lille, France; Hôpital Tenon, Paris, France; Institut Jean Godinot, Reims, France; Centre Clinical, Angoulème, France; Hôpitaux du Leman, Thonon, France; Groupe Hospitalier des Diaconesses, Paris, France; Institut Universitaire du Cancer, Toulouse, France; Hôpital Sainte Musse (CHITS), Toulon, France; CHU Amiens-Picardie - Hopital Nord, Amiens, France; Groupe Hospitalier Mutualiste de Grenoble, Grenoble, France; Clinique Clemenville, Montpellier, France; Centre Hospitalier du Pays d'Aix, Aix-en-Provence, France; CHRU Nimes, Nimes, France; GCS Recherche et Innovation, Sainte
| | - C Regis
- Institut Paoli Calmettes, Marseille, France; Institut de Cancérologie de l'Ouest - Site Paul Papin, Angers, France; Polyclinique Urbain V, Avignon, France; Institut Bergonie, Bordeaux, France; Centre Jean Perrin, Clermont Ferrand, France; CHU Limoges, Limoges, France; Centre Léon Bérard, Lyon, France; Clinique d'Aix, Aix-en-Provence, France; Hopital Privé Drome Ardèche - Clinique Pasteur, Guilherand Granges, France; Centre Oscar Lambret, Lille, France; Hôpital Tenon, Paris, France; Institut Jean Godinot, Reims, France; Centre Clinical, Angoulème, France; Hôpitaux du Leman, Thonon, France; Groupe Hospitalier des Diaconesses, Paris, France; Institut Universitaire du Cancer, Toulouse, France; Hôpital Sainte Musse (CHITS), Toulon, France; CHU Amiens-Picardie - Hopital Nord, Amiens, France; Groupe Hospitalier Mutualiste de Grenoble, Grenoble, France; Clinique Clemenville, Montpellier, France; Centre Hospitalier du Pays d'Aix, Aix-en-Provence, France; CHRU Nimes, Nimes, France; GCS Recherche et Innovation, Sainte
| | - E Darai
- Institut Paoli Calmettes, Marseille, France; Institut de Cancérologie de l'Ouest - Site Paul Papin, Angers, France; Polyclinique Urbain V, Avignon, France; Institut Bergonie, Bordeaux, France; Centre Jean Perrin, Clermont Ferrand, France; CHU Limoges, Limoges, France; Centre Léon Bérard, Lyon, France; Clinique d'Aix, Aix-en-Provence, France; Hopital Privé Drome Ardèche - Clinique Pasteur, Guilherand Granges, France; Centre Oscar Lambret, Lille, France; Hôpital Tenon, Paris, France; Institut Jean Godinot, Reims, France; Centre Clinical, Angoulème, France; Hôpitaux du Leman, Thonon, France; Groupe Hospitalier des Diaconesses, Paris, France; Institut Universitaire du Cancer, Toulouse, France; Hôpital Sainte Musse (CHITS), Toulon, France; CHU Amiens-Picardie - Hopital Nord, Amiens, France; Groupe Hospitalier Mutualiste de Grenoble, Grenoble, France; Clinique Clemenville, Montpellier, France; Centre Hospitalier du Pays d'Aix, Aix-en-Provence, France; CHRU Nimes, Nimes, France; GCS Recherche et Innovation, Sainte
| | - V Ceccato
- Institut Paoli Calmettes, Marseille, France; Institut de Cancérologie de l'Ouest - Site Paul Papin, Angers, France; Polyclinique Urbain V, Avignon, France; Institut Bergonie, Bordeaux, France; Centre Jean Perrin, Clermont Ferrand, France; CHU Limoges, Limoges, France; Centre Léon Bérard, Lyon, France; Clinique d'Aix, Aix-en-Provence, France; Hopital Privé Drome Ardèche - Clinique Pasteur, Guilherand Granges, France; Centre Oscar Lambret, Lille, France; Hôpital Tenon, Paris, France; Institut Jean Godinot, Reims, France; Centre Clinical, Angoulème, France; Hôpitaux du Leman, Thonon, France; Groupe Hospitalier des Diaconesses, Paris, France; Institut Universitaire du Cancer, Toulouse, France; Hôpital Sainte Musse (CHITS), Toulon, France; CHU Amiens-Picardie - Hopital Nord, Amiens, France; Groupe Hospitalier Mutualiste de Grenoble, Grenoble, France; Clinique Clemenville, Montpellier, France; Centre Hospitalier du Pays d'Aix, Aix-en-Provence, France; CHRU Nimes, Nimes, France; GCS Recherche et Innovation, Sainte
| | - G D'Halluin
- Institut Paoli Calmettes, Marseille, France; Institut de Cancérologie de l'Ouest - Site Paul Papin, Angers, France; Polyclinique Urbain V, Avignon, France; Institut Bergonie, Bordeaux, France; Centre Jean Perrin, Clermont Ferrand, France; CHU Limoges, Limoges, France; Centre Léon Bérard, Lyon, France; Clinique d'Aix, Aix-en-Provence, France; Hopital Privé Drome Ardèche - Clinique Pasteur, Guilherand Granges, France; Centre Oscar Lambret, Lille, France; Hôpital Tenon, Paris, France; Institut Jean Godinot, Reims, France; Centre Clinical, Angoulème, France; Hôpitaux du Leman, Thonon, France; Groupe Hospitalier des Diaconesses, Paris, France; Institut Universitaire du Cancer, Toulouse, France; Hôpital Sainte Musse (CHITS), Toulon, France; CHU Amiens-Picardie - Hopital Nord, Amiens, France; Groupe Hospitalier Mutualiste de Grenoble, Grenoble, France; Clinique Clemenville, Montpellier, France; Centre Hospitalier du Pays d'Aix, Aix-en-Provence, France; CHRU Nimes, Nimes, France; GCS Recherche et Innovation, Sainte
| | - F Del Piano
- Institut Paoli Calmettes, Marseille, France; Institut de Cancérologie de l'Ouest - Site Paul Papin, Angers, France; Polyclinique Urbain V, Avignon, France; Institut Bergonie, Bordeaux, France; Centre Jean Perrin, Clermont Ferrand, France; CHU Limoges, Limoges, France; Centre Léon Bérard, Lyon, France; Clinique d'Aix, Aix-en-Provence, France; Hopital Privé Drome Ardèche - Clinique Pasteur, Guilherand Granges, France; Centre Oscar Lambret, Lille, France; Hôpital Tenon, Paris, France; Institut Jean Godinot, Reims, France; Centre Clinical, Angoulème, France; Hôpitaux du Leman, Thonon, France; Groupe Hospitalier des Diaconesses, Paris, France; Institut Universitaire du Cancer, Toulouse, France; Hôpital Sainte Musse (CHITS), Toulon, France; CHU Amiens-Picardie - Hopital Nord, Amiens, France; Groupe Hospitalier Mutualiste de Grenoble, Grenoble, France; Clinique Clemenville, Montpellier, France; Centre Hospitalier du Pays d'Aix, Aix-en-Provence, France; CHRU Nimes, Nimes, France; GCS Recherche et Innovation, Sainte
| | - R Villet
- Institut Paoli Calmettes, Marseille, France; Institut de Cancérologie de l'Ouest - Site Paul Papin, Angers, France; Polyclinique Urbain V, Avignon, France; Institut Bergonie, Bordeaux, France; Centre Jean Perrin, Clermont Ferrand, France; CHU Limoges, Limoges, France; Centre Léon Bérard, Lyon, France; Clinique d'Aix, Aix-en-Provence, France; Hopital Privé Drome Ardèche - Clinique Pasteur, Guilherand Granges, France; Centre Oscar Lambret, Lille, France; Hôpital Tenon, Paris, France; Institut Jean Godinot, Reims, France; Centre Clinical, Angoulème, France; Hôpitaux du Leman, Thonon, France; Groupe Hospitalier des Diaconesses, Paris, France; Institut Universitaire du Cancer, Toulouse, France; Hôpital Sainte Musse (CHITS), Toulon, France; CHU Amiens-Picardie - Hopital Nord, Amiens, France; Groupe Hospitalier Mutualiste de Grenoble, Grenoble, France; Clinique Clemenville, Montpellier, France; Centre Hospitalier du Pays d'Aix, Aix-en-Provence, France; CHRU Nimes, Nimes, France; GCS Recherche et Innovation, Sainte
| | - E Jouve
- Institut Paoli Calmettes, Marseille, France; Institut de Cancérologie de l'Ouest - Site Paul Papin, Angers, France; Polyclinique Urbain V, Avignon, France; Institut Bergonie, Bordeaux, France; Centre Jean Perrin, Clermont Ferrand, France; CHU Limoges, Limoges, France; Centre Léon Bérard, Lyon, France; Clinique d'Aix, Aix-en-Provence, France; Hopital Privé Drome Ardèche - Clinique Pasteur, Guilherand Granges, France; Centre Oscar Lambret, Lille, France; Hôpital Tenon, Paris, France; Institut Jean Godinot, Reims, France; Centre Clinical, Angoulème, France; Hôpitaux du Leman, Thonon, France; Groupe Hospitalier des Diaconesses, Paris, France; Institut Universitaire du Cancer, Toulouse, France; Hôpital Sainte Musse (CHITS), Toulon, France; CHU Amiens-Picardie - Hopital Nord, Amiens, France; Groupe Hospitalier Mutualiste de Grenoble, Grenoble, France; Clinique Clemenville, Montpellier, France; Centre Hospitalier du Pays d'Aix, Aix-en-Provence, France; CHRU Nimes, Nimes, France; GCS Recherche et Innovation, Sainte
| | - B Beedassy
- Institut Paoli Calmettes, Marseille, France; Institut de Cancérologie de l'Ouest - Site Paul Papin, Angers, France; Polyclinique Urbain V, Avignon, France; Institut Bergonie, Bordeaux, France; Centre Jean Perrin, Clermont Ferrand, France; CHU Limoges, Limoges, France; Centre Léon Bérard, Lyon, France; Clinique d'Aix, Aix-en-Provence, France; Hopital Privé Drome Ardèche - Clinique Pasteur, Guilherand Granges, France; Centre Oscar Lambret, Lille, France; Hôpital Tenon, Paris, France; Institut Jean Godinot, Reims, France; Centre Clinical, Angoulème, France; Hôpitaux du Leman, Thonon, France; Groupe Hospitalier des Diaconesses, Paris, France; Institut Universitaire du Cancer, Toulouse, France; Hôpital Sainte Musse (CHITS), Toulon, France; CHU Amiens-Picardie - Hopital Nord, Amiens, France; Groupe Hospitalier Mutualiste de Grenoble, Grenoble, France; Clinique Clemenville, Montpellier, France; Centre Hospitalier du Pays d'Aix, Aix-en-Provence, France; CHRU Nimes, Nimes, France; GCS Recherche et Innovation, Sainte
| | - P Theret
- Institut Paoli Calmettes, Marseille, France; Institut de Cancérologie de l'Ouest - Site Paul Papin, Angers, France; Polyclinique Urbain V, Avignon, France; Institut Bergonie, Bordeaux, France; Centre Jean Perrin, Clermont Ferrand, France; CHU Limoges, Limoges, France; Centre Léon Bérard, Lyon, France; Clinique d'Aix, Aix-en-Provence, France; Hopital Privé Drome Ardèche - Clinique Pasteur, Guilherand Granges, France; Centre Oscar Lambret, Lille, France; Hôpital Tenon, Paris, France; Institut Jean Godinot, Reims, France; Centre Clinical, Angoulème, France; Hôpitaux du Leman, Thonon, France; Groupe Hospitalier des Diaconesses, Paris, France; Institut Universitaire du Cancer, Toulouse, France; Hôpital Sainte Musse (CHITS), Toulon, France; CHU Amiens-Picardie - Hopital Nord, Amiens, France; Groupe Hospitalier Mutualiste de Grenoble, Grenoble, France; Clinique Clemenville, Montpellier, France; Centre Hospitalier du Pays d'Aix, Aix-en-Provence, France; CHRU Nimes, Nimes, France; GCS Recherche et Innovation, Sainte
| | - P Gabelle
- Institut Paoli Calmettes, Marseille, France; Institut de Cancérologie de l'Ouest - Site Paul Papin, Angers, France; Polyclinique Urbain V, Avignon, France; Institut Bergonie, Bordeaux, France; Centre Jean Perrin, Clermont Ferrand, France; CHU Limoges, Limoges, France; Centre Léon Bérard, Lyon, France; Clinique d'Aix, Aix-en-Provence, France; Hopital Privé Drome Ardèche - Clinique Pasteur, Guilherand Granges, France; Centre Oscar Lambret, Lille, France; Hôpital Tenon, Paris, France; Institut Jean Godinot, Reims, France; Centre Clinical, Angoulème, France; Hôpitaux du Leman, Thonon, France; Groupe Hospitalier des Diaconesses, Paris, France; Institut Universitaire du Cancer, Toulouse, France; Hôpital Sainte Musse (CHITS), Toulon, France; CHU Amiens-Picardie - Hopital Nord, Amiens, France; Groupe Hospitalier Mutualiste de Grenoble, Grenoble, France; Clinique Clemenville, Montpellier, France; Centre Hospitalier du Pays d'Aix, Aix-en-Provence, France; CHRU Nimes, Nimes, France; GCS Recherche et Innovation, Sainte
| | - C Zinzindohoue
- Institut Paoli Calmettes, Marseille, France; Institut de Cancérologie de l'Ouest - Site Paul Papin, Angers, France; Polyclinique Urbain V, Avignon, France; Institut Bergonie, Bordeaux, France; Centre Jean Perrin, Clermont Ferrand, France; CHU Limoges, Limoges, France; Centre Léon Bérard, Lyon, France; Clinique d'Aix, Aix-en-Provence, France; Hopital Privé Drome Ardèche - Clinique Pasteur, Guilherand Granges, France; Centre Oscar Lambret, Lille, France; Hôpital Tenon, Paris, France; Institut Jean Godinot, Reims, France; Centre Clinical, Angoulème, France; Hôpitaux du Leman, Thonon, France; Groupe Hospitalier des Diaconesses, Paris, France; Institut Universitaire du Cancer, Toulouse, France; Hôpital Sainte Musse (CHITS), Toulon, France; CHU Amiens-Picardie - Hopital Nord, Amiens, France; Groupe Hospitalier Mutualiste de Grenoble, Grenoble, France; Clinique Clemenville, Montpellier, France; Centre Hospitalier du Pays d'Aix, Aix-en-Provence, France; CHRU Nimes, Nimes, France; GCS Recherche et Innovation, Sainte
| | - P Opinel
- Institut Paoli Calmettes, Marseille, France; Institut de Cancérologie de l'Ouest - Site Paul Papin, Angers, France; Polyclinique Urbain V, Avignon, France; Institut Bergonie, Bordeaux, France; Centre Jean Perrin, Clermont Ferrand, France; CHU Limoges, Limoges, France; Centre Léon Bérard, Lyon, France; Clinique d'Aix, Aix-en-Provence, France; Hopital Privé Drome Ardèche - Clinique Pasteur, Guilherand Granges, France; Centre Oscar Lambret, Lille, France; Hôpital Tenon, Paris, France; Institut Jean Godinot, Reims, France; Centre Clinical, Angoulème, France; Hôpitaux du Leman, Thonon, France; Groupe Hospitalier des Diaconesses, Paris, France; Institut Universitaire du Cancer, Toulouse, France; Hôpital Sainte Musse (CHITS), Toulon, France; CHU Amiens-Picardie - Hopital Nord, Amiens, France; Groupe Hospitalier Mutualiste de Grenoble, Grenoble, France; Clinique Clemenville, Montpellier, France; Centre Hospitalier du Pays d'Aix, Aix-en-Provence, France; CHRU Nimes, Nimes, France; GCS Recherche et Innovation, Sainte
| | - C Marsollier-Ferrer
- Institut Paoli Calmettes, Marseille, France; Institut de Cancérologie de l'Ouest - Site Paul Papin, Angers, France; Polyclinique Urbain V, Avignon, France; Institut Bergonie, Bordeaux, France; Centre Jean Perrin, Clermont Ferrand, France; CHU Limoges, Limoges, France; Centre Léon Bérard, Lyon, France; Clinique d'Aix, Aix-en-Provence, France; Hopital Privé Drome Ardèche - Clinique Pasteur, Guilherand Granges, France; Centre Oscar Lambret, Lille, France; Hôpital Tenon, Paris, France; Institut Jean Godinot, Reims, France; Centre Clinical, Angoulème, France; Hôpitaux du Leman, Thonon, France; Groupe Hospitalier des Diaconesses, Paris, France; Institut Universitaire du Cancer, Toulouse, France; Hôpital Sainte Musse (CHITS), Toulon, France; CHU Amiens-Picardie - Hopital Nord, Amiens, France; Groupe Hospitalier Mutualiste de Grenoble, Grenoble, France; Clinique Clemenville, Montpellier, France; Centre Hospitalier du Pays d'Aix, Aix-en-Provence, France; CHRU Nimes, Nimes, France; GCS Recherche et Innovation, Sainte
| | - C Dhainaut-Speyer
- Institut Paoli Calmettes, Marseille, France; Institut de Cancérologie de l'Ouest - Site Paul Papin, Angers, France; Polyclinique Urbain V, Avignon, France; Institut Bergonie, Bordeaux, France; Centre Jean Perrin, Clermont Ferrand, France; CHU Limoges, Limoges, France; Centre Léon Bérard, Lyon, France; Clinique d'Aix, Aix-en-Provence, France; Hopital Privé Drome Ardèche - Clinique Pasteur, Guilherand Granges, France; Centre Oscar Lambret, Lille, France; Hôpital Tenon, Paris, France; Institut Jean Godinot, Reims, France; Centre Clinical, Angoulème, France; Hôpitaux du Leman, Thonon, France; Groupe Hospitalier des Diaconesses, Paris, France; Institut Universitaire du Cancer, Toulouse, France; Hôpital Sainte Musse (CHITS), Toulon, France; CHU Amiens-Picardie - Hopital Nord, Amiens, France; Groupe Hospitalier Mutualiste de Grenoble, Grenoble, France; Clinique Clemenville, Montpellier, France; Centre Hospitalier du Pays d'Aix, Aix-en-Provence, France; CHRU Nimes, Nimes, France; GCS Recherche et Innovation, Sainte
| | - P-E Colombo
- Institut Paoli Calmettes, Marseille, France; Institut de Cancérologie de l'Ouest - Site Paul Papin, Angers, France; Polyclinique Urbain V, Avignon, France; Institut Bergonie, Bordeaux, France; Centre Jean Perrin, Clermont Ferrand, France; CHU Limoges, Limoges, France; Centre Léon Bérard, Lyon, France; Clinique d'Aix, Aix-en-Provence, France; Hopital Privé Drome Ardèche - Clinique Pasteur, Guilherand Granges, France; Centre Oscar Lambret, Lille, France; Hôpital Tenon, Paris, France; Institut Jean Godinot, Reims, France; Centre Clinical, Angoulème, France; Hôpitaux du Leman, Thonon, France; Groupe Hospitalier des Diaconesses, Paris, France; Institut Universitaire du Cancer, Toulouse, France; Hôpital Sainte Musse (CHITS), Toulon, France; CHU Amiens-Picardie - Hopital Nord, Amiens, France; Groupe Hospitalier Mutualiste de Grenoble, Grenoble, France; Clinique Clemenville, Montpellier, France; Centre Hospitalier du Pays d'Aix, Aix-en-Provence, France; CHRU Nimes, Nimes, France; GCS Recherche et Innovation, Sainte
| | - V Di Beo
- Institut Paoli Calmettes, Marseille, France; Institut de Cancérologie de l'Ouest - Site Paul Papin, Angers, France; Polyclinique Urbain V, Avignon, France; Institut Bergonie, Bordeaux, France; Centre Jean Perrin, Clermont Ferrand, France; CHU Limoges, Limoges, France; Centre Léon Bérard, Lyon, France; Clinique d'Aix, Aix-en-Provence, France; Hopital Privé Drome Ardèche - Clinique Pasteur, Guilherand Granges, France; Centre Oscar Lambret, Lille, France; Hôpital Tenon, Paris, France; Institut Jean Godinot, Reims, France; Centre Clinical, Angoulème, France; Hôpitaux du Leman, Thonon, France; Groupe Hospitalier des Diaconesses, Paris, France; Institut Universitaire du Cancer, Toulouse, France; Hôpital Sainte Musse (CHITS), Toulon, France; CHU Amiens-Picardie - Hopital Nord, Amiens, France; Groupe Hospitalier Mutualiste de Grenoble, Grenoble, France; Clinique Clemenville, Montpellier, France; Centre Hospitalier du Pays d'Aix, Aix-en-Provence, France; CHRU Nimes, Nimes, France; GCS Recherche et Innovation, Sainte
| | - E Lambaudie
- Institut Paoli Calmettes, Marseille, France; Institut de Cancérologie de l'Ouest - Site Paul Papin, Angers, France; Polyclinique Urbain V, Avignon, France; Institut Bergonie, Bordeaux, France; Centre Jean Perrin, Clermont Ferrand, France; CHU Limoges, Limoges, France; Centre Léon Bérard, Lyon, France; Clinique d'Aix, Aix-en-Provence, France; Hopital Privé Drome Ardèche - Clinique Pasteur, Guilherand Granges, France; Centre Oscar Lambret, Lille, France; Hôpital Tenon, Paris, France; Institut Jean Godinot, Reims, France; Centre Clinical, Angoulème, France; Hôpitaux du Leman, Thonon, France; Groupe Hospitalier des Diaconesses, Paris, France; Institut Universitaire du Cancer, Toulouse, France; Hôpital Sainte Musse (CHITS), Toulon, France; CHU Amiens-Picardie - Hopital Nord, Amiens, France; Groupe Hospitalier Mutualiste de Grenoble, Grenoble, France; Clinique Clemenville, Montpellier, France; Centre Hospitalier du Pays d'Aix, Aix-en-Provence, France; CHRU Nimes, Nimes, France; GCS Recherche et Innovation, Sainte
| | - A Tallet
- Institut Paoli Calmettes, Marseille, France; Institut de Cancérologie de l'Ouest - Site Paul Papin, Angers, France; Polyclinique Urbain V, Avignon, France; Institut Bergonie, Bordeaux, France; Centre Jean Perrin, Clermont Ferrand, France; CHU Limoges, Limoges, France; Centre Léon Bérard, Lyon, France; Clinique d'Aix, Aix-en-Provence, France; Hopital Privé Drome Ardèche - Clinique Pasteur, Guilherand Granges, France; Centre Oscar Lambret, Lille, France; Hôpital Tenon, Paris, France; Institut Jean Godinot, Reims, France; Centre Clinical, Angoulème, France; Hôpitaux du Leman, Thonon, France; Groupe Hospitalier des Diaconesses, Paris, France; Institut Universitaire du Cancer, Toulouse, France; Hôpital Sainte Musse (CHITS), Toulon, France; CHU Amiens-Picardie - Hopital Nord, Amiens, France; Groupe Hospitalier Mutualiste de Grenoble, Grenoble, France; Clinique Clemenville, Montpellier, France; Centre Hospitalier du Pays d'Aix, Aix-en-Provence, France; CHRU Nimes, Nimes, France; GCS Recherche et Innovation, Sainte
| | - J-M Boher
- Institut Paoli Calmettes, Marseille, France; Institut de Cancérologie de l'Ouest - Site Paul Papin, Angers, France; Polyclinique Urbain V, Avignon, France; Institut Bergonie, Bordeaux, France; Centre Jean Perrin, Clermont Ferrand, France; CHU Limoges, Limoges, France; Centre Léon Bérard, Lyon, France; Clinique d'Aix, Aix-en-Provence, France; Hopital Privé Drome Ardèche - Clinique Pasteur, Guilherand Granges, France; Centre Oscar Lambret, Lille, France; Hôpital Tenon, Paris, France; Institut Jean Godinot, Reims, France; Centre Clinical, Angoulème, France; Hôpitaux du Leman, Thonon, France; Groupe Hospitalier des Diaconesses, Paris, France; Institut Universitaire du Cancer, Toulouse, France; Hôpital Sainte Musse (CHITS), Toulon, France; CHU Amiens-Picardie - Hopital Nord, Amiens, France; Groupe Hospitalier Mutualiste de Grenoble, Grenoble, France; Clinique Clemenville, Montpellier, France; Centre Hospitalier du Pays d'Aix, Aix-en-Provence, France; CHRU Nimes, Nimes, France; GCS Recherche et Innovation, Sainte
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Martinez A, Filleron T, Rouanet P, Méeus P, Lambaudie E, Classe JM, Foucher F, Narducci F, Gouy S, Guyon F, Marchal F, Jouve E, Colombo PE, Mourregot A, Rivoire M, Chopin N, Houvenaeghel G, Jaffre I, Leveque J, Lavoue V, Leblanc E, Morice P, Stoeckle E, Verheaghe JL, Querleu D, Ferron G. Prospective Assessment of First-Year Quality of Life After Pelvic Exenteration for Gynecologic Malignancy: A French Multicentric Study. Ann Surg Oncol 2017; 25:535-541. [PMID: 29159738 DOI: 10.1245/s10434-017-6120-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Pelvic exenteration remains one of the most mutilating procedures, with important postoperative morbidity, an altered body image, and long-term physical and psychosocial concerns. This study aimed to assess quality of life (QOL) during the first year after pelvic exenteration for gynecologic malignancy performed with curative intent. METHODS A French multicentric prospective study was performed by including patients who underwent pelvic exenteration. Quality of life by measurement of functional and symptom scales was assessed using the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 (version 3.0) and the EORTC QLQ-OV28 questionnaires before surgery, at baseline, and 1, 3, 6, and 12 months after the procedure. RESULTS The study enrolled 97 patients. Quality of life including physical, personal, fatigue, and anorexia reported in the QLQ-C30 was significantly reduced 1 month postoperatively and improved at least to baseline level 1 year after the procedure. Body image also was significantly reduced 1 month postoperatively. Global health, emotional, dyspnea, and anorexia items were significantly improved 1 year after surgery compared with baseline values. Unlike younger patients, elderly patients did not regain physical and social activities after pelvic exenteration. CONCLUSIONS Therapeutic decision on performing a pelvic exenteration can have a severe and permanent impact on all aspects of patients' QOL. Deterioration of QOL was most significant during the first 3 months after surgery. Elderly patients were the only group of patients with permanent decreased physical and social function. Preoperative evaluation and postoperative follow-up evaluation should include health-related QOL instruments, counseling by a multidisciplinary team to cover all aspects concerning stoma care, sexual function, and long-term concerns after surgery.
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Affiliation(s)
- A Martinez
- Department of Surgical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer, Toulouse, France. .,Centre de Recherches en Cancérologie de Toulouse (CRCT), UMR 1037 INSERM, Toulouse, France.
| | - T Filleron
- Department of Biostatistics, Institut Claudius Regaud, Institut Universitaire du Cancer, Toulouse, France
| | - P Rouanet
- Department of Surgical Oncology, Institut du Cancer de Montpellier, Montpellier, France
| | - P Méeus
- Department of Surgical Oncology, CLCC Léon Bérard, Lyon, France
| | - E Lambaudie
- Department of Surgical Oncology, CLCC Paoli-Calmettes, Marseille, France
| | - J M Classe
- Department of Surgical Oncology, CLCC Institut Cancérologique de l'ouest, Nantes, France
| | - F Foucher
- Department of Surgical Oncology, CHU Rennes, Rennes, France
| | - F Narducci
- Department of Surgical Oncology, CLCC Oscar Lambret, Lille, France
| | - S Gouy
- Department of Surgical Oncology, Institut Gustave Roussy, Villejuif, France
| | - F Guyon
- Department of Surgical Oncology, Institut Bergonié, Bordeaux, France
| | - F Marchal
- Department of Surgical Oncology, Institut Cancérologie de Lorraine, Nancy, France
| | - E Jouve
- Department of Surgical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer, Toulouse, France
| | - P E Colombo
- Department of Surgical Oncology, Institut du Cancer de Montpellier, Montpellier, France
| | - A Mourregot
- Department of Surgical Oncology, Institut du Cancer de Montpellier, Montpellier, France
| | - M Rivoire
- Department of Surgical Oncology, CLCC Léon Bérard, Lyon, France
| | - N Chopin
- Department of Surgical Oncology, Institut du Cancer de Montpellier, Montpellier, France
| | - G Houvenaeghel
- Department of Surgical Oncology, CLCC Paoli-Calmettes, Marseille, France
| | - I Jaffre
- Department of Surgical Oncology, CLCC Institut Cancérologique de l'ouest, Nantes, France
| | - J Leveque
- Department of Surgical Oncology, CHU Rennes, Rennes, France
| | - V Lavoue
- Department of Surgical Oncology, CHU Rennes, Rennes, France
| | - E Leblanc
- Department of Surgical Oncology, CLCC Oscar Lambret, Lille, France
| | - P Morice
- Department of Surgical Oncology, Institut Gustave Roussy, Villejuif, France
| | - E Stoeckle
- Department of Surgical Oncology, Institut Bergonié, Bordeaux, France
| | - J L Verheaghe
- Department of Surgical Oncology, Institut Cancérologie de Lorraine, Nancy, France
| | - D Querleu
- Department of Surgical Oncology, Institut Bergonié, Bordeaux, France
| | - G Ferron
- Department of Surgical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer, Toulouse, France
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de Nonneville A, Gonçalves A, Zemmour C, Cohen M, Classe JM, Reyal F, Colombo PE, Jouve E, Giard S, Barranger E, Sabatier R, Bertucci F, Boher JM, Houvenaeghel G. Adjuvant chemotherapy in pT1ab node-negative triple-negative breast carcinomas: Results of a national multi-institutional retrospective study. Eur J Cancer 2017; 84:34-43. [PMID: 28780480 DOI: 10.1016/j.ejca.2017.06.043] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [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: 04/24/2017] [Revised: 06/19/2017] [Accepted: 06/27/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND Triple-negative breast cancers (TNBCs) are considered as associated with poor outcome, but prognosis of subcentimetric, node-negative disease remains controversial and evidence that adjuvant chemotherapy (CT) is effective in these small tumours remains limited. PATIENTS AND METHODS Our objective was to investigate the impact of CT on survival in pT1abN0M0 TNBC. Patients were retrospectively identified from a cohort of 22,475 patients who underwent primary surgery in 15 French centres between 1987 and 2013. As rare pathological types may display very particular prognoses in these tumours, we retained only the invasive ductal carcinomas of no special type according to the last World Health Organisation (WHO) classification which is the most common TNBC histological type. End-points were disease-free survival (DFS) and metastasis-free survival (MFS). A propensity score for receiving CT was estimated using a logistic regression including age, tumour size, Scarff Bloom and Richardson (SBR) grade and lymphovascular invasion. RESULTS Of a total of 284 patients with pT1abN0M0 ductal TNBC, 144 (51%) received CT and 140 (49%) did not. Patients receiving CT had more adverse prognostic features, such as tumour size, high grade, young age, and lymphovascular invasion. CT was not associated with a significant benefit for DFS (Hazard ratio, HR = 0.77 [0.40-1.46]; p = 0.419, log-rank test) or MFS (HR = 1.00 [0.46-2.19]; p = 0.997), with 5-year DFS and MFS in the group with CT versus without of 90% [81-94%] versus 84% [74-90%], and 90% [81-95%] versus 90% [83%-95%], respectively. Results were consistent in all supportive analyses including multivariate Cox model and the use of the propensity score for adjustment and as a matching factor for case-control analyses. CONCLUSIONS This study did not identify a significant DFS or MFS advantage for CT in subcentimetric, node-negative ductal TNBC. Although current consensus guidelines recommend consideration of CT in all TNBC larger than 5 mm, clinicians should carefully discuss benefit/risk ratio with patients, given the unproven benefits.
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Affiliation(s)
- A de Nonneville
- Aix-Marseille University, CNRS, INSERM, Institut Paoli-Calmettes, Department of Medical Oncology, CRCM, Marseille, France.
| | - A Gonçalves
- Aix-Marseille University, CNRS, INSERM, Institut Paoli-Calmettes, Department of Medical Oncology, CRCM, Marseille, France.
| | - C Zemmour
- Department of Clinical Research and Investigation, Biostatistics and Methodology Unit, Institut Paoli-Calmettes, Aix Marseille University, INSERM, IRD, SESSTIM, Marseille, France
| | - M Cohen
- Aix-Marseille University, CNRS, INSERM, Institut Paoli-Calmettes, Department of Surgical Oncology, CRCM, Marseille, France
| | - J M Classe
- Institut René Gauducheau, Saint-Herblain, France
| | - F Reyal
- Institut Curie, Paris, France
| | | | - E Jouve
- Institut Claudius Regaud, Toulouse, France
| | - S Giard
- Centre Oscar Lambret, Lille, France
| | | | - R Sabatier
- Aix-Marseille University, CNRS, INSERM, Institut Paoli-Calmettes, Department of Medical Oncology, CRCM, Marseille, France
| | - F Bertucci
- Aix-Marseille University, CNRS, INSERM, Institut Paoli-Calmettes, Department of Medical Oncology, CRCM, Marseille, France
| | - J M Boher
- Department of Clinical Research and Investigation, Biostatistics and Methodology Unit, Institut Paoli-Calmettes, Aix Marseille University, INSERM, IRD, SESSTIM, Marseille, France
| | - G Houvenaeghel
- Aix-Marseille University, CNRS, INSERM, Institut Paoli-Calmettes, Department of Surgical Oncology, CRCM, Marseille, France
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Viala M, Alexandre M, Thézenas S, Lamy PJ, Bibeau F, Gutowski M, Colombo PE, Romieu G, Jacot W, Guiu S. Abstract P6-09-28: Prognostic impact of the inclusion of uPA/PAI-1 in ER+/Her2- pN0 early breast cancer adjuvant treatments decision-making. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p6-09-28] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Purpose: Intermediate-risk early breast cancer (EBC) is a heterogeneous group in which adjuvant chemotherapy decision prove to be difficult. Clinical and pathological criteria might be insufficient to determine the best therapeutic options for patients, and validated biomarkers are urgently needed to help decision making, such as the LOE-I uPA/PAI-1 biomarker. The aim of this study is to evaluate the clinical outcome of a large, unselected, ER+/HER2- pN0 EBC cohort of patients in whom the routine clinical decision process included a prospective uPA/PAI-1 determination.
Methods: This monocentric retrospective study included 520 ER+/HER2- pN0/M0 EBC patients who had curative surgery in our center between 2006 and 2011. Adjuvant therapeutic strategy was decided based on clinico-pathological data, altogether with a routine prospective determination of uPA/PAI-1 tumor levels. We evaluated the correlation between uPA/PAI-1 levels, classical clinico-pathological variables and the patient's outcome (relapse free survival, RFS; overall survival, OS).
Results: Median age was 54 years (range 27-85). 75% of tumors were classified T1, 25% T2 and above. We found 80.8% of ductal carcinomas, 12.3% of lobular carcinomas and 6.9% of other histological types. SBR grade 1-2 represented 82.5% of our cohort versus 17.5% of grade 3. Mitotic count was <10 in 63.5% of cases, and ≥10 in 36.5%. Peri-tumoral invasion (PVI) was seen in 17% of tumors. Progesterone receptors (PR) were positive in 79.6% of cases. Median follow-up was 5.4 years. 5 and 10 years RFS were respectively 95% and 89% (n=33 local or metastatic relapse). 5 year OS was 96.3%. We found 40% of low uPA/PAI-1 levels, and 60% of high uPA and/or PAI-1 levels. By using uPA/PAI-1 levels in our adjuvant treatment decision-making, 75% of patients with low uPA/PAI-1 levels did not received chemotherapy and 60% of patients with high uPA and/or PAI-1 levels received chemotherapy. 98.3% of our patients received endocrine therapy as adjuvant treatment for at least 5 years. No statistical significant correlation was found between uPA/PAI-1 levels and RFS (p=0.3) or OS (p=0.28). In univariate analysis, tumor size (p=0.048; p=0.0694), histological grade (p=0.007; p=0.0142), PR status (p=0.001; p=0.0002) and mitotic count (p=0.0001; p=0.0001) were statistically correlated with RFS and OS, respectively. Using cox regression model, PR status (p<0.003) and mitotic count (p<0.001) appeared to be strongly correlated with RFS. No changes in significant variables were seen when the analyses were restricted to the grade 2 subgroup (n=339).
Conclusion: The individualization of patients' treatment using uPA/PAI-1 tumor levels allows the reversion of the well-known poor prognostic impact of high uPA/PAI-1 levels and strongly support the use of this LOE-I biomarker in clinical practice. PR status and mitotic activity remains independent major prognostic factors in optimally treated patients. The evaluation of the additional impact of multigene signature in this setting needs to be performed. Longer 10-years follow-up needs to be done in this ER+/HER2- subgroup, particularly to evaluate the risk of late relapse after endocrine therapy.
Citation Format: Viala M, Alexandre M, Thézenas S, Lamy P-J, Bibeau F, Gutowski M, Colombo P-E, Romieu G, Jacot W, Guiu S. Prognostic impact of the inclusion of uPA/PAI-1 in ER+/Her2- pN0 early breast cancer adjuvant treatments decision-making [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P6-09-28.
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Affiliation(s)
- M Viala
- Institut Cancerologie Montpellier, Montpellier, France; INSERM U1194 - IRCM, Montpellier, France; LABOSUD Ocbiologie, Montpellier, France
| | - M Alexandre
- Institut Cancerologie Montpellier, Montpellier, France; INSERM U1194 - IRCM, Montpellier, France; LABOSUD Ocbiologie, Montpellier, France
| | - S Thézenas
- Institut Cancerologie Montpellier, Montpellier, France; INSERM U1194 - IRCM, Montpellier, France; LABOSUD Ocbiologie, Montpellier, France
| | - P-J Lamy
- Institut Cancerologie Montpellier, Montpellier, France; INSERM U1194 - IRCM, Montpellier, France; LABOSUD Ocbiologie, Montpellier, France
| | - F Bibeau
- Institut Cancerologie Montpellier, Montpellier, France; INSERM U1194 - IRCM, Montpellier, France; LABOSUD Ocbiologie, Montpellier, France
| | - M Gutowski
- Institut Cancerologie Montpellier, Montpellier, France; INSERM U1194 - IRCM, Montpellier, France; LABOSUD Ocbiologie, Montpellier, France
| | - P-E Colombo
- Institut Cancerologie Montpellier, Montpellier, France; INSERM U1194 - IRCM, Montpellier, France; LABOSUD Ocbiologie, Montpellier, France
| | - G Romieu
- Institut Cancerologie Montpellier, Montpellier, France; INSERM U1194 - IRCM, Montpellier, France; LABOSUD Ocbiologie, Montpellier, France
| | - W Jacot
- Institut Cancerologie Montpellier, Montpellier, France; INSERM U1194 - IRCM, Montpellier, France; LABOSUD Ocbiologie, Montpellier, France
| | - S Guiu
- Institut Cancerologie Montpellier, Montpellier, France; INSERM U1194 - IRCM, Montpellier, France; LABOSUD Ocbiologie, Montpellier, France
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Maldera A, De Marco P, Colombo PE, Origgi D, Torresin A. Digital breast tomosynthesis: Dose and image quality assessment. Phys Med 2016; 33:56-67. [PMID: 28010921 DOI: 10.1016/j.ejmp.2016.12.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [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: 07/29/2016] [Revised: 10/31/2016] [Accepted: 12/04/2016] [Indexed: 12/01/2022] Open
Abstract
The aim of this work was to evaluate how different acquisition geometries and reconstruction parameters affect the performance of four digital breast tomosynthesis (DBT) systems (Senographe Essential - GE, Mammomat Inspiration - Siemens, Selenia Dimensions - Hologic and Amulet Innovality - Fujifilm) on the basis of a physical characterization. Average Glandular Dose (AGD) and image quality parameters such as in-plane/in-depth resolution, signal difference to noise ratio (SDNR) and artefact spread function (ASF) were examined. Measured AGD values resulted below EUREF limits for 2D imaging. A large variability was recorded among the investigated systems: the mean dose ratio DBT/2D ranged between 1.1 and 1.9. In-plane resolution was in the range: 2.2mm-1-3.8mm-1 in chest wall-nipple direction. A worse resolution was found for all devices in tube travel direction. In-depth resolution improved with increasing scan angle but was also affected by the choice of reconstruction and post-processing algorithms. The highest z-resolution was provided by Siemens (50°, FWHM=2.3mm) followed by GE (25°, FWHM=2.8mm), while the Fujifilm HR showed the lowest one, despite its wide scan angle (40°, FWHM=4.1mm). The ASF was dependent on scan angle: smaller range systems showed wider ASF curves; however a clear relationship was not found between scan angle and ASF, due to the different post processing and reconstruction algorithms. SDNR analysis, performed on Fujifilm system, demonstrated that pixel binning improves detectability for a fixed dose/projection. In conclusion, we provide a performance comparison among four DBT systems under a clinical acquisition mode.
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Affiliation(s)
- A Maldera
- Medical Physics Dept, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, 20162 Milano, Italy; Post Graduate School of Medical Physics, Università degli Studi di Milano, Physics Dept, Via Celoria, 16, 20133 Milano, Italy.
| | - P De Marco
- Medical Physics Dept, Istituto Europeo di Oncologia, Via Ripamonti, 435, 20141 Milano, Italy; Post Graduate School of Medical Physics, Università degli Studi di Milano, Physics Dept, Via Celoria, 16, 20133 Milano, Italy
| | - P E Colombo
- Medical Physics Dept, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, 20162 Milano, Italy
| | - D Origgi
- Medical Physics Dept, Istituto Europeo di Oncologia, Via Ripamonti, 435, 20141 Milano, Italy
| | - A Torresin
- Medical Physics Dept, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, 20162 Milano, Italy
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Classe JM, Baffert S, Sigal-Zafrani B, Fall M, Rousseau C, Alran S, Rouanet P, Belichard C, Mignotte H, Ferron G, Marchal F, Giard S, Tunon de Lara C, Le Bouedec G, Cuisenier J, Werner R, Raoust I, Rodier JF, Laki F, Colombo PE, Lasry S, Faure C, Charitansky H, Olivier JB, Chauvet MP, Bussières E, Gimbergues P, Flipo B, Houvenaeghel G, Dravet F, Livartowski A. Cost comparison of axillary sentinel lymph node detection and axillary lymphadenectomy in early breast cancer. A national study based on a prospective multi-institutional series of 985 patients 'on behalf of the Group of Surgeons from the French Unicancer Federation'. Ann Oncol 2012; 23:1170-1177. [PMID: 21896543 PMCID: PMC3335244 DOI: 10.1093/annonc/mdr355] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Revised: 05/11/2011] [Accepted: 06/20/2011] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Our objective was to assess the global cost of the sentinel lymph node detection [axillary sentinel lymph node detection (ASLND)] compared with standard axillary lymphadenectomy [axillary lymph node dissection (ALND)] for early breast cancer patients. PATIENTS AND METHODS We conducted a prospective, multi-institutional, observational, cost comparative analysis. Cost calculations were realized with the micro-costing method from the diagnosis until 1 month after the last surgery. RESULTS Eight hundred and thirty nine patients were included in the ASLND group and 146 in the ALND group. The cost generated for a patient with an ASLND, with one preoperative scintigraphy, a combined method for sentinel node detection, an intraoperative pathological analysis without lymphadenectomy, was lower than the cost generated for a patient with lymphadenectomy [€ 2947 (σ = 580) versus € 3331 (σ = 902); P = 0.0001]. CONCLUSION ASLND, involving expensive techniques, was finally less expensive than ALND. The length of hospital stay was the cost driver of these procedures. The current observational study points the heterogeneous practices for this validated and largely diffused technique. Several technical choices have an impact on the cost of ASLND, as intraoperative analysis allowing to reduce rehospitalization rate for secondary lymphadenectomy or preoperative scintigraphy, suggesting possible savings on hospital resources.
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Affiliation(s)
- J M Classe
- Surgical Department, Institut de Cancérologie de l'Ouest-Center Gauducheau, Nantes.
| | - S Baffert
- Medico economic unit, Institut Curie, Paris
| | | | - M Fall
- Medico economic unit, Institut Curie, Paris
| | - C Rousseau
- Nuclear medicine Department, Institut de Cancérologie de l'Ouest-Center Gauducheau, Nantes
| | - S Alran
- Surgical Department, Institut Curie, Paris
| | - P Rouanet
- Surgical Department, Center Val d'Aurel Montpellier
| | - C Belichard
- Surgical Department, Center René Huguenin, Saint Cloud
| | - H Mignotte
- Surgical Department, Center Léon Bérard, Lyon
| | - G Ferron
- Surgical Department, Institut Claudius Regaud, Toulouse
| | - F Marchal
- Surgical Department, Center Alexis Vautrin, Nancy
| | - S Giard
- Surgical Department, Center Oscar Lambret, Lille
| | | | - G Le Bouedec
- Surgical Department, Center Jean Perrin, Clermont Ferrand
| | - J Cuisenier
- Surgical Department, Center Georges François Leclerc, Dijon
| | - R Werner
- Surgical Department, Center Jean Godinot, Reims
| | - I Raoust
- Surgical Department, Center Georges Lacassagne, Nice
| | - J-F Rodier
- Surgical Department, Center Paul Strauss, Strasbourg
| | - F Laki
- Medico economic unit, Institut Curie, Paris; Surgical Department, Institut Curie, Paris
| | - P-E Colombo
- Surgical Department, Center Val d'Aurel Montpellier
| | - S Lasry
- Surgical Department, Center René Huguenin, Saint Cloud
| | - C Faure
- Surgical Department, Center Léon Bérard, Lyon
| | - H Charitansky
- Surgical Department, Institut Claudius Regaud, Toulouse
| | - J-B Olivier
- Surgical Department, Center Alexis Vautrin, Nancy
| | - M-P Chauvet
- Surgical Department, Center Oscar Lambret, Lille
| | - E Bussières
- Surgical Department, Center Bergonié, Bordeaux
| | - P Gimbergues
- Surgical Department, Center Jean Perrin, Clermont Ferrand
| | - B Flipo
- Surgical Department, Center Georges Lacassagne, Nice
| | - G Houvenaeghel
- Surgical Department, Institut Paoli Calmette Marseille, France
| | - F Dravet
- Surgical Department, Institut de Cancérologie de l'Ouest-Center Gauducheau, Nantes
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Colombo PE, Patani N, Bibeau F, Assenat E, Bertrand MM, Senesse P, Rouanet P. Clinical impact of lymph node status in rectal cancer. Surg Oncol 2011; 20:e227-33. [PMID: 21911287 DOI: 10.1016/j.suronc.2011.08.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Revised: 07/30/2011] [Accepted: 08/22/2011] [Indexed: 01/14/2023]
Abstract
Lymph node status at the time of diagnosis remains one of the principal indicators of prognosis in patients with rectal cancer. Involvement of loco-regional lymph nodes is relevant to surgical and clinical oncologists and continues to impact significantly upon local and systemic management strategies, in both neo-adjuvant and adjuvant settings. In this review, the clinical impact of lymph node status in the surgical management of rectal cancer is considered, with particular reference to the significance of lymphadenectomy and the potential implications for rectal tumours amenable to trans-anal excision. Current standards of care are reviewed and the extent to which the determination of lymph node status influences oncological decisions regarding neo-adjuvant and adjuvant therapies are discussed with areas of controversy highlighted.
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Affiliation(s)
- P E Colombo
- Department of Surgical Oncology, Val d'Aurelle Anticancer Centre, 34298 Montpellier Cedex 5, France.
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Colombo PE, Bertrand MM, Mourregot A, Gutowski M, Quenet F, Saint-Aubert B, Rouanet P. [Spontaneous recovery from extensive hepatic ischemia following an extended pancreaticoduodenectomy]. J Chir (Paris) 2008; 145:404-406. [PMID: 18955936 DOI: 10.1016/s0021-7697(08)74337-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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20
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Colombo PE, Mourregot A, Fabbro M, Gutowski M, Saint-Aubert B, Quenet F, Gourgou S, Rouanet P. Aggressive surgical strategies in advanced ovarian cancer: a monocentric study of 203 stage IIIC and IV patients. Eur J Surg Oncol 2008; 35:135-43. [PMID: 18289825 DOI: 10.1016/j.ejso.2008.01.005] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.9] [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: 05/15/2007] [Accepted: 01/08/2008] [Indexed: 01/13/2023] Open
Abstract
AIMS The standard treatment for advanced ovarian cancer consists of cytoreductive surgery associated with a platinum/paclitaxel-based chemotherapy. Nevertheless, there is still the question as to the extent and timing of the surgical debulking. The aim of this study was to evaluate the place of surgery in the therapeutic sequence. PATIENTS AND METHODS We reviewed data from all consecutive patients with stage IIIC and IV epithelial ovarian cancer, operated on at our institution between 1990 and 2005. Patients were divided into 2 groups, according to the position of surgery in the therapeutic sequence. Patients in group 1 received initial debulking surgery. Group 2 consisted of patients having received their first debulking after initial chemotherapy. RESULTS Two hundred and three patients were identified and frequently underwent aggressive surgery, in particular, digestive surgery with bowel resections. Perioperative mortality and morbidity rates were low (2% and 14%, respectively) and there was no difference between the groups. Overall survival in group 1 for patients with complete cytoreduction (residual disease (RD)=0), optimal surgery (RD<1cm) or sub-optimal surgery (RD>1cm) was 50%, 30% and 14%, respectively. In group 2, overall survival following complete surgery was 30%, and no long-term survival was observed when surgery was not complete at the time of interval surgery. Survival was worse for patients who had received more than 4 cycles of neoadjuvant chemotherapy. CONCLUSION This study confirms the importance of surgery in the prognosis of advanced ovarian cancer. Only the patient subgroup that underwent complete initial or interval surgery was associated with a prolonged remission. Optimal surgery with a controlled morbidity can be achieved in many cases, even if bowel resection is needed, at the time of primary debulking. In the interval cytoreductive surgery subgroup, the response to initial chemotherapy and surgery was found to be essential for prognosis.
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Affiliation(s)
- P-E Colombo
- Department of Surgical Oncology, CRLC Val d'Aurelle, Montpellier Cedex, France.
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21
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Puche P, Jacquet E, Borie F, Colombo PE, Bouyabrine H, Herrero A, Guillon F, Carabalona JP, Fabre JM, Millat B, Domergue J, Navarro F. [Treatment of biliary injuries after laparoscopic cholecystectomy: retrospective study of 27 patients]. J Chir (Paris) 2007; 144:403-408. [PMID: 18065895 DOI: 10.1016/s0021-7697(07)73995-9] [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] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
UNLABELLED Biliary injuries after laparoscopic cholecystectomy are rare but serious. Their mortality rate can reach 9%. AIM OF THE STUDY Describe the management of biliary injuries after laparoscopic cholecystectomy in our center. PATIENTS Between January 1995 and June 2005, 27 patients (13 women, 14 men) were treated. The mean age was 53 years old (range, 18-92 years). The biliary injuries were common bile duct sections (n=16, 60%), common bile duct stenoses (n=5, 18.5%), biliary fistulas from the cystic duct (n=4, 15%), and biliary fistulas from an aberrant biliary duct (n=2, 7.5%). RESULTS Acute cholecystis was present in 40% of cases (n=11). An intraoperative cholangiography was done in 12 patients (44%). The mortality rate was 0%. Of the common bile duct sections, 43% were diagnosed during the cholecystectomy (n=7) or after the cholecystectomy within a mean of 11.2 days (n=9). Common bile duct injuries were treated in 16 cases with hepatojejunostomy and in five cases with an external biliary drain. Fistulas from the cystic duct were diagnosed within a mean 14.8 days. A fistula from an aberrant biliary duct was diagnosed during the cholecystectomy (n=1) or in the second postoperative day (n=1). Fistulas were treated with a clip on the cystic duct (n=2), an external biliary drain (n=1), a biliary endoprosthesis (n=1), and the biliary aberrant duct suture (n=2). CONCLUSION Common bile duct injuries are a serious complication because their treatment is a hepaticojejunostomy in 75% of cases.
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Affiliation(s)
- P Puche
- Service Médico-Chirurgical des Maladies de l'Appareil Digestif et de Transplantation Hépatique, Hôpital Saint Eloi - Montpellier, France.
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Puche P, Jacquet E, Colombo PE, Jaber S, Alric P, Carabalona JP, Bouyabrine H, Domergue J, Navarro F. [Surgical management of a preaortic paraganglioma: Report of one case]. ACTA ACUST UNITED AC 2006; 131:559-63. [PMID: 16824474 DOI: 10.1016/j.anchir.2006.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [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: 10/10/2005] [Accepted: 05/25/2006] [Indexed: 10/24/2022]
Abstract
Paragangliomas (PG) are rare and often diagnosed in the young adult. One case of retroperitoneal preaortic paraganglioma localised between the celiac trunk and the superior mesenteric artery is reported. The management of paraganglioma involves endocrinologists, geneticists and surgeons but the only potentially curative treatment remains surgical resection. Pathology reports can not always discriminate between benign or malignant tumors. Hereditary in paraganglioma occurs in approximately 25% of cases. Genetic investigation is therefore mandatory in all patients with PG. Since the type of genetic mutation is correlated with tumoral aggressiveness, genetic investigation results should be taken into account when a surgical procedure is planned.
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Affiliation(s)
- P Puche
- Service médicochirurgical des maladies de l'appareil digestif et transplantation hépatique, hôpital Saint-Eloi, 80, avenue Augustin-Fliche, 34295 Montpellier, France.
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