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Chanal E, Bouleftour W, Guillot A, Rowinski E, Bernichon E, Tremeau L, Lardon R, Lacroix B, Lorin S, Delorme G, Perraud Y, Armand C, Levigne F, Vallard A, Langrand-Escure J, Fournel P, Benoite M, Vassal C. Current management of stage I testicular germ cell tumors in a French cancer institute. A practice analysis over the 10 past years. Bull Cancer 2019; 106:1086-1093. [PMID: 31582176 DOI: 10.1016/j.bulcan.2019.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 08/01/2019] [Accepted: 08/13/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Testicular Germ Cell Tumors (TGCTs) represent the most frequent malignant tumour among young male adults. Orchiectomy alone cure 80% of stage I. Standard options after orchiectomy include radiotherapy (RT), chemotherapy (CT) by 1 cycle of carboplatin AUC 7 or active surveillance (SV) for seminomatous GCTs (SGCT) and retroperitoneal lymphadenectomy (RPLND), CT by 1 or 2 cycles of Bleomycine Etoposide Cisplatine (BEP) or active surveillance for nonseminomatous GCTs (NSGCT). Adjuvant treatments decrease the relapse rate after orchiectomy with substantial toxicities without any benefit on overall survival. Recent guidelines accorded utmost importance on SV rather than adjuvants strategies. The main objective of this study was to describe our current practice over the 10 past years in regard of these recommendations. METHODS Data of 50 patients with stage I GCT treated in our institute were collected between 2006 and 2016. Demographic and anatomopathologic data were reported. Clinical practice in our center was analyzed during two periods [2006-2011] and [2012-2016] according to the European Association of Urology Guidelines in 2011. RESULTS Patient's median age was 35.3 years. The analysis of clinical practice during the last 10 years showed that in SGCT, main treatment was RT than SV and CT. This option declined over the years (89% between 2006-2010 versus 53% between 2011-2016) whereas SV was more often employed (27% between 2011-2016 versus none between 2006-2010). Surveillance was used for 64% of NSGCT. CONCLUSIONS In our center, RT was less used over the years for the benefit of SV which is recommended by guidelines.
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Affiliation(s)
- Edouard Chanal
- Institut de cancérologie Lucien-Newirth, Department of Medical Oncology, Saint-Priest-en-Jarez, France
| | - Wafa Bouleftour
- Institut de cancérologie Lucien-Newirth, Department of Medical Oncology, Saint-Priest-en-Jarez, France.
| | - Aline Guillot
- Institut de cancérologie Lucien-Newirth, Department of Medical Oncology, Saint-Priest-en-Jarez, France
| | - Elise Rowinski
- Institut de cancérologie Lucien-Newirth, Department of Medical Oncology, Saint-Priest-en-Jarez, France
| | - Emilie Bernichon
- Institut de cancérologie Lucien-Newirth, Department of Medical Oncology, Saint-Priest-en-Jarez, France
| | | | - Renaud Lardon
- Clinique mutualiste chirurgicale de Saint-Étienne, Urology department, Saint-Étienne, France
| | - Bertrand Lacroix
- Clinique mutualiste chirurgicale de Saint-Étienne, Urology department, Saint-Étienne, France
| | - Stephane Lorin
- Hôpital Privé de la Loire, Urology department, Loire, France
| | - Gregory Delorme
- Hôpital Privé de la Loire, Urology department, Loire, France
| | - Yves Perraud
- Hôpital Privé de la Loire, Urology department, Loire, France
| | - Corinne Armand
- Hôpital Privé de la Loire, Urology department, Loire, France
| | | | - Alexis Vallard
- Institut de cancérologie Lucien-Newirth, Department of Radiotherapy, Saint-Priest-en-Jarez, France
| | - Julien Langrand-Escure
- Institut de cancérologie Lucien-Newirth, Department of Radiotherapy, Saint-Priest-en-Jarez, France
| | - Pierre Fournel
- Institut de cancérologie Lucien-Newirth, Department of Medical Oncology, Saint-Priest-en-Jarez, France
| | - Mery Benoite
- Institut de cancérologie Lucien-Newirth, Department of Medical Oncology, Saint-Priest-en-Jarez, France
| | - Cecile Vassal
- Institut de cancérologie Lucien-Newirth, Department of Medical Oncology, Saint-Priest-en-Jarez, France
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Soler C, Perraud Y, Gremillet E, Armand C, Geissler B, Steiner A, Levigne F. Sentinel lymph node in prostate carcinoma: Methodology, feasibility, surgical, and oncological consequences: A prospective study about 93 patients. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.6_suppl.69] [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: 11/20/2022] Open
Abstract
69 Background: There are few studies in the field of prostatic sentinel lymph node (SLN) procedure: in the literature at the most 10 publications are found. However the interest of urological surgeons is growing fast. We want to evaluate the rate of SLN SPECT-CT detection, the rate of SLN involvement, and the incidence of the SLN biopsy on the surgical and oncological management of patients. Methods: 93 patients with prostate cancer were included (gleason 6-9). All patients were elected for a radical laparoscopic prostatectomy. Nanocis* was intratumorally injected, guided by transrectal ultrosonography. 2 injections 0.6 ml in each lobe of the prostate were performed. Patient underwent planar imaging and SPECT-CT 2 hours after injections. Surgery was performed 18 hours after. Results: A lymphatic pelvic drainage was seen in 95,6 % (89/93) by SPECT-CT (external or internal iliac arteries areas). For 27 patients lymphatic drainage was on the right side, for 24 patients it was on the left side, for the 37 remaining patients migration was bilateral. The radioguided lymphadenectomy was assisted by a laparoscopic gamma-probe (Clerad, France), the SLN detection rate was 97.7% (87/89); the average number of resected radioactive nodes was 1.6 (range 1 to 5). By all the ways, a limited pelvic lymph node dissection was performed (including external iliac to common iliac arteries areas) in all 93 cases. An SLN involvement was found in 6 cases (5/87= 5.75%); in these 6 cases and in the 81 cases without SLN involvement, no metastatic involvement was found in the other lymph nodes, as well as in the 6 patients for which no SLN could be selectively resected (4 with no drainage seen and 2 not detected intra-operatively although visualized on lymphoscintigraphy). Conclusions: The low rate of lymphatic involvement is not surprising considering the Gleason score range 6 to 9 (low metastatic risk). So, the preliminary results are very attractive, especially for these patients that could have been falsely considered as N0. Our study is still in progress, and if these results are confirmed on a larger scale, then SLN procedure could be considered in the routine management of low risk prostatic carcinomas.
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Affiliation(s)
- Claude Soler
- CHPL, Centre d'Imagerie Nucleaire, Saint-Etienne, France
| | - Yves Perraud
- Department of Urology, HPL, Saint-Etienne, France
| | - Eric Gremillet
- CHPL, Centre d'Imagerie Nucleaire, Saint-Etienne, France
| | | | | | - Aline Steiner
- CHPL, Centre d'Imagerie Nucleaire, Saint-Etienne, France
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Soler C, Perraud Y, Gremillet E, Armand C, Geissler B, Steiner A, Levigne F. Sentinel lymph node in prostate carcinoma: Methodology, feasibility, surgical, and oncological consequences, about 74 patients. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.e15109] [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: 11/20/2022] Open
Abstract
e15109 Background: There are few studies in the field of prostatic sentinel lymph node (SLN) procedure: in the international literature at the most 10 publications are found. However the interest of urological surgeons and oncologists is growing fast. Goals of our study were: on the first hand to evaluate the rate of SLN SPECT-CT detection and the rate of SLN involvement, on the other hand to evaluate the incidence of the SLN biopsy results on the surgical and oncological management. Methods: 74 patients with prostate cancer were included. All patients had a Gleason score between 6 and 8. All patients were elected for a radical laparoscopic prostatectomy. Nanocis-Tc 99m was intratumorally injected, guided by transrectal ultrosonography. 2 injections of 0.6 ml in each lobe of the prostate were performed, depending on the size of the prostate. Patient underwent planar imaging and SPECT-CT 2 hours after injections. Surgery was performed 18 hours after SPECT-CT lymphoscintigraphy. Results: A lymphatic pelvic drainage was seen in 94,6 % (70/74) by SPECT-CT. Lymphatic drainage was on the right side (23), on the left side (15), or bilateral (32). The radioguided lymphadenectomy was assisted by a laparoscopic gamma-probe, the SLN detection rate was 97% (68/70); the average number of resected radioactive nodes was 1.6 (range 1 to 5). By all the ways, a limited pelvic lymph node dissection was performed in all 74 cases. An SLN involvement was found in 5 cases (5/68= 7.35%); in these 5 cases and in the 63 cases without SLN involvement, no metastatic involvement was found in the other lymph nodes, as well as in the 6 patients for which no SLN could be selectively resected (4 with no drainage seen and 2 not detected intra-operatively although visualized on lymphoscintigraphy). Conclusions: The low rate of lymphatic involvement is not surprising considering the Gleason score range 6 to 8 (low metastatic risk). So, the preliminary results are very attractive, especially for these patients that could have been falsely considered as N0. Our study is still in progress, and if these results are confirmed on a larger scale, then SLN procedure could be considered in the routine management of low risk prostatic carcinomas.
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Affiliation(s)
- Claude Soler
- CHPL, Centre d'Imagerie Nucleaire, Saint-Etienne, France
| | - Yves Perraud
- Department of Urology, HPL, Saint-Etienne, France
| | - Eric Gremillet
- CHPL, Centre d'Imagerie Nucleaire, Saint-Etienne, France
| | | | | | - Aline Steiner
- CHPL, Centre d'Imagerie Nucleaire, Saint-Etienne, France
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Tostain J, Perraud Y, Preynat P, Duthel R. [Anterior sacral meningocele with urologic manifestations. Report of 3 cases]. Prog Urol 1992; 2:464-71. [PMID: 1302088] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Anterior sacral meningocele is defined as a spinal fluid-filled thecal sac in the pelvis communicating with the spinal subarachnoid space through a defect in the anterior sacral wall. Since scimitar shape of the sacrum is characteristic, diagnosis is easily confirmed by echography and myelography. The sac very often contains benign tumors and a thickened filum terminale which can achieve a tethered cord syndrome. This congenital malformation, whose autosomal inherited condition has been proposed, has usually few characteristic symptoms but can present itself as a neurogenic bladder from tethered cord origin. Neurosurgical treatment can prevent rupture of the meningocele with meningitis. In addition to symptomatic treatment of the neurogenic bladder, the urologist must advise neurosurgical operation to preserve potency and cure specific bladder dysfunction secondary to tethered cord syndrome.
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Affiliation(s)
- J Tostain
- Département d'Urologie, Polyclinique de Beaulieu, Saint-Etienne
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Tostain J, Preynat P, Perraud Y. [Major urological cancer excisions after the age of 75]. Prog Urol 1991; 1:1022-7. [PMID: 1726945] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
32 patients more than 75 years old had major surgical procedures for urologic neoplasms: radical nephrectomy for renal cell cancer (9 cases), nephroureterectomy for upper urinary tract tumor (3 cases), radical cystectomy for invasive bladder cancer (20 cases). Postoperative mortality was 12.5%. In the nephrectomy group, 3 palliative procedures gave a mean survival time of 7 months. On 9 curative procedures, 7 patients are alive and free of disease with a mean follow-up of 45.6 months. In the cystectomy group, 5 palliative procedures gave a mean survival time of 7 months. On 15 curative procedures, 6 patients are alive and free of disease with a mean follow-up of 18.6 months. Our data confirm that curative procedures can be performed in the elderly. Mean survival time and quality of life after palliative procedures suggest that only true comfort procedures have to be performed.
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Affiliation(s)
- J Tostain
- Département d'Urologie, Polyclinique de Beaulieu, Saint Etienne
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Abstract
We report on a young woman with anuric, terminal renal insufficiency whose bladder could not be used for renal transplantation. A Kock pouch was implanted during stage 1 of treatment and the capacity of the pouch was increased artificially with physiological saline solution. The patient subsequently underwent renal transplantation. Results were excellent with regard to continence and ease of catheterization. No complications due to infection were observed despite immunosuppression and electrolyte disorders were minor.
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Affiliation(s)
- P Heritier
- Département d'Urologie, Hôpital Nord, Centre Hospitalier, Universitaire de St. Etienne, Saint Priest, France
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