Publications (26)106.25 Total impact
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Article: HER2 status for prognosis and prediction of treatment efficacy in adenocarcinomas: A review.
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ABSTRACT: The past few years have seen flourish new biologic parameters for cancer prognosis that are revolutionizing therapeutic strategies. HER-2 is in this perspective a striking example, as it is now a key element for the care of 15-20% of breast cancer. HER-2 overexpression has first been reported as a prognostic factor before its consideration as a main parameter to predict treatment efficacy. However, although HER-2 status is now also used as a prognostic factor for many cancers, its ability to predict the action of trastuzumab in these new contexts is much lower than in breast cancer. In this literature review, we aimed to discuss HER-2 overexpression as a prognostic factor and as a predictive parameter of treatment response in selected solid tumors with a focus on adenocarcinomas.Critical reviews in oncology/hematology 04/2013; · 5.27 Impact Factor -
Article: Fight against cancer around the Mediterranean area: "Many hands make light work!"
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ABSTRACT: The geopolitical and strategic importance of the Mediterranean area is evident since a long time. In terms of health programs and means for cancer care, significant disparities have been reported between countries that borders the Mediterranean basin. AROME project began modestly in 2006 with a group of leaders who recognized the need to promote practical training of young people and, thus, contribute to reduce these inacceptable inequalities in terms of early diagnosis and management. Moreover, our project has been built from our belief that the socio-cultural specificity of this region, its epidemiology, availability of means for diagnosis and treatment, should impose a sustained regional research and better knowledge of tumor biology and identify the specificities that may require particular strategies of care that should not be based only on Western and Asian research data. We must thus take advantage of advances in the identification of intimate biological tumors to provide answers to our ignorance of the specific Mediterranean biology. In this paper, we illustrate this issue describing some particular cancers in this region such as breast and nasopharyngeal cancers.Critical reviews in oncology/hematology 11/2012; · 5.27 Impact Factor -
Article: Management of adenoid cystic carcinoma of the breast: a Rare Cancer Network study.
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ABSTRACT: Mammary adenoid cystic carcinoma (ACC) is a rare breast cancer. The aim of this retrospective study was to assess prognostic factors and patterns of failure, as well as the role of radiation therapy (RT), in ACC. Between January 1980 and December 2007, 61 women with breast ACC were treated at participating centers of the Rare Cancer Network. Surgery consisted of lumpectomy in 41 patients and mastectomy in 20 patients. There were 51(84%) stage pN0 and 10 stage cN0 (16%) patients. Postoperative RT was administered to 40 patients (35 after lumpectomy, 5 after mastectomy). With a median follow-up of 79 months (range, 6-285), 5-year overall and disease-free survival rates were 94% (95% confidence interval [CI], 88%-100%) and 82% (95% CI, 71%-93%), respectively. The 5-year locoregional control (LRC) rate was 95% (95% CI, 89%-100%). Axillary lymph node dissection or sentinel node biopsy was performed in 84% of cases. All patients had stage pN0 disease. In univariate analysis, survival was not influenced by the type of surgery or the use of postoperative RT. The 5-year LRC rate was 100% in the mastectomy group versus 93% (95% CI, 83%-100%) in the breast-conserving surgery group, respectively (p = 0.16). For the breast-conserving surgery group, the use of RT significantly correlated with LRC (p = 0.03); the 5-year LRC rates were 95% (95% CI, 86%-100%) for the RT group versus 83% (95% CI, 54%-100%) for the group receiving no RT. No local failures occurred in patients with positive margins, all of whom received postoperative RT. Breast-conserving surgery is the treatment of choice for patients with ACC breast cancer. Axillary lymph node dissection or sentinel node biopsy might not be recommended. Postoperative RT should be proposed in the case of breast-conserving surgery.International journal of radiation oncology, biology, physics 05/2011; 82(5):2118-24. · 4.59 Impact Factor -
Article: Concurrent trastuzumab--internal mammary irradiation for HER2 positive breast cancer: "It hurts to be on the cutting edge".
Radiotherapy and Oncology 05/2009; 94(1):119-20; author reply 120-1. · 5.58 Impact Factor -
Article: Optimal timing for adjuvant radiation therapy in breast cancer: a comprehensive review and perspectives.
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ABSTRACT: The optimal sequence of modalities involved in breast cancer treatment with respect to radiotherapy and the maximum acceptable interval between radiotherapy and surgery need to be determined. This review attempts a critical reading of the literature. A delay of radiotherapy more than 8-12 weeks after surgery adversely affects local recurrence. Radiotherapy should be administered within 7 months after surgery, when chemotherapy is administered first. Several chemotherapy regimens can be safely administered concurrently with radiotherapy. The concurrent use of tamoxifen with chemotherapy should be avoided, but not with radiotherapy. Data is insufficient with regard to concurrent use of aromatase inhibitors with radiotherapy. The use of trastuzumab concomitantly with radiotherapy may enhance toxicities but may also improve its efficacy. Although the issue of radiotherapy delay and that of sequence with chemotherapy or tamoxifen are clarified, the sequence of radiotherapy with aromatase inhibitors and trastuzumab needs to be defined. Individual radiosensitivity may influence toxicity. New biologic markers have to be determined in the future for tailoring radiotherapy in breast cancer.Critical reviews in oncology/hematology 11/2008; 71(2):102-16. · 5.27 Impact Factor -
Article: Are volumetric changes of brain metastases the best evaluation of efficacy?
Journal of Clinical Oncology 11/2008; 26(31):5137-8; author reply 5138-9. · 18.37 Impact Factor -
Article: [Cancer diagnosis announcement: an act to seal the pact of trust between doctors and patients].
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ABSTRACT: The announcement of the cancer diagnosis, an important moment in the set up of the doctor/patient relationship, must come together, if possible, with a quality of communication. This announcement is never insignificant, often traumatic both for the one who receives it and sometimes for the person who provides it. It must observe some rules of temporality, in its enunciation and take into account the psychological defences of patient's mechanisms. More accessible, but also more complex medical information is supposed to be more transparent, taking into account the wishes of patients considered as full actors of their health. As such, the announcement of bad news is in a relationship of care, trust represents the start of a full therapeutic act. One of the challenges of the diagnosis announcement remains the education of patients and physicians to encourage better adaptation to the disease and its treatments. This education can only take place in a pluridisciplinarity in order to optimize care. The diagnosis announcement must continuously oscillate between fair distance and proximity while respecting the autonomy, dignity and freedom of patient's choice. The respect of ethical principles will prevent incomprehension phenomena and seal the pact of trust between doctors and patients.Bulletin du cancer 11/2008; 95(9):841-7. · 0.67 Impact Factor -
Article: Partial breast irradiation as sole therapy for low risk breast carcinoma: early toxicity, cosmesis and quality of life results of a MammoSite brachytherapy phase II study.
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ABSTRACT: The MammoSite is a device that was developed with the goal of making breast-conserving surgery (BCT) more widely available. Our objective was to evaluate the MammoSite device performances after an open cavity placement procedure and quality of life in highly selected patients with early-stage breast cancer. From March 2003 to March 2005, 43 patients with T1 breast cancer were enrolled in a phase II study. The median age was 72 years. Twenty-five (58%) patients were treated with high-dose rate brachytherapy using the MammoSite applicator to deliver 34Gy in 10 fractions. The main disqualifying factor was pathologic sentinel node involvement (10/43; 23%). There were no device malfunctions, migration or rupture of the balloon. After a median follow-up of 13 months, there were no local recurrences and one contralateral lobular carcinoma. Seventeen (68%), 13 (52%), 8 (32%), 5 (20%) and 2 (8%) patients had erythema, seroma, inflammation, hematoma and sever infection, respectively. Only 2 patients developed telangiectasia. At 1 year the rate of "good to excellent" cosmetic results was 84%. Significant changes in QoL were observed for emotional and social well-being between 3 and 12 months. At 24 months, only emotional well-being subscore changes were statistically significant (p=0.015). Our data in patients older than 60 years support the previously published data. Histologic features were the main disqualifying criteria. With higher skin spacing levels we observed very low incidence of telangiectasia. QoL evaluation indicates that baseline scores were satisfactory. Changes concerned emotional and social well-being.Radiotherapy and Oncology 09/2008; 90(1):23-9. · 5.58 Impact Factor -
Article: Primary breast lymphoma: patient profile, outcome and prognostic factors. A multicentre Rare Cancer Network study.
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ABSTRACT: To asses the clinical profile, treatment outcome and prognostic factors in primary breast lymphoma (PBL). Between 1970 and 2000, 84 consecutive patients with PBL were treated in 20 institutions of the Rare Cancer Network. Forty-six patients had Ann Arbor stage IE, 33 stage IIE, 1 stage IIIE, 2 stage IVE and 2 an unknown stage. Twenty-one underwent a mastectomy, 39 conservative surgery and 23 biopsy; 51 received radiotherapy (RT) with (n = 37) or without (n = 14) chemotherapy. Median RT dose was 40 Gy (range 12-55 Gy). Ten (12%) patients progressed locally and 43 (55%) had a systemic relapse. Central nervous system (CNS) was the site of relapse in 12 (14%) cases. The 5-yr overall survival, lymphoma-specific survival, disease-free survival and local control rates were 53%, 59%, 41% and 87% respectively. In the univariate analyses, favorable prognostic factors were early stage, conservative surgery, RT administration and combined modality treatment. Multivariate analysis showed that early stage and the use of RT were favorable prognostic factors. The outcome of PBL is fair. Local control is excellent with RT or combined modality treatment but systemic relapses, including that in the CNS, occurs frequently.BMC Cancer 02/2008; 8:86. · 3.01 Impact Factor -
Article: Phyllodes tumor of the breast.
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ABSTRACT: To better identify prognostic factors for local control and survival, as well as the role of different therapeutic options, for phyllodes tumors, a rare fibroepithelial neoplasm of the breast. Data from 443 women treated between 1971 and 2003 were collected from the Rare Cancer Network. The median age was 40 years (range, 12-87 years). Tumors were benign in 284 cases (64%), borderline in 80 cases (18%), and malignant in 79 cases (18%). Surgery consisted of breast-conserving surgery (BCS) in 377 cases (85%) and total mastectomy (TM) in 66 cases (15%). Thirty-nine patients (9%) received adjuvant radiotherapy (RT). After a median follow-up of 106 months, local recurrence (LR) and distant metastases rates were 19% and 3.4%, respectively. In the malignant and borderline group (n = 159), RT significantly decreased LR (p = 0.02), and TM had better results than BCS (p = 0.0019). Multivariate analysis revealed benign histology, negative margins, and no residual disease (no RD) after initial treatment and RT delivery as independent favorable prognostic factors for local control; benign histology and low number of mitosis for disease-free survival; and pathologic tumor size < or = 3 cm and no tumor necrosis for overall survival. In the malignant and borderline subgroup multivariate analysis TM was the only favorable independent prognostic factor for disease-free survival. This study showed that phyllodes tumor patients with no RD after treatment have better local control. Benign tumors have a good prognosis after surgery alone. In borderline and malignant tumors, TM had better results than BCS. Thus, in these forms adjuvant RT should be considered according to histologic criteria.International Journal of Radiation OncologyBiologyPhysics 02/2008; 70(2):492-500. · 4.11 Impact Factor -
Article: Outcome and prognostic factors in breast sarcoma: a multicenter study from the rare cancer network.
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ABSTRACT: Breast sarcoma (BS) is a rare tumour. While surgical resection is the primary treatment, the role of radiation therapy (RT) and chemotherapy remains unclear. This study aimed at defining prognostic factors and treatment strategies. Data from 103 patients treated between 1976 and 2002 were collected. The median age was 55 years (range: 13-86); the median histological tumour size was 4.45 cm (range: 0.8-22). There were 42 angiosarcomas. Surgery consisted of wide excision in 34 cases, and total mastectomy in 69 cases. A total dose of 50 Gy in 25 fractions was delivered in 50 patients. At the completion of treatment, 89 patients had no residual tumour. After a median follow-up of 64 months, 56 patients developed recurrent disease: 38 presented a local relapse and 37 developed distant metastases. The 5-year disease-free survival (DFS) and overall survival (OS) were 44% (95% confidence interval [CI], 39-49%) and 55% (95% CI, 50-60%), respectively. In multivariate analysis, favourable prognostic factors for better local control were: no residual tumour after treatment, no cellular pleomorphism, and histology other than angiosarcoma. For DFS, the five favourable prognostic factors were non-menopausal status, no residual tumour after treatment, non-angiosarcoma histology, absence of tumour necrosis, and grade 1-2 histology. While angiosarcoma has the worst prognosis, the outcome of the other types of sarcomas may be worsened by residual tumour after loco-regional treatment and high grade histology, a classical prognostic factor of the other soft tissue sarcomas. During surgical procedure axillary dissection is not mandatory.Radiotherapy and Oncology 01/2008; 85(3):355-61. · 5.58 Impact Factor -
Article: Primary breast lymphoma: Patient profile, outcome and prognostic factors. A multicentre Rare Cancer Network study
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ABSTRACT: Abstract Background To asses the clinical profile, treatment outcome and prognostic factors in primary breast lymphoma (PBL). Methods Between 1970 and 2000, 84 consecutive patients with PBL were treated in 20 institutions of the Rare Cancer Network. Forty-six patients had Ann Arbor stage IE, 33 stage IIE, 1 stage IIIE, 2 stage IVE and 2 an unknown stage. Twenty-one underwent a mastectomy, 39 conservative surgery and 23 biopsy; 51 received radiotherapy (RT) with (n = 37) or without (n = 14) chemotherapy. Median RT dose was 40 Gy (range 12–55 Gy). Results Ten (12%) patients progressed locally and 43 (55%) had a systemic relapse. Central nervous system (CNS) was the site of relapse in 12 (14%) cases. The 5-yr overall survival, lymphoma-specific survival, disease-free survival and local control rates were 53%, 59%, 41% and 87% respectively. In the univariate analyses, favorable prognostic factors were early stage, conservative surgery, RT administration and combined modality treatment. Multivariate analysis showed that early stage and the use of RT were favorable prognostic factors. Conclusion The outcome of PBL is fair. Local control is excellent with RT or combined modality treatment but systemic relapses, including that in the CNS, occurs frequently.BMC Cancer. 01/2008; -
Article: Metabolic functional imaging for tumor radiosensitivity monitoring.
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ABSTRACT: Assessing tumor radiosensitivity before and during radiation therapy can be a crucial element in decision-making with regard to treatment. However, no known non-invasive test is available at present, which allows for a reliable evaluation of the radiosensitivity of a tissue subjected to radiotherapy. Among tests being evaluated, positron emission tomography (PET) is considered to be a promising method. The purpose of this review is to identify the tests and research paths that have recently been explored for the evaluation of tumor response to treatment after isotopic labeling revealed by nuclear imaging. The majority of the explored methodologies are based on the indirect evaluation of the radiosensitivity by cell proliferation or apoptosis, tissue oxygenation or hypoxia, intrinsic radiosensitivity of clonogenic cells, tumor metabolism and angiogenesis. The development of such methods would permit the adoption of a therapeutic regimen with respect to a given radiosensitivity of a tissue. Therefore, a given therapeutic strategy could be readjusted (by associating, for instance, a radiosensitizer of hypoxic cells) or even modified if it proved to be inadequate or when it presents an unfavorable cost-effectiveness ratio. We present here a critical review of the radiotracers revealed by nuclear imaging that are developed for radiosensitivity monitoring.Critical Reviews in Oncology/Hematology 07/2007; 62(3):227-39. · 4.41 Impact Factor -
Article: [New tools in adjuvant breast cancer radiotherapy].
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ABSTRACT: During the last century management of breast cancer became increasingly less aggressive for small tumors. Randomized trials demonstrated similar overall survival between mastectomy and breast-conservative surgery (BCS) followed by adjuvant radiation therapy (RT). BCS plus adjuvant RT +/- systemic therapy has become the standard of care for women with early breast cancer. Advances in modern RT technology allowed significant increase in high precision of target definition. Intensity modulated radiation therapy (IMRT) and gating, under investigation in miscellaneous cancers, are also in development for breast-cancer patients. These techniques decrease radiation toxicities and could be useful in the setting of concurrent use of RT and new systemic therapies such as trastuzumab. Another advance in RT is the development of accelerated partial breast irradiation (APBI) as a new concept in the adjuvant setting for early-stage breast cancer. Intraoperative RT (IORT), immediate postoperative RT (interstitial brachytherapy or Mammosite device implantation) and delayed postoperative RT (external beam of photons or protons with 3D conformation) are under investigation. In this review, the role of modern whole breast irradiation is discussed, the rational of partial breast irradiation is argued and the different techniques are detailed.Bulletin du cancer 05/2007; 94(4):389-97. · 0.67 Impact Factor -
Article: [The contribution of PET to radiation treatment planning].
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ABSTRACT: Advances in medical imaging have greatly enhanced the speciality of radiation oncology by allowing more healthy tissue to be speared for better tumour coverage. Positron emission tomography (PET) with the glucose analogue [18F]-fluoro-2-deoxy-D-glucose (FDG) is a functional imaging method that has become widely used in oncology over the last decade. It has been rapidly incorporated in the staging and treatment planing of many patients with cancer in several anatomic sites such as non-small cell lung carcinomas. However, the initial data were controversial by the use of non dedicated PET units, the lack of patient immobilisation for radiation therapy, or the lack of image registration for fusion PET images with computed tomography (CT). The increased number of combined PET/CT units installed and the development of new isotopes that allow advances in biological and molecular tumour and healthy tissue imaging should lead to enhanced target definition for highly conformal radiation therapy. Such developments might also allow tumour viability or healthy tissue function to be imaged, which could be used during treatment as early indicators of tumour response or healthy tissue injury, possibly leading to a change in treatment strategy based on functional and biological imaging. The contribution of PET imaging advances using FDG or new tracers for treatment planing in the new era of image guided radiation therapy will be discussed in this review.Bulletin du cancer 02/2007; 94(1):99-108. · 0.67 Impact Factor -
Article: Reduced-intensity conditioning regimen using low-dose total body irradiation before allogeneic transplant for hematologic malignancies: Experience from the European Group for Blood and Marrow Transplantation.
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ABSTRACT: The high rate of toxicity is the limitation of myeloblastive regimens before allogeneic transplantation. A reduced intensity regimen can allow engraftment of stem cells and subsequent transfer of immune cells for the induction of a graft-vs.-tumor reaction. The data from 130 patients (80 males and 50 females) treated between 1998 and 2003 for various hematologic malignancies were analyzed. The median patient age was 50 years (range, 3-72 years). Allogeneic transplantation using peripheral blood or bone marrow, or both, was performed in 104 (82%), 22 (17%), and 4 (3%) patients, respectively, from HLA identical sibling donors (n = 93, 72%), matched unrelated donors (n = 23, 18%), mismatched related donors (4%), or mismatched unrelated donors (6%). Total body irradiation (TBI) at a dose of 2 Gy delivered in one fraction was given to 101 patients (78%), and a total dose of 4-6 Gy was given in 29 (22%) patients. The median dose rate was 14.3 cGy/min (range, 6-16.4). After a median follow-up period of 20 months (range, 1-62 months), engraftment was obtained in 122 patients (94%). Acute graft-vs.-host disease of Grade 2 or worse was observed in 37% of patients. Multivariate analysis showed three favorable independent factors for event-free survival: HLA identical sibling donor (p < 0.0001; relative risk [RR], 0.15), complete remission (p < 0.0001; RR, 3.08), and female donor to male patient (p = 0.006; RR 2.43). For relapse, the two favorable prognostic factors were complete remission (p < 0.0001, RR 0.11) and HLA identical sibling donor (p = 0.0007; RR 3.59). In this multicenter study, we confirmed high rates of engraftment and chimerism after the reduced intensity regimen. Our results are comparable to those previously reported. Radiation parameters seem to have no impact on outcome. However, the lack of a statistically significant difference in terms of dose rate may have been due, in part, to the small population size in the subgroup analysis.International Journal of Radiation OncologyBiologyPhysics 02/2007; 67(2):544-51. · 4.11 Impact Factor -
Article: [HER-2/neu positive breast cancer: how to prescribe adjuvant trastuzumab (Herceptin)?].
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ABSTRACT: One of the most recent advances in the management of Her-2/neu positive breast cancer is the validation of a targeted therapy from bench to the clinic, particularly towards the adjuvant setting. The recommended dose of trastuzumab (Herceptin), a humanized monoclonal antibody targeting the HER-2 antigen, has been determined in phase I studies. In the metastatic patients two randomised trials have demonstrated its efficacy when associated to taxanes. In less than 10 years, trastuzumab became the standard of care in the adjuvant treatment of HER-2/neu positive breast cancer. In this setting, two combinations regimen with chemotherapy (concomitant or sequential) have been recently published. The concomitant schedule has been used in three studies (North American Group, BCIRG, FinHer), whereas in the Hera trial trastuzumab was started after the end of neo-adjuvant and adjuvant chemotherapy. In this article, the advantages and uncertainties on efficacy and toxicities of the trastuzumab administration modalities, associated or not to chemotherapy and radiation therapy, are discussed.Bulletin du cancer 11/2006; 93(10):991-9. · 0.67 Impact Factor -
Article: Outcomes and patterns of failure in solitary plasmacytoma: a multicenter Rare Cancer Network study of 258 patients.
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ABSTRACT: To assess the outcomes and patterns of failure in solitary plasmacytoma (SP). The data from 258 patients with bone (n = 206) or extramedullary (n = 52) SP without evidence of multiple myeloma (MM) were collected. A histopathologic diagnosis was obtained for all patients. Most (n = 214) of the patients received radiotherapy (RT) alone; 34 received chemotherapy and RT, and 8 surgery alone. The median radiation dose was 40 Gy. The median follow-up was 56 months (range 7-245). The median time to MM development was 21 months (range 2-135), with a 5-year probability of 45%. The 5-year overall survival, disease-free survival, and local control rate was 74%, 50%, and 86%, respectively. On multivariate analyses, the favorable factors were younger age and tumor size <4 cm for survival; younger age, extramedullary localization, and RT for disease-free survival; and small tumor and RT for local control. Bone localization was the only predictor of MM development. No dose-response relationship was found for doses >30 Gy, even for larger tumors. Progression to MM remains the main problem. Patients with extramedullary SP had the best outcomes, especially when treated with moderate-dose RT. Chemotherapy and/or novel therapies should be investigated for bone or bulky extramedullary SP.International Journal of Radiation OncologyBiologyPhysics 02/2006; 64(1):210-7. · 4.11 Impact Factor -
Article: Prognostic factors in solitary plasmacytoma of the bone: a multicenter Rare Cancer Network study.
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ABSTRACT: Solitary plasmacytoma (SP) of the bone is a rare plasma-cell neoplasm. There are no conclusive data in the literature on the optimal radiation therapy (RT) dose in SP. Therefore, in this large retrospective study, we wanted to assess the outcome, prognostic factors, and the optimal RT dose in patients with SP. Data from 206 patients with bone SP without evidence of multiple myeloma (MM) were collected. Histopathological diagnosis was obtained for all patients. The majority (n = 169) of the patients received RT alone; 32 chemotherapy and RT, and 5 surgery. Median follow-up was 54 months (7-245). Five-year overall survival, disease-free survival (DFS), and local control was 70%, 46%, and 88%; respectively. Median time to MM development was 21 months (2-135) with a 5-year probability of 51%. In multivariate analyses, favorable factors were younger age and tumor size < 5 cm for survival; younger age for DFS; anatomic localization (vertebra vs. other) for local control. Older age was the only predictor for MM. There was no dose-response relationship for doses 30 Gy or higher, even for larger tumors. Younger patients, especially those with vertebral localization have the best outcome when treated with moderate-dose RT. Progression to MM remains the main problem. Further investigation should focus on adjuvant chemotherapy and/or novel therapeutic agents.BMC Cancer 01/2006; 6:118. · 3.01 Impact Factor -
Article: [Breast adenocarcinoma: critical analysis of sentinel lymph node histopathological results of 542 procedures].
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ABSTRACT: Between February 2001 and March 2003, 542 sentinel lymph node procedures were performed for localised breast carcinoma (T0-T1, N0, M0) without any previous treatment. Frozen sections were performed in 515 cases and they did not reveal metastases in 446 cases. Fifty-two micrometastases < 2 mm and 18 macrometastases were reported by definitive histopathological exam. Axillary clearance was performed in 50/70 patients (38 with micrometastases and 12 for macrometastases). Modalities of histopathological procedure are discussed and particularly number and interval of serial slides with or without immunochemistry ; 81.8% (36/44) of micrometastases were detected on the two first serial sections. Decisional value of axillary clearance performed in case of micrometastases is also evaluated.Bulletin du cancer 11/2005; 92(11):983-7. · 0.67 Impact Factor
Top co-authors
Top Journals
Institutions
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2013
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Université Paris-Est Créteil Val de Marne - Université Paris 12
Créteil, Ile-de-France, France
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2012
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Hôpital Henri Mondor – Hôpitaux Universitaires Henri Mondor
Créteil, Ile-de-France, France
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2008
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Democritus University of Thrace
- Α΄ Πανεπιστημιακή Παθολογική Κλινική
Komotiní, Anatoliki Makedonia kai Thraki, Greece -
Université de Lausanne
Lausanne, VD, Switzerland
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2003–2008
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Centre Oscar Lambret
Lille, Nord-Pas-de-Calais, France
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2002–2006
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University Hospital of Lausanne
Lausanne, VD, Switzerland
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