F. Huguet

Pierre and Marie Curie University - Paris 6, Lutetia Parisorum, Île-de-France, France

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Publications (69)147.22 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: La radioterapia, junto a la cirugía y la quimioterapia, desempeña un papel preponderante en el tratamiento del cáncer. La radioterapia consiste en aplicar radiaciones ionizantes para destruir las células cancerosas. Con fines curativos, puede usarse de forma exclusiva o asociada a la cirugía (en período pre o postoperatorio). Su eficacia puede mejorarse con una quimioterapia concomitante. Con fines paliativos, puede ejercer una acción analgésica, descompresiva o hemostática. Los efectos secundarios de la radioterapia se deben a la irradiación de los tejidos sanos adyacentes al tumor. La radioterapia ha experimentado una gran evolución tecnológica desde la década de 1990, lo que permitió aumentar su eficacia y mejorar la tolerabilidad.
    EMC - Tratado de Medicina. 09/2014; 18(3):1–6.
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    ABSTRACT: Los tumores vaginales intraepiteliales e invasivos son infrecuentes. Las neoplasias intraepiteliales vaginales (VAIN) fueron descritas en 1952 por Graham y Meigs. Su potencial evolutivo no se conoce bien. En general, se admite que el 5% de las VAIN se transforma en un carcinoma epidermoide invasivo de la vagina. Desde el punto de vista terapéutico, la mayoría de los autores considera que el tratamiento conservador es la opción de primera elección. Se impone una vigilancia comparable a la de las neoplasias intraepiteliales del cuello uterino. Los cánceres primarios de la vagina representan el 1-2% de los tumores malignos ginecológicos y afectan, sobre todo, a la mujer menopáusica. En la mayoría de los casos, se trata de cánceres epidermoides. Los otros tipos histológicos son más infrecuentes. El factor de riesgo principal es una infección persistente por virus del papiloma humano, responsable de las lesiones de VAIN que pueden evolucionar hacia una forma invasiva. Los otros factores son un antecedente de histerectomía, el uso prolongado de un pesario y la radioterapia pélvica. El diagnóstico clínico, a menudo evidente, debe completarse con una colposcopia para precisar la topografía de las lesiones invasivas y preinvasivas, y con una evaluación de extensión clínica y mediante pruebas complementarias para la estadificación del tumor según las clasificaciones de la Federación Internacional de Ginecología y Obstetricia (FIGO) y TNM (tumor, ganglio [node], metástasis). El tratamiento depende del estadio de la lesión, de la edad de la paciente y del tipo histológico. La radioterapia es la piedra angular del tratamiento de los cánceres vaginales primarios. Es la modalidad terapéutica más citada en las publicaciones, la más conservadora y la que asegura un mínimo de secuelas. Las indicaciones de la cirugía son más infrecuentes. El pronóstico de estos cánceres primarios de la vagina depende del estadio FIGO, que es el parámetro pronóstico independiente más significativo, y de la edad.
    EMC - Ginecología-Obstetricia. 09/2014; 50(3):1–12.
  • F Huguet, S Mukherjee, M Javle
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    ABSTRACT: At the time of diagnosis, around 20% of patients with pancreatic cancer present at a resectable stage, 50% have metastatic disease and 30% have locally advanced tumour, non-metastatic but unresectable because of superior mesenteric artery or coeliac encasement. Despite advances in chemoradiotherapy and improved systemic chemotherapeutic agents, patients with locally advanced pancreatic cancer suffer from high rates of distant metastatic failure and from local progression, with a median survival time ranging from 5 to 11 months. In the past 30 years, modest improvements in median survival have been attained for these patients treated by chemoradiotherapy or chemotherapy protocols. The optimal therapy for patients with locally advanced pancreatic carcinoma remains controversial. This review aims to evaluate the role of radiotherapy for these patients.
    Clinical oncology (Royal College of Radiologists (Great Britain)). 07/2014;
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    ABSTRACT: To externally validate and assess the robustness of two nomograms designed to predict the probability of lymphatic dissemination for patients with early-stage endometrioid endometrial cancer.
    American journal of obstetrics and gynecology. 06/2014;
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    ABSTRACT: To develop a risk scoring system (RSS) to determine recurrence in women with early-stage type 1 endometrial cancer (EC).
    Annals of Surgical Oncology 06/2014; · 4.12 Impact Factor
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    ABSTRACT: Background:Lymphovascular space invasion (LVSI) is one of the most important predictors of nodal involvement and recurrence in early stage endometrial cancer (EC). Despite its demonstrated prognostic value, LVSI has not been incorporated into the European Society of Medical Oncology (ESMO) classification. The aim of this prospective multicentre database study is to investigate whether it may improve the accuracy of the ESMO classification in predicting the recurrence risk.Methods:Data of 496 patients with apparent early-stage EC who received primary surgical treatment between January 2001 and December 2012 were abstracted from prospective multicentre database. A modified ESMO classification including six risk groups was created after inclusion of the LVSI status in the ESMO classification. The primary end point was the recurrence accuracy comparison between the ESMO and the modified ESMO classifications with respect to the area under the receiver operating characteristic curve (AUC).Results:The recurrence rate in the whole population was 16.1%. The median follow-up and recurrence time were 31 (range: 1-152) and 27 (range: 1-134) months, respectively. Considering the ESMO modified classification, the recurrence rates were 8.2% (8 out of 98), 23.1% (15 out of 65), 25.9% (15 out of 58), and 45.1% (28 out of 62) for intermediate risk/LVSI-, intermediate risk/LVSI+, high risk/LVSI-, and high risk/LVSI+, respectively (P<0.001). In the low risk group, LVSI status was not discriminant as only 7.0% (14 out of 213) had LVSI+. The staging accuracy according to AUC criteria for ESMO and ESMO modified classifications were of 0.71 (95% CI: 0.68-0.74) and 0.74 (95% CI: 0.71-0.77), respectively.Conclusions:The current modified classification could be helpful to better define indications for nodal staging and adjuvant therapy, especially for patients with intermediate risk EC.British Journal of Cancer advance online publication, 8 May 2014; doi:10.1038/bjc.2014.237 www.bjcancer.com.
    British Journal of Cancer 05/2014; · 5.08 Impact Factor
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    ABSTRACT: Evaluation of the results of salvage radiation therapy with curative intent in the treatment of recurrent cervical carcinoma. Fourteen patients with a recurrence of a cervical cancer were treated in our department between 1982 and 2009. Five patients had a pelvic relapse, four a vaginal relapse and five a pelvic lymph node relapse. Four patients had first a surgical resection of the relapse, which was incomplete in two patients. All patients had pelvic radiotherapy with a median dose of 55Gy in conventional fractionation. Concurrent chemotherapy was administered to 12 patients. A vaginal brachytherapy with a median dose of 20Gy was performed in addition in 3 patients. The median follow-up was 39months. Safety of radiation therapy was correct with 29% of grade 3 acute or intestinal toxicity. Tumor control was observed in 10 patients (71%). Four patients presented a locoregional tumor progression. At the time of analysis, three patients had died from their cancer. From the date of relapse, the rate of overall survival at 2 and 5year was respectively 84% and 74%. Three patients (21%) had severe late effects. In our experience, chemoradiotherapy can achieve a high rate of remission in patients with isolated pelvic recurrence of cervical cancer. This treatment is feasible only if the patient had not received radiation therapy before or if the relapse is out of the previously irradiated volume.
    Cancer/Radiothérapie 01/2014; · 1.48 Impact Factor
  • Pancreatology 01/2014; 14(3):S6. · 2.04 Impact Factor
  • F. Huguet, S. Mukherjee, M. Javle
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    ABSTRACT: At the time of diagnosis, around 20% of patients with pancreatic cancer present at a resectable stage, 50% have metastatic disease and 30% have locally advanced tumour, non-metastatic but unresectable because of superior mesenteric artery or coeliac encasement. Despite advances in chemoradiotherapy and improved systemic chemotherapeutic agents, patients with locally advanced pancreatic cancer suffer from high rates of distant metastatic failure and from local progression, with a median survival time ranging from 5 to 11 months. In the past 30 years, modest improvements in median survival have been attained for these patients treated by chemoradiotherapy or chemotherapy protocols. The optimal therapy for patients with locally advanced pancreatic carcinoma remains controversial. This review aims to evaluate the role of radiotherapy for these patients.
    Clinical Oncology. 01/2014;
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    ABSTRACT: Purpose Evaluation of the results of salvage radiation therapy with curative intent in the treatment of recurrent cervical carcinoma. Patients and methods Fourteen patients with a recurrence of a cervical cancer were treated in our department between 1982 and 2009. Five patients had a pelvic relapse, four a vaginal relapse and five a pelvic lymph node relapse. Four patients had first a surgical resection of the relapse, which was incomplete in two patients. All patients had pelvic radiotherapy with a median dose of 55 Gy in conventional fractionation. Concurrent chemotherapy was administered to 12 patients. A vaginal brachytherapy with a median dose of 20 Gy was performed in addition in 3 patients. The median follow-up was 39 months. Results Safety of radiation therapy was correct with 29% of grade 3 acute or intestinal toxicity. Tumor control was observed in 10 patients (71%). Four patients presented a locoregional tumor progression. At the time of analysis, three patients had died from their cancer. From the date of relapse, the rate of overall survival at 2 and 5 year was respectively 84% and 74%. Three patients (21%) had severe late effects. Conclusion In our experience, chemoradiotherapy can achieve a high rate of remission in patients with isolated pelvic recurrence of cervical cancer. This treatment is feasible only if the patient had not received radiation therapy before or if the relapse is out of the previously irradiated volume.
    Cancer/Radiothérapie 01/2014; · 1.48 Impact Factor
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    ABSTRACT: Background:To externally validate and assess the robustness of two nomograms to predict the recurrence risk of women with endometrial cancer (EC).Methods:Using an independent, multicentre external patient cohort we assessed the discrimination and calibration of two nomograms - the 3-year isolated loco-regional (ILRR) and distant (DR) recurrence nomograms - in women with surgically treated stage I-III EC.Results:Two hundred and seventy one eligible women were identified from two university hospital databases and the Senti-Endo trial. The median follow-up and initial recurrence time were 38.1 (range: 12-69) and 22.0 (range: 8.3-55) months, respectively. The overall recurrence rate was 13.8% (37 out of 271). Predictive accuracy according to the discrimination was 0.69 (95% CI, 0.58-0.79) and 0.66 (95% CI, 0.60-0.71) for the 3-year ILRR and DR nomograms, respectively. The correspondence between observed recurrence rate and the nomogram predictions suggests a moderate calibration of the nomograms in the validation cohort.Conclusion:The nomograms were externally validated and shown to be partly generalisable to a new and independent patient population. The tools need to be improved by including information on the lymph node status and adjuvant therapies.British Journal of Cancer advance online publication, 29 August 2013; doi:10.1038/bjc.2013.500 www.bjcancer.com.
    British Journal of Cancer 08/2013; · 5.08 Impact Factor
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    ABSTRACT: BACKGROUND: Pancreatic carcinoma is one of the leading causes of cancer-related mortality. At the time of diagnosis, 30% of patients present with a locally advanced pancreatic carcinoma (LAPC). As circulating tumor cells (CTCs) count may be a surrogate of the cancer metastatic abilities, CTC detection rates and prognostic value were studied in a prospective cohort of LAPC patients. PATIENTS AND METHODS: An LAP07 international multicenter randomized study assesses in patients whose LAPC is controlled after 4 months of chemotherapy whether chemoradiotherapy could increase survival versus continuation of chemotherapy. A subgroup of patients included in the LAP07 trial was screened for CTCs (CellSearch(®)) before the start of the chemotherapy and after 2 months of treatment. Patient characteristics and survival were obtained prospectively and were correlated with CTC detection. RESULTS: Seventy-nine patients were included. One or more CTCs/7.5 ml were detected in 5% of patients before treatment and in 9% of patients after 2 months of treatment (overall detection rate: 11% of patients). CTC positivity was associated with poor tumor differentiation (P = 0.04), and with shorter overall survival (OS) in multivariable analysis (RR = 2.5, P = 0.01), together with anemia. CONCLUSIONS: The evaluation of micrometastatic disease using CTC detection appears as a promising prognostic tool in LAPC patients.
    Annals of Oncology 05/2013; · 7.38 Impact Factor
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    ABSTRACT: The authors report a case of Dropped Head Syndrome with an unusually rapid onset after an accident in a patient with a history of Hodgkin's lymphoma cured by chemotherapy and mantle field radiotherapy and compare this case to the rare published cases of chronic Dropped Head Syndrome occurring after this type of treatment. A 56-year-old man was treated at the age 36 years for supra-diaphragmatic Hodgkin's lymphoma by chemotherapy and mantle field radiotherapy according to a standard technique and standard doses (40 Gy, 20 fractions, 27 days). Seventeen years after the end of treatment, he experienced a violent whiplash injury, rapidly followed by a Dropped Head Syndrome, similar to the cases of chronic Dropped Head Syndrome already described in the context of Hodgkin's lymphoma (permanent flexion of the head, only reduced in the supine position). Physical and neurophysiological examination, electromyogram, and magnetic resonance imaging confirmed the diagnosis of Dropped Head Syndrome. Very few treatment options are available for the major disability related to Dropped Head Syndrome. This type of subacute onset of Dropped Head Syndrome has not been previously described. The good results of radiation therapy after chemotherapy allow a dose reduction to 30 Gy in the involved regions. This, together with recent progress in treatment planning, should allow eradication of these complications.
    Cancer/Radiothérapie 02/2013; 17(1):44–49. · 1.48 Impact Factor
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    ABSTRACT: BACKGROUND: Standard treatment for unresectable advanced head and neck squamous cell carcinoma is chemoradiotherapy, which can be toxic, particularly among patients with coexisting medical conditions. We report our experience with the hypofractionated radiotherapy regimen Irradiation HypoFractionnée 2 Séances Quotidiennes (IHF2SQ). METHODS: We retrospectively reviewed 78 patients treated with the IHF2SQ regimen. Radiotherapy was administrated as 2 fractions of 3 Gy per day (days 1 and 3), during the first, third, fifth, and seventh week of treatment with concurrent platinum-based chemotherapy. RESULTS: Tolerance was excellent. Forty-one patients had complete or partial response. Median overall survival (OS) was 12.9 months and median progression-free survival (PFS) was 10.3 months. One-year OS, specific survival (SS), and PFS were 58%, 71%, 51.5%, respectively. Independent predictive factors increasing the PFS were response to chemoradiotherapy, male sex, and laryngeal tumor location. CONCLUSIONS: This regimen is an alternative to conventional chemoradiotherapy with good response rates and acceptable toxicity for selected patients. © 2013 Wiley Periodicals, Inc. Head Neck, 2013.
    Head & Neck 01/2013; · 2.83 Impact Factor
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    ABSTRACT: BACKGROUND: Neoadjuvant chemoradiation therapy for locally unresectable and borderline resectable pancreatic cancer may allow some patients to a undergo a resection, but whether or not this increases post-operative morbidity remains unclear. METHODS: The post-operative morbidity of 29 patients with initially locally unresectable/borderline pancreatic cancer who underwent a resection were compared with 29 patients with initially resectable tumours matched for age, gender, the presence of comorbidities (yes/no), American Society of Anesthesiology (ASA) score, tumour location (head/body-tail), procedure (pancreaticoduodenectomy/distal pancreatectomy) and vascular resection (yes /no). Wilcoxon's signed ranks test was used for continuous variables and McNemar's chi-square test for categorical variables. RESULTS: Compared with patients with initially resectable tumours, patients who underwent a resection after pre-operative chemoradiation therapy had similar rates of overall post-operative complications (55% versus 41%, P = 0.42), major complications (21% versus 21%, P = 1), pancreatic leaks and fistulae (7% versus 10%, P = 1) and mortality (0% versus 1.7%, P = 1). CONCLUSION: Although some previous studies have suggested differences in post-operative morbidity after chemoradiation, our case-matched analysis did not find statistical differences in surgical morbidity and mortality associated with pre-operative chemoradiation therapy.
    HPB 01/2013; · 1.94 Impact Factor
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    ABSTRACT: The authors report a case of Dropped Head Syndrome with an unusually rapid onset after an accident in a patient with a history of Hodgkin's lymphoma cured by chemotherapy and mantle field radiotherapy and compare this case to the rare published cases of chronic Dropped Head Syndrome occurring after this type of treatment. A 56-year-old man was treated at the age 36 years for supra-diaphragmatic Hodgkin's lymphoma by chemotherapy and mantle field radiotherapy according to a standard technique and standard doses (40Gy, 20 fractions, 27 days). Seventeen years after the end of treatment, he experienced a violent whiplash injury, rapidly followed by a Dropped Head Syndrome, similar to the cases of chronic Dropped Head Syndrome already described in the context of Hodgkin's lymphoma (permanent flexion of the head, only reduced in the supine position). Physical and neurophysiological examination, electromyogram, and magnetic resonance imaging confirmed the diagnosis of Dropped Head Syndrome. Very few treatment options are available for the major disability related to Dropped Head Syndrome. This type of subacute onset of Dropped Head Syndrome has not been previously described. The good results of radiation therapy after chemotherapy allow a dose reduction to 30Gy in the involved regions. This, together with recent progress in treatment planning, should allow eradication of these complications.
    Cancer/Radiothérapie 12/2012; · 1.48 Impact Factor
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    ABSTRACT: Pancreatic carcinoma is a leading cause of cancer-related mortality. Approximately 30% of pancreatic cancer patients present with locally advanced, unresectable nonmetastatic disease. For these patients, two therapeutic options exist: systemic chemotherapy or chemoradiotherapy. Within this context, the optimal technique for pancreatic irradiation is not clearly defined. A search to identify relevant studies was undertaken using the Medline database. All Phase III randomized trials evaluating the modalities of radiotherapy in locally advanced pancreatic cancer were included, as were some noncontrolled Phase II and retrospective studies. An expert panel convened with members of the Radiation Therapy Oncology Group and GERCOR cooperative groups to review identified studies and prepare the guidelines. Each member of the working group independently evaluated five endpoints: total dose, target volume definition, radiotherapy planning technique, dose constraints to organs at risk, and quality assurance. Based on this analysis of the literature, we recommend either three-dimensional conformal radiation therapy or intensity-modulated radiation therapy to a total dose of 50 to 54 Gy at 1.8 to 2 Gy per fraction. We propose gross tumor volume identification to be followed by an expansion of 1.5 to 2 cm anteriorly, posteriorly, and laterally, and 2 to 3 cm craniocaudally to generate the planning target volume. The craniocaudal margins can be reduced with the use of respiratory gating. Organs at risk are liver, kidneys, spinal cord, stomach, and small bowel. Stereotactic body radiation therapy should not be used for pancreatic cancer outside of clinical trials. Radiotherapy quality assurance is mandatory in clinical trials. These consensus recommendations are proposed for use in the development of future trials testing new chemotherapy combinations with radiotherapy. Not all of these recommendations will be appropriate for trials testing radiotherapy dose or dose intensity concepts.
    International journal of radiation oncology, biology, physics 08/2012; 83(5):1355-64. · 4.59 Impact Factor
  • Pancreas 08/2012; 41(6):973-4. · 2.95 Impact Factor
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    ABSTRACT: Circulating (CTC) and disseminated tumor cells (DTC) represent two different steps of the metastatic process. As with other types of cancer, the recent development of techniques for the detection of CTC and DTC respectively in the blood and bone marrow of patients generated many results in digestive cancers. However, the interpretation of these results and of the prognostic value of CTC/DTC is often limited by the small cohort size and the heterogeneity of detection methods. The aim of this article is to review the different results and their clinical impact, and discuss the possible use of CTC and DTC as new biomarkers. First of all, it is important to take into account the variability of epithelial markers used for the initial stage of immunoselection of CTC/DTC as well as that of molecular or cytological markers used for the second stage of detection. In esophageal, gastric, pancreatic and hepatocellular carcinomas, and in the ileal and pancreatic neuroendocrine tumors, some studies showed a correlation between the detection of CTC and/or DTC and a clinical pejorative course, whether these tumors were at localized or metastatic stages. On colorectal cancer in the adjuvant setting, a recent meta-analysis showed an association between the detection of CTC in peripheral blood and disease-free survival or overall survival. These results are consistent with those of a study that identified detection of CTC as a prognostic factor for relapse in stage II. This last study concluded that it was necessary to achieve long-term evaluation of CTC as a biomarker to guide the decisions of chemotherapy for stage II. In metastatic colorectal cancer, the FDA approved in 2007 the use of pretherapeutic levels of CTC and its variations per-treatment, determined by CellSearch(®) technology, as a tool in treatments management. However, the modalities of this monitoring have to be specified and clinical benefit or the cost-effectiveness of a treatment based on this new biomarker has to be evaluated. Finally, the qualitative and quantitative monitoring of CTC could be a non-invasive tool to monitor changes in tumor biology throughout the disease, and thereby improve the understanding of the processes of dissemination and therapeutic resistance.
    Bulletin du cancer 04/2012; 99(5):535-44. · 0.61 Impact Factor

Publication Stats

378 Citations
147.22 Total Impact Points

Institutions

  • 2013–2014
    • Pierre and Marie Curie University - Paris 6
      • Laboratoire de Biologie du Développement
      Lutetia Parisorum, Île-de-France, France
  • 2009–2014
    • Hôpital Tenon (Hôpitaux Universitaires Est Parisien)
      • Service d'Oncologie - Radiothérapie
      Lutetia Parisorum, Île-de-France, France
  • 2007–2012
    • Assistance Publique – Hôpitaux de Paris
      Lutetia Parisorum, Île-de-France, France
    • Université Victor Segalen Bordeaux 2
      Burdeos, Aquitaine, France
  • 2008
    • Institut du Cancer de Montpellier Val d'Aurelle
      Montpelhièr, Languedoc-Roussillon, France
  • 2005
    • Institut Bergonié
      Burdeos, Aquitaine, France