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C Tunon de Lara,
G Goudy,
G Macgrogan,
M Durand, J-M Dilhuydy,
A Avril,
E Stoeckle,
J-E Bussières,
M Debled,
I de Mascarel,
L Mauriac
[show abstract]
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ABSTRACT: To analyze the characteristics and to establish prognosis factors for 52 men suffering from breast cancer from 1980 to 2004.
Men treated for breast cancer (invasive or in situ). A retrospective study analyzed clinical and histological characteristics, and treatment procedures. The probability of survival or recurrence was calculated using the Kaplan-Meier method. Prognostic factors were studied using the Log Rank test.
The mean age of our patients was 63.5 years old. In 73.1% of cases, subaerolar tumors were the initial symptoms, the average size was 30.31 mm. Among patients, 17 (32.7%) had T1, 19 (36.5%) T2, two (3.8%) T3 and 14 (26.9%) T4. The most represented histological type was the infiltrative ductal carcinoma (84.6%). The spread rate to axillary lymph nodes was 63.6%. The hormone dependency of these tumors was proven in 84.6% of cases. Overall survival rate were about 69% at five years and 32% at 10 years. The spread to lymph node and to derm, the clinical stage were significant factors influencing disease free survival. None of these factors had any significance regarding overall survival.
Male breast cancer is a rare disease (about 1% of breast cancer) with a poor prognosis (32% 10 years disease free survival). An early diagnosis and better knowledge of the disease would certainly lead to improvement of prognosis.
Gynécologie Obstétrique & Fertilité 05/2008; 36(4):386-94. · 0.52 Impact Factor
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ABSTRACT: L’objectif est de connaître, de manière qualitative, les facteurs socioculturels qui ont motivé les femmes à participer à
une campagne de dépistage des cancers du sein.
La méthode ethnographique est fondée sur l’observation participante. Elle est adaptée à la recherche médicale: 50 entretiens
semi-structurés sont réalisés. Ils sont enregistrés, intégralement retranscrits puis analysés. Dans les Bouches-du-Rhône (3e campagne de dépistage), les 25 femmes interrogées n’ont pas participé aux deux campagnes précédentes. Dans la Charente (1re campagne de dépistage), les 25 femmes interrogées n’ont participé qu’après avoir reçu une lettre de relance à l’invitation.
Si l’intérêt d’une mammographie de dépistage organisé est admis, il n’induit pas nécessairement une participation. Les motifs
de non-participation évoqués lors des premières invitations sont la nouveauté, la hiérarchisation des contraintes sociales
et familiales, la gestion des problèmes de santé concomitants. L’information médiatique, la presse féminine, la peur de la
perte des acquis sociaux ou la gratuité du test sont des facteurs de participation. Les différentes modalités de dépistage
ne sont pas toujours intégrées. Il existe des variations culturelles et environnementales. Dans les Bouches-du-Rhône, les
acteurs de santé, l’avis de la fille ont un rôle pertinent. Les facteurs climatiques interviennent: non-participation précédente
due au mistral. En Charente, le réseau de sociabilité, l’invitation par canton ont entraîné une meilleure participation. Le
civisme est prégnant, des femmes viennent uniquement « par politesse » vis-à-vis de l’association organisatrice de la campagne.
Les décisions de participation sont toujours dues à une conjonction d’arguments. Le médecin généraliste, notamment dans les
Bouches-du-Rhône, a un rôle stratégique. La réception par courrier de l’invitation est un facteur de personnalisation qui
interpelle la femme comme actrice de sa propre santé. L’information et le réseau de sociabilité permettent à la femme d’entrer
dans la phase liminale d’un rituel propitiatoire.
ObjectivesTo qualitatively investigate sociocultural factors that motivate women to participate in a breast cancer screening campaign.
MethodologyAn ethnographic methodology involving participant observation was used. This was adapted for medical research: 50 semi-structured
interviews were conducted. They were recorded, completely rewritten and then analysed. In Bouches-du-Rhône (3rd screening campaign), the 25 women interviewed had not participated in the two previous campaigns. In Charente (1st screening
campaign), the 25 women interviewed only participated after receiving a reminder invitation.
ResultsIf the role of mammography screening is accepted, it does not necessarily result in participation. Reasons for non-participation
in the initial invitations were: novelty, social and family restrictions, and the management of concomitant health problems.
The media, women’s press, the fear of losing social benefits or the lack of charge for the test were participation factors.
The various screening methods are still not integrated. There are cultural and environmental variations. In Bouches-du-Rhône,
health professionals and daughter’s opinions have a relevant role. Climatic factors are also involved: not participating previously
because of the mistral. In Charente, the sociability network, and invitations on a per district basis resulted in better participation.
Public-spiritedness was influential: women only came out of politeness to the association organising the campaign.
ConclusionParticipation decisions are still based on a variety of discussions. The general practitioner, especially in Bouches-du-Rhône,
has a strategic role. The receipt of an invitation calls for women to be responsible for their own health. Information and
the sociability network allow women to get involved in the liminal phase of a propitiary ritual.
Psycho-Oncologie 02/2008; 2(1):13-20. · 0.26 Impact Factor
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ABSTRACT: Depuis les débuts des sciences humaines en cancérologie, la recherche sociologique et anthropologique, dans les établissements
de soins, s’est largement développée sans toujours convaincre de son intérêt. Cet article vise à aborder les freins qui entravent
la rencontre et la compréhension mutuelles entre soignants et chercheurs en sciences humaines, les problématiques qu’engendre
l’introduction des sciences humaines en cancérologie, ainsi que les intérêts et les apports pratiques que peut apporter un
véritable partenariat soignant-chercheur.
From now on, the introduction of human sciences studies in the field of oncology has not always been conclusive. This article
aims to analyze the bounds that border the meeting and the understanding between physicians and human sciences researchers.
It also treats the problems due to the introduction of human sciences in the field of oncology and points up the interests
and practical contributions that a partnership between physicians and researchers could bring.
Oncologie 02/2008; 10(3):208-212. · 0.17 Impact Factor
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G André,
C Tunon-de-Lara,
G Macgrogan,
H Laharie-Mineur,
J-E Bussieres,
F Valentin,
B Barreau,
M-H Dilhuydy, J-M Dilhuydy,
L Mauriac,
M Debled,
M Durand,
S Mathoulin,
A Avril
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ABSTRACT: In a retrospective study of bilateral Ductal Carcinoma In Situ (DCIS), cases were analysed to determine the relationship between the two events.
From 1971 to 2001, among 812 patients with DCIS in Bergonie Institute, 78 suffering from bilateral DCIS and only19 were treated entirely in our institute. It was either synchronous DCIS or asynchronous (before 6 months). We realised a comparative study between, clinical and pathological characteristics of each DCIS.
In case of asynchronous DCIS, contra lateral DCIS occurred after a median 75-months period and until 22 years after the first event. We found at least for one histological subtype an agreement in 53% of cases. In 31% of cases, the grade was the same. For low plus intermediary grade versus high grade, the agreement was 53%. There was a subtype and grade agreement of 32% and a subtype or grade agreement in 63% of cases.
Histological agreement between the two lesions indicated the possible existence of in situ bilateral disease in these women. The local relapse rate was 20% and all of them were invasive. The risk of relapse in controlateral breast is high and patient needs a long follow up even in case of mastectomy.
Journal de Gynécologie Obstétrique et Biologie de la Reproduction 06/2007; 36(3):260-6. · 0.42 Impact Factor
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Revue Francophone de Psycho-Oncologie 11/2006; 5(4):241-243.
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ABSTRACT: Une tude bibliographique sur les publications concernant la prise en compte de l’entourage des patients, montre que ce sont les pays scandinaves et anglosaxons qui ont le plus avanc dans cette rflexion et dans la mise en place de programmes valus destins apporter soutien, conseils et aide aux proches de malades atteints de cancer. L’entourage concerne les proches, c’est--dire la famille et les amis, et dans certains cas, l’quipe soignante. Il s’agit d’une vision trs large dans le cadre d’une prise en charge globale.Nous assistons en France depuis les premiers tats Gnraux des malades du cancer organiss par La Ligue Nationale contre le Cancer en 1998 et en 2000 une volution irrversible des mentalits qui ne peut que dboucher, grce aussi au Plan Cancer, un meilleur soutien non seulement des patients mais encore de leur entourage.A survey of published studies and programs concerning the family and friends of cancer patients shows that Scandinavian and Anglo-Saxon countries are well ahead in the development of evaluated programs for information and help, considering the patient and their close relations, as well as the medical team as a whole, in a global approach to treatment and follow-up. In France, since the first tats Gnraux des malades (National meeting of patients) for cancer patients organised by the Ligue Nationale contre le Cancer in 1998 and 2000 and the establishment of the Cancer Plan, we witness an irreversible evolution of attitudes and mental process leading to a better support of patients and their families and friends.
Oncologie 05/2005; 7(4):323-328. · 0.17 Impact Factor
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ABSTRACT: Cette tude a pour objectif dapprcier le vcu psychologique diffrentiel des macrobiopsies du sein afin dadapter le don dinformation et la prise en charge des femmes. Un questionnaire sur le stress peru (Q1) est remis en fin de procdure (T1) 73 femmes. lannonce des rsultats histologiques (T2), un questionnaire (Q2) est remis ces mmes patientes (du 1er mars 2002 au 31 mars 2003). Ce questionnaire a t valid grce une analyse en composantes principales suivie de rotation Varimax. Cela permet didentifier trois facteurs: procdure, qualit de vie, information et vcu post-prlvement. Deux sous-groupes en fonction des rsultats histologiques sont constitus. Le premier sous-groupe (G1) correspond aux femmes ayant un rsultat histologique bnin, le second sous-groupe (G2) correspond aux femmes ayant un rsultat histologique malin. Seul le facteur procdure prsente un vcu diffrentiel entre T1 et T2 (p = 0,022 ). Il ny a pas de diffrences significatives entre les sous-groupes G1 et G2 dans le vcu diffrentiel de la procdure (p = 0,357). Linformation est considre comme satisfaisante dans 90 % des cas. Une information adapte et une empathie mdicale sont le garant dune bonne tolrance de ce type de procdure.The aim of this study was to investigate patient perceptions after stereotactic breast biopsy instrumentation after the procedure and after the results. From March 2002 to March 2003, a questionnaire (response type Likert) on stress was given to 73 patients who had breast biopsies procedures—the first time at the end of the procedure (T1), then after the histological diagnosis (T2). There are two groups of women: The first group (G1) corresponds to patients with a benign diagnosis and the second group (G2) corresponds to patients with malignant diagnosis. The questionnaire has been validated (analysis of principal component with Varimax rotation). Three factors were identified: procedure, quality of life, information and perception after biopsy. Only the procedure factor was different at T1 and T2 (p = 0.022). There was no statistically significant difference according to procedures and histological disease (p = 0.357). The information satisfied patients in 90% cases. Information and medical empathy conditioned patients perceptions. Patients tolerated the procedures well.
Revue Francophone de Psycho-Oncologie 11/2004; 3(4):206-210.
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ABSTRACT: Le but de lenqute dopinion Parcours de femmes 2001 tait dvaluer la prise en charge globale et les besoins de patientes atteintes dun cancer fminin. Les femmes incluses dans cette tude transversale et observationnelle, prsentaient un cancer du sein ou un cancer gyncologique (ovaires, utrus), de tout stade avec un traitement ayant dbut depuis au moins 3 mois et/ou termin depuis moins dun an. De fvrier novembre 2001, 2 839 questionnaires ont t distribus: 1 870 patientes lont retourn (soit 66 %), 87 % dentre elles prsentaient un cancer du sein. Au total, 92 % des femmes dclarent avoir reu des informations/explications au moment du diagnostic; cependant un dficit en informations tait rapport chez 34 % des patientes prsentant une rcidive; 18 % seulement des patientes ont t associes la dcision thrapeutique et 60 % des femmes ont cherch des informations complmentaires soit auprs des mdias, soit auprs dautres patientes ou du milieu mdical. La fatigue reprsente le principal problme, rapport par 78 % des patientes, cette fatigue nest pas suffisamment prise en charge par les soignants en raison des difficults diagnostiques et thrapeutiques. Dautres difficults lies la vie familiale, affective et socioprofessionnelle sont difficilement identifies et insuffisamment prises en considration par les soignants. En conclusion, linformation donne aux patientes atteintes de cancers mammaires ou gyncologiques doit tre plus complte au moment de la rcidive notamment sur les effets secondaires lis aux traitements. La prise en charge psychosociale doit faire lobjet dune nouvelle approche plus globale ncessitant une coordination entre les diffrentes structures existantes.The aim of the survey Parcours de femmes 2001 was to evaluate the overall management and care of patients with female cancers and to determine their needs. Women with breast or gynecological cancer, who had either received at least 3 months of treatment or had completed treatment less than 1 year before the study, were enrolled in this cross-sectional, observational study. From February to November 2001, 2,839 questionnaires were distributed; 1,870 were returned (66% response rate), mainly by breast cancer patients (87%). While 92% of women reported having received information at diagnosis, a lack of information was reported in 34% of relapsed patients. Only 18% of patients were included in the treatment decision process; and 60% of women obtained complementary information from the media, patients and care professionals. Fatigue was the most severe problem quoted (78% of cases) and was poorly managed by caregivers due to diagnostic and treatment difficulties. Problems relating to family and to affective and socio-professional life were poorly identified and remained largely unmanaged. Information given to female cancer patients must be improved in relapsed patients particularly regarding the adverse effects of treatment. Psychosocial management requires a more holistic approach through new channels together with the coordination of existing structures.
Oncologie 10/2004; 6(7):494-504. · 0.17 Impact Factor
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ABSTRACT: The aim of the survey 'Parcours de Femmes 2001' was to evaluate the overall management and care of women with female cancers and to determine their needs.
Women with breast or gynecological cancer who had either received at least 3 months of treatment or had completed treatment <1 year before the study were enrolled in this cross-sectional, observational study.
From February to November 2001, 2839 questionnaires were distributed; 1870 were returned (66% response rate), mainly by breast cancer patients (87%). While 92% of women reported having received information at diagnosis, 34% of relapsed patients complained of lack of information concerning their disease and treatment. Only 18% of patients were included in the treatment decision process and 66% of women obtained complementary information from the media, patients and care professionals. Fatigue was the most severe problem quoted (78% of cases) and was poorly managed by caregivers due to diagnostic and treatment difficulties. Problems relating to family and to affective and socio-professional life were poorly identified and remained largely unmanaged.
Information given to female cancer patients must be improved in relapsed patients, particularly regarding the adverse effects of treatment. Psychosocial management requires a more holistic approach through new channels, together with the coordination of existing structures.
Annals of Oncology 07/2004; 15(7):1056-64. · 6.43 Impact Factor
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L Mauriac,
E Luporsi,
B Cutuli,
A Fourquet,
J R Garbay,
S Giard,
F Spyratos,
B Sigal-Zafrani, J M Dilhuydy,
V Acharian, [......],
A Lesur,
N Shen,
L Cany,
I Dagousset,
M H Gaspard,
H Hoarau,
A Hubert,
M H Monira,
N Perrié,
G Romieu
British Journal of Cancer 09/2003; 89 Suppl 1:S17-31. · 5.04 Impact Factor
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G MacGrogan,
P Rudolph,
I de Mascarel,
L Mauriac,
M Durand,
A Avril, J M Dilhuydy,
J Robert,
S Mathoulin-Pélissier,
V Picot,
A Floquet,
G Sierankowski,
J M Coindre
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ABSTRACT: The isoform of Topoisomerase II (Topo II) is a proliferation marker as well as a target for several chemotherapeutic agents such as anthracyclines. In vitro studies have demonstrated the relationship between the Topo II expression level and chemosensitivity of target cancer cells. To verify this effect in vivo, we selected 125 patients presenting with T2>3 cm and T3 N0–1 M0 breast tumours who were treated by six cycles of primary chemotherapy, including epirubicin before any surgery. Therapy response was assessed by clinical and X-ray mammogram measurements of tumour shrinkage. The pretherapeutic core biopsies were immunostained with a monoclonal antibody (Ki-S7) against Topo II. Ki-S7 positivity ranged from 0 to 50% (median, 15%). A high percentage of Ki-S7-positive cells (>15%) was associated with tumour regression under chemotherapy (OR=2.88, CI: 1.3–6.4, P=0.004). Ki-S7 further emerged as an independent predictor of tumour regression (OR=3.34, CI: 1.41–7.93, P=0.006), together with tumour size of less than 40 mm (OR=3.82, CI: 1.58–9.25, P=0.002) and negative oestrogen receptor (ER) status (OR=3.35, CI: 1.43–7.86, P=0.005), in a multivariate analysis including tumour size, SBR grade, ER and PR status, Ki-67, p53 and Her-2/neu. Our clinical results confirm in vitro data on the relationship between Topo II expression and tumour chemosensitivity and thus may have important practical implications.Keywords: Topoisomerase II, breast cancer, primary chemotherapy, anthracyclines, Her-2/neu
British Journal of Cancer 08/2003; 89(4):666-671. · 5.04 Impact Factor
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G MacGrogan,
P Rudolph,
I de Mascarel Id,
L Mauriac,
M Durand,
A Avril, J M Dilhuydy,
J Robert,
S Mathoulin-Pélissier,
V Picot,
A Floquet,
G Sierankowski,
J M Coindre
[show abstract]
[hide abstract]
ABSTRACT: The alpha isoform of Topoisomerase IIalpha (Topo IIalpha) is a proliferation marker as well as a target for several chemotherapeutic agents such as anthracyclines. In vitro studies have demonstrated the relationship between the Topo IIalpha expression level and chemosensitivity of target cancer cells. To verify this effect in vivo, we selected 125 patients presenting with T(2)>3 cm and T(3) N(0-1) M(0) breast tumours who were treated by six cycles of primary chemotherapy, including epirubicin before any surgery. Therapy response was assessed by clinical and X-ray mammogram measurements of tumour shrinkage. The pretherapeutic core biopsies were immunostained with a monoclonal antibody (Ki-S7) against Topo IIalpha. Ki-S7 positivity ranged from 0 to 50% (median, 15%). A high percentage of Ki-S7-positive cells (>15%) was associated with tumour regression under chemotherapy (OR=2.88, CI: 1.3-6.4, P=0.004). Ki-S7 further emerged as an independent predictor of tumour regression (OR=3.34, CI: 1.41-7.93, P=0.006), together with tumour size of less than 40 mm (OR=3.82, CI: 1.58-9.25, P=0.002) and negative oestrogen receptor (ER) status (OR=3.35, CI: 1.43-7.86, P=0.005), in a multivariate analysis including tumour size, SBR grade, ER and PR status, Ki-67, p53 and Her-2/neu. Our clinical results confirm in vitro data on the relationship between Topo IIalpha expression and tumour chemosensitivity and thus may have important practical implications.
British Journal of Cancer 08/2003; 89(4):666-71. · 5.04 Impact Factor
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Cancer/Radiothérapie 07/2003; 7(3):213-21. · 1.49 Impact Factor
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L Mauriac,
E Luporsi,
B Cutuli,
A Fourquet,
J R Garbay,
S Giard,
F Spyratos,
B Sigal-Zafrani, J M Dilhuydy,
V Acharian,
C Balu-Maestro,
M P Blanc-Vincent,
C Cohen-Solal,
B De Lafontan,
M H Dilhuydy,
B Duquesne,
R Gilles,
A Lesur,
N Shen
Gynécologie Obstétrique & Fertilité 04/2003; 31(3):284-315. · 0.52 Impact Factor
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ABSTRACT: This paper reports the patient care experience during the course of the radiotherapy. Plights are multiple. Patients are confronted with a complex and unknown distressing space, an irrelavant information, a banalization of side effects, an isolation with a frequent inadequate support of their family or the caregivers team, with the fear of a definitive abandonment at the end of the treatment without comforting follow-up. It is imperative to state a real policy in order to improve the patient support. Sensibilization and training of the caregivers, in spite of a frequent overbooking technical work, is required in a pluridisciplinary approach to provide a relevant reception with the collaboration of psychologists, social workers and self care groups and associations. The personal implication of the physicians and technologists is also essential. The simple smile is the intangible proof of the reliable emotional support.
Cancer/Radiothérapie 12/2002; 6 Suppl 1:196s-206s. · 1.49 Impact Factor
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A Fourquet,
B Cutuli,
E Luporsi,
L Mauriac,
J R Garbay,
S Giard,
F Spyratos,
B Sigal-Zafrani, J M Dilhuydy,
V Acharian, [......],
A Lesur,
N Shen,
L Cany,
I Dagousset,
M H Gaspard,
H Hoarau,
A Hubert,
M H Monira,
N Perrié,
G Romieu
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ABSTRACT: The "Standards, Options and Recommendations" (SOR) project, started in 1993, is a collaboration between the Federation of french cancer centers (FNCLCC), the 20 french cancer centers, and specialists from french public universities, general hospitals and private clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and the outcome of cancer patients. The methodology is based on a literature review and critical appraisal by a multidisciplinary group of experts, with feedback from specialists in cancer care delivery.
To develop clinical practice guidelines for non metastatic breast cancer patients according to the definitions of the Standards, Options and Recommendations project.
Data were identified by searching Medline, web sites, and using the personal reference lists of members of the expert groups. Once the guidelines were defined, the document was submitted for review to 148 independent reviewers.
This article presents the chapter radiotherapy resulting from the 2001 update of the version first published in 1996. The modified 2001 version of the standards, options and recommendations takes into account new information published. The main recommendations are: (1) Breast irradiation after conservative surgery significantly decrease the risk of local recurrence (level of evidence A) and the decrease in the risk of local recidive after chest wall irradiation is greater as the number of risk factors for local recurrence increases (level of evidence A). (2) After conservative surgery, a whole breast irradiation should be performed at a minimum dose of 50 Gy in 25 fractions (standard, level of evidence A). (3) A boost in the tumour bed should be performed in women under 50 years, even if the surgical margins are free (standard, level of evidence B). (4) Internal mammary chain irradiation is indicated for internal or central tumours in the absence of axillary lymph node involvement (expert agreement) and in the presence of lymph node involvement (standard, level of evidence B1). (5) Sub- and supra-claviculr lymph node irradiation is indicated in patients with axillary node involvement (standard, level of evidence B1).
Cancer/Radiothérapie 07/2002; 6(4):238-58. · 1.49 Impact Factor
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C Tunon-de-Lara,
I de-Mascarel,
G Mac-Grogan,
E Stöckle,
O Jourdain,
V Acharian,
C Guegan,
A Faucher,
E Bussieres,
M Trojani,
F Bonichon,
B Barreau,
M H Dilhuydy, J M Dilhuydy,
L Mauriac,
M Durand,
A Avril
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ABSTRACT: Six hundred seventy-six patients with ductal carcinoma in situ of the breast (DCIS) from 1971 to 1995 were included in the study. Computerized patient files were retrospectively analyzed. Clinical findings were less frequently reported to reveal DCIS after 1989. Positive mammographic findings were obtained in 87% of patients and were mainly represented by microcalcifications (79.4%). Treatment procedures were breast-conserving surgery (BCS) alone (37.5%), BCS followed by radiation (BCSR) (25.5%), or mastectomy (M) (37%). The actuarial local recurrence was 2.6% in the M group (94 months of follow-up), 14.5% in the BCS group (85,7 months of follow-up), and 7.5% in the BCSR group (78.8 months of follow-up). Predictive factors of recurrence in all patients were invaded margin status and age. In the BCS group, grade was also a predictive factor. The analysis per decade shows that the lesions currently diagnosed are less serious than those of the past. All the recurrence in patients with positive margins was in the same quadrant as the original lesion. This further emphasizes the need for clear margins.
American Journal of Clinical Oncology 01/2002; 24(6):531-6. · 2.01 Impact Factor
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ABSTRACT: Fatigue is a common complaint for the cancer patient during and after radiotherapy, according to the published studies. Fatigue is a subjective symptom mostly underestimated by oncologists and other care givers. Etiology is complex, poorly understood in spite of obvious causes like insomnia, nausea, pain, depression, psychological distress, anemia, hypothyroidism, menopause disturbances, treatment adverse effects. Fatigue presents multifactorial and multidimensional aspects. To evaluate it, many tools can be used as single-item, unidimensional and multidimensional instruments. Practically, the open discussion with the patient throughout radiotherapy is essential to define it. Taking charge fatigue requires its acknowledgment by radiotherapist, treatment of associated symptoms with a multidisciplinary approach.
Cancer/Radiothérapie 12/2001; 5 Suppl 1:131s-138s. · 1.49 Impact Factor
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ABSTRACT: The radiotherapy of the breast or the chest wall is a complex technique. The definition of the gross tumour volume and the clinical target volume depends on clinical, anatomical and histological criteria. The volumes are located by physical examination, mammography, echography and tomodensitometry. The implantation of surgical clips in the lumpectomy cavity is useful for the boost field. The planning target volume takes into consideration movements of tissues during respiration and variations in beam geometry characteristics. The organs at risk (heart, lung) must be considered systematically. Technical contrivances are necessary to modify and homogenize dose distribution. Conformational irradiation allows an individually design treatment planning. Intensity-modulated radiotherapy technique is a future advantageous technique still under evaluation.
Cancer/Radiothérapie 11/2001; 5(5):550-9. · 1.49 Impact Factor
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B Cutuli,
C Borel,
F Dhermain,
S M Magrini,
T H Wasserman,
J A Bogart,
M Provencio,
B de Lafontan,
A de la Rochefordiere,
E Cellai,
Y Graic,
P Kerbrat,
C Alzieu,
E Teissier, J M Dilhuydy,
H Mignotte,
M Velten
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ABSTRACT: To assess the clinical and histological characteristics of breast cancer (BC) occurring after Hodgkin's disease (HD) and give possible therapies and prevention methods.
In a retrospective multicentric analysis, 117 women and two men treated for HD subsequently developed 133 BCs. The median age at diagnosis of HD was 24 years. The HD stages were stage I in 25 cases (21%), stage II in 70 cases (59%), stage III in 13 cases (11%), stage IV in six cases (5%) and not specified in five cases (4%). Radiotherapy (RT) was used alone in 74 patients (63%) and combined modalities with chemotherapy (CT) was used in 43 patients (37%).
BC occurred after a median interval of 16 years. TNM classification (UICC, 1978) showed 15 T0 (11.3%), 44 T1 (33.1%), 36 T2 (27.1%), nine T3 (6.7%), 15 T4 (11.3%) and 14 Tx (10.5%). Ductal infiltrating carcinoma and ductal carcinoma in situ (DCIS) represented 81.2 and 11.3% of the cases, respectively. Among the infiltrating carcinoma, the axillary involvement rate was 50%. Seventy-four tumours were treated by mastectomy without (67) or with (ten) RT. Forty-four tumours had lumpectomy without (12) or with (32) RT. Another four received RT alone, and one CT alone. Sixteen patients (12%) developed isolated local recurrence. Thirty-nine patients (31.7%) developed metastases and 34 died; 38 are in complete remission whereas five died of intercurrent disease. The 5-year disease-specific survival rate was 65.1%. The 5-year disease-specific survival rates for the pN0, pN1-3 and pN>3 groups were 91, 66 and 15%, respectively (P<0.0001), and 100, 88, and 64% for the TIS, T1 and T2. For the T3 and T4, the survival rates decreased sharply to 32 and 23%, respectively. These secondary BC are of two types: a large number of aggressive tumours with a very unfavourable prognosis (especially in the case of pN>3 and/or T3T4), and many tumours with a 'slow spreading' such as DCIS and microinvasive lesions. These lesions developed especially in patients treated exclusively by RT.
The young women and girls treated for HD should be carefully monitored in the long-term by clinical examination, mammography and ultrasonography. We suggest that a baseline mammography is performed 5-8 years after supradiaphragmatic irradiation (complete mantle or involved field) in patients who were treated before 30 years of age. Subsequent mammographies should be performed every 2 years or each year, depending on the characteristics of the breast tissue (e.g. density) and especially in the case of an association with other BC risk factors. This screening seems of importance due to excellent prognosis in our T(1S)T(1) groups, and the possibility of offering these young women a conservative treatment.
Radiotherapy and Oncology 06/2001; 59(3):247-55. · 5.58 Impact Factor
