J Levêque

Université de Rennes 2, Roazhon, Brittany, France

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Publications (184)294.06 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: The objective of this retrospective study was to determine the incidence of recurrence of breast cancer after mastectomy for ductal carcinoma in situ (DCIS) in our institution, and to evaluate the associated risk factors while comparing them to those proposed in the literature. The files of 218 patients who had undergone mastectomy for pure DCIS or DCIS with micro-invasion at Centre Eugène Marquis between January 2003 and November 2013 were compared for: age at diagnosis, type of mastectomy and immediate reconstruction, tumor characteristics, and the evaluation of the sentinel axillary lymph node. The mean follow-up period was 30.5 months. In a mean period of 39.13 months, 8 patients (3.67%) developed a recurrence post-mastectomy, 2 of whom with distant metastasis. Two others developed distant metastases subsequently during treatment. All 4 died due to progression of metastases, while the other 4 are alive and disease-free after treatment. The only risk factor was young age at initial diagnosis (<40 years). None of the other factors described in the literature, such as high grade or diffuse disease, comedo-necrosis, positive margins or micro-invasion were statistically significant. The recurrence of breast cancer after mastectomy for DCIS is rare, however, it carries a high mortality rate for those who do relapse. Patients who have high risk factors such as young age at diagnosis and high risk tumor factors should be followed closely for signs of recurrence and/or metastasis. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Breast (Edinburgh, Scotland) 08/2015; DOI:10.1016/j.breast.2015.06.005 · 2.58 Impact Factor
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    ABSTRACT: Breast-conserving surgery with radiation therapy is the primary treatment for ductal carcinoma in situ (DCIS). Re-excision is indicated when clear resection margins have not been achieved, although in some cases the procedure may be unnecessary as there is no residual tumor. The purpose of our three-Center retrospective study was to identify predictors of positive re-excision findings following breast-conserving surgery for DCIS. A total of 285 patients underwent re-excision following conservative treatment for DCIS between 01/01/08 and 12/31/13 at three breast-cancer referral Centers. We conducted a retrospective, comparative review of the factors that differentiated patients with a residual tumor from those without. The study was based on clinical, radiological, surgical and pathological criteria. A total of 180 patients (63%) had residual tumor after conservative treatment. Six factors were predictive on univariate analysis: young age (p=0.025), non-menopausal status (p=0.016), absence of preoperative biopsy (p=0.0029), high nuclear grade (p=0.0181), lesion size >30 mm (p=0.032), and positive surgical margins (p=0.0016). Four factors remained independently predictive on multivariate analysis: non-menopausal status (p=0.0017), high nuclear grade (p=0.0031), lesion size >30 mm (p=0.012) and positive surgical margins (p=0.0013). We calculated a 93% probability of positive re-excision findings if all four factors were combined. On the other hand, if none of the factors were present, the rate fell to 18%. In cases of DCIS, where risk factors for both involved lumpectomy margins and recurrence are carefully studied, knowledge of the risk factors for residual tumor can help guide therapeutic choices. Copyright© 2015 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.
    Anticancer research 06/2015; 35(6):3471-7. · 1.87 Impact Factor
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    ABSTRACT: Pelvic exenteration requires complete resection of the tumor with negative margins to be considered a curative surgery. The purpose of this review is to assess the optimal preoperative evaluation and surgical approach in patients with recurrent cervical cancer to increase the chances of achieving a curative surgery with decreased morbidity and mortality in the era of concurrent chemoradiotherapy. Review of English publications pertaining to cervical cancer within the last 25 years were included using PubMed and Cochrane Library searches. Modern imaging (MRI and PET-CT) does not accurately identify local extension of microscopic disease and is inadequate for preoperative planning of extent of resection. Today, only half of pelvic exenteration procedures obtain uninvolved surgical margins. Clear margins are required for curative pelvic exenterations, but are poorly predictable by pre-operative assessment. More extensive surgery, i.e. the infra-elevator exenteration with vulvectomy, is a logical surgical choice to increase the rate of clear margins and to improve patient survival following surgery for recurrent cervical carcinoma. Copyright © 2015 Elsevier Ltd. All rights reserved.
    European Journal of Surgical Oncology 04/2015; DOI:10.1016/j.ejso.2015.03.235 · 2.89 Impact Factor
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    ABSTRACT: The purpose of this work was to study the continuation rate of intrauterine device (IUD) copper in a nulliparous population.
    Gynécologie Obstétrique & Fertilité 01/2015; 43(2). DOI:10.1016/j.gyobfe.2015.01.003 · 0.58 Impact Factor
  • M Jégu · A Some Der · K Morcel · C Abadie · X Fritel · J Levêque
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    ABSTRACT: Germline mutations BRCA1&2 are responsible in women for breast and ovarian cancers that commonly occur at a young age: as such, there are strong interactions between the oncological risks and the events of reproductive life, pregnancy, breastfeeding, and management of infertility. A review of the international literature from the PubMed database was conducted, and recommendations of French health agencies were exposed. Published studies are case-control and cohort studies in the majority, with a low level of evidence. Pregnancy and lactation have no effect on breast and ovaries or even decreases the risk. The sex ratio among patients carrying the mutation is in favor of girls. It is not observed more infertility in patients carrying a mutation despite a strong suspicion of premature ovarian failure, and infertility treatments do not increase breast and ovarian risk. There are ethical debates concerning the place of pre-natal diagnosis: both experts and concerned patients recommend a case-by-case analysis of the requests. Copyright © 2014 Elsevier Masson SAS. All rights reserved.
  • M. Jégu · A. Some Der · K. Morcel · C. Abadie · X. Fritel · J. Levêque
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    ABSTRACT: Les mutations constitutionnelles délétères BRCA1&2 sont responsables chez la femme de cancers mammaires et ovariens qui surviennent fréquemment dans le jeune âge : à ce titre, existent des interactions fortes entre les risques cancérologiques et les évènements de la vie reproductive, grossesses, allaitement, prise en charge de l’infertilité.
    Journal de Gynécologie Obstétrique et Biologie de la Reproduction 11/2014; 44(1). DOI:10.1016/j.jgyn.2014.10.011 · 0.62 Impact Factor
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    ABSTRACT: To assess value of sonography, hCG and progesterone for diagnosis of first trimester nonviable pregnancy and to assess first trimester miscarriage management (except evacuation). French and English publications were searched using PubMed, Cochrane Library and international learned societies recommendations. First trimester nonviable pregnancy is established with gestational sac mean diameter and embryo crown-rump length. Mean sac diameter≥25mm without embryo (LE2) or embryo crown-rump length≥7mm without heartbeat (LE2) by transvaginal sonography allows to diagnose pregnancy failure. Intrauterine pregnancy of uncertain viability is defined by intra-uterine gestational sac without embryo with heartbeat or without pregnancy diagnosis failure and requires a new transvaginal sonography. The delay for this second sonography depends on the aspect of intrauterine picture (i.e. presence of yolk sac or not, presence of embryo or not) (LE4). Human chorionic gonadotropin (hCG) and progesterone are useful for pregnancy of unknown location (i.e. no gestational sac at transvaginal sonography): hCG ratio<15% between two-day serum samples when first hCG is<2000UI/mL (LE2) or low serum progesterone level (<3.2ng/mL) (LE2) exclude viable intrauterine pregnancy. There is not known prevention strategy for threatened miscarriage. Copyright © 2014 Elsevier Masson SAS. All rights reserved.
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    ABSTRACT: To establish recommendations for early recurrent miscarriages (≥3 miscarriages before 14weeks of amenorrhea). Literature review, establishing levels of evidence and recommendations for grades of clinical practice. Women evaluation includes the search for a diabetes (grade A), an antiphospholipid syndrome (APS) (grade A), a thyroid dysfunction (grade A), a hyperprolactinemia (grade B), a vitamin deficiency and a hyperhomocysteinemia (grade C), a uterine abnormality (grade C), an altered ovarian reserve (grade C), and a couple chromosome analysis (grade A). For unexplained early recurrent miscarriages, treatment includes folic acid and progesterone supplementation, and a reinsurance policy in the first quarter (grade C). It is recommended to prescribe the combination of aspirin and low-molecular-weight heparin when APS (grade A), glycemic control in diabetes (grade A), L-Thyroxine in case of hypothyroidism (grade A) or the presence of thyroid antibodies (grade B), bromocriptine if hyperprolactinemia (grade B), a substitution for vitamin deficiency or hyperhomocysteinemia (grade C), sectionning a uterine septum (grade C) and treating an uterine acquired abnormality (grade C). These recommendations should improve the management of couples faced with early recurrent miscarriages. Copyright © 2014 Elsevier Masson SAS. All rights reserved.
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    ABSTRACT: Évaluer la valeur diagnostique des examens complémentaires pour affirmer l’arrêt d’une grossesse au premier trimestre de grossesse et la stratégie de prise en charge des patientes ayant une grossesse arrêtée au premier trimestre (hors évacuation).
    Journal de Gynécologie Obstétrique et Biologie de la Reproduction 11/2014; 43(10). DOI:10.1016/j.jgyn.2014.09.012 · 0.62 Impact Factor
  • Journal de Gynécologie Obstétrique et Biologie de la Reproduction 11/2014; 43(10). DOI:10.1016/j.jgyn.2014.09.020 · 0.62 Impact Factor
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    ABSTRACT: Établir des recommandations concernant les fausses couches à répétition (FCR) (≥ 3 fausses couches avant 14 semaines d’aménorrhée).
    Journal de Gynécologie Obstétrique et Biologie de la Reproduction 11/2014; 43(10). DOI:10.1016/j.jgyn.2014.09.014 · 0.62 Impact Factor
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    ABSTRACT: Transvaginal pelvic ultrasound is the first-line imaging examination for presumed benign ovarian tumors (PBOT) in adult women (Grade A). Ultrasound is sufficient for characterizing a unilocular anechoic cyst smaller than 7 cm (Grade A). Magnetic resonance imaging is the recommended second-line investigation for indeterminate masses or masses larger than 7 cm (Grade B). Serum CA-125 assay is not recommended for first-line diagnosis in adult women (Grade C). In women with a unilocular anechoic cyst, hormone therapy is ineffective and not recommended (Grade A). Ultrasound-guided aspiration is not recommended (Grade B). Abstention is an option in adult women with a unilocular asymptomatic anechoic cyst smaller than 10 cm and no history of cancer (Grade B). If symptoms develop, laparoscopy is the gold standard for surgical treatment of PBOT (Grade A). Conservative surgical treatment (cystectomy) should be preferred to oophorectomy in pre-menopausal women without a previous history of cancer (Grade C). In cases of suspected adnexal torsion, laparoscopic surgical exploration is recommended (Grade B). Conservative treatment or detorsion without oophorectomy is recommended for pre-menopausal women regardless of the estimated torsion duration and macroscopic appearance of the ovary (Grade B). During pregnancy, expectant management is recommended for unilocular asymptomatic anechoic cysts smaller than 6 cm (Grade C).
    European Journal of Obstetrics & Gynecology and Reproductive Biology 10/2014; 183. DOI:10.1016/j.ejogrb.2014.10.012 · 1.63 Impact Factor
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    ABSTRACT: Objectives: The aim of this study was to assess the prognostic factors after curative pelvic exenterations performed for recurrent uterine cervical or vaginal cancers in the era of concomitant chemoradiotherapy. Methods: We retrospectively enrolled 16 patients with recurrent uterine cervical or vaginal cancer and tumor-free resection margins on pelvic exenteration pathological analysis between October 1997 and April 2014. Results: Pelvic exenterations were performed for 13 recurrent cervical cancers and 3 recurrent vaginal cancers. All of the patients had received pelvic irradiation (external radiotherapy for 14 patients and brachytherapy for 2 patients). The median age at the recurrence was 59.5 years (49-77 years), and the median tumor size was 4.35 cm (2-9 cm). There were no intraoperative or postoperative deaths. The 5-year disease-free survival and overall survival were 30% and 34.1%, respectively. The following 3 factors affected the disease-free survival: tumor size greater than 5 cm (P = 0.05), mesorectal lymph node involvement (P = 0.02), and vascular emboli (P = 0.0093). Conclusions: The presence of vascular emboli is a new prognostic factor in cases of recurrent cervical or vaginal cancer. Assessing the presence of vascular emboli on pretherapeutic biopsies could facilitate the selection of patients eligible for curative pelvic exenterations.
    International Journal of Gynecological Cancer 09/2014; 24(9). DOI:10.1097/IGC.0000000000000288 · 1.95 Impact Factor
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    ABSTRACT: Objective Pregnancy before 15 years old remains a troublesome issue for medical teams which are not used to working with adolescents. The aim of this work is to study the outcome of the pregnancies among very young adolescents, the psycho-social context, the medical management, the professionals involved in it and the follow-up after pregnancy. Materials and methods Retrospective analysis from four cases, in the university hospital of Rennes, during the year 2011. Results All the pregnancies were terminated, half of them on a psychological indication. Three adolescents showed evidence of major psychological distress and two of them had a history of sexual abuse. The medical care was heterogeneous, from the first meet until the follow-up after pregnancy, including the medical abortion. A multidisciplinary teamwork was found in three of the four cases. Conclusion Pregnancy before the age of 15 years old is a rare event and often ends with a medical abortion. The medical management of those vulnerable adolescents is complex and requires a multidisciplinary team approach all along the follow-up. A national evaluation of clinical practice in this area seems to be needed.
    La Revue Sage-Femme 09/2014; 43(7):514–520. DOI:10.1016/j.sagf.2014.09.002
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    ABSTRACT: Objectives: To assess cervical regeneration after large loop excision of the transformation zone (LLETZ) by ultrasound (US) measurements of cervical length (CL) before conization as well as in the postoperative short- and long-term and to identify factors affecting regeneration. Patients and Methods: This was a prospective observational study including patients under 45 years of age treated by LLETZ for Cervical Intraepithelial Neoplasia (CIN) with repeated measurements of CL by transvaginal US before and just after LLETZ, at 1 and 6 months postoperatively. Results: A total of 83 patients were enrolled, out of which 53 were included in the study. The mean CL was 28.6 mm (±5.7) preoperatively versus 18.3 mm (±4.2) after surgery; 21.8 mm (± 4.4) at 1 month and 25.5 mm (±4.9) at 6 months. The mean cone length estimated by US was 10.3 mm (±3.4). The differences in CL before/after conization and CL after conization/at 6 months were statistically significant (p<0.0001). Cervical regeneration at 6 months was 71% (±20), statistically greater than regeneration at 1 month (32%, ±16) (p<0.0001). Discussion: Post-conization cervical tissue regeneration occurred with almost three quarters of the initial cervical length restored at 6 months. Further studies evaluating obstetric outcomes after LLETZ according to cervical regeneration might subsequently be used in clinical practice to identify high-risk pregnancies by pre- and postoperative US measurements of the cervical length. A rigorous assessment of CIN treatment risks and benefits remains essential when considering treating patients of childbearing age given a potential obstetric risk from conization.
    Anticancer research 07/2014; 34(7):3799-805. · 1.87 Impact Factor
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    ABSTRACT: Background The orphan receptors COUP-TF (chicken ovalbumin upstream promoter transcription factor) I and II are members of the nuclear receptor superfamily that play distinct and critical roles in vertebrate organogenesis. The involvement of COUP-TFs in cancer development has recently been suggested by several studies but remains poorly understood. Methods MCF-7 breast cancer cells overexpressing COUP-TFI and human breast tumors were used to investigate the role of COUP-TFI in the regulation of CXCL12/CXCR4 signaling axis in relation to cell growth and migration. We used Immunofluorescence, western-blot, RT-PCR, Formaldehyde-assisted Isolation of Regulatory Elements (FAIRE) assays, as well as cell proliferation and migration assays. Results Previously, we showed that COUP-TFI expression is enhanced in breast cancer compared to normal tissue. Here, we report that the CXCL12/CXCR4 signaling pathway, a crucial pathway in cell growth and migration, is an endogenous target of COUP-TFI in breast cancer cells. The overexpression of COUP-TFI in MCF-7 cells inhibits the expression of the chemokine CXCL12 and markedly enhances the expression of its receptor, CXCR4. Our results demonstrate that the modification of CXCL12/CXCR4 expression by COUP-TFI is mediated by the activation of epithelial growth factor (EGF) and the EGF receptor. Furthermore, we provide evidence that these effects of COUP-TFI increase the growth and motility of MCF-7 cells in response to CXCL12. Cell migration toward a CXCL12 gradient was inhibited by AMD3100, a specific antagonist of CXCR4, or in the presence of excess CXCL12 in the cell culture medium. The expression profiles of CXCR4, CXCR7, CXCL12, and COUP-TFI mRNA in 82 breast tumors and control non-tumor samples were measured using real-time PCR. CXCR4 expression was found to be significantly increased in the tumors and correlated with the tumor grade, whereas the expression of CXCL12 was significantly decreased in the tumors compared with the healthy samples. Significantly higher COUP-TFI mRNA expression was also detected in grade 1 tumors. Conclusions Together, our mechanistic in vitro assays and in vivo results suggest that a reduction in chemokine CXCL12 expression, with an enhancement of CXCR4 expression, provoked by COUP-TFI, could be associated with an increase in the invasive potential of breast cancer cells.
    BMC Cancer 06/2014; 14(1):407. DOI:10.1186/1471-2407-14-407 · 3.32 Impact Factor
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    ABSTRACT: Objectives To assess whether there is a correlation between the length of a conization specimen and the length of the cervix measured by vaginal ultrasonography after the operation Patients and methods Prospective observational study including patients less than 45 years with measurement of cervical length before and the day of the conization, and measuring the histological length of the specimen. Results Among the 40 patients enrolled, the average ultrasound measurements before conization was 26.9 mm (± 4.9 mm) against 18.1 mm (± 4.4 mm) after conization with a mean difference of 8.8 mm (± 2.4 mm) (difference statistically significant P < .0001). The extent of histological specimen was 9 mm (± 2.2 mm) on average. A correlation between ultrasound and histological measurements with a correlation coefficient R = 0.85 was found statistically significant (P < 0.0001). Moreover, the rate of cervix length remove by loop-excision in our series is 33% (± 8.5%). Discussion A good correlation between the measurements of the specimen and the cervical ultrasound length before and after conization was found, as a significant reduction in cervical length after conization. The precise length of the specimen should be known in case of pregnancy and the prevention of prematurity due to conization rests on selected indications and efficient surgical technique.
    Journal de Gynécologie Obstétrique et Biologie de la Reproduction 04/2014; 43(4):288–293. DOI:10.1016/j.jgyn.2013.03.014 · 0.62 Impact Factor

Publication Stats

732 Citations
294.06 Total Impact Points

Institutions

  • 2008–2015
    • Université de Rennes 2
      Roazhon, Brittany, France
  • 2000–2013
    • Université de Rennes 1
      • Faculté de Médecine
      Roazhon, Brittany, France
  • 1998–2013
    • Centre Hospitalier Universitaire de Rennes
      • Service de gynécologie
      Roazhon, Brittany, France
  • 2012
    • Unité Inserm U1077
      Caen, Lower Normandy, France
  • 1994–2012
    • Centre Eugène Marquis
      Roazhon, Brittany, France
  • 2010
    • Centre Hospitalier de Bretagne Sud
      Lorient, Brittany, France
    • Sainte Anne Military Teaching Hospital
      Toulon-sur-Mer, Provence-Alpes-Côte d'Azur, France
    • Institut de Recherche en Cancerologie de Montpellier
      Montpelhièr, Languedoc-Roussillon, France
  • 2009
    • European University of Brittany
      Roazhon, Brittany, France
  • 1994–1997
    • CHRU de Strasbourg
      Strasburg, Alsace, France