Stéphane Temam

Institut de Cancérologie Gustave Roussy, Île-de-France, France

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Publications (97)327.2 Total impact

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    ABSTRACT: To propose an original experience-based reference framework for the management of the thyroid gland during a total laryngectomy in our institution. The steps were based on 1) the incidence and patterns of thyroid gland invasion (TGI), 2) preoperative and pathologic factors associated with TGI, and 3) the relationship between TGI and oncologic efficacy endpoints after treatment. Retrospective cohort study. We reviewed the records of 182 patients who had undergone a total laryngectomy with a total thyroidectomy or loboisthmectomy in our center. Among 23 patients (12.6%), the thyroid gland was directly invaded by disease in 22 and by metastasis in one. Subglottic primary site was the only preoperative factor associated (P =.03). TGI was associated with pathological signs of anterior extralaryngeal invasive disease (thyroid cartilage transfixion, P = .002; cricothyroid membrane invasion, P < .0001; and prelaryngeal soft tissue infiltration, P < .0001) and ipsilateral VIb lymph node metastasis (P = .004). As expected, disease-free survival was significantly lower in patients with TGI (P = .04) and peristomal control was significantly reduced in patients with TGI (P = .038). To our knowledge, this is the largest monocentric series of TGI specimens after a total laryngectomy for laryngeal neoplasms described to date. Focus must be placed on anteroinferior spread, which is likely to invade the cricothyroid membrane, because TGI is part of the extension of extralaryngeal cancer. We propose original experience-based management of thyroid management during a total laryngectomy to improve the level of accuracy of decision making during the surgical procedure whenever possible. 4 Laryngoscope, 2015. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.
    The Laryngoscope 06/2015; DOI:10.1002/lary.25417 · 2.03 Impact Factor
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    ABSTRACT: Primary upper aerodigestive tract malignancy remains a cancer having a poor prognosis, despite current progress in treatment, due to a generally late diagnosis. We conducted a preliminary assessment of five dyes approved for human use for the imaging of head and neck tissues at the cellular level, which could be considered for clinical examination. We investigated fluorescence endomicroscopic images on fresh samples obtained from head and neck surgeries after staining with hypericin, methylene blue, toluidine blue, patent blue or indocyanine green to provide a preliminary consideration as to whether these images contain enough information for identification of non-pathologic and pathologic tissues. The distribution pattern of dye has been examined using probe-based confocal laser endomicroscopy (pCLE) in ex vivo specimens and compared with corresponding histology. In most samples, the image quality provided by pCLE with both dyes allowed pathologists to recognize histological characteristics to identify the tissues. The combination of pCLE imaging with these dyes provides interpretable images close to conventional histology; a promising clinical tool to assist physicians in examination of upper aerodigestive tract, as long as depth imaging issues can be overcome. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
    Journal of Oral Pathology and Medicine 03/2015; DOI:10.1111/jop.12316 · 1.87 Impact Factor
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    ABSTRACT: Evaluation of the qualitative improvement in the visualisation of head and neck carcinoma obtained by dual-energy CT via material density iodine-water images as compared to conventional CT Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to third-party sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. www.myESR.org Squamous cell carcinoma is the most frequent of head and neck cancers. Computed tomography (CT) is widely recommended for initial staging. Dual energy computed tomography (DECT) technology has been implemented in some commercial CT devices for the last several years. DECT uses several technical approaches depending on manufacturer, and post-processing can provide a variety of types of images or maps [1, 2]. Among these maps is a set of images called the "Material density iodine-water" map. The present study uses the material density iodine-water map to evaluate the qualitative improvement in the visualization of head and neck squamous cell carcinoma provided by DECT as compared to CT.
    ECR 2015 - European Congress of Radiology, Vienna (Austria); 03/2015
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    ABSTRACT: TEACHING POINTS - Perineural spread is frequent - An optimal protocol is required TABLE OF CONTENTS/OUTLINE Introduction Head and neck cancer frequently spread along peripheral nerves. It most commonly involves the trigeminal (V) and the facial (VII) nerves, the rotondum (V2) and ovale (V3) foramens. Its frequency is variable (depending on tumor histologic type and location). Its diagnosis is crucial because it bears a poor prognosis (survival, local recurrence and metastasis) and warrants treatment adaptation. Teaching points The radiologic signs are an enlargement of the foramen or of cranial nerves associated with either a contrast enhancement asymmetry (MRI and cT-scan) or a hypermetabolism (FDG-PET/CT). Imaging and analysis must systematically include a coronal reconstruction (V2 and V3) and the imaging of the cavernous sinus. On MRI, a T1-weighted sequence with gadolinium chelate injection and suppression of fat signal is required. The primary advantage of a dedicated Head and Neck PET/CT protocol over the whole body acquisition is in the detection of small lymph node metastases. A baseline imaging after surgery and/or radiotherapy is particularly useful for the follow-up. Conclusions In head and neck cancer, the presence or absence of « extra-cranial » perineural extension should always be reported and an optimal protocol is required.
    Radiological Society of North America's 100th Scientific Assembly and Annual Meeting, Chicago; 11/2014
  • 10/2014; 131(4):A53-A54. DOI:10.1016/j.aforl.2014.07.144
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    ABSTRACT: Disease relapses occur in up to 40 % of cases after radiotherapy (RT) for early-stage glottic laryngeal neoplasms, and the foremost remaining treatment option is salvage total laryngectomy (STL). Our objectives were to review the outcomes of patients treated with salvage surgery after RT for early-stage carcinoma of the glottic larynx and to assess prognostic factors. We retrospectively analyzed 43 patients who underwent surgery. Overall and disease-free survival rates among subgroups were calculated and compared, stratified by preoperative stage, vocal cord mobility and postoperative histopathologic data. Recurrences occurred 22.7 months after the end of RT. Surgery was STL in 33 cases (76.8 %). The main prognostic factors associated with survival rates were initial vocal cord mobility, vocal cord mobility at the diagnosis of recurrence, and changes in mobility. Vocal cord mobility is an important clinical criterion in treatment decision making for early-stage glottis carcinoma and remains important during follow-up.
    Archiv für Klinische und Experimentelle Ohren- Nasen- und Kehlkopfheilkunde 09/2014; DOI:10.1007/s00405-014-3286-x · 1.61 Impact Factor
  • 39th ESMO Congress (ESMO); 09/2014
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    ABSTRACT: To assess the use of radiotherapy (RT) or concurrent chemoradiotherapy (CRT) following taxane-based induction chemotherapy (T-ICT) in locally advanced head and neck squamous cell carcinoma (LAHNSCC) and to evaluate the tolerability of CRT after T-ICT. From 01/2006 to 08/2012, 173 LAHNSCC patients treated as a curative intent by T-ICT, followed by definitive RT/CRT were included in this analysis. There was an 86% objective response (OR) after ICT among 154 evaluable patients. Forty-four patients received less than three cycles (25%) and 20 received only one cycle of T-ICT. The 3-year actuarial overall survival (OS) was 49% and there was no OS difference according to the type of ICT (regimen or number of cycle) or the addition of concurrent CT (cisplatin, carboplatin, or cetuximab) to RT. In multivariate analysis (MVA), clinically involved lymph node (cN+), age more than 60 years, the absence of OR after ICT, and performance status of at least 1 predicted for a decreased OS, with hazard ratios (HR) of 2.8, 2.2, 2.1, and 2, respectively. The 3-year actuarial locoregional control (LRC) and distant control (DC) rates were 52 and 73%, respectively. In MVA, the absence of OR after ICT (HR: 3.2), cN+ (HR: 3), and age more than 60 years (HR: 1.7) were prognostic for a lower LRC whereas cN+ (HR: 4.2) and carboplatin-based T-ICT (HR: 2.9) were prognostic for a lower DC. The number of cycles (≤2) received during ICT was borderline significant for DC in the MVA (P=0.08). Among patients receiving less than or equal to three cycles of ICT, higher outcomes were observed in patients who received cisplatin-based T-ICT (vs. carboplatin-based T-ICT) or subsequent CRT (vs. RT). T-ICT in our experience, followed by RT or CRT, raises several questions on the role and type of induction, and the efficacy of CRT over RT. The role of RT or CRT following induction, although feasible in these advanced patients, awaits answers from randomized trials.
    Anti-Cancer Drugs 08/2014; 25(10). DOI:10.1097/CAD.0000000000000161 · 1.89 Impact Factor
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    International Federation of Head and Neck oncology Societies, New York; 07/2014
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    ABSTRACT: Histological assessment is an essential tool in the diagnosis and guidance of the treatment of various diseases, in particular cancer, of the head and neck. Recent major advances in optical imaging techniques have made it possible to acquire high-resolution in vivo images at the cellular scale. Confocal endomicroscopy is a non-invasive technique, which can be highly useful whenever meaningful in situ histological information is required. The technical aspects of confocal endomicroscopy are introduced, followed by an overview of major clinical studies in the field of head and neck cancer. Ongoing technical developments, contributing to improvements in imaging of the upper aero-digestive tract, are also discussed. Finally, the potential complementarities of functional and molecular imaging, as compared to morphological endomicroscopy, are highlighted.
    Oral Oncology 06/2014; 50(8). DOI:10.1016/j.oraloncology.2014.05.002 · 3.03 Impact Factor
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    ABSTRACT: Introduction Twenty-five cases of airway fire during tracheostomy have been reported in the literature. The authors describe a case observed in their centre 3 years ago, discuss the causes and preventive management and propose guidelines for prevention of this complication. Case report A 66-year-old woman was intubated and ventilated with 100% oxygen during general anaesthesia for tracheostomy. On opening the trachea by monopolar diathermy, the oxygen present in the endotracheal tube caught fire, inducing combustion of the tube spreading to the lower airways. This airway fire was responsible for severe acute respiratory failure and the formation of multiple laryngotracheal stenoses. Discussion Combustion of the endotracheal tube due to ignition of anaesthetic gases induced by the heat generated by diathermy is responsible for airway fire. These various phenomena are discussed. Prevention is based on safety measures and coordination of surgical and anaesthetic teams.
    European Annals of Otorhinolaryngology, Head and Neck Diseases 06/2014; DOI:10.1016/j.anorl.2013.07.001
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    ABSTRACT: Introduction Vingt-cinq cas d’embrasement des voies aériennes au cours d’une trachéotomie chirurgicale ont été rapportés dans la littérature. Nous rapportons 1 cas survenu dans notre centre, avec 3 ans de recul. Nous commentons et discutons les causes et la prise en charge préventive. Des recommandations sont suggérées afin de prévenir cet évènement indésirable. Cas clinique Il s’agissait d’une patiente de 66 ans ventilée par intubation orotrachéale en oxygène à 100 %. Lors de l’ouverture trachéale au bistouri monopolaire, l’oxygène présent dans la trachée d’intubation a pris feu, entraînant une combustion de la sonde d’intubation et une diffusion de l’embrasement aux voies aériennes inférieures. Cet embrasement a été responsable d’une insuffisance respiratoire aiguë sévère puis de sténoses étagées laryngotrachéales. Discussion La combustion de la sonde d’intubation par l’embrasement des gaz ventilatoires dû au rôle activateur de la chaleur générée par le bistouri électrique, est en cause dans les embrasements des voies aériennes. Ces phénomènes sont discutés. La prévention repose sur des mesures de sécurité et une coordination anesthésique et chirurgicale que nous suggérons.
    06/2014; 131(3):182–184. DOI:10.1016/j.aforl.2014.01.014
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    ABSTRACT: The purpose of this study was to analyze our experience with the composed double skin paddle fibula free flap to reconstruct large mandibulofacial defects. Between 2006 and 2011, a total of 32 composed double skin paddle fibula free flap procedures were performed on 32 patients (mean age 54.4 ± 9.7 years, mean follow-up period of 3.4 ± 1.7 years). A chart review was drawn up to determine the type of defects covered by each skin paddle, the vascular anatomy, the origin of the perforators, and any associated complications. The distal septocutaneous skin paddle (Nakajima type B) was used for the reconstruction of the floor of the mouth in most cases. The proximal paddle (Nakajima type D) was used for base of the tongue, mobile tongue, soft palate, internal cheek, inferior lip, and the skin of the chin and neck. The lateral soleus pedicle arose from the fibular pedicle in 28 cases and directly from the tibial-fibular trunk in four cases. There were two partial soleus skin paddle losses. Seven complications required revision surgery: due to a cervical abscess in two cases, due to a hematoma in two cases, due to a disunion of the second skin paddle leading to an orostoma in two cases, and due to an exposition of the osteosynthesis material in one case. In large mandibulofacial defects, a second skin paddle raised on the soleus perforators may be of benefit when reconstructing the soft palate, neck, cheek, or tongue as the length of its pedicle renders a second free flap unnecessary. IV. Laryngoscope, 2013.
    The Laryngoscope 06/2014; 124(6). DOI:10.1002/lary.24452 · 2.03 Impact Factor
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    ABSTRACT: The goal of the present work was to compare outcomes of definitive concurrent cisplatin-based chemoradiotherapy (CRT) with cetuximab-based bioradiotherapy (BRT) in locally advanced head-and-neck squamous cell carcinoma (HNSCC). Between 2006 and 2012, 265 patients with locally advanced HNSCC were treated at our institution with CRT (n = 194; 73 %) with three cycles of cisplatin (100 mg/m(2), every 3 weeks) or BRT (n = 71; 27 %) with weekly cetuximab. Patients receiving BRT had more pre-existing conditions (Charlson index ≥ 2) than the CRT group (p = 0.005). Median follow-up was 29 months. In all, 56 % of patients treated with CRT received the planned three cycles (92 % at least two cycles) and 79 % patients treated with BRT received six cycles or more. The 2-year actuarial overall survival (OS) and progression-free survival (PFS) were 72 % and 61 %, respectively. In the multivariate analysis (MVA), T4 stage, N2-3 stage, smoking status (current smoker as compared with never smoker), and non-oropharyngeal locations predicted for OS, whereas BRT association with OS was of borderline significance (p = 0.054). The 2-year actuarial locoregional control (LRC) and distant control (DC) rates were 73 and 79 %, respectively. CRT was independently associated with an improved LRC (2-year LRC: 76 % for CRT vs. 61 % for BRT) and DC (2-year LRC: 81 % for CRT vs. 68 % for BRT) in comparison with BRT (p < 0.001 and p = 0.01 in the MVA). Subgroup analyses showed that T4 patients benefited significantly from CRT (vs. BRT) in LRC, while T1-3 did not. BRT patients had more G3-4 skin complications (p < 0.001) and CRT patients had higher rates of feeding tube placement (p = 0.006) and G3-4 gastrointestinal toxicities (p < 0.001). This retrospective analysis showed a better LRC in locally advanced HNSCC treated by cisplatin-based CRT than cetuximab-based BRT, and a nonsignificant trend towards an improved OS.
    Strahlentherapie und Onkologie 03/2014; DOI:10.1007/s00066-014-0626-0 · 2.73 Impact Factor
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    ABSTRACT: Squamous cell carcinoma of larynx with subglottic extension (sSCC) is a rare location described to carry a poor prognosis. The aim of this study was to analyze outcomes and feasibility of larynx preservation in sSCC patients. Between 1996 and 2012, 197 patients with sSCC were treated at our institution and included in the analysis. Stage III-IV tumors accounted for 76 %. Patients received surgery (62 %), radiotherapy (RT) (18 %), or induction chemotherapy (CT) (20 %) as front-line therapy. The 5-year actuarial overall survival (OS), locoregional control (LRC), and distant control rate were 59 % (95 % CI 51-68), 83 % (95 % CI 77-89), and 88 % (95 % CI 83-93), respectively, with a median follow-up of 54.4 months. There was no difference in OS and LRC according to front-line treatments or between primary subglottic cancer and glottosupraglottic cancers with subglottic extension. In the multivariate analysis, age > 60 years and positive N stage were the only predictors for OS (HR 2, 95 % CI 1.2-3.6; HR1.9, 95 % CI 1-3.5, respectively). A lower LRC was observed for T3 patients receiving a larynx preservation protocol as compared with those receiving a front-line surgery (HR 14.1, 95 % CI 2.5-136.7; p = 0.02); however, no difference of ultimate LRC was observed according to the first therapy when including T3 patients who underwent salvage laryngectomy (p = 0.6). In patients receiving a larynx preservation protocol, the 5-year larynx-preservation rate was 55 % (95 % CI 43-68), with 36 % in T3 patients. The 5-year larynx preservation rate was 81 % (95 % CI 65-96) and 35 % (95 % CI 20-51) for patients who received RT or induction CT as a front-line treatment, respectively. Outcomes of sSCC are comparable with other laryngeal cancers when managed with modern therapeutic options. Larynx-preservation protocols could be a suitable option in T1-T2 (RT or chemo-RT) and selected T3 sSCC patients (induction CT).
    Strahlentherapie und Onkologie 03/2014; 190(7). DOI:10.1007/s00066-014-0647-8 · 2.73 Impact Factor
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    ABSTRACT: BACKGROUND: Human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (SCC) is associated with favorable survival. The purpose of this study was to evaluate the prevalence and prognostic significance of the HPV infection through both the p16 expression status and the oncogenic HPV DNA viral load. METHODS: A retrospective chart review was conducted on all patients treated for oropharyngeal SCC between January 2007 and June 2009. P16 expression status by immunohistochemistry and HPV DNA viral load by quantitative polymerase chain reaction (qPCR) were evaluated on routine pretreatment tumor samples. RESULTS: One hundred thirty-three patients (94 men and 39 women) were included in the study. Mean age was 59 years. One hundred twenty-two lesions (92%) were localized to lymphoid areas. Sixty-seven patients (50%) were p16+, and 87 patients (65%) harbored HPV DNA. The p16+/HPV DNA+ profile (48%) was associated with the most favorable prognosis. HPV16 was responsible for the majority of the infections (89%). CONCLUSION: HPV is common among oropharyngeal SCC in France, and acts as an independent prognostic factor. © 2013 Wiley Periodicals, Inc. Head Neck, 2013.
    Head & Neck 02/2014; 36(2). DOI:10.1002/hed.23302 · 3.01 Impact Factor
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    ABSTRACT: Identification of MET genetic alteration, mutation, or amplification in oropharyngeal squamous cell carcinoma (OPSCC) could lead to development of MET selective kinase inhibitors. The aim of this study was to assess the frequency and prognostic value of MET gene mutation, amplification, and protein expression in primary OPSCC. A retrospective chart review was conducted of patients treated for single primary OPSCC between January 2007 and December 2009. Pre-treatment OPSCC tissue samples were analyzed for MET mutations, gene amplification, and overexpression using Sanger sequencing, FISH analysis, and immunohistochemistry respectively. Univariate and multivariate analyses were used to analyze correlations between molecular abnormalities and patient survival. 143 patients were included in this study. Six cases (4%) were identified that had a genetic variation, but previously described mutations such as p.Tyr1235Asp (Y1235D) or p.Tyr1230Cys (Y1230C) were not detected. There were 15 high polysomy cases, and only 3 cases met the criteria for true MET amplification, with ≥10% amplified cells per case. Immunohistochemistry evaluation showed 43% of cases were c-MET negative and in 57% c-MET was observed at the tumor cell level. Multivariate analysis showed no significant association between MET mutation, amplification, or expression and survival. Our study shows a low frequency of MET mutations and amplification in this cohort of OPSCC. There was no significant correlation between MET mutations, amplification, or expression and patient survival. These results suggest that patient selection based on these MET genetic abnormalities may not be a reliable strategy for therapeutic intervention in OPSCC.
    PLoS ONE 01/2014; 9(1):e84319. DOI:10.1371/journal.pone.0084319 · 3.53 Impact Factor
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    ABSTRACT: Squamous cell carcinoma of larynx with subglottic extension is a rare location described to carry a poor prognosis. The aim of this study was to analyze outcomes and feasibility of definitive radiotherapy in patients with squamous cell carcinoma. Between 1998 and 2012, 56 patients with squamous cell carcinoma were treated at our institution and included in the analysis. Patients received definitive radiotherapy/chemoradiotherapy alone (63%) or after induction chemotherapy (37%) at our institute. The 5-year actuarial overall survival, progression-free survival and specific survival were 64% (CI 95%: 48-90), 45% (CI 95%: 28-61), 88% (CI 95%: 78-98), respectively, with median follow-up of 74months. The 5-year locoregional control was 69% (CI 95%: 56-83) and the 5-year distant control was 95% (CI 95%: 89-100). There was no difference in overall survival and locoregional control according to front-line treatments or between primary subglottic cancer and glotto-supraglottic cancers with subglottic extension. In the multivariate analysis, performance status of at least 1 and positive N stage were the only predictors for overall survival (hazard ratio [HR] [CI 95%]: 6.5 [1.3-34; P=0.03] and 11 [1.6-75; P=0.02], respectively). No difference of locoregional control was observed according to the first received therapy. The univariate analysis retrieved that T3-T4 patients had a lower locoregional control (HR: 3.1; CI 95%: 1.1-9.2, P=0.04), but no prognostic factor was retrieved in the multivariate analysis. In patients receiving a larynx preservation protocol, 5-year larynx preservation rate was 88% (CI 95%: 78-98), and 58% in T3 patients. The 5-year larynx preservation rate was 91% (CI 95%: 79-100) and 83% (CI 95%: 66-100) for patients who received radiotherapy/chemoradiotherapy or induction chemotherapy as a front-line treatment, respectively. This analysis suggests that the results for squamous cell carcinoma patients treated with radiotherapy/chemoradiotherapy are comparable to those obtained for other laryngeal tumors. This thus suggests the feasibility of laryngeal preservation protocols for infringement subglottic for selected cases. Further studies are needed to clarify these preliminary data.
    Cancer/Radiothérapie 12/2013; 18(1). DOI:10.1016/j.canrad.2013.06.047 · 1.11 Impact Factor
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    Société Française de Cancérologie Cervico-Faciale, Liège; 11/2013
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    Société Française de Cancérologie Cervico-Faciale, Liège; 11/2013

Publication Stats

1k Citations
327.20 Total Impact Points

Institutions

  • 2003–2013
    • Institut de Cancérologie Gustave Roussy
      • Department of Radiotherapy
      Île-de-France, France
  • 2011
    • Shahid Beheshti University of Medical Sciences
      Teheran, Tehrān, Iran
  • 2010
    • Université Paris-Sud 11
      Orsay, Île-de-France, France
  • 2006–2008
    • University of Texas MD Anderson Cancer Center
      • Department of Thoracic Head Neck Medical Oncology
      Houston, Texas, United States
  • 2000
    • French Institute of Health and Medical Research
      • Genetics, Reproduction and Development Laboratory
      Paris, Ile-de-France, France