B. Comet

Centre Oscar Lambret, Lille, Nord-Pas-de-Calais, France

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Publications (16)16.58 Total impact

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    ABSTRACT: Objective:Brain tumors are classically associated with neurological and/or psychiatric symptomatology. Behavioral or cognitive disorders can underlie delirium, personality changes, psychotic reactions, and mood disorders.Method:To illustrate this, we report the case of a 60-year-old male patient confronted with an inoperable glioblastoma multiforme on the splenium of the corpus callosum, of poor prognosis, treated by concomitant radiochemotherapy with temozolomide, who developed psychotic depression with Cotard's syndrome. Clinical manifestations of this syndrome with untoward consequences in terms of prognosis are classically characterized by intense moral suffering, indignity and pessimistic fixations, suicidal ideations, and a nihilistic delusion relating to one's own body.Results:Nevertheless, this association between Cotard's syndrome and glioblastoma has been seldom described. To our knowledge, this is the first time that this has been described as a complication of this particular tumor location. Some neuropsychopathological hypotheses are proposed, which involve medical, iatrogenic, and psychogenesis issues.Significance of results:This case report points to the necessary collaboration between psychiatrists, neuro-oncologists and radiation oncologists in improving the patient's management and quality of life.
    Palliative and Supportive Care 02/2012; · 0.98 Impact Factor
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    ABSTRACT: Normal tissues tolerance limits the use of reirradiation for recurrent head-and-neck cancers (HNC). Stereotactic body radiotherapy (SBRT) could offer precise irradiation while sparing healthy tissues. Results of a feasibility study using SBRT with or without cetuximab are reported for reirradiation of recurrent primary HNC. Patients with inoperable recurrent, or new primary tumor, in a previously irradiated area were included. Reirradiation dose was 36 Gy in six fractions of 6 Gy to the 85% isodose line covering 95% of the planning target volume. Patients with squamous cell carcinoma received concomitant cetuximab. Between June 2007 and January 2010, 40 patients were prospectively treated for 43 lesions. Median age was 60 and median tumor size was 29 mm. Fifteen patients received concomitant cetuximab and 1 received concomitant cisplatin. Median follow-up was 25.6 months with 34 patients evaluable for tumor response. Median overall survival was 13.6 months and response rate was 79.4% (15 complete and 12 partial responses). Grade 3 toxicity occurred in 4 patients. These results suggest that short SBRT with or without cetuximab is an effective salvage treatment with good response rate in this poor prognosis population with previously irradiated HNC. Treatment is feasible and, with appropriate care to limiting critical structure, acute toxicities are acceptable. A prospective multicenter Phase II trial of SRT and concomitant cetuximab in recurrent HNC squamous cell carcinoma is ongoing.
    International journal of radiation oncology, biology, physics 02/2012; 84(1):203-9. · 4.59 Impact Factor
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    ABSTRACT: The standard treatment for recurrent or second primary head and neck cancers is surgery which can only be performed in 25% of the patients. For inoperable patients, three options can be discussed: supportive care only, chemotherapy or radiotherapy with or without chemotherapy. The goal of this article is to review the indications and new developments in re-irradiation for recurrent or second primary head and neck cancers. The le Groupe d'Etude des Tumeurs de la Tête et du Cou (GETTEC)-le Groupe d'Oncologie et de Radiothérapie Tête et Cou (GORTEC) (99-01) trial showed that radio-chemotherapy improved disease-free survival for a highly selected population. All conventional and conformational radiotherapy series showed improved local control and disease-free survival rates, but at the expense of acute and late toxicities demanding a drastic patients selection. New radiotherapy techniques such as intensity modulated radiotherapy (IMRT) and stereotactic body radiotherapy (SBRT) have improved oncological results with reduced toxicities, offering treatments which are spread over six to seven weeks for IMRT and two weeks for SBRT. Re-irradiation is an attractive alternative treatment for selected inoperable patients and its effectiveness can be potentiated by systemic treatments such as chemotherapy or targeted therapy. The development of new radiotherapy techniques such as IMRT and SBRT has improved healthy tissues tolerance and future studies should help define the specific IMRT and SBRT indications.
    Current opinion in otolaryngology & head and neck surgery 01/2012; 20(2):137-41.
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    ABSTRACT: Recurrences or second primary head and neck cancers meant, for a long time, therapeutic dead ends. Surgery was the standard treatment, but could only be achieved in 25% of the patients. The GETTEC-GORTEC (99-01) randomized trial showed that radiochemotherapy improved disease-free survival for a highly selected population. For inoperable patients, three options can be discussed: supportive care only, chemotherapy or radiotherapy with or without chemotherapy. The EXTREME protocol showed that combining platinum, 5FU and cetuximab improved overall survival for recurrent or metastatic forms. This is certainly the best option for advanced forms, which are not accessible to radiotherapy. Concerning radiotherapy, only one randomized trial compared chemoradiotherapy to chemotherapy alone using methotrexate. The overall survival, the main objective in this study, was not improved, however, the enrollment was incomplete and included many advanced stage tumors. Other articles are based on Vokes' initial work of radiochemotherapy delivered in split-course over a period of 11 weeks. All conventional and conformational radiotherapy series showed improved local control and disease-free survival rates, but at the expense of acute and late toxicities demanding a drastic patients selection. New radiotherapy techniques such as intensity modulated radiotherapy (IMRT) and stereotactic body radiotherapy (SBRT) have reduced toxicities with a likely oncological results improvement, offering treatments which are spread over six to seven weeks for IMRT and two weeks for SBRT. The better treatment tolerance allows an increasing number of eligible patients. The main future objective will be to define the specific IMRT and SBRT indications.
    Bulletin du cancer 12/2011; 98(12):1477-88. · 0.61 Impact Factor
  • European Journal of Cancer - EUR J CANCER. 01/2011; 47.
  • B Comet, E Lartigau
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    ABSTRACT: Locally advanced head and neck cancers are primarily treated by a multimodal approach, including a combination of surgery, radiotherapy and chemotherapy. However, local relapse rate in a previously irradiated area remains high. Reirradiation for a nonoperable recurrence or a new primary tumour is now a therapeutic option thanks to technical progresses. This review presents results of published series in terms of toxicity and tumour response. All the publications are heterogeneous (population, dose, fractionation, concomitant chemotherapy or targeted therapy) and it is thus difficult to compare results. Reirradiation is feasible and appears less toxic with new techniques such as image guided radiotherapy (IMRT) or stereotactic radiotherapy, which could offer precise radiation delivery while sparing healthy tissues. Concomitant chemotherapy or targeted therapy may improve local control. Prospective evaluation of tumour response and complications is necessary.
    Cancer/Radiothérapie 10/2010; 14(6-7):416-20. · 1.48 Impact Factor
  • Cancer Radiotherapie - CANCER RADIOTHER. 01/2010; 14(6):619-620.
  • Cancer Radiotherapie - CANCER RADIOTHER. 01/2010; 14(6):620-620.
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    ABSTRACT: Infiltrating MBC represents less than 1% of all male cancers. Our study details clinico-pathological features, treatments and prognostic factors in a large French cohort. Four hundred and eighty-nine patients were collected from 1990 to 2005. Median age was 66 years (34% over 70 years) and median follow-up 58 months. According to TN classification, we found T(1): 39%, T(2): 41%, T(3)T(4): 9%, T(x): 11% and N(1)N(2): 27%. Lumpectomy (L) and mastectomy (M) were performed in 8.6% and 91.4% of the cases. Axillary dissection (AD), sentinel node biopsy or both were performed in 90%, 2% and 5% of the cases, respectively. Ninety-five percent of tumours were ductal carcinomas; 47% were pT(1), 20% pT(2) and 33% pT(3)-T(4). Axillary nodal involvement was present in 52.8% cases. ER and PgR were positive in 92% and 89% cases. Radiotherapy (RT) was performed in 85% of the patients. Hormonal treatment (HT) was delivered in 72% of the cases. Tamoxifen and aromatase inhibitors were used in 85% and 12% of the cases; 34% of the patients received chemotherapy (CT). Local recurrence (LR), nodal recurrences (NR) and metastases occurred in 2%, 5% and 22% of the cases; 2% and 10% developed contralateral BC and second cancer. The 5- and 10-year overall survival (OS) rates were 81% and 59%; disease-specific survivals (DSS) were 89% and 72%. Death causes were BC 56%, second cancer 8%, complications 3%, intercurrent disease 15% and unknown 18%. In a univariate analysis, metastatic risk factors were T stage (T1: 19%, T(2): 26%, T(3)T(4): 40%; p=0.013), pN status (pN(0): 12% pN(1-3): 26% pN(>3): 44%; p<0.0001) and presence of locoregional recurrence (62% versus 18% p<0.0001). In a multivariate analysis, axillary nodal involvement and high SBR remain prognostic factors. Earlier diagnosis and wide use of adjuvant treatments (RT/HT/CT) widely decreased LR and increased survival rates in MBC, reaching female ones. Prognostic factors were also very similar to female ones.
    Critical reviews in oncology/hematology 06/2009; 73(3):246-54. · 5.27 Impact Factor
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    ABSTRACT: Male breast cancer (MBC) is considered as a rare disease comprising about 1% of all breast cancers. As compared to women breast cancer, MBC has some similarities and also some particularities related to age, comorbidities, breast volume, diagnostic delay, prognosis and survival. Modified radical mastectomy (MRM) with axillary dissection is the gold standard. Sentinel lymph node dissection is a promising option for early stages. Adjuvant radiation is proposed because of the high frequency of node involvement and central tumor location. In hormone receptor positive tumors tamoxifen remains the gold standard endocrine therapy because of the lack of data on aromatase inhibitors. Adjuvant chemotherapy can be proposed to high-risk patients while trastuzumab should be an option in breast cancer that overexpresses HER2. In the setting of considerable evolution in the management of women breast cancer, this review aimed to point out on the similarities and particularities of MBC and the future challenges to improve MBC outcome.
    Bulletin du cancer 03/2009; 96(2):181-9. · 0.61 Impact Factor
  • Cancer Radiotherapie - CANCER RADIOTHER. 01/2009; 13(6):636-637.
  • Fuel and Energy Abstracts 01/2009; 75(3).
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    ABSTRACT: Whole breast irradiation delivering an equivalent dose of 50 Gy in 5 weeks, followed by a 10 to 16 Gy-boost to the tumor bed is the standard of care after breast-conserving surgery for early-breast cancer. Accelerated partial breast irradiation (APBI) is currently under investigations in large multi-institutional, prospective, randomized trials to objectively address the critical endpoints of treatment efficacy, toxicity and cosmesis. Patient's selection for this new approach is crucial to individualise treatments and define the subgroups of patients who will really benefit from APBI in terms of quality of life without decreasing long-term results of the disease control and cosmesis. In this review, we will discuss the patients' profiles selection for APBI regarding their general and tumor criteria. The differences between APBI techniques either performed intra or post operatively will be also discussed.
    Cancer/Radiothérapie 12/2007; 11(6-7):287-95. · 1.48 Impact Factor
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    ABSTRACT: Les thérapies ciblées prennent de plus en plus de place dans l’arsenal thérapeutique de nombreux cancers. Leur association avec la chimiothérapie s’est révélée efficace avec des profils de toxicités différents. Avec l’allongement de la survie des malades et l’accumulation de données d’efficacité des associations thérapeutiques (thérapies ciblées entre elles, et/ou à la chimiothérapie et/ou à la radiothérapie), se pose la question du rapport entre le bénéfice et le risque de séquelles à long terme. Dans cet article nous ferons le point sur le développement des associations de différentes familles de thérapies ciblées avec l’irradiation au plan expérimental et les premiers résultats obtenus en clinique en termes d’efficacité et de risque de toxicité. Recent clinical trials have demonstrated the effectiveness of targeted therapies in treating a number of cancers in metastatic and adjuvant settings. Toxicity profiles differ when targeted therapies are combined or when they are associated with chemotherapy. In the future, with the increasing use of a variety of combinations (targeted therapies combined with chemotherapy and/or radiation therapy), the benefit-to-risk ratio for late sequelae will rise, especially in patients who survive for longer periods. This article discusses recent advances in combining targeted therapies with radiation therapy, in experimental models and clinical trials.
    Oncologie 05/2007; 9(6):458-465. · 0.10 Impact Factor
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    ABSTRACT: During the last half of century considerable research on radiosensitivity biomarkers has been published. However, to date there is no non-invasive marker of cellular radiosensitivity identified for clinical routinely use. In this review, the main functional and metabolic imaging isotopic techniques for tumor radiosensitivity that have been explored over the last years are being described. This indirect evaluation fall into 3 topics associated with tumor proliferation rate or apoptosis, tumor hypoxic fraction, neoangiogenesis and the intrinsic radiosensitivity of clonogenic tumor cells. The final objective of the radiosensitivity monitoring during radiotherapy would be to adapt treatment strategy for overcoming the identified radioresistance mechanism such as hypoxia by the addition of radiosensitisers for example. This would allow better tumor control rather than continue inefficient and costly treatment delivery, which in addition could compromise outcome.
    Cancer/Radiothérapie 06/2006; 10(3):124-33. · 1.48 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: During the last half of century considerable research on radiosensitivity biomarkers has been published. However, to date there is no non-invasive marker of cellular radiosensitivity identified for clinical routinely use. In this review, the main functional and metabolic imaging isotopic techniques for tumor radiosensitivity that have been explored over the last years are being described. This indirect evaluation fall into 3 topics associated with tumor proliferation rate or apoptosis, tumor hypoxic fraction, neoangiogenesis and the intrinsic radiosensitivity of clonogenic tumor cells. The final objective of the radiosensitivity monitoring during radiotherapy would be to adapt treatment strategy for overcoming the identified radioresistance mechanism such as hypoxia by the addition of radiosensitisers for example. This would allow better tumor control rather than continue inefficient and costly treatment delivery, which in addition could compromise outcome.
    Cancer Radiotherapie - CANCER RADIOTHER. 01/2006; 10(3):124-133.