[Show abstract][Hide abstract] ABSTRACT: Background:
Cytoreductive peritoneal surgery (CRS) associated with hyperthermic peritoneal chemotherapy (HIPEC) has long been considered the standard treatment for colorectal peritoneal metastases (CPM). However, although efficacy of surgery has been demonstrated, evidence supporting HIPEC's role is less certain.
Overall survival (OS), progression-free survival (PFS) and morbidity were analysed retrospectively for fifty consecutively included patients treated for colorectal CPM with complete CRS and systemic chemotherapy only.
Median peritoneal cancer index (PCI) was 8 (range 1-24). 23 patients had liver or lung metastases (LLM). 22 patients had synchronous CPM. 27 complications occurred (12 Grade 1/2, 14 Grade 3, 1 Grade 4a, 0 Grade 5). Median follow-up was 62.5 months (95 %CI 45.4-81.3), median survival 32.4 months (21.5-41.7). Three- and 5-year OS were 45.5% (0.31-0.59) and 29.64% (0.17-0.44) respectively. Presence of LLMs associated with peritoneal carcinomatosis was significantly associated with poorer prognosis, with survival at 5 years of 13.95% (95 %CI 2.9-33.6) vs. 43.87% (22.2-63.7) when no metastases were present (P= 0.018). Median PFS was 9.5 months (95 %CI 6.2-11.1).
With an equivalent PCI range and despite one of the highest rates of LLM in the literature, our survival data of CRS + systemic chemotherapy only compare well with results reported after additional HIPEC. Tolerance was better with acceptable morbidity without any mortality. Extra-hepatic metastasis (LLM) is a strong factor of poor prognosis. Awaiting the results of the randomized PRODIGE trial, these results indicate that CRS + systemic chemotherapy only is a robust hypothesis to treat colorectal CPM.
PLoS ONE 03/2015; 10(3):e0122816. DOI:10.1371/journal.pone.0122816 · 3.23 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Hepar lobatum carcinomatosum (HLC) is an exceptional acquired hepatic distortion which consists in irregularly lobulated hepatic contours seen in patients with known liver metastases, usually from breast carcinoma. We aimed to describe and analyze five similar cases of HLC resulting from metastatic mammary carcinoma in the liver and associated with rapid hepatic failure.Methods
Five cases of HLC were investigated. Medical (including blood liver tests), radiological and histological data (2 cases) were collected and retrospectively analyzed. All patients were followed up for metastatic invasive ductal carcinoma of the breast and had a common pattern of treatment with combination of targeted therapies (bevacizumab, AVASTIN) and chemotherapy (paclitaxel, TAXOL).ResultsAll the patients showed rapid hepatic failure after a mean of 9 courses of bevacizumab/paclitaxel. In all cases, liver imaging revealed liver capsule retraction and an irregular lobular margin. An apparent tumor regression of all liver metastases was showed in two cases. Biopsies were consistent with sinusoidal obstruction syndrome (SOS) and, surprisingly, no tumoral cells were found.Conclusion
Although rare, such an unusual pattern of liver metastasis may mimick acute cirrhosis and cause rapid hepatic failure in patients, despite possible apparent tumor regression on imaging. The etiology of this pathology is unclear, and may involve multiple pathogenic factors. Direct or indirect vascular injury plays an important role in the development of HLC.
Diagnostic and interventional imaging 11/2014; 96(1). DOI:10.1016/j.diii.2014.11.003
[Show abstract][Hide abstract] ABSTRACT: Over 50% of colorectal cancer (CRC) patients develop metastases. The aim of this study was to evaluate efficacy and tolerance of first-line FOLFIRI(R) + bevacizumab (B) treatment for metastatic CRC, and to assess genetic polymorphisms as potential markers.
Adult patients with histologically-proven, non-resectable metastatic CRC and ECOG <= 2 were included. 14-day cycles consisted of bevacizumab (5 mg/kg), irinotecan (180 mg/m2), bolus FU (400 mg/m2) and leucovorin (400 mg/m2), followed by 46-hour FU infusions (2400 mg/m2). Primary endpoint was response rate according to RECIST criteria. Secondary endpoints were overall (OS) and progression-free (PFS) survivals, response duration, and toxicity. Associations between clinical data, UGT1A1, thymidylate synthase, VEGFA polymorphisms and PFS, OS and toxicity were analyzed.
Sixty-two patients were enrolled (median age 68y). 59/62 patients were eligible and evaluable for response at 6 months: 28 showed partial response (47.5%; 95%CI; 34.3-60.9), 20 stable disease (33.9%) and 11 progression (18.6%). Grade 3/4 toxicities were as follows: neutropenia 16.1%; diarrhea 11.3%; nausea-vomiting 1.6%. Median response duration was 9.5 months (range 2.7-20); median PFS 10.3 months (range 8.8-11.7); and median OS 25.7 months (range 20.2-29.7). 11/59 initially unresectable patients were resectable after treatment. VEGFA polymorphism (rs25648) was associated with better OS (HR: 3.61; 95%CI: 1.57-8.30).
FOLFIRI(R) + bevacizumab is active with good response rate, long median OS, and a good safety profile. A VEGFA polymorphism might have a prognostic value in this malignancy.Trial registration: Clinicaltrials.gov: NCT00467142 (registration date: April 25, 2007).
BMC Research Notes 04/2014; 7(1):260. DOI:10.1186/1756-0500-7-260
[Show abstract][Hide abstract] ABSTRACT: To evaluate diaphragmatic hernias (DH) after percutaneous radiofrequency ablation (PRFA) for basal lung nodules and to detect risk factors.
Between January 2009 and December 2012, the presence of DH was retrospectively recorded in all of the patients who underwent PRFA with multitine expandable electrodes for ablation of nodules in the lower lobe. All nodules were classified into three groups according to the location of the tines after deployment relative to the diaphragm: In group 1, the tines were at a distance of >1 cm from the diaphragm; in group 2, at least one tine was in contact with the diaphragm without perforation; and in group 3, at least one tine was perforating the diaphragm.
We recorded 4 cases of DH (3 on the left side, 1 on the right side) in 156 patients (2.3 % of procedures). The delay of onset was 7.8 months. DH occurred in groups 2 (n = 1) and 3 (n = 3). Only the 3 cases that occurred on the left side were symptomatic (2 intussusceptions and 1 gastroesophageal reflux) and were surgically repaired. The electrode was positioned in the center of the diaphragm in all cases.
The central position of the electrode and the contact of at least one tine with the diaphragm after deployment seem to be a risk factor to develop DH.
CardioVascular and Interventional Radiology 02/2014; DOI:10.1007/s00270-014-0854-9 · 2.07 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Introduction:
Sarcoidosis and sarcoid reactions have been previously reported in association with cancer. Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is a minimally invasive test for investigating mediastinal lymph nodes
Patients and methods:
We conducted a retrospective review of 54 patients undergoing EUS-FNA in a cancer institute for suspected metastatic mediastinal lymph nodes showed by CT-imaging or positron emission tomography (PET). Patients with non-caseating granuloma identified by EUS-FNA were included
EUS-FNA identified non-caseating granuloma in seven out of the 54 included patients. Most of them had positive PET. One patient had a prior history of sarcoidosis before the diagnosis of cancer. Another patient developed micrometastasis associated with sarcoid-like reaction. There was no adverse outcome associated with the EUS-FNA procedure
Sarcoidosis must be included in the differential diagnosis of patients with a history of malignancy who develop mediastinal lymphadenopathy. EUS-FNA is a safe and minimally invasive test to obtain tissue diagnosis.
La Revue de Médecine Interne 06/2013; 34(10). DOI:10.1016/j.revmed.2013.04.013 · 1.07 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: L’ablation par radiofréquence (RF) est une technique en plein essor et relativement sûre pour le traitement des métastases pulmonaires. Les lésions proches du diaphragme sont difficiles à traiter en raison du risque de brûlure de ce dernier. La perforation diaphragmatique avec constitution d’une hernie diaphragmatique est une complication évolutive rare mais grave. Son traitement est chirurgical. Nous présentons le premier cas décrit dans la littérature d’occlusion sur hernie diaphragmatique gauche à distance d’une RF pulmonaire.
Journal de Chirurgie Viscerale 04/2013; 150(2):177–178. DOI:10.1016/j.jchirv.2012.10.011
[Show abstract][Hide abstract] ABSTRACT: Radiofrequency ablation (RF) is a relatively safe and reliable technique for the treatment of pulmonary metastases that has seen rapidly expanding use. Lesions situated near the diaphragm are difficult to treat by RF due to the risk of thermal injury to the diaphragm. Diaphragmatic perforation with progressive development of a diaphragmatic hernia is a rare but serious complication. Treatment is surgical. We present the first case reported in the literature of intestinal obstruction in a left diaphragmatic hernia that developed following RF treatment of a pulmonary metastasis.
Journal of Visceral Surgery 03/2013; 150(2). DOI:10.1016/j.jviscsurg.2013.01.005 · 1.75 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Mediastinal lymphadenopathy may be detected by CT-scan or positron emission tomography. Malignant (e.g, lung cancer, metastatic cancer, lymphoma), infectious (e.g, tuberculosis, histoplasmosis), and systemic processes (e.g, sarcoidosis) can cause mediastinal adenopathy. In the posterior and inferior mediastinum, endoscopic ultrasound visualizes and directs transesophageal fine needle aspiration of adenopathy. In the anterior mediastinum, endobronchial ultrasound visualizes and directs transbronchial fine needle aspiration of adenopathy. We discuss the role of EUS and EBUS in the evaluation of mediastinal adenopathy according to their anatomical localization.
Bulletin du cancer 06/2012; 99(7-8):761-70. DOI:10.1684/bdc.2012.1606 · 0.60 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Screening high-risk individuals with imaging tests, such as endoscopic ultrasound and computed tomography, can lead to the detection and treatment of predominantly asymptomatic premalignant lesions. These pancreatic lesions consist of resectable, mostly branch-type non-invasive intraductal papillary mucinous neoplasms. Endoscopic ultrasound features of chronic pancreatitis are highly prevalent in high-risk individuals and these directly correlate with multifocal lobulocentric parenchymal atrophy due to pancreatic intraepithelial neoplasia. Long-term, multi-prospective studies are needed to determine if screening for early pancreatic adenocarcinoma and timely intervention will result in decreased pancreatic cancer incidence and mortality in high-risk individuals.
Bulletin du cancer 06/2011; 98(7):827-36. DOI:10.1684/bdc.2011.1396 · 0.60 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: ObjectifsLe conseil diététique dans l’étude interventionnelle randomisée INOGAD reposait sur l’utilisation de fiches de conseil expliquées
au patient lors d’entretien en face-à-face au cours des cures successives de chimiothérapie. L’objectif de cette étude ancillaire
était d’en évaluer l’observance.
Matériel et méthodesL’observance de 33 patients du groupe bénéficiant de l’intervention nutritionnelle a été évaluée en les interrogeant sur l’application
des conseils centrés sur les besoins et les symptômes des patients: diminution de l’appétit, troubles du transit, nausées
et vomissements, troubles du goût, douleurs buccales, troubles de la déglutition et besoins des patients diabétiques. À chaque
visite, les symptômes étaient recueillis. La proportion de suivi des conseils et la proportion de prise de compléments nutritionnels
oraux par rapport à la prescription étaient mesurées.
RésultatsL’âge moyen des patients était de 76,5 ans (écarttype [ET]: 5,3 ans). Au total, 152 visites de suivi ont été effectuées, et
le symptôme le plus fréquent était la perte d’appétit. Une aide à domicile a été mise en place chez sept personnes. Des compléments
oraux ont été prescrits pour 22 patients et pris dans une proportion de 0,68 (ET: 0,41). Au cours du suivi, les troubles du
goût sont devenus plus fréquents. L’observance des conseils a été au minimum de 0,60 pour les troubles du goût jusqu’à 0,70
pour les conseils comportementaux en cas de perte d’appétit.
ConclusionLes modalités du soutien diététique reposant sur des entretiens répétés, le suivi des symptômes et des fiches de conseil a
été bien accepté par les patients âgés en cours de traitement oncogériatrique.
AimThe dietary counseling applied in the ongoing randomized control trial INOGAD was based on face to face interviewing and dietary
cards during the successive cures of chemotherapy. The aim of this ancillary study was to assess older patients’compliance
with this method.
ProcedureIn the intervention group 33 patients were assessed for compliance with advices targeted on needs and recorded symptoms: appetite
loss, bowel troubles, nausea and vomiting, taste troubles, oral pain, dysphagia, and the needs of patients with diabetes.
At each visit symptoms and compliance were assessed. Proportion of actually implemented advices or proportion of oral supplement
actually ingested related to prescription were measured.
ResultsMean patients age was 76.5 yr (Standard-Deviation, 5.3 yr). All in all, 152 follow-up visits were done and the most frequent
symptom was appetite loss. A professional help at home was implemented in 7 patients. Oral supplementations were prescribed
in 22 patients and were taken in a 0.68 (SD 0.41). During the follow-up taste troubles became more frequent. Compliance with
card advices were from 0.60 (taste troubles) to 0.70 (appetite loss).
ConclusionDietary counseling consisting in repeated consultations, symptoms follow-up and dietary cards was well received by elderly
cancer patients during the course of their chemotherapy treatment.
Mots clésIntervention nutritionnelle–Complémentation orale–Oncogériatrie–Observance–Chimiothérapie
KeywordsNutritional intervention–Dietary supplement–Onco-geriatrics–Compliance–Chemotherapy
[Show abstract][Hide abstract] ABSTRACT: Screening high-risk individuals with imaging tests, such endoscopic ultrasound and computed tomography, can lead to the detection and treatment of predominantly asymptomatic premalignant lesions. These pancreatic lesions consist of resectable, mostly branch-type non invasive intraductal papillary mucinous neoplasms. Endoscopic ultrasound features of chronic pancreatitis are highly prevalent in high-risk individuals and these directly correlate with multifocal lobulocentric parenchymal atrophy due to pancreatic intraepithelial neoplasia. Long-term, multi-prospective studies are needed to determine if screening for early pancreatic adenocarcinoma and timely intervention results in decreased pancreatic cancer incidence and mortality in high-risk individuals.
La Presse Médicale 03/2011; 40(3):230-8. DOI:10.1016/j.lpm.2010.11.009 · 1.08 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Esophageal adenocarcinoma and its precursor Barrett's esophagus are increasing in incidence in western populations. Gastroesophageal reflux and high body mass index (BMI) are known risk factors. Studies about Barrett's esophagus in obese patients have emphasised the role of central adiposity as a stronger risk factor than BMI in the development of specialized intestinal metaplasia and subsequently esophagus adenocarcinoma. The proinflammatory impact of adipocytokines of the abdominal fat associated with the metabolic syndrome is also relevant. Except cardiovascular diseases, type 2 diabetes and non alcoholic steatohepatitis, abdominal obesity and metabolic syndrome are responsible of an increase of prevalence of esophageal adenocarcinoma, but also other cancer sites. In this review, we study the up to date main epidemiologic and physiopathologic data concerning this association that could be important in future for a preventive action in obese patients, especially when metabolic syndrome is present.
[Show abstract][Hide abstract] ABSTRACT: The association of microscopic colitis with celiac disease is rare. A case of microscopic colitis associated with celiac disease and following administration of venlafaxine in a 67-year-old patient is described. The pathophysiologic hypotheses of such an association are discussed.
La Revue de Médecine Interne 01/2009; 30(1):74-77. DOI:10.1016/j.revmed.2008.04.005 · 1.07 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Sporadic colonic juvenile polyps are uncommon in adults. We report three cases for which clinical manifestations were presence of occult blood in the stool, rectal bleeding or chronic diarrhea. Two of these polyps occurred in the caecum which is an uncommon localisation. Endoscopic characteristics of these polyps were indistinguishable from adenomas. Endoscopic resection was complicated in one case by bleeding.