[Interest of a sterilised anti-burning gel in radiation dermatitis: results of a comparative study]. / Intérêt d'un gel stérile anti-brûlure dans les radiodermites : résultats d'une étude comparative.

Trial objectives were to assess effectiveness and tolerance of sterilized Avène thermal spring water anti burning gel (ATSW gel) in prevention of radiation dermatitis in adults irradiated (6 weeks) for breast (n=61) or head and neck (n=8) cancer. Patients included in this open labelled, 2 parallel groups, multicentric study, were randomly assigned to apply five times daily for ten weeks either the Avène spring water gel (n=35) or trolamine cream (n=34). The median of emergence of the first objective radiation dermatitis signs was 31 days in the ATSW gel group and 29 days in the control group (p=0,924). The median incidence for pruritus in patients of the ETA gel group was 46 days versus 27 days (p=0,028) and 44 days versus 24 days for pain (p=0,426). Global efficacy was <> in 46,7 % of patients of the ETA gel group versus 17,2 % (p=0,029) and tolerance was <> in 65,5 % of the ETA gel group versus 40,7 % (p=0,107). No radionecrosis was observed. In conclusion, the efficacy of the Avène spring water gel was similar to the control product in prophylaxis of radiation dermatitis. Tolerance was better and the pruritus was significantly more delayed in patients who applied the Avène spring water gel than in controls.

Clinical relevance of KRAS mutation detection in metastatic colorectal cancer treated by Cetuximab plus chemotherapy.

The predictive value of KRAS mutation in metastatic colorectal cancer (MCRC) patients treated with cetuximab plus chemotherapy has recently been suggested. In our study, 59 patients with a chemotherapy-refractory MCRC treated with cetuximab plus chemotherapy were included and clinical response was evaluated according to response evaluation criteria in solid tumours (RECIST). Tumours were screened for KRAS mutations using first direct sequencing, then two sensitive methods based on SNaPshot and PCR-ligase chain reaction (LCR) assays. Clinical response was evaluated according to gene mutations using the Fisher exact test. Times to progression (TTP) were calculated using the Kaplan-Meier method and compared with log-rank test. A KRAS mutation was detected in 22 out of 59 tumours and, in six cases, was missed by sequencing analysis but detected using the SNaPshot and PCR-LCR assays. Remarkably, no KRAS mutation was found in the 12 patients with clinical response. KRAS mutation was associated with disease progression (P=0.0005) and TTP was significantly decreased in mutated KRAS patients (3 vs 5.5 months, P=0.015). Our study confirms that KRAS mutation is highly predictive of a non-response to cetuximab plus chemotherapy in MCRC and highlights the need to use sensitive molecular methods, such as SNaPshot or PCR-LCR assays, to ensure an efficient mutation detection.

Influence of the delay of adjuvant postoperative radiation therapy on relapse and survival in oropharyngeal and hypopharyngeal cancers.

PURPOSE: To determine whether the delay between surgery and the beginning of radiation therapy influences survival or the risk of local-regional relapse in oropharyngeal or hypopharyngeal squamous cell carcinomas. METHODS AND MATERIALS: From 2052 patients referred to the Henri Becquerel Center for the radiation therapy of an oropharyngeal or hypopharyngeal cancer between January 1, 1981 and December 31, 1992, 420 were included in a retrospective study. Exclusion criteria were another cancer, metastasis, incomplete resection, lack of homolateral lymph node resection, or previous chemotherapy. Radiation therapy delivered 45 to 75 Gy on initial location and lymph node. Follow-up was performed until December 31, 1997. A Cox proportional hazard regression analysis was used to evaluate the prognostic factors. RESULTS: The delay between surgery and radiation therapy was not found to be a significant prognostic factor for survival or risk of local-regional relapse. The only parameters found to influence local-regional and survival control were margins' pathologic state (respectively p < 0.0001 and p = 0.015) and T (p < 0.0001) and N (respectively p < 0.0001 and p = 0.0004) stages. In terms of local-regional relapse only, age was a prognostic factor (p = 0.048), and a trend was noted for tumor emboli in vessels or nerves (p = 0.061). CONCLUSION: In patients with oropharyngeal or hypopharyngeal squamous cell carcinoma, the delay between surgical procedure and radiation therapy does not influence survival or risk of local-regional relapse. Radiation therapy might be subjected to complete healing in these patients.

[Classical anticoagulant treatment of venous thromboembolic disease in cancer patients. Apropos of a retrospective study of 71 patients]. / Traitement anticoagulant classique de la maladie thromboembolique veineuse chez les patients cancéreux. A propos d'une série rétrospective de 71 patients.

In order to evaluate the efficiency of classical anticoagulant therapy for venous thromboembolic disease in cancer patients, we retrospectively analysed 71 patients treated with intravenous heparin first and then with antivitamin K. After a mean follow-up of 185 +/- 25 days, 23 patients (33%) were dead; nine patients (12%) had suffered from major haemorrhagic complications, which were not fatal, four of which were due to heparin overdosage; 17 patients (24%) showed recurrent venous thromboembolic disease. According to univariate statistical analysis, risk of major bleeding was not associated with the presence of either thrombocytopenia, abnormal blood coagulation, metastases and/or any other hemorrhagic risk factors; recurrence of venous thromboembolic disease was not associated with the presence of other risk factors for venous thromboembolic disease, nor with the presence or absence of metastases and/or of ongoing chemotherapy. Such results suggest that classical anticoagulant therapy for venous thromboembolic disease in cancer patients is neither effective nor safe. The present retrospective study underlines needs for further prospective analyses in order to evaluate potential benefit from other therapeutic strategies, such as use of low molecular weight heparins and/or vena cava filter placement.