Are anti-vitamin K drugs contraindicated with cetuximab during head-and-neck cancer concomitant radiotherapy?

Two cases of severe skin reactions to cetuximab and concomitant radiation therapy are reported in patients treated for locally advanced head-and-neck squamous cell carcinoma and concurrently treated with an antivitamin K drug for cardiovascular diseases. The role of vitamin K in the epidermal growth factor/epidermal growth factor receptor pathway is discussed. A plea for a specific registry is entered.

Leiomyosarcoma of the inferior nasal concha: a case report and literature review.

Leiomyosarcomas (LMSs) of the sinonasal tracts are rarely reported. We present a case of an LMS of the left inferior nasal concha, and discuss the management options with review of the literature. A 72-year-old female patient presented with epistaxis. Clinical examination and medical imaging showed a tumour arising from the left inferior nasal concha. An endoscopic resection was performed. Anatomopathological and immunohistochemical analyses revealed the tumour to be a grade 3 LMS with uncertain posterior margins. The patient was a Jehovah's Witness and refused more radical surgical resection due to religious beliefs; therefore, adjuvant conformal radiotherapy (60 Gy) was performed. LMS of the nasal cavity is a rare and locally aggressive tumour with a high tendency of recurrence, requiring radical surgical resection and long-term follow-up. The prognosis of a nasal cavity LMS is better than that of an LMS located in the paranasal sinuses.

[Impact of radiotherapy on fertility in female patients]. / Impact de la radiothérapie sur la fertilité féminine.

Although insufficiently documented, the impact of radiation therapy on fertility should not be neglected in female patients. Toxicity on reproductive function is dual and is characterized by both mechanistic deleterious effects on the genital tract and partial or complete loss of ovarian function. Moreover, gonadic toxicity may be increased by the concurrent use of chemotherapy or surgical procedure. In some circumstances, ovarian transposition may be justified for young patients. But no compromise may be accepted in terms of carcinologic results. At least, the effect of low-doses of irradiation has not been demonstrated for extra-pelvic radiotherapy.

[Potential place of FDG-PET for the GTV delineation in head and neck and lung cancers]. / Rôle potentiel de la TEP-FDG pour la définition du volume tumoral macroscopique (GTV) des cancers des voies aérodigestives supérieures et du poumon.

The recent progresses performed in imaging, computational and technological fields bring new opportunities to achieve high precision radiation dose delivery. However, IMRT requires a particular attention at the target delineation step to avoid inadequate dosage to TVs/OARs. In this context, the biological information provided by PET might advantageously complete CT-Scan to refine the target delineation in HNSCC and lung cancer. Integrating PET into the treatment planning however requires the use and validation of accurate and reproducible segmentation methods, which adequately integrate the PET image properties such as the blur effect and the high level of noise. In this context, we developed specific tools, i.e. edge-preserving filters for denoising and deconvolution algorithms for deblurring that allowed the detection of gradient intensity peaks. Our gradient-based method has been validated on phantom and patient materials, and proved to be more accurate than threshold-based approaches. With this tool in hand, we demonstrated that the use of FDG-PET resulted in smaller TVs than the CT-based TVs, on both pre- and per-treatment images, and significantly improved the dose distributions to the TVs/OARs. This opens avenues for dose escalation strategies that might potentially improve the tumor local control.

Ultrasound-guided percutaneous radiofrequency ablation in elderly breast cancer patients: preliminary institutional experience.

Breast cancer is a major source of morbidity and mortality in the elderly population and the number of patients will increase by 30% in future decades. Surgery and endocrine therapy could be considered as the standard treatment in elderly breast cancer patients, but anaesthesia for surgery requires a specific approach taking into account physiological and psychological alterations secondary to ageing. In cases with major alterations of performance status, percutaneous radiofrequency ablation (RFA) could be substituted for the surgical treatment. The aim of the current study is to evaluate the efficacy and feasibility of this technique. Five tumours in four consecutive patients (aged 79-82 years) contraindicated for surgery with symptomatic cT1-2N0M0, positive oestrogen receptor status, low grade were treated by percutaneous radiofrequency-lump ablation under local analgesia, using percutaneous ultrasound guidance. Thermal lesions were produced with RF power 30 W, at a frequency of 500 kHz. Ultrasound-guided percutaneous biopsy of the RF treated breast was performed during the follow-up. We report a successful RFA lump ablation experience in the treatment of four tumours (4/5). One local recurrence occurred within 4 months after RFA. The other biopsies taken during the follow up showed all fat necrosis within the oil cyst and no malignant cells. One abscess occurred at 9 months within the treated area. After a mean follow up of 29.4 months, all the patients are still alive without any other signs of recurrence or metastases. Ultrasound-guided percutaneous RFA is safe and feasible in the management of breast cancer in elderly patients. Nevertheless, further large comparative studies are needed in order to validate such a minimally invasive procedure in current practice.

Different clinical impact of estradiol receptor determination according to the analytical method: A study on 1940 breast cancer patients over a period of 16 consecutive years.

The knowledge of estrogen receptor (ER) status is important in the management of breast cancer patients. More precisely, analytical methods for ER determination have changed over the last two decades from ligand binding assay (LBA) dextran-coated charcoal (DCC) to enzyme immuno-assay (EIA) and more recently immunohistochemistry (IHC). We examined the respective clinical impact of ER determination according to these 3 methods over the period 1983-1999 within a group of 1940 patients, all operated and followed in the single institution Centre Antoine Lacassagne. Validated cut off values were 10 and 15 fmol/mg protein for both LBA-DCC and EIA, respectively and 10% of stained cells for IHC. During the years it was noted that the initial size of the tumor decreased and that the proportion of positive axillary nodes and negative ER tumors was different according to the ER method. ER negativity was 20, 13 and 10% in LBA-DCC, EIA, IHC, respectively. ER was a strong predictor of overall survival in the whole population (Mantel-Cox, p < 0.00001); however when stratifying the analysis on ER method groups, ER was still a prognostic indicator in the EIA, LBA-DCC group but not in the IHC group (the follow-up was too short). It is important to keep these data in mind when conducting large retrospective studies evaluating prognostic markers in breast cancer patients.

[Ovarian metastasis and lung adenocarcinoma: a case report]. / Métastase ovarienne et adénocarcinome pulmonaire: observation d'un cas clinique.

Ovarian metastasis as first dissemination site of a lung adenocarcinoma has not been described in the literature. We report the case of a 61-year-old woman who had a pneumectomy for a centrally located lung adenocarcinoma, which was discovered on a routine chest X-Ray. During the follow-up, a Positron Emission Tomography (PET)-Scan showed a hypercaptation in the pelvic region. Abdominal CT-scan confirmed the presence of a mass which was compatible with a primary ovarian tumor. The patient underwent a hysterectomy and bilateral salpingo-oophorectomy. Pathology reported an adenocarcinoma. Immunohistochemical staining revealed cells expression for Thyroid Transcription Factor 1 (TTF-1), cytokeratin 7 (CK-7) and focally cytokeratin 20 (CK-20). Clinical course, pathological and immunohistochemical data concluded to the diagnosis of ovarian metastasis of the lung adenocarcinoma. In conclusion, in the differential diagnosis of an ovarian metastasis, clinicians should not forget the lung as primary site since epidemiologic data of lung cancer in women show progressive incidence.

Radiological and surgical placement of port devices: a 4-year institutional analysis of procedure performance, quality of life and cost in breast cancer patients.

PURPOSE: The present study is designed to evaluate and compare percutaneous radiologic arm port (R) and surgical subclavian port (S) devices in two homogeneous sets of breast cancer patients in terms of safety, efficacy, quality of life (QoL) and cost analysis. MATERIAL AND METHODS: This study involved a retrospective review of a prospective databank including 200 consecutive port device implantation attempted procedures performed over a 4-year period, in two similar groups of 100 breast cancer women who underwent either the surgical cephalic vein cutdown approach or the percutaneous basilic vein catheterization for intravenous adjuvant chemotherapy. Parameters analyzed included technical success, procedure duration, complications, QoL and cost evaluation for both techniques. RESULTS: The success rate for port implantation was higher for R than for S placement (96% versus 91%). Mean implant duration time was 5.6 and 7.6 months for R and S, respectively. The overall complication rate was 10 and 16% for R and S, respectively. Mean implant duration time, without any complication or death, was 6.4 and 7.8 months for R and S, respectively. Six and seven percent for R and S, respectively, had to be removed prematurely. Both techniques exhibited very good QoL. Direct costs were respectively euro 230.8 and 219.1 for R and S, respectively. CONCLUSION: The significant advantages of R over S include higher success rate, higher cosmetic results despite a 15% relative overcost for R placement. Both are indicated for breast cancer chemotherapy treatment, nevertheless R placement is mandatory in anxious patients who fear surgery, in case of previous cervico-thoracic irradiation or upper extremity venous thrombosis, or in patients at risk of respiratory insufficiency.

[Guillain-Barré syndrome and non-Hodgkin's lymphoma. Report of one case and review of literature]. / Syndrome de Guillain-Barré et lymphome non-hodgkinien. A propos d'une observation et revue de la littérature.

Patients with lymphoma frequently develop neurologic abnormalities mainly due to nervous system infiltration but also direct drug toxicity. Moreover Guillain-Barré syndrome (GBS) remains a possible neuropathy, rarely described in non-Hodgkin's lymphoma. We describe a case of GBS in a patient with non-Hodgkin's high grade lymphoma. A 74-year old man with a newly diagnosed stage I high-grade lymphoma (precursor B-cell Burkitt like type according to the R.E.A.L. Classification) develop flaccid quadriparesis, 7 days after the end of the third course of CHOP treatment. The clinical course and neurological examination were consistent with GBS. The patient was in tumoral complete response. Despite appropriate treatment and a transfer in a reanimation unit, the patient died 3 days after the beginning of neurologic symptoms. The low number of cases described in the international literature doesn't permit to understand the association of this neurologic disease with non-Hodgkin's lymphoma. Collecting more data could lead interesting information to know the place of malignant hematological disease in the natural history of GBS.

[A new area for radiotherapy with favourable features]. / Une nouvelle ère pour la radiothérapie avec des avancées prometteuses.

Radiotherapy is a complex medical speciality involving technology research, biology research and clinical research. All these basic researches are performed in order to optimise the management of cancer treatment patients. The aim of the present review is to present radiotherapy as a moving speciality whatever the concerned section. It will be particularly described the new approaches in terms of technology but also clinical developments.