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1.
ESMO Open ; 6(4): 100197, 2021 08.
Article in English | MEDLINE | ID: mdl-34474811

ABSTRACT

BACKGROUND: Oncological care was considerably impacted by the COVID-19 pandemic. Worrisome declines in diagnostic procedures and cancer diagnoses in 2020 have been reported; however, nationwide, population-based evidence is limited. Quantification of the magnitude and distribution of the remaining outstanding diagnoses is likewise lacking. METHODS: Using accelerated delivery of data from pathology laboratories to the Belgian Cancer Registry, we compared the nationwide rates of new diagnoses of invasive cancers in 2020 to 2019. RESULTS: We observed a 44% reduction in total diagnoses of invasive cancers in April 2020 compared with April 2019, coinciding with the first wave of the COVID-19 pandemic. The reduction was largest in older patients and for skin cancers (melanoma and nonmelanoma). Reductions in diagnosis were less pronounced among children and adolescents (0-19 years). A smaller decline was observed for most cancers with typically poorer prognosis or obvious symptoms, including some hematological malignancies, lung, and pancreatic cancer. Suspension of organized population screening programs was reflected in a strong decline in diagnosis in the screening age groups for female breast cancer (56%) and for colorectal cancer in both men (49%) and women (60%). The number of diagnoses began to increase from the end of April and stabilized at the beginning of June at or just above 2019 levels. There has yet to be a complete recovery in cancer diagnoses, with an estimated 6%, or ∼4000 diagnoses, still outstanding for all of 2020. Among solid tumors, head and neck cancers have the largest remaining year-over-year decrease in diagnoses at 14%. CONCLUSION: These results add to the evidence of a profound impact of the COVID-19 pandemic on oncological care and identify groups at risk for continuing diagnostic delays. These data should stimulate health care providers worldwide to facilitate targeted, accessible, and efficient procedures for detection of cancers affected by this delay.


Subject(s)
Breast Neoplasms , COVID-19 , Adolescent , Aged , Belgium/epidemiology , Child , Female , Humans , Male , Pandemics , SARS-CoV-2
2.
Acta Gastroenterol Belg ; 79(3): 421-428, 2016.
Article in English | MEDLINE | ID: mdl-28209100

ABSTRACT

BACKGROUND AND AIMS: Investigation of the first participation rate and follow-up results of the Flemish colorectal cancer screening program. PATIENTS AND METHODS: In 2013 five age cohorts with an even age between 66 and 74 year old (n=243 335) were invited by mail to return a completed iFOBT. Participants who tested positive (≥75ng/ml) were referred to a follow-up colonoscopy. RESULTS: Participation rate was 48.4% (n=117 774). Overall positivity rate was 10.1%, and 78.1% of those tested positive underwent a colonoscopy. The positive predictive value of colonoscopy for CRC was 8.2%, for advanced adenoma 16.9% and for non-advanced adenoma 36.5%. CONCLUSIONS: Based on the EU-guidelines 35% was expected as participation for a first screening round, thus a participation rate of 48.4% is more than acceptable for a first screening year. The high positivity rate can partly be explained by including only the older ages in the start-up-period and by the first year of mass screening in Flanders. (Acta gastroenterol. belg., 2016, 79, 421-428).


Subject(s)
Colorectal Neoplasms/diagnosis , Early Detection of Cancer , Adenoma , Aged , Belgium , Cohort Studies , Colonoscopy , Female , Humans , Male , Mass Screening , Occult Blood
3.
Eur J Cancer ; 45(13): 2304-11, 2009 Sep.
Article in English | MEDLINE | ID: mdl-19502050

ABSTRACT

PURPOSE: For cytostatic agents or when the response assessment is difficult, adaptations to phase II designs may allow a better assessment of therapeutic activity: first by using the progression-free survival rate (PFSR) as primary end-point instead of the response rate, and second by considering progression-free survival (PFS) risk groups based on a prognostic index (PI). In mesothelioma, current treatments yield disappointingly poor results and there is a need to investigate new regimens. The purpose of this report is to provide a PI for PFS in mesothelioma and reference values for the PFSR. MATERIALS AND METHODS: Data on 523 patients included in 10 European Organisation for Research and Treatment of Cancer (EORTC) mesothelioma studies were analysed to identify prognostic factors using a multivariate Cox regression model. Subsequently, a PI and a nomogram for PFS were developed. The PFSRs at 3, 4, 5 and 6 months were estimated. RESULTS: A performance status>0, stage IV disease and mixed or sarcomatous histological type were indicators of a poor prognosis for PFS. From the PI, based on these three variables, four risk groups were defined. The median progression-free survival ranged from 5.3 to 2.1 months in these risk categories. The PFSRs at 3 months were 70.6%, 62.4%, 54.2% and 42.1% in the four categories, respectively. CONCLUSION: The PI allows dividing patients into homogeneous risk categories in which PFSRs can be calculated and used to design future phase II mesothelioma trials. Defining homogeneous categories of patients avoids dilution of results between groups and improves the assessment of therapeutic activity.


Subject(s)
Clinical Trials, Phase II as Topic , Mesothelioma/mortality , Neoplasms, Glandular and Epithelial/mortality , Adult , Aged , Aged, 80 and over , Disease-Free Survival , Female , Humans , Male , Middle Aged , Prognosis , Proportional Hazards Models , Young Adult
4.
Leukemia ; 21(8): 1715-22, 2007 Aug.
Article in English | MEDLINE | ID: mdl-17541398

ABSTRACT

Chromosomal translocations represent an important prognostic indicator in B-cell chronic lymphocytic leukemia (B-CLL). However, their value had been neither determined in homogeneously treated patients nor compared to that of IgV(H) mutational status. Sixty-five B-CLL patients were investigated using cytogenetics, interphase fluorescence in situ hybridization (FISH), analysis of IgV(H) and of TP53 mutational status before treatment with 2-chloro-2'-deoxyadenosine (CdA). Translocations (n=45) were detected in 42% of the patients, including both balanced (n=12) and unbalanced (n=33) types. IgV(H) was mutated in 43% of the patients. Patients with translocations were more heavily pretreated (P=0.05), presented with more complex karyotypes (P<0.001), 17p abnormalities and TP53 mutations, and had a higher failure rate (59 vs 21% in patients without translocations, P=0.004). Patients with unbalanced translocations displayed a shorter median treatment-free survival (TFS, 6.9 vs 35.9 months, log rank 22.72, P<0.001) and overall survival (OS, 13.0 vs 68.0 months, log rank 16.51, P<0.001), as compared to patients without translocation. In multivariate analysis, unbalanced translocations were independently associated with therapeutic failure, short TFS and short OS. IgV(H) mutational status was independently associated with risk of failure and TFS, but not OS. In B-CLL patients treated with CdA, translocations are strong predictors of outcome.


Subject(s)
Antineoplastic Agents/therapeutic use , Cladribine/therapeutic use , Leukemia, Lymphocytic, Chronic, B-Cell/genetics , Leukemia, Lymphocytic, Chronic, B-Cell/mortality , Translocation, Genetic , Adult , Aged , Aged, 80 and over , Chromosome Aberrations , Chromosomes, Human, Pair 11/genetics , Chromosomes, Human, Pair 13/genetics , Chromosomes, Human, Pair 17/genetics , Female , Humans , In Situ Hybridization, Fluorescence , Interphase , Karyotyping , Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy , Male , Middle Aged , Mutation/genetics , Prognosis , Risk Factors , Survival Rate , Treatment Failure , Tumor Suppressor Protein p53/genetics , Tumor Suppressor Protein p53/metabolism
5.
Med Mal Infect ; 35(5): 269-72, 2005 May.
Article in French | MEDLINE | ID: mdl-15885955

ABSTRACT

The Foot and Mouth disease is considered a relatively mild disease in susceptible animals but it has a considerable economical impact in France and worldwide due to the huge economical losses that it generates. A system for the prevention of the disease was developed thirty years ago and has since been continuously improved. The current system for the prevention of FMD is based on training and information of all those involved in the surveillance of susceptible animals, over all the national territory, and on the control of imported animals and animal products. This system, developed in close collaboration with the European Commission and the other EU member states, allows control measures to be implemented almost instantaneously, if a case is suspected to avoid spreading of the disease.


Subject(s)
Foot-and-Mouth Disease/epidemiology , Population Surveillance , Animal Diseases/epidemiology , Animals , Disease Transmission, Infectious/prevention & control , Foot-and-Mouth Disease/prevention & control , Foot-and-Mouth Disease/transmission , France/epidemiology , Health Surveys , Incidence
6.
Ann Hematol ; 83(6): 356-63, 2004 Jun.
Article in English | MEDLINE | ID: mdl-15024607

ABSTRACT

The combination of purine analogs with alkylating agents is able to produce a synergistic antitumoral effect. However, the addition of immunosuppressive and DNA-targeting agents might increase purine analog-related complications. The risk for serious complications was evaluated in 38 patients treated with 2-chloro-2'-deoxyadenosine (CDA) and cyclophosphamide (CP). The diagnoses were chronic lymphocytic leukemia (CLL) in 15, Waldenström's macroglobulinemia in 4, mantle cell lymphoma in 6, follicular non-Hodgkin's lymphoma (NHL) in 10, and other low-grade NHL in 3 patients. All patients were pretreated (median: 2 lines, range: 1-5) and 23 (61%) were refractory. The patients received a median of two courses (range: 1-5) of 5.6 mg/m(2) CDA, followed by a median of 200 mg/m(2) CP, for 3 days. The response rate was 51% [complete remission (CR): 14%, partial remission (PR): 38%]. Grade 3/4 infections occurred in 16 (42%) patients. Dose-limiting cytopenias were seen in 22 (58%) patients. In 12 (32%) patients, autoimmune manifestations developed requiring treatment in most of them. Second cancers arose in five (13%) patients (myelodysplastic syndrome/acute myelocytic leukemia in three, lung cancer in two). Multivariate analysis showed that cytopenias, gender (F), prior radiotherapy, and age (>65 years) predicted for the complications seen after CDA-CP. To conclude, because of the high incidence of complications, caution is warranted in selecting patients with advanced lymphoid malignancies for the CDA-CP protocol.


Subject(s)
Antineoplastic Combined Chemotherapy Protocols/adverse effects , Lymphoproliferative Disorders/complications , Lymphoproliferative Disorders/drug therapy , Adult , Aged , Aged, 80 and over , Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Cladribine/administration & dosage , Cladribine/adverse effects , Cyclophosphamide/administration & dosage , Cyclophosphamide/adverse effects , Female , Humans , Leukopenia/chemically induced , Leukopenia/epidemiology , Lymphoproliferative Disorders/immunology , Lymphoproliferative Disorders/pathology , Male , Middle Aged , Neoplasms, Second Primary/chemically induced , Neoplasms, Second Primary/epidemiology , Neoplasms, Second Primary/etiology , Opportunistic Infections/chemically induced , Opportunistic Infections/epidemiology , Opportunistic Infections/microbiology , Survival Analysis
7.
Muscle Nerve ; 18(7): 720-9, 1995 Jul.
Article in English | MEDLINE | ID: mdl-7783762

ABSTRACT

We report the results of botulinum toxin type A (Dysport, Porton Products, UK) treatment over 5 years in 107 patients with blepharospasm, Meige's syndrome, oromandibular dystonia, hemifacial spasm, cervical dystonia, and writer's cramp. Electromyography was used to localize dystonic muscles and guide Dysport injections in Meige's syndrome, oromandibular dystonia, cervical dystonia, and writer's cramp. All but 2 Meige's syndrome and 2 writer's cramp patients responded to treatment. Improvement was dramatic in blepharospasm (79%) and hemifacial spasm (90%); pronounced in cervical dystonia (74%); and moderate in Meige's syndrome (53%), oromandibular dystonia (57%), and writer's cramp (34%). Although Dysport doses were 50-75% lower than usually reported, response and improvement rates as well as relapse intervals were similar to those of others. To treat cervical dystonia relapses, only 50% of the initial dose was required for continued optimal relief of symptoms. Low-dose Dysport was associated with a very low incidence of dysphagia in cervical dystonia.


Subject(s)
Botulinum Toxins/therapeutic use , Movement Disorders/drug therapy , Adult , Aged , Blepharospasm/drug therapy , Botulinum Toxins/adverse effects , Dose-Response Relationship, Drug , Dystonia/drug therapy , Female , Follow-Up Studies , Humans , Male , Meige Syndrome/drug therapy , Middle Aged , Movement Disorders/physiopathology , Muscle Cramp/drug therapy , Spasm/drug therapy , Time Factors , Videotape Recording
8.
Eur Respir J ; 3(10): 1217-20, 1990 Nov.
Article in English | MEDLINE | ID: mdl-1708729

ABSTRACT

We report a case of primary bronchogenic adenocarcinoma, complicated by pleural effusion, in which very high pleural amylase activity was found, whilst serum amylase was normal. Isoamylase determination showed a salivary-type amylase. Concerning the origin of this enzyme, ultrastructural study of the malignant cells obtained from the pleural fluid suggested a local amylase synthesis. The pathophysiological significance of electron-dense granules found in these cells is also discussed.


Subject(s)
Adenocarcinoma/enzymology , Amylases/analysis , Carcinoma, Bronchogenic/enzymology , Lung Neoplasms/enzymology , Pleural Effusion, Malignant/enzymology , Adenocarcinoma/complications , Adenocarcinoma/ultrastructure , Amylases/blood , Carcinoma, Bronchogenic/complications , Carcinoma, Bronchogenic/ultrastructure , Cytoplasmic Granules/metabolism , Cytoplasmic Granules/ultrastructure , Female , Humans , Lung Neoplasms/complications , Lung Neoplasms/ultrastructure , Middle Aged , Pleural Effusion, Malignant/etiology , Pleural Effusion, Malignant/pathology
9.
Ann Neurol ; 26(2): 239-47, 1989 Aug.
Article in English | MEDLINE | ID: mdl-2789014

ABSTRACT

Nine positron emission tomography studies of regional cerebral glucose metabolism were performed in 7 patients with probable striatonigral degeneration, a disorder characterized by parkinsonian features and absent or poor response to L-dopa. When compared with values obtained in normal volunteers, mean cerebral glucose metabolism was slightly reduced in subjects with striatonigral degeneration who, in addition, had a marked (20.5%, +/- 3 SD) relative hypometabolism in putaminal and caudate nuclei. Significant hypometabolism was also found in motor/premotor as well as in prefrontal cortex. In 2 subjects who were studied twice a deterioration of relative striatal metabolism paralleled clinical evolution. Magnetic resonance imaging disclosed the presence of abnormal iron deposits in the putamen in all cases but showed no cortical anomalies. These results suggest that positron emission tomography with [18F]fluorodeoxyglucose may provide an index of cell and processes degeneration in the striatum in striatonigral degeneration and is able to detect functional deficits in frontal cortex. The presence of striatal hypometabolism might be a predictor of a poor response to L-dopa.


Subject(s)
Brain Diseases/metabolism , Corpus Striatum/metabolism , Frontal Lobe/metabolism , Glucose/pharmacokinetics , Substantia Nigra/pathology , Aged , Brain Diseases/diagnosis , Brain Diseases/diagnostic imaging , Corpus Striatum/diagnostic imaging , Corpus Striatum/pathology , Deoxyglucose/analogs & derivatives , Female , Fluorodeoxyglucose F18 , Frontal Lobe/diagnostic imaging , Frontal Lobe/pathology , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Tomography, Emission-Computed
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