Partial versus whole breast irradiation: Side effects, patient satisfaction and costs.

PURPOSE: Since accelerated partial breast irradiation has demonstrated non-inferiority to whole breast irradiation regarding recurrence rate in patients with early stage breast cancer, our objective was to compare its impact on short-term adverse events, patient satisfaction and costs. MATERIALS AND METHODS: Patients with early stage breast cancer treated by breast-conserving surgery between 2007 and 2012 were included: 48 women who received three-dimensional conformal accelerated partial breast irradiation in a multicentre phase-II trial were paired with 48 patients prospectively treated with whole breast irradiation. Adverse events, and patients' opinions concerning cosmesis, satisfaction and pain, were gathered 1 month after treatment. Direct and indirect costs were collected from the French National Health Insurance System perspective until the end of radiotherapy. RESULTS: When comparing its impact, skin reactions occurred in 37% of patients receiving three-dimensional conformal accelerated partial breast radiotherapy and 60% of patients receiving whole breast irradiation (P=0.07); 98% were very satisfied in the group three-dimensional conformal accelerated partial breast radiotherapy versus 46% in the group treated with whole breast irradiation (P<0.001); direct costs were significantly lower in the group treated with partial breast irradiation (mean cost: 2510€ versus 5479€/patient), due to less radiation sessions. CONCLUSION: In patients with early-stage breast cancer, partial irradiation offered a good alternative to whole breast irradiation, as it was less expensive and satisfactory. These, and the clinical safety and tolerance results, need to be confirmed by long-term accelerated partial breast irradiation results in on-going phase III trials.

[Cancer in Africa, a new health challenge. Examples of Mali and OncoMali]. / Le cancer en Afrique, un nouveau défi sanitaire. Exemples du Mali et de l'association OncoMali.

Oncology is perceived as a secondary problem of public health in emerging countries. Nevertheless the annual incidence of cancers is rapidly expanding (approximately 100 to 120/100 000 subsaharan Africa). It can explain by the high incidence of the infectious pathologies associated with a high oncogene risk (hepatitis, HIV, Helicobacter ...) but also by national and international prevention policies still too much reduced. If this epidemiological tendency continues, Africa will count in 2020 near a million new cases of cancers every year. The incidence increases but the morbi-mortality is also very high in these countries. This observation exceeds the simple consequence of a defect of means. The sociocultural landscape and the mental representations of this disease are also in cause. We shall evoke in this article the situation of Africa by quoting the example of Mali. We shall conclude on the individual contributions which can be made through the example of the association "OncoMali".

[Necrotizing dermatitis due to Vibrio Vulnificus]. / Dermohypodermite nécrosante à Vibrio vulnificus.

BACKGROUND: Vibrio vulnificus is a Gram-negative halophilic pathogen for man that can cause septicemia in patients with chronic liver disease. In healthy subjects, infections are generally local or regional. We report two cases of necrotizing dermo-hypodermitis due to Vibrio vulnificus. CASE REPORTS: The first patient was a 21-year-old fisherman who developed extensive necrotizing dermo-hypodermitis 24 hours after a penetrating scratch with a fish bone. The second patient was also a fisherman. This 35-year-old man developed a massive area of necrotic tissue on the left leg, also 48 hours after a penetrating fish bone scratch. Both patients exhibited neutrophil hyperleukocytosis and thrombocytopenia. Bacteriological study of the pus and damaged tissue identified Vibrio vulnificus. Blood cultures were negative. Liver tests and liver ultrasound were normal. The course was favorable in both cases with antibiotic treatment and excision of the necrotic tissue. DISCUSSION: For these two cases of Vibrio vulnificus necrotizing dermo-hypodermitis, the diagnosis was based on epidemiological, clinical and bacteriological arguments. Neither of these patients had liver disease, explaining the limited locoregional nature of the infection. The severity of the skin necrosis and its rapid course are related to the toxins produced by V. vulnificus. Curative medical and surgical care is generally effective in cases without septicemia and prognosis is good. Education of exposed subjects, fishermen and patients with chronic liver disease, should be helpful for prevention.