[Treatment of cervical cancer]. / Arbre décisionnel et thérapeutique des cancers du col de l'utérus.

The treatment of uterine cervical cancer evolved the last past twenty years. The management of early stages cervical cancer is based on surgery +/- after an initial brachytherapy in order to increase loco-regional control. A conservative treatment preserving uterine and ovarian functions is sometimes possible for young patients < 40 years old wishing to conceive. This strategy allows pregnancies with low recurrence rate. Finally, the use of the sentinel lymph node staging should be validated within the next few years. The treatment of locally advanced stages is based on concomitant chemoradiation therapy, which allows obtaining an important complete tumour response rate (90%). Thereafter, the irradiation modalities will depend on the para-aortic lymph nodes status diagnosed by PET-computed tomography +/- staging laparoscopic para-aortic lymphadenectomy. The use of completion surgery may be indicated in case of cervical residual disease and has to be balanced with its specific morbidity. All the decisions are made during a multidisciplinary tumour board.

Clues pointing to simple hysterectomy to treat early-stage cervical cancer.

Radical hysterectomy and pelvic lymphadenectomy is recommended for stage Ia2-Ib1 cervical cancer while parametrial involvement (PI) is rare. Our aim was to evaluate criteria to select women with low risk of PI that could benefit from simple hysterectomy. Factors associated with low risk of PI were analyzed in a series of 37 patients with stage Ia2-Ib1 cervical cancer undergoing radical hysterectomy and sentinel lymph node procedure from 2003 to 2008. PI was associated with tumor size (p<0.001) and lymphovascular space invasion (LVSI) (p=0.007). PI was found in 4.5% of patients with tumor size 2 cm (p=0.04). The negative predictive value was 100% for absence of LVSI (95% CI: 0.83-1) and for combinations: tumor size

[Sentinel lymph node biopsy in invasive breast cancer in 2009]. / Mise au point sur le prélèvement du ganglion sentinelle dans le cancer invasif du sein en 2009.

Sentinel lymph node biopsy (SLNB) has become an alternative to axillary lymph node dissection (ALND) despite the limited recidive long-term results. SLNB can not only reduce ALND morbidity but also provide ultrastadification with serial sectionning and immunohistochemistry analysis which increase the sensitivity of detection of sentinel node (SN) metastasis. Micrometastasis or isolated tumor cells are frequently discovered. However, their diagnostic and pronostic values are still subject to controversy. Most of large randomized trials have determined that double detection (colorimetric and isotopic) improved SN identification rate and decreased false negative rate; and that periareolar injection was equally effective, even superior than peritumoral injection with the major advantage of its simplicity in non palpable tumors. One of the unsolved problems of SLNB is to determine if its indications may be extended to larger tumors, to node sampling before or after neoadjuvant chemotherapy, or after previous lumpectomy or breast surgery, in case of palpable axillary node, and in case of multifocal tumor. Another challenge is to determine if complementary ALND in case of SLND metastasis is necessary, because 40 to 70% of non sentinel nodes (NSN) are tumor-free. Several predictive models (nomograms, scores, partitioning recursive models) have been developed to predict non-SN status in SN-positive patients. These models must be validated in independent cohorts to enable their use in routine.