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Boulahssass R, Gonfrier S, Sanchez M, Rambaud C, Gary A, Turpin J, Bereder I, Guerin O. A CLINICAL SCORE TO PREDICT THE EARLY DEATH AT 100 DAYS IN ELDERLY METASTATIC CANCERS. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Rambaud C, Boulahssass R, Gonfrier S, Sanchez M, Borchiellini D, Durand M, Sacco G, Guerin O. THE NONAGENARIAN PATIENTS WITH CANCER IN THE UCOG PACA-EST COHORT. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Hofman P, Beaulande M, Ben Hadj S, Erb G, Pomerol JF, Lassalle S, Butori C, Long E, Washetine K, Guerin O, Guigay J, Mouroux J, Leroy S, Marquette CH, Hofman V, Ilie M. Automated brightfield multiplex immunohistochemistry to quantify biomarkers related to immune senescence: Relationships with survival in non-small cell lung cancer patients. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.e20500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e20500 Background: Elderly patients have an eroded immune characterized by a progressive decline in immune surveillance that favors infection and cancer development. Tumor cells can escape immune surveillance by upregulating inhibitory immune checkpoint such as PD-L1. High expression of PD-L1 was reported in association with CD8+T-cell exhaustion and increased levels of CD33+ myeloid-derived suppressor cells. Although low CD4/CD8 ratio is associated with increased mortality, the status of the CD4+T-cells as a clinical marker of immunosenescence is less well characterized in the field of aging. The aim of this study was to determine the presence of immunosenescence biomarkers according to age in non-small cell lung cancer (NSCLC) patients and to evaluate them as predictive biomarkers of patients’ outcome. Methods: One hundred NSCLC patients, matched by age (50 patients < 70 years, 50 patients ≥70 years) were included. An automated 4-Plex optical IHC assay was developed on the Discovery ULTRA automated stainer using monoclonal antibodies PD-L1 (SP263), CD4, CD8, and CD33. The stained slides were scanned with Nanozoomer HT 2.0 Scanner, and analyzed with Calopix software. Results: The CD4/CD8 ratio and PD-L1 expression in tumor and immune cells were significantly lower in elderly NSCLC patients ≥70 years than in age-paired patients, while absolute count of CD33+ was increased. Patients with CD4/CD8 ratio higher than two, high PD-L1 density and low CD33+ frequency achieved increase in median disease-free survival. Conclusions: Distribution of PD-L1, CD4, CD8, and CD33 cells was influenced by age in NSCLC patients. The proportion of CD8 + CD28- T cells, CD4+ T cells and CD4/CD8 ratio may be used as predictive biomarkers of anti-PD-L1 therapy efficacy in NSCLC patients. The automated 4-Plex IHC assay together with its respective digital analysis could serve as a tool for further characterizing tumors and their microenvironment and provide a better understanding of which patients may benefit from immunotherapy.
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Boulahssass R, Gonfrier S, Isabelle B, Evesque L, Gary A, Hannoun Levi JM, Borchiellini D, Brocker P, Cavaglione G, Barranger E, Benizri E, Frin AC, Creisson A, Kreitmann T, Bernard JL, Poissonnet G, Amiel J, Guigay J, Francois E, Guerin O. Influence of the comprehensive geriatric assessment (CGA) in elderly metastatic cancer patients. Analysis from a prospective cohort of 1048 patients. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.10045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Boulahssass R, Gonfrier S, Ferrero JM, Marine S, Saja D, Mari V, Piche T, Bereder JM, Delotte J, Turpin JM, Ouvrier D, Barrière J, Largillier R, Rambaud C, Benchimol D, Follana P, Otto J, Guigay J, Francois E, Guerin O. A clinical score to predict the early death at 100 days after a comprehensive geriatric assessment (CGA) in elderly metastatic cancers , analysis from a prospective cohort study with 1048 patients. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e21532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Boulahssass R, Gonfrier S, Ferrero JM, Auben F, Rambaud C, Mari V, Turpin JM, Piche T, Isabelle B, Bereder JM, Hannoun Levi JM, Delotte J, Largillier R, Evesque L, Follana P, Borchiellini D, Benchimol D, Guigay J, Francois E, Guerin O. A clinical score to predict early death at 100 days after a comprehensive geriatric assessment (CGA) in elderly cancer patients: A prospective study with 815 patients. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.9511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Sacco G, Turpin JM, Marteu A, Sakarovitch C, Teboul B, Boscher L, Brocker P, Robert P, Guerin O. Inertial sensors as measurement tools of elbow range of motion in gerontology. Clin Interv Aging 2015; 10:491-7. [PMID: 25759568 PMCID: PMC4345924 DOI: 10.2147/cia.s70452] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND AND PURPOSE Musculoskeletal system deterioration among the aging is a major reason for loss of autonomy and directly affects the quality of life of the elderly. Articular evaluation is part of physiotherapeutic assessment and helps in establishing a precise diagnosis and deciding appropriate therapy. Reference instruments are valid but not easy to use for some joints. The main goal of our study was to determine reliability and intertester reproducibility of the MP-BV, an inertial sensor (the MotionPod(®) [MP]) combined with specific software (BioVal [BV]), for elbow passive range-of-motion measurements in geriatrics. METHODS This open, monocentric, randomized study compared inertial sensor to inclinometer in patients hospitalized in an acute, post-acute, and long-term-care gerontology unit. RESULTS Seventy-seven patients (mean age 83.5±6.4 years, sex ratio 1.08 [male/female]) were analyzed. The MP-BV was reliable for each of the three measurements (flexion, pronation, and supination) for 24.3% (CI 95% 13.9-32.8) of the patients. Separately, the percentages of reliable measures were 59.7% (49.2-70.5) for flexion, 68.8% (58.4-79.5) for pronation, and 62.3% (51.2-73.1) for supination. The intraclass correlation coefficients were 0.15 (0.07-0.73), 0.46 (0.27-0.98), and 0.50 (0.31-40 0.98) for flexion, pronation, and supination, respectively. CONCLUSION This study shows the convenience of the MP-BV in terms of ease of use and of export of measured data. However, this instrument seems less reliable and valuable compared to the reference instruments used to measure elbow range of motion in gerontology.
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Delotte J, Arias T, Guerin O, Boulahssass R, Bereder I, Bongain A, Benchimol D, Bereder JM. Hyperthermic intraperitoneal chemotherapy for the treatment of recurrent ovarian cancer in elderly women. Acta Obstet Gynecol Scand 2015; 94:435-9. [DOI: 10.1111/aogs.12577] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 12/29/2014] [Indexed: 12/27/2022]
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Couderc AL, Camalet J, Schneider S, Turpin JM, Bereder I, Boulahssass R, Gonfrier S, Bayer P, Guerin O, Brocker P. Cobalamin deficiency in the elderly: aetiology and management: a study of 125 patients in a geriatric hospital. J Nutr Health Aging 2015; 19:234-9. [PMID: 25651452 DOI: 10.1007/s12603-014-0525-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Cobalamin deficiency is frequent in elderly patients and the main aetiologies are food-cobalamin malabsorption and pernicious anaemia. The aim of our retrospective study was to identify the causes and methods of management of cobalamin deficiency at Nice geriatric university hospital. METHODS A retrospective monocentric study was conducted over 14 months at Nice geriatric hospital, which included patients with cobalamin deficiency having received supplementation. The clinical and paraclinical data, etiological diagnosis, treatment and follow-up modalities were analyzed retrospectively. RESULTS We studied 125 elderly patients whose median age was 85.5 ± 7 years. The etiological diagnosis was food-cobalamin malabsorption for 72 patients (57.6 %), nutritional cobalamin deficiency for 15 patients (12 %), pernicious anaemia for 12 patients (9.6 %) and there was no etiological diagnosis for 26 patients (20.8 %). Concerning cobalamin therapy, 111 patients (88.8 %) received oral therapy and 14 (11.2 %) intramuscular therapy. Vitamin B12 levels increased significantly after supplementation (p<0.001) but cobalamin administration varied according to the diagnoses (p<0.001) and was less effective in patients with dementia (p=0.04) and food-cobalamin malabsorption. CONCLUSION Our study showed the importance of food-cobalamin malabsorption in etiological diagnosis in accordance with the literature, but also the non-negligible share of nutritional cobalamin deficiency. Mainly oral cobalamin supplementation was used in our study with a significant increase in vitamin B12 levels. An oral cobalamin regimen is proposed for elderly patients with cobalamin deficiency but with no severe neurological signs.
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Boulahssass R, gonfrier S, Auben F, Mari V, Rambaud C, Turpin J, Brocker P, François E, Guerin O. Poor nutritional status is an independent factor of worse outcomes in the second group of Balducci score. J Geriatr Oncol 2014. [DOI: 10.1016/j.jgo.2014.09.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Delotte J, Boulahssass R, Auben F, Quaranta D, Rambaud C, Mounier N, Eric F, Guerin O. [Gynecological cancers in elderly women]. SOINS. GERONTOLOGIE 2014:33-37. [PMID: 25373267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Pelvic gynaecological cancers are common in elderly women. Diagnosis and the decision to treat require multidisciplinary expertise. An oncologic, surgical and geriatric evaluation contributes to a split decision and personalised care. The care team is involved in the geriatric evaluation, information, education and patient monitoring throughout the treatment plan.
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Boulahssass R, Mari V, Gonfrier S, Auben F, Rambaud C, Ferrero JM, Turpin JM, Bereder JM, Isabelle B, Mahamat A, Cavaglione G, Saada E, Follana P, Benizri E, Otto J, Delotte J, Benchimol D, Brocker P, Francois E, Guerin O. Predictive factors of early death during 100 days after a comprehensive geriatric assessment in older patients with cancer: A prospective cohort study of 576 patients. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.9511] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Retornaz F, Guillem O, Gholam D, Codoul JF, Bratisevic C, Morvan F, Rinaldi Y, Barriere N, Nahon S, Butaud C, Guerin O, Boulahssass R, Rousseau F. Frailty markers for prediction of mortality in first-line chemotherapy for colon cancer patients: Results of MOST/ASRO 101 study. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.9553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Boulahssass R, Auben F, Gonfrier S, Mari V, Ferrero JM, Borchiellini D, Bernard JL, Turpin JM, Rambaud C, Gary A, Sacco G, Dittlot C, Mailland V, Benchimol D, Brocker P, Hannoun-Levi JM, Francois E, Guerin O. Treatment decisions for older patients with cancer: Influence of the Comprehensive Geriatric Assessment (CGA) and the choice of the patient and their caregiver. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e20518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Mari V, Fogliarini A, Boulahssass R, Ciais C, Francois E, Guerin O. What about the elderly cancer patients’ living wills? J Geriatr Oncol 2013. [DOI: 10.1016/j.jgo.2013.09.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Boulahssass R, Mari V, Gonfrier S, Auben F, Abakar-Mahamat A, Ludovic E, Borchiellini D, Brocker P, Francois E, Guerin O. Early death in older patients with cancer: risk factors of worse outcomes? J Geriatr Oncol 2013. [DOI: 10.1016/j.jgo.2013.09.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Boulahssass R, Auben F, Gonfrier S, Turpin J, Bereder I, Mari V, Licausi V, Brocker P, Francois E, Guerin O. Geriatric interventions in the management of older patients with cancer. Eur Geriatr Med 2013. [DOI: 10.1016/j.eurger.2013.07.300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Rolland Y, de Souto Barreto P, Abellan Van Kan G, Annweiler C, Beauchet O, Bischoff-Ferrari H, Berrut G, Blain H, Bonnefoy M, Cesari M, Duque G, Ferry M, Guerin O, Hanon O, Lesourd B, Morley J, Raynaud-Simon A, Ruault G, Souberbielle JC, Vellas B. Vitamin D supplementation in older adults: searching for specific guidelines in nursing homes. J Nutr Health Aging 2013; 17:402-12. [PMID: 23538667 DOI: 10.1007/s12603-013-0007-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The prevalence of vitamin D insufficiency is very high in the nursing home (NH) population. Paradoxically, vitamin D insufficiency is rarely treated despite of strong clinical evidence and recommendations for supplementation. This review aims at reporting the current knowledge of vitamin D supplementation in NH and proposing recommendations adapted to the specificities of this institutional setting. DESIGN Current literature on vitamin D supplementation for NH residents was narratively presented and discussed by the French Group of Geriatrics and Nutrition. RESULT Vitamin D supplementation is a safe and well-tolerated treatment. Most residents in NH have vitamin D insufficiency, and would benefit from vitamin D supplement. However, only few residents are actually treated. Current specific and personalized protocols for vitamin D supplementation may not be practical for use in NH settings (e.g., assessment of serum vitamin D concentrations before and after supplementation). Therefore, our group proposes a model of intervention based on the systematic supplementation of vitamin D (1,000 IU/day) since the patient's admission to the NH and throughout his/her stay without the need of a preliminary evaluation of the baseline levels. Calcium should be prescribed only in case of poor dietary calcium intake. CONCLUSION A population-based rather than individual-based approach may probably improve the management of vitamin D insufficiency in the older population living in NH, without increasing the risks of adverse health problems. The clinical relevance and cost effectiveness of this proposal should be assessed under NH real-world conditions to establish its feasibility.
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Sacco G, Joumier V, Darmon N, Dechamps A, Derreumaux A, Lee JH, Piano J, Bordone N, Konig A, Teboul B, David R, Guerin O, Bremond F, Robert P. Detection of activities of daily living impairment in Alzheimer's disease and mild cognitive impairment using information and communication technology. Clin Interv Aging 2012; 7:539-49. [PMID: 23271900 PMCID: PMC3526878 DOI: 10.2147/cia.s36297] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND One of the key clinical features of Alzheimer's disease (AD) is impairment in daily functioning. Patients with mild cognitive impairment (MCI) also commonly have mild problems performing complex tasks. Information and communication technology (ICT), particularly techniques involving imaging and video processing, is of interest in order to improve assessment. The overall aim of this study is to demonstrate that it is possible using a video monitoring system to obtain a quantifiable assessment of instrumental activities of daily living (IADLs) in AD and in MCI. METHODS The aim of the study is to propose a daily activity scenario (DAS) score that detects functional impairment using ICTs in AD and MCI compared with normal control group (NC). Sixty-four participants over 65 years old were included: 16 AD matched with 10 NC for protocol 1 (P1) and 19 MCI matched with 19 NC for protocol 2 (P2). Each participant was asked to undertake a set of daily tasks in the setting of a "smart home" equipped with two video cameras and everyday objects for use in activities of daily living (8 IADLs for P1 and 11 for P2, plus 4 temporal execution constraints). The DAS score was then computed from quantitative and qualitative parameters collected from video recordings. RESULTS In P1, the DAS score differentiated AD (DAS(AD,P1) = 0.47, 95% confidence interval [CI] 0.38-0.56) from NC (DAS(NC,P1) = 0.71, 95% CI 0.68-0.74). In P2, the DAS score differentiated MCI (DAS(MCI,P2) = 0.11, 95% CI 0.05-0.16) and NC (DAS(NC,P2) = 0.36, 95% CI 0.26-0.45). CONCLUSION In conclusion, this study outlines the interest of a novel tool coming from the ICT world for the assessment of functional impairment in AD and MCI. The derived DAS scores provide a pragmatic, ecological, objective measurement which may improve the prediction of future dementia, be used as an outcome measurement in clinical trials and lead to earlier therapeutic intervention.
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Villars H, Oustric S, Andrieu S, Baeyens JP, Bernabei R, Brodaty H, Brummel-Smith K, Celafu C, Chappell N, Fitten J, Frisoni G, Froelich L, Guerin O, Gold G, Holmerova I, Iliffe S, Lukas A, Melis R, Morley JE, Nies H, Nourhashemi F, Petermans J, Ribera Casado J, Rubenstein L, Salva A, Sieber C, Sinclair A, Schindler R, Stephan E, Wong RY, Vellas B. The primary care physician and Alzheimer's disease: an international position paper. J Nutr Health Aging 2010; 14:110-20. [PMID: 20126959 DOI: 10.1007/s12603-010-0022-0] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This paper aims to define the role of the primary care physician (PCP) in the management of Alzheimer's disease (AD) and to propose a model for a work plan. The proposals in this position paper stem from a collaborative work of experts involved in the care of AD patients. It combines evidence from a literature review and expert's opinions who met in Paris, France, on July 2009 during the International Association of Geriatrics and Gerontology (IAGG) World Congress. The PCP's intervention appears essential at many levels: detection of the onset of dementia, diagnostic management, treatment and follow-up. The key role of the PCP in the management of AD, as care providers and care planners, is consolidated by the family caregiver's confidence in their skills. In primary care practice the first step is to identify dementia. The group proposes a "case finding" strategy, in target situations in which dementia should be detected to allow, secondarily, a diagnosis of AD, in certain cases. We propose that the PCP identifies 'typical' cases. In typical cases, among older subjects, the diagnosis of "probable AD" can be done by the PCP and then confirm by the specialist. While under-diagnosis of AD exists, so does under-disclosure. Disclosure to patient and family should be done by both specialist and PCP. Then, the PCP has a central role in management of the disease with the general objectives to detect, prevent and treat, when possible, the complications of the disease (falls, malnutrition, behavioural and psychological symptoms of dementia). The PCP needs to give basic information to the caregiver on respite care and home support services in order to prevent crisis situations such as unplanned institutionalisation and "emergency" hospital admission. Finally, therapeutic research must be integrated in the daily practice of PCP. It is a matter of patients' right to benefit from access to innovation and clinical research whatever his age or diseases, while of course fully respecting the rules and protective measures that are in force.
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Boulahssass R, Chamorey E, Bereder I, Francois E, Follana P, Guerin O. P21 Observational data in a retrospective study about 59 older patients with cancers after a comprehensive geriatric assessment (CGA). Crit Rev Oncol Hematol 2009. [DOI: 10.1016/s1040-8428(09)70059-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Boulahssass R, Guerin O, Bereder I, Chamorey E, Ouderc A, Mari V, Francois E, Pras P, Brocker P, Thyss A. P20 Impact of comprehensive geriatric assessment in oncology. A retrospective study about 59 older patients with cancers. Crit Rev Oncol Hematol 2009. [DOI: 10.1016/s1040-8428(09)70058-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Zouba N, Bremond F, Thonnat M, Anfosso A, Pascual É, Malléa P, Mailland V, Guerin O. A computer system to monitor older adults at home: Preliminary results. ACTA ACUST UNITED AC 2009. [DOI: 10.4017/gt.2009.08.03.011.00] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Bereder I, Guerin O, Boulahssass R, Couderc A, Mailland V, Macone F, Mounier N, Habre J, Karimdjee- Soilihi B, Bereder J. Cytoreductive surgery combined with peritoneal intraoperative heated chemotherapy for management of peritoneal carcinomatosis in 59 adults older than age 65. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e20657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e20657 Background: Peritoneal carcinomatosis (PC) has long been regarded as a terminal disease with short median survival. Recent success of new approach, combining surgery and intraperitoneal heated chemotherapy (HIPEC) are reported. But in the most studies patients over 65 years are excluded. We report our experience in this selected group of patients. Methods: A retrospective study was performed to evaluate toxicity and to identify the principal prognostic indicators with this combined treatment. All patients had cytoreductive surgery and HIPEC. This population of patients was compared with younger over the same period. We have excluded patient with frailty by comprehensive onco-geriatric assessment based upon cognitive, nutritional assessment and cormorbidities. Results: The study included 291 procedures in 249 patients between 2000 and 2008. 64 procedures were performed in 59 older patients (group 1) and 227 procedures in 190 younger patients (group 2). The principal etiologies of PC in group1 were recurrent ovarian cancer (N=33), colorectal cancer (N=9), peritoneal mesothelioma (N=6), pseudomyxoma (N=9) and sarcomatosis (N=2). No death occurred in post operative course and the procedure related morbidity rate was 10%. 5 years overall and free survival rate were respectively 33% and 15%. Median overall survival was 44 months and median disease free survival was 13 months. There were no difference between group1 and 2 for survival. Independent prognostic factors for survival by multivariate analysis were extent of carcinomatosis, completeness of cytoreductive surgery and performance status. Conclusions: Therapeutic approach combining cytoreductive surgery with HIPEC may achieve long-term survival in a selected group of patients with PC with acceptable mortality and morbidity. For elderly patients, this treatment could be performed in selected cases without frailty. No significant financial relationships to disclose.
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Paillocher N, Lacourtoisie SA, Fondrinier É, Catala L, Morand C, Boursier J, Guerin O, Descamps P. [Infiltrating breast cancer in women younger than 25 years: 13 cases]. Presse Med 2007; 35:1618-1624. [PMID: 17086115 DOI: 10.1016/s0755-4982(06)74869-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To study the prognosis of breast cancer in woman younger than 25 years and to compare it with that of other age groups to identify prognostic and histologic factors specific to this group. METHOD Retrospective study of all cases of infiltrating ductal carcinoma treated at our hospital from January 1977 through July 2005, examining clinical, histologic, and treatment variables as well as 5-year overall survival and 5-years disease-free survival rates. RESULTS The study included 13 women younger than 25 years at diagnosis. Their average age at diagnosis was 23.3 years (CI=1 year). Time from initial signs of disease until diagnosis averaged 6.6 months (CI=2.5). Clinically, the average tumor size was 28.78 mm (CI=6.06), with 46% classified as T1, 31% as T2 and 23% as T4d. We found 92.3% to be invasive ductal carcinoma, with 30% including an in-situ component; 53.8% were SBR grade 3 and 23% included axillary node invasion. Hormone receptors were present in 61.5% of tumors. During the follow-up period, we observed two deaths (with a 5-year overall survival rate, however, of 91%) and 6 recurrences (5-year disease-free survival: 66.5%). CONCLUSION Prognosis appears unfavorable among young women (younger than 40 years) with breast cancer. In our series, neither prognosis nor clinical or histologic characteristics differed in the subgroup of very young women (younger than 26 years).
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