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Baijnath P, Pelissier M, Sahki N, Henrot P. Evaluation of pre-therapeutic imaging work-up in the staging of endometrial cancer: Interest in a systematic second opinion in a cancer center. J Gynecol Obstet Hum Reprod 2024; 53:102716. [PMID: 38142752 DOI: 10.1016/j.jogoh.2023.102716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/20/2023] [Accepted: 12/21/2023] [Indexed: 12/26/2023]
Abstract
RATIONALE AND OBJECTIVES To evaluate the interest of a systematic second opinion in quality assessment and FIGO staging in the pretherapeutic imaging work-up. MATERIALS AND METHODS A retrospective observational study was conducted on 156 patients who underwent surgery for endometrioid cancer in our institution. 42 % had their initial MRI scans performed in expert centers (University Hospital and Cancer center) and 58 % in non-expert centers. Quality assessment, concordances between initial reports, and second opinions by a junior and a senior ICL radiologist versus histopathological data were analyzed. RESULTS MRI scans performed in expert centers were more complete and more likely to be rated as higher quality. The overall accuracy of T staging from initial reports vs gold standard was 0.59 (95 % CI, 0.46-0.71) in expert centers and 0.49 (95 % CI, 0.38-0.60) in non-expert centers. The overall accuracy and Kappa of a second opinion for FIGO 2009 staging from expert center and non-expert center examinations were 0.61 (95 % CI, 0.48-0.72) vs 0.50 (95 % CI, 0.39-0.60) and 0.37 vs 0.27 for junior reader and 0.62 (95 % CI, 0.49-0.74) vs 0.48 (95 % CI, 0.37-0.58) and 0.39 vs 0.24 for senior reader, respectively. There was also a significant lower confidence level of the junior radiologist in MRI FIGO staging for non-expert center examinations (p 0.003). CONCLUSION Accuracy in the FIGO 2009 staging and quality assessment are higher for MR examinations performed from expert centers than in non-expert centers. A systematic second opinion by radiologists in expert centers should be proposed before pre-treatment multidisciplinary consultation.
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Affiliation(s)
- Pawan Baijnath
- Service d'imagerie médicale et de radiologie, Institut de Cancérologie de Lorraine Alexis Vautrin, Vandoeuvre-les-Nancy F-54500, France.
| | - Margaux Pelissier
- Service d'imagerie médicale et de radiologie, Institut de Cancérologie de Lorraine Alexis Vautrin, Vandoeuvre-les-Nancy F-54500, France
| | - Nassim Sahki
- Unité de biostatistique, Institut de Cancérologie de Lorraine Alexis Vautrin, Vandoeuvre-les-Nancy, France
| | - Philippe Henrot
- Service d'imagerie médicale et de radiologie, Institut de Cancérologie de Lorraine Alexis Vautrin, Vandoeuvre-les-Nancy F-54500, France
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Renard S, Demogeot N, Bruand M, Sahki N, Marchesi V, Gehin W, Meknaci E, Peiffert D. Adjuvant pulse-dose-rate brachytherapy for oral cavity and oropharynx carcinoma: Outcome and toxicity assessment of 66 patients. J Contemp Brachytherapy 2024; 16:21-27. [PMID: 38584888 PMCID: PMC10993891 DOI: 10.5114/jcb.2024.135626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 01/31/2024] [Indexed: 04/09/2024] Open
Abstract
Purpose Brachytherapy (BT) is a validated radiation technique for treatment of early stage tumors of oral cavity and oropharynx. This study aimed to analyze the results of our institute's patients after replacing low-dose-rate (LDR) with pulse-dose-rate (PDR) brachytherapy. Material and methods We retrospectively collected data from all patients treated between 2009 and 2020 for squamous cell carcinoma (floor of the mouth, tongue, and oropharynx) using adjuvant interstitial BT with or without external RT. Primary outcome was local control. Secondary outcomes were regional control rate and toxicity. Statistical analysis of local and regional recurrences were described using Kaplan-Meier method. Prognostic value of each factor for recurrence or toxicity was evaluated with bivariate Fine-Gray model. Results Data from 66 patients were analyzed. Local and regional recurrences were reported in 11% and 20% of the patients, respectively. No significant factors were identified in the present study. Grade 2 and 3 acute mucositis were reported in 21% of patients, and were more frequent in the BT only group. Almost half (47%) of the patients described acute pain following BT, and 26% required stage 2 or 3 analgesics. Trophic disorders were observed in 16 patients. Five patients presented with soft tissue necrosis (STN) and required medical treatment, of whom one subsequently required hyperbaric oxygen therapy. No predictive factors were identified for STN risk. Two patients developed osteoradionecrosis. Conclusions Oral and oropharyngeal PDR-BT as adjuvant treatment is safe and effective for well-defined indications.
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Affiliation(s)
- Sophie Renard
- Department of Brachytherapy, Institut de Cancérologie de Lorraine, Vandoeuvre-les-Nancy, Franc
| | - Nicolas Demogeot
- Department of Brachytherapy, Institut de Cancérologie de Lorraine, Vandoeuvre-les-Nancy, Franc
| | - Marie Bruand
- Department of Brachytherapy, Institut de Cancérologie de Lorraine, Vandoeuvre-les-Nancy, Franc
| | - Nassim Sahki
- Methodology Biostatistics Unit, Institut de Cancérologie de Lorraine, Vandoeuvre-les-Nancy, France
| | - Vincent Marchesi
- Department of Brachytherapy, Institut de Cancérologie de Lorraine, Vandoeuvre-les-Nancy, Franc
| | - William Gehin
- Department of Brachytherapy, Institut de Cancérologie de Lorraine, Vandoeuvre-les-Nancy, Franc
| | - Emilie Meknaci
- Department of Brachytherapy, Institut de Cancérologie de Lorraine, Vandoeuvre-les-Nancy, Franc
| | - Didier Peiffert
- Department of Brachytherapy, Institut de Cancérologie de Lorraine, Vandoeuvre-les-Nancy, Franc
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Merlin JL, Husson M, Sahki N, Gilson P, Massard V, Harlé A, Leroux A. Integrated Molecular Characterization of HER2-Low Breast Cancer Using Next Generation Sequencing (NGS). Biomedicines 2023; 11:3164. [PMID: 38137385 PMCID: PMC10740754 DOI: 10.3390/biomedicines11123164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 11/17/2023] [Accepted: 11/26/2023] [Indexed: 12/24/2023] Open
Abstract
Based on immunohistochemistry (IHC) and in situ hybridization (ISH), HER2-low breast cancers (BC) subtype-defined as IHC1+ or IHC2+/ISH- tumors-emerged and represent more than half of all BC. We evaluated the performance of NGS for integrated molecular characterization of HER2-low BC, including identification of actionable molecular targets, copy number variation (CNV), and microsatellite instability (MSI) analysis. Thirty-one BC specimens (11 HER2+, 10 HER2-, and 10 HER2-low) were routinely analyzed using IHC and ISH, and were selected and analyzed using NGS for gene mutations including ESR1, PIK3CA, AKT1, ERBB2, TP53, BRCA1, and BRCA2, CNV, and MSI. CNV values for the ERBB2 gene were significantly (p < 0.001) different between HER2+, and either HER2-low or HER2- tumors with mean values of 7.8 (SD = 6.8), 1.9 (SD = 0.3), and 2.0 (SD = 0.3), respectively. Using 3.25 as the cutoff value, 96.8% overall concordance of HER2 status was achieved between IHC and NGS compared to IHC and ISH. Using NGS, gene mutations and amplifications were detected in 68% (21/31) and 19% (6/31) of the cases, respectively. One case of MSI was detected in a HER2-negative and ISH unamplified case. Beside IHC, NGS allows the identification of HER2-low subtype simultaneously, with the detection of multiple actionable gene mutations being helpful for molecular board treatment selection.
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Affiliation(s)
- Jean-Louis Merlin
- Biopathology Department, Institut de Cancérologie de Lorraine—Alexis Vautrin, CNRS UMR7039 CRAN Université de Lorraine, 6 Avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy, France
| | - Marie Husson
- Biopathology Department, Institut de Cancérologie de Lorraine—Alexis Vautrin, CNRS UMR7039 CRAN Université de Lorraine, 6 Avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy, France
| | - Nassim Sahki
- Methodology Biostatistics Unit, Institut de Cancérologie de Lorraine—Alexis Vautrin, 54519 Vandoeuvre-lès-Nancy, France
| | - Pauline Gilson
- Biopathology Department, Institut de Cancérologie de Lorraine—Alexis Vautrin, CNRS UMR7039 CRAN Université de Lorraine, 6 Avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy, France
| | - Vincent Massard
- Medical Oncology Department, Institut de Cancérologie de Lorraine—Alexis Vautrin, 54519 Vandœuvre-lès-Nancy, France
| | - Alexandre Harlé
- Biopathology Department, Institut de Cancérologie de Lorraine—Alexis Vautrin, CNRS UMR7039 CRAN Université de Lorraine, 6 Avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy, France
| | - Agnès Leroux
- Biopathology Department, Institut de Cancérologie de Lorraine—Alexis Vautrin, CNRS UMR7039 CRAN Université de Lorraine, 6 Avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy, France
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Geoffrois L, Harlé A, Sahki N, Sikanja A, Granel-Brocard F, Hervieu A, Mortier L, Jeudy G, Michel C, Nardin C, Huin-Schohn C, Merlin JL. Personalized follow-up of circulating DNA in resected stage III/IV melanoma: PERCIMEL multicentric prospective study protocol. BMC Cancer 2023; 23:554. [PMID: 37328818 DOI: 10.1186/s12885-023-11029-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 05/30/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND With more than 15,000 new cases /year in France and 2,000 deaths, cutaneous melanoma represents approximately 4% of incidental cancers and 1.2% of cancer related deaths. In locally advanced (stage III) or resectable metastatic (stage IV) melanomas, medical adjuvant treatment is proposed and recent advances had shown the benefit of anti-PD1/PDL1 and anti-CTLA4 immunotherapy as well as anti-BRAF and anti-MEK targeted therapy in BRAF V600 mutated tumors. However, the recurence rate at one year is approximately 30% and justify extensive research of predictive biomarkers. If in metastatic disease, the follow-up of circulating tumor DNA (ctDNA) has been demonstrated, its interest in adjuvant setting remains to be precised, especially because of a lower detection rate. Further, the definition of a molecular response could prove useful to personalized treatment. METHODS PERCIMEL is an open prospective multicentric study executed through collaboration of the Institut de Cancérologie de Lorraine (non-profit comprehensive cancer center) and 6 French university and community hospitals. A total of 165 patients with resected stage III and IV melanoma, eligible to adjuvant imunotherapy or anti-BRAF/MEK kinase inhibitors will be included. The primary endpoint is the presence of ctDNA, 2 to 3 weeks after surgery, defined as mutated ctDNA copy number calculated as the allelic fraction of a clonal mutation relative to total ctDNA. Secondary endpoints are recurrence-free survival, distant metastasis-free survival and specific survival. We will follow ctDNA along treatment, quantitatively through ctDNA mutated copy number variation, qualitatively through the presence of cfDNA and its clonal evolution. Relative and absolute variations of ctDNA during follow-up will be also analyzed. PERCIMEL study aims at provide scientific evidence that ctDNA quantitative and qualitative variations can be used to predict the recurrence of patients with melanoma treated with adjuvant immunotherapy or kinase inhibitors, thus defining the notion of molecular recurrence.
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Affiliation(s)
- Lionnel Geoffrois
- Medical Oncology Department, Institut de Cancérologie de Lorraine, Vandoeuvre Les Nancy, France
| | - Alexandre Harlé
- Biopathology Department, Institut de Cancérologie de Lorraine, CNRS UMR7039 CRAN Université de Lorraine, Vandoeuvre Les Nancy, France
| | - Nassim Sahki
- Methodology Biostatistics Unit, Institut de Cancérologie de Lorraine, Vandoeuvre Les Nancy, France
| | - Aleksandra Sikanja
- Clinical Research Department, Institut de Cancérologie de Lorraine, Vandoeuvre Les Nancy, France
| | | | - Alice Hervieu
- Medical Oncology Department, Centre Georges François Leclerc, Dijon, France
| | - Laurent Mortier
- Dermatology Department CHRU Lille, Inserm U1189, Université de Lille, Lille, France
| | | | - Catherine Michel
- Dermatology Department, GHR Mulhouse Sud Alsace, Mulhouse, France
| | - Charlée Nardin
- Dermatology Department CHU Besançon, Inserm 1098 RIGHT Université Franche Comté, Besançon, France
| | - Cécile Huin-Schohn
- Clinical Research Department, Institut de Cancérologie de Lorraine, Vandoeuvre Les Nancy, France
| | - Jean-Louis Merlin
- Biopathology Department, Institut de Cancérologie de Lorraine, CNRS UMR7039 CRAN Université de Lorraine, Vandoeuvre Les Nancy, France.
- Clinical Research Department, Institut de Cancérologie de Lorraine, Vandoeuvre Les Nancy, France.
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