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Ouali K, Michels J, Blanc-Durand F, Leary A, Kfoury M, Genestie C, Morice P, Zaccarini F, Scherrier S, Gouy S, Maulard A, Pautier P. [Current post-surgical treatment strategies in first-line ovarian cancer]. Bull Cancer 2024; 111:267-276. [PMID: 36863923 DOI: 10.1016/j.bulcan.2023.01.020] [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: 10/14/2022] [Revised: 12/18/2022] [Accepted: 01/29/2023] [Indexed: 03/04/2023]
Abstract
Although the management of epithelial ovarian cancer has evolved significantly over the past few years, it remains a public health issue, as most patients are diagnosed at an advanced stage and relapse after first line treatment. Chemotherapy remains the standard adjuvant treatment for International Federation of Gynecology and Obstetrics (FIGO) stage I and II tumors, with some exceptions. For FIGO stage III/IV tumors, carboplatin- and paclitaxel-based chemotherapy are the standard of care, in combination with targeted therapies, especially bevacizumab and/or poly-(ADP-ribose) polymerase inhibitors, that have become a key milestone of first-line treatment. Our decision making for the maintenance therapy is based on the FIGO stage, tumor histology, timing of surgery (i.e. primary or interval debulking surgery), residual tumor, response to chemotherapy, BRCA mutation and homologous recombination (HR) status.
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Affiliation(s)
- Kaïssa Ouali
- Institut Gustave-Roussy, Département d'innovations thérapeutiques et essais précoces (DITEP), 114, avenue Édouard-Vaillant, 94805 Villejuif, France; Institut Gustave-Roussy, Département de médecine, 114, avenue Édouard-Vaillant, 94805 Villejuif, France.
| | - Judith Michels
- Institut Gustave-Roussy, Département de médecine, 114, avenue Édouard-Vaillant, 94805 Villejuif, France
| | - Felix Blanc-Durand
- Institut Gustave-Roussy, Département de médecine, 114, avenue Édouard-Vaillant, 94805 Villejuif, France
| | - Alexandra Leary
- Institut Gustave-Roussy, Département de médecine, 114, avenue Édouard-Vaillant, 94805 Villejuif, France
| | - Maria Kfoury
- Institut Gustave-Roussy, Département de médecine, 114, avenue Édouard-Vaillant, 94805 Villejuif, France
| | - Catherine Genestie
- Institut Gustave-Roussy, Département de biologie et pathologie médicale, 114, avenue Édouard-Vaillant, 94805 Villejuif, France
| | - Philippe Morice
- Institut Gustave-Roussy, Département d'anesthésie, chirurgie et imagerie interventionnelle, 114, avenue Édouard-Vaillant, 94805 Villejuif, France
| | - François Zaccarini
- Institut Gustave-Roussy, Département d'anesthésie, chirurgie et imagerie interventionnelle, 114, avenue Édouard-Vaillant, 94805 Villejuif, France
| | - Stéphanie Scherrier
- Institut Gustave-Roussy, Département d'anesthésie, chirurgie et imagerie interventionnelle, 114, avenue Édouard-Vaillant, 94805 Villejuif, France
| | - Sebastien Gouy
- Institut Gustave-Roussy, Département d'anesthésie, chirurgie et imagerie interventionnelle, 114, avenue Édouard-Vaillant, 94805 Villejuif, France
| | - Amandine Maulard
- Institut Gustave-Roussy, Département d'anesthésie, chirurgie et imagerie interventionnelle, 114, avenue Édouard-Vaillant, 94805 Villejuif, France
| | - Patricia Pautier
- Institut Gustave-Roussy, Département de médecine, 114, avenue Édouard-Vaillant, 94805 Villejuif, France
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Kfoury M, Hazzaz RE, Sanson C, Durand FB, Michels J, Blameble EC, Tang R, Le Formal A, Lecerf E, Gouy S, Maulard A, Pautier P, Rouleau E, Leary A. Circulating Tumor DNA from Ascites as an alternative to tumor sampling for genomic profiling in ovarian cancer patients. Biomark Res 2023; 11:93. [PMID: 37858195 PMCID: PMC10588202 DOI: 10.1186/s40364-023-00533-1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 10/09/2023] [Indexed: 10/21/2023] Open
Abstract
Genomic testing is crucial for the management of ovarian cancer. DNA from biopsies at diagnostic laparoscopies or interval debulking surgery after neoadjuvant chemotherapy, has a high failure rate. At relapse, biopsies may not be feasible. The aim of our study was to evaluate the feasibility and usefulness of measuring genomic instability score (GIS) on cell-free DNA (cfDNA) from ascites.Patients enrolled in a prospective study (NCT03010124) consented to analysis of biological samples. CfDNA was extracted from 1 to 4 ml of double-centrifuged fresh ascites. Targeted Next-generation sequencing (NGS) including TP53 mutation (TP53m) was performed on cfDNA to confirm the presence of tumor cfDNA. Single Nucleotide Polymorphism Array estimating somatic copy number alterations (SCNA) was performed to calculate GIS for Homologous-Recombination deficiency (HRD).Twenty nine ascites were collected from 20 patients with suspected or confirmed OC. 93% (27/29) samples had detectable cfDNA (median 1120 ng [24-5732]) even when obtained during chemotherapy. A deleterious mutation was identified in 100%, with high allelic frequencies (median 60% [3.3-87%]), confirming that cfDNA was tumoral. SCNA analyses on 17 patients showed 11 high GIS, and 6 low GIS. 4 patients with confirmed BRCA mutation had a high GIS on ascites. When available from the same patient, SCNA profiles on ascites and tumor were superimposable.Ascites is frequent at diagnosis and relapse and yields large amounts of tumoral cfDNA. SCNA analysis on ascitic cfDNA is feasible and can detect the same HRD scar as tumor testing. Ascites could provide an alternative to tumor sampling for HRD and BRCA testing.
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Affiliation(s)
- Maria Kfoury
- Department of Oncology, Gustave Roussy Cancer Center, Villejuif, 94800, France.
- Department of Oncology, Institut Paoli-Calmettes, 232 Boulevard Sainte Marguerite, Marseille, 13009, France.
| | - Reda El Hazzaz
- Department of Medical Oncology, AR-RAZI Cancer Center, FEZ, Villejuif, 30050 , Morocco
| | - Claire Sanson
- Department of Surgery, Hôpital Pitié-Salpétrière, Paris, 75013, France
| | - Felix Blanc Durand
- Department of Oncology, Gustave Roussy Cancer Center, Villejuif, 94800, France
| | - Judith Michels
- Department of Oncology, Gustave Roussy Cancer Center, Villejuif, 94800, France
| | | | - Roseline Tang
- Department of Medical Biology and Pathology, Cancer Genetics Laboratory, Villejuif, 94800, France
| | - Audrey Le Formal
- Inserm UMR 981, Gustave Roussy Cancer Center, Villejuif, 94800, France
| | - Elodie Lecerf
- Department of Oncology, Gustave Roussy Cancer Center, Villejuif, 94800, France
| | - Sebastien Gouy
- Department of Surgery, Gustave Roussy Cancer Center, Villejuif, 94800, France
| | - Amandine Maulard
- Department of Surgery, Gustave Roussy Cancer Center, Villejuif, 94800, France
| | - Patricia Pautier
- Department of Oncology, Gustave Roussy Cancer Center, Villejuif, 94800, France
| | - Etienne Rouleau
- Department of Medical Biology and Pathology, Cancer Genetics Laboratory, Villejuif, 94800, France
| | - Alexandra Leary
- Department of Oncology, Gustave Roussy Cancer Center, Villejuif, 94800, France
- Inserm UMR 981, Gustave Roussy Cancer Center, Villejuif, 94800, France
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Ferron G, De Rauglaudre G, Becourt S, Delanoy N, Joly F, Lortholary A, You B, Bouchaert P, Malaurie E, Gouy S, Kaminsky MC, Meunier J, Alexandre J, Berton D, Dohollou N, Dubot C, Floquet A, Favier L, Venat-Bouvet L, Fabbro M, Louvet C, Lotz JP, Abadie-Lacourtoisie S, Desauw C, Del Piano F, Leheurteur M, Bonichon-Lamichhane N, Rastkhah M, Follana P, Gantzer J, Ray-Coquard I, Pujade-Lauraine E. Neoadjuvant chemotherapy with or without nintedanib for advanced epithelial ovarian cancer: Lessons from the GINECO double-blind randomized phase II CHIVA trial. Gynecol Oncol 2023; 170:186-194. [PMID: 36706645 DOI: 10.1016/j.ygyno.2023.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 11/21/2022] [Revised: 12/23/2022] [Accepted: 01/10/2023] [Indexed: 01/27/2023]
Abstract
AIM The oral anti-angiogenic therapy nintedanib prolongs progression-free survival (PFS) when combined with chemotherapy after primary surgery for advanced epithelial ovarian cancer. The randomized phase II CHIVA trial evaluated the impact of combining nintedanib with neoadjuvant chemotherapy (NACT) for epithelial ovarian cancer. METHODS Patients with newly diagnosed unresectable FIGO stage IIIC-IV epithelial ovarian cancer received 3-4 cycles of carboplatin plus paclitaxel every 3 weeks as NACT before interval debulking surgery (IDS), followed by 2-3 post-operative cycles. Patients were randomized 2:1 to receive either nintedanib 200 mg twice daily or placebo on days 2-21 every 3 weeks during NACT (omitting peri-operative cycles), and then as maintenance therapy for up to 2 years. The primary endpoint was PFS. RESULTS Between January 2013 and May 2015, 188 patients were randomized (124 to nintedanib, 64 to placebo). PFS was significantly inferior with nintedanib (median 14.4 versus 16.8 months with placebo; hazard ratio 1.50, p = 0.02). Overall survival (OS) was also inferior (median 37.7 versus 44.1 months, respectively; hazard ratio 1.54, p = 0.054). Nintedanib was associated with increased toxicity (grade 3/4 adverse events: 92% versus 69%, predominantly hematologic and gastrointestinal), lower response rate by RECIST (35% versus 56% before IDS), and lower IDS feasibility (58% versus 77%) versus placebo. CONCLUSIONS Adding nintedanib to chemotherapy and in maintenance as part of NACT for advanced epithelial ovarian cancer cannot be recommended as it increases toxicity and compromises chemotherapy efficacy (IDS, PFS, OS). CLINICALTRIALS govregistration: NCT01583322.
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Affiliation(s)
- Gwénaël Ferron
- Institut Claudius Regaud, Département de Chirurgie Oncologique, IUCT Oncopole, Toulouse, France.
| | | | | | - Nicolas Delanoy
- Institut du Cancer Paris CARPEM, Assistance Publique Hôpitaux de Paris (AP-HP), APHP. Centre, Department of Medical Oncology, Hôpital Européen Georges Pompidou, Paris, France.
| | - Florence Joly
- Centre François Baclesse, Oncologie Médicale, Unicaen, Caen, France.
| | - Alain Lortholary
- Hôpital Privé du Confluent, Centre Catherine de Sienne, Nantes, France.
| | - Benoît You
- Medical Oncology, Institut de Cancérologie des Hospices Civils de Lyon (IC-HCL), CITOHL, Université Lyon, Université Claude Bernard Lyon 1, Faculté de Médecine Lyon-Sud, EA3738 Centre pour l'Innovation en Cancérologie de LYon (CICLY), Lyon, France; GINECO-GINEGEPS, Paris, France.
| | - Patrick Bouchaert
- Hôpital de la Milétrie - Centre Hospitalier Universitaire de Poitiers, Pôle Régional de Cancérologie, Service d'Oncologie, Poitiers, France.
| | - Emmanuelle Malaurie
- Centre Hospitalier Intercommunal de Créteil, Oncologie Radiothérapie, Créteil, France.
| | - Sebastien Gouy
- Gustave Roussy, Gynécologie Médicale, Villejuif, France.
| | | | - Jérôme Meunier
- Centre Hospitalier Régional d'Orléans, Service Oncologie Médicale, Orléans, France.
| | - Jérôme Alexandre
- Université de Paris Cité, Service d'Oncologie Médicale, AP-HP, Hôpital Cochin Port Royal, Paris, France.
| | - Dominique Berton
- ICO Centre René Gauducheau, Boulevard Jacques Monod, Saint Herblain, France.
| | - Nadine Dohollou
- Polyclinique Bordeaux Nord, Oncologie Radiothérapie, Bordeaux, France.
| | - Coraline Dubot
- Hôpital René Huguenin, Institut Curie, Oncologie Médicale, Saint Cloud, France.
| | | | - Laure Favier
- Centre Georges François Leclerc, Oncologie Médicale, Dijon, France.
| | | | | | | | | | | | - Christophe Desauw
- Centre Hospitalier Régional Universitaire de Lille - Hôpital Huriez, Lille, France.
| | | | | | | | | | | | - Justine Gantzer
- ICANS, Institut de Cancérologie Strasbourg-Europe, Strasbourg, France.
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Deluche E, Marti C, Jochum F, Bendifallah S, Azaïs H, Deidier J, Cockenpot V, Menoux I, Kissel M, Balaya V, Betrian S, Mathevet P, Chargari C, Gouy S, Genestie C, Uzan C, Devouassoux-Shisheboran M, Guyon F, Akladios C, Body N, Guani B. [Application in France of the 2021 European recommendations on endometrial cancer]. Bull Cancer 2023; 110:55-68. [PMID: 36462971 DOI: 10.1016/j.bulcan.2022.11.003] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/15/2022] [Accepted: 11/16/2022] [Indexed: 12/02/2022]
Abstract
The latest European recommendations of the European Societies of Gynecological Oncology (ESGO), Radiotherapy and Oncology (ESTRO) and Anatomopathology (ESP) concerning the management of patients with endometrial cancer were published in 2021. On behalf of the French Society of Gynecologic Oncology (SFOG) and the SFOG campus, we wish to summarize for the French-speaking readership the main measures with a more specific application for France. We also incorporate data from a Delphi survey conducted with a panel of French and French-speaking Swiss experts. The data presented in this article relate to histo-molecular characteristics, radiological data of endometrial cancer, and management of low-risk, intermediate-risk, intermediate-high-risk, and metastatic cancers. The aim of this review article is to show the application of the latest international recommendations to clinicians and pathologists for the implementation of these recommendations.
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Affiliation(s)
- Elise Deluche
- Service d'Oncologie Médicale, 2, avenue Martin Luther King, Limoges, France.
| | - Carolin Marti
- Université de Lausanne, UNIL, Lausanne, Suisse; Service de gynécologie obstétrique, HFR, Fribourg, Suisse
| | - Floriane Jochum
- Université Paris-Saclay, département de Gynécologie, Institut Curie, Paris, France; Hopitaux Universitaires de Strasbourg, département de Gynécologie et d'Obstétrique, Strasbourg, France
| | | | - Henri Azaïs
- Hôpital Européen Georges Pompidou, Service de chirurgie oncologique gynécologique et mammaire, Paris, France
| | - Jonas Deidier
- Hôpital Universitaire Paris Ouest Site G Pompidou AP-HP, département de Radiologie, Paris, France
| | | | - Inès Menoux
- ICANS, département de Radiothérapie, Strasbourg, France
| | - Manon Kissel
- Département de Radiothérapie, institut Curie, Paris, France
| | - Vincent Balaya
- Hôpital Foch, département de Gynécologie, Suresnes, France
| | - Sarah Betrian
- IUCT Oncopole, département d'oncologie médicale, Toulouse, France
| | - Patrice Mathevet
- Université de Lausanne, UNIL, Lausanne, Suisse; CHUV, département de Gynécologie et d'Obstétrique, Lausanne, Suisse
| | - Cyrus Chargari
- Gustave Roussy, département de radio-oncologie, Paris, France
| | - Sebastien Gouy
- Gustave Roussy, département de gynécologie oncologie chirurgicale, Paris, France
| | | | - Catherine Uzan
- AP-HP, Hôpital de la Pitié Salpêtrière, département de gynécologie et d'obstétrique, Paris, France; Institut Universitaire de cancérologie, Sorbonne Université, Paris, France
| | | | - Frederic Guyon
- Institut Bergonié, département d'oncologie chirurgicale, Bordeaux, France
| | - Cherif Akladios
- Hopitaux Universitaires de Strasbourg, département de Gynécologie et d'Obstétrique, Strasbourg, France
| | - Noémie Body
- Institut de Cancérologie de l'Ouest (ICO), département d'Oncologie Chirurgicale, Angers, France
| | - Benedetta Guani
- Université de Lausanne, UNIL, Lausanne, Suisse; CHUV, département de Gynécologie et d'Obstétrique, Lausanne, Suisse; Université de Fribourg, UNIFR, Fribourg, Suisse
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Sanson C, Zaccarini F, Majer M, Pautier P, Genestie C, Chargari C, Gouy S, Morice P. Neoadjuvant chemotherapy in fertility-sparing management of FIGO 2018 stage IB2 cervical cancer. Int J Gynecol Cancer 2022; 32:680-685. [PMID: 35504625 DOI: 10.1136/ijgc-2021-003293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Claire Sanson
- Department of Gynecological Surgery, Gustave Roussy, Villejuif, Île-de-France, France
| | - François Zaccarini
- Department of Gynecological Surgery, Gustave Roussy, Villejuif, Île-de-France, France
| | - Michael Majer
- Department of Radiology, Gustave Roussy, Villejuif, Île-de-France, France
| | - Patricia Pautier
- Department of Medical Oncology, Gustave Roussy, Villejuif, Île-de-France, France
| | - Catherine Genestie
- Department of Pathology, Gustave Roussy, Villejuif, Île-de-France, France
| | - Cyrus Chargari
- Department of Radiation Oncology, Gustave Roussy, Villejuif, Île-de-France, France
| | - Sebastien Gouy
- Department of Gynecological Surgery, Gustave Roussy, Villejuif, Île-de-France, France
| | - Philippe Morice
- Department of Gynecological Surgery, Gustave Roussy, Villejuif, Île-de-France, France
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Morice P, Maulard A, Scherier S, Sanson C, Zarokian J, Zaccarini F, Espenel S, Pautier P, Leary A, Genestie C, Chargari C, Grynberg M, Gouy S. Oncologic results of fertility sparing surgery of cervical cancer: An updated systematic review. Gynecol Oncol 2022; 165:169-183. [PMID: 35241291 DOI: 10.1016/j.ygyno.2022.01.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [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: 12/07/2021] [Revised: 01/12/2022] [Accepted: 01/17/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Several techniques can be proposed as fertility sparing surgery in young patients treated for cervical cancer but uncertaincies remain concerning their outcomes. Analysis of oncological issues is then the first aim of this review in order to evaluate the best strategy. RESULTS Data were identified from searches of MEDLINE, Current Contents, PubMed and from references in relevant articles from January 1987 to 15th of September 2021. We carry out an updated systematic review involving 5862 patients initially selected for fertility-sparing surgery in 275 series. FINDINGS In patients having a stage IB1 disease, recurrence rate/RR in patients undergoing simple conisation/trachelectomy, radical trachelectomy/RT by laparoscopico-vaginal approach, laparotomic or laparoscopic approaches are respectively: 4.1%, 4.7%, 2.4% and 5.2%. In patients having a stage IB2 disease, RR after neoadjuvant chemotherapy or RT by laparotomy are respectively 13.2% and 4.8% (p = .0035). After neoadjuvant treatment a simple cone/trachelectomy was carried out in 91 (30%) patients and a radical one in 210 (70%) cases. But the lowest pregnancy rate is observed in patients undergoing RT by laparotomy (36%). CONCLUSIONS The choice between these treatments should be based above all, on objective oncological data that strike a balance for each procedure between the best chances for cure and the fertility results. In patients having a stage IB1 disease, oncological results are quite similar according to the procedure used. In patients having a stage IB2 disease, RT by open approach has the lowest RR. Anyway the lowest pregnancy rate is observed in patients undergoing RT by laparotomy.
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Affiliation(s)
- P Morice
- Department of Gynecological Surgery, Gustave-Roussy, Villejuif, France; Inserm Unit 10-30, Gustave-Roussy, Villejuif, France; University Paris-Sud (Paris XI), Le Kremlin-Bicêtre, France.
| | - A Maulard
- Department of Gynecological Surgery, Gustave-Roussy, Villejuif, France
| | - S Scherier
- Department of Gynecological Surgery, Gustave-Roussy, Villejuif, France
| | - C Sanson
- Department of Gynecological Surgery, Gustave-Roussy, Villejuif, France
| | - J Zarokian
- Department of Gynecological Surgery, Gustave-Roussy, Villejuif, France
| | - F Zaccarini
- Department of Gynecological Surgery, Gustave-Roussy, Villejuif, France
| | - S Espenel
- Department of Radiation Oncology, Gustave-Roussy, Villejuif, France
| | - P Pautier
- Department of Medical Oncology, Gustave-Roussy, Villejuif, France
| | - A Leary
- Department of Medical Oncology, Gustave-Roussy, Villejuif, France; Inserm Unit 981, Gustave-Roussy, Villejuif, France
| | - C Genestie
- Department of Pathology, Gustave-Roussy, Villejuif, France
| | - C Chargari
- Inserm Unit 10-30, Gustave-Roussy, Villejuif, France; Department of Radiation Oncology, Gustave-Roussy, Villejuif, France
| | - M Grynberg
- University Paris-Sud (Paris XI), Le Kremlin-Bicêtre, France; Department of Reproductive Medicine, Hôpital Antoine-Béclère, Clamart, France
| | - S Gouy
- Department of Gynecological Surgery, Gustave-Roussy, Villejuif, France
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7
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Zhou Y, Espenel S, Achkar S, Leary A, Gouy S, Chargari C. Combined modality including novel sensitizers in gynecological cancers. Int J Gynecol Cancer 2022; 32:389-401. [DOI: 10.1136/ijgc-2021-002529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 12/06/2021] [Indexed: 01/05/2023] Open
Abstract
Standard treatment of locally advanced gynecological cancers relies mainly on platinum-based concurrent chemoradiotherapy followed by brachytherapy. Current chemotherapeutic drugs are only transiently effective and patients with advanced disease often develop resistance and subsequently, distant metastases despite significant initial responses of the primary tumor. In addition, some patients still develop local failure or progression, suggesting that there is still a place for increasing the anti-tumor radiation effect. Several strategies are being developed to increase the probability of curing patients. Vaginal cancer and vulva cancer are rare diseases, which resemble cervical cancer in their histology and pathogenesis. These gynecological cancers are predominantly associated with human papilloma virus infection. Treatment strategies in other unresectable gynecologic cancers are usually derived from evidence in locally advanced cervical cancers. In this review, we discuss mechanisms by which novel therapies could work synergistically with conventional chemoradiotherapy, from pre-clinical and ongoing clinical data. Trimodal, even quadrimodal treatment are currently being tested in clinical trials. Novel combinations derived from a metastatic setting, and being tested in locally advanced tumors, include anti-angiogenic agents, immunotherapy, tumor-infiltrating lymphocytes therapy, adoptive T-cell therapy and apoptosis inducers to enhance chemoradiotherapy efficacy through complementary molecular pathways. In parallel, radiosensitizers, such as nanoparticles and radiosensitizers of hypoxia aim to maximize the effect of radiotherapy locally.
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Sallée C, Margueritte F, Gouy S, Tardieu A, Belghiti J, Lambaudie E, Collinet P, Guyon F, Legros M, Monteil J, Gauthier T. 262 FDG-PET/CT and para-aortic staging in endometrial cancer. a french multicentric study. Eur J Obstet Gynecol Reprod Biol 2022. [DOI: 10.1016/j.ejogrb.2021.11.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Chargari C, Arbyn M, Leary A, Abu-Rustum NR, Basu P, Bray F, Chopra S, Nout R, Tanderup K, Viswanathan AN, Zacharopoulou C, Soria JC, Deutsch E, Gouy S, Morice P. Increasing global accessibility to high-level treatments for cervical cancers. Gynecol Oncol 2022; 164:231-241. [PMID: 34716024 PMCID: PMC9496636 DOI: 10.1016/j.ygyno.2021.10.073] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 10/04/2021] [Accepted: 10/11/2021] [Indexed: 01/03/2023]
Abstract
Human papillomaviruses (HPV)-related gynecological cancers are a major health care issue, and a leading cause of cancer death in low- and middle-income countries (LMIC). In 2020, the World Health Organization launched a program aimed at cervical cancer elimination, by screening and vaccination strategies. Offering the best possible care to women diagnosed with invasive cancer is a complementary objective. Treatment of cervical cancer as per modern standards is complex and multimodal, mainly relying on surgery, external-beam radiotherapy (+/-chemotherapy) and brachytherapy. In parallel with the pivotal role of multidisciplinary discussion, international societies provide guidance to define the most effective and least toxic anti-cancer strategy, homogenize treatment protocols and provide benchmark quality indicators as a basis for accreditation processes. The challenge is to offer the appropriate diagnostic workup and treatment upfront and to avoid non- evidence-based treatment that consumes resources, impairs quality of life (QoL), and compromises oncological outcome. Various strategies may be applied for improving treatment quality: development of surgical mentorship, companion-training programs and international cooperation. The lack of radiotherapy/brachytherapy facilities is a major concern in LMIC. Reinforcing international support in terms of education, training, research and development and technical cooperation with national projects is required to increase access to minimum requirements but also introduce modern techniques, upgrade radiotherapy/brachytherapy services, and expand access to modern systemic treatments. In countries with robust economies, compliance to standards should also be increased. Integrative cancer care and multidisciplinary approaches are needed to tackle the dual challenge of increasing cure rates while minimizing QoL impairment. Appropriate dimensioning of the resources to avoid harmful treatment delays and access to expert referral centers is also a priority.
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Affiliation(s)
- C Chargari
- Radiation Oncology, Gustave Roussy Cancer Campus, Villejuif, France; Inserm U-1030, Université Paris-Saclay, Le Kremlin-Bicêtre, France.
| | - M Arbyn
- Unit Cancer Epidemiology - Belgian Cancer Centre, Brussels, Belgium
| | - A Leary
- Medical Oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | - N R Abu-Rustum
- Surgical Oncology, Memorial Sloan Kettering Cancer Center, New York, United States; European Society of Gynecological Oncology, Geneva, Switzerland
| | - P Basu
- Early Detection, Prevention & Infection Branch, International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - F Bray
- Cancer Surveillance Branch, International Agency for Research on Cancer, UK
| | - S Chopra
- Radiation Oncology, Advanced Centre for Treatment Research and Education in Cancer, Tata Memorial Centre, Navi Mumbai, Homi Bhabha National Institute, Maharashtra, India
| | - R Nout
- Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, the Netherlands
| | - K Tanderup
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - A N Viswanathan
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins Medicine, Baltimore, MD, United States
| | - C Zacharopoulou
- European Parliament, Committee on the Environment, Public Health and Food Safety, France
| | - J C Soria
- Governance, Gustave Roussy Cancer Campus, Villejuif, France; Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - E Deutsch
- Radiation Oncology, Gustave Roussy Cancer Campus, Villejuif, France; Inserm U-1030, Université Paris-Saclay, Le Kremlin-Bicêtre, France; Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - S Gouy
- Inserm U-1030, Université Paris-Saclay, Le Kremlin-Bicêtre, France; Université Paris-Saclay, Le Kremlin-Bicêtre, France; Surgical Oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | - P Morice
- Inserm U-1030, Université Paris-Saclay, Le Kremlin-Bicêtre, France; European Society of Gynecological Oncology, Geneva, Switzerland; Université Paris-Saclay, Le Kremlin-Bicêtre, France; Surgical Oncology, Gustave Roussy Cancer Campus, Villejuif, France
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10
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Sanson C, Majer M, Pautier P, Gouy S, Morice P. Unexplained uterine atrophy following neoadjuvant chemotherapy in fertility sparing management of cervical cancer. Lancet 2021; 398:e17. [PMID: 34838181 DOI: 10.1016/s0140-6736(21)02253-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/19/2021] [Accepted: 10/03/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Claire Sanson
- Department of Surgery, Institute Gustave Roussy, Cancer Campus, Villejuif, France
| | - Michael Majer
- Department of Imaging, Institute Gustave Roussy, Cancer Campus, Villejuif, France
| | - Patricia Pautier
- Department of Medical Oncology, Institute Gustave Roussy, Cancer Campus, Villejuif, France
| | - Sebastien Gouy
- Department of Surgery, Institute Gustave Roussy, Cancer Campus, Villejuif, France
| | - Philippe Morice
- Department of Surgery, Institute Gustave Roussy, Cancer Campus, Villejuif, France; Inserm U-1030, Université Paris-Saclay, Le Kremlin-Bicêtre, France.
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11
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Ricotta G, Maulard A, Pautier P, Leary A, Chargari C, Gouy S, Genestie C, Morice P. 948 Brenner borderline ovarian tumor: a case series and literature review. Pathology 2021. [DOI: 10.1136/ijgc-2021-esgo.532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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12
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Bréban-Kehl M, Zaccarini F, Sanson C, Maulard A, Scherier S, Genestie C, Chargari C, Pautier P, Leary A, Balleyguier C, Morice P, Gouy S. [Fertility preservation in cervical cancer, analysis of 30 years of practice and immersion in future developments]. ACTA ACUST UNITED AC 2021; 50:62-68. [PMID: 34487915 DOI: 10.1016/j.gofs.2021.09.001] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The strategy of fertility preservation (FP) in cervical cancer has been challenged for several years and a therapeutic de-escalation seems to be necessary. In this context, we evaluated the oncological, fertility and obstetric outcomes of surgical techniques performed in our centre for FP. METHODS This retrospective uni centric trial included 75 patients, managed at the Gustave Roussy Institute between 1995 and 2020, for cervical cancer (stage IB1 FIGO 2018) and having conducted a fertility preservation project after a complete pre-therapy work-up. The objective of this study was to understand our results on fertility and obstetrical outcomes and to correlate them with oncological data and finally to evaluate the evolution of our surgical practices. RESULTS 54 patients benefited from an extended trachelectomy and no lymph node involvement was found. 1 patient received a complementary treatment postoperatively which did not allow to preserve her fertility. The recurrence rate was 4.8% (4/75) with one death described. 31 pregnancies were obtained, representing a pregnancy rate of 50%. 74% of pregnancies were obtained spontaneously and 60% of pregnancies were carried to term. CONCLUSION Our results are similar to those in the literature. Despite a fertility preservation project, only half of the patients were able to achieve a pregnancy.
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Affiliation(s)
- M Bréban-Kehl
- Département de chirurgie gynécologique, Institut Gustave Roussy, 114, rue Edouard Vaillant, 94805 Villejuif Cedex, France
| | - F Zaccarini
- Département de chirurgie gynécologique, Institut Gustave Roussy, 114, rue Edouard Vaillant, 94805 Villejuif Cedex, France
| | - C Sanson
- Département de chirurgie gynécologique, Institut Gustave Roussy, 114, rue Edouard Vaillant, 94805 Villejuif Cedex, France
| | - A Maulard
- Département de chirurgie gynécologique, Institut Gustave Roussy, 114, rue Edouard Vaillant, 94805 Villejuif Cedex, France
| | - S Scherier
- Département de chirurgie gynécologique, Institut Gustave Roussy, 114, rue Edouard Vaillant, 94805 Villejuif Cedex, France
| | - C Genestie
- Département d'anatomopathologie, Institut Gustave Roussy, Villejuif, France
| | - Cyrus Chargari
- Département de radiothérapie, Institut Gustave Roussy, Villejuif, France
| | - P Pautier
- Département d'oncologie médicale, Institut Gustave Roussy, Villejuif, France; Unité Inserm U 981 Gustave Roussy, Villejuif, France
| | - A Leary
- Département d'oncologie médicale, Institut Gustave Roussy, Villejuif, France; Unité Inserm U 981 Gustave Roussy, Villejuif, France
| | - C Balleyguier
- Département de radiologie, Institut Gustave Roussy, Villejuif, France
| | - P Morice
- Département de chirurgie gynécologique, Institut Gustave Roussy, 114, rue Edouard Vaillant, 94805 Villejuif Cedex, France; Unité Inserm U 10-30, Gustave Roussy, Villejuif, France; Université Paris-Sud (Paris XI), Le Kremlin Bicêtre, France
| | - S Gouy
- Département de chirurgie gynécologique, Institut Gustave Roussy, 114, rue Edouard Vaillant, 94805 Villejuif Cedex, France; Unité Inserm U 10-30, Gustave Roussy, Villejuif, France; Université Paris-Sud (Paris XI), Le Kremlin Bicêtre, France.
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13
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Joseph A, Juncheng P, Mondini M, Labaied N, Loi M, Adam J, Lafarge A, Astesana V, Obrist F, Klein C, Bloy N, Stoll G, Signolle N, Genestie C, Damotte D, Alifano M, Leary A, Pautier P, Morice P, Gouy S, Deutsch E, Chargari C, Dieu-Nosjean MC, Cremer I, Michels J, Kroemer G, Castedo M. Metabolic features of cancer cells impact immunosurveillance. J Immunother Cancer 2021; 9:jitc-2021-002362. [PMID: 34162714 PMCID: PMC8231002 DOI: 10.1136/jitc-2021-002362] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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] [Accepted: 05/20/2021] [Indexed: 01/27/2023] Open
Abstract
Background Tumors rewire their metabolism to achieve robust anabolism and resistance against therapeutic interventions like cisplatin treatment. For example, a prolonged exposure to cisplatin causes downregulation of pyridoxal kinase (PDXK), the enzyme that generates the active vitamin B6, and upregulation of poly ADP-ribose (PAR) polymerase-1 (PARP1) activity that requires a supply of nicotinamide (vitamin B3) adenine dinucleotide. We investigated the impact of the levels of PDXK and PAR on the local immunosurveillance (ie, density of the antigen presenting cells and adaptive immune response by CD8 T lymphocytes) in two different tumor types. Methods Tumors from patients with locally advanced cervical carcinoma (LACC) and non-small cell lung cancer (NSCLC) were stained for PAR, PDXK, dendritic cell lysosomal associated membrane glycoprotein (DC-LAMP) and CD8 T cell infiltration. Their correlations and prognostic impact were assessed. Cisplatin-resistant NSCLC cell clones isolated from Lewis-lung cancer (LLC) cells were evaluated for PAR levels by immunoblot. Parental (PARlow) and cisplatin-resistant (PARhigh) clones were subcutaneously injected into the flank of C57BL/6 mice. Tumors were harvested to evaluate their immune infiltration by flow cytometry. Results The infiltration of tumors by CD8 T and DC-LAMP+ cells was associated with a favorable overall survival in patients with LACC (p=0.006 and p=0.008, respectively) and NSCLC (p<0.001 for both CD8 T and DC-LAMP cells). We observed a positive correlation between PDXK expression and the infiltration by DC-LAMP (R=0.44, p=0.02 in LACC, R=0.14, p=0.057 in NSCLC), and a negative correlation between PAR levels and CD8 T lymphocytes (R=−0.39, p=0.034 in LACC, R=−0.18, p=0.017 in NSCLC). PARP1 is constitutively hyperactivated in cisplatin-resistant LLC cells manifesting elevated intracellular levels of poly(ADP-ribosyl)ated proteins (PARhigh). Tumors formed by such cancer cells injected into immunocompetent mice were scarcely infiltrated by CD8 T (p=0.028) and antigen presenting cells (p=0.086). Conclusions Oncometabolic features can impact local immunosurveillance, providing new functional links between cisplatin resistance and therapeutic failure.
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Affiliation(s)
- Adrien Joseph
- Equipe 11 labellisée par la Ligue contre le Cancer, Université de Paris, Sorbonne Université, INSERM U1138, Centre de Recherche des Cordeliers, INSERM, Paris, France.,Metabolomics and Cell Biology Platforms, Gustave Roussy Cancer Campus, Villejuif, France.,Faculté de médecine, Université de Paris Saclay, Kremlin Bicêtre, France
| | - Pan Juncheng
- Equipe 11 labellisée par la Ligue contre le Cancer, Université de Paris, Sorbonne Université, INSERM U1138, Centre de Recherche des Cordeliers, INSERM, Paris, France.,Metabolomics and Cell Biology Platforms, Gustave Roussy Cancer Campus, Villejuif, France.,Faculté de médecine, Université de Paris Saclay, Kremlin Bicêtre, France
| | - Michele Mondini
- INSERM U1030, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Nizar Labaied
- Pathology Department, Gustave Roussy Institute, Villejuif, Île-de-France, France
| | - Mauro Loi
- INSERM U1030, Gustave Roussy, Université Paris-Saclay, INSERM, Villejuif, Val-de-Marne, France
| | - Julien Adam
- Pathology Department, Gustave Roussy Institute, Villejuif, Val-de-Marne, France.,Pathology Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - Antoine Lafarge
- Equipe 11 labellisée par la Ligue contre le Cancer, Université de Paris, Sorbonne Université, INSERM U1138, Centre de Recherche des Cordeliers, INSERM, Paris, France.,Metabolomics and Cell Biology Platforms, Gustave Roussy Cancer Campus, Villejuif, France.,Faculté de médecine, Université de Paris Saclay, Kremlin Bicêtre, France
| | - Valentina Astesana
- Equipe 11 labellisée par la Ligue contre le Cancer, Université de Paris, Sorbonne Université, INSERM U1138, Centre de Recherche des Cordeliers, INSERM, Paris, France.,Metabolomics and Cell Biology Platforms, Gustave Roussy Cancer Campus, Villejuif, France.,Faculté de médecine, Université de Paris Saclay, Kremlin Bicêtre, France
| | - Florine Obrist
- Equipe 11 labellisée par la Ligue contre le Cancer, Université de Paris, Sorbonne Université, INSERM U1138, Centre de Recherche des Cordeliers, INSERM, Paris, France.,Metabolomics and Cell Biology Platforms, Gustave Roussy Cancer Campus, Villejuif, France.,Faculté de médecine, Université de Paris Saclay, Kremlin Bicêtre, France
| | - Christophe Klein
- Centre d'Histologie, Imagerie cellulaire et Cytométrie (CHIC), Centre de Recherche des Cordeliers, Paris, Île-de-France, France
| | - Norma Bloy
- Equipe 11 labellisée par la Ligue contre le Cancer, Université de Paris, Sorbonne Université, INSERM U1138, Centre de Recherche des Cordeliers, INSERM, Paris, France.,Metabolomics and Cell Biology Platforms, Gustave Roussy Cancer Campus, Villejuif, France.,Faculté de médecine, Université de Paris Saclay, Kremlin Bicêtre, France
| | - Gautier Stoll
- Equipe 11 labellisée par la Ligue contre le Cancer, Université de Paris, Sorbonne Université, INSERM U1138, Centre de Recherche des Cordeliers, INSERM, Paris, France.,Metabolomics and Cell Biology Platforms, Gustave Roussy Cancer Campus, Villejuif, France
| | - Nicolas Signolle
- Pathology Department, Gustave Roussy Institute, Villejuif, Île-de-France, France
| | - Catherine Genestie
- Pathology Department, Gustave Roussy Institute, Villejuif, Île-de-France, France
| | - Diane Damotte
- Departments of Pathology and Thoracic Surgery, Hospital Cochin Assistance Publique Hopitaux de Paris, APHP, Paris, Île-de-France, France
| | - Marco Alifano
- Department of Thoracic Surgery, Hospital Cochin Assistance Publique Hopitaux de Paris, APHP, Paris, Île-de-France, France
| | - Alexandra Leary
- Department of Medical Oncology, Gustave Roussy Institute, Villejuif, Île-de-France, France
| | - Patricia Pautier
- Department of Medical Oncology, Gustave Roussy Institute, Villejuif, Île-de-France, France
| | - Philippe Morice
- Department of Gynecologic Surgery, Gustave Roussy Institute, Villejuif, Île-de-France, France
| | - Sebastien Gouy
- Department of Gynecologic Surgery, Gustave Roussy Institute, Villejuif, Île-de-France, France
| | - Eric Deutsch
- Radiotherapy Department, Brachytherapy Unit, Gustave Roussy Institute, Villejuif, Val-de-Marne, France
| | - Cyrus Chargari
- Radiotherapy Department, Brachytherapy Unit, Gustave Roussy Institute, Villejuif, Val-de-Marne, France
| | - Marie-Caroline Dieu-Nosjean
- Sorbonne University, UMRS 1135, INSERM U1135, Centre d'Immunologie et des Maladies Infectieuses (Cimi-Paris), INSERM, Paris, Île-de-France, France
| | - Isabelle Cremer
- INSERM U1138, Centre de Recherche des Cordeliers, Université de Paris, Sorbonne Université, 75006 Paris, France
| | - Judith Michels
- Department of Medical Oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | - Guido Kroemer
- Equipe 11 labellisée par la Ligue contre le Cancer, Université de Paris, Sorbonne Université, INSERM U1138, Centre de Recherche des Cordeliers, INSERM, Paris, France .,Suzhou Institute for Systems Medicine, Chinese Academy of Medical Sciences, Suzhou, China.,Karolinska Institute, Department of Women's and Children's Health, Karolinska University Hospital, Stockholm, Sweden.,Pôle de Biologie, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Maria Castedo
- Equipe 11 labellisée par la Ligue contre le Cancer, Université de Paris, Sorbonne Université, INSERM U1138, Centre de Recherche des Cordeliers, INSERM, Paris, France .,Metabolomics and Cell Biology Platforms, Gustave Roussy Cancer Campus, Villejuif, France
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14
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Ricotta G, Maulard A, Genestie C, Pautier P, Leary A, Chargari C, Candiani M, Morice P, Gouy S. ASO Visual Abstract: Brenner Borderline Ovarian Tumor-A Case Series and Literature Review. Ann Surg Oncol 2021. [PMID: 34091805 DOI: 10.1245/s10434-021-10002-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Giulio Ricotta
- Department of Gynaecologic Surgery, Gustave-Roussy, Villejuif, France
| | - Amandine Maulard
- Department of Gynaecologic Surgery, Gustave-Roussy, Villejuif, France
| | | | - Patricia Pautier
- Department of Medical Oncology, Gustave-Roussy, Villejuif, France
| | - Alexandra Leary
- Department of Medical Oncology, Gustave-Roussy, Villejuif, France
| | - Cyrus Chargari
- Department of Radiation Oncology, Gustave-Roussy, Villejuif, France
| | - Massimo Candiani
- IRCCS San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - Philippe Morice
- Department of Gynaecologic Surgery, Gustave-Roussy, Villejuif, France. .,Paris Sud University Kremlin Bicetre, Paris, France.
| | - Sebastien Gouy
- Department of Gynaecologic Surgery, Gustave-Roussy, Villejuif, France
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15
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Zaccarini F, Roosen A, Sanson C, Maulard A, Scherier S, Pautier P, Leary A, Chargari C, Morice P, Gouy S. [Low-grade serous ovarian carcinoma: A retrospective study on 34 complete cytoreductive surgeries]. ACTA ACUST UNITED AC 2021; 49:750-755. [PMID: 33933671 DOI: 10.1016/j.gofs.2021.04.009] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Indexed: 10/21/2022]
Abstract
AIM OF THE STUDY Low-grade serous ovarian cancer is a distinct, slow-growing entity that affects mainly young women. The objective of this study was to describe the clinical characterisitics and survival outcomes of a population of patients suffering from advanced stage CSBG. PATIENTS AND METHODS A retrospective study was carried out in patients with advanced stage ovarian CSBG (FIGO IIIb-IV) who had complete macroscopic cytoreductive surgery, at Gustave Roussy Institut, Villejuif, between 2004 and 2017. RESULTS Thirty-four patients were included, who were mainly young women (mean age 41.3 years), diagnosed at FIGO stage IIIC (91 %). The median follow-up was 41 months. Neoadjuvant chemotherapy was administered in 16 patients (47.1 %), and complete response never occurred. Upper abdominal surgical procedures were necessary in 90 % of cases and a bowel resection was performed in more than 80 % of cases. Over 90 % of patients received adjuvant chemotherapy followed by maintenance treatment with bevacizumab in over 40 % of cases. During follow-up, 9 (26 %) deaths occurred. Five-year overall survival was 70 % and disease-free survival was 20 %. CONCLUSION CSBG of the ovary has a low chemosensitivity and requires maximum surgical management, which should be performed in expert centers.
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Affiliation(s)
- F Zaccarini
- Service de chirurgie gynécologique, Gustave-Roussy, Villejuif, France.
| | - A Roosen
- Service de chirurgie gynécologique, Gustave-Roussy, Villejuif, France
| | - C Sanson
- Service de chirurgie gynécologique, Gustave-Roussy, Villejuif, France
| | - A Maulard
- Service de chirurgie gynécologique, Gustave-Roussy, Villejuif, France
| | - S Scherier
- Service de chirurgie gynécologique, Gustave-Roussy, Villejuif, France
| | - P Pautier
- Service d'oncologie médicale, Gustave-Roussy, Villejuif, France
| | - A Leary
- Service d'oncologie médicale, Gustave-Roussy, Villejuif, France
| | - C Chargari
- Service de radiothérapie, Gustave-Roussy, Villejuif, France
| | - P Morice
- Service de chirurgie gynécologique, Gustave-Roussy, Villejuif, France
| | - S Gouy
- Service de chirurgie gynécologique, Gustave-Roussy, Villejuif, France
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16
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Ricotta G, Maulard A, Genestie C, Pautier P, Leary A, Chargari C, Candiani M, Morice P, Gouy S. Brenner Borderline Ovarian Tumor: A Case Series and Literature Review. Ann Surg Oncol 2021; 28:6714-6720. [PMID: 33768396 DOI: 10.1245/s10434-021-09879-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 03/04/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Most frequent borderline ovarian tumors are serous and mucinous subtypes. Less frequent borderline diseases are endometrioid, clear-cell, and Brenner tumors (BBOT). Very little is known about the latter subtype, and most studies include very short series or case reports. The aim of this study is to determine the prognosis of a continuous series of BBOT and analyze data published in the literature on this rare entity. PATIENTS AND METHODS A retrospective review of patients with BBOT treated or referred to our institutions was conducted. A centralized histological review by a reference pathologist and data on the clinical characteristics, management, and outcomes of patients were required for inclusion. RESULTS Overall, 17 patients were identified. Median age was 62 (range 42-85) years. Six patients underwent unilateral salpingo-oophorectomy, and 11 bilateral salpingo-oophorectomy +/- hysterectomy and/or staging surgery. In total, 16 patients had unilateral tumor, and all patients had stage I disease. Stromal microinvasion was observed in three cases. Median follow-up was 60 months (range 7-118 months). One patient developed a recurrence in contralateral ovary after unilateral salpingo-oophorectomy. One patient had previous history of urothelial tumor. CONCLUSIONS Peritoneal staging surgery is not required because all patients reported had stage I disease. One recurrence occurred. When reviewing all the 82 cases reported in the literature (including ours), 9% had previous history or synchronous urothelial tumor, suggesting the need to carefully check for urological disease in patients with BBOT.
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Affiliation(s)
- Giulio Ricotta
- Department of Gynaecologic Surgery, Gustave-Roussy, Villejuif, France
| | - Amandine Maulard
- Department of Gynaecologic Surgery, Gustave-Roussy, Villejuif, France
| | | | - Patricia Pautier
- Department of Medical Oncology, Gustave-Roussy, Villejuif, France
| | - Alexandra Leary
- Department of Medical Oncology, Gustave-Roussy, Villejuif, France
| | - Cyrus Chargari
- Department of Radiation Oncology, Gustave-Roussy, Villejuif, France
| | - Massimo Candiani
- IRCCS San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - Philippe Morice
- Department of Gynaecologic Surgery, Gustave-Roussy, Villejuif, France. .,Paris Sud University, Kremlin Bicetre, France.
| | - Sebastien Gouy
- Department of Gynaecologic Surgery, Gustave-Roussy, Villejuif, France
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17
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Gouy S, Seebacher V, Chargari C, Terroir M, Grimaldi S, Ilenko A, Maulard A, Genestie C, Leary A, Pautier P, Morice P, Deandreis D. False negative rate at 18F-FDG PET/CT in para-aortic lymphnode involvement in patients with locally advanced cervical cancer: impact of PET technology. BMC Cancer 2021; 21:135. [PMID: 33549033 PMCID: PMC7866875 DOI: 10.1186/s12885-021-07821-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 09/21/2020] [Accepted: 01/19/2021] [Indexed: 11/25/2022] Open
Abstract
Background The identification of factors responsible for false negative (FN) rate at 18F- Fluorodeoxyglucose (FDG) Positron Emission Tomography /Computed Tomography (PET/CT) in para-aortic (PA) lymph nodes in the presurgical staging of patients with locally advanced cervical cancer (LACC) is challenging. The aim of this study was to evaluate the impact of PET/CT technology. Methods A total of 240 consecutive patients with LACC (International Federation of Gynecology and Obstetrics, FIGO, stage IB2-IVA) and negative Magnetic Resonance Imaging (MRI) and/or Computed Tomography (CT) and negative 18F-FDG PET/CT in the PA region, undergoing laparoscopic PA lymphadenectomy before chemoradiotherapy were included. The FN rate in patients studied with Time of flight (TOF) PET/CT (TOF PET) or non-Time of flight PET/CT (no-TOF PET) technology was retrospectively compared. Results Patients presented with FIGO stage IB (n = 78), stage IIA-B (n = 134), stage III (n = 18) and stage IVa (n = 10), squamous cell carcinoma (n = 191) and adenocarcinoma (n = 49). 141/240 patients were evaluated with no-TOF PET/CT and 99/240 with TOF PET/CT. Twenty-two patients (9%) had PA nodal involvement at histological analysis and considered PET/CT FN findings. The FN rate was 8.5% for no-TOF PET and 10% for TOF PET subgroup respectively (p = 0.98). Ninety patients (38%) presented with pelvic node uptakes at PET/CT. The FN rate in the PA region was 18% (16/90) and 4% (6/150) in patients with and without pelvic node involvement at PET/CT respectively (19 vs 3% for no-TOF PET and 17 vs 5% for TOF PET subgroup). Conclusions In LACC, FN rate in PA lymph nodes detection is a clinical issue even for modern PET/CT, especially in patients with pelvic uptake. Surgical lymphadenectomy should be performed in case of negative PET/CT at PA level in these patients, while it could be discussed in the absence of pelvic uptake.
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Affiliation(s)
- Sebastien Gouy
- Department of Gynecologic Surgery, Gustave Roussy and Paris Saclay, 114 Rue Edouard Vaillant, Villejuif, France.,University Paris Sud, Orsay, France.,Unit INSERM 1030, 114 Rue Edouard Vaillant, Villejuif, France
| | - Veronika Seebacher
- Department of Gynecologic Surgery, Gustave Roussy and Paris Saclay, 114 Rue Edouard Vaillant, Villejuif, France
| | - Cyrus Chargari
- University Paris Sud, Orsay, France.,Department of Radiotherapy and Brachytherapy Unit, Gustave Roussy and Paris Saclay, 114 Rue Edouard Vaillant, Villejuif, France.,Effets biologiques des rayonnements, Institut de Recherche Biomédicale des Armées, Bretigny-sur-Orge, France
| | - Marie Terroir
- Department of Nuclear Medicine and Endocrine Oncology, Gustave Roussy and Paris Saclay, 114 Rue Edouard Vaillant, 94800, Villejuif, France
| | - Serena Grimaldi
- Department of Nuclear Medicine and Endocrine Oncology, Gustave Roussy and Paris Saclay, 114 Rue Edouard Vaillant, 94800, Villejuif, France
| | - Anna Ilenko
- Department of Gynecologic Surgery, Gustave Roussy and Paris Saclay, 114 Rue Edouard Vaillant, Villejuif, France
| | - Amandine Maulard
- Department of Gynecologic Surgery, Gustave Roussy and Paris Saclay, 114 Rue Edouard Vaillant, Villejuif, France
| | - Catherine Genestie
- Department of Pathology, Gustave Roussy and Paris Saclay, 114 Rue Edouard Vaillant, Villejuif, France
| | - Alexandra Leary
- Department of Medical Oncology, Gustave Roussy and Paris Saclay, 114 Rue Edouard Vaillant, Villejuif, France
| | - Patricia Pautier
- Department of Medical Oncology, Gustave Roussy and Paris Saclay, 114 Rue Edouard Vaillant, Villejuif, France
| | - Philippe Morice
- Department of Gynecologic Surgery, Gustave Roussy and Paris Saclay, 114 Rue Edouard Vaillant, Villejuif, France.,University Paris Sud, Orsay, France.,Unit INSERM 1030, 114 Rue Edouard Vaillant, Villejuif, France
| | - Désirée Deandreis
- Department of Nuclear Medicine and Endocrine Oncology, Gustave Roussy and Paris Saclay, 114 Rue Edouard Vaillant, 94800, Villejuif, France. .,Department of Medical Sciences, Nuclear Medicine Division, the University of Turin, C.so Dogliotti, 14 10126, Turin, Italy.
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Gouy S, Maria S, Faron M, Maulard A, Pautier P, Leary A, Chargari C, Genestie C, Morice P. Results After Conservative Surgery of Stage II/III Serous Borderline Ovarian Tumors. Ann Surg Oncol 2020; 28:3597-3604. [PMID: 33140251 DOI: 10.1245/s10434-020-09250-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 09/28/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The aim of this study was to assess the outcomes of a large series of patients treated conservatively for stage II or III serous borderline tumors of the ovary (SBOTs) with a long-term follow-up. METHODS Patients with SBOTs and peritoneal implants, treated in or referred to our institution, were retrospectively reviewed. Outcomes of patients treated conservatively (preservation of the uterus and at least a part of one ovary) to promote subsequent fertility were specifically analyzed. RESULTS Between 1971 and 2017, 212 patients were identified and followed-up. Among these patients, 65 underwent conservative treatment; eight patients had invasive implants. Among patients treated conservatively, 38 (58%) patients recurred. Twenty-eight recurrences were observed under the form of borderline tumor on the spared ovary and/or noninvasive implants, but eight patients had a recurrence under the form of invasive disease. Compared with radical surgery, the use of conservative treatment (p < 0.0001) was a prognostic factor on disease-free survival (DFS), but without an impact on overall survival (OS). Nevertheless, three deaths occurred. Twenty-four pregnancies (13 spontaneous) were observed in 20 patients (29 patients wanted to become pregnant). CONCLUSION In this series collecting the largest number of patients undergoing conservative surgery for stage II/III SBOTs, spontaneous pregnancies can be achieved after conservative treatment of advanced-stage disease, but the recurrence rate is high and three deaths were observed. These patients were spared their fertility but with a high rate of recurrence. Uncertainties regarding the safety of conservative treatment should be exposed to these patients.
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Affiliation(s)
- Sebastien Gouy
- Department of Gynaecologic Surgery, Institut Gustave-Roussy, Villejuif, France
| | - Sophie Maria
- Department of Gynaecologic Surgery, Institut Gustave-Roussy, Villejuif, France
| | - Matthieu Faron
- Department of Gynaecologic Surgery, Institut Gustave-Roussy, Villejuif, France
| | - Amandine Maulard
- Department of Gynaecologic Surgery, Institut Gustave-Roussy, Villejuif, France
| | - Patricia Pautier
- Department of Medical Oncology, Institut Gustave-Roussy, Villejuif, France
| | - Alexandra Leary
- Department of Medical Oncology, Institut Gustave-Roussy, Villejuif, France
| | - Cyrus Chargari
- Department of Radiation Oncology, Institut Gustave-Roussy, Villejuif, France
| | | | - Philippe Morice
- Department of Gynaecologic Surgery, Institut Gustave-Roussy, Villejuif, France. .,Paris-Sud University, Paris, France.
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19
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Fabien M, Schernberg A, Gouy S, Maulard A, Alexandra L, Genestie C, Pierre A, Kissel M, Fumagalli I, Pautier P, Deutsch E, Haie-Meder C, Morice P, Chargari C. PD-0655: Comprehensive analysis of patient outcome after local relapse of locally advanced cervical cancer. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00677-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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20
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Boustani J, Achkar S, Bartaut A, Genestie C, Gouy S, Kissel M, Pautier P, Morice P, Haie-Meder C, Chargari C. PO-1135: Place of radiotherapy as part of multimodal management of cervical glassy cell carcinoma. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01152-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Bronsart E, Petit C, Gouy S, Bockel S, Espenel S, Kumar T, Fumagalli I, Maulard A, Ayachy RE, Genestie C, Leary A, Pautier P, Morice P, Haie-Meder C, Chargari C. Evaluation of adjuvant vaginal vault brachytherapy in early stage cervical cancer patients. Cancer Radiother 2020; 24:860-865. [PMID: 33129715 DOI: 10.1016/j.canrad.2020.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 10/12/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE Adjuvant external beam radiotherapy (EBRT) was shown to decrease pelvic relapses in patients with an early stage cervical cancer and intermediate-risk histopathological prognostic factors, at the cost of increased bowel morbidity. We examined the feasibility and results of adjuvant brachytherapy alone as an alternative to EBRT in this situation. PATIENTS AND METHODS Medical records of consecutive patients receiving adjuvant brachytherapy between 1991 and 2018 for an early stage cervical cancer were examined. Patients were included if they presented a pT1a2N0 or pT1b1N0 disease following radical colpohysterectomy. Adjuvant vaginal wall brachytherapy (without EBRT) was indicated because of a tumor size≥2cm and/or presence of lymphovascular space invasion (LVSI). Patients received 60Gy to 5mm of the vaginal wall, through low-dose or pulse-dose rate technique. Patients' outcome was examined for disease control, toxicities and prognostic factors. RESULTS A total of 40 patients were included. Eight patients (20%) had LVSI, 26 patients (65%) had a tumor size≥2cm. With median follow-up time of 42.0 months, 90% of patients were in complete remission and four patients (10%) experienced tumor relapse, all in the peritoneal cavity, and associated with synchronous pelvic lymph node failure in 2/4 patients. No vaginal or isolated pelvic nodal failure was reported. At 5 year, overall survival was 83.6% (CI95%: 67.8-100%) and disease-free survival was 85.1% (CI95%: 72.6-99.9%). In univariate analysis, probability of relapse correlated with tumor size≥3cm (P=0.004). No acute or late toxicity grade more than 2 was reported. CONCLUSION Brachytherapy alone was a well-tolerated adjuvant treatment for selected patients with intermediate risk factors. The risk of relapse in patients with tumor size≥3cm was however high, suggesting that EBRT is more appropriate in this situation.
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Affiliation(s)
- E Bronsart
- Department of Radiation Oncology, Gustave-Roussy, Paris-Saclay University, Villejuif, France
| | - C Petit
- Department of Radiation Oncology, Gustave-Roussy, Paris-Saclay University, Villejuif, France
| | - S Gouy
- Department of Gynecologic Surgery, Gustave-Roussy, Villejuif, France
| | - S Bockel
- Department of Radiation Oncology, Gustave-Roussy, Paris-Saclay University, Villejuif, France
| | - S Espenel
- Department of Radiation Oncology, Gustave-Roussy, Paris-Saclay University, Villejuif, France
| | - T Kumar
- Department of Radiation Oncology, Gustave-Roussy, Paris-Saclay University, Villejuif, France
| | - I Fumagalli
- Department of Radiation Oncology, Gustave-Roussy, Paris-Saclay University, Villejuif, France
| | - A Maulard
- Department of Gynecologic Surgery, Gustave-Roussy, Villejuif, France
| | - R El Ayachy
- Department of Radiation Oncology, Gustave-Roussy, Paris-Saclay University, Villejuif, France
| | - C Genestie
- Department of Pathology, Gustave-Roussy, Villejuif, France
| | - A Leary
- Department of Medical Oncology, Gustave-Roussy, Villejuif, France
| | - P Pautier
- Department of Medical Oncology, Gustave-Roussy, Villejuif, France
| | - P Morice
- Department of Gynecologic Surgery, Gustave-Roussy, Villejuif, France
| | - C Haie-Meder
- Department of Radiation Oncology, Gustave-Roussy, Paris-Saclay University, Villejuif, France; GIE Charlebourg, groupe Amethyst, 65, avenue Foch, 92250 La-Garenne-Colombes, France
| | - C Chargari
- Department of Radiation Oncology, Gustave-Roussy, Paris-Saclay University, Villejuif, France; French Military Health Academy, Paris, France; Institut de recherche biomédicale des armées, Brétigny-sur-Orge, France.
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22
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Colomba-Blameble E, Pautier P, Michels J, Pommeret F, Kfoury M, Maulard A, Gouy S, Morice P, Genestie C, Leary A. 848P Features and clinical outcomes for younger women with epithelial ovarian cancer (EOC). Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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23
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Maulard A, Chargari C, Faron M, Alwohaibi A, Leary A, Pautier P, Genestie C, Morice P, Gouy S. A new score based on biomarker values to predict the prognosis of locally advanced cervical cancer. Gynecol Oncol 2020; 159:534-538. [PMID: 32828580 DOI: 10.1016/j.ygyno.2020.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 08/02/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To define a prognostic score based on pretreatment values of leucocyte, platelet and hemoglobin in locally advanced cervical cancer (LACC). MATERIAL AND METHODS We conducted a prospective study of 238 patients for LACC with negative PET imaging in the para-aortic (PA) area and who were undergoing laparoscopic PA lymphadenectomies. All patients were treated with chemo-radiation and brachytherapy. RESULTS Patients had clinical International Federation of Gynecology and Obstetrics stages IB2 (n = 76), IIA (n = 13), IIB (n = 122), III (n = 18) or IVA (n = 9). We identified three biological parameters (at the time of diagnosis) with three cut-offs which impacted disease free survival (DFS) and overall survival (OS): <12 g/dL for hemoglobin, >10,000/μL for leucocyte and >300 × 109/L for platelet. A score is calculated, as shown in the table below, by adding the scores of all three biological parameters together (with a maximum score of three). DFS at 36 months was 87.3% [78.3-97.4], 58% [45-74.6], 79.1% [71.1-88], 58% [45-74.6] and 56.8% [37.8-85.4] for scores of 0, 1, 2 and 3 respectively. OS at 36 months was 92.6% [84.9-100], 84% [76.6-92.1], 62.5% [48.9-79.9] and 67% [46.8-96] for scores of 0, 1, 2 and 3 respectively. CONCLUSION This score includes three biomarkers with easily remembered cut-offs that allow us to identify, at the time of diagnosis, those patients with a high risk of relapse (scores of two or three) and those requiring dose escalation.
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Affiliation(s)
- Amandine Maulard
- Department of Gynecologic Surgery, Gustave Roussy, Villejuif, France
| | - Cyrus Chargari
- Department of Radiotherapy and Brachytherapy Unit, Institut de Recherche Biomédicale des Armées, Bretigny-sur-Orge, France; Effets biologiques des rayonnements, Institut de Recherche Biomédicale des Armées, Bretigny-sur-Orge, France; University Paris Sud, France
| | - Matthieu Faron
- Department of Digestive Surgery, Gustave Roussy, Villejuif, France
| | - Asim Alwohaibi
- Department of Gynecologic Surgery, Gustave Roussy, Villejuif, France
| | - Alexandra Leary
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | - Patricia Pautier
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | | | - Philippe Morice
- Department of Gynecologic Surgery, Gustave Roussy, Villejuif, France; University Paris Sud, France; Unit INSERM 1030, Villejuif, France
| | - Sebastien Gouy
- Department of Gynecologic Surgery, Gustave Roussy, Villejuif, France; Unit INSERM 1030, Villejuif, France.
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24
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Poirot C, Fortin A, Lacorte JM, Akakpo JP, Genestie C, Vernant JP, Brice P, Morice P, Leblanc T, Gabarre J, Delmer A, Badachi Y, Drouineaud V, Gouy S, Chalas C, Egels S, Dhédin N, Touraine P, Dommergues M, Lebègue G, Wolf JP, Capron F, Lefebvre G, Boissel N. Impact of cancer chemotherapy before ovarian cortex cryopreservation on ovarian tissue transplantation. Hum Reprod 2020; 34:1083-1094. [PMID: 31116405 DOI: 10.1093/humrep/dez047] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 02/27/2019] [Accepted: 03/07/2019] [Indexed: 12/18/2022] Open
Abstract
STUDY QUESTION How efficacious is transplantation of ovarian cortex previously exposed to chemotherapy? SUMMARY ANSWER Prior exposure to chemotherapy did not disrupt the function of cryopreserved ovarian tissue after transplantation. WHAT IS KNOWN ALREADY Ovarian tissue cryopreservation (OTC) followed by ovarian tissue transplantation (OTT) is an efficacious technique for restoration of female fertility. At least 130 children have been born following this procedure. To date, little is known about the efficacy of OTT in patients exposed to cancer chemotherapy prior to OTC. STUDY DESIGN, SIZE, DURATION This study evaluates the recovery of ovarian function and fertility in 31 consecutive patients who had received OTT, between 2005 and 2015. PARTICIPANTS/MATERIALS, SETTING, METHODS Thirty one patients, wanting children, were transplanted with autologous ovarian cortex, among which 22 patients (71%) had been exposed to chemotherapy before OTC. Recovery of ovarian function was considered total once menstruation occurred. Ovarian function recovery (OFR), ovarian graft survival, and incidence of pregnancy were related to previous chemotherapy exposure, type of chemotherapy and graft characteristics (number of grafted fragments and follicular density). MAIN RESULTS AND ROLE OF CHANCE The amount of ovarian tissue collected was the only parameter to show any significant change between patients with versus without previous chemotherapy. At 1 year after OTT, the cumulative incidence of OFR was 83% (93% in patients exposed to chemotherapy and 67% in others (P = 0.14)). A low follicular density (<0.3 foll/mm2) in the transplant and a low number of grafted fragments (<16) were significantly associated with a delayed OFR. Graft survival at 2 years after OTT was 77%. It was significantly lower in patients exposed to bifunctional alkylating agents before ovarian cryopreservation and in patients with a low follicular density. The proportion of women who succeeded in having at least one live birth was 23% in the total population, 0% (0/9) in the group 'no previous chemotherapy', and 32% (7/22) in the group 'previous chemotherapy'. The cumulative incidence of pregnancy (Kaplan-Meier) at 3 years after OTT was 36% overall and 49% in case of previous chemotherapy, with no difference related to previous chemotherapy exposure. In total there were 13 pregnancies and 8 births in 7 patients. LIMITATIONS, REASONS FOR CAUTION The pathology in the two groups of patients was not comparable. In the group of patients who had chemotherapy before OTC, there were 95% of hematological malignancies. In the group of patients who did not have chemotherapy before OTC only 1 out of 9 patients had a malignant hematological disease while 44% had some pathology affecting the ovaries. Few women are available for study and only large changes are likely to have statistical significance. WIDER IMPLICATIONS OF THE FINDINGS These results suggest that prior cancer chemotherapy should no longer be considered a limitation to cryopreservation of ovarian tissue and current recommendations in this regard should be revised. STUDY FUNDING/COMPETING INTEREST(S) This study was supported by the Agence de la Biomédecine (France's biomedical office). There are no competing interests to report. TRIAL REGISTRATION NUMBER NCT02184806.
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Affiliation(s)
- C Poirot
- Department of Hematology, Adolescents and Young Adults Unit, Fertility Preservation, Assistance Publique-Hôpitaux de Paris (AP-HP) Saint Louis Hospital, Paris, France.,Médecine Sorbonne Université, Paris, France
| | - A Fortin
- Department of Obstetrics Gynecology, AP-HP Pitié-Salpêtrière-Charles Foix University Hospital, Paris, France
| | - J M Lacorte
- Médecine Sorbonne Université, Paris, France.,Department of Hormonal Biochemistry, AP-HP Pitié-Salpêtrière-Charles Foix University Hospital, Paris, France
| | - J P Akakpo
- Department of Radiology, AP-HP Pitié-Salpêtrière-Charles Foix University Hospital, Paris, France
| | - C Genestie
- Department of Pathology, Gustave Roussy Institute, Villejuif, France
| | - J P Vernant
- Médecine Sorbonne Université, Paris, France.,Department of Hematology, AP-HP Pitié-Salpêtrière-Charles Foix University Hospital, Paris, France
| | - P Brice
- Department of Hematology/Oncology, AP-HP Saint Louis Hospital, Paris, France
| | - P Morice
- Department of Oncological Surgery, Gustave Roussy Institute, Villejuif, France.,Paris-Sud XI University, Le Kremlin-Bicêtre, France
| | - T Leblanc
- Department of Pediatric Hematology, AP-HP Robert Debré University Hospital, Paris, France
| | - J Gabarre
- Department of Hematology, AP-HP Pitié-Salpêtrière-Charles Foix University Hospital, Paris, France
| | - A Delmer
- Department of Clinical Hematology, Robert Debré Hospital, Reims, France.,Reims Champagne-Ardenne University, Reims, France
| | - Y Badachi
- Department of Radiology, AP-HP Pitié-Salpêtrière-Charles Foix University Hospital, Paris, France
| | - V Drouineaud
- Department of Reproductive Biology, AP-HP Cochin Hospital, Paris, France
| | - S Gouy
- Department of Oncological Surgery, Gustave Roussy Institute, Villejuif, France
| | - C Chalas
- Department of Reproductive Biology, AP-HP Cochin Hospital, Paris, France
| | - S Egels
- Department of Radiology, AP-HP Pitié-Salpêtrière-Charles Foix University Hospital, Paris, France
| | - N Dhédin
- Department of Hematology, Adolescents and Young Adults Unit, Fertility Preservation, Assistance Publique-Hôpitaux de Paris (AP-HP) Saint Louis Hospital, Paris, France
| | - P Touraine
- Médecine Sorbonne Université, Paris, France.,Department of Endocrinology, AP-HP Pitié-Salpêtrière-Charles Foix University Hospital, Paris, France
| | - M Dommergues
- Médecine Sorbonne Université, Paris, France.,Department of Obstetrics Gynecology, AP-HP Pitié-Salpêtrière-Charles Foix University Hospital, Paris, France
| | - G Lebègue
- Department of Obstetrics Gynecology, AP-HP Pitié-Salpêtrière-Charles Foix University Hospital, Paris, France
| | - J P Wolf
- Department of Reproductive Biology, AP-HP Cochin Hospital, Paris, France.,Paris Descartes University, Paris, France
| | - F Capron
- Médecine Sorbonne Université, Paris, France.,Department of Pathology, AP-HP Pitié-Salpêtrière-Charles Foix University Hospital, Paris, France
| | - G Lefebvre
- Department of Obstetrics Gynecology, AP-HP Pitié-Salpêtrière-Charles Foix University Hospital, Paris, France
| | - N Boissel
- Department of Hematology, Adolescents and Young Adults Unit, Fertility Preservation, Assistance Publique-Hôpitaux de Paris (AP-HP) Saint Louis Hospital, Paris, France.,Paris Diderot University, Paris, France
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25
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Espenel S, Kissel M, Garcia MA, Schernberg A, Gouy S, Bockel S, Limkin E, Fabiano E, Meillan N, Magné N, Leary A, Pautier P, Morice P, Fumagalli I, Haie-Meder C, Chargari C. Implementation of image-guided brachytherapy as part of non-surgical treatment in inoperable endometrial cancer patients. Gynecol Oncol 2020; 158:323-330. [PMID: 32475773 DOI: 10.1016/j.ygyno.2020.05.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 05/20/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE This study assessed outcomes of inoperable endometrial cancer (IEC) patients treated with definitive external beam radiation therapy (EBRT) followed by a 3D image-guided brachytherapy boost. METHODS All consecutive patients treated with EBRT followed by 3D image-guided brachytherapy for IEC were retrospectively included. EBRT delivered a dose of 45Gy. Then, patients had an uterovaginal brachytherapy guided by 3D imaging. Clinical target volume (CTVBT) included the whole uterus and the initial disease extent. Gross tumour volume (GTVres) included the residual disease at time of brachytherapy. RESULTS Twenty-seven patients were identified. Causes of inoperability were comorbidities (37%) or tumour loco regional extent (63%). Including EBRT and brachytherapy, the median D90 (minimal dose delivered to 90% of the volume) was 60.7 GyEQD2 (IQR = 56.4-64.2) for the CTVBT, and was 73.6 GyEQD2 (IQR = 64.1-83.7) for the GTVres. The median overall treatment time was 50 days (IQR = 46-54). The mean follow-up was 36.5 months (SD = 30.2). The cumulative incidence of local, pelvic and distant failures was 19% (n = 5), 7% (n = 2) and 26% (n = 7), respectively. Five-year overall survival was 63% (95% CI = 43-91). Late urinary and gastro intestinal toxicities ≥ grade 2 were reported in four (15%) and two patients (7%) respectively. No vaginal toxicity ≥ grade 2 was reported. CONCLUSIONS EBRT followed by intracavitary brachytherapy seems to be an effective option for IEC. The implementation of 3D concepts at time of brachytherapy may contribute to high local control probability and low toxicity profile. Large scale retrospective or prospective data are needed to confirm these early data.
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Affiliation(s)
- S Espenel
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, 114 Rue Edouard Vaillant, 94800 Villejuif, France.
| | - M Kissel
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, 114 Rue Edouard Vaillant, 94800 Villejuif, France.
| | - M A Garcia
- Department of Public Health, Lucien Neuwirth Cancer Institute, 108 bis avenue Albert Raimond, BP60008, 42271 Saint-Priest-en-Jarez, France
| | - A Schernberg
- Department of Radiation Oncology, Institut Curie, 26 Rue d'Ulm, 75005 Paris, France
| | - S Gouy
- Department of Surgery, Gustave Roussy Cancer Campus, 114 Rue Edouard Vaillant, 94800 Villejuif, France.
| | - S Bockel
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, 114 Rue Edouard Vaillant, 94800 Villejuif, France.
| | - E Limkin
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, 114 Rue Edouard Vaillant, 94800 Villejuif, France.
| | - E Fabiano
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, 114 Rue Edouard Vaillant, 94800 Villejuif, France.
| | - N Meillan
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, 114 Rue Edouard Vaillant, 94800 Villejuif, France.
| | - N Magné
- Department of Radiation Oncology, Lucien Neuwirth Cancer Institute, 108 bis avenue Albert Raimond, BP60008, 42271 Saint-Priest-en-Jarez, France.
| | - A Leary
- Department of Medical Oncology, Gustave Roussy Cancer Campus, 114 Rue Edouard Vaillant, 94800 Villejuif, France.
| | - P Pautier
- Department of Medical Oncology, Gustave Roussy Cancer Campus, 114 Rue Edouard Vaillant, 94800 Villejuif, France.
| | - P Morice
- Department of Surgery, Gustave Roussy Cancer Campus, 114 Rue Edouard Vaillant, 94800 Villejuif, France; Paris Saclay University, Kremlin Bicêtre, 63 Rue Gabriel Péri, 94270 Le Kremlin-Bicêtre, France.
| | - I Fumagalli
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, 114 Rue Edouard Vaillant, 94800 Villejuif, France
| | - C Haie-Meder
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, 114 Rue Edouard Vaillant, 94800 Villejuif, France.
| | - C Chargari
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, 114 Rue Edouard Vaillant, 94800 Villejuif, France; Paris Saclay University, Kremlin Bicêtre, 63 Rue Gabriel Péri, 94270 Le Kremlin-Bicêtre, France; Institut de Recherche Biomédicale des Armées, D19, 91220 Brétigny sur Orge, France.
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26
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Leblanc E, Narducci F, Hudry D, Mailliez A, Lemaire AS, Tresch-Bruneel E, Salzet M, Pomel C, Caquant F, Houvenaeghel G, Charvolin JY, Crouzet A, Guyon F, Fouche Y, Ferron G, Gouy S, Vaini-Cowen V, Fourchotte V, Golfier F, Collinet P. Results of a prospective phase II national study: Prophylactic radical fimbriectomy (NCT01608074), in women with a documented high risk of breast/ovarian cancer—Final pathological results and outcomes. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.1594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
1594 Background: Risk-reducing salpingo-oophorectomy (RRSO) is the gold standard in surgical prophylaxis of pelvic high-grade serous carcinoma (HGSC) for women at risk of breast/ovarian cancer. Due to significant adverse effects of early oophorectomy, 20-30% of women delay or deny performing this operation. Recent data highlight the fallopian origin of most pelvic HGSC, especially its fimbrial part. Thus, we suggested a new two-step risk-reducing procedure: the radical fimbriectomy (RF) with delayed oophorectomy (DO) (Leblanc et al Gyn Oncol 2011), leading to the current RF/DO Phase 2 study. We present the definitive results on primary and secondary objectives of this trial. Methods: BRCA1/2 carriers or any women with a documented familial risk of breast/ovarian cancer were first counseled to perform a classical laparoscopic RRSO. If they denied, they were offered to enter the RF/DO study. All specimens were submitted to the SEE-FIM pathological protocol. Pathological data along with all intra- and 30-day and beyond post-operative adverse events were prospectively recorded. Follow-up consisted in an annual clinical breast and gynecological examination, with tumor markers and hormonal status assessment. Primary endpoint was the rate of pelvic serous carcinoma. Secondary endpoints were procedure morbidity, rates of tubal abnormalities, breast cancer, secondary oophorectomy. Results: From January 2012 to October 2014, 121 RF were performed: 120 by laparoscopy, 1 laparotomy (concurrent myomectomy). An occult neoplasia was found in 3 cases with 1 invasive HGSC. Intraoperative complications were two grade1 bleedings without transfusion with no grade ≥3 early post-operative or delayed complication. With a median follow-up of 5.3 years (0.2 -7.6), no patient developed any pelvic HGSC, 21 patients developed a breast cancer (3 de novo, 18 recurrences/contralateral.). 1 cancer-free BRCA1-mutated lady delivered safe twins, after an uneventful post-RF pregnancy obtained with assisted reproductive technology (ART). Overall, 29 women underwent DO (by choice: 12 or menopause: 17) resulting in grade 3b complication in 1 case, but no pathological abnormality. Conclusions: RF/DO appears as a safe, well tolerated and effective procedure in terms of occult neoplasia detection. A successful pregnancy with ART was possible after radical fimbriectomy. Longer follow-up and larger cohort are necessary to confirm its efficacy in terms of ovarian cancer prophylaxis. Clinical trial information: NCT01608074.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Sebastien Gouy
- Department of Surgery, Gustave Roussy Cancer Centre, Villejuif, France
| | | | | | - Francois Golfier
- Centre de Reference des Maladies Trophoblastiques, Centre Hospitalier Lyon-Sud, EMR3738, Université Lyon 1, Lyon, France
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Leary A, el Hazzaz R, Le Formal A, Lecerf E, Brizais C, Colomba Blameble E, Gouy S, Maulard A, Boursin Y, Pautier P. ctDNA from ascites as an alternative to tumor sampling for HRD (homologous recombination deficiency) testing in ovarian cancer (OC). J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.6066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6066 Background: Knowledge regarding HRD status is becoming crucial to guide maintenance strategies for patients with newly diagnosed OC. Unfortunately, for patients (pts) treated with neoadjuvant chemotherapy (NACT), HRD testing on small biopsies from diagnostic laparoscopies (Dx Lap) or interval debulking has a high failure rate. At relapse, biopsies may not be feasible. Aim: Evaluate the feasibility and usefulness of HRD testing on cfDNA from ascites Methods: Pts enrolled in a prospective biological study (OvBIOMark) consented to analysis of biological samples obtained as part of routine diagnosis. cfDNA was extracted from 1-2ml of double-centrifuged fresh ascites and subjected to 1) targeted NGS including the most common somatic mutations in high grade ovarian cancer ( TP53) to confirm presence of tumor cfDNA and 2) SNParray for copy number (CN) analyses to calculate a genomic instability score (GIS) for HRD. Results: Thirty four ascites samples were collected from 25 pts with suspected or confirmed OC. For 15/25 pts samples were obtained at Dx Lap, and for 10 pts samples were obtained at relapse. Seven pts underwent repeat ascitic drains during treatment or at relapse. 97% (33/34) of ascitic samples had detectable cfDNA (median = 980ng, range:80-5730ng) even when obtained during chemotherapy. A deleterious mutation was identified in 87% (29/33) of samples with high allelic frequencies (median allelic frequency, AF = 60%; 3.3-87%), confirming that most of detected cfDNA was tumoral. The most common mutation was a TP53m (86%; 25/29). We have performed CN analysis on cfDNA from ascites on 17 of these patients to evaluate their HRD status. Ten pts had a high GIS (HRD+), and 7 pts a low GIS (HRD-). The 4 pts with confirmed BRCAm included in this study had a high GIS on ascites. When available from the same patient, the CN profiles derived from ascites cfDNA and tumor sampling were superimposable. Conclusions: Ascites yields large amounts of cfDNA, which can be confirmed as tumoral based on TP53 mutation detection. CN analysis on ascitic cfDNA is feasible and can be used to detect the same HRD scar as tumor testing. Ascites is frequent at diagnosis, especially in pts with inoperable disease planned for NACT and could provide a useful alternative to tumor for HRD and BRCA testing.
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Affiliation(s)
| | | | | | | | - Chloé Brizais
- Gustave Roussy Cancer center, INSERM U981, Villejuif, France
| | | | - Sebastien Gouy
- Department of Surgery, Gustave Roussy Cancer Centre, Villejuif, France
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Joseph A, Castedo-Delrieu M, Bloy N, Labaied N, Mondini M, Loi M, Klein C, Genestie C, Pautier P, Morice P, Gouy S, Deutsch E, Chargary C, Kroemer G, Michels J. Prognostic value of dendritic cells in locally advanced cervical cancer patients. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e18016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e18016 Background: Cervical cancer is a Human papillomaviruses (HPV)-related disease. T cell infiltration is reported to be associated with a positive prognosis. We evaluated the prognostic value of the tumor-infiltrating dendritic cells (DC). Targeting this immune compartment might be clinically relevant. Methods: We characterized by immunohistochemistry the Dendritic cell lysosomal associated membrane glycoprotein (DC-Lamp) and CD8 T cell infiltration (high/low according to the median density) in patients with locally advanced cervical cancer (LACC) undergoing curative-intent concurrent chemoradiation followed by uterovaginal brachytherapy boost. They were treated in our institution between March 2004 and August 2011. The image acquisition was performed with a Zeiss Axio Scan Z1 microscope. CD8 T cells were detected using an algorithm created in Visiopharm software on manually selected regions of interest (ROI) and DC-Lamp was detected manually. We exported the number of cells and the surface of ROI to calculate the density. Results: A total of 91 patients were identified, with a median follow-up of 4.2 years (range: 0.1-10.3). Patient’s characteristics are listed in the table. DC-Lamphigh (n = 45) LACC patients showed a positive prognosis for overall survival (OS) by univariate (Odds Ratio (OR) = 0.20 [0.06 – 0.72], p = 0.013) and multivariate analyses (incorporating FIGO stage) (OR = 0.17 [0.05 – 0.61], p = 0.006). There was a positive correlation between DC-Lamp and CD8 (R = 0,25 et p = 0,095), which is significant in squamous cell carcinoma patients (R = 0.38, p = 0.039). There was a trend for improved risk stratification for the simultaneous assessment of DC-Lamp and CD8 levels, with DC-Lamphigh/CD8high patients having the best prognosis and DC-Lamplow/CD8low patients having the worst prognosis (p = 0.074). Conclusions: LACC patients with high intratumoral DC density have a favorable outcome. These results underscore the clinical potential of therapeutic strategies that target DC (e.g. Toll like receptor agonists) to render more patients responsive to immune checkpoint blockers. [Table: see text]
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Affiliation(s)
- Adrien Joseph
- Institut National de la Santé et de la Recherche Médicale, U1138, Centre de Recherche des Cordeliers, Equipe 11 Labellisée Ligue Nationale Contre le Cancer, Paris, France
| | - Maria Castedo-Delrieu
- Institut National de la Santé et de la Recherche Médicale, U1138, Centre de Recherche des Cordeliers, Equipe 11 Labellisée Ligue Nationale Contre le Cancer, Paris, France
| | - Norma Bloy
- Institut National de la Santé et de la Recherche Médicale, U1138, Centre de Recherche des Cordeliers, Equipe 11 Labellisée Ligue Nationale Contre le Cancer, Paris, France
| | - Nizar Labaied
- Department of Pathology, Gustave Roussy Comprehensive Cancer Center, Villejuif, France
| | - Michele Mondini
- INSERM U1030, Gustave Roussy Cancer Campus, Villejuif, France
| | - Mauro Loi
- University of Florence, Florence, Italy
| | | | | | - Patricia Pautier
- GINECO, French Sarcoma Group and Gustave Roussy Cancer Center, Villejuif, France
| | - Philippe Morice
- Department of Surgery, Gustave Roussy Cancer Centre, Villejuif, France
| | - Sebastien Gouy
- Department of Surgery, Gustave Roussy Cancer Centre, Villejuif, France
| | | | - Cyrus Chargary
- Radiotherapy Department, Brachytherapy Unit, Gustave Roussy Cancer Campus, Villejuif, France
| | | | - Judith Michels
- Gustave Roussy Comprehensive Cancer Center, Villejuif, France
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Holub K, Busato F, Gouy S, Sun R, Pautier P, Genestie C, Morice P, Leary A, Deutsch E, Haie-Meder C, Biete A, Chargari C. Analysis of Systemic Inflammatory Factors and Survival Outcomes in Endometrial Cancer Patients Staged I-III FIGO and Treated with Postoperative External Radiotherapy. J Clin Med 2020; 9:E1441. [PMID: 32408668 PMCID: PMC7291051 DOI: 10.3390/jcm9051441] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 02/27/2020] [Revised: 03/24/2020] [Accepted: 03/31/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The causal link between elevated systemic inflammation biomarkers and poor survival has been demonstrated in cancer patients. However, the evidence for this correlation in endometrial cancer (EC) is too weak to influence current criteria of risk assessment. Here, we examined the role of inflammatory indicators as a tool to identify EC patients at higher risk of death in a retrospective observational study. METHODS A total of 155 patients surgically diagnosed with EC stage I-III FIGO 2009 and treated with postoperative External Beam Radiotherapy (EBRT) ± brachytherapy and chemotherapy according to ESMO-ESTRO-ESGO recommendation for patients at high risk of recurrence at the Gustave Roussy Institut, France, and Hospital Clínic, Spain, between 2008 and 2017 were evaluated. The impact of pre-treatment Neutrophil-to-Lymphocyte Ratio (NLR ≥ 2.2), Monocyte-to-Lymphocyte Ratio (MLR ≥ 0.18), Systemic Immune-Inflammatory Index (SII ≥ 1100) and lymphopenia (<1.0×109/L) on overall survival (OS), cancer-specific survival and progression-free survival was evaluated. Subsequently, a cohort of 142 patients within high-advanced risk groups according to ESMO-ESGO-ESTRO classification was evaluated. RESULTS On univariate analysis, NLR (HR = 2.2, IC 95% 1.1-4.7), SII (HR = 2.2, IC 95% 1.1-4.6), MLR (HR = 5.0, IC 95% 1.1-20.8) and lymphopenia (HR = 3.8, IC 95% 1.6-9.0) were associated with decreased OS. On multivariate analysis, NLR, MLR, SII and lymphopenia proved to be independent unfavorable prognostic factors. CONCLUSIONS lymphopenia and lymphocytes-related ratio are associated with poorer outcome in surgically staged I-III FIGO EC patients classified as high risk and treated with adjuvant EBRT and could be considered at cancer diagnosis. External validation in an independent cohort is required before implementation for patients' stratification.
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Affiliation(s)
- Katarzyna Holub
- Radiation Oncology Department, Hospital Clinic de Barcelona, University of Barcelona, 08036 Barcelona, Spain;
- Radiotherapy Department, Gustave Roussy Cancer Campus, 94800 Villejuif, France; (F.B.); (R.S.); (E.D.); (C.H.-M.); (C.C.)
| | - Fabio Busato
- Radiotherapy Department, Gustave Roussy Cancer Campus, 94800 Villejuif, France; (F.B.); (R.S.); (E.D.); (C.H.-M.); (C.C.)
| | - Sebastien Gouy
- Surgery Department, Gustave Roussy Cancer Campus, 94800 Villejuif, France; (S.G.); (P.M.)
| | - Roger Sun
- Radiotherapy Department, Gustave Roussy Cancer Campus, 94800 Villejuif, France; (F.B.); (R.S.); (E.D.); (C.H.-M.); (C.C.)
| | - Patricia Pautier
- Medical Oncology Department, Gustave Roussy Cancer Campus, 94800 Villejuif, France; (P.P.); (A.L.)
| | - Catherine Genestie
- Pathology Department, Gustave Roussy Cancer Campus, 94800 Villejuif, France;
| | - Philippe Morice
- Surgery Department, Gustave Roussy Cancer Campus, 94800 Villejuif, France; (S.G.); (P.M.)
| | - Alexandra Leary
- Medical Oncology Department, Gustave Roussy Cancer Campus, 94800 Villejuif, France; (P.P.); (A.L.)
| | - Eric Deutsch
- Radiotherapy Department, Gustave Roussy Cancer Campus, 94800 Villejuif, France; (F.B.); (R.S.); (E.D.); (C.H.-M.); (C.C.)
| | - Christine Haie-Meder
- Radiotherapy Department, Gustave Roussy Cancer Campus, 94800 Villejuif, France; (F.B.); (R.S.); (E.D.); (C.H.-M.); (C.C.)
| | - Albert Biete
- Radiation Oncology Department, Hospital Clinic de Barcelona, University of Barcelona, 08036 Barcelona, Spain;
| | - Cyrus Chargari
- Radiotherapy Department, Gustave Roussy Cancer Campus, 94800 Villejuif, France; (F.B.); (R.S.); (E.D.); (C.H.-M.); (C.C.)
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Kubelac P, Genestie C, Auguste A, Mesnage S, Le Formal A, Pautier P, Gouy S, Morice P, Bentivegna E, Maulard A, Adam J, Achimas-Cadariu P, Leary A. Changes in DNA Damage Response Markers with Treatment in Advanced Ovarian Cancer. Cancers (Basel) 2020; 12:E707. [PMID: 32192091 PMCID: PMC7140046 DOI: 10.3390/cancers12030707] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 03/08/2020] [Accepted: 03/11/2020] [Indexed: 12/19/2022] Open
Abstract
Ovarian cancer (OC) is sensitive to upfront chemotherapy, which is likely attributable to defects in DNA damage repair (DDR). Unfortunately, patients relapse and the evolution of DDR competency are poorly described. We examined the expression of proposed effectors in homologous recombination (HR: RAD51, ATM, FANCD2), error-prone non-homologous end-joining (NHEJ: 53BP1), and base excision repair pathways (BER: PAR and PARP1) in a cohort of sequential OC samples obtained at diagnosis, after neoadjuvant chemotherapy (NACT), and/or at relapse from a total of 147 patients. Immunohistochemical (IHC) expression was quantified using the H-score (0-300), where H ≤ 10 defined negativity. Before NACT, a significant number of cases lacked the expression of some effectors: 60%, 60%, and 24% were PAR-, FANCD2-, or RAD51-negative, with a reassuringly similar proportion of negative biomarkers after NACT. In multivariate analysis, there was a poorer progression-free survival (PFS) and overall survival (OS) for cases with competent HR at diagnosis (PRE-NACT 53BP1-/RAD51+, hazard ratio (HR) 3.13, p = 0.009 and HR 2.78, p = 0.024) and after NACT (POST-NACT FANCD2+/RAD51+ HR 1.89, p = 0.05 and HR 2.38, p = 0.02; POST-NACT PARP-1+/RAD51+ HR 1.79, p = 0.038 and HR 2.04, p = 0.034), reflecting proficient DNA repair. Overall, HR-competent tumors appeared to have a dismal prognosis in comparison with tumors utilizing NHEJ, as assessed either at baseline or post-NACT. Accurate knowledge of the HR status during treatment is clinically important for the efficient timing of platinum-based and targeted therapies with poly(ADP-ribose) polymerase inhibitors (PARPi).
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Affiliation(s)
- Paul Kubelac
- Department of Oncology, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj Napoca, Romania; (P.K.); (P.A.-C.)
- The Oncology Institute “Prof. Dr. Ion Chiricuta”, 400015 Cluj Napoca, Romania
| | - Catherine Genestie
- INSERM U981, Gustave Roussy Cancer Center, 94805 Villejuif, France; (C.G.); (A.A.); (S.M.); (A.L.F.)
- Gustave Roussy Cancer Center, Department of Pathology, Université Paris-Saclay, 94805 Villejuif, France;
| | - Aurelie Auguste
- INSERM U981, Gustave Roussy Cancer Center, 94805 Villejuif, France; (C.G.); (A.A.); (S.M.); (A.L.F.)
| | - Soizick Mesnage
- INSERM U981, Gustave Roussy Cancer Center, 94805 Villejuif, France; (C.G.); (A.A.); (S.M.); (A.L.F.)
| | - Audrey Le Formal
- INSERM U981, Gustave Roussy Cancer Center, 94805 Villejuif, France; (C.G.); (A.A.); (S.M.); (A.L.F.)
| | - Patricia Pautier
- Gustave Roussy Cancer Center, Department of Medical Oncology, Université Paris-Saclay, 94805 Villejuif, France;
| | - Sebastien Gouy
- Gustave Roussy Cancer Center, Department of Surgery, Université Paris-Saclay, 94805 Villejuif, France; (S.G.); (P.M.); (E.B.); (A.M.)
| | - Philippe Morice
- Gustave Roussy Cancer Center, Department of Surgery, Université Paris-Saclay, 94805 Villejuif, France; (S.G.); (P.M.); (E.B.); (A.M.)
| | - Enrica Bentivegna
- Gustave Roussy Cancer Center, Department of Surgery, Université Paris-Saclay, 94805 Villejuif, France; (S.G.); (P.M.); (E.B.); (A.M.)
| | - Amandine Maulard
- Gustave Roussy Cancer Center, Department of Surgery, Université Paris-Saclay, 94805 Villejuif, France; (S.G.); (P.M.); (E.B.); (A.M.)
| | - Julien Adam
- Gustave Roussy Cancer Center, Department of Pathology, Université Paris-Saclay, 94805 Villejuif, France;
| | - Patriciu Achimas-Cadariu
- Department of Oncology, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj Napoca, Romania; (P.K.); (P.A.-C.)
- The Oncology Institute “Prof. Dr. Ion Chiricuta”, 400015 Cluj Napoca, Romania
| | - Alexandra Leary
- INSERM U981, Gustave Roussy Cancer Center, 94805 Villejuif, France; (C.G.); (A.A.); (S.M.); (A.L.F.)
- Gustave Roussy Cancer Center, Department of Medical Oncology, Université Paris-Saclay, 94805 Villejuif, France;
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Mignot F, Gouy S, Schernberg A, Bockel S, Espenel S, Maulard A, Leary A, Genestie C, Annede P, Kissel M, Fumagalli I, Pautier P, Deutsch E, Haie-Meder C, Morice P, Chargari C. Comprehensive analysis of patient outcome after local recurrence of locally advanced cervical cancer treated with concomitant chemoradiation and image-guided adaptive brachytherapy. Gynecol Oncol 2020; 157:644-648. [PMID: 32173045 DOI: 10.1016/j.ygyno.2020.03.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Accepted: 03/02/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Since dose escalation allowed by image-guided adaptive brachytherapy (IGABT) in locally advanced cervical cancer (LACC), local relapses have become a rare event. Only scarce data are available on the outcome of patients experiencing a local relapse after IGABT. METHODS Between 2004 and 2016, all consecutive patients treated at Gustave Roussy Institute for LACC and receiving concomitant chemoradiation and IGABT were analysed. Clinical and treatment-related prognostic factors for survival after local relapse were searched, in order to potentially identify patients requiring salvage treatment. RESULTS Two hundred and fifty-nine patients were treated during this period. With a median follow-up of 4.1 years, 10.8% (n = 28) had a local relapse. Among these patients, 53.6% had synchronous lymph nodes or distant metastatic relapse and only 13 patients (5% of all patients) had isolated local relapse. After local relapse, median survival was 47 months and three patients were alive at last follow-up. Only three patients with local relapse could receive salvage surgery (10.7%). Metastases occurrence and pelvic wall involvement were the main contraindications (67.9%) for salvage surgery. Among the three patients treated with surgery, two are still alive at last follow-up without significant complication. Improved survival was observed among the two patients who could have surgery (p = .02). Local progression led to serious symptoms in 75% of patients. Only the time interval between brachytherapy and relapse (<1 year) was prognostic for 2-year overall survival (p = .005). CONCLUSION Salvage surgery is feasible in a very low number of highly selected patients with local relapse following IGABT. Local failure is a major cause of severe local symptoms, confirming that every effort should be done to achieve long-term local control through dose escalation.
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Affiliation(s)
- F Mignot
- Brachytherapy Unit, Radiation Oncology, Gustave Roussy, University Paris Saclay, Villejuif, France.
| | - S Gouy
- Department of Surgery, Gustave Roussy, University Paris Saclay, Villejuif, France
| | - A Schernberg
- Brachytherapy Unit, Radiation Oncology, Gustave Roussy, University Paris Saclay, Villejuif, France
| | - S Bockel
- Brachytherapy Unit, Radiation Oncology, Gustave Roussy, University Paris Saclay, Villejuif, France
| | - S Espenel
- Brachytherapy Unit, Radiation Oncology, Gustave Roussy, University Paris Saclay, Villejuif, France
| | - A Maulard
- Department of Surgery, Gustave Roussy, University Paris Saclay, Villejuif, France
| | - A Leary
- Department of Medical Oncology, Gustave Roussy, University Paris Saclay, Villejuif, France
| | - C Genestie
- Department of Pathology, Gustave Roussy, University Paris Saclay, Villejuif, France
| | - P Annede
- Brachytherapy Unit, Radiation Oncology, Gustave Roussy, University Paris Saclay, Villejuif, France
| | - M Kissel
- Brachytherapy Unit, Radiation Oncology, Gustave Roussy, University Paris Saclay, Villejuif, France
| | - I Fumagalli
- Brachytherapy Unit, Radiation Oncology, Gustave Roussy, University Paris Saclay, Villejuif, France
| | - P Pautier
- Department of Medical Oncology, Gustave Roussy, University Paris Saclay, Villejuif, France
| | - E Deutsch
- Brachytherapy Unit, Radiation Oncology, Gustave Roussy, University Paris Saclay, Villejuif, France
| | - C Haie-Meder
- Brachytherapy Unit, Radiation Oncology, Gustave Roussy, University Paris Saclay, Villejuif, France
| | - P Morice
- Department of Surgery, Gustave Roussy, University Paris Saclay, Villejuif, France
| | - C Chargari
- Brachytherapy Unit, Radiation Oncology, Gustave Roussy, University Paris Saclay, Villejuif, France; French Military Health Services Academy, Paris, France; Institut de Recherche Biomédicale des Armées, Brétigny sur Orge, France
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Angeles MA, Mallet E, Rouanet P, Cabarrou B, Méeus P, Lambaudie E, Foucher F, Narducci F, Loaec C, Gouy S, Guyon F, Marchal F, Gladieff L, Martínez-Gómez C, Migliorelli F, Martinez A, Ferron G. Comparison of postoperative complications and quality of life between patients undergoing continent versus non-continent urinary diversion after pelvic exenteration for gynecologic malignancies. Int J Gynecol Cancer 2019; 30:233-240. [PMID: 31796531 DOI: 10.1136/ijgc-2019-000863] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 09/26/2019] [Accepted: 10/01/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Pelvic exenteration and its reconstructive techniques have been associated with high postoperative morbidity and a negative impact on patient quality of life. The aim of our study was to compare postoperative complications and quality of life in patients undergoing continent compared with non-continent urinary diversion after pelvic exenteration for gynecologic malignancies. METHODS We designed a multicenter study of patients from 10 centers who underwent an anterior or total pelvic exenteration with urinary reconstruction for histologically confirmed persistent or recurrent gynecologic malignancy after previous treatment with radiotherapy. From January 2005 to September 2008, we included patients retrospectively, and from September 2008 to May 2009, patients were included prospectively which allowed collection of quality of life data. Demographic, surgical, and follow-up data were analyzed. Postoperative complications were classified according to the Clavien-Dindo classification. Quality of life was assessed using the European Organization for Research and Treatment of Cancer (EORTC)-QLQ-C30 (V.3.0) and EORTC-QLQ-OV28 quality of life questionnaires. We compared patients who underwent a continent urinary diversion with those who underwent a non-continent reconstruction. RESULTS We included 148 patients, 92 retrospectively and 56 prospectively. Among them, 77.4% had recurrent disease and 22.6% persistent disease after the primary treatment. In 70 patients, a urinary continent diversion was performed, and 78 patients underwent a non-continent diversion. Median age of the continent and incontinent groups was 53.5 (range 33-78) years and 57 (26-79) years, respectively. There were no significant differences between the continent and non-continent groups in median length of hospitalization (28.5 vs 26 days, P=0.19), postoperative grade III-IV complications (42.9% vs 42.3%, P=0.95), complications needing surgical (27.9% vs 34.6%, P=0.39) or radiological (14.7% vs 12.8%, P=0.74) intervention, and complication type (digestive (23.2% vs 16.7%, P=0.32) and urinary (15.9% vs 16.7%, P=0.91)). There were no significant differences between the groups in global health, global quality of life, and body image perception scores 1 year after surgery. CONCLUSION Continent and incontinent urinary reconstructions are equivalent in terms of postoperative complications and quality of life scores.
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Affiliation(s)
- Martina Aida Angeles
- Surgical Oncology, Institut Claudius Regaud IUCT-oncopole, Toulouse, Occitanie, France
| | - Estelle Mallet
- Surgical Oncology, Centre Antoine-Lacassagne, Nice, Provence-Alpes-Côte d'Azu, France
| | - Philippe Rouanet
- Department of Surgical Oncology, Institut régional du Cancer de Montpellier, Montpellier, France
| | - Bastien Cabarrou
- Biostatistics Unit, Institut Claudius Regaud, Toulouse, Occitanie, France
| | - Pierre Méeus
- Department of Surgical Oncology, Institut Léon Bérard, Lyon, France
| | | | - Fabrice Foucher
- Department of Surgical Oncology, Centre Eugene Marquis, Rennes, Bretagne, France
| | | | - Cécile Loaec
- Institut de Cancerologie de l'Ouest, Nantes, France
| | - Sebastien Gouy
- Institut Gustave-Roussy, Villejuif, Île-de-France, France
| | | | - Frédéric Marchal
- Surgical Oncology, Institut de Cancérologie de Lorraine, Vandoeuvre-les-Nancy, Lorraine, France
| | - Laurence Gladieff
- Medical Oncology, Institut Claudius Regaud, Toulouse, Occitanie, France
| | - Carlos Martínez-Gómez
- Surgical Oncology, Institut Claudius Regaud IUCT-oncopole, Toulouse, Occitanie, France.,INSERM CRCT 1, Toulouse, France
| | - Federico Migliorelli
- Department of Women, Children and Adolescents, Hopitaux Universitaires de Geneve, Geneva, Switzerland
| | - Alejandra Martinez
- INSERM CRCT 1, Toulouse, France.,Institut Claudius Regaud, Toulouse, Occitanie, France
| | - Gwenael Ferron
- Institut Claudius Regaud, Toulouse, Occitanie, France .,INSERM CRCT 19, Toulouse, France
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Lécuru F, Bakrin N, Classe JM, Colombo PE, Ferron G, Freyer G, Glehen O, Gouy S, Huchon C, Narducci F, Pocard M, Pomel C, Rouzier R. [CHIP and ovarian cancer]. Gynecol Obstet Fertil Senol 2019; 47:617-618. [PMID: 31252153 DOI: 10.1016/j.gofs.2019.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Indexed: 06/09/2023]
Affiliation(s)
- F Lécuru
- Service de chirurgie cancérologique gynécologique et du Sein, hôpital européen Georges Pompidou, AP-HP, 75015 Paris, France; Faculté de médecine, université Paris Descartes, 75006 Paris, France; UMR S1124, université Paris Descartes, 75006 Paris, France.
| | - N Bakrin
- Chirurgie générale, oncologique et endocrinienne, centre hospitalier Lyon Sud, hospices civils de Lyon, 69495 Pierre-Bénite, France; EMR 3738, faculté Lyon Sud Charles Mérieux, université Lyon 1, 69000 Lyon, France
| | - J M Classe
- Chirurgie oncologique, institut de cancérologie de l'Ouest, 44000 Nantes, France; Faculté de médecine, université de Nantes, 44000 Nantes, France
| | - P E Colombo
- Département de chirurgie, Centre Val d'Aurelle, 34000 Montpellier, France
| | - G Ferron
- Institut universitaire du Cancer, 31100 Toulouse, France
| | - G Freyer
- Service d'onclogie médicale, institut de cancérologie des hospices civils de Lyon, 69000 Lyon, France; Université Lyon 1, 69000 Lyon, France
| | - O Glehen
- Chirurgie générale, oncologique et endocrinienne, centre hospitalier Lyon Sud, hospices civils de Lyon, 69495 Pierre-Bénite, France; EMR 3738, faculté Lyon Sud Charles Mérieux, université Lyon 1, 69000 Lyon, France
| | - S Gouy
- Département de chirurgie, institut Gustave Roussy, 94800 Villejuif, France
| | - C Huchon
- Service de gynécologie et obstétrique, université Versailles-Saint-Quentin en Yvelines, CHI Poissy-St-Germain, 10, rue du champ Gaillard, BP 3082, 78303 Poissy cedex, France; EA 7285 Risques cliniques et sécurité en santé des femmes, université Versailles-Saint-Quentin en Yvelines, 78000 Versailles, France
| | - F Narducci
- Centre Oscar Lambret, 59000 Lille, France
| | - M Pocard
- Unité Inserm U1275, université Paris 7, CAP Paris-Tech : Carcinose Péritoine Paris technologique, hôpital Lariboisière, 2, rue Ambroise Paré, 75475 Paris cedex 10, France; Chirurgie digestive cancérologique, hôpital Lariboisière, Assistance publique des Hôpitaux de Paris, 2, rue Ambroise Paré, 75475 Paris cedex 10, France
| | - C Pomel
- Service de chirurgie oncologique, Centre Jean Perrin, 63011 Clermont-Ferrand, France; Université d'Auvergne, 63011 Clermont-Ferrand, France
| | - R Rouzier
- Département de chirurgie, institut Curie, 92210 Saint-Cloud, France; Université Versailles St Quentin, 78000 Versailles, France
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Chargari C, Deutsch E, Blanchard P, Gouy S, Martelli H, Guérin F, Dumas I, Bossi A, Morice P, Viswanathan AN, Haie-Meder C. Brachytherapy: An overview for clinicians. CA Cancer J Clin 2019; 69:386-401. [PMID: 31361333 DOI: 10.3322/caac.21578] [Citation(s) in RCA: 127] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Brachytherapy is a specific form of radiotherapy consisting of the precise placement of radioactive sources directly into or next to the tumor. This technique is indicated for patients affected by various types of cancers. It is an optimal tool for delivering very high doses to the tumor focally while minimizing the probability of normal tissue complications. Physicians from a wide range of specialties may be involved in either the referral to or the placement of brachytherapy. Many patients require brachytherapy as either primary treatment or as part of their oncologic care. On the basis of high-level evidence from randomized controlled trials, brachytherapy is mainly indicated: 1) as standard in combination with chemoradiation in patients with locally advanced cervical cancer; 2) in surgically treated patients with uterine endometrial cancer for decreasing the risk of vaginal vault recurrence; 3) in patients with high-risk prostate cancer to perform dose escalation and improve progression-free survival; and 4) in patients with breast cancer as adjuvant, accelerated partial breast irradiation or to boost the tumor bed. In this review, the authors discuss the clinical relevance of brachytherapy with a focus on indications, levels of evidence, and results in the overall context of radiation use for patients with cancer.
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Affiliation(s)
- Cyrus Chargari
- Department of Radiation Oncology, Gustave Roussy Comprehensive Cancer Center, Villejuif, France
- French Military Health Academy, Paris, France
| | - Eric Deutsch
- Department of Radiation Oncology, Gustave Roussy Comprehensive Cancer Center, Villejuif, France
- Faculty of Medicine, Paris-South University/Paris Saclay, Paris, France
- Molecular Radiotherapy Unit 1030, National Institute of Health and Medical Research (INSERM), Paris, France
| | - Pierre Blanchard
- Department of Radiation Oncology, Gustave Roussy Comprehensive Cancer Center, Villejuif, France
| | - Sebastien Gouy
- Department of Surgery, Gustave Roussy Comprehensive Cancer Center, Villejuif, France
| | - Hélène Martelli
- Department of Pediatric Surgery, Kremlin Bicetre University Hospital, Kremlin Bicetre, France
| | - Florent Guérin
- Department of Pediatric Surgery, Kremlin Bicetre University Hospital, Kremlin Bicetre, France
| | - Isabelle Dumas
- Department of Radiation Oncology, Gustave Roussy Comprehensive Cancer Center, Villejuif, France
| | - Alberto Bossi
- Department of Radiation Oncology, Gustave Roussy Comprehensive Cancer Center, Villejuif, France
| | - Philippe Morice
- Department of Surgery, Gustave Roussy Comprehensive Cancer Center, Villejuif, France
- Paris-South University/Paris Saclay, Paris, France
| | - Akila N Viswanathan
- Department of Radiation Oncology, Johns Hopkins Medicine, Baltimore, Maryland
| | - Christine Haie-Meder
- Department of Radiation Oncology, Gustave Roussy Comprehensive Cancer Center, Villejuif, France
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Lavoue V, Huchon C, Akladios C, Alfonsi P, Bakrin N, Ballester M, Bendifallah S, Bolze P, Bonnet F, Bourgin C, Chabbert-Buffet N, Collinet P, Courbiere B, De la motte rouge T, Devouassoux-Shisheboran M, Falandry C, Ferron G, Fournier L, Gladieff L, Golfier F, Gouy S, Guyon F, Lambaudie E, Leary A, Lecuru F, Lefrere-Belda M, Leblanc E, Lemoine A, Narducci F, Ouldamer L, Pautier P, Planchamp F, Pouget N, Ray-Coquard I, Rousset-Jablonski C, Senechal-Davin C, Touboul C, Thomassin-Naggara I, Uzan C, You B, Daraï E. Management of epithelial cancer of the ovary, fallopian tube, primary peritoneum. Long text of the joint French clinical practice guidelines issued by FRANCOGYN, CNGOF, SFOG, GINECO-ARCAGY, endorsed by INCa. (Part 2: systemic, intraperitoneal treatment, elderly patients, fertility preservation, follow-up). J Gynecol Obstet Hum Reprod 2019; 48:379-386. [DOI: 10.1016/j.jogoh.2019.03.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 03/19/2019] [Indexed: 10/27/2022]
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Chargari C, Haie-Meder C, Gouy S, Deutsch E. SP-0123 Improving outcomes in high-risk locally advanced cervical cancer: extended field RT, adjuvant chemotherapy or immunotherapy? Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30543-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Lavoue V, Huchon C, Akladios C, Alfonsi P, Bakrin N, Ballester M, Bendifallah S, Bolze PA, Bonnet F, Bourgin C, Chabbert-Buffet N, Collinet P, Courbiere B, De la Motte Rouge T, Devouassoux-Shisheboran M, Falandry C, Ferron G, Fournier L, Gladieff L, Golfier F, Gouy S, Guyon F, Lambaudie E, Leary A, Lecuru F, Lefrere-Belda MA, Leblanc E, Lemoine A, Narducci F, Ouldamer L, Pautier P, Planchamp F, Pouget N, Ray-Coquard I, Rousset-Jablonski C, Senechal-Davin C, Touboul C, Thomassin-Naggara I, Uzan C, You B, Daraï E. Management of epithelial cancer of the ovary, fallopian tube, and primary peritoneum. Long text of the Joint French Clinical Practice Guidelines issued by FRANCOGYN, CNGOF, SFOG, and GINECO-ARCAGY, and endorsed by INCa. Part 1: Diagnostic exploration and staging, surgery, perioperative care, and pathology. J Gynecol Obstet Hum Reprod 2019; 48:369-378. [PMID: 30936027 DOI: 10.1016/j.jogoh.2019.03.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 03/19/2019] [Indexed: 11/27/2022]
Abstract
An MRI is recommended for an ovarian mass that is indeterminate on ultrasound. The ROMA score (combining CA125 and HE4) can also be calculated (grade A). In presumed early-stage ovarian or tubal cancers, the following procedures should be performed: an omentectomy (at a minimum, infracolic), an appendectomy, multiple peritoneal biopsies, peritoneal cytology (grade C), and pelvic and para-aortic lymphadenectomies (grade B) for all histologic types, except the expansile mucinous subtypes, for which lymphadenectomies can be omitted (grade C). Minimally invasive surgery is recommended for early-stage ovarian cancer, when there is no risk of tumor rupture (grade B). For FIGO stages III or IV ovarian, tubal, and primary peritoneal cancers, a contrast-enhanced computed tomography (CT) scan of the thorax/abdomen/pelvis is recommended (grade B), as well as laparoscopic exploration to take multiple biopsies (grade A) and a carcinomatosis score (Fagotti score at a minimum) (grade C) to assess the possibility of complete surgery (i.e., leaving no macroscopic tumor residue). Complete surgery by a midline laparotomy is recommended for advanced ovarian, tubal, or primary peritoneal cancer (grade B). For advanced cancers, para-aortic and pelvic lymphadenectomies are recommended when metastatic adenopathy is clinically or radiologically suspected (grade B). When adenopathy is not suspected and when complete peritoneal surgery is performed as the initial surgery for advanced cancer, the lymphadenectomies can be omitted because they do not modify either the medical treatment or overall survival (grade B). Primary surgery (before other treatment) is recommended whenever it appears possible to leave no tumor residue (grade B).
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Affiliation(s)
- V Lavoue
- Service de gynécologie, CHU de Rennes, Hôpital sud, 16 Bd de Bulgarie, 35000 Rennes, France; INSERM 1242, Chemistry, Oncogenesis, Stress and Signaling, Centre Eugène Marquis, Rue Bataille Flandres-Dunkerques, Rennes, France.
| | - C Huchon
- Service de Gynécologie, CHI Poissy, France
| | - C Akladios
- Service de Gynécologie, Hôpital Hautepierre, CHU Strasbourg, France
| | - P Alfonsi
- Service d'Anesthésie, Hôpital Saint Joseph, Paris, France
| | - N Bakrin
- Service de chirurgie digestive, CHU Lyon-Sud, Pierre-Bénite, Lyon, France
| | - M Ballester
- Service de gynécologie, GH Diaconesses Croix Saint Simon, Paris, France
| | - S Bendifallah
- Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Hôpital Tenon, 4 rue de La Chine, APHP, Institut Universitaire de Cancérologie Sorbonne Université, UMRS-938, France
| | - P A Bolze
- Service de chirurgie gynécologique, CHU Lyon-Sud, Pierre Bénite, Lyon, France
| | - F Bonnet
- Service d'anesthésie, Hôpital Tenon, AP-HP, Paris, France
| | - C Bourgin
- Service de Chirurgie Gynécologique, Hôpital Jeanne de Flandres, CHRU, Lille, France
| | - N Chabbert-Buffet
- Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Hôpital Tenon, 4 rue de La Chine, APHP, Institut Universitaire de Cancérologie Sorbonne Université, UMRS-938, France
| | - P Collinet
- Service de Chirurgie Gynécologique, Hôpital Jeanne de Flandres, CHRU, Lille, France
| | - B Courbiere
- Pôle Femmes-Parents-Enfants - Centre Clinico-Biologique d'AMP, AP-HM La Conception, 147 bd Baille, 13005 Marseille/Aix Marseille Université, CNRS, IRD, Avignon Université, IMBE UMR 7263, 13397 Marseille, France
| | | | | | - C Falandry
- Service d'oncogériatrie, Hospices civiles de Lyon, CHU Lyon-Sud, Pierre-Bénite, Lyon, France
| | - G Ferron
- Service d'oncologie chirurgicale, Institut Claudius Regaud, IUCT Oncopole, Toulouse, France
| | - L Fournier
- Service de radiologie, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
| | - L Gladieff
- Service d'oncologie médicale, Institut Claudius Regaud, IUCT Oncopole, Toulouse, France
| | - F Golfier
- Service de chirurgie gynécologique, CHU Lyon-Sud, Pierre Bénite, Lyon, France
| | - S Gouy
- Service de chirurgie, Institut Gustave Roussy, Villejuif, France
| | - F Guyon
- Service de chirurgie, Institut Bergonié, Bordeaux, France
| | - E Lambaudie
- Service de chirurgie, Institut Paoli Calmette, Marseille, France
| | - A Leary
- Service d'oncologie médicale, Institut Gustave Roussy, Villejuif, France
| | - F Lecuru
- Service de chirurgie gynécologique et oncologique, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
| | - M A Lefrere-Belda
- Service d'anatomo-pathologie, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
| | - E Leblanc
- Service de chirurgie, Centre Oscar Lambret, Lille, France
| | - A Lemoine
- Service d'anesthésie, Hôpital Tenon, AP-HP, Paris, France
| | - F Narducci
- Service de chirurgie, Centre Oscar Lambret, Lille, France
| | - L Ouldamer
- Service de chirurgie gynécologique, CHU de Tours, France
| | - P Pautier
- Service d'oncologie médicale, Institut Gustave Roussy, Villejuif, France
| | - F Planchamp
- Service de méthodologie, Institut Bergonié, Bordeaux, France
| | - N Pouget
- Service de chirurgie, Curie (site Saint Cloud), Paris, France
| | - I Ray-Coquard
- Service d'oncologie médicale, Centre Léon Bérard, Lyon, France
| | | | | | - C Touboul
- Service de chirurgie gynécologique, CHI de Créteil, Créteil, France
| | | | - C Uzan
- Service de chirurgie et cancérologie gynécologique et mammaire, Hôpital Pitié Salpêtrière, Institut Universitaire de Cancérologie, Sorbonne Université, INSERM U938, France
| | - B You
- Service d'oncologie médicale, Institut de cancérologie des Hospices Civils de Lyon, Pierre-Bénite, Lyon, Paris, France
| | - E Daraï
- Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Hôpital Tenon, 4 rue de La Chine, APHP, Institut Universitaire de Cancérologie Sorbonne Université, UMRS-938, France
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Affiliation(s)
- Philippe Morice
- From the Departments of Gynecological Surgery and Medical Oncology (P.M., S.G., A.L.), INSERM Unit 981 (A.L.), and INSERM Unit 10-30 (P.M.), Gustave Roussy Cancer Campus, Villejuif, and University Paris-Sud (Paris XI), Le Kremlin Bicêtre (P.M.) - both in France
| | - Sebastien Gouy
- From the Departments of Gynecological Surgery and Medical Oncology (P.M., S.G., A.L.), INSERM Unit 981 (A.L.), and INSERM Unit 10-30 (P.M.), Gustave Roussy Cancer Campus, Villejuif, and University Paris-Sud (Paris XI), Le Kremlin Bicêtre (P.M.) - both in France
| | - Alexandra Leary
- From the Departments of Gynecological Surgery and Medical Oncology (P.M., S.G., A.L.), INSERM Unit 981 (A.L.), and INSERM Unit 10-30 (P.M.), Gustave Roussy Cancer Campus, Villejuif, and University Paris-Sud (Paris XI), Le Kremlin Bicêtre (P.M.) - both in France
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Lavoué V, Huchon C, Akladios C, Alfonsi P, Bakrin N, Ballester M, Bendifallah S, Bolze PA, Bonnet F, Bourgin C, Chabbert-Buffet N, Collinet P, Courbiere B, De la Motte Rouge T, Devouassoux-Shisheboran M, Falandry C, Ferron G, Fournier L, Gladieff L, Golfier F, Gouy S, Guyon F, Lambaudie E, Leary A, Lécuru F, Lefrère-Belda MA, Leblanc E, Lemoine A, Narducci F, Ouldamer L, Pautier P, Planchamp F, Pouget N, Ray-Coquard I, Rousset-Jablonski C, Sénéchal-Davin C, Touboul C, Thomassin-Naggara I, Uzan C, You B, Daraï E. [Part II drafted from the short text of the French guidelines entitled "Initial management of patients with epithelial ovarian cancer" developed by FRANCOGYN, CNGOF, SFOG, GINECO-ARCAGY and endorsed by INCa. (Systemic and intraperitoneal treatment, elderly, fertility preservation, follow-up)]. ACTA ACUST UNITED AC 2019; 47:111-119. [PMID: 30704955 DOI: 10.1016/j.gofs.2018.12.011] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Indexed: 10/27/2022]
Abstract
Adjuvant chemotherapy with carboplatin and paclitaxel is recommended for all high-grade ovarian or Fallopian tube cancers, stage FIGO I-IIA (grade A). After a complete first surgery, it is recommended to deliver 6 cycles of intravenous (grade A) or to propose intraperitoneal (grade B) chemotherapy, to be discussed with patient, according to the benefit/risk ratio. After a complete interval surgery for a FIGO III stage, the hyperthermic intra peritoneal chemotherapy (HIPEC) can be proposed in the same conditions of the OV-HIPEC trial (grade B). In case of tumor residue after surgery or FIGO stage IV, chemotherapy associated with bevacizumab is recommended (grade A). For BRCA mutated patient, Olaparib is recommended (grade B).
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Affiliation(s)
- V Lavoué
- Service de gynécologie, hôpital sud, CHU de Rennes, 16, boulevard de Bulgarie, 35000 Rennes, France; Inserm 1242, chemistry, oncogenesis, stress and signaling, centre Eugène-Marquis, rue Bataille-Flandres-Dunkerques, 35000 Rennes, France.
| | - C Huchon
- Service de gynécologie, CHI Poissy, 78000 Poissy, France
| | - C Akladios
- Service de gynécologie, hôpital Hautepierre, CHU de Strasbourg, 67000 Strasbourg, France
| | - P Alfonsi
- Service d'anesthésie, hôpital Saint-Joseph, 75014 Paris, France
| | - N Bakrin
- Service de chirurgie digestive, CHU Lyon-Sud, Pierre-Bénite, 69000 Lyon, France
| | - M Ballester
- Service de gynécologie, groupe hospitalier Diaconesses-Croix-Saint-Simon, 75020 Paris, France
| | - S Bendifallah
- Service de gynécologie-obstétrique et médecine de la reproduction, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France; Institut universitaire de cancérologie, UMRS-938, Sorbonne université, 75000 Paris, France
| | - P A Bolze
- Service de chirurgie gynécologique, CHU Lyon-Sud, Pierre-Bénite, 69000 Lyon, France
| | - F Bonnet
- Service d'anesthésie, hôpital Tenon, AP-HP, 75020 Paris, France
| | - C Bourgin
- Service de chirurgie gynécologique, hôpital Jeanne-de-Flandres, CHRU de Lille, 59000 Lille, France
| | - N Chabbert-Buffet
- Service de gynécologie-obstétrique et médecine de la reproduction, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France; Institut universitaire de cancérologie, UMRS-938, Sorbonne université, 75000 Paris, France
| | - P Collinet
- Service de chirurgie gynécologique, hôpital Jeanne-de-Flandres, CHRU de Lille, 59000 Lille, France
| | - B Courbiere
- Pôle Femmes-Parents-Enfants, centre clinico-biologique d'AMP, AP-HM La Conception, 147, boulevard Baille, 13005 Marseille, France; CNRS, IRD, IMBE UMR 7263, Avignon université, Aix Marseille université, 13397 Marseille, France
| | | | - M Devouassoux-Shisheboran
- Service d'anatomo-pathologie, hospices civiles de Lyon, CHU Lyon-Sud, Pierre-Bénite, 69000 Lyon, France
| | - C Falandry
- Service d'oncogériatrie, hospices civiles de Lyon, CHU Lyon-Sud, Pierre-Bénite, 69000 Lyon, France
| | - G Ferron
- Service d'oncologie chirurgicale, institut Claudius-Regaud, IUCT Oncopole, 31000 Toulouse, France
| | - L Fournier
- Service de radiologie, hôpital européen Georges-Pompidou, AP-HP, 75015 Paris, France
| | - L Gladieff
- Service d'oncologie médicale, institut Claudius-Regaud, IUCT Oncopole, 31000 Toulouse, France
| | - F Golfier
- Service de chirurgie gynécologique, CHU Lyon-Sud, Pierre-Bénite, 69000 Lyon, France
| | - S Gouy
- Service de chirurgie, institut Gustave-Roussy, 94000 Villejuif, France
| | - F Guyon
- Service de chirurgie, institut Bergonié, 33000 Bordeaux, France
| | - E Lambaudie
- Service de chirurgie, institut Paoli-Calmette, 13000 Marseille, France
| | - A Leary
- Service d'oncologie médicale, institut Gustave-Roussy, 94000 Villejuif, France
| | - F Lécuru
- Service de chirurgie gynécologique et oncologique, hôpital européen Georges-Pompidou, AP-HP, 75015 Paris, France
| | - M A Lefrère-Belda
- Service d'anatomo-pathologie, hôpital européen Georges-Pompidou, AP-HP, 75015 Paris, France
| | - E Leblanc
- Service de chirurgie, centre Oscar-Lambret, 59000 Lille, France
| | - A Lemoine
- Service d'anesthésie, hôpital Tenon, AP-HP, 75020 Paris, France
| | - F Narducci
- Service de chirurgie, centre Oscar-Lambret, 59000 Lille, France
| | - L Ouldamer
- Service de chirurgie gynécologique, CHU de Tours, 37000 Tours, France
| | - P Pautier
- Service d'oncologie médicale, institut Gustave-Roussy, 94000 Villejuif, France
| | - F Planchamp
- Service de méthodologie, institut Bergonié, 33000 Bordeaux, France
| | - N Pouget
- Service de chirurgie, Curie (site Saint-Cloud), 75000 Paris, France
| | - I Ray-Coquard
- Service d'oncologie médicale, centre Léon-Bérard, 69000 Lyon, France
| | | | | | - C Touboul
- Service de chirurgie gynécologique, CHI de Créteil, 94000 Créteil, France
| | | | - C Uzan
- Service de chirurgie et cancérologie gynécologique et mammaire, hôpital Pitié-Salpêtrière, 75013 Paris, France; Inserm U938, institut universitaire de cancérologie, Sorbonne université, 75000 Paris, France
| | - B You
- Service d'oncologie médicale, institut de cancérologie, hospices civils de Lyon, Pierre-Bénite, 69000 Lyon, France
| | - E Daraï
- Service de gynécologie-obstétrique et médecine de la reproduction, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France; Institut universitaire de cancérologie, UMRS-938, Sorbonne université, 75000 Paris, France
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Lavoué V, Huchon C, Akladios C, Alfonsi P, Bakrin N, Ballester M, Bendifallah S, Bolze PA, Bonnet F, Bourgin C, Chabbert-Buffet N, Collinet P, Courbiere B, De la Motte Rouge T, Devouassoux-Shisheboran M, Falandry C, Ferron G, Fournier L, Gladieff L, Golfier F, Gouy S, Guyon F, Lambaudie E, Leary A, Lécuru F, Lefrère-Belda MA, Leblanc E, Lemoine A, Narducci F, Ouldamer L, Pautier P, Planchamp F, Pouget N, Ray-Coquard I, Rousset-Jablonski C, Sénéchal-Davin C, Touboul C, Thomassin-Naggara I, Uzan C, You B, Daraï E. [Part I drafted from the short text of the French Guidelines entitled "Initial management of patients with epithelial ovarian cancer" developed by FRANCOGYN, CNGOF, SFOG, GINECO-ARCAGY and endorsed by INCa. (Diagnosis management, surgery, perioperative care, and pathological analysis)]. ACTA ACUST UNITED AC 2019; 47:100-110. [PMID: 30686724 DOI: 10.1016/j.gofs.2018.12.010] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Indexed: 10/27/2022]
Abstract
Faced to an undetermined ovarian mass on ultrasound, an MRI is recommended and the ROMA score (combining CA125 and HE4) can be proposed (grade A). In case of suspected early stage ovarian or fallopian tube cancer, omentectomy (at least infracolonic), appendectomy, multiple peritoneal biopsies, peritoneal cytology (grade C) and pelvic and para-aortic lymphadenectomy are recommended (grade B) for all histological types, except for the expansive mucinous subtype where lymphadenectomy may be omitted (grade C). Minimally invasive surgery is recommended for early stage ovarian cancer, if there is no risk of tumor rupture (grade B). Laparoscopic exploration for multiple biopsies (grade A) and to evaluate carcinomatosis score (at least using the Fagotti score) (grade C) are recommended to estimate the possibility of a complete surgery (i.e. no macroscopic residue). Complete medial laparotomy surgery is recommended for advanced cancers (grade B). It is recommended in advanced cancers to perform para-aortic and pelvic lymphadenectomy in case of clinical or radiological suspicion of metastatic lymph node (grade B). In the absence of clinical or radiological lymphadenopathy and in case of complete peritoneal surgery during an initial surgery for advanced cancer, it is possible not to perform a lymphadenectomy because it does not modify the medical treatment and the overall survival (grade B). Primary surgery is recommended when no tumor residue is possible (grade B).
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Affiliation(s)
- V Lavoué
- Service de gynécologie, hôpital sud, CHU de Rennes, 16, boulevard de Bulgarie, 35000 Rennes, France; Inserm 1242, Chemistry, Oncogenesis, Stress and Signaling, Centre Eugène Marquis, rue Bataille Flandres-Dunkerques, 35000 Rennes, France.
| | - C Huchon
- Service de gynécologie, CHI Poissy, 78000 Poissy, France
| | - C Akladios
- Service de gynécologie, hôpital Hautepierre, CHU Strasbourg, 67000 Strasbourg, France
| | - P Alfonsi
- Service d'anesthésie, hôpital Saint-Joseph, 75014 Paris, France
| | - N Bakrin
- Service de chirurgie digestive, CHU Lyon-Sud, Pierre-Bénite, 69000 Lyon, France
| | - M Ballester
- Service de gynécologie, groupe hospitalier Diaconesses Croix Saint Simon, 75020 Paris, France
| | - S Bendifallah
- Service de gynécologie-obstétrique et médecine de la reproduction, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France; UMRS-938, institut universitaire de cancérologie Sorbonne université, 75000 Paris, France
| | - P A Bolze
- Service de chirurgie gynécologique, CHU Lyon-Sud, Pierre-Bénite, 69000 Lyon, France
| | - F Bonnet
- Service d'anesthésie, hôpital Tenon, AP-HP, 75020 Paris, France
| | - C Bourgin
- Service de chirurgie gynécologique, hôpital Jeanne de Flandres, CHRU, 59000 Lille, France
| | - N Chabbert-Buffet
- Service de gynécologie-obstétrique et médecine de la reproduction, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France; UMRS-938, institut universitaire de cancérologie Sorbonne université, 75000 Paris, France
| | - P Collinet
- Service de chirurgie gynécologique, hôpital Jeanne de Flandres, CHRU, 59000 Lille, France
| | - B Courbiere
- Pôle Femmes-Parents-Enfants-Centre Clinico-Biologique d'AMP, AP-HM La Conception, 147, boulevard Baille, 13005 Marseille, France; IMBE UMR 7263, Aix-Marseille université, CNRS, IRD, Avignon université, 13397 Marseille, France
| | | | - M Devouassoux-Shisheboran
- Service d'anatomopathologie, hospices civiles de Lyon, CHU Lyon-Sud, Pierre-Bénite, 69000 Lyon, France
| | - C Falandry
- Service d'oncogériatrie, hospices civiles de Lyon, CHU Lyon-Sud, Pierre-Bénite, 69000 Lyon, France
| | - G Ferron
- Service d'oncologie chirurgicale, institut Claudius Regaud, IUCT Oncopole, 31000 Toulouse, France
| | - L Fournier
- Service de radiologie, hôpital Européen Georges Pompidou, AP-HP, 75015 Paris, France
| | - L Gladieff
- Service d'oncologie médicale, institut Claudius Regaud, IUCT Oncopole, 31000 Toulouse, France
| | - F Golfier
- Service de chirurgie gynécologique, CHU Lyon-Sud, Pierre-Bénite, 69000 Lyon, France
| | - S Gouy
- Service de chirurgie, institut Gustave Roussy, 94000 Villejuif, France
| | - F Guyon
- Service de chirurgie, institut Bergonié, 33000 Bordeaux, France
| | - E Lambaudie
- Service de chirurgie, institut Paoli Calmette, 13000 Marseille, France
| | - A Leary
- Service d'oncologie médicale, institut Gustave Roussy, 94000 Villejuif, France
| | - F Lécuru
- Service de chirurgie gynécologique et oncologique, hôpital Européen Georges Pompidou, AP-HP, 75015 Paris, France
| | - M A Lefrère-Belda
- Service d'anatomopathologie, hôpital Européen Georges Pompidou, AP-HP, 75015 Paris, France
| | - E Leblanc
- Service de chirurgie, Centre Oscar Lambret, 59000 Lille, France
| | - A Lemoine
- Service d'anesthésie, hôpital Tenon, AP-HP, 75020 Paris, France
| | - F Narducci
- Service de chirurgie, Centre Oscar Lambret, 59000 Lille, France
| | - L Ouldamer
- Service de chirurgie gynécologique, CHU de Tours, 37000 Tours, France
| | - P Pautier
- Service d'oncologie médicale, institut Gustave Roussy, 94000 Villejuif, France
| | - F Planchamp
- Service de méthodologie, institut Bergonié, 33000 Bordeaux, France
| | - N Pouget
- Service de chirurgie, Curie (site Saint Cloud), 75000 Paris, France
| | - I Ray-Coquard
- Service d'oncologie médicale, Centre Léon Bérard, 69000 Lyon, France
| | | | | | - C Touboul
- Service de chirurgie gynécologique, CHI de Créteil, 94000 Créteil, France
| | | | - C Uzan
- Service de chirurgie et cancérologie gynécologique et mammaire, hôpital Pitié-Salpêtrière, 75013 Paris, France; Inserm U938, institut universitaire de cancérologie, Sorbonne université, 75000 Paris, France
| | - B You
- Service d'oncologie médicale, institut de cancérologie des hospices Civils de Lyon, Pierre-Bénite, 69000 Lyon Paris, France
| | - E Daraï
- Service de gynécologie-obstétrique et médecine de la reproduction, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France; UMRS-938, institut universitaire de cancérologie Sorbonne université, 75000 Paris, France
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Chargari C, Gouy S, Pautier P, Haie-Meder C. Cancers du col utérin : nouveautés dans la prise en charge en oncologie radiothérapie. Cancer Radiother 2018; 22:502-508. [DOI: 10.1016/j.canrad.2018.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 06/26/2018] [Indexed: 11/30/2022]
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Gouy S, Arfi A, Maulard A, Pautier P, Bentivegna E, Leary A, Chargari C, Genestie C, Morice P. Results from a Monocentric Long-Term Analysis of 23 Patients with Ovarian Sertoli-Leydig Cell Tumors. Oncologist 2018; 24:702-709. [PMID: 30201740 DOI: 10.1634/theoncologist.2017-0632] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [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: 11/29/2017] [Accepted: 05/08/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Sertoli-Leydig cell tumors (SLCTs) represent less than 0.5% of ovarian tumors. Because of the rarity of this tumor and its peak in frequency at around 25 years of age, this study aimed to describe SLCT management strategies. OBJECTIVE The objective of this study was to determine the management (i.e., conservative surgery and adjuvant chemotherapy) of ovarian SLCTs. RESULTS This retrospective analysis included 23 patients treated for ovarian SLCTs. A centralized pathologic review of the tumors was conducted. Patients were referred to or treated in our institution for an ovarian SLCT between 1994 and 2015. The median age at diagnosis was 33 years (range, 4-82 years). According to the 2014 Federation of Gynecology and Obstetrics classification, tumors were classified as stage Ia (n = 15: well differentiated, n = 1; of intermediate differentiation, n = 8; undifferentiated, n = 4; and undefined, n = 2), stage Ib (n = 1), stage Ic1 (n = 5), stage IIb (n = 1), and stage IIIc (n = 1). Surgery was conservative in 13 patients (Ia, n = 7; Ib, n = 1; Ic1, n = 5) and radical in 10 patients (Ia, n = 8; IIb, n = 1; IIIc, n = 1). Seven patients received adjuvant chemotherapy with a cisplatin-based regimen (Ia, n = 2; Ic1, n = 3; IIb, n = 1) or docetaxel + gemcitabine (IIIc, n = 1). Median follow-up was 61 months (range, 15-252 months). Eight patients experienced a relapse (Ia, n = 2; Ib, n = 1; Ic1, n = 3; IIb, n = 1; IIIc, n = 1). Of these, six had at least one peritoneal carcinomatosis, and four died (Ic1, n = 2; IIb, n = 1; and Ia, n = 1). Two patients had a local relapse (one uterus and one ovary) and survived without disease after relapse treatment. The median time between the initial treatment and relapse was 28 months (range 9-70). CONCLUSION Conservative surgery was safe for patients with stage Ia ovarian SLCTs. The place of conservative surgery for stage Ic1 remains to be defined. The best chemotherapy regimen remains to be defined. IMPLICATIONS FOR PRACTICE For stage Ia disease, conservative surgery (in women of reproductive age) was safe and effective for treating ovarian Seroli-Leydig cell tumors. Adjuvant chemotherapy should be proposed for stage Ia when poor prognostic factors are present (poor differentiation, retiform pattern, or heterologous elements). For stage Ic1 and more severe stages, radical surgery and adjuvant chemotherapy should be considered. The combination of bleomycin, etoposide, and cisplatin was the most frequently used regimen, but the best chemotherapy regimen remains to be defined.
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Affiliation(s)
- Sebastien Gouy
- Department of Gynecologic Surgery, Gustave Roussy, Villejuif, France
| | - Alexandra Arfi
- Department of Gynecologic Surgery, Gustave Roussy, Villejuif, France
| | - Amandine Maulard
- Department of Gynecologic Surgery, Gustave Roussy, Villejuif, France
| | - Patricia Pautier
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | - Enrica Bentivegna
- Department of Gynecologic Surgery, Gustave Roussy, Villejuif, France
| | - Alexandra Leary
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | - Cyrus Chargari
- Department of Radiotherapy, Brachytherapy Unit, Villejuif, France
- Unit INSERM 1030, Villejuif, France
- Effets biologiques des rayonnements, Institut de Recherche Biomédicale des Armées, Bretigny-sur-Orge, France
| | | | - Philippe Morice
- Department of Gynecologic Surgery, Gustave Roussy, Villejuif, France
- Unit INSERM 1030, Villejuif, France
- University Paris Sud, Paris, France
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Schernberg A, Bockel S, Annede P, Fumagalli I, Escande A, Mignot F, Kissel M, Morice P, Bentivegna E, Gouy S, Deutsch E, Haie-Meder C, Chargari C. Tumor Shrinkage During Chemoradiation in Locally Advanced Cervical Cancer Patients: Prognostic Significance, and Impact for Image-Guided Adaptive Brachytherapy. Int J Radiat Oncol Biol Phys 2018; 102:362-372. [PMID: 29920324 DOI: 10.1016/j.ijrobp.2018.06.014] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 05/30/2018] [Accepted: 06/05/2018] [Indexed: 10/14/2022]
Abstract
PURPOSE To study the prognostic value of gross tumor volume (GTV) shrinkage and its dosimetric implication in a large cohort of patients with cervical cancer receiving definitive chemoradiotherapy plus image guided adaptive brachytherapy. METHODS AND MATERIALS Clinical records of consecutive patients treated in our institution between February 2004 and November 2015 by concurrent chemoradiotherapy (45 Gy in 25 fractions ± lymph node boosts) followed by a magnetic resonance imaging-guided adaptive pulse-dose rate brachytherapy were included. The prognostic value of GTV and its evolution after chemoradiotherapy were examined first on initial staging magnetic resonance imaging and then at time of brachytherapy. All measures and measurement cutoffs were selected using time-dependent area under the curve for 3-year progression-free survival (PFS). RESULTS GTV evolution between diagnosis and the time of brachytherapy was assessed in 247 patients. After chemoradiotherapy, complete response was observed in 75 patients (28%). Optimal cutoffs were GTV = 55 cm3 at diagnosis, GTV = 7.5 cm3 at brachytherapy, and GTV reduction ≥90%. All patients with volume above or reduction below these cutoffs had significant reduced overall survival, PFS, local control, and distant metastasis control (P < .001). Patients with anemia at diagnosis had a lower tumor volume response rate (P < .001). In multivariate analysis, incorporating the International Federation of Gynecology and Obstetrics stage, N+ stage, anemia, and dosimetric parameters for image guided adaptive brachytherapy, GTV optimal volume reduction after chemoradiotherapy was independently associated with improved overall survival, PFS, local control, and distant metastasis control (P < .001). CONCLUSIONS These results could provide a rationale for dose de-escalation studies in brachytherapy for patients displaying optimal GTV volumetric reduction after chemoradiotherapy and may reinforce the need for dose escalation in poorly responding patients.
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Affiliation(s)
- Antoine Schernberg
- Radiotherapy Department, Brachytherapy Unit, Gustave Roussy Cancer Campus, Villejuif, France; INSERM U1030, Gustave Roussy Cancer Campus, Villejuif, France
| | - Sophie Bockel
- Radiotherapy Department, Brachytherapy Unit, Gustave Roussy Cancer Campus, Villejuif, France
| | - Pierre Annede
- Radiotherapy Department, Brachytherapy Unit, Gustave Roussy Cancer Campus, Villejuif, France
| | - Ingrid Fumagalli
- Radiotherapy Department, Brachytherapy Unit, Gustave Roussy Cancer Campus, Villejuif, France
| | - Alexandre Escande
- Radiotherapy Department, Brachytherapy Unit, Gustave Roussy Cancer Campus, Villejuif, France
| | - Fabien Mignot
- Radiotherapy Department, Brachytherapy Unit, Gustave Roussy Cancer Campus, Villejuif, France
| | - Manon Kissel
- Radiotherapy Department, Brachytherapy Unit, Gustave Roussy Cancer Campus, Villejuif, France
| | - Philippe Morice
- Faculté de médecine PARIS Sud, Université Paris Sud, Université Paris-Saclay, France; Department of Surgery, Gustave Roussy, Villejuif, France
| | | | - Sebastien Gouy
- Department of Surgery, Gustave Roussy, Villejuif, France
| | - Eric Deutsch
- Radiotherapy Department, Brachytherapy Unit, Gustave Roussy Cancer Campus, Villejuif, France; INSERM U1030, Gustave Roussy Cancer Campus, Villejuif, France; Department of Surgery, Gustave Roussy, Villejuif, France
| | - Christine Haie-Meder
- Radiotherapy Department, Brachytherapy Unit, Gustave Roussy Cancer Campus, Villejuif, France
| | - Cyrus Chargari
- Radiotherapy Department, Brachytherapy Unit, Gustave Roussy Cancer Campus, Villejuif, France; INSERM U1030, Gustave Roussy Cancer Campus, Villejuif, France; Department of Surgery, Gustave Roussy, Villejuif, France; French Military Health Services Academy, Ecole du Val-de-Grâce, Paris, France; Institut de Recherche Biomédicale des Armées, Bretigny-sur-Orge, France.
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Leblanc E, Narducci F, Hudry D, Bresson L, Charvolin JY, Ferron G, Guyon F, Fourchotte V, Lambaudie E, Baron M, Fouche Y, Gouy S, Collinet P, Caquant F, Pomel C, Golfier F, Vaini-Cowen V, Lemaire AS, Tresch-Bruneel E, Vuagnat P. First results of a prospective national controlled study: Prophylactic Radical Fimbriectomy (NCT01608074), in women with a hereditary familial risk of breast/ovarian cancer—Tolerance and pathological findings. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.5574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Sebastien Gouy
- Department of Surgery, Gustave Roussy Cancer Centre, Villejuif, France
| | | | | | | | - Francois Golfier
- Centre de Reference des Maladies Trophoblastiques, Centre Hospitalier Lyon-Sud, EMR3738, Université Lyon 1, Lyon, France
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Bacorro W, Manea N, Dumas I, Gouy S, Bentivegna E, Morice P, Deutsch E, Haie-Meder C, Chargari C. EP-1506: Simultaneous integrated nodal boost in cervical cancer: acute toxicity and treatment compliance. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31815-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Castelnau-Marchand P, Pautier P, Genestie C, Leary A, Bentivegna E, Gouy S, Scoazec J, Morice P, Haie-Meder C, Chargari C. EP-1505: Multimodal management of locally advanced neuroendocrine cervical carcinoma. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31814-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Bacorro W, Dumas I, Escande A, Gouy S, Bentivegna E, Morice P, Haie-Meder C, Chargari C. Dose-volume effects in pathologic lymph nodes in locally advanced cervical cancer. Gynecol Oncol 2018; 148:461-467. [DOI: 10.1016/j.ygyno.2017.12.028] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 12/24/2017] [Accepted: 12/29/2017] [Indexed: 02/07/2023]
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Mesnage SJL, Auguste A, Genestie C, Dunant A, Pain E, Drusch F, Gouy S, Morice P, Bentivegna E, Lhomme C, Pautier P, Michels J, Le Formal A, Cheaib B, Adam J, Leary AF. Neoadjuvant chemotherapy (NACT) increases immune infiltration and programmed death-ligand 1 (PD-L1) expression in epithelial ovarian cancer (EOC). Ann Oncol 2017; 28:651-657. [PMID: 27864219 DOI: 10.1093/annonc/mdw625] [Citation(s) in RCA: 127] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Lymphocytic infiltration at diagnosis is prognostic in EOC, however, the impact of NACT on tumour infiltrating lymphocytes (TILs) or PD-L1 expression remains poorly described. Patients and methods Patients with EOC and sequential samples (pre-NACT, post-NACT or relapse) were retrospectively identified. TILs were evaluated on whole sections; stromal TILs (sTILs) scored as percentage of stromal area with high sTILs defined as ≥50%; intra-epithelial TILs (ieTILs) scored semi-quantitatively (0-3) with high ieTILs ≥2. A smaller number were available for PD-L1 evaluation, cut-off for positivity was ≥5% staining. Results sTILs were detected in all tumours at diagnosis (range 2-90%, median 20%), with 22% (25/113) showing high sTILs. Among evaluable paired pre/post-NACT samples (N = 83), an overall increase in median sTILs from 20% to 30% was seen following NACT (P = 0.0005); individually the impact of NACT varied with sTILs increasing in 51% (42/83), decreasing in 25%, and stable in 24%. Post-NACT sTILs were predictive of platinum-free interval (PFI), patients with PFI ≥6 months had significantly higher post-NACT sTILs (sTILs 28% versus 18% for PFI <6 months, P = 0.026); pre-NACT sTILS were not predictive. At diagnosis, 23% showed high ieTILs, and following NACT 33% showed increasing ieTILs. Proportion of tumours with PD-L1-positive immune cells was 30% (15/50) pre-NACT and 53% (27/51) post-NACT (P = 0.026). Among paired tumours, 63% of PD-L1-negative tumours became positive after NACT, furthermore cisplatin induced PD-L1 expression in PD-L1-negative EOC cell lines. On multivariate analysis, high sTILs both pre- and post-NACT were independent prognostic factors for progression-free survival (PFS) (HR 0.49, P = 0.02 and HR 0.60, P = 0.05, respectively). No prognostic impact of ieTILs or PD-L1 expression was detected. Conclusions In EOC, sTILs levels are prognostic at diagnosis and remain prognostic after NACT. TILs and PD-L1 expression increase following NACT. Evaluation of immune parameters in the post-NACT tumour may help select patients for immunotherapy trials.
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Affiliation(s)
- S J L Mesnage
- INSERM U981 Gynaecological Tumours, Gustave Roussy Cancer Center, Villejuif
| | - A Auguste
- INSERM U981 Gynaecological Tumours, Gustave Roussy Cancer Center, Villejuif.,Faculty of Sciences, University Paris-Sud, Orsay
| | - C Genestie
- INSERM U981 Gynaecological Tumours, Gustave Roussy Cancer Center, Villejuif.,Departments of Biopathology, Gustave Roussy, Villejuif, France
| | - A Dunant
- Department of Biostatistics and Epidemiology, Gustave Roussy, Villejuif, France
| | - E Pain
- INSERM U981 Gynaecological Tumours, Gustave Roussy Cancer Center, Villejuif
| | - F Drusch
- Translational Research and Histocytopathology Laboratory, Gustave Roussy, 114 rue E Vaillant, 94805, Villejuif, France
| | - S Gouy
- Gustave Roussy, Université Paris-Saclay, Department of Gynecologic Surgery, F-94805, Villejuif, France
| | - P Morice
- Gustave Roussy, Université Paris-Saclay, Department of Gynecologic Surgery, F-94805, Villejuif, France
| | - E Bentivegna
- Gustave Roussy, Université Paris-Saclay, Department of Gynecologic Surgery, F-94805, Villejuif, France
| | - C Lhomme
- Oncology, Gustave Roussy Cancer Center, Villejuif, France
| | - P Pautier
- Oncology, Gustave Roussy Cancer Center, Villejuif, France
| | - J Michels
- Oncology, Gustave Roussy Cancer Center, Villejuif, France
| | - A Le Formal
- INSERM U981 Gynaecological Tumours, Gustave Roussy Cancer Center, Villejuif.,Faculty of Sciences, University Paris-Sud, Orsay
| | - B Cheaib
- Oncology, Gustave Roussy Cancer Center, Villejuif, France
| | - J Adam
- INSERM U981 Gynaecological Tumours, Gustave Roussy Cancer Center, Villejuif.,Departments of Biopathology, Gustave Roussy, Villejuif, France
| | - A F Leary
- INSERM U981 Gynaecological Tumours, Gustave Roussy Cancer Center, Villejuif.,Faculty of Sciences, University Paris-Sud, Orsay.,Oncology, Gustave Roussy Cancer Center, Villejuif, France
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Gouy S, Saidani M, Maulard A, Bach-Hamba S, Bentivegna E, Leary A, Pautier P, Devouassoux-Shisheboran M, Genestie C, Morice P. Results of Fertility-Sparing Surgery for Expansile and Infiltrative Mucinous Ovarian Cancers. Oncologist 2017; 23:324-327. [PMID: 29242280 DOI: 10.1634/theoncologist.2017-0310] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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: 07/04/2017] [Accepted: 10/02/2017] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND No series had been reported focusing on the results of fertility-sparing surgery in stage I mucinous ovarian cancers according to histotype (infiltrative vs. expansile). Investigating such outcomes was the aim of the present study. MATERIALS AND METHODS The present study was a retrospective analysis of patients treated conservatively with preservation of the uterus and contralateral ovary from 1976 to 2016. The pathology of the tumors was reviewed by two expert pathologists according to the 2014 World Health Organization (WHO) classification criteria. Oncologic and fertility results were analyzed. RESULTS Twenty-one patients fulfilled the inclusion criteria, twelve with expansile and nine with infiltrative cancer. All patients had a unilateral tumor and underwent unilateral salpingo-oophorectomy in one-step (n = 6) or two-step (n = 15) surgeries. All but one had complete peritoneal staging surgery based on cytology, omentectomy, and random peritoneal biopsies. Ten had nodal staging surgery. The International Federation of Gynecology and Obstetrics stages were IA (n = 9), IC1 (n = 6), and IC2 (n = 6); the nuclear grades were grade 1 (n = 9), grade 2 (n = 5), and grade 3 (n = 1). Two patients recurred (one expansile and one infiltrative type) 19 and 160 months after surgery, respectively. One stage IA, nuclear grade 2 expansile tumor recurred on the spared ovary; the patient remains alive. The other stage IA infiltrative tumor recurred as peritoneal spread; the patient is alive with disease. Six patients became pregnant; four with expansile tumors and two with infiltrative tumors. CONCLUSION The type of mucinous cancer has no impact on the oncologic outcome in this series of patients treated conservatively. Fertility-sparing surgery should be considered for early-stage infiltrative-type tumors. IMPLICATIONS FOR PRACTICE According to the most recently updated World Health Organization classification guidelines, mucinous cancers should be classified as either expansile or infiltrative. The infiltrative type has a poorer prognosis, but there are no data about the safety of fertility-sparing surgery (FSS) in this context. A collection of 21 cases reviewed by two expert pathologists this study is the first devoted to the conservative treatment of mucinous tumors according to both subtypes. The key result was that the type of mucinous cancer has no impact on the oncologic outcome; thus, FSS may be considered in both subtypes.
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Affiliation(s)
- Sebastien Gouy
- Department of Gynecologic Surgery, Gustave Roussy, Villejuif, France
| | - Marine Saidani
- Department of Gynecologic Surgery, Gustave Roussy, Villejuif, France
| | - Amandine Maulard
- Department of Gynecologic Surgery, Gustave Roussy, Villejuif, France
| | - Slim Bach-Hamba
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | - Enrica Bentivegna
- Department of Gynecologic Surgery, Gustave Roussy, Villejuif, France
| | - Alexandra Leary
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
- INSERM U981, Gustave Roussy, Villejuif, France
| | - Patricia Pautier
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | | | | | - Philippe Morice
- Department of Gynecologic Surgery, Gustave Roussy, Villejuif, France
- Unit INSERM 1030, Villejuif, France
- University Paris Sud, Paris, France
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Martinez A, Filleron T, Rouanet P, Méeus P, Lambaudie E, Classe JM, Foucher F, Narducci F, Gouy S, Guyon F, Marchal F, Jouve E, Colombo PE, Mourregot A, Rivoire M, Chopin N, Houvenaeghel G, Jaffre I, Leveque J, Lavoue V, Leblanc E, Morice P, Stoeckle E, Verheaghe JL, Querleu D, Ferron G. Prospective Assessment of First-Year Quality of Life After Pelvic Exenteration for Gynecologic Malignancy: A French Multicentric Study. Ann Surg Oncol 2017; 25:535-541. [PMID: 29159738 DOI: 10.1245/s10434-017-6120-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Pelvic exenteration remains one of the most mutilating procedures, with important postoperative morbidity, an altered body image, and long-term physical and psychosocial concerns. This study aimed to assess quality of life (QOL) during the first year after pelvic exenteration for gynecologic malignancy performed with curative intent. METHODS A French multicentric prospective study was performed by including patients who underwent pelvic exenteration. Quality of life by measurement of functional and symptom scales was assessed using the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 (version 3.0) and the EORTC QLQ-OV28 questionnaires before surgery, at baseline, and 1, 3, 6, and 12 months after the procedure. RESULTS The study enrolled 97 patients. Quality of life including physical, personal, fatigue, and anorexia reported in the QLQ-C30 was significantly reduced 1 month postoperatively and improved at least to baseline level 1 year after the procedure. Body image also was significantly reduced 1 month postoperatively. Global health, emotional, dyspnea, and anorexia items were significantly improved 1 year after surgery compared with baseline values. Unlike younger patients, elderly patients did not regain physical and social activities after pelvic exenteration. CONCLUSIONS Therapeutic decision on performing a pelvic exenteration can have a severe and permanent impact on all aspects of patients' QOL. Deterioration of QOL was most significant during the first 3 months after surgery. Elderly patients were the only group of patients with permanent decreased physical and social function. Preoperative evaluation and postoperative follow-up evaluation should include health-related QOL instruments, counseling by a multidisciplinary team to cover all aspects concerning stoma care, sexual function, and long-term concerns after surgery.
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Affiliation(s)
- A Martinez
- Department of Surgical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer, Toulouse, France. .,Centre de Recherches en Cancérologie de Toulouse (CRCT), UMR 1037 INSERM, Toulouse, France.
| | - T Filleron
- Department of Biostatistics, Institut Claudius Regaud, Institut Universitaire du Cancer, Toulouse, France
| | - P Rouanet
- Department of Surgical Oncology, Institut du Cancer de Montpellier, Montpellier, France
| | - P Méeus
- Department of Surgical Oncology, CLCC Léon Bérard, Lyon, France
| | - E Lambaudie
- Department of Surgical Oncology, CLCC Paoli-Calmettes, Marseille, France
| | - J M Classe
- Department of Surgical Oncology, CLCC Institut Cancérologique de l'ouest, Nantes, France
| | - F Foucher
- Department of Surgical Oncology, CHU Rennes, Rennes, France
| | - F Narducci
- Department of Surgical Oncology, CLCC Oscar Lambret, Lille, France
| | - S Gouy
- Department of Surgical Oncology, Institut Gustave Roussy, Villejuif, France
| | - F Guyon
- Department of Surgical Oncology, Institut Bergonié, Bordeaux, France
| | - F Marchal
- Department of Surgical Oncology, Institut Cancérologie de Lorraine, Nancy, France
| | - E Jouve
- Department of Surgical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer, Toulouse, France
| | - P E Colombo
- Department of Surgical Oncology, Institut du Cancer de Montpellier, Montpellier, France
| | - A Mourregot
- Department of Surgical Oncology, Institut du Cancer de Montpellier, Montpellier, France
| | - M Rivoire
- Department of Surgical Oncology, CLCC Léon Bérard, Lyon, France
| | - N Chopin
- Department of Surgical Oncology, Institut du Cancer de Montpellier, Montpellier, France
| | - G Houvenaeghel
- Department of Surgical Oncology, CLCC Paoli-Calmettes, Marseille, France
| | - I Jaffre
- Department of Surgical Oncology, CLCC Institut Cancérologique de l'ouest, Nantes, France
| | - J Leveque
- Department of Surgical Oncology, CHU Rennes, Rennes, France
| | - V Lavoue
- Department of Surgical Oncology, CHU Rennes, Rennes, France
| | - E Leblanc
- Department of Surgical Oncology, CLCC Oscar Lambret, Lille, France
| | - P Morice
- Department of Surgical Oncology, Institut Gustave Roussy, Villejuif, France
| | - E Stoeckle
- Department of Surgical Oncology, Institut Bergonié, Bordeaux, France
| | - J L Verheaghe
- Department of Surgical Oncology, Institut Cancérologie de Lorraine, Nancy, France
| | - D Querleu
- Department of Surgical Oncology, Institut Bergonié, Bordeaux, France
| | - G Ferron
- Department of Surgical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer, Toulouse, France
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