Abstract OT-38-01: MEDEA: A randomized trial of weight loss to reduce cancer-related fatigue (CRF) among overweight and obese breast cancer (BC) patients
Cancer Research, 2021
Rationale: Overweight and obesity are highly prevalent among BC patients and are linked to poorer... more Rationale: Overweight and obesity are highly prevalent among BC patients and are linked to poorer prognosis and worse patient-reported outcomes (PROs). Weight loss interventions, based on caloric restriction, increased physical activity (PA) and behavioral counselling, are safe and feasible among BC survivors and hold the promise to improve BC-specific outcomes. MEDEA: Motivating to Exercise and Diet, and Educating to healthy behaviors After breast cancer (ClinicalTrials.gov NCT04304924) will evaluate the impact of weight loss on CRF. Trial design: French multi-center 1:1 randomized controlled trial comparing a 12-month personalized, telephone-based weight loss program + health education intervention vs health education alone in overweight or obese BC patients. Endpoints and measures: Primary endpoint: difference in self-reported CRF 12 months post-randomization between arms, measured using the EORTC QLQ-C30 CRF subscale. Secondary endpoints: 1) PROs (EORTC QLQ-C30, -B45, -FA12), an...
Cancers invasifs du col utérin. Résultats et complications de deux séries parallèles traitées par association radiochirurgicale ou irradiation exclusive : Cancérologie - Hématologie
Notre etude a porte sur 667 patientes traitees pour cancer du col uterin entre 1977 et fin 1991. ... more Notre etude a porte sur 667 patientes traitees pour cancer du col uterin entre 1977 et fin 1991. Durant cette periode, le protocole therapeutique a comporte pour les patientes de moins de 50 ans avec lesions T1B et T2 une association radiochirurgicale, et pour les patientes de plus de 50 ans ainsi que pour tous les T3, une irradiation exclusive. Les patientes du groupe radiochirurgical ont recu une curietherapie avant chirurgie (CHDU avec lymphadenectomie bilaterale) precedee ou non d'une irradiation externe a dose moderee. Le groupe d'irradiation exclusive a recu une irradiation externe suivie d'un complement de curietherapie utero-vaginale. Les petits T1B ont eu leur curietherapie en premier avec irradiation complementaire des aires ganglionnaires. La dosimetrie faite par ordinateur a respecte les recommandations de l'ICRU N°38. La serie radiochirurgicale comportait 203 T1 (65%), 101 T2 (33%) et 6 T3 (2%). La serie radiotherapique comportait 83 T1 (23%), 177 T2 (50...
Consultation dédiée de prescription d’une hormonothérapie adjuvante chez la femme jeune traitée pour cancer du sein hormonosensible : une clé pour améliorer l’adhésion ?
Bulletin du Cancer, 2019
Adjuvant endocrine therapy is highly effective and appropriate for all breast cancer patients wit... more Adjuvant endocrine therapy is highly effective and appropriate for all breast cancer patients with hormone receptor positive tumors, pre and post menopausal women. It's an oral daily pill for many years, after primary treatment. Although this medication dramatically reduces reccurrence rates and risk of death, many breast cancer survivors either fail to take pills with prescribed frequency (adherence) or discontinue therapy (persistence) or even never begin to take it. It's difficult to know exactly the prevalence of adherence and persistence but women age younger than 40 years had the highest risk of discontinuation. Medical literature of the last 15 years in this area has been carefully reviewed considering initiation treatment background, specificity of premenopausal young women population, healthcare provider and patient communication and respective views. It's highlighted that dedicated care, at first and after in follow up, is an essential part for better adherence. Guidelines processing are more and more complicated, expert medical assesment is required, shared decision must be provide. Patients need enhanced knowledge about mode of action, benefits but also potential side effects, and optimized patient provider relationship for empathy and better comprehension. Providers must believe in treatment relevance and convey their convictions.
Abstract OT1-03-02: CICLADES: Monitoring of ESR1, PIK3CA and AKT1 ctDNA mutations during real-life follow-up of patients with advanced breast cancer treated with endocrine therapy
Cancer Research, 2019
Activating ESR1 mutations have recently been reported as a key mechanism leading to Aromatase Inh... more Activating ESR1 mutations have recently been reported as a key mechanism leading to Aromatase Inhibitor (AI) resistance. ESR1 mutations occur rarely in primary breast cancers. However, in large retrospective studies, ESR1 mutations occurred in up to 39% of Estrogen-Receptor(ER)-positive metastatic breast cancer resistant to AI. Numerous hotspot mutations have been identified, most of them affecting the ligand-binding domain (LBD) and leading to ligand-independent activation of the ER and to resistance to AI. Phosphatidylinositol 3-kinase (PI3K)/AKT pathway is involved in key Cellular Mechanisms and mutations in PIK3CA and AKT1 are frequently reported in breast cancer. In this study, we propose to use a capture-based Next Generation Sequencing (NGS) assay and to use the barcoding and polishing features in our analysis pipeline. This assay will be able to detect all mutations on AKT1, PIK3CA, ESR1 and other genes on circulating tumor DNA (ctDNA) extracted from blood samples of patient...
Acquisition et modélisation de connaissances d'adaptation, une étude pour le traitement du cancer du sein
Actes des journées …
Résumé La phase d'adaptation du raisonnement à partir de cas s'appuie sur des connaissa... more Résumé La phase d'adaptation du raisonnement à partir de cas s'appuie sur des connaissances qui ne sont pas toujours simples à mettre en évidence. Cet article présente et analyse une expérience d'acquisition et de modélisation de connaissances d'adaptation dans le domaine de ...
La thrombose associée au cancer est une complication fréquente résultant de divers mécanismes vas... more La thrombose associée au cancer est une complication fréquente résultant de divers mécanismes vasculaires liés au cancer, au traitement antitumoral et au patient, et qui est associée à un mauvais pronostic. L'anticoagulation recommandée, en prévention ou en traitement curatif, repose essentiellement sur les héparines de bas poids moléculaire (HBPM) ou les anticoagulants oraux directs. L'enjeu de la thromboprophylaxie, pour laquelle les HBPM sont privilégiées en raison d'un moindre risque hémorragique notamment en cas de tumeur digestive endoluminale ou urothéliale en place, demeure l'identification des patients à risque. La question majeure concernant la prise en charge des thromboses avérées est le choix de l'anticoagulant. Du fait de la simplicité de leur administration, les anticoagulants oraux directs apparaissent comme attractifs, et les études randomisées les ayant évalués ont montré leur efficacité. Cependant, ces études sont limitées par le profil des patients inclus qui ne sont pas toujours représentatifs des situations en vraie vie, notamment concernant les cancers à risque hémorragique et certains traitements antitumoraux, inhibiteurs de tyrosine kinase notamment, qui peuvent interagir avec les anticoagulants oraux tome xx > n8x > xx 2022
Association between physical activity and neoadjuvant chemotherapy completion and pathologic complete response in primary breast cancer: the CANTO study
Background Elevated body mass index (BMI) represents a risk factor for cancer-related fatigue (CR... more Background Elevated body mass index (BMI) represents a risk factor for cancer-related fatigue (CRF). Weight loss interventions are feasible and safe in cancer survivors, leading to improved cardio-metabolic and quality of life (QOL) outcomes and modulating inflammatory biomarkers. Randomized data are lacking showing that a lifestyle intervention aimed at weight loss, combining improved diet, exercise, and motivational counseling, reduces CRF. Motivating to Exercise and Diet, and Educating to healthy behaviors After breast cancer (MEDEA) is a multi-center, randomized controlled trial evaluating the impact of weight loss on CRF in overweight or obese survivors of breast cancer. Herein, we described the MEDEA methodology. Methods Patients (N = 220) with stage I–III breast cancer and BMI ≥ 25 kg/m2, within 12 months of primary treatment, and able to walk ≥ 400 m are eligible to enroll. Participants are randomized 1:1 to health education alone vs. a personalized telephone-based weight lo...
Abstract P1-17-04: Health related quality of life at the end of acute treatments for early stage breast cancer patients
Cancer Research, 2020
Background: Nowadays, the assessment of health related quality of life (HRQOL) in women with brea... more Background: Nowadays, the assessment of health related quality of life (HRQOL) in women with breast cancer (BC) has become very important, with the improvement of their prognosis and the growing number of BC survivors. HRQOL is therefore a main endpoint in cancer therapeutic care and its improvement should be an important goal of BC treatment. The aim of this study was to assess HRQOL at the end of acute treatment in BC patients using data of the multicenter prospective French CANTO cohort. Methods: CANTO (NCT 01993498) is a multicenter prospective observational study (26 centers in France) whose main objective is to study the chronic toxicities of anticancer treatments in 12,000 women with localized stages I to III BC. HRQOL was assessed at baseline and at the end of acute treatments (surgery +/- radiotherapy +/- chemotherapy) using the EORTC-QLQ-C30 questionnaire and its BC specific module, the EORTC-QLQ-BR23 questionnaire. The EORTC-QLQ-C30 is composed of 30 items which allow gen...
CAV 2011 - Le cancer du sein chez la femme jeune. consultation médicale
Reunion thematique du Centre Regional Anticancereux de Nancy. Titre : CAV 2011 - Le cancer du sei... more Reunion thematique du Centre Regional Anticancereux de Nancy. Titre : CAV 2011 - Le cancer du sein chez la femme jeune. Intervenants : Anne LESUR (Medecin oncologue au Centre Regional Anticancereux de Nancy (Centre Alexis Vautrin). Virginie ADAM (Psychologue au Centre Regional Anticancereux de Nancy (Centre Alexis Vautrin). Resume : Anne LESUR medecin oncologue prend en charge les patientes atteintes d’un cancer du sein en fin de traitement chirurgical, et/ou radiotherapique, et/ou chimiotherapique pour un suivi qui permet de donner des explications sur la maladie et de faire adherer la patiente a une reprise de vie normale tout en rappelant les inconvenients et les surveillances a assurer. Virginie ADAM, psychologue prend recoit les patientes qui le souhaite afin de les aider tant dans le deroulement de la maladie que dans l’entourage familiale que societal. L’auteur n’a pas transmis de conflit d’interet concernant les donnees diffusees dans cette video ou publiees dans la referenc...
Etude statistique d'une serie de 672 carcinomes du col uterin. Resultats et complications selon l'age et les modalites de traitement
Bulletin Du Cancer, 1995
L'etude porte sur 672 carcinomes infiltrants du col uterin traites de 1977 a fin 1991, d'... more L'etude porte sur 672 carcinomes infiltrants du col uterin traites de 1977 a fin 1991, d'une part par association radiochirurgicale (311 patients), d'autre part par irradiation exclusive (361 patients). La serie radiochirurgicale comprend essentiellement des stades IB et II et des patientes de moins de 50 ans en raison du protocole therapeutique, la grande majorite des patientes de plus de 50 ans et tous les stades III etant traites par irradiation exclusive. La radiotherapie externe a ete faite le plus souvent par quatre champs par accelerateur lineaire de 12 et 25 MeV. La curietherapie uterovaginale a utilise la technique des moulages. Dans 55 cas, une curietherapie interstitielle a ete realisee en complement sur nodule residuel. Une dosimetrie ordinateur a ete faite pour chaque malade avec calcul des doses aux organes a risques et aux aires ganglionnaires (points de calcul ICRU n° 38). Les resultats a 5 ans sont les suivants pour la serie totale : controle locoregiona...
Pour en finir avec la densité mammaire et le traitement hormonal substitutif de la ménopause
Le nombre de femmes traitees a la menopause par hormones augmente, tout en restant aux alentours ... more Le nombre de femmes traitees a la menopause par hormones augmente, tout en restant aux alentours de 30 %. Faut-il changer nos attitudes de depistage pour ces patientes, en sachant que des modifications de la densite radiologiques sont enregistrees chez 20 a 25 % d'entre elles ? L'augmentation de la densite mammaire est-elle prejudiciable et augmente-t-elle le risque de cancer du sein ?
Quelle hormonothérapie adjuvante chez la femme non ménopausée atteinte d'un cancer du sein ? : Le cancer du sein de la jeune femme (moins de 35 ans) [2e partie]
Gestion des effets secondaires de l’hormonothérapie du cancer du sein chez la femme jeune
Bulletin du Cancer, 2019
Despite proven survival benefits after breast cancer, long-trem compliance with adjuvant hormone ... more Despite proven survival benefits after breast cancer, long-trem compliance with adjuvant hormone therapy remains a major issue, partly due to the side effects of treatment. In young women treated for breast cancer, these treatments include tamoxifen, anti-aromatase and LH-RH analogues, with even more side effects when these treatments are combined, especially for younger patients with more aggressive disease. The management of the potential side effects requires first of all detailed and precise information at initiation of treatment, and preventive measures including patient education. Once the treatment has been initiated, clinicians should be able to propose to their patients appropriate measures to alleviate the potential of the side effects, which can be of various types: biological (dyslipidemia), physical (weight gain, hot flushes, vaginal dryness, sexual disorders with low libido, musculoskeletal symptoms…) or psychosocial (anxio-depressive disorders, poor body image, difficulties of professional reintegration). Management of these effects can combine various modalities: drugs (switching hormone therapy, anti-depressants, hormonal treatments of vaginal dryness in some cases, gabapentin), physical treatments (CO2 laser for vulvovaginal atrophy) or psycho-physical techniques (physical activity, mindfulness, acupuncture…). Eventually, the lenghth of these adjuvant hormonal treatments requires supportive measures to help young patients engage in new lifestyle measures, in particular in term of physical activity and diet. This will help them mitigate the symptoms related to these side-effects while reducing the long-term risks related to their disease and treatments.
Tolérance du Tamoxifène en traitement adjuvant et devenir lointain de 55 femmes non ménopausées suivies à l’Institut de cancérologie de Lorraine, pour un cancer du sein
Bulletin du Cancer, 2019
INTRODUCTION Objectives: the purpose of this study is to assess TAM safety in terms of side effec... more INTRODUCTION Objectives: the purpose of this study is to assess TAM safety in terms of side effects and hormonal status, the persistence of the treatment over a five years time-frame and to report the remote follow-up data. METHODS Fifty five patients were included patients between January 2001 and November 2002 at the Institut de cancérologie de Lorraine. The subjects were aged 50 years or less, premenopausal at diagnosis and treated with adjuvant TAM therapy at a daily dose of 20 mg, for an expected duration of 5 years, at a daily. After 2 years, prospective evaluation was completed and monitoring of ovarian function was performed as usual in the institution (1x/year). All data were retrospectively evaluated in 2019. RESULTS In these 55 patients, the cumulative incidences of cysts and hot flushes 5 years after treatment were 68.5 % and 77.6 %, respectively. Of the 33 patients with chemoreactive amenorrhea, half had cycles which resumed within a median of 9 months. In the 10 patients without chemotherapy-induced amenorrhea, 4 had a cycle stop. Of these, 3 patients had cycles that, resumed within 1, 4 and 8 months. 34 patients (61.3 %) had taken Tamoxifen for at least 5 years. After 15 years of treatment, overall and progression-free survival was 90.7 % and 67.4 %, respectively. CONCLUSION The observation of the tolerance to the treatment for 5 years and beyond, contributes to the quality of information delivered to future patients starting the treatment, allowing a better understanding and in the long term a better observance.
Abstract OT-38-01: MEDEA: A randomized trial of weight loss to reduce cancer-related fatigue (CRF) among overweight and obese breast cancer (BC) patients
Cancer Research, 2021
Rationale: Overweight and obesity are highly prevalent among BC patients and are linked to poorer... more Rationale: Overweight and obesity are highly prevalent among BC patients and are linked to poorer prognosis and worse patient-reported outcomes (PROs). Weight loss interventions, based on caloric restriction, increased physical activity (PA) and behavioral counselling, are safe and feasible among BC survivors and hold the promise to improve BC-specific outcomes. MEDEA: Motivating to Exercise and Diet, and Educating to healthy behaviors After breast cancer (ClinicalTrials.gov NCT04304924) will evaluate the impact of weight loss on CRF. Trial design: French multi-center 1:1 randomized controlled trial comparing a 12-month personalized, telephone-based weight loss program + health education intervention vs health education alone in overweight or obese BC patients. Endpoints and measures: Primary endpoint: difference in self-reported CRF 12 months post-randomization between arms, measured using the EORTC QLQ-C30 CRF subscale. Secondary endpoints: 1) PROs (EORTC QLQ-C30, -B45, -FA12), an...
Cancers invasifs du col utérin. Résultats et complications de deux séries parallèles traitées par association radiochirurgicale ou irradiation exclusive : Cancérologie - Hématologie
Notre etude a porte sur 667 patientes traitees pour cancer du col uterin entre 1977 et fin 1991. ... more Notre etude a porte sur 667 patientes traitees pour cancer du col uterin entre 1977 et fin 1991. Durant cette periode, le protocole therapeutique a comporte pour les patientes de moins de 50 ans avec lesions T1B et T2 une association radiochirurgicale, et pour les patientes de plus de 50 ans ainsi que pour tous les T3, une irradiation exclusive. Les patientes du groupe radiochirurgical ont recu une curietherapie avant chirurgie (CHDU avec lymphadenectomie bilaterale) precedee ou non d'une irradiation externe a dose moderee. Le groupe d'irradiation exclusive a recu une irradiation externe suivie d'un complement de curietherapie utero-vaginale. Les petits T1B ont eu leur curietherapie en premier avec irradiation complementaire des aires ganglionnaires. La dosimetrie faite par ordinateur a respecte les recommandations de l'ICRU N°38. La serie radiochirurgicale comportait 203 T1 (65%), 101 T2 (33%) et 6 T3 (2%). La serie radiotherapique comportait 83 T1 (23%), 177 T2 (50...
Consultation dédiée de prescription d’une hormonothérapie adjuvante chez la femme jeune traitée pour cancer du sein hormonosensible : une clé pour améliorer l’adhésion ?
Bulletin du Cancer, 2019
Adjuvant endocrine therapy is highly effective and appropriate for all breast cancer patients wit... more Adjuvant endocrine therapy is highly effective and appropriate for all breast cancer patients with hormone receptor positive tumors, pre and post menopausal women. It's an oral daily pill for many years, after primary treatment. Although this medication dramatically reduces reccurrence rates and risk of death, many breast cancer survivors either fail to take pills with prescribed frequency (adherence) or discontinue therapy (persistence) or even never begin to take it. It's difficult to know exactly the prevalence of adherence and persistence but women age younger than 40 years had the highest risk of discontinuation. Medical literature of the last 15 years in this area has been carefully reviewed considering initiation treatment background, specificity of premenopausal young women population, healthcare provider and patient communication and respective views. It's highlighted that dedicated care, at first and after in follow up, is an essential part for better adherence. Guidelines processing are more and more complicated, expert medical assesment is required, shared decision must be provide. Patients need enhanced knowledge about mode of action, benefits but also potential side effects, and optimized patient provider relationship for empathy and better comprehension. Providers must believe in treatment relevance and convey their convictions.
Abstract OT1-03-02: CICLADES: Monitoring of ESR1, PIK3CA and AKT1 ctDNA mutations during real-life follow-up of patients with advanced breast cancer treated with endocrine therapy
Cancer Research, 2019
Activating ESR1 mutations have recently been reported as a key mechanism leading to Aromatase Inh... more Activating ESR1 mutations have recently been reported as a key mechanism leading to Aromatase Inhibitor (AI) resistance. ESR1 mutations occur rarely in primary breast cancers. However, in large retrospective studies, ESR1 mutations occurred in up to 39% of Estrogen-Receptor(ER)-positive metastatic breast cancer resistant to AI. Numerous hotspot mutations have been identified, most of them affecting the ligand-binding domain (LBD) and leading to ligand-independent activation of the ER and to resistance to AI. Phosphatidylinositol 3-kinase (PI3K)/AKT pathway is involved in key Cellular Mechanisms and mutations in PIK3CA and AKT1 are frequently reported in breast cancer. In this study, we propose to use a capture-based Next Generation Sequencing (NGS) assay and to use the barcoding and polishing features in our analysis pipeline. This assay will be able to detect all mutations on AKT1, PIK3CA, ESR1 and other genes on circulating tumor DNA (ctDNA) extracted from blood samples of patient...
Acquisition et modélisation de connaissances d'adaptation, une étude pour le traitement du cancer du sein
Actes des journées …
Résumé La phase d'adaptation du raisonnement à partir de cas s'appuie sur des connaissa... more Résumé La phase d'adaptation du raisonnement à partir de cas s'appuie sur des connaissances qui ne sont pas toujours simples à mettre en évidence. Cet article présente et analyse une expérience d'acquisition et de modélisation de connaissances d'adaptation dans le domaine de ...
La thrombose associée au cancer est une complication fréquente résultant de divers mécanismes vas... more La thrombose associée au cancer est une complication fréquente résultant de divers mécanismes vasculaires liés au cancer, au traitement antitumoral et au patient, et qui est associée à un mauvais pronostic. L'anticoagulation recommandée, en prévention ou en traitement curatif, repose essentiellement sur les héparines de bas poids moléculaire (HBPM) ou les anticoagulants oraux directs. L'enjeu de la thromboprophylaxie, pour laquelle les HBPM sont privilégiées en raison d'un moindre risque hémorragique notamment en cas de tumeur digestive endoluminale ou urothéliale en place, demeure l'identification des patients à risque. La question majeure concernant la prise en charge des thromboses avérées est le choix de l'anticoagulant. Du fait de la simplicité de leur administration, les anticoagulants oraux directs apparaissent comme attractifs, et les études randomisées les ayant évalués ont montré leur efficacité. Cependant, ces études sont limitées par le profil des patients inclus qui ne sont pas toujours représentatifs des situations en vraie vie, notamment concernant les cancers à risque hémorragique et certains traitements antitumoraux, inhibiteurs de tyrosine kinase notamment, qui peuvent interagir avec les anticoagulants oraux tome xx > n8x > xx 2022
Association between physical activity and neoadjuvant chemotherapy completion and pathologic complete response in primary breast cancer: the CANTO study
Background Elevated body mass index (BMI) represents a risk factor for cancer-related fatigue (CR... more Background Elevated body mass index (BMI) represents a risk factor for cancer-related fatigue (CRF). Weight loss interventions are feasible and safe in cancer survivors, leading to improved cardio-metabolic and quality of life (QOL) outcomes and modulating inflammatory biomarkers. Randomized data are lacking showing that a lifestyle intervention aimed at weight loss, combining improved diet, exercise, and motivational counseling, reduces CRF. Motivating to Exercise and Diet, and Educating to healthy behaviors After breast cancer (MEDEA) is a multi-center, randomized controlled trial evaluating the impact of weight loss on CRF in overweight or obese survivors of breast cancer. Herein, we described the MEDEA methodology. Methods Patients (N = 220) with stage I–III breast cancer and BMI ≥ 25 kg/m2, within 12 months of primary treatment, and able to walk ≥ 400 m are eligible to enroll. Participants are randomized 1:1 to health education alone vs. a personalized telephone-based weight lo...
Abstract P1-17-04: Health related quality of life at the end of acute treatments for early stage breast cancer patients
Cancer Research, 2020
Background: Nowadays, the assessment of health related quality of life (HRQOL) in women with brea... more Background: Nowadays, the assessment of health related quality of life (HRQOL) in women with breast cancer (BC) has become very important, with the improvement of their prognosis and the growing number of BC survivors. HRQOL is therefore a main endpoint in cancer therapeutic care and its improvement should be an important goal of BC treatment. The aim of this study was to assess HRQOL at the end of acute treatment in BC patients using data of the multicenter prospective French CANTO cohort. Methods: CANTO (NCT 01993498) is a multicenter prospective observational study (26 centers in France) whose main objective is to study the chronic toxicities of anticancer treatments in 12,000 women with localized stages I to III BC. HRQOL was assessed at baseline and at the end of acute treatments (surgery +/- radiotherapy +/- chemotherapy) using the EORTC-QLQ-C30 questionnaire and its BC specific module, the EORTC-QLQ-BR23 questionnaire. The EORTC-QLQ-C30 is composed of 30 items which allow gen...
CAV 2011 - Le cancer du sein chez la femme jeune. consultation médicale
Reunion thematique du Centre Regional Anticancereux de Nancy. Titre : CAV 2011 - Le cancer du sei... more Reunion thematique du Centre Regional Anticancereux de Nancy. Titre : CAV 2011 - Le cancer du sein chez la femme jeune. Intervenants : Anne LESUR (Medecin oncologue au Centre Regional Anticancereux de Nancy (Centre Alexis Vautrin). Virginie ADAM (Psychologue au Centre Regional Anticancereux de Nancy (Centre Alexis Vautrin). Resume : Anne LESUR medecin oncologue prend en charge les patientes atteintes d’un cancer du sein en fin de traitement chirurgical, et/ou radiotherapique, et/ou chimiotherapique pour un suivi qui permet de donner des explications sur la maladie et de faire adherer la patiente a une reprise de vie normale tout en rappelant les inconvenients et les surveillances a assurer. Virginie ADAM, psychologue prend recoit les patientes qui le souhaite afin de les aider tant dans le deroulement de la maladie que dans l’entourage familiale que societal. L’auteur n’a pas transmis de conflit d’interet concernant les donnees diffusees dans cette video ou publiees dans la referenc...
Etude statistique d'une serie de 672 carcinomes du col uterin. Resultats et complications selon l'age et les modalites de traitement
Bulletin Du Cancer, 1995
L'etude porte sur 672 carcinomes infiltrants du col uterin traites de 1977 a fin 1991, d'... more L'etude porte sur 672 carcinomes infiltrants du col uterin traites de 1977 a fin 1991, d'une part par association radiochirurgicale (311 patients), d'autre part par irradiation exclusive (361 patients). La serie radiochirurgicale comprend essentiellement des stades IB et II et des patientes de moins de 50 ans en raison du protocole therapeutique, la grande majorite des patientes de plus de 50 ans et tous les stades III etant traites par irradiation exclusive. La radiotherapie externe a ete faite le plus souvent par quatre champs par accelerateur lineaire de 12 et 25 MeV. La curietherapie uterovaginale a utilise la technique des moulages. Dans 55 cas, une curietherapie interstitielle a ete realisee en complement sur nodule residuel. Une dosimetrie ordinateur a ete faite pour chaque malade avec calcul des doses aux organes a risques et aux aires ganglionnaires (points de calcul ICRU n° 38). Les resultats a 5 ans sont les suivants pour la serie totale : controle locoregiona...
Pour en finir avec la densité mammaire et le traitement hormonal substitutif de la ménopause
Le nombre de femmes traitees a la menopause par hormones augmente, tout en restant aux alentours ... more Le nombre de femmes traitees a la menopause par hormones augmente, tout en restant aux alentours de 30 %. Faut-il changer nos attitudes de depistage pour ces patientes, en sachant que des modifications de la densite radiologiques sont enregistrees chez 20 a 25 % d'entre elles ? L'augmentation de la densite mammaire est-elle prejudiciable et augmente-t-elle le risque de cancer du sein ?
Quelle hormonothérapie adjuvante chez la femme non ménopausée atteinte d'un cancer du sein ? : Le cancer du sein de la jeune femme (moins de 35 ans) [2e partie]
Gestion des effets secondaires de l’hormonothérapie du cancer du sein chez la femme jeune
Bulletin du Cancer, 2019
Despite proven survival benefits after breast cancer, long-trem compliance with adjuvant hormone ... more Despite proven survival benefits after breast cancer, long-trem compliance with adjuvant hormone therapy remains a major issue, partly due to the side effects of treatment. In young women treated for breast cancer, these treatments include tamoxifen, anti-aromatase and LH-RH analogues, with even more side effects when these treatments are combined, especially for younger patients with more aggressive disease. The management of the potential side effects requires first of all detailed and precise information at initiation of treatment, and preventive measures including patient education. Once the treatment has been initiated, clinicians should be able to propose to their patients appropriate measures to alleviate the potential of the side effects, which can be of various types: biological (dyslipidemia), physical (weight gain, hot flushes, vaginal dryness, sexual disorders with low libido, musculoskeletal symptoms…) or psychosocial (anxio-depressive disorders, poor body image, difficulties of professional reintegration). Management of these effects can combine various modalities: drugs (switching hormone therapy, anti-depressants, hormonal treatments of vaginal dryness in some cases, gabapentin), physical treatments (CO2 laser for vulvovaginal atrophy) or psycho-physical techniques (physical activity, mindfulness, acupuncture…). Eventually, the lenghth of these adjuvant hormonal treatments requires supportive measures to help young patients engage in new lifestyle measures, in particular in term of physical activity and diet. This will help them mitigate the symptoms related to these side-effects while reducing the long-term risks related to their disease and treatments.
Tolérance du Tamoxifène en traitement adjuvant et devenir lointain de 55 femmes non ménopausées suivies à l’Institut de cancérologie de Lorraine, pour un cancer du sein
Bulletin du Cancer, 2019
INTRODUCTION Objectives: the purpose of this study is to assess TAM safety in terms of side effec... more INTRODUCTION Objectives: the purpose of this study is to assess TAM safety in terms of side effects and hormonal status, the persistence of the treatment over a five years time-frame and to report the remote follow-up data. METHODS Fifty five patients were included patients between January 2001 and November 2002 at the Institut de cancérologie de Lorraine. The subjects were aged 50 years or less, premenopausal at diagnosis and treated with adjuvant TAM therapy at a daily dose of 20 mg, for an expected duration of 5 years, at a daily. After 2 years, prospective evaluation was completed and monitoring of ovarian function was performed as usual in the institution (1x/year). All data were retrospectively evaluated in 2019. RESULTS In these 55 patients, the cumulative incidences of cysts and hot flushes 5 years after treatment were 68.5 % and 77.6 %, respectively. Of the 33 patients with chemoreactive amenorrhea, half had cycles which resumed within a median of 9 months. In the 10 patients without chemotherapy-induced amenorrhea, 4 had a cycle stop. Of these, 3 patients had cycles that, resumed within 1, 4 and 8 months. 34 patients (61.3 %) had taken Tamoxifen for at least 5 years. After 15 years of treatment, overall and progression-free survival was 90.7 % and 67.4 %, respectively. CONCLUSION The observation of the tolerance to the treatment for 5 years and beyond, contributes to the quality of information delivered to future patients starting the treatment, allowing a better understanding and in the long term a better observance.
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