Purpose Axillary dissection is the standard management of the axilla in invasive breast carcinoma... more Purpose Axillary dissection is the standard management of the axilla in invasive breast carcinoma. This surgery is responsible for functional sequelae and some options are considered, including axillary radiotherapy. In 1992, we published the initial results of a prospective randomized trial comparing lumpectomy plus axillary radiotherapy versus lumpectomy plus axillary dissection. We present an update of this study with a median follow-up of 180 months (range, 12 to 221 months). Patients and Methods Between 1982 and 1987, 658 patients with a breast carcinoma less than 3 cm in diameter and clinically uninvolved lymph nodes were randomly assigned to axillary dissection or axillary radiotherapy. All patients underwent wide excision of the tumor and breast irradiation. Results The two groups were similar for age, tumor-node-metastasis system stage, and presence of hormonal receptors; 21% of the patients in the axillary dissection group were node-positive. Our initial results showed an ...
We present the cytagenetic analysis of 23 cases of polyploid colorectal adenocarcinomas. We took ... more We present the cytagenetic analysis of 23 cases of polyploid colorectal adenocarcinomas. We took advantage of the high intratumoral heterogeneity of the karyotypes to identify clones, subclones, and cell-to-cell variations. This allowed us to reconstruct the chromosomal evolution of each tumor and to propose a schema of the chromosomal changes in relation to the endoreduplication process. All but one case were characterized by a relative deficiency of chromosomes 17p and 18. Other deficiencies affecting the late-replicating X, and to a lesser degree, lp, 5q, 14, 15, 8p, 10, 21, and 4, and excesses affecting the early-replicating X, 8q, 13, 16, 17q, and 11 were frequently associated. This pattern of imbalances is very similar to that of the manosamic type previously described in near-diploid tumors. The pattern of the 23rd tumor corresponded to those of the trisomie type tumors. These data largely confirm the existence of two distinct processes of chromosomal evolution in colorectal adenocarcinomas, with a strong tendency to undergo endoreduplication for the monosomic type near-diploid tumors. To correlate cytogenetic and molecular data, allelic losses analyses were investigated for probes of chromosomes 17p and 18. In all 12 informative tumors, a loss of heterozygosity for probes of the short arm of chromosome 17 indicated the occurrence of a rearrangement of chromosome 17 before the endoreduplication. The same was true for allelic losses for probes of chromosome 18 found in 11 of 12 informative tumors. The correlation between cytogenetic and molecular data is thus excellent and indicates that losses of 17p and 18 are early events in the tumor process. From the Departments of Biology (M.
Background: All methods available for SNB identification suffer from many flaws including cost of... more Background: All methods available for SNB identification suffer from many flaws including cost of the probes, allergies or management of radioactive material. Breast cancer is a challenging issue in LMIC [1]. Fluorescein has been described first in this meeting [2-3] as an alternative cheap and safe tracer in SNB mapping [4]. Our aim was to reproduce the feasibility and the safety of fluorescein SNB mapping compared with Isosulfan blue dye as a reference. Methods: Ten patients, with biopsy proven BC, were operated on for SNB biopsy and prospectively included over a period of one year (April 2018 - April 2019). Patients had 2 cc Isosulfan blue dye and 2 cc 10% fluorescein mixed with 4 cc of 9% saline solution injected subcutaneously in the peri-areolar area prior to lymph node biopsy. Fluorescent lymph nodes were detected by 5 nm ultra-violet light-emitting diode flashlight. They were removed and then remaining blue and/or suspicious nodes were removed. The detection rate and the com...
Darwin said that "the species that survive are not the strongest or the most intelligent, bu... more Darwin said that "the species that survive are not the strongest or the most intelligent, but they are the ones that will be able to adapt." In addition, in an article of the Lancet, volume 22, issue 2, p182-189, February 01, 2021 titled "Global demand for cancer surgeons: Evaluation of the optimal number of surgeons and anesthesiologists between 2018 and 2040" concerning 143 countries of low, medium and high-income levels, we are provided with predictions that concern us all. The model used in this study estimates that the number of cancer cases requiring surgery will increase by 5 million (52%) from 2018 (9,065,000) to 2040 (13,821,000). The largest relative increase will mainly affect 34 lowincome countries, where the level of equipment is the lowest. To balance these figures with high-income countries would require an increase in the number of surgeons by four and anesthetists by 5.5. However, this does not mean that the number of surgeons in high-income coun...
Background and Aims The heterogeneous nature of breast cancer can make decisions on adjuvant chem... more Background and Aims The heterogeneous nature of breast cancer can make decisions on adjuvant chemotherapy following surgical resection challenging. Oncotype DX is a validated gene expression profil-ing test that predicts the likelihood of adjuvant chemotherapy benefit in early-stage breast cancer. The aim of this study is to determine the costs of chemotherapy in private hospitals in France, and evaluate the cost-effectiveness of Oncotype DX from national insurance and societal perspectives. Methods Amulticenter study was conducted in seven French private hospitals, capturing retrospec-tive data from 106 patient files. Cost estimates were used in conjunction with a published Markov model to assess the cost-effectiveness of using Oncotype DX to inform chemother-apy decision making versus standard care. Sensitivity analyses were performed. Results The cost of adjuvant chemotherapy in private hospitals was estimated at EUR 8,218 per pa-
Une proportion importante de patientes menopausees traitees par inhibiteurs de l’aromatase pour l... more Une proportion importante de patientes menopausees traitees par inhibiteurs de l’aromatase pour leur cancer du sein rapporte des effets secondaires, notamment des douleurs osseuses. Chez ces patientes, les difficultes a traiter la douleur et a en identifier clairement les causes peuvent conduire a l’arret du traitement. Le vieillissement est associe a des modifications physiologiques qui peuvent avoir un impact sur la pharmacocinetique des medicaments. L’elimination peut etre modifiee, avec une reduction de la clairance des medicaments, resultant en une augmentation de l’exposition au medicament, traduite par une aire sous la courbe augmentee. L’augmentation rapportee de l’exposition aux inhibiteurs de l’aromatase etant d’environ 50 %, un schema posologique discontinu avec une administration tous les deux jours pourrait entrainer une exposition au medicament similaire au schema quotidien habituel.
It is the merit of a French surgeon, Pierre Denoix, the former director of the Gustave Roussy Ins... more It is the merit of a French surgeon, Pierre Denoix, the former director of the Gustave Roussy Institute, to have created two major concepts in the breast cancer management: 1) the TNM classification and 2) the multidisciplinary “committees”. The TNM classification described four (in fact five) clinical T classes from T0 (non palpable tumor), T1 (0-2cm), T2 (2-5cm), T3 (over 5cm) and T4 (chest wall or cutaneous invasion). During the years, this initial classification improved separating the main classes in subclasses (T1a or T1b for example) and adding the pos t -opera t ive classification (pTNM) according to the size in the permanent section of the operative specimen in pathology report. This classification also included the clinical axillary nodal status N0, 1a, 1b, 2 and 3. The lymph node status in the TNM classification has also been recently upgraded by adding micro-metastatic and IHC characteristics of the lymph node according to post operative assessments. The M status is not ...
genomic alterations have been merged for the benefits of our patients. However, several difficult... more genomic alterations have been merged for the benefits of our patients. However, several difficulties appeared quickly in the management of the patients according to their presentation with cancer or before the cancer diagnosis. Bilateral mastectomy could be discussed when the patient is tested positive for BRCA mutation. However, when the patient had cancer in a high-risk family, until recently, the results of the tests took very long to obtain, and this prevented the medical team from offering the best choice to the patient. This is not the case anymore, and the results can now be obtained in a few weeks for a reasonable price. On the other hand, aside from the BRCA mutations, new predisposition genes have been discovered, including high-penetrance p53, and PALB2, and other genes called VUS (variants of unknown significance) in which the risk is unknown or very 3 low. Therefore, delivering comprehensive information is increasingly becoming critical for clinicians. Since Angelina Jo...
Prof. Yazid Belkacemi, M.D., Ph.D. Address: Service d'Oncologie-Radiotherapie, Henri Mondor, ... more Prof. Yazid Belkacemi, M.D., Ph.D. Address: Service d'Oncologie-Radiotherapie, Henri Mondor, CHU 51 Ave., Mal De Lattre de Tassigny, Creteil, 94000, France Tel: +33 1 49 81 54 22 Fax: +33 1 49 81 25 89 Email: [email protected] Adjuvant Regional Nodal Irradiation Recommendations After Z0011 (Alliance) Trial Results: “Our Doubts ACOSOG and Uncertainties Maybe Traitors for Undertreated Patients”
Background: Although various Oncoplastic Breast Surgery (OBS) techniques have been introduced for... more Background: Although various Oncoplastic Breast Surgery (OBS) techniques have been introduced for varied sizes of the breast and locations of tumors , surgeons are still faced with serious challenges for tumors which have developed in special anatomic part of the breast. A good instance of these challenges is the tumors located far from Nipple Areola Complex (NAC) especially in the upper inner quadrant. We aimed to assess the application of newly introduced OBS technique (Cross Technique) in these situations. Methods: The data of 95 patients who suffered from breast cancer and operated with Cross method were assessed in this prospective survey. Data was gathered regarding demographic variables, the size, location, and pathologic characteristics of tumors, patients' BMI and breast circumference and cup size. The patients were recruited to the study according to inclusion and exclusion criteria and the study protocol which was approved by the research deputy of department of surge...
The Prosigna® breast cancer prognostic gene signature assay identifies a gene-expression profile ... more The Prosigna® breast cancer prognostic gene signature assay identifies a gene-expression profile that permits the classification of tumors into subtypes and gives a score for the risk of recurrence (ROR) at 10 years. The primary objective of this multicenter study was to evaluate the impact of Prosigna's assay information on physicians' adjuvant treatment decisions in patients with early-stage breast cancer. Secondary objectives were to assess confidence of practitioners in their therapeutic recommendations before and after the added information provided by the Prosigna assay; and to evaluate the emotional state of patients before and after the Prosigna test results. Consecutive patients with invasive early-stage breast cancer were enrolled in a prospective, observational, multicenter study carried out in 8 hospitals in France. The Prosigna test was carried out on surgical specimens using the nCounter® Analysis System located at the Institut Curie. Both before and after rece...
Résumé:La maladie de Mondor a été décrite en 1939. Elle se voit après traumatisme thoracique et n... more Résumé:La maladie de Mondor a été décrite en 1939. Elle se voit après traumatisme thoracique et notamment après traitement de cancer du sein. Elle a été rapportée a une «tronculite sub-aiguë de la paroi thoracique antéro-latérale» et habituellement liée à une phlébite. Nous lions la maladie de Mondor aux brides aponévrotiques rétractiles cicatricielles observées après curage axillaire pour cancer du sein et/ou à la section des lymphatiques au niveau du creux axillaire. La rupture manuelle de brides au prix d’une douleur brève permet une récupération fonctionnelle immédiate et la disparition tout aussi immédiate des douleurs.Abstract:Mondor’s disease was described in 1939. It occurs after thoracic trauma and especially after treatment of breast cancer. Mondor attributed this condition to a subacute subcutaneous fibrous band of the anterolateral chest wall, usually due to phlebitis. Mondor’s disease actually appears to be due to retractile scarring of the fascia observed after axillary lymph node dissection for breast cancer and/or section of axillary lymphatics. Manual rupture of the fibrous bands causes brief pain, but ensures immediate functional recovery and immediate pain relief.
Résumé:Les traitements néoadjuvants du cancer du sein sont employés de plus en plus souvent. Ils ... more Résumé:Les traitements néoadjuvants du cancer du sein sont employés de plus en plus souvent. Ils confèrent des aspects particuliers à la technique chirurgicale. Le problème principal est posé par la réponse clinique complète après chimiothérapie. Ici plus qu’ailleurs, la multidisciplinarité permet de surmonter ces difficultés.Abstract:Neoadjuvant treatment in breast cancer is being used more and more frequently. It modifies surgical procedures, but a major problem appears in cases of complete clinical response after chemotherapy. A multidisciplinary approach remains the best way to resolve this issue.
Purpose Axillary dissection is the standard management of the axilla in invasive breast carcinoma... more Purpose Axillary dissection is the standard management of the axilla in invasive breast carcinoma. This surgery is responsible for functional sequelae and some options are considered, including axillary radiotherapy. In 1992, we published the initial results of a prospective randomized trial comparing lumpectomy plus axillary radiotherapy versus lumpectomy plus axillary dissection. We present an update of this study with a median follow-up of 180 months (range, 12 to 221 months). Patients and Methods Between 1982 and 1987, 658 patients with a breast carcinoma less than 3 cm in diameter and clinically uninvolved lymph nodes were randomly assigned to axillary dissection or axillary radiotherapy. All patients underwent wide excision of the tumor and breast irradiation. Results The two groups were similar for age, tumor-node-metastasis system stage, and presence of hormonal receptors; 21% of the patients in the axillary dissection group were node-positive. Our initial results showed an ...
We present the cytagenetic analysis of 23 cases of polyploid colorectal adenocarcinomas. We took ... more We present the cytagenetic analysis of 23 cases of polyploid colorectal adenocarcinomas. We took advantage of the high intratumoral heterogeneity of the karyotypes to identify clones, subclones, and cell-to-cell variations. This allowed us to reconstruct the chromosomal evolution of each tumor and to propose a schema of the chromosomal changes in relation to the endoreduplication process. All but one case were characterized by a relative deficiency of chromosomes 17p and 18. Other deficiencies affecting the late-replicating X, and to a lesser degree, lp, 5q, 14, 15, 8p, 10, 21, and 4, and excesses affecting the early-replicating X, 8q, 13, 16, 17q, and 11 were frequently associated. This pattern of imbalances is very similar to that of the manosamic type previously described in near-diploid tumors. The pattern of the 23rd tumor corresponded to those of the trisomie type tumors. These data largely confirm the existence of two distinct processes of chromosomal evolution in colorectal adenocarcinomas, with a strong tendency to undergo endoreduplication for the monosomic type near-diploid tumors. To correlate cytogenetic and molecular data, allelic losses analyses were investigated for probes of chromosomes 17p and 18. In all 12 informative tumors, a loss of heterozygosity for probes of the short arm of chromosome 17 indicated the occurrence of a rearrangement of chromosome 17 before the endoreduplication. The same was true for allelic losses for probes of chromosome 18 found in 11 of 12 informative tumors. The correlation between cytogenetic and molecular data is thus excellent and indicates that losses of 17p and 18 are early events in the tumor process. From the Departments of Biology (M.
Background: All methods available for SNB identification suffer from many flaws including cost of... more Background: All methods available for SNB identification suffer from many flaws including cost of the probes, allergies or management of radioactive material. Breast cancer is a challenging issue in LMIC [1]. Fluorescein has been described first in this meeting [2-3] as an alternative cheap and safe tracer in SNB mapping [4]. Our aim was to reproduce the feasibility and the safety of fluorescein SNB mapping compared with Isosulfan blue dye as a reference. Methods: Ten patients, with biopsy proven BC, were operated on for SNB biopsy and prospectively included over a period of one year (April 2018 - April 2019). Patients had 2 cc Isosulfan blue dye and 2 cc 10% fluorescein mixed with 4 cc of 9% saline solution injected subcutaneously in the peri-areolar area prior to lymph node biopsy. Fluorescent lymph nodes were detected by 5 nm ultra-violet light-emitting diode flashlight. They were removed and then remaining blue and/or suspicious nodes were removed. The detection rate and the com...
Darwin said that "the species that survive are not the strongest or the most intelligent, bu... more Darwin said that "the species that survive are not the strongest or the most intelligent, but they are the ones that will be able to adapt." In addition, in an article of the Lancet, volume 22, issue 2, p182-189, February 01, 2021 titled "Global demand for cancer surgeons: Evaluation of the optimal number of surgeons and anesthesiologists between 2018 and 2040" concerning 143 countries of low, medium and high-income levels, we are provided with predictions that concern us all. The model used in this study estimates that the number of cancer cases requiring surgery will increase by 5 million (52%) from 2018 (9,065,000) to 2040 (13,821,000). The largest relative increase will mainly affect 34 lowincome countries, where the level of equipment is the lowest. To balance these figures with high-income countries would require an increase in the number of surgeons by four and anesthetists by 5.5. However, this does not mean that the number of surgeons in high-income coun...
Background and Aims The heterogeneous nature of breast cancer can make decisions on adjuvant chem... more Background and Aims The heterogeneous nature of breast cancer can make decisions on adjuvant chemotherapy following surgical resection challenging. Oncotype DX is a validated gene expression profil-ing test that predicts the likelihood of adjuvant chemotherapy benefit in early-stage breast cancer. The aim of this study is to determine the costs of chemotherapy in private hospitals in France, and evaluate the cost-effectiveness of Oncotype DX from national insurance and societal perspectives. Methods Amulticenter study was conducted in seven French private hospitals, capturing retrospec-tive data from 106 patient files. Cost estimates were used in conjunction with a published Markov model to assess the cost-effectiveness of using Oncotype DX to inform chemother-apy decision making versus standard care. Sensitivity analyses were performed. Results The cost of adjuvant chemotherapy in private hospitals was estimated at EUR 8,218 per pa-
Une proportion importante de patientes menopausees traitees par inhibiteurs de l’aromatase pour l... more Une proportion importante de patientes menopausees traitees par inhibiteurs de l’aromatase pour leur cancer du sein rapporte des effets secondaires, notamment des douleurs osseuses. Chez ces patientes, les difficultes a traiter la douleur et a en identifier clairement les causes peuvent conduire a l’arret du traitement. Le vieillissement est associe a des modifications physiologiques qui peuvent avoir un impact sur la pharmacocinetique des medicaments. L’elimination peut etre modifiee, avec une reduction de la clairance des medicaments, resultant en une augmentation de l’exposition au medicament, traduite par une aire sous la courbe augmentee. L’augmentation rapportee de l’exposition aux inhibiteurs de l’aromatase etant d’environ 50 %, un schema posologique discontinu avec une administration tous les deux jours pourrait entrainer une exposition au medicament similaire au schema quotidien habituel.
It is the merit of a French surgeon, Pierre Denoix, the former director of the Gustave Roussy Ins... more It is the merit of a French surgeon, Pierre Denoix, the former director of the Gustave Roussy Institute, to have created two major concepts in the breast cancer management: 1) the TNM classification and 2) the multidisciplinary “committees”. The TNM classification described four (in fact five) clinical T classes from T0 (non palpable tumor), T1 (0-2cm), T2 (2-5cm), T3 (over 5cm) and T4 (chest wall or cutaneous invasion). During the years, this initial classification improved separating the main classes in subclasses (T1a or T1b for example) and adding the pos t -opera t ive classification (pTNM) according to the size in the permanent section of the operative specimen in pathology report. This classification also included the clinical axillary nodal status N0, 1a, 1b, 2 and 3. The lymph node status in the TNM classification has also been recently upgraded by adding micro-metastatic and IHC characteristics of the lymph node according to post operative assessments. The M status is not ...
genomic alterations have been merged for the benefits of our patients. However, several difficult... more genomic alterations have been merged for the benefits of our patients. However, several difficulties appeared quickly in the management of the patients according to their presentation with cancer or before the cancer diagnosis. Bilateral mastectomy could be discussed when the patient is tested positive for BRCA mutation. However, when the patient had cancer in a high-risk family, until recently, the results of the tests took very long to obtain, and this prevented the medical team from offering the best choice to the patient. This is not the case anymore, and the results can now be obtained in a few weeks for a reasonable price. On the other hand, aside from the BRCA mutations, new predisposition genes have been discovered, including high-penetrance p53, and PALB2, and other genes called VUS (variants of unknown significance) in which the risk is unknown or very 3 low. Therefore, delivering comprehensive information is increasingly becoming critical for clinicians. Since Angelina Jo...
Prof. Yazid Belkacemi, M.D., Ph.D. Address: Service d'Oncologie-Radiotherapie, Henri Mondor, ... more Prof. Yazid Belkacemi, M.D., Ph.D. Address: Service d'Oncologie-Radiotherapie, Henri Mondor, CHU 51 Ave., Mal De Lattre de Tassigny, Creteil, 94000, France Tel: +33 1 49 81 54 22 Fax: +33 1 49 81 25 89 Email: [email protected] Adjuvant Regional Nodal Irradiation Recommendations After Z0011 (Alliance) Trial Results: “Our Doubts ACOSOG and Uncertainties Maybe Traitors for Undertreated Patients”
Background: Although various Oncoplastic Breast Surgery (OBS) techniques have been introduced for... more Background: Although various Oncoplastic Breast Surgery (OBS) techniques have been introduced for varied sizes of the breast and locations of tumors , surgeons are still faced with serious challenges for tumors which have developed in special anatomic part of the breast. A good instance of these challenges is the tumors located far from Nipple Areola Complex (NAC) especially in the upper inner quadrant. We aimed to assess the application of newly introduced OBS technique (Cross Technique) in these situations. Methods: The data of 95 patients who suffered from breast cancer and operated with Cross method were assessed in this prospective survey. Data was gathered regarding demographic variables, the size, location, and pathologic characteristics of tumors, patients' BMI and breast circumference and cup size. The patients were recruited to the study according to inclusion and exclusion criteria and the study protocol which was approved by the research deputy of department of surge...
The Prosigna® breast cancer prognostic gene signature assay identifies a gene-expression profile ... more The Prosigna® breast cancer prognostic gene signature assay identifies a gene-expression profile that permits the classification of tumors into subtypes and gives a score for the risk of recurrence (ROR) at 10 years. The primary objective of this multicenter study was to evaluate the impact of Prosigna's assay information on physicians' adjuvant treatment decisions in patients with early-stage breast cancer. Secondary objectives were to assess confidence of practitioners in their therapeutic recommendations before and after the added information provided by the Prosigna assay; and to evaluate the emotional state of patients before and after the Prosigna test results. Consecutive patients with invasive early-stage breast cancer were enrolled in a prospective, observational, multicenter study carried out in 8 hospitals in France. The Prosigna test was carried out on surgical specimens using the nCounter® Analysis System located at the Institut Curie. Both before and after rece...
Résumé:La maladie de Mondor a été décrite en 1939. Elle se voit après traumatisme thoracique et n... more Résumé:La maladie de Mondor a été décrite en 1939. Elle se voit après traumatisme thoracique et notamment après traitement de cancer du sein. Elle a été rapportée a une «tronculite sub-aiguë de la paroi thoracique antéro-latérale» et habituellement liée à une phlébite. Nous lions la maladie de Mondor aux brides aponévrotiques rétractiles cicatricielles observées après curage axillaire pour cancer du sein et/ou à la section des lymphatiques au niveau du creux axillaire. La rupture manuelle de brides au prix d’une douleur brève permet une récupération fonctionnelle immédiate et la disparition tout aussi immédiate des douleurs.Abstract:Mondor’s disease was described in 1939. It occurs after thoracic trauma and especially after treatment of breast cancer. Mondor attributed this condition to a subacute subcutaneous fibrous band of the anterolateral chest wall, usually due to phlebitis. Mondor’s disease actually appears to be due to retractile scarring of the fascia observed after axillary lymph node dissection for breast cancer and/or section of axillary lymphatics. Manual rupture of the fibrous bands causes brief pain, but ensures immediate functional recovery and immediate pain relief.
Résumé:Les traitements néoadjuvants du cancer du sein sont employés de plus en plus souvent. Ils ... more Résumé:Les traitements néoadjuvants du cancer du sein sont employés de plus en plus souvent. Ils confèrent des aspects particuliers à la technique chirurgicale. Le problème principal est posé par la réponse clinique complète après chimiothérapie. Ici plus qu’ailleurs, la multidisciplinarité permet de surmonter ces difficultés.Abstract:Neoadjuvant treatment in breast cancer is being used more and more frequently. It modifies surgical procedures, but a major problem appears in cases of complete clinical response after chemotherapy. A multidisciplinary approach remains the best way to resolve this issue.
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Papers by Remy Salmon