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In France, we are lacking an identified pathway for training in gynaecological cancer surgery. The four competent French learned societies, the SFOG, the CNGOF, the SFCO and the SCGP, supported by the CNU of ObstetricsGynaecology- and UNICANCER, agreed to materialize this course and attest it by a certification awarded by a national jury.The national committee of certification in gynaecological oncology made up of 10 members, representing the 6 concerned organizations, set itself 5 objectives: the definition of the eligibility criteria for training centres; the determination of a check-list to be filled by the candidate; the determination of a targeted curriculum for the training in gynecological oncological surgery; the determination of the assets necessary for the certification of a candidate already in practice; and the practical organization of the certification.Criteria for approval of centres for training included 150 gynaecological cancer cases per year, among which 100 excisional surgeries, including 20 advanced-stage ovarian cancers. For certification of candidate who followed the curriculum established by the committee or by validation of prior experience for an actual practitioner, a candidate must validate a logbook and fill out a checklist including 4 parts: theoretical and practical training; research and publications; teaching and subscription to a continuing education program. The accomplished elements of the logbook and the checklist will be evaluated by a score. The first certification session is planned for the end of 2021.The optimisation of the surgical management of patients treated for gynaecological cancer is achieved through the identification of a training course and the certification, by a national jury, of the skills of surgeons who have completed it.

In France, we are lacking an identified pathway for training in gynaecological cancer surgery. The four competent French learned societies: the SFOG, the CNGOF, the SFCO and the SCGP supported by the CNU of ObstetricsGynaecology, and UNICANCER agreed to materialize this course and attest it by a certification awarded by a national jury.The national committee of certification in gynaecological oncology made up of ten members, representing the 6 concerned organizations, set itself five objectives: the definition of the eligibility criteria for training centres; the determination of a check-list to be filled by the candidate; the determination of a targeted curriculum for the training in gynecological oncological surgery; the determination of the assets necessary for the certification of a candidate already in practice; and the practical organization of the certification.Criteria for approval of centres for training included 150 gynaecological cancer cases per year, among which 100 excisional surgeries, including twenty advanced-stage ovarian cancers. For certification of candidate who followed the curriculum established by the committee or by validation of prior experience for an actual practitioner, a candidate must validate a logbook and fill out a checklist including four parts: theoretical and practical training; research and publications; teaching and subscription to a continuing education program. The accomplished elements of the logbook and the checklist will be evaluated by a score. The first certification session is planned for the end of 2021.

The editorial committee of the Bulletin du Cancer is proud to comply with his annual analysis of some of the worldwide updates in oncology that emerge in 2020. We know that all new breakthroughs will not be addressed and apologise for not being comprehensive, but we hope that the topics deciphered herein will bring the reader interesting information in his daily practice in gyneco-oncology, uro-oncology, neuro-oncology, digestive oncology, pneumo-oncology, hemato-oncology, pediatric oncology, or in palliative care.

Resume Objectif La situation sanitaire exceptionnelle lie a la pandemie au coronavirus SARS-CoV-2 (Covid-19) a necessite une profonde et rapide adaptation des pratiques de prise en charge en cancerologie gynecologique. L’objectif principal etait d’estimer la proportion de patientes avec modification de traitement. Methode Etude prospective multicentrique menee dans 3 services universitaires de gynecologie obstetrique (hospices civils de Lyon, France) durant la periode de confinement (16 mars au 11 mai 2020). Toutes les patientes presentant un cancer du sein non metastatique ou un cancer gynecologique ont ete inclues. Les traitements prevus, reellement realises, reportes, les delais du report et les modifications organisationnelles (RCP, teleconsultations) ont ete etudies. Resultats Deux cent cinq patientes consecutives ont ete inclues, âge moyen de 60,5 ± 1,0. Sept patientes (3,4 %) ont presente une infection au SARS-CoV-2, dont 2 sont decedees. Le traitement prevu a ete maintenu pour 122 patientes (59,5 %), reporte pour 72 patientes (35,1 %), annule pour 11 patientes (5,4 %). Parmi les 115 interventions chirurgicales prevues, 40 (34,8 %) ont ete reportees, 7 annulees (6,1 %) et 9 patientes (7,8 %) ont eu une modification du geste chirurgical. Parmi les 59 (28,8 %) traitements par radiotherapie prevus, 24 (40,7 %) reportee et 2 (3,4 %) annules. Parmi les 56 (27,3 %) traitements par chimiotherapie prevus, 8 (14,3 %) ont ete reportes et 2 (3,6 %) annules. Les dossiers de 145 patientes (70,7 %) ont ete discutees en RCP. Cent cinquante-huit patientes (77 %) ont beneficie d’un systeme de teleconsultation. Conclusion Notre etude a permis d’evaluer l’impact de la pandemie de Covid-19 sur la prise en charge therapeutique des patientes atteintes de cancers gynecologiques durant la periode de confinement. Cela ameliorera notre prise en charge en cas de rebond epidemique ou de crise sanitaire future.

This article aims to describe and list the clinical trials that have changed our practices in breast cancer, urological cancer, gynecological cancer, cancer of the upper aerodigestive tract and digestive cancer in the last ten years.We listed and selected the studies published between 2010 and 2020. The articles were identified on the basis of a Medline search with PubMed and knowledge of the authors.Five to six trials were selected in breast cancer, urological cancers, gynecological cancers, cancers of the upper aerodigestive tract and digestive cancers asking the different fundamental questions in radiotherapy.Depending on the pathologies, the questions raised over the past 10 years remain fundamental questions such as the place of neoadjuvant treatment, the place of hypofractionation or the type of chemotherapy concomitant with radiotherapy.

Recommendations for the management of patients with gynecological cancer during the COVID-19 pandemic period.Recommendations based on the consensus conference model.In the case of a COVID-19 positive patient, surgical management should be postponed for at least 15 days. For cervical cancer, the place of surgery must be re-evaluated in relation to radiotherapy and Radio-Chemotherapy-Concomitant and the value of lymph node staging surgeries must be reviewed on a case-by-case basis. For advanced ovarian cancers, neo-adjuvant chemotherapy should be favored even if primary cytoreduction surgery could be envisaged. It is lawful not to offer hyperthermic intraperitoneal chemotherapy during a COVID-19 pandemic. In the case of patients who must undergo interval surgery, it is possible to continue the chemotherapy and to offer surgery after 6 cycles of chemotherapy. For early stage endometrial cancer, in case of low and intermediate preoperative ESMO risk, hysterectomy with bilateral annexectomy associated with a sentinel lymph node procedure should be favored. It is possible to consider postponing surgery for 1 to 2 months in low-risk endometrial cancers (FIGO Ia stage on MRI and grade 1-2 endometrioid cancer on endometrial biopsy). For high ESMO risk, it ispossible to favor the MSKCC algorithm (combining PET-CT and sentinel lymph node biopsy) in order to omit pelvic and lumbar-aortic lymphadenectomies.During COVID-19 pandemic, patients suffering from cancer should not lose life chance, while limiting the risks associated with the virus.

Over the past years, planet oncology has kept changing and moving forward. Recent results of important clinical trials are challenging our daily practices. With modesty, the Editorial Board of BulletinduCancer has selected some clinical trials they consider as "must-know about" even if they go beyond our medical fields.

Pelvic bone marrow is the site of nearly 50% of total hematopoiesis. Radiation therapy of pelvic lymph node areas, and cancers located near the bony structures of the pelvis, exposes to hematological toxicity in the range of 30 to 70%. This toxicity depends on many factors, including the presence or absence of concomitant chemotherapy and its type, the volume of irradiated bone, the received doses, or the initial hematopoietic reserve. Intensity modulated radiation therapy allows the optimisation of dose deposit on at risk organs while providing optimal coverage of target volumes. However, this suggests that dose constraints should be known precisely to limit the incidence of radiation side effects. This literature review focuses firstly on pelvic lymph node areas and bony volumes nearby, then on the effects of irradiation on bone marrow and the current dosimetric constraints resulting from it, and finally on hematological toxicities by carcinologic location and progress in reducing these toxicities.

The management of patients undergoing immunosuppressive agents is really challenging. Based on precaution principle, it seems mandatory to stop immunosuppressive (or immunomodulating) agents during radiation. Yet, it is impossible in grafted patients. It is possible in patients with autoimmune disease, but in this case, the autoimmune disease might modify patient's radio-sensitivity. We provide a short review about the safety of radiotherapy in grafted/auto-immune patients. The literature is limited with data coming from outdated case-report or case-control studies. It seems that radiotherapy is feasible in grafted patients, but special dose-constraints limitations must probably be considered for the transplant and the other organs at risk. There is very little data about the safety of radiotherapy, when associated with immunomodulating agents. The most studied drug is the methotrexate but only its prescription as a chemotherapy (high doses for a short period of time) was reported. When used as an immunomodulator, it should probably be stopped 4 months before and after radiation. Apart from rheumatoid arthritis, it seems that collagen vascular diseases and especially systemic scleroderma and systemic lupus erythematous feature increased radio-sensitivity with increased severe late toxicities. Transplanted patients and collagen vascular disease patients should be informed that there is very little data about safety of radiation in their case.

Genital intraepithelial neoplasias (IEN) are precursors of squamous cell carcinoma. The ideal treatment must be efficacious, conservative and well-tolerated. CO2 laser is one of the recommended therapies, but its efficacy and safety have not been extensively studied.This was a retrospective single-center study. Sixteen patients (8 women and 8 men) treated with CO2 laser for genital IEN, whether high-grade or differentiated, were included. Surgical lateral margins of 3 to 5mm were taken macroscopically during treatment. The CO2 laser session, assessment of therapeutic response and follow-up were undertaken by a dermatologist at the University Hospital of Caen.The mean patient age was 68.1 years and mean follow-up was 52.7 months (5-130). Lesions were isolated in 87.5% of patients. The recurrence rates of genital intraepithelial neoplasia after CO2 laser treatment were 58% for women and 40% for men. No impact on quality of life or on sexual activity was reported in over 90% of patients.Whatever the treatment recommended for intraepithelial neoplasia, recurrence is frequent. CO2 laser is an effective and well-tolerated conservative therapeutic option. It enables rapid clinical remission, but as with all currently available treatments, long-term dermatologic follow-up remains necessary.

Intensity-modulated radiation therapy reduces the dose to organs at risk in patients treated for gynecological malignancies. Given the steep dose gradients around the planning target volume, internal movement of organs during treatment may cause a planning target volume underdosage and organs at risk overdosage in case of systematic error. It is therefore important to take into account the movement of the pelvic organs and to investigate potential solutions provided by image-guided radiotherapy. A review of the literature was carried out using the following databases: Medline, Embase, Cochrane Library, Web of Science, Cinahl and Pubmed. Appropriate search strategies for each database were applied based upon the following terms "uterine neoplasms, image-guided radiotherapy, adaptive radiotherapy, organ motion and target volume". These studies show that uterine motion is mainly influenced by bladder filling and by cervix and vaginal vault motion due to rectal filling. Population-based clinical target volume-planning target volume margins are large resulting in unnecessary organs at risk inclusion within the planning target volume, reducing the benefits of intensity-modulated radiotherapy. As pelvic organ motion seems to be patient specific, individualised planning target volume margins and adaptive radiotherapy strategies could allow adequate coverage of the planning target volume and increase organs at risk savings. In this study, we review the different techniques of image-guided radiotherapy and the perspective of adaptive radiotherapy.

Endometriosis and adenomyosis are histologically defined. The frequency of endometriosis cannot be precisely estimated in the general population. Endometriosis is considered a disease when it causes pain and/or infertility. Endometriosis is a heterogeneous disease with three well-recognized subtypes that are often associated with each other: superficial endometriosis (SUP), ovarian endometrioma (OMA), and deep infiltrating endometriosis (DIE). DIE is frequently multifocal and mainly affects the following structures: the uterosacral ligaments, the posterior vaginal cul-de-sac, the bladder, the ureters, and the digestive tract (rectum, recto-sigmoid junction, appendix). The role of menstrual reflux in the pathophysiology of endometriosis is major and explains the asymmetric distribution of lesions, which predominate in the posterior compartment of the pelvis and on the left (NP3). All factors favoring menstrual reflux increase the risk of endometriosis (early menarche, short cycles, AUB, etc.). Inflammation and biosteroid hormones synthesis are the main mechanisms favoring the implantation and the growth of the lesions. Pain associated with endometriosis can be explained by nociception, hyperalgia, and central sensitization, associated to varying degrees in a single patient. Typology of pain (dysmenorrhea, deep dyspareunia, digestive or urinary symptoms) is correlated with the location of the lesions. Infertility associated with endometriosis can be explained by several non-exclusive mechanisms: a pelvic factor (inflammation), disrupting natural fertilization; an ovarian factor, related to oocyte quality and/or quantity; a uterine factor disrupting implantation. The pelvic factor can be fixed by surgical excision of the lesions that improves the chance of natural conception (NP2). The uterine factor can be corrected by an ovulation-blocking treatment that improves the chances of getting pregnant by in vitro fertilization (NP2). The impact of endometrioma exeresis on the ovarian reserve (NP2) should be considered when a surgery is scheduled. Endometriosis is a multifactorial disease, resulting from combined action of genetic and environmental factors. The risk of developing endometriosis for a first-degree relative is five times higher than in the general population (NP2). Identification of genetic variants involved in the disease has no implication for clinical practice for the moment. The role of environmental factors, particularly endocrine disrupters, is plausible but not demonstrated. Literature review does not support the progression of endometriosis over time, either in terms of the volume or the number of the lesions (NP3). The risk of acute digestive occlusion or functional loss of a kidney in patients followed for endometriosis seems exceptional. These complications were revealing the disease in the majority of cases. IVF does not increase the intensity of pain associated with endometriosis (NP2). There is few data on the influence of pregnancy on the lesions, except the possibility of a decidualization of the lesions that may give them a suspicious aspect on imaging. The impact of endometriosis on pregnancy is debated. There is an epidemiological association between endometriosis and rare subtypes of ovarian cancer (endometrioid and clear cell carcinomas) (NP2). However, the relative risk is moderate (around 1.3) (NP2) and the causal relationship between endometriosis and ovarian cancer is not demonstrated so far. Considering the low incidence of endometriosis-associated ovarian cancer, there is no argument to propose a screening or a risk reducing strategy for the patients.

Most women with cystic fibrosis reach adulthood and should have appropriate gynecological follow-up and contraception.There is no specific contra-indication to any contraception due to cystic fibrosis itself. Combined estrogen-progesterone contraception can be used in most cases (including transplanted women). In case of transplantation, intra-uterine devices should be used carefully (risk of pelvic inflammatory disease, potential risk of contraceptive failure with copper intra-uterine devices). Hormonal contraceptives may not be effective in women taking corrective treatments aiming to correct the maturation defect of the chloride channel. Screening for cervical cancer is recommended with a pap smear every three years for women aged 25-65, but yearly and starting at a younger age among transplanted women who are at higher risk for cervical dysplasia. Human Papillomavirus vaccination should be offered to all young women.Women with cystic fibrosis and health care providers should be better informed on screening and on sexual and reproductive health to avoid unplanned pregnancies, to take into account drug interactions and to prevent cervical disease.Regular and specific gynecological management is mandatory in cases of cystic fibrosis.

The multidisciplinary team meeting has become a standard medical practice in oncology. However, no evaluation of this activity was carried out in Morocco. The aim of this study was to evaluate the multidisciplinary team meeting of gynecological mammary cancers in a National Tertiary Referral Center. The study was carried out by retrospective analysis of 207 cases of patients randomly selected among the 1190 cases recruited during the year 2015. Completeness and quality criteria were evaluated. The global completeness rate of passage in multidisciplinary team meeting is 38%. According to the therapeutic specialities, the completeness of passage in multidisciplinary team meeting is 68% of surgery, 35% of medical oncology and 19% of radiotherapy. As far as localizations are concerned, the completeness of passage in multidisciplinary team meeting is 43% for the breast and only 19% for the cervix. A quorum was met 100% of the cases. In 96% of cases the treatment performed is in accordance with the decision of the multidisciplinary team meeting. Eighty-four percent of cases performed multidisciplinary team meeting within less than one month. This analysis shows that the completeness of the transition to multidisciplinary team meeting has not reached the 100% planned by our institution. However, the requirements for conducting the multidisciplinary team meeting were generally met. This study shows an organizational evolution of our structure based on collective and multidisciplinary medical decision. The national obligation measure of multidisciplinary team meeting is necessary.

The recent discovery of the earliest hominin cancer, a 1.7-million-year-old osteosarcoma from South Africa has raised the question of the origin of cancer and its determinants. We aimed to determine whether malignant and benign tumors exist in the past societies.A review of literature using Medline database and Google about benign and malignant tumors in prehistory and antiquity. Only cases with morphological and paraclinical analysis were included. The following keywords were used: cancer; paleopathology; malignant neoplasia; benign tumor; leiomyoma; myoma; breast cancer; mummies; soft tissue tumor; Antiquity.Thirty-five articles were found in wich there were 34 malignant tumors, 10 benign tumors and 11 gynecological benign tumors.The fact that there were some malignant tumors, even few tumors and probably underdiagnosed, in the past may be evidence that cancer is not only a disease of the modern world. Cancer may be indeed a moving target: we have likely predisposing genes to cancer inherited from our ancestors. The malignant disease could therefore appear because of our modern lifestyle (carcinogens and risk factors related to the modern industrial society).

Immunotherapy is on the roll. After revolutionary effects in melanoma, immunotherapy is invading other locations. If current treatments, chemotherapies or targeted therapies block one pathway, immunotherapy should be understood as the activation of a whole system. Indeed, oncogenesis process is defined as an escape of the immune system and the stimulation of this system can block the carcinogenic process. The aim of the present review is to describe the place of immunotherapy in the treatment of solid cancers.

Rhabdomyosarcoma, most common soft tissue tumor in children, represent 8% of solid tumors in children. Conversely, in adults, this histology is very rare and no consensual recommendation is supported. If gynecological localization is one of the most frequent in children, it is a minority in adults. The management of this type of tumor is based on treatment multimodality combining surgery, chemotherapy, radiotherapy and brachytherapy. This pathological separate entity differs from other sarcomas by its greater sensitivity to chemotherapy and radiotherapy. The aim of this study is to conduct a general review of diagnostic and treatment of genital tract rhabdomyosarcoma in adults, and to report pathological characteristics of this type of tumor.

International audience; Objective The "Institut national du cancer" has established since 2007 a minimum threshold of 20 patients per year per center to treat patients with gynecologic cancer. This review aims to assess whether the literature data validate this approach, and specifically for ovarian cancer. Methods A search of the MEDLINE database was conducted, to reference all relevant articles evaluating one hand the links between the survival of patients with ovarian cancer and the average volume of patients per center and by operator; and secondly the relationship between quality of oncological surgery and these volumes. Results Nineteen studies met our inclusion criteria; seventeen were retrospective and two were prospective; population samples ranged from 476 to 96,802 patients. The most important data, quantitatively and qualitatively, concern the evaluation of survival based on the average volume per center, with 8 out of 13 studies finding a statistically significant correlation between average volume per center and survival. Data on the quality of surgery are less abundant and more heterogeneous, depending on the definition of the "optimal" surgery by the authors. Conclusion The establishment of threshold centers appears to be an effective way to improve survival in ovarian cancer. However, these thresholds would have to be specific to ovarian cancer and not extended to "gynecological cancers."

To investigate the prevalence of human papillomaviruses (HPV) in cancers located at different sites in patients from west Algerian and collected between 2010 and 2014.Extracted DNA from archival formaldehyde-fixed and paraffin-embedded tissues was provided from 39 anogenital cancers, 10 head and neck cancers and 36 skin cancers. The viral DNA was detected using the INNO-LiPA HPV Genotyping Extra(®) kit.The prevalence of HPV was 100% in cervical cancers, 40% in vaginal cancers, 17% in vulvar cancers, 33% in anal cancers, 0% in tonsil and larynx cancers and 6.4% in skin squamous cell carcinoma. In cervical cancers, the most prevalent genotypes were HPV16 (52%) and HPV18 (12%) as single infection.The overall results agree partially with literature. Extensive research is necessary to promote HPV vaccine to reduce in particular the burden of cervical cancer in Algeria.

Endoscopic para-aortic lymphadenectomy (PALN) is a crucial step in the management of gynecological cancers. However, some concerns exist on the completeness of PALN according to the route (transperitoneal vs. extraperitoneal single-port or multiport). We compared these three surgical techniques using a propensity score.We retrospectively reviewed all patients undergoing an endoscopic PALN for a gynecological cancer from May 2010 to Mars 2015. Fifty-one patients had a single-port extraperitoneal PALN, 16 a multiport extraperitoneal PALN and 62 a transperitoneal PALN. Factors independently related to technique performances were tested on a multivariate model adjusted for a propensity score.The number of lymph nodes removed by transperitoneal route was 15 and extraperitoneal route single and multiport was 12. After adjustment for the propensity score of undergoing the extraperitoneal approach, no difference in the number of lymph node removed was noted (P=0.17). There was more lymphocyst after transperitoneal (17%) and multiport extraperitoneal PALN (19%) than after extraperitoneal PALN (2%) (P=0.04). Success rate of single-port extraperitoneal PALN was 94% (n=48). Four patients required a conversion to an open route due to vascular injury.Using a propensity score, single-port extraperitoneal route offers similar efficacy to perform PALN than transperitoneal or multiport extraperitoneal route but with less lymphocysts.

Modifications of radiotherapy indications or schedules because of age could be discussed in view of a different evolution of the disease or because of specific toxicities. One important aim is to decrease the number of hospital transports. For breast cancer, the rate of local relapse after lumpectomy is lower in old patients; moreover, characteristics of the disease are often more favourable (hormonosensitivity, low grade). However, adjuvant irradiation decreases significantly the incidence of breast relapse and must be systematically proposed. Hypofractionnated schedules must be recommended; limited data are available for accelerated partial breast irradiation in old women and these techniques must not be used in routine. For low or intermediate risk prostate cancer, assessment of comorbidities is crucial before considering any invasive treatment. A life expectancy of at least 10 years is required if a curative approach, potentially toxic is proposed. In this case, radiotherapy is often the good choice, giving less sequelae than surgery. The indication of androgen deprivation must take into account cardiovascular and bone history. Management of gynaecological cancers must follow the same recommendations as in young women. Exclusive postoperative brachytherapy must be recommended in early stage endometrial carcinomas. Brachytherapy must be also systematically integrated in the radiotherapy program for cervix cancers, even in old women.

This article, devoted specifically to gynaecological cancers and their impact on the sexual and marital lives, is a collaboration between the psychologists and onco-gynaecologist within a cancer center. In oncology, gynaecological cancers' treatments involve at the same time anatomical, physiological and functional modifications impacting, in a major way, on the sexual life of women. All the phases of the sexual answer can be touched. Beyond the physical and aesthetic consequences of the treatments, the sexual dysfunctions are generally caused by the deep psychological upheaval induced by the disease affecting a strongly invested female body. Female cancer is also a true test for the couple challenged in its emotional, functional and sexual cohesion: emotional distress, attachment link dysfunction, change of role within the couple, disordered state of communication. The couple cannot survive and find a harmonious intimate life without communication about sexual health between the medical team, the patient and her partner. All doctors and nurses must be able to initiate the subject throughout the course of care by respecting four prerequisites: to be aware of the importance to approach this subject, to create a climate of trust, to dare the questions and to respect the rhythm of the patient and her partner.

The role of gonadotropins in the genesis of malignant diseases, in particular gynecologic cancers, is still controversial. The production of ovarian steroids, as a consequence of FSH and LH actions, may constitute a bias to draw reliable conclusions. Over the past decades, the use of exogenous gonadotropins has markedly increased in cancer patients, candidates for fertility preservation, and in survivors facing infertility as a consequence of gonadotoxic treatments. In gynecologic cancers, high serum estradiol levels may be problematic and can therefore be overcome by specific protocols of ovarian stimulation. However, exogenous gonadotropin administration in cancer patients should systematically be included in a multidisciplinary approach. The present article discusses the possible role of gonadotropins as tumorigenic factors and the use of exogenous gonadotropins in females suffering from cancer.

Pelvic gynaecological cancers are common in elderly women. Diagnosis and the decision to treat require multidisciplinary expertise. An oncologic, surgical and geriatric evaluation contributes to a split decision and personalised care. The care team is involved in the geriatric evaluation, information, education and patient monitoring throughout the treatment plan.

Define the phases composing the learning curve of total hysterectomy (TH) and radical hysterectomy with pelvic lymphadenectomy (RHPL) robot-assisted performed by a single surgeon with no prior experience in laparoscopic surgery.We retrospectively analyzed 72 procedures (TH, n=34 and RHPL, n=38) conducted between 2002 and 2011. The surgeon console time (CT) was used to determine the learning curve of TH and RHPL using CUSUM analysis. Epidemiological data, perioperative and postoperative complications were compared from the different phases of the learning curve.CUSUM analysis of surgeon console time (CUSUMCT) identified two learning phases for the TH group (phase 1: initial learning, phase 2: surgical skill increase). For the RHPL group, three learning phases were identified (phase 1: initial learning, phase 2: extending surgical indications, phase 3: control of surgical skills). Perioperative and postoperative complication rates did not differ significantly between the learning phases. Surgeon CT decreased from the 9th case (P=0.01) for the TH group and from the 13th case (P=0.04) for the RHPL group.CUSUM analysis of the learning curve in robotic-assisted gynecologic oncology surgery identified two phases of learning curve for simple procedures such as total hysterectomy and three phases for more complex procedures as radical hysterectomy with pelvic lymphadenectomy.

Peutz-Jeghers syndrome (PJS) is a rare autosomal dominant disease due to mutations in the tumor suppressor gene STK11. PJS is characterized by periorificial hyperpigmented macules (lentiginosis) and hamartomatous polyposis. Polyps can be located anywhere in the gastrointestinal tract, but are preferably observed in the small bowel (70-90%), the colon (50%) and the stomach (25%). They tend to be cancerous in a particular sequence hamartoma-dysplasia-cancer. The diagnosis is often made in the first or second decade following the appearance of lentigines or upon the occurrence of complications due to polyps (obstruction, intussusception, occult bleeding responsible for anemia). Furthermore PJS is associated with a significant increase in cancer risk (relative risk of 89% over the life according to the most recent series). Digestive cancers are the more frequent with cumulative incidences of 55% for gastro-intestinal cancer (39% for colorectal cancer, 13% for small bowel cancer and between 11 and 36% for pancreatic cancer, respectively). There is also an increased risk of non digestive cancers. In particular the risk of breast cancer is similar to that of patients carrying deleterious BRCA1 or BRCA2 mutations (cumulative incidence of 45%). Gynecological and gonadal tumors are frequent as well and can be more (adenoma malignum) or less aggressive (ovarian sex cord tumors with annular tubules and testicular tumors with calcified Sertoli cells). Finally the frequency of lung cancer is moderately increased. Recommendations for screening and management based on retrospective series in the literature have led to various strategies. The aim of this paper is to summarize the clinical and molecular diagnostic criteria of PJS as well as recommendations on screening strategies, management and monitoring.

The evaluation of quality of life has become essential in gynecological oncology. Recent guidelines have been published to improve the collection, analysis and publication of the data quality of life that will make them more reliable, reproducible and integrate them into the final treatment decision. This year at ASCO, in breast cancer, the benefit of sentinel lymph node dissection compared to the quality of life has been demonstrated. New data on cognitive function in patients treated for breast cancer show the importance of the evaluation of these disorders especially among elderly patients who are at-risk populations. Medical strategies including targeted therapies can improve survival without impairing the quality of life, also with improved gastrointestinal symptoms in case of combination chemotherapy with bevacizumab in patients with ovarian cancer in a situation early recurrence. Similarly, the addition of a pathway inhibitor M- Tor (everolimus) with hormonal therapy does not induce degradation of the quality of life in women with metastatic breast cancer.

The presence of adnexal masses during pregnancy is a rare situation but due to a broader use of sonography; its occurrence is increasing. Their management essentially relies on imagery. We report the case of an 18 weeks-pregnant women presenting bilateral teratomas visualized by RMI. She was successfully treated by laparoscopy. This paper approaches the management of adnexal masses during pregnancy. The epidemiology, possible complications, diagnostic approach and the therapeutic management are discussed.

To ascertain the pattern and frequency of female genital malignancies among the different age groups, the common presenting complaints of cervical cancer patients and stages of presentation as seen in Sagamu, Ogun State.A retrospective analysis of reports of formalin fixed paraffin embedded tissue blocks and slides of all female genital samples received at Morbid AnatomyHistopathology Department of Olabisi Onabanjo University Teaching Hospital, Sagamu from January 1st, 2003 to June 30th, 2012. The personal data and clinical history were retrieved from laboratory forms and the patients' case files.The age range of patients whose specimens were reviewed was between 21-85 years. Cancers of the cervix accounted for majority (65.1%) of the cases followed by ovarian cancer (23.2%) and cancer involving the uterus (10.5%). Sixty-six percent of the cervical cancer patients are 50 years and above. Majority of the cervical cancer cases (82.2%) were squamous cell carcinoma. The common clinical features were post-menopausal bleeding (53.3%), vaginal discharge (43.3%), and intermenstrual bleeding (16.7%). The interval between onset of symptoms and seeking of healthcare was 6.7 ± 3.66 months. Stage IIIB cervical cancer was seen in 40% of the cervical cancer patients analyzed while no case of Stage IA was seen. Ninety-three percent of these patients were referred for radiotherapy.Cancer of the cervix is the commonest gynaecological malignancy and most patients presented late. Free or government subsidized cervical cancer screening programmes and awareness campaign is highly recommended.

Cancer treatment has evolved toward personalized medicine. It is mandatory for clinicians to ascertain tumor biological features in order to optimize patients' treatment. Identification and characterization of circulating tumor cells demonstrated a prognostic value in many solid tumors. Here, we describe the main technologies for identification and characterization of circulating tumor cells and their clinical application in gynecologic and breast cancers.

Melanoma of the female genital tract is a rare location (less than 2% of melanomas all sites combined). These cancers have a very poor prognosis, due to the delay in diagnosis. Vulvar location is about 1% of melanomas then the vaginal location, uterine and ovarian. There is no consensus to date regarding their care, due to the rarity of the lesions. Their treatment must however be based on the current data concerning gynaecological cancers as well as standard management of cutaneous melanoma. The treatment is often based on conservative surgery, because radical resection does not improve survival. For the vulva and vagina, reconstructive surgery is possible. Treatment is sometimes supplemented by chemotherapy or radiotherapy, which could improve local control. The interest in the use of targeted therapy in these locations is not well known because of their rarity, but the study of genes c-Kit and BRAF provides new prospects for treatment. The objective of this review is to describe and report the current state of knowledge about gynaecologic melanomas.

The observatory of gynecological rare tumors (TMRG) has been initially created for ovarian rare neoplasms (TMRO). Because of the similarities between ovarian and other gynecological tumors, this observatory has been then extended to all gynecological rare tumors. The recognition by INCa of three national expert centers (centre Léon-Bérard, hôpitaux de Paris, institut Gustave-Roussy) in rare gynecological cancers and a network of regional expert centers in 2010, expend the experience of the website "Observatoire francophone des tumeurs rares de l'ovaire". The major goals of this gynecology rare tumors experts network, are to promote systematic second opinion for initial diagnostic by experts in gynecopathology, systematic multidisciplinary advice by surgeons and medical oncologist experts, to disseminate clinical guidelines dedicated to rare gynecological tumors, to promote specific fundamental and translational research within clinical trials dedicated to rare tumors. At the end, we would like to improve benefit in term of survival and/or fertility for all these potential young patients.

Squamous cell carcinomas account for over 90 % of cancers of the oral cavity in France. Alcohol and tobacco are the main risk factors. Delay in diagnosis is unfortunately frequent. The management of the cancer is based on surgery, possibly associated to radiation therapy and chemotherapy. The survival rate at 5 years does not exceed 30-40%. We hope to see a decrease in the number of oral cancer thanks to the development of preventive medicine (alcohol and tobacco cessation and early detection of potentially malignant lesions). Vulvar squamous cell carcinoma is a rare disease which traditionally affect elderly woman but continues to rise in incidence especially in younger women. There are at least 2 forms of genital squamous cell carcinoma. The most common form is found on older women arising in a background of lichen sclerosus and the second is associated with "high risk" human papillomavirus infection affecting younger women. A biopsy is usually required for diagnosis. Attempts to reduce genital cancer must focus on treating precursor lesions, namely lichen sclerosus and HPV-related intraepithelial neoplasia (VIN and PIN). Most genital cancer occur on undiagnosed or untreated lichens sclerosus, vulvar inspection when women attend for their cervical smears or seeking about significance of any chronic genital symptom by a clinical examination.

The purpose of our study was to assess the feasibility of outpatient laparoscopy in a cohort of 22 patients admitted for bilateral oophorectomy (n=11) and preoperative diagnostic laparoscopy (n=11).Between December 2012 and May 2013, we included 22 patients in our study. All selected patients received a questionnaire the day before surgery. The questionnaire consisted of chapters on intraoperatively, and the postoperative assessments of patients regarding a possible return home on the evening of surgery. The ability to output was measured with the score of Chung at the evening of surgery and in the morning before leaving.The mean age of patients was 60 years. The average length of stay was 1.2 days. Postoperative pain tends to be higher in the morning in the bilateral oophorectomy group (P=0.06), nausea and vomiting are the same in both groups. In the bilateral oophorectomy group, six patients were able to go out and five wished it; in the diagnostic laparoscopy group nine patients were able to go out and two wished it, this difference was significant (P=0.041).The outpatient hospital is the norm for many surgeries. In our study, 47% of patients able to go out wishing that output. This difference is important when comparing the two groups. There are more patients wishing an output in the oophorectomy group. This reduction in length of stay must be compensated by a medical and paramedical supervision at home.A large number of surgical procedure are performed on an outpatient basis. Patients who underwent diagnostic laparoscopy are more fragile, they should receive active postoperative support to enable an outpatient hospital.

Gynecological cancers are lymphophilic cancers, which require the systematic inclusion of nodal areas in the clinical target volume when irradiation is planned in the therapeutic strategy for these cancers. Radiotherapy with intensity modulation that achieves better saving of healthy tissue is more often used. However, the very steep dose gradients generated by this technique can lead to poorer coverage of target volumes if they are not defined very precisely by taking into account their anatomical location. This is particularly true for lymph node target volumes, so the purpose of this article is to present recommendations from a literature review focused on this issue, in terms of selection and delineation of lymph node in irradiation of cervix and endometrial cancers.

The gynecological and mammary cancers constitute a major preoccupation for the international community because they represent an important cause of mortality and morbidity among women. However, their systematic tracking is not always current in our countries of the south. This survey aims to evaluate the epidemiological features of these cancers in hospital-academic environment in Cotonou.It is a retrospective survey with a structural descriptive and analytic aim during a period of 9 years, from January 1st, 2000 to December 31, 2008.On 210 cases of recorded gynecological and mammary cancers during this period, the cancer of the breast comes at the first rank with 44,3% of the cases. The cancer of the cervix represents 26,7% of the cases followed by the cancer of the ovaries (18,6%) and the cancer of the endometrium (9,5%). The cancers of the vulva and the vagina are weakly represented. The delay of consultation after the apparition of the first signs in our series is most often included between 1 and 6 months (32,2%) but goes also beyond 3 years (26,1%). The cancer of the cervix and the endometrium are found in most aged women, whereas the cancer of the breast covers all ages. Most cancers (65%) are diagnosed at an advanced stage (III stage or IV). The different anatomopathological types that are found more frequently are the ductal invasive carcinoma (33%) for the breast, the squamous cell carcinoma for cervix (62%) and the endometrioid adenocarcinoma for the endometrium (30%). The costly management of the cancers reduces the therapeutic possibilities, leading to 42% of survival at 5 years.In our survey, it comes out again that the screening of gynecological cancers is not well organized in our country as well as the health education of the woman and reproduction. It appears appropriate to set in motion a management program of the cancers in our country what would allow an early screening and appropriate management.

Economic data in the literature for brachytherapy are still sparse and heterogeneous, with few controlled prospective studies and a perspective most often limited to those of the provider (health insurances). Moreover, these observation and conclusions are difficult to generalize in France. The prospective health economic studies performed in France in the framework of a national program to sustain innovative and costly therapies (STIC program) launched by the French cancer national institute are therefore of most importance. With the exception of prostate brachytherapy with permanent seeds, the valorisation of the brachytherapy activity by the French national health insurance does not take into account the degree of complexity and the real costs supported by health institutions (i.e. no specific valorisation for 3D image-based treatment planning and dose optimization and for the use of pulsed dose rate brachytherapy).

The use of image-guided brachytherapy has led to a significant change in application techniques and improvements in treatment planning. Today, 3D imaging has replaced orthogonal radiographs for a large number of treatments, providing a possibility of an optimization adapted to the anatomy of each patient. When properly selected and implemented, this imaging provides accurate 3D information of volumes and brachytherapy device, allowing moving from a dose to points assessment to a dose/volume evaluation. This article describes the contribution of different imaging modalities for the different brachytherapy techniques: gynecological brachytherapy, interstitial brachytherapy (breast, penis, etc.) and prostate brachytherapy. It reminds recommendations for the establishment of protocols of images acquisition and 3D reconstruction of brachytherapy devices (applicators, plastic tubes, needles, etc.).

mst.2012.0019 Auteur(s) : M. Ondounda1 magondounda@yahoo.fr, S. Pither Antchoue2, C Zamba3 1 Service de medecine, 2 Service de gynecologie, Hopital d’instruction des armees Omar-Bongo-Ondimba, Libreville, Gabon 3 Centre de traitement ambulatoire du centre hospitalier, Libreville, Gabon Correspondance: M. Ondounda Une femme gabonaise âgee de 33 ans, infectee depuis 2005 par le virus de l’immunodeficience humaine (VIH) de type 1, sous abacavir, didanosine et indinavir-ritonavir depuis [...]

International audience; Each year, 13,000 newly gynecologic cancers are diagnosed in France. Gynecologic cancers were specifically heterogeneous (localisations, histologic subgroups, age class, etc). This work was delineated for a national call dedicated to gynecologic cancers. This review reports the major needs in terms of scientific research dedicated to gynecologic cancers in the biologic, epidemiology, human and sociologic fields. For example, medico-economic strategies adapted to ethnosociologic context, specifically for cervix cancer, took important part of the epidemiologic research. Impact of gynecologic cancer in terms of symptoms and late effects, quality of life after treatments and fertility needs to be specifically explored. For fundamental research, molecular characterisation, biologic markers, impact of immunology and genetics represent the major part of the field need to be explored. Finally, therapeutic and diagnosis innovations, optimization of treatments strategies and development of predictive models in order to perform individual prediction taking into account several risk factors (clinical and molecular) to offer help in management of gynecologic cancers are required.