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Resume Objectifs Le cancer du sein est le premier cancer feminin. En cancerologie, il est essentiel d’apporter un accompagnement aux patientes. L’avenement de la chirurgie ambulatoire permet d’optimiser le parcours de prise en charge. La necessite d’accompagnement des patientes pose la question de sa compatibilite avec l’ambulatoire. L’objectif est de comparer la satisfaction des patientes operees d’un cancer du sein en ambulatoire par rapport a celles restant une nuit postoperatoire. Methodes Les patientes incluses dans l’etude ont beneficie d’une chirurgie conservatrice du sein. Il s’agit d’une etude mixte, une partie quantitative, observationnelle et prospective utilisant un questionnaire de satisfaction et une partie qualitative qui a consiste en des entretiens individuels semi-directifs. Le critere de jugement principal etait la satisfaction des patientes (comparaison de notes elevees). Resultats Il y avait 91 patientes au total, 38 dans le groupe ambulatoire et 53 dans le groupe hospitalisation d’une nuit. Il n’a pas ete retrouve de difference significative de satisfaction entre les deux groupes (p = 0,18). Les difficultes frequemment soulignees par les patientes durant leur sejour etaient les contraintes organisationnelles, le manque de confort hospitalier et l’attente parfois longue. Le besoin d’accompagnement humain faisait l’unanimite. Conclusions La satisfaction etait excellente dans l’etude. Le mode d’hospitalisation ne semble pas jouer ici un role sur la satisfaction. Une prise en charge de ce type ne peut s’envisager qu’avec des moyens humains et techniques suffisants. La recuperation amelioree apres chirurgie semble etre une alternative.

Background The impact of the first coronavirus disease 2019 (COVID-19) wave on cancer patient management was measured within the nationwide network of the Unicancer comprehensive cancer centers in France. Patients and methods The number of patients diagnosed and treated within 17 of the 18 Unicancer centers was collected in 2020 and compared with that during the same periods between 2016 and 2019. Unicancer centers treat close to 20% of cancer patients in France yearly. The reduction in the number of patients attending the Unicancer centers was analyzed per regions and cancer types. The impact of delayed care on cancer-related deaths was calculated based on different hypotheses. Results A 6.8% decrease in patients managed within Unicancer in the first 7 months of 2020 versus 2019 was observed. This reduction reached 21% during April and May, and was not compensated in June and July, nor later until November 2020. This reduction was observed only for newly diagnosed patients, while the clinical activity for previously diagnosed patients increased by 4% similar to previous years. The reduction was more pronounced in women, in breast and prostate cancers, and for patients without metastasis. Using an estimated hazard ratio of 1.06 per month of delay in diagnosis and treatment of new patients, we calculated that the delays observed in the 5-month period from March to July 2020 may result in an excess mortality due to cancer of 1000-6000 patients in coming years. Conclusions In this study, the delays in cancer patient management were observed only for newly diagnosed patients, more frequently in women, for breast cancer, prostate cancer, and nonmetastatic cancers. These delays may result is an excess risk of cancer-related deaths in the coming years., Highlights • A reduction of the number of cancer patients attending cancer centers was observed in France from January to July 2020. • This reduction was observed only for newly diagnosed patients. • The reduction of new diagnosis was more pronounced in women, for breast cancer, and prostate cancer, and nonmetastatic cancer. • No compensation was observed for the last months of 2020. The magnitude of delays may be larger in centers within the same country. • An estimation of the excess cancer death resulting from these delays is presented.

GANEA2 study was designed to assess accuracy and safety of sentinel lymph node (SLN) after neo-adjuvant chemotherapy (NAC) in breast cancer patients. Early breast cancer patients treated with NAC were included. Before NAC, patients with cytologically proven node involvement were allocated into the pN1 group, other patient were allocated into the cN0 group. After NAC, pN1 group patients underwent SLN and axillary lymph node dissection (ALND); cN0 group patients underwent SLN and ALND only in case of mapping failure or SLN involvement. The main endpoint was SLN false negative rate (FNR). Secondary endpoints were predictive factors for remaining positive ALND and survival of patients treated with SLN alone. From 2010 to 2014, 957 patients were included. Among the 419 patients from the cN0 group treated with SLN alone, one axillary relapse occurred during the follow-up. Among pN1 group patients, with successful mapping, 103 had a negative SLN. The FNR was 11.9% (95% CI 7.3–17.9%). Multivariate analysis showed that residual breast tumor size after NAC ≥ 5 mm and lympho-vascular invasion remained independent predictors for involved ALND. For patients with initially involved node, with negative SLN after NAC, no lympho-vascular invasion and a remaining breast tumor size 5 mm, the risk of a positive ALND is 3.7% regardless the number of SLN removed. In patients with no initial node involvement, negative SLN after NAC allows to safely avoid an ALND. Residual breast tumor and lympho-vascular invasion after NAC allow identifying patients with initially involved node with a low risk of ALND involvement.

Background Half of the patient treated with neoadjuvant chemotherapy (NAC) for a large operable breast cancer has no axillary lymph node involvement at the time of surgery. Sentinel lymph node detection (SLND), after NAC, is aimed to select patient who should be safely spared of an axillary lymphadenectomy (ALND).GANEA 2 is a French prospective multi institutional trial, aimed to assess SLND after NAC. Objective To assess the risk of relapse for patients without previous axillary node involvement treated with NAC followed with a SLND without a systematic lymphadenectomy. Patients and Method Inclusion: FIGO stage T1-T3 infiltrating breast carcinoma, indication of NAC. Exclusion: inflammatory cancer, local relapse, contra-indication to NAC, NAC interrupted due to progressive disease. Design: indication to plan a NAC, axillary sonography with fine needle cytology before NAC to select patients without lymph node involvement, SLND after NAC. ALND was mandatory in case of SLN involvement (macro or micro-metastasis) or SLND failure. Follow-up was scheduled with a medical visit / 6 months with axillary assessment and a mammography each year. Follow-up results are updated every 6 months. Pathological analysis were carried out according to standard methods and classified according to the last American Joint Committee staging system. Studied parameters were SLND detection rate, pathological results on breast specimen and nodes, rate of relapse (axilla, breast, metastasis), and survival. Results From July 2010 to February 2014, 587 patients were enrolled, from 17 institutions, and experienced breast tumor surgery and a SLND after NAC. Each patient experienced breast surgery. A breast tumour pathological complete response was found in 21.3% (125/587). SLND rate was 97% (570/587), with a median number of 2 sentinel nodes (1-9). Patients with a sentinel detection failure (n=17) experienced a systematic lymphadenectomy, without any involvement (n=13), a micro-metastasis (n=2) and a macro-metastasis (n=2). A total of 140 patients had at least one sentinel node involved: macro-metastasis (n=86), micro-metastasis (n=54). A lymphadenectomy was performed in 128 cases: metastasis free (n=100), macro-metastasis (n=17), micro-metastasis (n=11). A total of 430 patients had a SLN metastasis free (75% ;430/570). A not mandatory lymphadenectomy was performed (n=14): metastasis free (n=11), macro-metastasis (n=2) and micro-metastasis (n=1). 17 patients were lost to follow-up. A total of 399 patients without sentinel node involvement were followed 2.3 years (from 0.5 to 5.6 yrs). At 3 years overall survival was 97.8% [94.9-99.1], disease free survival was 94.8% [91.0-97.1%]. Six patients died. Fifteen patients experienced a relapse: 8 metastasis, 4 homolateral breast, 2 controlateral breast, 1 homolateral axillary relapse. Conclusion This is the most important series of patients followed 2.3 years after SLND without axillary lymphadenectomy after NAC for an advanced breast cancer, showing acceptable results. The current series validate the safety of this conservative strategies avoiding systematic lymphadenectomy to patients without initially involved axillary node treated with NAC. Citation Format: Classe J-M, Loaec C, Alran S, Paillocher N, Tunon-Lara C, Gimbergues P, Faure-Virelizier C, Chauvet M-P, Lasry S, Dupre P-F, Verhaeghe J-L, De Blaye P, Gutowski M, Barranger E, Lecuru F, Lefevre Lacoeuille C, Loussert L, Lambaudie E, Ferron G, Campion L. Sentinel node detection after neoadjuvant chemotherapy in patient without previous axillary node involvement (GANEA 2 trial): Follow-up of a prospective multi-institutional cohort [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr S2-07.

Introduction : The harvest of the latissimus dorsi muscle for the realization of immediate breast reconstruction induces a large dorsal scar measuring up to 20 centimeters, while only the muscle is used. We present here the results of our experience of endoscopic harvesting of the latissimus dorsi muscle using 3D technology. Our main objective is to reduce the dorsal scar and second assess the functional consequences for patients. Methods: Between December 1st, 2015 , and June 1st, 2016, there were 7 patients who underwent latissimus dorsi endoscopic harvesting, with 3D technology, for an immediate breast reconstruction after a skin-sparing or nipple sparing mastectomy. Results: 4 patients had latissimus dorsi muscle with breast implant and 3 patients by latissimus dorsi muscle only. The age average was 55 years (range 45-70). The mean length of surgery was 250 minutes (range 150- 380). The mean length of hospitalization was 7 days (range 4-12 days). One patient treated for local recurrence had skin necrosis because of previous radiotherapy. Donor site seroma was the main post surgery drawback. Patients on average benefited from 3 evacuations (range 1-5) of 850ml (range 640-1270ml). Acceptance of the reconstructed breast was good in six cases, and poor in one case. Only one patient reported discomfort at the donor site 1 month after surgery. Conclusion: The endoscopic 3D latissimus dorsi flap harvesting allows to reduce donor site scar. There is no significant difference concerning complications or post-operative pain and functional discomfort between the endoscopic and classic harvesting procedure. Citation Format: Barranger E, Dejode M. Endoscopic 3D latissimus dorsi muscle harvesting for immediate breast reconstruction. Results of our 7 patients experience in Antoine Lacassagne Nice Cancer Center [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P3-14-14.

Introduction/Background In SOLO1 trial, maintenance therapy with olaparib considerably improved progression-free survival (PFS) among women with newly-diagnosed, advanced BRCA-mutated HGEOC. Based on the large real-life ESME ovarian cancer (OC) cohort, we aimed to describe the patient‘s characteristics and survival outcomes of a selected cohort of BRCA-mutated patients before the era of PARP inhibitors maintenance in first line. Methodology ESME OC is a national cohort including all patients (pts) with EOC managed in the 18 French Comprehensive Cancer Centres (NCT03275298). ESME Research program collected retrospective data from patient‘s medical records. BRCA1, BRCA2, or both mutated patients with de novo diagnosed advanced (FIGO stage III or IV) high-grade serous or endometrioid EOC were eligible. Primary objective was to describe patient‘s characteristics, clinical features and treatment patterns. Results Of the 4777 patients with OC treated in first line by platinum-based chemotherapy between 2011 and 2016, 266 were included. Median age was 57.0 (33–81). 187 pts (70.3%) harbored a BRCA1 mutation, and 75 (28.2%) a BRCA2 mutation. 66.9% of patients had FIGO stage III disease. Almost all patients (95.5%) underwent surgical resection, after neoadjuvant chemotherapy (48%), or primary debulking surgery (44.9%). 119 pts (44.7%) received maintenance therapy and majority with bevacizumab alone (78.9%). After a median follow-up of 51.7months, the median PFS (mPFS) was 28.6months [95 CI: 26.2–32.4]. Patients exhibited higher mPFS in case of FIGO stage III than stage IV (32.4 months and 25.4 months, respectively), or BRCA2 mutation than BRCA1 (33.3 months and 27.7 months, respectively). Although populations were non comparable, mPFS was close between patients treated with or without maintenance (28.3 and 29.5 months, respectively). Median PFS2 were 51.4 months and 50.4 months, respectively. Estimated 5-year OS for the whole population was 69.2% [95 CI: 65.3–73.0]. Conclusion This large ESME OC cohort described clinical features and real-life survival outcomes among pts with newly diagnosed advanced BRCA-mutated HGEOC treated in specialized centres. Disclosure This work was supported by UNICANCER. The ESME OC database is supported by an industrial consortium (Roche, Pfizer, AstraZeneca, MSD, Eisai and Daiichi Sankyo). Data collection, analyses and publications are totally managed by R&D UNICANCER independently of the industrial consortium. All the authors declare that there is no conflict of interest regarding the publication of this article.

Breast cancer is the primary female cancer. In cancerology, it is essential to give to the patient some support. The advent of outpatient surgery optimizes the care path. This need for support of patients raises the question of its compatibility with the day surgery. The purpose is to compare the satisfaction of outpatients with those who stay overnight after surgery of breast cancer. MéTHODS: Patients who underwent breast conservative surgery were included. It is a mixed study, a quantitative, observational and prospective one using a satisfaction survey and a qualitative one which consisted on semi - directive individual interviews. We compared the satisfaction rate (highest marks).There were 91 patientes, 38 in the ambulatory group and 53 in the overnight group. There was no significant difference in satisfaction between the two groups (P=0.18). The difficulties frequently highlighted by the patients during their stay were the organizational management, the lack of hospital comfort and the sometimes long wait. The need for human support was unanimous.The satisfaction was excellent in the study. The mode of hospitalization does not seem to play a role here on satisfaction. This hospitalization mode can only be envisaged by providing sufficient human and technical resources. Enhanced recovery after surgery appears to be an alternative to outpatient surgery.

Introduction La prise en charge des patients genere de grande quantite de donnees dont 80 % sont enregistrees dans des comptes rendus (CR) textuels non structures. Au centre Antoine-Lacassagne (CAL), c’est plus de trois millions de CR qui constituent un reservoir d’informations tres peu exploite. A l’heure du big data et de l’intelligence artificielle (IA), la creation d’une plateforme de donnees de sante structurees et exploitables est un important challenge pour les etablissements de sante. L’objectif de cette premiere etape de RUBY etait de developper, en collaboration avec IBM, des algorithmes d’IA capables de structurer les donnees des CR des patientes atteintes d’un cancer du sein et de les integrer automatiquement dans un fichier de donnees structurees. Cette etude de type « preuve de concept » a ete realisee sur la premiere consultation (PCONS), la premiere biopsie (PBIO), la premiere chirurgie (PCHIR) et le premier CR d’anatomopathologie (PANA) des patientes du CAL. Methodes Deux bases de donnees de cancer du sein ont ete fusionnees pour creer une base de donnees structurees (BDDS) : la base SEIN-CAL (patientes prises en charge avant 2008) et la base ESME-CSM (patients prises en charge apres 2008). La population a ete scindee en deux, permettant de creer une cohorte d’entrainement (CE = 70 % des patientes et leurs CR associes) et une cohorte de test (CT = 30 %). Les CR ont necessite un pretraitement, et une segmentation a ete effectuee afin de faciliter l’identification des donnees a extraire. Les CR ont ete annotes manuellement avec BRAT, puis des algorithmes d’apprentissage utilisant le reseau neuronal convolutif ont ete executes avec SpaCy. Un fichier de donnees structurees (.csv) a ete produit et les indicateurs de performances de RUBY ont ete evalues et compares aux performances d’une structuration manuelle des donnees par un attache de recherche clinique (ARC). Resultats Plus de 2300 patientes ont ete incluses dans les deux bases fusionnees. Pour les variables PCONS, sur 8 variables testees, la precision de RUBY etait comprise entre 64 % et 98 % respectivement pour les variables « N clinique » et « indication de la premiere venue ». Pour PBIO, sur 10 variables, la precision de RUBY variait de 93 a 100 %. Pour PCHIR, la precision de RUBY etait > 93 % pour 6 des 7 variables d’interet et de 79 % pour l’ « indication de la chirurgie ». Pour PANA, la precision de RUBY etait > 90 % pour 15/19 variables dont 11 etaient > 95 %, la precision etait > 75 % pour les 4 autres variables. A ce stade de niveau d’apprentissage, les performances de RUBY sont superieures a celles d’un ARC dans 43 % des cas. Le temps necessaire pour structurer automatiquement les donnees des 2300 patientes a ete de moins de 25 minutes avec RUBY versus 30 jours par un ARC en structuration manuelle. Conclusion Les premiers resultats de RUBY sont tres encourageants et une nouvelle phase d’annotation est en cours afin d’ameliorer les resultats de l’algorithme. Les performances de RUBY sont meilleures sur les CR semi structures comme PBIO, PCHIR et PANA. Les PCONS sont les plus difficiles a structurer automatiquement car restent medecins-dependants. Le demonstrateur RUBY a permis de progresser dans la structuration automatique des donnees du cancer du sein au CAL. Il est maintenant necessaire d’optimiser les algorithmes afin d’ameliorer les performances de RUBY et de deployer cette application a d’autres types de CR et d’autres pathologies puis d’autres etablissements.

The sentinel node procedure (GS) is the recommended technique for axillary surgical exploration in localized breast cancer with no clinical or radiological lymph node involvement. This surgical technique is based on a dual isotope and colorimetric detection. Although it allows a significant reduction in morbidity compared to axillary dissection (CA), this procedure induces a number of organizational constraints, in particular for the radioisotope injection. Specially for this reason, other GS methods have emerged in recent years, some of which appear promising (detection by fluorescence and magnetic iron). The objective of this paper was to carry out a synthesis of the reference method of detection (radioisotope) GS and analyze the recent literature on new detection methods.

PurposeTo prospectively determine the range of abdominopelvic ultrasonographic findings, including Doppler resistance index (RI) of uterine arteries, 2 and 24hours after uncomplicated delivery.MethodWomen who delivered vaginally or after cesarean section without complication from January 2012 to April 2012 in a tertiary care hospital were prospectively included. Abdominopelvic ultrasonography, including uterine artery resistance index (RI) at duplex Doppler ultrasonography, was performed 2hours and 24hours after delivery.ResultsNinety-two women (mean age, 32.7 years) were included. Sixty-one (66%) delivered vaginally and 31 (34%) had cesarean section. Twenty-four hours after vaginal delivery, endometrial and anterior wall thicknesses dropped and uterine width increased (P

Background To define a core set of geriatric data to be methodically collected in clinical cancer trials of older adults, enabling comparison across trials. Patients and methods Following a consensus approach, a panel of 14 geriatricians from oncology clinics identified seven domains of importance in geriatric assessment. Based on the international recommendations, geriatricians selected the mostly commonly used tools/items for geriatric assessment by domain (January–October 2015). The Geriatric Core Dataset (G-CODE) was progressively developed according to RAND appropriateness ratings and feedback during three successive Delphi rounds (July–September 2016). The face validity of the G-CODE was assessed with two large panels of health professionals (55 national and 42 international experts) involved both in clinical practice and cancer trials (March–September 2017). Results and discussion After the last Delphi round, the tools/items proposed for the G-CODE were the following: (1) social assessment: living alone or support requested to stay at home; (2) functional autonomy: Activities of Daily Living (ADL) questionnaire and short instrumental ADL questionnaire; (3) mobility: Timed Up and Go test; (4) nutrition: weight loss during the past 6 months and body mass index; (5) cognition: Mini-Cog test; (6) mood: mini-Geriatric Depression Scale and (7) comorbidity: updated Charlson Comorbidity Index. More than 70% of national experts (42 from 20 cities) and international experts (31 from 13 countries) participated. National and international surveys showed good acceptability of the G-CODE. Specific points discussed included age-year cut-off, threshold of each tool/item and information about social support, but no additional item was proposed. Conclusion We achieved formal consensus on a set of geriatric data to be collected in cancer trials of older patients. The dissemination and prospective use of the G-CODE is needed to assess its utility.

Introduction A l’heure de la medecine personnalisee, les etudes cliniques sont une opportunite pour les patients et un challenge pour les investigateurs. Les criteres de selection etant de plus en plus complexes, l’identification des patients eligibles est chronophage, couteuse et souvent infructueuse. L’informatisation des dossiers medicaux devrait permettre l’utilisation en routine d’outils automatises de pre-screening. L’objectif de ce travail etait de developper une application informatique permettant de fouiller les dossiers medicaux afin d’emettre une alerte automatique lorsqu’un patient eligible est detecte. Methodes Au Centre Antoine Lacassagne (CAL) les dossiers medicaux (DM) sont informatises et stockes dans le logiciel Clinicom®. Ils sont exportes quotidiennement sous forme de fichiers texte. PAPY (Pre-screening par Python®), a ete developpe afin de recuperer ces DM et les indexer. Il va ensuite rechercher dans les DM, a l’aide d’expressions regulieres, les patients eligibles. La performance de PAPY a ete evaluee sur l’etude « Iodine Breast : NCT02759133 ». Toutes les patientes venues au CAL d’avril a juillet 2018 pour un cancer du sein ont ete evaluees (population source). Trois cohortes de patientes ont ete constituees et comparees. Cohorte C1 : toutes les patientes eligibles evaluees manuellement sur la population source (cinq minutes de relecture par dossier). Cohorte C2 : patientes incluses dans l’etude en pratique standard (patientes identifiees lors des consultations). Cohorte C3 : patientes detectees par PAPY. La performance a ete evaluee par le calcul de la sensibilite, specificite, vrais positifs, faux positifs, gain de temps. Resultats La population source etait constituee de 184 patientes, la cohorte C1 etait de 23 patientes (100 %). La pratique standard (C2) inclus 15/23 (65 %) patientes eligibles. PAPY (C3) identifie 26 patientes eligibles dont 14/23 (60 %) appartiennent a C1 et 9/15 (60 %) appartiennent a C2 ; 5/26 (20 %) patientes de C3 n’ont pas ete detectees dans C2 mais sont eligibles (C1) et 12/26 (35 %) patientes sont des faux positif. Trois (13 %) des patientes de C1 ne sont ni incluses en pratique standard ni identifiees par PAPY. L’analyse montre que la pratique standard a une sensibilite de 0,65 [0,45, 0,80] et une specificite de 100 %, PAPY est proche 0,60 [0,41, 0,77] avec une specificite de 0,92 [0,87, 0,95]. Le temps necessaire pour analyser les dossiers C1 est de 46 heures, le temps de controle manuel des 23 dossiers selectionnes par PAPY a ete estime a 1 heures 55 minutes. Conclusion PAPY est proche de la pratique standard (sensibilite : 0,60 versus 0,65). Malgre 35 % de faux positifs, le gain de temps reste considerable, seules les patientes detectees etant evaluees pour l’inclusion. PAPY detecte 20 % de patientes eligibles mais non incluses et peut donc venir en complement de la pratique courante. PAPY se heurte aux problemes connus des systemes automatises de recrutement tels que le temps de validation des comptes rendus medicaux et la disponibilite du personnel hospitalier pour les inclusions. PAPY a ete utilise en routine pour sept etudes, des e-mails automatiques sont envoyes a chaque detection de patient eligible. Afin de diminuer le taux de faux positifs, l’integration des criteres de non inclusion a l’aide d’expressions negatives est en cours. Une collaboration avec l’equipe de linguistique Base, Corpus, Langage (UMR7320) devrait permettre une meilleure selection des patients en ameliorant l’identification de termes.

El termino «patologia benigna de mama» incluye un grupo heterogeneo de lesiones, sintomas e imagenes radiologicas. Las lesiones de la mama son en su mayoria benignas. El objetivo que se persigue al diagnosticar estas lesiones siempre es descartar un cancer o una lesion con riesgo de «degeneracion», lo que posibilita un seguimiento adecuado. En este trabajo, se revisaran las lesiones benignas mas frecuentes segun su potencial carcinologico (sin riesgo, con riesgo bajo o con riesgo importante), con atencion especial a dos entidades: la enfermedad fibroquistica y las lesiones de hiperplasia. Un buen conocimiento de estas lesiones permite adaptar el seguimiento de forma multidisciplinaria (ginecologo, radiologo, patologo) y no practicar la reseccion de forma demasiado sistematica, ya que determinadas lesiones pueden considerarse dentro de la normalidad. En cambio, otras, de riesgo, no son visibles mediante las tecnicas de imagen y deben manejarse de forma apropiada.

The sentinel lymph node (SLN) is a standard for the surgical treatment of axillary localized breast cancer N0. It is based on a double isotopic and color detection. With a gamma detecting probe connected to an infrared camera, Declipse SPECT system (Surgiceye(®)) is able to detect and locate any radioactive source in 3D. Mobile character for use in the operating room is particularly interesting for the intraoperative detection of SLN. We illustrate its usefulness in a clinical case where the preoperative identification of SLN by lymphoscintigraphy was not informative.

Resume But Determiner l’apport de l’echographie 2D-3D dans le suivi des patientes apres traitement conservateur d’un placenta accreta. Patients et methodes Sept patientes avec traitement conservateur de placenta accreta entre 2007 et 2009 ont ete incluses. Chaque patiente beneficiait d’un examen clinique mensuel avec echographie 2D-3D. Les donnees suivantes etaient relevees : evenements cliniques, echogenecite a l’echographie 2D, vascularisation au doppler couleur, mesure de la proportion de voxels gris a l’echographie 3D, ainsi que des indices de vascularisation (IV), de flux (IF) et de perfusion (produit de IV et IF). Resultats Le suivi moyen etait de 228 jours [75–369] avec 8 echographies en moyenne par patientes [2–14]. La duree moyenne d’elimination placentaire a ete de 280 jours [120–365]. Une plage anechogene apparaissait systematiquement avant l’elimination complete du reliquat placentaire en echographie 2D. Une disparition de la vascularisation en doppler couleur etait systematiquement associee a un arret des metrorragies. Les differents parametres mesures en echographie 3D etaient tres heterogenes et aucune correlation n’a pu etre mise en evidence avec des evenements cliniques. Conclusion Un suivi regulier est essentiel apres traitement conservateur de placenta accreta mais l’interet de l’echographie 3D par rapport a l’echographie 2D n’a pu etre demontre.

Gynecologie Obstetrique & Fertilite - Sous presse. Epreuves corrigees par l'auteur. Disponible en ligne depuis le samedi 21 mai 2016

Introduction A l’heure des big data, la conception et la maintenance de grandes bases de donnees sont devenues un enjeu majeur. Dans le cadre de leurs travaux de recherches les investigateurs collectent les donnees de leurs patients dans des bases de donnees personnelles (Excel®, Access®). Notre objectif est de doter l’etablissement d’un ensemble de bases centralisees et administrees sous un meme systeme de gestion de base de donnees (Ennov Clinical®), pour les principales pathologies traitees. L’interet pour les investigateurs est de disposer d’un receptacle par pathologie leur permettant de realiser l’import de leurs anciennes bases et la saisie directe des nouveaux patients. La qualite, l’accessibilite et la securite des donnees est ensuite assuree par les data managers (DM). Methodes Chaque base doit permettre de repondre aux questions posees par les investigateurs, de fait le choix des variables a recueillir est un objectif majeur. Lors de la constitution d’une base, le DM consulte chaque specialiste de la pathologie afin de connaitre toutes les variables d’interet. Il concoit ainsi le draft du cahier d’observation « papier » (CRF) de la base. Puis des reunions pluridisciplinaires sont organisees afin de valider definitivement le CRF. Le DM realise alors le cahier d’observation « electronique » (eCRF), parametre les controles de coherences et concoit les tables d’export. La base devenue operationnelle permet au DM d’importer les donnees des investigateurs et de faire saisir des nouveaux patients. En fonction des questions posees, le DM realisera les exports pour l’analyse statistique et la publication. Resultats En 2013, la base « RECTUM » incluant 2408 variables pour un eCRF de 137 pages a suivi ce processus de realisation. Les fichiers de l’investigateur y ont ete implementes et un article sur la preservation des organes des patients traites par radiotherapie a ete publie dans Acta Oncologica (impact factor [IF] : 3,4). En 2014, de nouveaux patients ont ete ajoutes permettant une nouvelle publication sur le meme theme dans l’« European Journal of Cancer » (EJC) (IF : 7,19). En 2015, la base devenait multicentrique, un nouvel article sur la preservation d’organes a ete publie dans l’EJC. L’annee 2018 est marquee par l’integration de nos donnees dans l’« International Watch and Wait Database » (IWWD), suivie d’une publication dans le Lancet (IF : 53) sur les resultats a long terme des traitements du cancer du rectum. La base a egalement evolue en 2018 par ajout de variables dans l’eCRF afin de repondre a une nouvelle question sur le calcul des volumes tumoraux, un article est en cours de redaction dans « Journal of Radiation Oncology » (IF : 5,54). Conclusion La base RECTUM a donc permis la publication de quatre articles en cinq ans correspondant a 96 points SIGAPS soit une valorisation de 200K€ pour le CAL. Le projet BaseCAL compte a ce jour trois bases developpees selon cette methode dans les pathologies suivantes : RECTUM, SEIN (3 articles, 56 SIGAPS en 2018), et VADS (4 articles, 56 SIGAPS en 2018). Prochainement, l’incrementation de ces bases deviendra automatique en utilisant une methode d’intelligence artificielle basee sur le « natural language processing » en cours de developpement. Le succes de ces bases se mesure en termes de publications et de points SIGAPS. Il repose sur la motivation et l’implication des investigateurs, le choix des variables, la qualite des donnees ainsi que sur une etroite interaction entre biostatisticiens, DMs et investigateurs.

Introduction/Materiels Il s’agit de presenter la mise en œuvre du reperage des tumeurs mammaires non-palpables par grain d’iode 125 et les resultats intermediaires d’une comparaison avec la technique classique utilisant un guide metallique (harpon). C’est une etude prospective monocentrique de non-inferiorite, randomisee avec une stratification selon le statut histologique. Le repere utilise est un grain d’iode 125 (IsoSeed® – Eckert & Ziegler) de dimension O 0,8 mm×4,5 mm emettant un rayonnement gamma de 27 keV. Methodes/Resultats/Conclusion Le grain d’iode d’activite comprise entre 5 et 10 MBq est mis en place en radiologie sous controle echographique ou mammographique jusqu’a 10 jours avant la chirurgie. Le reperage du ganglion sentinelle est realise la veille ou le jour meme par nanocolloides marques au 99mTc. Des etudes preliminaires ont permis de verifier le caractere radio-opaque et echogene du grain ; l’efficacite des sondes peroperatoires, notamment en termes de conflit entre le 99mTc et le 125I, la verification de la presence du grain dans la piece operatoire (Faxitron), les aspects de radioprotection et le circuit multidisciplinaire du grain. L’etude intermediaire porte sur les 116 premieres patientes. Soixante reperages par harpon et 56 reperages par grain d’iode ont ete realises. Cinquante grains ont ete places sous echographie et 6 sous mammographie. Les durees de mise en place radiologique et de l’acte operatoire sont reduites avec le grain d’iode (p

The main goal of preoperative chemotherapy is to reduce the size of the tumor and allow conservative treatment. Neoadjuvant treatment can affect axillary status with a downstaging in one third of the cases. For these patients, the benefit of axillary node dissection is questioned and the sentinel node biopsy (SLNB) seems to be a relevant option. However, the timing of performing SLNB is still debated especially for clinical negative patients with negative axillary ultrasound before preoperative chemotherapy. For axillary positive nodes proved by biopsy/cytology before preoperative chemotherapy, SLNB can be an option if there is a good clinical and radiological response.

Objectif de l’etude L’objectif de l’etude etait, comparer la probabilite de survie sans mastectomie a 10 ans observee apres irradiation partielle et acceleree a celles estimees avec et sans irradiation totale du sein, chez les patientes âgees atteintes d’un cancer du sein localise. Materiel et methode Les patientes incluses avaient plus de 66 ans, etaient atteintes d’un cancer du sein infiltrant, des stade pT1 ou pT2 N0 M0, traitees par chirurgie conservatrice avec marges saines. L’irradiation partielle acceleree du sein a ete realisee par curietherapie interstitielle de haut debit de dose de 32 a 34 Gy en huit a dix fractions. Albert et al. ont etabli un nomogramme afin de predire la probabilite de survie sans mastectomie a 10 ans avec et sans irradiation totale du sein chez les patientes âgees de 66 a 79 ans. Pour chaque patiente traitee, la probabilite de survie sans mastectomie a 10 ans avec et sans irradiation totale du sein a ete calculee avec le nomogramme d’Albert et comparee a celle observee apres irradiation partielle acceleree du sein. La toxicite a egalement ete relevee. Resultats Nous avons inclus 79 patientes prises en charge par irradiation partielle acceleree du sein entre 2005 et 2016 dans le centre Antoine-Lacassagne. L’âge median etait de 77 ans (extremes : 66–89 ans). Il s’agissait essentiellement de tumeurs de stade pT1 (91,1 %) et d’histologie canalaire infiltrante (93,7 %). Une hormonotherapie adjuvante a ete mise en place pour 72 patientes (91,1 %). Avec un suivi median de 96,8 mois, une seule mastectomie a ete realisee chez une patiente de 85 ans, 88 mois apres la curietherapie. La probabilite de survie sans mastectomie a 10 ans observee pour la population traitee etait de 97,4 %. Les probabilites de survie sans mastectomie a 10 ans estimees avec le nomogramme d’Albert sans radiotherapie et avec irradiation totale du sein etaient respectivement de 92,7 % et 96,3 %. Aucune toxicite de grade 3 ou plus n’a ete observee. Conclusion La probabilite de survie sans mastectomie a 10 ans observee apres irradiation partielle acceleree du sein est superieure a celle estimee avec le nomogramme d’Albert sans radiotherapie et au moins non inferieure a celle estimee avec irradiation totale du sein. Chez les patientes âgees, l’irradiation partielle acceleree du sein semble etre une bonne alternative entre l’irradiation totale du sein et l’absence d’irradiation.

Assess the biopsy's feasibility of the sentinel lymph node biopsy (SLNB) using optonuclear probe after of indocyanine green (ICG) and radio-isotope (RI) injections.Twenty-one patients with a localized breast cancer and unsuspicious axillary nodes underwent a SLNB after both injections of ICG and radio-isotope.One or more SLN were identified on the 21 patients (identification rate of 100%). The median number SLN was 2 (1-3). Twenty SLN were both radio-actives and fluorescents (54.1%), 11 fluorescent only (29.7%) and 6 were only radio-actives (16.2%). Seven patients had a metastatic SLN (8 SLN overall). Among them, only one had a micrometastasic SLN, 5 others had a macrometastatic SLN and one patient had two macrometastatic SLNs. Among the 8 metastatic SLN, 5 were both fluorescent and radioactive, 2 were only fluorescent and 1 was only radioactive.Detection SLN using optonuclear probe after indocyanine green and radio-isotope injections is effective and could be, after validation by randomized trial, a reliable alternative to the blue dye injection for teams who consider that combined detection as the reference.

The sentinel node procedure (GS) is the recommended technique for axillary surgical exploration in localized breast cancer with no clinical or radiological lymph node involvement. This surgical technique is based on a dual isotope and colorimetric detection. Although it allows a significant reduction in morbidity compared to axillary dissection (CA), this procedure induces a number of organizational constraints, in particular for the radioisotope injection. Specially for this reason, other GS methods have emerged in recent years, some of which appear promising (detection by fluorescence and magnetic iron). The objective of this paper was to carry out a synthesis of the reference method of detection (radioisotope) GS and analyze the recent literature on new detection methods.

Introduction For the excision of nonpalpable breast lesions, the surgeon needs a landmark previously placed under radiological or ultrasound imaging control. The current technique consists in implanting a metal wire from the lesion to the skin, which presents some constraints in terms of patient comfort, surgery precision (potential wire migration) and medical organization. Here is presented the implementation of breast lesion localization using an 125I radioactive seed as part of a mononoclinical trial comparing the wire-guided and radioguided techniques. Today, a feedback over 18 patients enables a first report on this technique. Methods In order to insure the feasibility of the iodine seed (IsoSeed® - Eckert & Ziegler) technique, the radiopaque and echogenic seed’s features were checked. In the surgery room, the iodine seed (A Results The seed is visible under X-Ray and ultrasound imaging. Thus this localization technique is possible, as well as the control of the seed presence into the lesion using Faxitron imaging (X-Ray). The 11 mm diameter probe was approved by the surgeons. With a 1.5 cm focalization (FWHM of the radial sensitivity curve), it offers the best compromise sensitivity/focalization. In light of the clinical activities, the scattered radiation of 99mTc does not trouble the 125I seed detection. For a seed implanted at 1, 2 and 3 cm depth, the breast skin dose was respectively evaluated at 2.2, 0.5 and 0.2 mGy/MBq/day. The highest activity and implantation duration being 10 MBq and 10 days, there is no contraindication to this technique due to radioprotection. The simulation using the piece of meat led to validate every step of the protocol with the different operators and thus resolve every major difficulty in relation to this technique. Conclusions The 18 iodine seed localizations (activity: 4.4 ± 1.5 MBq (1 σ ) , presence duration in the breast: 4.6 ± 3 days (1 σ ) ) were successful and enabled to optimize the established protocol. They confirm that this technique brings the solution to the constraints linked to the wire-guided localization: the seed positioning and the surgery gesture are made easier, the patient comfort is unquestionably improved and the medical organization flows better. Today, no seed migration has been observed, which may also promise a gain in precision.

Objectifs Evaluer les resultats a long terme d’un second traitement conservateur radiochirurgical pour une recidive homolaterale d’un cancer du sein. Materiels et methodes Etude retrospective monocentrique evaluant les resultats cliniques d’une tumorectomie et une re-irradiation mammaire partielle acceleree par une technique de curietherapie interstitielle de bas- ou haut-debit de dose en cas de recidive locale d’une cancer du sein. Pour la curietherapie de haut debit de dose, les contraintes de dose etaient pour le volume cible anatomoclinique (CTV) : V100 ≥ 95 % ( Vx = volume recevant x % de la dose prescrite), V150 dose-non uniformity ratio ) Resultats Entre 09/2000 et 09/2014, 117 patientes ont beneficie d’un second traitement conservateur pour une recidive. Le volume cible anatomoclinique median etait de 50 cm 3 , les V100, V150 et V200 medians respectivement de 96 %, 38 % et 14 %. Le DNR median etait de 0,43. Apres un suivi en mediane de 63 mois (intervalle de confiance a 95 % : 47–75), trois patientes (2 %) ont ete atteintes d’une deuxieme recidive locale a 70, 82 et 128 mois. Les probabilites de survie sans deuxieme recidive locale et de survie sans progression a 5 ans etaient respectivement de 100 % (0–100) et 91 % (85–97). La probabilite de survie globale a 5 ans etait de 93 % (87–99). Quatre-vingt-cinq patientes (73 %) ont souffert d’une toxicite, pour 65 % de grade 1, 31 % de grade 2 et 5 % de grade 3. Aucune toxicite de grade 4 ou 5 n’a ete constatee. Les fibroses cutanee et sous-cutanee etaient majoritaires (64 %). Les patientes souffrant d’une toxicite severe (de grade 3 ou plus) avaient un volume cible anatomoclinique moyen statistiquement plus grand (50 contre 73 cm 3 , p = 0,009). Aucune mastectomie n’a ete realisee pour toxicite induite et la probabilite de survie sans mastectomie a 5 ans etait de 99 % (I97–100). Conclusion En cas de recidive locale de cancer du sein, un second traitement conservateur radiochirurgical peut etre propose en alternative a une mastectomie radicale.