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4 results on '"C. Lemanski"'

1. Sphincter‐saving surgery for ultra‐low rectal carcinoma initially indicated for abdominoperineal resection: Is it safe on a long‐term follow‐up?

Author

C. Lemanski, Denis Pezet, Philippe Rouanet, François Dravet, Eric Rullier, Marc Pocard, Jean Luc Faucheron, Sophie Gourgou, Merhdad Jafari, Laurent Mineur, Jean Michel Fabre, Jacques Balosso, Bernard Lelong, Christophe Taoum, Laurent Bresler, Michel Rivoire, Institut du Cancer de Montpellier (ICM), Centre Léon Bérard [Lyon], Institut Paoli-Calmettes, Fédération nationale des Centres de lutte contre le Cancer (FNCLCC), CHU Bordeaux [Bordeaux], Centre Régional de Lutte contre le Cancer Oscar Lambret [Lille] (UNICANCER/Lille), Université de Lille-UNICANCER, Institut Sainte Catherine [Avignon], Service de Chirurgie d'Oncologie Digestive [CHU Lariboisière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Hospitalier Universitaire [Grenoble] (CHU), Centre René Gauducheau, CRLCC René Gauducheau, CHU Clermont-Ferrand, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), and Centre Hospitalier Universitaire de Nancy (CHU Nancy)

Subjects
Male, [SDV]Life Sciences [q-bio], Anal Canal, law.invention, MESH: Aged, 80 and over, 0302 clinical medicine, Randomized controlled trial, intersphincteric resection, law, Prospective Studies, MESH: Aged, Aged, 80 and over, MESH: Middle Aged, Proctectomy, Abdominoperineal resection, MESH: Anal Canal, MESH: Follow-Up Studies, General Medicine, Middle Aged, Prognosis, neoadjuvant radiotherapy, Oncology, 030220 oncology & carcinogenesis, Female, 030211 gastroenterology & hepatology, Adult, medicine.medical_specialty, Randomization, Long term follow up, Adenocarcinoma, MESH: Prognosis, 03 medical and health sciences, Rectal carcinoma, Overall survival, medicine, Humans, ultra low rectal carcinoma, Aged, MESH: Humans, MESH: Organ Sparing Treatments, Rectal Neoplasms, business.industry, MESH: Proctectomy, MESH: Adenocarcinoma, MESH: Rectal Neoplasms, MESH: Adult, sphincter saving surgery, Intersphincteric resection, MESH: Male, MESH: Prospective Studies, Surgery, Sphincter saving surgery, business, MESH: Female, Organ Sparing Treatments, Follow-Up Studies
Abstract

International audience; Background: Rate of abdominoperineal resection (APR) varies from countries and surgeons. Surgical impact of preoperative treatment for ultra-low rectal carcinoma (ULRC) initially indicated for APR is debated. We report the 10-year oncological results from a prospective controlled trial (GRECCAR 1) which evaluate the sphincter saving surgery (SSR).Methods: ULRC indicated for APR were included (n = 207). Randomization was between high-dose radiation (HDR, 45 + 18 Gy) and radiochemotherapy (RCT, 45 Gy + 5FU infusion). Surgical decision was based on tumour volume regression at surgery. SSR technique was standardized as mucosectomy (M) or partial (PISR)/complete (CISR) intersphincteric resection.Results: Overall SSR rate was 85% (72% ISR), postoperative morbidity 27%, with no mortality. There were no significant differences between the HDR and RCT groups: 10-year overall survival (OS10) 70.1% versus 69.4%, respectively, 10.2% local recurrence (9.2%/14.5%) and 27.6% metastases (32.4%/27.7%). OS and disease-free survival were significantly longer for SSR (72.2% and 60.1%, respectively) versus APR (54.7% and 38.3%). No difference in OS10 between surgical approaches (M 78.9%, PISR 75.5%, CISR 65.5%) or tumour location (low 64.8%, ultralow 76.7%).Conclusion: GRECCAR 1 demonstrates the feasibility of safely changing an initial APR indication into an SSR procedure according to the preoperative treatment tumour response. Long-term oncologic follow-up validates this attitude.

Published
2020
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2. The “missing middle”: class and urban governance in Delhi’s unauthorised colonies

Author

C. Lemanski, S.Tawa Lama-Rewal, C. Lemanski, and S.Tawa Lama-Rewal

Abstract

This research critically engages with existing theories of class and urban governance, and is empirically located in Delhi, India. The paper argues that existing theories of urban participatory governance in the global South, which polarise urban citizens and their mobilisation strategies into the elite, typically understood as guilty of ‘capturing’ participatory structures; and the poor, conceptualised as excluded from formal governance mechanisms but active in more politicised forms of mobilisation, are incomplete. This research identifies urban citizens who fit neither the ‘elite’ nor ‘poor’ conceptual binary, and explores how such ‘ordinary’ citizens engage in participatory urban governance. Empirically, research addresses Delhi’s unauthorised colonies (UCs), residential areas that have evolved mostly on private land that is not classified ‘residential’ in the Delhi Master Plan. Housing roughly a quarter to one‐third of Delhi’s population and comprising a mix of classes, UCs are technically illegal locations for residential development, are consequently excluded from Delhi’s network of basic urban services (water, roads, electricity) and face potential demolition. UCs are conceptualised as representing India’s ‘missing middle’ both empirically, highlighting the multiplicity of the middle class, and conceptually, revealing the failure of binary concepts to accurately describe participatory urban governance for those in ‘the middle’. In addition, analysis highlights how UCs’ invisibility (linked to their heterogeneity – i.e. their empirical and conceptual ‘middle‐ness’) functions as both an asset and a limitation in terms of participation in urban governance. The paper calls for greater recognition in academic and policy debates regarding the nuances in everyday life that are overlooked by neat binaries. As the Delhi case shows, a large proportion of urban populations are neither ‘poor’ nor ‘elite’, and arguably a similar trend is likely to exist in cities thro

Published
2012

3. The actual benefit of intraoperative radiation therapy using 50 kV x-rays in early breast cancer: A retrospective study of 676 patients.

Author

Tallet A, Racadot S, Boher JM, Cohen M, Barrou J, Houvenaeghel G, Gutowski M, Delmond L, and Lemanski C

Subjects
Female, Humans, Mastectomy, Mastectomy, Segmental, Neoplasm Recurrence, Local surgery, Retrospective Studies, X-Rays, Breast Neoplasms diagnostic imaging, Breast Neoplasms radiotherapy, Breast Neoplasms surgery
Abstract

This French study reports the 5-year results of partial-breast irradiation using intraoperative radiation therapy (IORT) with 50 kV x-rays, in select early breast cancer patients. We report a retrospective analysis of 676 consecutive early breast cancer patients treated between November 2011 and December 2015 by partial-breast irradiation using the INTRABEAM ® system. Patients were highly selected based on the ASTRO and GEC-ESTRO criteria and underwent breast-conservative surgery and IORT, completed with additional whole-breast irradiation (WBI) when unexpected unfavorable prognostic factors were found at the final pathology report. Patients' outcomes relative to local and distant control, overall and breast cancer-specific survival, and toxicity are presented, as well as rates of additional WBI. Additional WBI was mandatory in one third of patients (31%), mainly due to lymph node involvement and extensive intraductal component. With a median follow-up time of 54 months, the 5-year local recurrence rate was 1.7% [95%CI: 0.9-3.3]; the median time to local recurrence was 23 months; ipsilateral breast recurrences mainly occurred in the same quadrant (7/11); in the restricted population, meeting all predefined criteria and treated with IORT alone (406 patients), the local recurrence rate was 1.5% [95%CI: 0.6-3.6]. Five-year distant tumor control was 98.6% [95%CI: 97.2-99.3], and the median time to distant recurrence was 22 months. Five-year overall survival was 96.5% [95%CI: 94.2-97.8], and 5-year breast cancer-specific survival was 98.9% [95%CI: 97.6-99.7]. In patients treated with IORT alone, there was no grade 3 toxicity, only four grade 3 (mainly fibrosis) affected patients treated with IORT and WBI. Grade 1-2 toxicity rates were 14% and 34.4% in patients treated with IORT alone and IORT plus WBI, respectively. Partial-breast irradiation using IORT by a 50 kV photon device is safe and well-tolerated in select patients with early breast cancer and is a valuable option in patients reluctant for adjuvant WBI., (© 2020 Wiley Periodicals, Inc.)

Published
2020
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