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The main objective of this study was to assess the feasibility of breast reconstruction by exclusive autologous fat grafting (AFG). The secondary objectives were to identify predictive factors for technique failure and to assess the satisfaction and quality of life of patients who have benefited from exclusive AFG breast reconstruction using satisfaction and WHOQOL-BREF surveys.We carried out a monocentric retrospective study. We included 118 patients who achieved breast reconstruction that was initially planned as exclusive AFG reconstruction, between April 2015 and November 2020.The success rate was 72.88% (86 patients). The only risk factor for failure we objectified was irradiation (OR=2.90). A total of 85 percent of patients felt that the result met their expectations. However, 82.93% rated their quality of life as good or very good.The AFG technique is well described, easily reproducible, and serious complications are rare. It allows for a less invasive autologous reconstruction than free or pedicle flaps. This type of reconstruction should probably be reserved for motivated patients with a small breast size or agreeing to a contralateral breast reduction procedure.

Background There is a trend towards de-escalation in early breast cancer axillary surgery. In the American College of Surgeons Oncology Group (ACOSOG) Z-0011 trial, observation was shown to be non-inferior in terms of overall survival to complementary axillary lymph node dissection (cALND) in patients with up to two sentinel lymph node (SLN) metastases. The study included patients with T1-T2 invasive breast cancer, clinically node negative, undergoing breast-conserving surgery with SLN biopsy, followed by systemic therapy and radiotherapy. The aim of our study was to evaluate the impact of applying these ACOSOG Z-0011 inclusion criteria in routine practice. Patients and methods This retrospective observational study was conducted in a French comprehensive cancer center where patients treated for breast cancer with primary surgery were prospectively included between 2010 and 2016. Patients meeting ACOSOG Z-0011 inclusion criteria were analyzed. Results Among the 1900 included patients, 1497 (79 %) met the ACOSOG Z-0011 criteria before surgery. Of these, 390 (20 %) had one or two metastatic SLN and could have avoided cALND. Out of these patients, 319 (81 %) presented cT1 tumors. During the study period, cALND was performed in 320 (82 %) patients and was free of metastases in 80 % of cases, having an impact on eligibility for adjuvant chemotherapy in only 3 (0.8 %) patients. Conclusions In situations of primary breast cancer surgery, use of ACOSOG Z-0011 criteria could reduce the rate of cALND by 20 %. Further studies are needed to help select patients for whom abstention from any axillary surgery would be reasonable.

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.

This phase III trial included patients with ultra-low rectal adenocarcinoma that initially required abdominoperineal resection. The surgical decision was based on clinical tumour status after preoperative treatment. The overall sphincter-saving resection rate was 85 per cent, with 72 per cent rate of intersphincteric resection. Long-term results showed that changing the initial abdominoperineal resection indication into a sphincter-saving resection according to tumoral response is oncologically safe. Saving the sphincter

Backgrounds: Autologous fat grafting has become a frequent, simply reproducible and low-risk technique in breast reconstruction. The potential risk of fat tissue transfer to the breast in oncologic patients remains to be discussed, but one must clearly distinguish the situation where there is a breast parenchyma left and where the whole gland has been removed, like in our study. Although lipotransfer has become very popular, only a limited number of case series have been reported up to date. The presented study describes an optimized treatment and complications for breast reconstruction after total mastectomy by lipotransfer alone. Patients and methods: A retrospective study was performed in two French centers with five surgeons between February 2011 and June 2015, including 54 patients. Inclusion criteria were patients with prior breast cancer, treated by mastectomy and with a finished breast reconstruction with exclusive fat grafting. Exclusion criteria were prior reconstruction with implant or flap. We used two technics for liposuction: manual aspiration with syringes (pouret kit®) or waterjet assisted liposuction (body-jet®). The BRAVA® could be combined with the reconstruction. Our study had 2 main objectives: evaluate the factors influencing the number of surgical procedures and study the complications and carcinologic evolution. Statistical analysis was performed using stata 13.1 SE. Results: We included 54 patients, 49 delayed reconstructions including two bilateral reconstructions and 5 immediate reconstructions. The morphologic data showed: a normal BMI for 70,3 % (38/54) patients and a bra cup A or B for 72,2 % (39/54). 39 patients had radiotherapy during the cancer treatment and the mean time between radiotherapy and reconstruction was 19 months. For the patients without radiotherapy, the mean time between mastectomy and reconstruction was 22 months. 6 patients (11%) were smoker or diabetic. We used manual aspiration in 37 patients (68,5 %) and hydro dissection in 17 patients (31,5%). 10 patients received BRAVA system in complement. We performed 231 fat grafting procedures with an average of 4,2 per patient. The mean total quantity of fat injected was 904 ml per patient with a mean quantity per procedure of 219 ml. The mean time between two procedures was 4,3 months. Only the prior radiotherapy treatment increases the number of fat grafting procedures significantly (p=0,02) and the use of hydro dissection with bodyjet decreases the number of fat grafting procedures significantly (p=0,04). We observed one failure of procedure requiring an implant and three patients with metastatic disease without local recurrence with a mean follow of 5, 2 years. We also observed 3% of infectious complications (7/231) and 19 patients presented fat necrosis (34%). Of these 19 cases of fat necrosis, 6 (11 %) required a surgery. Conclusion: Autologous fat grafting can be proposed as an alternative for total reconstruction after mastectomy with a low level of complications and no local recurrence in our study. Only anterior radiotherapy increases the number of procedures probably due to fibrosis and lack of cutaneous flexibility. Citation Format: Bordes V, Campion L, Lejeune F, Loirat Y, Boiffard F, Brillaud-Meflah V, Dravet F, Bouffaut A-L. Exclusive fat grafting breast reconstruction after mastectomy: Feasibility and complications on 54 patients [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 P3-14-04.

Resume Objectifs L’objectif etait d’evaluer les facteurs pronostiques des carcinomes lobulaires infiltrants (CLI) T1 et T2 du sein et les facteurs predictifs de l’atteinte ganglionnaire axillaire. Methodes Etude retrospective multicentrique, menee de 1999 a 2008, parmi 13 centres francais. Les donnees concernant les patientes traitees d’un cancer du sein T1 ou T2 par une chirurgie premiere ont ete recueillies. Une mastectomie partielle ou totale etait realisee avec un curage axillaire systematique durant la periode de validation ou en cas d’envahissement des ganglions sentinelles. Parmi ces 8100 patients, 940 cas de CLI ont ete extraits. Apres analyse univariee identifiant les facteurs pronostiques significatifs, une regression logistique de Cox a ete appliquee. L’analyse a permis de determiner les facteurs pronostiques de survie sans recidive (SSR) et de survie globale (SG). Les differents facteurs correles a une atteinte des ganglions lymphatiques ont ete recherches en analyse univarie, puis multivarie, afin de determiner les facteurs predictifs d’envahissement ganglionnaire axillaire. Resultats L’âge median etait de 60 ans (27–89). La majorite des patientes presentaient une tumeur d’une taille superieure a 10 mm (n = 676 : 72 %), avec une minorite de lesions de haut grade SBR (n = 38 : 4 %) et une majorite de statut hormonal positif (n = 880 : 93,6 %). La duree mediane de suivi etait de 59 mois (1–131). Les facteurs significativement associes a une diminution de la SSR etaient le grade SBR 3 (hazard ratio [HR] : 3,85, IC 1,21–12,21), la taille tumorale superieure a 2 cm (HR : 2,85, IC : 1,43–5,68) et le statut ganglionnaire macrometastatique (HR : 3,11, IC : 1,47–6,58). L’analyse multivariee mettait en evidence un impact significatif sur la SG de l’âge de moins de 50 ans (HR : 5,2, IC : 1,39–19,49), du grade SBR 3 (HR : 5,03, IC : 1,19–21,25), de la taille tumorale superieure a 2 cm (HR : 2,53, IC : 1,13–5,69). Il n’a pas ete mis en evidence de correlation significative entre la prescription de chimiotherapie et la SSR (odds ratio [OR] 0,8, IC : 0,35–1,80) ou la SG (OR : 0,72, IC : 0,28–1,82). La SSR n’etait pas differente entre les pN0 (aucune invasion axillaire), les pNi+ (cellules tumorales isolees) ou les pNmic (micrometastase). Il n’y avait pas de difference entre un ou plus d’un ganglion lymphatique macromatastatique (pN1). Les SSR etaient statistiquement differentes entre les pN1 et les autres statuts ganglionnaires (pN0, pNi+ ou pNmic). Les facteurs associes a l’atteinte ganglionnaire en analyse multivariee etaient : l’âge entre 51 et 65 ans (OR : 2,1, IC 1,45–3,04), l’âge inferieur a 50 ans (OR 3,2, IC : 2,05–5,03), la taille tumorale superieure a 2 cm (OR 4,4, IC : 3,2–6,14), le grade SBR 2 (OR 1,9, IC : 1,30–2,90) et le grade SBR 3 (OR 3,5, IC : 1,61–7,75). Conclusion L’analyse de cette serie de 940 CLI de stade T1 et T2 apporte plusieurs informations : les facteurs associes a l’atteinte des ganglions lymphatiques axillaires sont l’âge de moins de 65 ans, la taille de la tumeur de plus de 20 mm et un grade SBR 2 ou 3. Les memes facteurs sont significativement correles aux taux de SSR et de SG. L’envahissement macrometastatique des ganglions axillaires a un impact significatif sur la SSR et la SG, contrairement aux pNi+ et aux pNmic, qui semblent avoir le meme pronostic que les pN0.

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 43 - N° 3 - p. 229-234

International audience; BACKGROUND: Pure Tubular Carcinoma (PTC) of the breast is a rare histological subtype of invasive breast cancer characterized by a low rate of lymph node involvement. Currently there is no consensus on less surgical axillary node staging according to this histological subtype. METHODS: We performed a retrospective multi-institutional study. Inclusion criteria were PTC, sentinel lymph node detection (SLND) and conservative breast surgery. RESULTS: From January 1999 to December 2006, 234 patients were included in the study from 9 institutions. The median pathological tumor size was 9.59 (1-22) mm. SLN were successfully detected in 98% (229/234) of patients. Among the 234 patients, a macrometastasis was found in 6 cases (2.5%), micrometastasis in 15 cases (6.4%), and isolated cells in 2 cases (0.8%). In the case of patients with SLND macrometastasis, half of them had macrometastasis in the complementary axillary lymphadenectomy, and none in the case of SLN only micrometastasis or isolated cells. Of the 122 patients with a pathological tumor size 10 mm) was the only parameter significatively linked to the risk of lymph node involvement (p = 0.007). CONCLUSION: In a large multi-institutional series with SLND, we have shown that the risk of axillary lymph node involvement in PTC is very low. In the case of PTC

Background To estimate the proportion of elderly patients (>70 years) with breast cancer eligible for an Exclusive IntraOperative RadioTherapy (E-IORT) and to evaluate their local recurrence-free survival rate. Methods This retrospective study examining two cohorts focuses on patients over 70 years old: a multi-centric cohort of 1411 elderly patients and a mono-centric cohort of 592 elderly patients. All patients underwent conservative surgery followed by external radiotherapy for T0-T3 N0-N1 invasive breast cancer, between 1980 and 2008. Results Within each cohort two groups were identified according to the inclusion criteria of the RIOP trial (R group) and TARGIT E study (T group). Each group was divided into two sub-groups, patients eligible (E) or non-eligible (nE) for IORT. The population of patients that were eligible in the TARGIT E study but not in the RIOP trial were also studied in both cohorts. The proportion of patients eligible for IORT was calculated, according to the eligibility criteria of each study. A comparison of the 5-year local or locoregional recurrence-free survival rate between eligible vs non-eligible patients was made. In both cohorts, the proportion of patients eligible according to the RIOP trial’s eligibility criteria was 35.4 and 19.3%, and according to the TARGIT E study criteria was 60.9 and 45.3%. The 5-year locoregional recurrence-free survival rate was not significantly different between RE and RnE groups, TE and TnE groups. In both cohorts RE and (TE-RE) groups were not significantly different. Conclusions Our results encourage further necessary studies to define and to extend the eligibility criteria for per operative exclusive radiotherapy.

To determine overall survival of patients treated for a first relapse of FIGO stage III ovarian cancer, outside of randomized trial, with a long term follow-up and to identify prognostic factors.A consecutive series of 108 patients treated for a first relapse of a FIGO stage III ovarian cancer was retrospectively included from December 1999 to November 2004. Each patient was treated with platinum-based chemotherapy in case of late (6 months) relapse and with salvage chemotherapy without platinum in case of6 months relapse. For statistical analysis the studied parameters were age, histological subtype, the completeness of initial surgery, disease-free period, localization of the relapse, clinical response to second-line chemotherapy, the completeness of secondary cytoreductive surgery (SCS) when it was performed.Median follow-up from the first relapse was 40 months. From the 108 patients, 35 underwent SCS. Median overall survival from the first relapse was 13 months in case of no SCS or non-optimal SCS and 35 months for patient with an optimal SCS (p = 0.006). In a multivariate analysis age, disease-free period, the clinical presentation of the relapse, completeness of SCS and response to second line chemotherapy appeared to be independent prognostic factors.Prognostic factors of ovarian cancer relapse are directly or indirectly linked with the feasibility of a complete SCS. Thus in the case of an ovarian cancer relapse, the feasibility of SCS must be considered in order to give the patient the best chance to experience its complete removal.

The extent of cytoreductive surgery and the amount of residual disease are among the most important factors impacting the survival of women with advanced ovarian cancer. Chronology of treatment is still debating. In the French standard treatment, primary surgery remains the cornerstone and interval surgery is an option. Neoadjuvant chemotherapy followed by surgery may reduce morbidity and mortality. Nevertheless the impact of this strategy on survival is still controversial.

Resume La prise en charge des cancers du sein est multidisciplinaire mais, comme pour la plupart des tumeurs solides, c’est le plus souvent vers le chirurgien que la patiente est initialement dirigee. Si la mastectomie et le curage axillaire ont toujours des indications indiscutables, l’evolution actuelle permet un recours de plus en plus frequent au traitement conservateur et a la technique du ganglion sentinelle dont les indications devraient encore s’elargir dans les annees a venir. Grâce a la chimiotherapie neoadjuvante et aux techniques d’oncoplastie, le chirurgien peut realiser un traitement conservateur pour des tumeurs de volume important sans prejudice en termes de survie globale. La question des marges d’exerese et du risque recidive locale homolaterale n’est pas consensuelle mais une limite de 2 a 3 mm semble acceptable alors que les techniques d’oncoplastie permettent une resection large et in sano, en preservant l’esthetique du sein. Dans cette revue, nous detaillons l’etat des pratiques concernant la chirurgie conservatrice et radicale, le curage axillaire et la detection du ganglion sentinelle, les marges d’exerese, les techniques d’oncoplastie.

Resume La surveillance d’une patiente traitee pour un cancer du sein est basee sur le risque de recidive locale. Le point le plus important reste la mammographie annuelle et le dosage des marqueurs n’a toujours pas montre son interet. L’absence de benefice d’une surveillance clinique, biologique et radiologique intensive est prouvee depuis longtemps mais les recommandations, issues d’accords d’experts, sont toujours un sujet de discussion et n’ont pas evolue plus de dix ans. L’evolution des modalites de cette surveillance va dependre de la place que vont prendre l’IRM et la TEP. A propos de la recidive a distance, une meilleure connaissance du risque est possible grâce a l’etude du profil biologique initial des tumeurs. Malheureusement, une intensification de la surveillance pour certaines tumeurs a haut risque n’aura d’interet que s’il existe une alternative therapeutique plus efficace en situation metastatique.

The standard management for advanced-stage epithelial ovarian cancer is optimum cytoreductive surgery followed by aggressive cytotoxic chemotherapy. However retroperitoneal remains controversial. The multiple directions of the lymph drainage pathway in ovarian cancer have been recognized. The incidence and pattern of lymph node involvement depends on the extent of disease progression and the histological type. Thus, it is difficult to specify a single node as the sentinel node. In this chapter, we review and discuss the actual benefits of lymph node dissection in patients with ovarian cancer, analysing previously reported and ongoing trials. A recent large randomized trial in patients with advanced ovarian cancer revealed that systemic lymphadenectomy had no impact on survival compared with removing only macroscopic lymph nodes but improves progression-free survival significantly. Further studies are needed to balance risks and benefits of systematic lymphadenectomy in advanced-stage disease.

PurposeTo determine the detection rate, the false-negative rate, and the accuracy of sentinel lymph node (SLN) detection after neoadjuvant chemotherapy (NAC) for advanced breast cancer.Patients and MethodsA prospective multicentric study was initiated to evaluate the results of SLN biopsy with the combined method after NAC for advanced large operable breast cancer.ResultsFrom September 2003 to March 2007, 195 patients enrolled from 12 institutions were found suitable for evaluation. The detection rate was 90% (176 of 195 patients), and the false-negative rate was 11.5% (six of 52 patients). Patients without axillary palpable nodes (N0) before NAC had a better detection rate compared with patients with axillary suspicious nodes (N1, 94.6% v 81.5%; P = .008). The false-negative rate was not correlated with clinical nodal status before NAC (9.4% v 15%; P = .66).ConclusionThis study confirms the feasibility of SLN biopsy after NAC in the case of large operable breast cancer. The detection rate, false-negative rate, and accuracy do not differ from those obtained in the case of early breast cancer without NAC, thus demonstrating the feasibility of SLN biopsy after NAC.

Resume Objectif Proposer une strategie de surveillance endometriale adaptee chez les femmes non menopausees traitees par tamoxifene en traitement adjuvant d’un cancer du sein hormonodependant. Patientes et methodes Nous avons repris les dossiers de 152 femmes non menopausees traitees pour un cancer du sein entre 2003 et 2005 et mises sous tamoxifene. Parmi ces dernieres, 70 ont alors ete suivies regulierement sur le plan endometrial par des echographies endovaginales. Resultats Vingt-six hypertrophies endometriales etaient retrouvees a l’echographie. Les examens complementaires realises chez les 19 patientes explorees (hysterosonographie ou hysteroscopie) retrouvaient 14 anomalies : 11 polypes et trois hyperplasies. Dans cette analyse, 20 % des femmes premenopausees suivies sous tamoxifene presentaient ainsi des anomalies endometriales a type de polypes ou d’hyperplasies apres un suivi de six a 36 mois. Parmi celles-ci, seulement 50 % presentaient des symptomes a type de metrorragies. Discussion et conclusion Bien qu’une surveillance echographique ne soit pas systematique chez les femmes menopausees, elle pourrait etre proposee chez les femmes non menopausees pour qui les metrorragies ne peuvent pas jouer leur signal d’alarme et chez qui on retrouve de frequentes anomalies potentiellement a risque de cancer endometrial.

The technique of detection and resection of the sentinel lymph node applied to early breast cancer management aims to spare the patient with a low risk of lymph node involvement an unnecessary axillary lymphadenectomy. This innovating technique lies on the double hypothesis of an accuracy to predict non sentinel lymph node status and to induce a lower morbidity when compared with axillary lymphadenectomy. This multidisciplinary technique depends on surgeons, nuclear physicians and pathologists. In practice sentinel lymph nodes are detected thanks to two types of tracers, the Blue and the colloids marked with technetium, harvested by the surgeon guided by the blue lymphatic channel and the use of a gamma probe detection, analyzed by the pathologist according to a particular procedure with the concept of serial slices, and possibly immuno histo chemistry. The objectives of this review are to specify the state of knowledge concerning the different steps: detection, surgical resection and the pathological analysis of the sentinels lymph nodes and to focus on validated and controversial indications, and on the main ongoing trials.

The rate of axillary recurrence (AR) after sentinel lymph node biopsy is usually low but few studies investigated its impact on survival. Our aim was to determine the rate and predictive factors of AR in a large cohort of breast cancer patients and its impact on survival.From 1999 to 2013, 14,095 patients who underwent surgery for clinically N0 previously untreated breast cancer and had sentinel lymph node biopsy were analysed. A simplified score predictive of AR was established.Median follow-up was 55.2 months. AR was observed in 0.51% of cases, with a median time to onset of 43.4 months. In multivariate analysis, the occurrence of AR was significantly correlated with grade 2 or 3 disease, absence of radiotherapy and tumour subtype (hormonal receptor [HR]- / human estrogen receptor [HER]+). AR rates were 1% for triple-negative tumours, 2.8% for HER2-positive tumours, 0.4% for luminal A tumours, 0.9% for HER2-negative luminal B tumours, and 0.5% for HER2-positive luminal B tumours. A simplified score predictive of the occurrence of AR was established. Patients could be divided into three different score groups (p0.0001). In multivariate analysis, overall survival was significantly lower in cases of AR (p0.0001), age50, lymphovascular invasion, grade 3 disease, sentinel node (SN) macrometastases, tumour size20 mm, absence of chemotherapy and triple-negative phenotype. Survival in patients with AR was significantly lower in case of early-onset (2 years) AR (p = 0.017).Isolated AR is more common in Her2-positive/HR-negative triple-negative tumours with a more severe prognosis in triple-negative and Her2-positive/HR-negative tumours, and represents an independent adverse factor justifying an indication for systemic treatment for AR treatment. However, the benefit of any systemic treatment remains to be proven.

Aim Sentinel lymph node (SLN) biopsy was recently recommended after prior breast tumour surgery and lymphadenectomy is not the gold standard anymore for nodal staging after a lesion's removal. The purpose of our study was to evaluate the good practices of use of SLN biopsy in this context. Patients and methods From 2006 to 2012, 138 patients having undergone a surgical biopsy without prior diagnosis of an invasive carcinoma with a definitive histological analysis in favour of this diagnosis were included in a prospective observational multicentric study. Each patient had a nodal staging following SLN biopsy with subsequent systematic lymphadenectomy. Results The detection rate of SLN was 85.5%. The average number of SLNs found was 1.9. The relative detection failure risk rate was multiplied by 4 in the event of an interval of less than 36 days between the SLN biopsy and the previous breast surgery, and by 9 in the event of using a single-tracer detection method. The false negative rate was 6.25%. The prevalence of metastatic axillary node involvement was 11.6%. In 69% of cases only the SLN was metastatic. The post-operative seroma rate was 19.5%. Conclusion Previous conservative breast tumour surgery does not affect the accuracy of the SLN biopsy. A sufficient interval of greater than 36 days between the two operations could allow to improve the SLN detection rate, although further studies are needed to validate this statement. Clinical trial registration number NCT00293865 .

Background After axillary lymphadenectomy for breast cancer, a suction drain is routinely inserted into the axilla to prevent seroma formation. This drain is an obstacle to reducing hospital stay after breast-conserving surgery. This was a prospective randomized clinical trial to assess the safety and results of axillary padding without the use of a drain. Methods Between May 2001 and August 2003, 100 women were randomly allocated axillary padding without a drain or with the use of an axillary suction drain. Prospective assessments were made of morbidity, pain, shoulder mobility, quality of life and medical costs including length of hospital stay. Results Using axillary padding significantly reduced the mean (s.d.) length of hospital stay (1·8(1) versus 4·5(2) days, P < 0·001). Postoperative complications, pain, shoulder mobility and quality of life were similar in the two groups. There was no difference in the duration of the two procedures. Conclusion Axillary padding after axillary lymphadenectomy was feasible and safe, without a drain, and shortened hospital stay.

Background Fluorine 18–fluoro-2-deoxyglucose (FDG) positron emission tomography ( 18 F-FDG PET) can be used to visualize metastases in patients with differentiated thyroid carcinoma that does not take up radioiodine ( 131 I). This study was aimed at evaluating the feasibility of 18 F-FDG radio-guided surgery in patients with radioiodine-negative differentiated thyroid cancer. Methods Ten patients received a mean activity of 265 MBq of 18 F-FDG 30 minutes before operation. Radioactivity uptake (counts per second [cps], with a pretime of 10 seconds) in tumor and normal tissues was measured before and after resection. Results Patients with 1 to 5 foci detected by FDG-PET were included in the study. Six of these patients were injected with recombinant human thyroid-stimulating hormone (TSH) preoperatively. Abnormal findings detected by preoperative 18 F-FDG PET were also detected with the gamma probe in all patients. The mean tumor activity in vivo was 3,272 cps, and tumor-to-neck and tumor-to-shoulder ratios were, respectively, 1.40 and 1.73. Tumor resection was incomplete in 3 patients. When resection was complete, mean radioactivity at the tumor site was decreased by 22%. The ex vivo mean tumor-to-normal tissue ratio was 2.4. All positive tissues detected with the probe were confirmed histologically to be differentiated thyroid cancer. The surgeon's hands were exposed to 90 to 270 μSv. Conclusions These results show the feasibility and benefit of 18 F-FDG radio-guided surgery with a gamma probe in the management of differentiated thyroid cancer patients with radioiodine-negative recurrence.

Aim This study aimed to evaluate patient information provided, the management of post-operative symptoms and post-operative care, and patient satisfaction with ambulatory breast surgery over a 1-year period. Methods From January to December 2000, all breast cancer patients undergoing conservative breast surgery were offered surgery as an outpatient procedure at the Ambulatory Surgery Unit. Results Two hundred and thirty six patients underwent outpatient surgery. None were readmitted during the first night or the first week. Two hundred and nineteen patients completed a questionnaire. One hundred and sixty nine patients (group 1) underwent wide local excision (WLE) and 50 (group 2), WLE and axillary lymphadenectomy. Patients in group 2 experienced more pain at discharge from the hospital ( p ≤0.01) and during the first week after discharge ( p ≤0.00001) than patients in group 1. The mean overall satisfaction score was 8.97 on a scale of 1–10. Post-operative information provided by the surgeon before discharge from the hospital was rated 8.90 on a scale of 1–10 while information provided by the nurse was rated 9.33 ( p Conclusion Ambulatory surgery for breast cancer patients is safe and popular with patients, however, post-operative pain presents problem.

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 32 - N° 6 - p. 529-534

Many components of mitogenic signalling pathways have been identified over the past 15 years, including the large family of protein kinases. Dysregulation of these biological processes may play an important role in the growth and survival of cancer cells. The 20 members of the fibroblast growth factor (FGF) family transduce a variety of biological signals via distinct transmembrane tyrosine kinase receptors (FGFR1 – FGFR4) encoded by four closely related genes (Powers et al, 2000). Mature FGFR proteins, which act as membrane-spanning tyrosine kinase receptors, have an extracellular ligand-binding domain, a transmembrane domain and a split intracellular tyrosine kinase domain (Green et al, 1996). Fibroblast growth factor -mediated signals have mitogenic, angiogenic and hormone regulatory effects and play key roles in a wide variety of crucial biological activities requiring cell growth, differentiation, migration and chemotaxis. Molecular anomalies of FGFR genes (inappropriate expression, single nucleotide polymorphism (SNP), splice variations, genomic alterations) have been described in several types of human cancer (bladder, cervical, colorectal carcinomas and multiple myeloma) and in skeletal deformities (achondroplasia, Crouzon syndrome and thanatophoric dysplasia type II) (Muenke and Schell, 1995; Avet-Loiseau et al, 1998; Cappellen et al, 1999; Vajo et al, 2000. Bange et al, (2002) recently studied the role of an SNP responsible for a missense mutation (G388R) in the transmembrane domain of FGFR4, in the progression and prognosis of nodepositive breast cancer. This G → A transition changes the sense of codon 388 from Gly (GGG) to Arg (AGG). The authors concluded that the G388R mutation in heterozygous or homozygous state was significantly over-represented in node-positive breast cancer patients with early relapse, but has no role in tumour formation, making this SNP a prognostic marker. On a worldwide basis, they found that allele distribution in normal controls and breast cancer patients did not differ significantly, showing an estimated 45.4% for the Gly/Gly allele, 45.7% for the Gly/Arg allele, and 8.9% for the Arg/Arg allele (Bange et al, 2002). No relationship has been found between this SNP and the prognosis for node-negative breast cancer. Our aim was to confirm the findings of Bange et al on a larger cohort, using an improved PCR – RFLP analysis and a reinforced and more adapted statistical analysis for investigating the possible association between G388R mutation and early cancer progression. Screening was conducted in a cohort of node-positive breast cancer patients who received different adjuvant therapies (endocrine (n=67), or chemotherapeutic (n=72)) and in a cohort of node-negative breast cancer patients (n=95). These cohorts were followed up, respectively, for median periods of 89 and 87 months. PCR – RFLP analysis was modified to make molecular screening more convenient and less time-consuming. Curves for disease-free survival (DFS) were plotted according to the Kaplan – Meier method, and the log-rank test was used for comparisons between groups, as in the study of Bange et al, (Kaplan and Meier, 1958; Cox and Oakes, 1984). Statistical analysis was reinforced by using three other nonparametric linear rank tests (Breslow, Peto – Prentice and Tarone – Ware) (Breslow, 1970; Peto and Peto, 1972; Tarone and Ware, 1977; Prentice, 1978).

Aim: Sentinel axillary lymph node (SALN) detection is a new technique. Surgeons must progress up a learning curve in order to guarantee quality and safety equivalent to axillary lymphadenectomy. To ensure accurate staging of patients this learning curve must include SALN detection and an axillary lymphadenectomy. The aim of our work was to validate the principles and evaluate the consequences of learning curve for SALN detection from a prospective series of 200 consecutive patients. Method: Prospective assessment was made of the detection and false negative rates, post operative morbidity as abcess and seroma, and length of hospital stay. Results: We evaluated the performance from the first to the hundredth case for each surgeon. Detection rate improved to 85% after patient number 10. False negative rate was less than 6%. Post operative axillary morbidity included 11% of seromas and 2% of abcess. Mean hospital stay was 2.8 days. Conclusion: Multidisciplinary validation of the learning period contributes to an accurate and safe SALN.

As the performance of early (H+1 to H+4) and late (D1) lymphoscintigraphic images raises organizational problems in outpatient surgery for breast cancer, only early images are generally obtained. The present study evaluated whether two series of images are better than one and defined the advantages of both methodologies. One hundred and eighteen patients with infiltrating breast carcinoma (T0, T1 and T2) were included in the study: 87 in group A (early and late images) and 31 in group B (only early images). All patients received two peritumoral injections of 99mTc-sulfur colloid, 15–18 MBq (group A) and

Backgrounds: Sentinel lymph node (SLN) biopsy is a highly accurate predictor of axillary status and has become the surgical axillary standard in breast cancer patients. About 50–70 % of patients with involved SLN have no additional non sentinel node (NSN) involved, suggesting that it be possible to avoid ALND in selected patients. Many tools have been developed to help surgeons in NSLN evaluation but they all need pathological data from tumor and SLN and can't be used during surgery. Developed for intraoperative detection of SLN macro or micrometastasis involvement, the semi-automated molecular one step nucleic acid amplification (OSNA), as accurate as pathology, is available. Two simple nomograms have been developed to predict NSN involvement based on the number of CK19 mRNA copy determined by OSNA: · Nomogram developed by Peg V (Eur J Surg Oncol 2013): based on total tumoral load (TTL). TTL is defined as the addition of CK19 mRNA copies of each positive SLN (copies/μL). A TTL≥1.2 × 10(5) copies/ml (specificity=85.3%, negative predictive value (NPV) = 80%) can predict NSN involvement. · Nomogram developed by Di Filippo F (Journal of Experimental & Clinical Cancer Research 2015): based on the number of CK19 mRNA copies and ultrasound tumor size. These two variables are categorized using quartiles with a score for each and the addition of both corresponds to a probability of NSN involvement (sensitivity = 98.1%, NPV = 92.5 %). Patients and Methods: this is a retrospective study of 299 patients. Each patient had SLN involvement (macro or micrometastasis) and underwent a complementary ALND. The main objective was to evaluate the performance of each nomogram using a discrimination ability model, assessed by ROC analysis. Predictive accuracy was measured by the area under ROC curves (AUC) reported with its 95 % confidence interval. The second objective was to compare the two nomograms using Hanley & McNeil method, to test the statistical significance of the difference between the AUC. Analysis was performed using stata 13.1 SE. Results: The mean age was 59, 1 year. Most patients were treated for an infiltrating ductal carcinoma (80.3%, 240/299). The mean ultrasound tumor size was 13 mm and the mean pathological tumor size was 15 mm. The median number of examined SLN was 2 with a macro-metastasis in 67, 6%, 202/299). 70 patients had involved nodes in ALND (23%). The discrimination of N Peg, quantified with AUC was 0.685 (p Hanley & McNeil method shows that Di Filippo nomogram is significantly superior to Peg nomogram (p=0,048). Conclusion: The current study shows that these two nomograms are reliable and can be used to predict NSLN involvement. The combination of molecular data and ultrasound tumor size seems to be more efficient than molecular data alone. These results are similar to results of nomogram studies based on pathological analysis but only these nomograms integrating molecular data can be used during the surgery. Citation Format: Bordes V, Campion L, Jezequel P, Lefrancois A, Boiffard F, Brillaud-Meflah V, Dravet F, Jaffre I, Classe J-M. Non-sentinel lymph nodes involvement in early breast cancer patients: Performance of two predictive nomograms integrating the analysis of sentinel nodes by one step nucleic acid amplification in a cohort of 299 patients [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 P2-01-33.

Resume But de l’etude : Le but de cette etude prospective etait d’apprecier les possibilites de prise en charge ambulatoire de la chirurgie senologique, d’evaluer les raisons d’hospitalisation traditionnelle, les causes et le taux de « conversion », et la morbidite postoperatoire apres chirurgie ambulatoire. Patientes et methodes : Au cours de l’annee 1999, sur 625 patientes susceptibles d’etre prises en charge en chirurgie ambulatoire (chirurgie a visee diagnostique et chirurgie conservatrice du sein), 418 ont ete programmees en chirurgie ambulatoire (67 %) et 207 en chirurgie traditionnelle (33 %). Les causes de non prise en charge en chirurgie ambulatoire etaient plus environnementales (64 %) que medicales (16 %). Resultats : Le taux de conversion a ete de 12,4 %. Le taux reel de chirurgie ambulatoire a ete de 58,6 %. Les causes de conversion ont ete plus souvent medicales (50 %) et environnementales (21 %) que chirurgicales (23 %). La morbidite, hors lymphocele axillaire, a ete equivalente dans les deux modes d’hospitalisation. Apres curage axillaire, le taux de lymphoceles a ete plus eleve en cas de chirurgie ambulatoire (27,4 % contre 16,1 %). Conclusion : La chirurgie ambulatoire est une bonne alternative a l’hospitalisation traditionnelle, en senologie notamment pour la chirurgie a but diagnostique. Pour la chirurgie mammaire avec curage axillaire, ce mode de prise en charge est egalement possible ; une information claire doit faire accepter la surmorbidite mineure. Une etude sur l’indice de satisfaction des patientes est indispensable.

p53 tumor-suppressor gene mutation and p53 protein over-expression have been reported with higher frequency in early-onset breast carcinomas (EOBC). Given the role attributed to normal p53 protein in DNA-repair mechanisms, other somatic genomic alterations would be expected to be associated with this abnormality. Amplification of the c-erbB-2 (HER-2/neu) oncogene and over-expression of the corresponding p185erbB-2 protein have been linked to prognosis and response to therapy in breast cancer. In a retrospective study of 62 formalin-fixed paraffin-embedded invasive EOBC (diagnosed at 35 years or less), the amplification status of the c-erbB-2 gene detected by fluorescence in situ hybridization (FISH) using a unique sequence probe was compared with p53 protein accumulation measured by immunohistochemistry (IHC) and phenotypic features. p185erbB2-protein expression was also detected by immunohistochemistry, together with estrogen-receptor (ER) and progesterone-receptor (PR) expression. The data for a sub-set of 33 node-negative EOBC cases were compared with 70 node-negative tumors diagnosed in women above 36 years of age. Compared with node-negative BC in older women, node-negative EOBC was significantly more likely to feature high grade, high proliferation rate, negative ER and/or PR and p53 over-expression (p < 0.05). A trend toward a higher incidence of c-erbB-2 amplification in EOBC (21% vs. 9%) reached near-significance (p = 0.07). In EOBC, c-erbB-2 amplification and p53 over-expression were not associated with high tumor grade or high cell-proliferation rate, in contrast to the significant associations of these markers in tumors in older women. Abnormalities in tumor markers, including c-erbB-2 gene amplification and p53-protein over-expression, occur at different rates in women with EOBC as compared with BC developing in older women. This finding may reflect a different pathogenesis for EOBC, and warrants further investigation.

Background A subgroup of T1N0M0 breast cancer (BC) carries a high potential of relapse, and thus may require adjuvant systemic therapy (AST). Patients and methods Retrospective analysis of all patients with T1 BC, who underwent surgery from January 1999 to December 2009 at 13 French sites. AST was not standardized. Results Among 8100 women operated, 5423 had T1 tumors (708 T1a, 2208 T1b and 2508 T1c 11–15 mm). T1a differed significantly from T1b tumors with respect to several parameters (lower age, more frequent negative hormonal status and positive HER2 status, less frequent lymphovascular invasion), exhibiting a mix of favorable and poor prognosis factors. Overall survival was not different between T1a, b or c tumors but recurrence-free survival was significantly higher in T1b than in T1a tumors (P = 0.001). In multivariate analysis, tumor grade, hormone therapy and lymphovascular invasion were independent prognostic factors. Conclusion Relatively poor outcome of patients with T1a tumors might be explained by a high frequency of risk factors in this subgroup (frequent negative hormone receptors and HER2 overexpression) and by a less frequent administration of AST (endocrine treatment and chemotherapy). Tumor size might not be the main determinant of prognosis in T1 BC.

Hyperthermic intraperitoneal chemotherapy (HIPEC) and complete surgical removal of the tumor, in relapsing patients may provide a clinical benefit. There is no consensus considering the place of HIPEC for patients who had first ovarian cancer relapse. To assess for possible efficacy of HIPEC on overall survival (OS) rates in this situation, we performed a multi-institutional study. The current study was a retrospective case control multi-institutional study comparing a group of patients treated with HIPEC to a group of patients treated without HIPEC. Inclusion criteria were first relapse of a serous ovarian carcinoma and >6 months after the end of initial treatment. Exclusion criteria were another pathological subtype of ovarian cancer, a relapse at

In cases where breast conservative surgery was performed for infiltrative ductal carcinoma (IDC), margin status is an independent prognostic factor for local ipsilateral relapse (LIR). There is no validated definition of a clear margin. We investigated factors associated with residual disease on re-excision specimen and the impact of margin status on the risk of LIR.From January 1992 to December 2002, 454 patients were retrospectively included. Patients had undergone conservative surgery and radiotherapy for IDC. Two groups were defined: group 1, involved or close margin (3 mm) and a re-excision; and group 2, involved or close margin without re-excision. The risk factors for residual disease in the re-excision specimen were analyzed in group 1, and the rate of 5-year LIR was analyzed in both groups.Among patients who experienced a surgical re-excision for involved or close margin, 21% (55 of 206) had residual tumor. The multivariate analysis showed that only a margin involved with intraductal carcinoma remained predictive for residual disease. According to the multivariate analysis, only hormone therapy (p10(-6)), diffuse involved margins (p = 0.003), and margins involved with intraductal component (p10(-6)) were predictive of LIR. Re-excision for a margin involved with intraductal carcinoma significantly improved local relapse-free survival (p0.001).In cases of IDC, re-excision for a close margin or a focally involved margin had no impact on local relapse-free survival. The decision to perform a surgical re-excision for an involved margin should not be systematic but should take multiple risk factors into consideration, such as patient age or margin diffuse involvement.

Our objective was to assess the global cost of the sentinel lymph node detection [axillary sentinel lymph node detection (ASLND)] compared with standard axillary lymphadenectomy [axillary lymph node dissection (ALND)] for early breast cancer patients.We conducted a prospective, multi-institutional, observational, cost comparative analysis. Cost calculations were realized with the micro-costing method from the diagnosis until 1 month after the last surgery.Eight hundred and thirty nine patients were included in the ASLND group and 146 in the ALND group. The cost generated for a patient with an ASLND, with one preoperative scintigraphy, a combined method for sentinel node detection, an intraoperative pathological analysis without lymphadenectomy, was lower than the cost generated for a patient with lymphadenectomy [€ 2947 (σ = 580) versus € 3331 (σ = 902); P = 0.0001].ASLND, involving expensive techniques, was finally less expensive than ALND. The length of hospital stay was the cost driver of these procedures. The current observational study points the heterogeneous practices for this validated and largely diffused technique. Several technical choices have an impact on the cost of ASLND, as intraoperative analysis allowing to reduce rehospitalization rate for secondary lymphadenectomy or preoperative scintigraphy, suggesting possible savings on hospital resources.

Background The feasibility and safety of oxaliplatin-based hyperthermic intraperitoneal chemotherapy (HIPEC) associated with cytoreductive surgery (CRS) was assessed in patients with peritoneal carcinomatosis resulting from primary advanced or relapsing epithelial ovarian cancer (EOC). Methods Thirty-one patients received neoadjuvant platin-based chemotherapy followed by oxaliplatin-based HIPEC associated with CRS as consolidation of primary therapy (n = 19) or for relapsing disease (n = 12). Grade 3/4 complications were recorded according to National Cancer Institute definitions. Results Median peritoneal carcinomatosis index (PCI) was 2.7 after neoadjuvant chemotherapy. Mean duration of surgery was 352 min (range 105–614) and median hospital stay was 11 days (range 6–87). Grade 3 toxicity was observed in nine patients: five required repeat surgery, two an invasive procedure, four rehospitalization, and three a return to the ICU. No grade 4 toxicity occurred, excepted one hypokalemia. Median progression-free survival (PFS) for primary advanced EOC was 13.2 months and 1-year PFS was 59.3%. Median PFS for relapsing patients was 14.3 months and 1-year PFS was 54.4%. Conclusion CRS with oxaliplatin-based HIPEC is feasible and relatively safe in recurrent and primary EOC. HIPEC after neoadjuvant chemotherapy reduces the PCI and decreases the number of surgical procedures and morbidity. Further evaluations of this procedure are required to assess the survival benefits. J. Surg. Oncol. 2011;103:10–16. © 2010 Wiley-Liss, Inc.

According to national recommendations, the surgical oncologic specimens addressed to a pathology department must have the required clinical information. The objectives of this study are to evaluate the quality of filling out a pathology form used in breast pathology, to specify the nonconformity consequences on breast management, on histology report and to define modes of action in order to obtain an increase in the number of correct pathology forms.It is a prospective study on pathology forms transmitted with tumorectomy for cancers or microcalcifications filled out by three surgeons from the 1st October, 2004 to the 31st April, 2005.Two hundred and fifty-nine pathology forms were analyzed. There were not correctly filled out in a third of the cases. Nonconformity concerns only one preset information in 69% of pathology forms and is variable according to the surgeons (14 to 31%). The chapters least informed are "lesion" and "type of surgery". These nonconformities involve additional work for the pathologist either because the missing information must be found or because the specimen management must be modified.The prefilled pathology form is a guarantee of quality control. In our study, in 70% of cases, they are accurate. To improve this conformity rate, quality improvement plans must be implemented.

Purpose To determine the optimal injection path for blue dye and radiocolloid for sentinel lymph node (SLN) biopsy in early breast cancer. Patients and Methods A prospective randomized multicentric study was initiated to compare the peritumoral (PT) injection site to the periareolar (PA) site in 449 patients. Results The detection rate of axillary SLN by lymphoscintigraphy was significantly higher (P = .03) in the PA group (85.2%) than in the PT group (73.2%). Intraoperative detection rate by blue dye and/or gamma probe was similar (99.11%) in both groups. The rate of SLN detection was somewhat higher in the PA group than in the PT group: 95.6% versus 93.8% with blue dye (P = .24) and 98.2% versus 96.0% by probe (P = .16), respectively. The number of SLNs detected by lymphoscintigraphy and by probe was significantly higher in the PA group than in the PT group, 1.5 versus 1.2 (P = .001) and 1.9 versus 1.7 (P = .02). The blue and hot concordance was 95.6% in the PA group and 91.5% in the PT group (P = .08). The mean ex vivo count of the SLN was significantly higher in the PA group than in the PT group (P < .0001). Conclusion This study strongly validates the PA injection technique given the high detection rate (99.1%) of SLN and the high concordance (95.6%) between blue dye and the radiotracer, as well as higher significant ex and in vivo counts, improving SLN probe detection.

Objective In Europe, until recently the standard treatment for locally advanced rectal cancer was preoperative radiotherapy (RT). The objective of this study was to evaluate the influence on survival of intervals between diagnosis and treatment. Patients and methods The influence on survival of intervals between diagnosis and surgery (Dg-Surg), diagnosis and initiation of RT (Dg-Rad), and completion of RT and surgery (Rad-Surg) was evaluated in a retrospective series of patients treated with preoperative RT. Between 1991 and 1998, 102 patients received treatment with preoperative RT without concomitant chemotherapy at the Rene Gauducheau Cancer Center. Patients generally received 45 Gy (80%) in 25 fractions over 35 days for T2–T3–T4 N0–N1 M0 rectal adenocarcinoma located mainly (62.7%) in the lower third of the rectum (≤ 5 cm from anal margin). Thirty-five pN1 patients were treated with postoperative chemotherapy. Differences between survival were assessed by the log-rank test, and prognostic factors by the Cox test. Results Median time was 14.7 weeks for Dg-Surg, 4.6 weeks for Dg-Rad and 5.1 weeks for Rad-Surg. Median follow-up from diagnosis was 57.4 months. Five-year local relapse-free survival was 83.9%, metastasis-free survival 64% and overall survival 60.8%. No factor was predictive of tumour response to RT. Log-rank and multivariate analysis showed that overall survival was significantly influenced by lower-third tumours, pT, pN and Dg-Surg (poorer survival when ≥ 16 weeks: OR = 2.59, P = 0.005). Metastasis-free survival correlated significantly with Dg-Surg (≥ 16 weeks: OR = 2.05, P = 0.05). Conclusion An interval of more than 16 weeks between diagnosis and surgery may reduce overall survival of patients treated with preoperative RT for locally advanced rectal cancer. Surgery should be performed shortly after completion of RT for patients with no possibility of sphincter preservation, or a minimal risk of morbidity from an abdominoperineal excision.

We relate 2 cases reports about rectal cancer and pregnancy. This association is rare but is a real problem of management because diagnosis is done latly and it mate have incompatibility between treatments and pregnancy. A medical bibliography has been done, to define the best medical procedure in function of the disease staging and the pregnancy term. It shows that a multi disciplinary decision must be done, which take into consideration the choice of the obstetricals, pediatricians, surgeons, and oncologists, but also the patient's choice.

PurposeTwo chemoprevention randomized studies using tamoxifen showed drug efficacy; however, adverse effects such as hot flushes, endometrial cancer, and above all, thromboembolism, remain a problem. 4 hydroxytamoxifen (4-OHT) is a very active metabolite of tamoxifen. This randomized study was designed to analyze if 4-OHT gel, administered percutaneously on the breast skin, can inhibit the proliferation of malignant breast cells to the same extent as orally administered tamoxifen.Patients and MethodsFifty-five postmenopausal women with an invasive estrogen receptor–positive breast cancer were randomly assigned to receive (for 2 to 3 weeks) either 4-OHT gel (0.5, 1, or 2 mg/d) or oral tamoxifen (20 mg/d) or no treatment. Response was evaluated using proliferation markers (Ki-67, proliferating cell nuclear antigen) and apoptosis markers in tissue samples obtained by Tru-cut biopsy before treatment, and at surgery after treatment.ResultsAdministration of 4-OHT gel resulted in reductions in tumor tissue proliferation indexes (Ki-67 and PCNA), with approximate equivalence between the1.0 mg/d or 2.0 mg/d 4-OHT dose, and oral tamoxifen, but had no effect on apoptotic markers. Plasma levels of 4-OHT were consistently higher in the oral tamoxifen group than in the gel groups. No dose-related pattern was shown for estrogen or progesterone receptor levels, and topical 4-OHT gel appeared to be generally well tolerated. Hot flushes are as common in the two higher gel doses as with tamoxifen.ConclusionPercutaneous 4-OHT gel has a local impact on tumor proliferation. It could be tested in future propective trials of chemoprevention or ductal carcinoma in situ adjuvant hormonotherapy.

Previous reports have shown that axillary sentinel lymph node (ASLN) radiodetection allows accurate axillary staging for patients with early breast cancer. Radioguided surgery implies the use of a gamma-probe to count the emitted radioactivity of marked ASLNs. Several gamma-probes are commercially available, each with its own properties. The clinical impact of the type of gamma-probe used for ASLN radiodetection remains to be evaluated.Three commercially available gamma-probes were evaluated: a scintillator with a bismuth germanate crystal (probe A), a semiconductor with a cadmium telluride crystal (probe B), and a semiconductor with a cadmium zinc telluride crystal (probe C). Two hundred patients with early breast cancer were prospectively enrolled to undergo ASLN radiodetection and axillary lymphadenectomy. ASLN mapping consisted of injecting (99m)Tc-sulfur-colloid around the tumor. For each patient, sentinel lymph nodes were counted successively with the 3 probes and the sensitivity of each gamma-probe was determined from ASLN residual activity. The results of detection rates and false-negative rates for each probe were compared.Mean residual ASLN activity was 52 kBq (range, 0.07-189 kBq). Sensitivity was compared among the 3 probes and found to be best for probe A. The detection rate of probe A was significantly better than that of probe B (93% vs. 86%, P = 0.05) but not different from that of probe C (93% vs. 90%). No differences in false-negative rates were observed among the 3 probes.ASLN detection rate depends on the type of gamma-probe used. Because failure to detect the ASLN leads to complete axillary lymphadenectomy, involving local morbidity and other sequelae, the type of gamma-probe must be considered important for sentinel lymph node radiodetection.

Standard therapy for advanced ovarian cancer includes cytoreductive surgery associated with platin based chemotherapy. Secondary surgery for recurrent ovarian cancer remains controversial. Actually there is not randomized trial based on this question. Furthermore literature shows that patients with recurrent disease may derive a significant survival benefit from optimal debulking. The datas availables indicate that prolonged disease free interval and feasibility of complete surgical resection are the main prognosis criteria. Proper selection of patients with recurrent ovarian cancer is essential to improve the therapeutic benefit of secondary surgery. There is a large place for trials and evaluation of innovatives techniques as hyperthermic intraperitoneal chemotherapy or intraperitoneal radio-immunotherapy.

This study aimed at evaluating the relationship between the nonvisualization of sentinel nodes (SNs) at lymphoscintigraphy and the intraoperative detection rate, radioactive counts in vivo, and histological status of SNs. Two hundred eighty patients with infiltrating breast carcinoma (T0, T1/T2) underwent preoperative lymphoscintigraphy before gamma probe–guided SN biopsy. The surgical identification rate with a gamma probe was 84.6% (56 of 280) in lymphoscintigraphy-negative patients and 93.2% (224 of 280) in lymphoscintigraphy-positive patients (P < .05) after two subdermal periareolar injections. The average number of SNs per patient was 1.7 in lymphoscintigraphy-negative patients and 2.2 in lymphoscintigraphy-positive patients (P < .01), as assessed by gamma detection. The mean age of lymphoscintigraphy-negative patients was 62 ± 10 years, versus 55 ± 13 years for lymphoscintigraphy-positive patients (P < .001). The median radioactive count in dissected SNs identified by gamma detection was 204 cps (range, 4–618 cps) in lymphoscintigraphy-negative patients, versus 606 cps (range, 43–16,928 cps) in lymphoscintigraphy-positive patients (P < .001). The rate of macrometastatic SNs was 40% in lymphoscintigraphy-negative patients, versus 30% in lymphoscintigraphy-positive patients (not significant), whereas the size of involved SNs was 16.6 mm in lymphoscintigraphy-negative patients, versus 13.1 in lymphoscintigraphy-positive patients (P < .05). The micrometastasis detection rate in SNs from lymphoscintigraphy-negative patients was 6.25%, versus 23.3% in lymphoscintigraphy-positive patients (P < .01). Negative lymphoscintigraphy was observed in 20% of patients and was more frequent in elderly patients. Negative lymphoscintigraphy was predictive of a lower surgical identification rate and fewer detected SNs. These SNs had fewer micrometastases, were fairly large, and tended to harbor metastases.

BACKGROUND Previous reports have shown that regional lymph node involvement in patients with early-stage breast carcinoma can be evaluated by resection of axillary sentinel lymph nodes (ASLN). Axillary lymphadenectomy may be unnecessary in the absence of ASLN involvement. In the current study, the authors compared the results of ASLN resection in patients with lobular invasive carcinoma (LIC) with the results from patients with ductal invasive carcinoma (DIC) in terms of detection rates and false-negative rates. METHODS For ASLN detection, technetium 99m sulfur-colloid and patent blue were injected around the tumor. Each patient underwent both ASLN resection and complete axillary lymphadenectomy. Detection rates and false-negative rates were evaluated in patients with LIC and in patients with DIC. RESULTS Two hundred forty-three patients with invasive, early-stage breast carcinoma were enrolled in the study (208 patients with DIC and 35 patients with LIC). The median patient age, pathologic tumor size, hormone receptor status, and rates of involved lymph nodes were equivalent for both groups. ASLN detection and false-negative rates did not differ for patients with LIC and patients with DIC. CONCLUSIONS The ASLN detection rate was not dependent on the pathologic type of invasive carcinoma. Pathologic examination of ASLN in patients with LIC and in patients with DIC predicted axillary lymph node status with the same predictive value in terms of lymph node metastasis. For patients with LIC, ASLN examination overestimated the rate of micrometastasis as diagnosed by immunohistochemical techniques. These results will require confirmation in larger studies. Cancer 2004;100:935–41. © 2004 American Cancer Society.

Hypothesis Axillary lymphadenectomy performed without the use of a drain but with padding of the axilla is feasible and safe on an outpatient basis in the setting of conservative surgery for breast cancer. Design Prospective clinical study. Setting Public oncology center. Patients Two hundred seven patients were treated in our oncology center between January 11 and December 28, 1999, by means of this method of axillary lymphadenectomy based on axillary padding without a drain. One-day surgery was offered to each patient. Intervention At the end of each functional axillary lymphadenectomy, the axilla was padded with the use of axillary aponeurosis and local muscles. Axillary suction drains were not used at all in this series of patients. Main Outcome Measures Prospective assessment was performed, without randomization, with regard to the length of hospital stay, the reasons for postoperative conversion from 1-day surgery to traditional hospitalization, and postoperative complications. Results Eighty-seven (42.0%) of the 207 patients underwent a 1-day procedure. In the 1-day surgery group, 87 (84.5%) of the 103 patients benefited from a true 1-day surgery procedure. The main reasons for conversion were nausea and anxiety rather than surgical complications. Hospital stay never exceeded 3 days. The most common postoperative complication was axillary seroma, with an average incidence of 22.2%. Conclusion Breast-preserving surgery with axillary lymphadenectomy and padding of the axilla, precluding the use of a drain, is feasible and safe on a 1-day surgery basis for selected consenting patients.

Abstract #207 BACKGROUND. Pure tubular carcinoma (PTC) is a favourable histologic subtype of breast cancer with a low rate of lymph node involvement. This study was initiated to assess the sentinel lymph node (SLN) detection rate and the rate of axillary involvement. METHODS. Inclusion criteria were a PTC (tubular component >90%) core biopsy diagnosed breast cancer smaller than 20 mm, and a homolateral clinically axilla free of nodal involvement. Patients underwent a SLND alone or with an Axillary level I-II Lymphadenectomy (AL). An AL was performed in the case of the learning curve, or in the case of SLN involvement – macrometastases, micrometastases or isolated cells - or in the case of mapping failure. RESULTS. From January 1999 to December 2006, 234 patients were selected from 9 French Comprehensive Cancer Centers. Median tumour size was 9.59 mm (1-22) . The SLN detection rate was 97.9% (229/234). The median number of SLN harvested was 2.15 (range 0-8). Respectively the frequency of macrometastasis - >2mm - was 2.6% (6/229), micrometastasis was 6.5% (15/229) and isolated cells was 0.8% (2/229). There were no false negative cases among the 24 patients with a systematic complementary axillary lymphadenectomy performed in the case of a learning curve. Axillary macrometastasis were found in non sentinel lymph nodes after completed axillary lymphadenectomy in 3 / 6 patients with macrometastasis, in 1/15 patients with micrometastasis and in 0/2 patients with isolated cells. There was no lymph node involvement for tumour size < 10mm. Pathological tumor size >10 mm was statistically correlated to the risk of axillary involvement (p=0.0223). CONCLUSIONS. This study confirms that in the case of PTC ≤ 20mm SLN detection is feasible and the risk of lymph node involvement very low. In the case of PTC Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 207.

Objective This randomized study compared two neoadjuvant treatments in patients with a low rectal cancer less than 2 cm from the anal verge that would have required APR before radiotherapy. Method A total of 207 patients (71% uT3) with a rectal carcinoma at 0.5 cm from the anal verge were randomized in two groups. The group HDR received a high dose of radiotherapy (45 Gy + boost 18 Gy). The group RCT received 45 Gy with concomitant chemotherapy (5FU). Surgery was performed 6 weeks after treatment, surgeons were trained with TME, APR and intersphincteric resection. Results The rate of sphincter preserving surgery was 83% after HDR and 86% after RCT (P = 0.69). There was no difference in morbidity, clinical tumour regression (80% vs. 87%) and complete pathological response (8% vs. 15%) between HDR and RCT. Overall, the rate of R0 resection was 78%. After a follow-up of 23 months, the rates of local and distant recurrence were 6% and 19% respectively and the disease-free survival was 77%. Survival was better after sphincter preservation than after APR. Conclusion Sphincter preservation was achieved in 85% of ultra-low rectal carcinomas without compromising oncological prinicples. No difference was observed between HDR and RCT. Further follow-up is necessary to confirm this conservative approach.

3527 Background: GRECCAR 1 is a phase III randomised multicenter trial which compared two preoperative treatments for low rectal carcinoma which should be classicaly treated by abdominoperineal resection (Eligibility: distance between the tumor [T] and the levator ani [LA] less than 2 cm). Methods: Between 2001 and 2005, 207 patients with rectal adenocarcinomas were included in 13 French centers. The average distance between the tumor and the levator ani was 0.8 cm. 72% of the tumors were classified T3 with 60% of N1 on pre treatment endorectal ultrasonography. The mean lenght of the tumors was 5 cm on colonoscopy. Preoperative treatment randomisation was made between high dose radiation (HDR: 45 + 18 Gy: 106 patients) and radio-chemotherapy (RTCT: 45 Gy + 5FU continuous infusion: 101 patients). All surgeons performed homogeous technique for intersphincteric resection. Results: Conservative rate was 83% (HDR) and 86% (RTCT) (p: 0.64) with 84% (140/168) of intersphincteric resection. Conservative rate did not differ according to the distance T-LA: 0 cm: 84% / 1–2 cm: 84% and 3 cm: 91%. No post operative mortality was noticed with a 15% post operative morbidity rate, same in the two arms. Sterilized specimen rate was respectively 7% and 12.5% (p: 0.29), the mean inferior safety margin and radial margin was 1 cm and 4 mm, same in the two groups as the 90% R0 resection rate. On specimen, nodal involvement rate was 5.6% for pT0–1, 29% for pT2 and 56% for pT3–4. No difference was seen for down-staging between the two groups (p: 0.59). With a 22 months follow up, we noticed 92% rate of stoma closure in the conservative group. Seven patients had a local recurrence and 25 metastases with 12 patient’s death. Conclusions: GRECCAR 1 is the first prospective randomized trial which shows an 85% rate of sphincter conservative surgery due to down staging induced by preoperative tretament. No significant difference was seen between HDR and RTCT with a trend for more morbidity in the first group. Intersphincteric resection is a safe technical procedure in order to preserv the striated sphincter with sufficient lateral and inferior margins. No significant financial relationships to disclose.

Introduction Si le diagnostic d’hyperplasie canalaire atypique (HCA) sur macrobiopsie est une indication classique d’exerese chirurgicale en raison du risque de sous-estimation de cancer, la signification des lesions de metaplasie cylindrique atypique (MCA) est peu documentee. But du travail Comparer les lesions observees sur piece d’exerese apres un diagnostic d’HCA ou MCA sur macrobiopsie pour microcalcifications. Materiel et methodes Cinq cent soixante-dix macrobiopsies ont ete realisees entre 2000 et 2003 pour microcalcifications. Des lesions d’HCA et MCA ont ete diagnostiquees chez 80 patientes. Cinquantetrois des 80 patientes ont beneficie d’une exerese chirurgicale. Les criteres cliniques (âge, antecedents, menopause, THS) et radiologiques (classification ACR, taille, pourcentage d’exerese des microcalcifications) etaient connus. Resultats Sur les 53 patientes, le diagnostic sur macrobiopsie etait une HCA dans 27 cas (50,9 %), une MCA dans 26 cas (49,1 %). Le diagnostic de carcinome sur piece d’exerese (14 carcinomes canalaires in situ et 4 carcinomes infiltrants) etait porte dans 18 cas (34 %) : dans 13 cas (72,2 %), le diagnostic sur macrobiopsie etait une HCA ; dans 5 cas (27,8 %) une MCA. Conclusions Les lesions d’HCA diagnostiquees sur macrobiopsie sont statistiquement liees a un risque plus eleve de cancer par rapport aux lesions de MCA independamment de tout autre facteur (test de Fisher, p = 0,042). Il serait interessant d’etudier si d’autres parametres histologiques (extension des lesions, type de MCA), cliniques et/ou radiologiques permettent de selectionner une population de patientes MCA a risque plus eleve de cancer.