[Prospective evaluation of radiation-induced thyroid disorders after breast and supraclavicular irradiation]. / Évaluation prospective des dysthyroïdies radio-induites après irradiation mammaire et sus-claviculaire.

PURPOSE: The thyroid is an endocrine gland playing a major role in metabolism and development by the secretion of T4 and T3 thyroid hormones. Due to its anatomical position, it is often included in the target volume for the irradiation of certain tumours and thus receives significant doses (10 to 80Gy). The treatment of breast cancer requires in most cases a breast irradiation associated or not with a lymph node irradiation. The aim of our study was to investigate prospectively the frequency of thyroid disorders in patients with breast cancer treated by radiation, with or without irradiation of the supra- and subclavicular lymph nodes. MATERIAL AND METHODS: This prospective multicentre study (institut Godinot, institut de cancérologie Strasbourg Europe and institut de cancérologie de Lorraine) concerned adult patients with non-metastatic breast carcinoma treated by adjuvant irradiation. They were included in a non-randomized way between February 2013 and June 2015 and divided into two groups according to treatment: (i) breast radiotherapy associated with irradiation of the supra- and subclavicular lymph nodes (group 1), or (ii) breast irradiation alone (group 2). The dose - volume histogram of the thyroid was systematically edited by the physics department. Each patient had a consultation with an endocrinologist at the beginning of the treatment and was monitored by blood analyses including TSH, T4L, antithyroglobulin and antiperoxidase antibodies every 6 months until the 60th month after the end of radiotherapy. Data were described by numbers and percentages for qualitative variables; by means, medians, standard deviation and ranges for quantitative variables. Statistical associations were tested by Chi2, Fisher's, Student's, or analysis of variance tests depending on the conditions of application. Survival analyses were performed by log rank tests and Cox models. RESULTS: This study initially included 500 patients, 245 in group 1 and 252 in group 2 (three patients were later excluded for false inclusion). Thyroid abnormalities occurred in 76 patients, representing an incidence of 15.3%. The mean time of the first occurrence of thyroid disorders was 24.3 months. It was more frequent in group 1 with a prevalence of 19.2% against 11.5% in group 2 (P=0.01745). A maximal radiation dose delivered to the thyroid gland greater than 20Gy (odds ratio [OR]: 1.82; P=0.018) or 30Gy (OR: 1.89; P=0.013) was significantly associated with a higher incidence of thyroid disorders, as was a mean dose greater than 30Gy (OR: 5.69; P=0.049). A percentage of thyroid volume receiving 30Gy (V30) greater than 50% (P=0.006) or greater than 62.5% (P=0.021) was significantly associated with an increased incidence of thyroid disorder and more precisely, hypothyroidism (P=0.0007). In multivariate analysis, no factor associated with the occurrence of thyroid disorder was identified. However, in the subgroup analysis concerning group 1 (receiving supraclavicular irradiation), a maximal radiation dose greater than 30Gy appeared to be a risk factor for the occurrence of thyroid disorders (P=0.040). CONCLUSION: Thyroid disorder, and in particular hypothyroidism, may be a late side effect of locoregional breast radiotherapy. Patients receiving this treatment should have a biological monitoring of thyroid function.

[Real world data in radiotherapy: A data farming project by Unitrad]. / Données de vie réelle en radiothérapie : le data farming du groupe Unitrad.

The aim of the data farming project by the Unitrad group is to produce and use large quantities of structured real-life data throughout radiotherapy treatment. Starting in 2016, target real world data were selected at expert consensus conferences and regularly updated, then captured in MOSAIQ© as the patient was treated. For each partner institution, the data was then stored in a relational database, then extracted and used by researchers to create real world knowledge. This production was carried out in a multicentre, coordinated fashion. When necessary, the raw data was shared according to the research projects, in compliance with regulations. Feedack was provided at each stage, enabling the system to evolve flexibly and rapidly, using the "agile" method. This work, which is constantly evolving, has led to the creation of health data warehouses focused on data of interest in radiotherapy, and the publication of numerous academic studies. It forms part of the wider context of the exploitation of real-life data in cancerology. Unitrad data farming is a collaborative project for creating knowledge from real-life radiotherapy data, based on an active network of clinicians and researchers.

[New outcome rates for random sampling telephone surveys]. / Pour de nouveaux indicateurs de qualité des enquêtes téléphoniques par sondage aléatoire.

BACKGROUND: Survey non-response rates are important quality indicators. Refusal rates can induce non-response bias in health survey estimates. However, comparisons across surveys highlight inconsistencies in the use of survey outcome categories and in the calculation of response rates. In this paper we discuss the relevance of these indicators and suggest other survey quality indicators. METHODS: Outcome rates from two French random-digit dialing (RDD) telephone surveys are compared : the Nicolle survey on infectious diseases of 4112 individuals conducted in 2006, and the HIV knowledge, attitude, belief and practices (KABP) survey of 5071 individuals in 2004. Based on the same protocol, we describe in details the way the two RDD samples were drawn and how non-response rates were estimated. RESULTS: Non-response rates were different: 36% in Nicolle survey and 18% in KABP survey. However, the quantity of telephone numbers required to obtain one interview was higher in the KABP survey: 2.8 telephone numbers versus 2.1 in the Nicolle survey. The participation rates, aggregating together refusals, break-off and non-reachable numbers, were equivalent for the two surveys. This result occurred because of a greater proportion of unreached calls in the KABP surveys, which is not integrated into the non-response rates commonly used. CONCLUSION: Survey non-response rate is insufficient to estimate the quality of a survey. The need for other indicators has been previously stressed in the literature, notably with the adoption and utilization of the American Association for Public Opinion Research (AAPOR) standard definitions of four indicators. But these indicators are quite complex for evaluating non-response bias between surveys. In addition to the classical refusal rate, two other indicators are proposed in this paper: participation rate (number of complete interviews divided by the number of eligible and of unknown eligibility units) and a liking contact rate (number of unreachable units because of a long absence, break-off or non-answer divided by the number of eligible and of unknown eligibility units). The sum of these three indicators is equal to 100% and thus easier to manipulate when comparing surveys.

Psychological and physical impact in women treated for breast cancer: Need for multidisciplinary surveillance and care provision.

PURPOSE: Cancer survivors often experience adverse physical and psychosocial effects. Fear of recurrence is a difficulty very commonly reported in post-cancer life. The primary objective of this study was to describe post-cancer supportive care needs in patients treated for breast cancer. PATIENTS AND METHODS: In this monocentric observational study, cancer survivors aged≥18years, diagnosed with breast cancer and treated in 2017 (cohort A) and in 2015 (cohort B) were administered a post-cancer needs questionnaire, and the Fear of Cancer Recurrence Inventory (severity subscale). RESULTS: The study included 139 patients. Pain (51.9%), fatigue (51.9%), weight gain during treatment (35.1%), psychological difficulties (20.5%), and difficulties in marriage and sexual life (13.1%) were the complaints in the post-cancer period. There were no differences between the two cohorts. The severity subscale of the Fear of Cancer Recurrence Inventory showed 35.8% patients with a score>13. The fear of recurrence was a source of social difficulties, psychological disorders, and difficulties in marriage and sexual life. CONCLUSIONS: Not only FCR, but also issues such as fatigue, pain, psychological difficulties, and difficulties in marriage and sexual life all call for a psycho-oncological follow-up. Clinical and radio-senological surveillance is essential, but it absolutely must be accompanied by a multidisciplinary follow-up, with central importance to psychological care.

The impact of genetic outreach education and support to primary care on practitioner's confidence and competence in dealing with familial cancers.

AIMS: To determine the level of competence and confidence in general practice in relation to the management of familial cancers and to determine the impact of providing genetic educational outreach on confidence and competence. METHODS: Confidence and competence in dealing with familial cancers was measured using a postal questionnaire sent to all general practitioners and practice nurses in 4 geographical areas in central England. In 2 areas, genetic educational outreach was provided to 10 randomly selected practices and a matched analysis of questionnaire responses before and after intervention was done to determine the impact of the intervention. RESULTS: Respondents were more confident in dealing with patient queries around familial breast cancer risk than those around bowel cancer. This was inconsistent with the ability to correctly assign familial risk, with 48% incorrectly assigning a high-risk categorisation to a low-risk breast cancer scenario. Respondents who had taken part in the intervention reported more confidence in dealing with issues related to the management of patient queries around bowel cancer. Following intervention, participants were more likely to report feeling confident in knowing the relevant family history to collect (72.4% of respondents from participating practices compared to 56.1% from non-participating practices; OR 2.39, p = 0.02, 95% CI 1.14-5.00) and in making a basic assessment of risk (72.4% compared to 38.9%; OR 3.65, p = 0.01, 95% CI 1.38-9.61). CONCLUSIONS: Providing genetic educational outreach has a positive impact upon how confident primary care staff feel in dealing with patient queries over familial cancers, particularly in relation to bowel cancer. Further research is needed to explore the impact of providing this service on other relevant outcomes such as appropriateness of referrals to genetic services.

[Hypofractionated radiotherapy in rectal cancer for elderly patients]. / Radiothérapie hypofractionnée des cancers du rectum chez le sujet âgé.

Rectal cancer is a common pathology in the elderly. The standard for advanced rectal tumors is a chemoradiotherapy regimen combined 50Gy with concomitant chemotherapy followed by a surgery. This treatment induces interruptions of chemoradiotherapy and toxicities G3-4 more important in people over 70 years of age. Hypofractionated radiotherapy 5×5Gy with surgery following week is an alternative. All retrospective studies on this fractionation report an excellent immediate and chronic tolerance. The randomized phase III NACRE trial, comparing these 2 radiotherapy, followed by surgery at 6-8 week, established a standard in the management of the elderly patients.

[Depressive disorders and use of health services in the French population according to the Health Barometer 2005]. / Troubles dépressifs et recours aux soins dans la population française à partir des données du Baromètre Santé 2005.

BACKGROUND: Whereas depressive disorders are major problems of public health, there is few reliable data in general population in France. OBJECTIVE: The objective of this study is to estimate the 12-month prevalence rates of depressive disorders and use of health services in French general population, and to identify the sociodemographic variables associated with Major Depressive Episode (MDE) and use of health services for mental disorder. METHOD: This study was carried out from the data of the Health Barometer 2005, a random survey about several topics of health. Thirty thousand five hundred and fourteen individuals from 12 to 75 years were interviewed by telephone from October 2004 to February 2005. Depressive disorders were assessed by a standardized tool (CIDIsf) according to the classification of the DSM-IV (16710 individuals have answered the questions of mental health: 60% of the individuals aged 15 or older). RESULTS: 7.8% of the individuals interviewed reported a MDE over the last 12 months. In majority, the episodes were relatively serious (0.4% of mild episode and 2.9% of single episode) and were mainly associated with sex, age and marital status. Among these individuals, only 38.3% had consulted a health service for mental health during that period and 10.8% had psychotherapy. The main associated factors for use of services were age, educational level and depression severity. CONCLUSION: These first national reliable dataset confirms the extent of depressive disorders in general population and highlights the problems of use of health services and treatments. Also, this study shows that there are instruments and methodologies making it possible to study mental disorders and use of health services in general population. It suggests to look further into the exploration of these issue and to develop this kind of survey to study other problems of mental health.

[Technique of complex mammary irradiation: Mono-isocentric 3D conformational radiotherapy and helical tomotherapy]. / Techniques d'irradiation mammaire complexe : radiothérapie conformationelle tridimensionnelle mono-isocentrique et nomothérapie hélicoïdale.

PURPOSE: To evaluate the dosimetric contribution of helical tomotherapy for breast cancers compared with conformal radiotherapy in mono-isocentric technique. PATIENTS AND METHOD: For 23 patients, the dosimetric results in mono-isocentric 3D conformational radiotherapy did not satisfy the constraints either of target volumes nor organs at risk. A prospective dosimetric comparison between mono-isocentric 3D conformational radiotherapy and helical tomotherapy was therefore carried out. RESULTS: The use of helical tomotherapy showed a benefit in these 23 patients, with either an improvement in the conformity index or homogeneity, but with an increase in low doses. Of the 23 patients, two had pectus excavatum, five had past thoracic irradiation and two required bilateral irradiation. The other 14 patients had a combination of morphology and/or indication of lymph node irradiation. For these patients, helical tomotherapy was therefore preferred to mono-isocentric 3D conformational radiotherapy. CONCLUSIONS: Tomotherapy appears to provide better homogeneity and tumour coverage. This technique of irradiation may be justified in the case of morphological situations such as pectus exavatum and in complex clinical situations. In other cases, conformal radiotherapy in mono-isocentric technique remains to be favoured.

[Comparison of two national food surveys (INCA 1 1998-99 and Health Nutrition Barometer 2002) with regard to five food recommendations of the National Nutrition and Health Program]. / Comparaison de deux enquêtes nationales de consommations alimentaires (INCA 1 1998/99 et Baromètre santé nutrition 2002) au regard de cinq objectifs alimentaires du Programme national nutrition santé.

BACKGROUND: Monitoring the dietary intake of the French population requires the implementation and regular renewal of representative national survey. As these surveys can use different methodologies (food frequency questionnaire, 24 hour recall, 3 or 7-day dietary record...), it seems useful to check whether they supply similar results. The aim of this study is to determine whether two representative national surveys with different methodologies can be used alternately to monitor changes in food consumption of the French population. METHOD: Percentages of consumers aged 15-75 were compared between two national food surveys (Health Nutrition Barometer 2002 and INCA 1 1998-99) with respect to five food frequency recommendations of the French National Nutrition and Health Program. RESULTS: The same public health priorities were found in both surveys: the food groups were graded according to the same hierarchy of adequate food intake prevalences (ascending: fruits and vegetables, dairy products, fish, starchy foods and meat-fish-egg products). On the other hand, significant statistical different elements were pointed out in a few food groups which may be explained by methodological patterns. Definitions of portions and food groups, survey duration and seasons are indeed important parameters to be considered when comparing surveys. CONCLUSION: The results show the need to elaborate standardized methods for comparison of food consumption surveys, which can be useful for the evaluation of the national nutritional recommendations. The methodological limitations described in this study also indicate that the quantitative description of food intake trends should improve when established by the results of the same regularly repeated survey.

[Evaluation of breast HER2+ cancer pathologic response after a taxan plus trastuzumab-based chemotherapy]. / Étude de réponse histologique du cancer du sein HER2+ après chimiothérapie néoadjuvante associant taxane et trastuzumab.

OBJECTIVES: In our study, we aimed to assess the pathologic complete response after neo-additive chemotherapy that contains a taxan associated to trastuzumab for patients treated from breast cancer at the institute Jean-Godinot between 2012 and 2014, and to evaluate factors associated to this pathologic complete response. METHODS: Retrospective study with clinical, anatomopathologic and radiologic parameters analysis before and after new adjuvant chemotherapy. The statistical analysis was done on logiciel XL-STAT, the Mann-Whitney-Wilcoxon for quantitative variables and Fisher exact tests for qualitative variables, the Spearman rang test. RESULTS: The rate of pathologic complete response is 38.8%. The prognostic factor associated to pathologic complete response is a Ki-67>44%. CONCLUSION: The pathologic complete response rate corresponds to international lower rate; because of the lack of several data, we found out only one prognostic factor, Ki-67>44%.

Periodontal and prosthodontic treatment for patients with advanced periodontal disease.

This article describes prosthetic management of advanced periodontally involved dentitions. Overall prognosis and means of assessing scores to prospective abutment teeth are presented. Esthetic treatment and prognosis of surgically elongated dentitions is discussed, and a method to determine what the patient will look like after completion of treatment is presented. A specific approach using ceramometal restorations with modified long bevel and minimum gold collar and the use of electrosurgery for subgingival access is covered.

[Comparison of two types of behavior and attitude surveys on alcohol, tobacco and illegal drug use]. / Comparaison de 2 modalités d'enquête sur les comportements et attitudes au sujet de l'alcool, du tabac et des drogues illégales.

BACKGROUND: The aim of this study was to compare the results of two types of surveys frequently used in France to monitor alcohol, tobacco and illegal drug consumptions. METHODS: Data from a random sample phone survey (1993 18-75 year old French adults in November and December 1995), a quota sample face-to-face survey (1000 18-75 year old French adults in November 1995) and other sources (sales statistics and other surveys) were compared. RESULTS: Results from the two types of surveys were similar for alcohol and tobacco consumption prevalence. Concerning smoking prevalence, the random survey gave an estimate of 35.5% for the smokers ratio versus 35.2% with the quota sample survey. The daily alcohol consumer percentage was 20.9% and 22.1% respectively with the random and the quota sample surveys. Differences were observed for attitudes and illegal substances consumption: the random sample phone survey estimated at 15.5% people using drug during their life versus 13.9% for the quota sample face-to-face survey. CONCLUSIONS: Quota sampling and face-to-face surveys can be used to monitor alcohol, tobacco consumption and to a lesser extent, drug consumption trends, especially by repeated surveys, instead of random sample phone survey which are more time and money consuming.

[Sleep disorders in patients with personality disorders]. / Troubles du sommeil chez des patients présentant des troubles de la personnalité.

63 patients with personality disorders have been hospitalized in a Sleep Disorder Clinic. Sleep disorders usually started during childhood, disappeared ant the reappeared around the age of 25. The polysomnographic data do not show a specific profile. Most of the patients were of the schizotypal or the borderline type. Therapeutic guidelines are presented.

[Disturbed eating behavior and suicide thoughts among adolescents: results of a national telephone survey ]. / Conduites alimentaires perturbées et pensées suicidaires chez les adolescents: résultats d'une enquête nationale par téléphone.

The objective of this paper is to study the relation between the disturbed eating behaviours and the suicidal thoughts. In the Young People Health Barometer 97/98, 13.3% of the adolescents interviewed stated that they have "quite often" or "very often" overeaten and experienced difficulty in stopping themselves in the last 12 months. 1.0% have voluntarily vomited, 4.8% are afraid of starting to eat for fear of not being able to stop themselves, 5.6% eat in secret. Moreover, 10.3% say that they have had thoughts about suicide in the last 12 months. Percentage of suicidal thoughts increases notably with the number of declared disturbed eating behaviours. The adjusted odd ratio on sex and age for having had thoughts about suicide, comparing those declaring at least one of these eating behaviours to those declaring none of these behaviours, is 2.9.

[Potential indications for helical tomotherapy in breast cancers]. / Indications potentielles de la tomothérapie hélicoïdale dans les cancers du sein.

PURPOSE: To evaluate the dosimetric gain obtained in either the planning target volume or organs at risk coverage by the use of intensity-modulated radiation therapy in some particular postoperative breast cancers. PATIENTS AND METHOD: Prospective dosimetric comparison between monoisocentric conformal radiotherapy and intensity-modulated radiation therapy in nine patient files. RESULTS: Using intensity-modulated radiation therapy was shown to improve in each case, at least one conformity, homogeneity, and coverage index either for planning target volumes or for organs at risk. Intensity-modulated radiation therapy was therefore always chosen rather than conformal monoisocentric radiotherapy. CONCLUSIONS: Indications to retain intensity-modulated radiation therapy would consist of bilateral lesions, pectus excavatum, past thoracic irradiation (Hodgkin's disease) and complex volumes in obese or overweight patients.

[Conventional 2D and monoisocentric 3D techniques in breast and lymphatic irradiation: a dosimetric comparison]. / Techniques classique bidimensionnelle et mono-isocentrique tridimensionnelle dans l'irradiation du sein et des aires ganglionnaires : comparaison dosimétrique.

PURPOSE: The activity of our radiation oncology department mainly relies on breast pathology. Since July 2009, all the irradiations delivered simultaneously to the breast (CTV1), the surgical bed (CTV2), the internal mammary chain and the supra- and infraclavicular areas have been carried out using a mono-isocentric technique. This study aimed to compare dosimetric results between conventional 2D and mono-isocentric 3D techniques with or without optimization. PATIENTS AND METHODS: From January to August 2009, 20 patients with breast cancer in whom irradiation of the CTV1, CTV2, internal mammary chain and supra- and infraclavicular areas was retained, were included in a specific cohort. In each case, we have compared dosimetric results obtained with the conventional technique and with a mono-isocentric 3D technique, either with manual field in the field segmentation or with automatic segmentation (Oncentra Masterplan(®) from Nucletron(®), Optimizer(®) solution). Selected criteria were as follows: V95, V107 and mean dose (Dmean) to the target volumes, V20 and V30 to the ipsilateral lung, V35 and mean dose to the heart and maximal dose (Dmax) to the spinal cord. RESULTS: Supra- and infraclavicular areas irradiation was significantly better using the mono-isocentric 3D technique (V95 %: 89.7 % vs. 77.1 %; P=0.001) as well as dose homogeneity (Dmean: 46.3 Gy vs. 45.1 Gy; P=0.008). No statistical difference was observed for the other target volumes. Heart and spinal cord protection were better with the mono-isocentric 3D technique (respectively Dmean: 8.4Gy vs. 11.1 Gy; P<0.0001 and Dmax: 29.2 Gy vs. 35.8 Gy; P=0.0003). CONCLUSION: Mono-isocentric irradiation of the breast and lymphatic areas is a modern technique that benefits from imaging and computer progresses while being simple to carry out using standard planning system and linear accelerators. Mono-isocentric 3D irradiation with manual segmentation of the breast and the nodal areas provides a target volume irradiation comparing with conventional technique 2D and a better protection of the heart and of the spinal cord.