[Interest of robotic stereotactic radiosurgery in the management of brain metastases: Results of a retrospective, single center analysis]. / Place de la radiochirurgie stéréotaxique robotisée dans la prise en charge des métastases cérébrales : résultats d'une analyse rétrospective monocentrique.

PURPOSE: The management of malignant brain metastases becomes a main issue for the treatment of patients, because of the survival extension related to the improvement in systemic treatments. Robotic stereotactic radiosurgery (RSR) is a new approach in this indication. The purpose of this analysis was to define the efficacy of RSR, in order to determine prognostic factors of survival and factors of response. PATIENTS AND METHODS: It was a retrospective, single center (polyclinique de Bordeaux Nord Aquitaine) analysis performed from 2012 to 2015, involving patients with malignant brain metastases treated by RSR using the Cyberknife® technique. We analyzed the following parameters: response to RSR, prognostic and predictive factors of response, and survival. RESULTS: A total of 72 RSRs were performed among 55 analyzed patients; 62 treatments were assessable with a median follow-up of 9.4 months. The main delivered dose on the 80%-isodose was 20Gy. A complete response was achieved in 40.3% of patients (stability or regression=83.9%). The overall survival was 13 months. The risk of failure was significantly correlated with the increase in metastasis size and non-adenocarcinoma histology. A performance status<2 was the main prognostic factor of survival. CONCLUSIONS: The RSR allowed treating 3 to 5 brain metastases, avoiding an entire brain irradiation, and maintaining survival and quality of life.

Clinical value of circulating endothelial cell levels in metastatic colorectal cancer patients treated with first-line chemotherapy and bevacizumab.

BACKGROUND: We investigated whether circulating endothelial cells (CECs) predict clinical outcome of first-line chemotherapy and bevacizumab in metastatic colorectal cancer (mCRC) patients. PATIENTS AND METHODS: In a substudy of the randomized phase II FNCLCC ACCORD 13/0503 trial, CECs (CD45- CD31+ CD146+ 7-amino-actinomycin- cells) were enumerated in 99 patients by four-color flow cytometry at baseline and after one cycle of treatment. We correlated CEC levels with objective response rate (ORR), 6-month progression-free survival (PFS) rate (primary end point of the trial), PFS, and overall survival (OS). Multivariate analyses of potential prognostic factors, including CEC counts and Köhne score, were carried out. RESULTS: By multivariate analysis, high baseline CEC levels were the only independent prognostic factor for 6-month PFS rate (P < 0.01) and were independently associated with worse PFS (P = 0.02). High CEC levels after one cycle were the only independent prognostic factor for ORR (P = 0.03). High CEC levels at both time points independently predicted worse ORR (P = 0.025), 6-month PFS rate (P = 0.007), and PFS (P = 0.02). Köhne score was the only variable associated with OS. CONCLUSION: CEC levels at baseline and after one treatment cycle may independently predict ORR and PFS in mCRC patients starting first-line bevacizumab and chemotherapy.

[Effects of an intravenous injection of nicardipine on cerebral blood flow in subarachnoid hemorrhage caused by intracranial aneurysm]. / Effets d'une injection intraveineuse de nicardipine sur le débit sanguin cérébral au cours des hémorragies méningées par anévrisme intracrânien.

Fifteen patients with ruptured intracranial aneurysm have been operated before undergoing post surgery xenon inhalation for cerebral blood flow valuation: first measurement has been performed as CBF reference; 2nd measurement has been done after 0.1 mg.kg-1 I.V. bolus of nicardipine; sides effects are mainly due to BP fall 2/15 and some consequent neurological distress have been noticed (2/15); results should be carefully interpreted. Significant CBF increase have been measured after nicardipine injection, specially in brain area correlated to low CBF before injection (the lower the CBF, the higher the increase of local flow). The study prompt us to check the effect of nicardipine on patient (with CBF measurement after nicardipine test) before giving the treatment. Problems remain to be solved with further studies and not yet established: correlation between hemodynamics changes and clinical status and also which time of disease evolution is the best to be treated.