Survival effect of laparoscopic para-aortic staging in locally advanced cervical cancer: a retrospective cohort analysis.

OBJECTIVE: This study compares two methods of evaluating para-aortic node involvement in locally advanced cervical cancer (LACC) in order to define external radiotherapy treatment fields: laparoscopic surgical para-aortic lymphadenectomy or PET-CT imaging. POPULATION: We selected 187 patients with LACC who had been treated by chemoradiation therapy in two comprehensive cancer centres from January 2001 to December 2013. A total of 98 underwent para-aortic evaluation by PET-CT (Centre 1) and 89 received surgical laparoscopic excision (Centre 2). METHODS: All patients with LACC were retrospectively collected in each centre. OS and DFS were calculated using the Kaplan-Meier's method and survival curves were compared using log-rank test. MAIN OUTCOME MEASURES: Outcomes were the comparison of patients' disease-free (DFS) and overall survival (OS) between the two centres. RESULTS: Patients had a significantly better disease-free survival in cohort 1 than in cohort 2, at 2 years [80.9% (71.7-87.5) versus 57.1% (46.1-67.3)] and at 5 years [70.5% (58.8-79.9) versus 49.2% (38.2-60.4)] (P = 0.009). These results are confirmed by multivariate analysis model [hazard ratio (HR) 1.93; 95% CI 1.03-3.61; P = 0.04]. The overall survival was also better in cohort 1, both at 2 and 5 years [93.5% (86.5-97.0) versus 78.5% (68.5-86.0) and 85.1% (73.2-92.2) versus 63.8% (51.9-74.2), respectively; P = 0.006]. The multivariate analysis model found concordant results with an increased relative risk of death for patients treated in cohort 2 (HR 2.55; 95% CI 1.09-5.99; P = 0.01). CONCLUSION: In this retrospective cohort analysis, para-aortic surgical staging in LACC is more deleterious for patients than is radiological staging in terms of OS and DFS. TWEETABLE ABSTRACT: Para-aortic surgical staging in LACC is more deleterious for patients than clinical staging.

[Salvage concomitant chemoradiation therapy for non-metastatic inflammatory breast cancer after chemotherapy failure]. / Chimioradiothérapie concomitante des cancers du sein inflammatoire, non métastatiques, non répondeurs à une chimiothérapie première.

PURPOSE: To evaluate the surgical possibility following concomitant chemoradiotherapy for inflammatory breast cancer, after unsucessful neoadjuvant chemotherapy. PATIENTS AND METHODS: The data from ten patients with inflammatory breast cancer treated between 1996 and 2010 by concomitant chemoradiotherapy after unsucessful neoadjuvant chemotherapy were analysed. All patients had an invasive carcinoma. All patients received a neoadjuvant chemotherapy, including anthracyclin, six patients received taxan and one received trastuzumab. Radiotherapy was delivered to the breast and regional lymph nodes in all patients at a dose of 50Gy; a boost of 20Gy was delivered to one patient. Concomitant chemotherapy was based on weekly cisplatin for six patients, on cisplatin and 5-fluorouracil the first and last weeks of radiotherapy for four patients. RESULTS: The median follow-up for all patients was 44 months. Mastectomy was performed in nine patients. Two- and 5-year overall survival rates were respectively 70 % and 60 %. Median local recurrence delay was 5 months; six patients died (all from cancer), seven developped metastasis. Grade 1 and 2 epithelite was respectively observed in six and two patients, grade 2 renal toxicity in three patients, grade 2 neutropenia in one patient. CONCLUSION: Concomitant chemoradiotherapy for inflammatory breast cancer after unsucessful neoadjuvant chemotherapy may control the disease in some patients and lead to mastectomy. These results have to be confirmed through a multicentric study with more patients.

[Cryoconservation of ovarian tissue: indications and outcome of the patients]. / Cryoconservation du tissu ovarien: indications et devenir des patientes.

OBJECTIVES: Ovarian Tissue Cryopreservation (OTC) is a very promising approach of fertility preservation for women and young patients who have to follow gonadotoxic treatments (chemotherapy, radiotherapy…). The aim of this study was to analyse the indications and the outcomes of the patients who had OTC in our center during the last 17 years. PATIENTS AND METHODS: The study is retrospective. Forty-six patients, who underwent OTC in the Laboratory of Reproductive Biology of the University Hospital of Clermont-Ferrand, between January 1997 and December 2009, were included. RESULTS: The average age on the day of ovarian tissue harvesting was 19.5 years. Fifty-two percent of the patients were minor. In order of decreasing frequency, the diseases for which OTC has been proposed were hematologic, ovarian tumors, sarcoma ou PNET and breast neoplasia. In 93.5 %, the harvesting of ovarian cortex was performed by laparoscopy. After OTC, 82.6 % of the patients were treated by chemotherapy. A bone marrow transplant was performed for 48 % of the study patients. At the time of data collection, 57 % of the patients who had evaluation of their ovarian function presented premature ovarian failure. Eight patients had one or more pregnancies after treatment. It was a natural pregnancy for five of them. The three others were obtained by medically assisted procreation (in vitro fertilization and oocyte donation). DISCUSSION AND CONCLUSION: We report a long-term follow-up of patients treated in our center for OTC. The originality of our study is to evaluate all aspects of OTC from the decision to propose the patients an OTC to their outcomes several years after the ovarian tissue harvesting. It is therefore a multidisciplinary approach both oncology, gynecological and pediatric whereas OTC is often considered restrictively in the literature. Finally, it seems to be essential to establish a specific medical care for these patients. This monitoring will allow an adequate assessment of pubertal development and ovarian function, management of estrogen deficiency and secondary infertility, supporting patients in their desire for motherhood.

[Laparoscopic treatment of adnexal abscesses. A series of 39 patients]. / Traitement coelioscopique des abcès annexiels. A propos d'une série de 39 patientes.

OBJECTIVE: Evaluate short- and long-term follow-up of patients treated by laparoscopy and antibiotherapy for tubo-ovarian abscess. METHODS: We report a retrospective study of 39 patients treated from January 1983 to December 1992. Clinical files were examined and a questionnaire was mailed to patients. RESULTS: None of the patients needed to be reoperated for failure of the first laparoscopic treatment. A laparoscopic control after 3 month was done in 35 cases, which allowed complete adhesiolysis in every patients. We performed distal tubal surgery in 17 patients at that time and oriented 6 patients directly towards IVF. Subsequent fertility, in 19 patients followed without contraception, demonstrated a rate of spontaneous intra-uterine pregnancy of 63%. CONCLUSION: This study confirms that laparoscopy remains the technique of choice in initial management of adnexal abscesses.

[Functional aspects of lymphatic drainage of the human ovary in vivo explored with isotopic lymphography]. / Aspects fonctionnels du drainage lymphatique de l'ovaire humain in vivo explore par lymphographie isotopique.

Pelvic lymphoscintigraphy with 99 m Tc colloid injected directly in mesovarium during coelioscopy is able to schon that: drainage of ovaries' lymph is taken up by pelvic, paraortic or both lymph nodes, during genital activity ovarian lymph often diffuse in the other side of the pelvis with a true regional circulation.

Treatment of acute salpingitis with sulbactam/ampicillin.

The combination of sulbactam/ampicillin was compared to cefoxitin for the treatment of acute salpingitis in 40 women divided into two groups of 20 women each. There were 11 patients in each group who were given doxycycline because of evidence of chlamydial infection. All patients were diagnosed by laparoscopic examination and evaluated by the same procedure 7-12 weeks later. At the second laparoscopy, only 1 of the 20 patients (5%) treated with sulbactam/ampicillin had severe adhesions, while 6 of the 20 patients (40%) treated with cefoxitin had severe adhesions. Tubal patency was without obstruction in 14 patients (70%) given the combination treatment and in 12 patients (60%) given cefoxitin. Side effects were essentially absent in both groups.