Management of epithelial cancer of the ovary, fallopian tube, primary peritoneum. Long text of the joint French clinical practice guidelines issued by FRANCOGYN, CNGOF, SFOG, GINECO-ARCAGY, endorsed by INCa. (Part 2: systemic, intraperitoneal treatment, elderly patients, fertility preservation, follow-up).

Adjuvant chemotherapy by carboplatin and paclitaxel is recommended for all high-grade ovarian and tubal cancers (FIGO stages I-IIA) (grade A). After primary surgery is complete, 6 cycles of intravenous chemotherapy (grade A) are recommended, or a discussion with the patient about intraperitoneal chemotherapy, according to her risk-benefit ratio. After complete interval surgery for FIGO stage III, hyperthermic intraperitoneal chemotherapy (HIPEC) can be proposed, in accordance with the modalities of the OV-HIPEC trial (grade B). In cases of postoperative tumor residue or in FIGO stage IV tumors, chemotherapy associated with bevacizumab is recommended (grade A).

[Part II drafted from the short text of the French guidelines entitled "Initial management of patients with epithelial ovarian cancer" developed by FRANCOGYN, CNGOF, SFOG, GINECO-ARCAGY and endorsed by INCa. (Systemic and intraperitoneal treatment, elderly, fertility preservation, follow-up)]. / Partie 2 rédigée à partir de la synthèse de la recommandation nationale de bonnes pratiques cliniques intitulée « Conduites à tenir initiales devant des patientes atteintes d'un cancer épithélial de l'ovaire ¼ élaborée par FRANCOGYN, CNGOF, SFOG, GINECO-ARCAGY et labélisée par l'INCa. (Traitement systémique et intrapéritonéal, personnes âgées, préservation de la fertilité et suivi).

Adjuvant chemotherapy with carboplatin and paclitaxel is recommended for all high-grade ovarian or Fallopian tube cancers, stage FIGO I-IIA (grade A). After a complete first surgery, it is recommended to deliver 6 cycles of intravenous (grade A) or to propose intraperitoneal (grade B) chemotherapy, to be discussed with patient, according to the benefit/risk ratio. After a complete interval surgery for a FIGO III stage, the hyperthermic intra peritoneal chemotherapy (HIPEC) can be proposed in the same conditions of the OV-HIPEC trial (grade B). In case of tumor residue after surgery or FIGO stage IV, chemotherapy associated with bevacizumab is recommended (grade A). For BRCA mutated patient, Olaparib is recommended (grade B).

Evaluation and impact of residual disease in locally advanced cervical cancer after concurrent chemoradiation therapy: results of a multicenter study.

BACKGROUND: The aim of this study was to evaluate the diagnosis and impact of residual disease (RD) after concurrent chemoradiation therapy (CRT) in locally advanced cervical cancer (FIGO IB2-IVA). METHODS: This retrospective multicenter study included 159 patients who were treated with completion surgery after CRT between 2006 and 2012. Magnetic resonance imaging (MRI) was performed 4-6 weeks after CRT and compared to pathological evidence of residual disease. Kaplan-Meier survival curves were plotted and univariate/multivariate analyses were performed to assess the association between RD and the outcome. RESULTS: Residual disease was present in 45.3% of the patients and detected by MRI in 57.1%. The MRI had a 29.2% false positive rate and an 11.1% false negative rate. The overall survival (OS) rates at 3 and 5 years were 78.6% (CI 95% [71%-86.9%]) and 76.5% (CI 95% [68.2%-85.7%]), respectively. The disease free survival (DFS) rates at 3 and 5 years were 73.4% (CI 95% [65.6%-82%]) and 71.1% (CI 95% [62.7%-80.1%]), respectively. RD greater than 10 mm decreased DFS (HR = 4.84, p = 0.03), whereas RD between 1 and 10 mm (HR = 0.31, p = 0.58) and less than 1 mm (HR = 0.37, p = 0.54) had no impact on DFS. The OS was not changed by RD. DISCUSSION: The MRI accuracy value is not sufficient to select patients who might benefit from completion surgery. Residual disease over 10 mm decreased DFS but did not impact OS.

[Simultaneous radiochemotherapy in locally advanced cancers of the cervix: a preliminary study]. / Radio-chimiothérapie concomitante dans les cancers du col utérin localement avancés: étude préliminaire.

We have designed a combined treatment strategy of bifractionated split course radiotherapy (RT) and concomitant chemotherapy (CT) to try to improve the results of RT in inoperable cervical carcinoma. After evaluation, patients were submitted to further radical surgery or additional RT-CT depending on the treatment results. Between January 1988 and January 1992, 25 patients with non metastatic inoperable disease entered in the protocol. The stage of the disease was: T3N0 4 patients, T3 with hydronephrosis seven patients, T3N1 12 patients, and T4N0 two patients. Nineteen patients received two courses of CT with fluorouracil (F), cisplatin (P) with or without etoposide. Pelvic RT was given twice daily (two fractions of 3 Gy) on days 1, 3, 15 and 17. A combination of F 400 mg/m2/d and P 15 mg/m2/d in continuous infusion with oral etoposide (100 mg/d) and hydroxyurea (500 mg/d) in 11 patients was delivered concomitantly on days 1-3 and 14-17. A clinical and radiological evaluation was performed four weeks later. Patients with objective response underwent radical hysterectomy (group A) and those with incomplete response received additional RT-CT protocol (group B). All patients had endocavitary brachytherapy at the end of treatment. After two cycles of CT there were four PR in 19 patients and 5 failures. After RT-CT there were 12 CR (48%) and eight PR. There was a relationship between disease status after RT-CT and response to initial CT in those 19 patients who received the neoadjuvant CT. Fifteen patients were in group A, six of whom had no histologically active disease in the post-operative sample. However all 15 patients were rendered free of disease. Ten patients were in group B, five of whom attained the clinical CR status. In total, 20 of 25 patients (80%) were in CR at the end of treatment. Six patients experienced pelvic recurrence and two patients distant metastases. Four of the five patients with incomplete response had evolutive disease. The overall survival is 60% and 36% at 1 and 2 years respectively after a median follow-up of 22 months (14-48 m). The protocol was tolerable. These results compare favorably with those of conventional RT and warrant further evaluation.

[Experimental histological study of the local toxicity of intra-tubal injections of methotrexate]. / Etude histologique expérimentale de la toxicité locale de l'injection intratubaire de méthotrexate.

The injection of methotrexate is an alternative to laparoscopic surgical treatment of unruptured ectopic pregnancy. An experimental trial on rabbits was designed to evaluate this new approach. In situ injection of methotrexate does not cause either real tubal epithelial impairment, nor an adverse effect on treated rabbits' fertility. However, sub-peritoneal injections of methotrexate are responsible for a typical histological lesion. These results are discussed emphasising the importance of the way the administration is carried out.