HPV ctDNA detection of high-risk HPV types during chemoradiotherapy for locally advanced cervical cancer.

BACKGROUND: Chemoradiotherapy (CRT) is the standard of care for patients diagnosed with locally advanced cervical cancer (LACC), a human papillomavirus (HPV)-related cancer that relapses in 30%-60% of patients. This study aimed to (i) design HPV droplet digital PCR (ddPCR) assays for blood detection (including rare genotypes) and (ii) monitor blood HPV circulating tumor DNA (HPV ctDNA) levels during CRT in patients with LACC. METHODS: We analyzed blood and tumor samples from 55 patients with HPV-positive LACC treated by CRT in a retrospective cohort (n = 41) and a prospective cohort (n = 14). HPV-ctDNA detection was carried out by genotype-specific ddPCR. RESULTS: HPV ctDNA was successfully detected in 69% of patients (n = 38/55) before CRT for LACC, including nine patients with a rare genotype. HPV-ctDNA level was correlated with HPV copy number in the tumor (r = 0.41, P < 0.001). HPV-ctDNA positivity for HPV18 (20%, n = 2/10) was significantly lower than for HPV16 (77%, n = 27/35) or other types (90%, n = 9/10, P = 0.002). HPV-ctDNA detection (positive versus negative) before CRT was associated with tumor stage (P = 0.037) and lymph node status (P = 0.02). Taking into account all samples from the end of CRT and during follow-up in the prospective cohort, positive HPV-ctDNA detection was associated with lower disease-free survival (DFS) (P = 0.048) and overall survival (OS) (P = 0.0013). CONCLUSION: This is one of the largest studies to report HPV-ctDNA detection before CRT and showed clearance of HPV ctDNA at the end of treatment in most patients. Residual HPV ctDNA at the end of CRT or during follow-up could help to identify patients more likely to experience subsequent relapse.

[E-consult®, an e-health application to improve breast cancer surgery patient's information]. / E-consult®, application d'e-santé pour mieux informer les patientes en consultation de chirurgie pour cancer du sein.

INTRODUCTION: The use of new information and communication technologies is one way of better informing the patient. E-health includes telemedicine but also patient information and self-monitoring, or continuous remote monitoring with connected objects and mobile apps. It is in this context that we have developed and designed a digital application, e-consult®, which we use at the François Baclesse center, dedicated to improving information for patients. The objective of this study was to assess the performance of the e-consult® application in current practice, in order to know if the information delivered to patients was better retained with the application. METHODS: We conducted a prospective, single-center study at the Cancer Center François Baclesse. One group was received in consultation with the use of e-consult®, the other without. Following the consultation, the patient was given a questionnaire concerning her illness and a satisfaction questionnaire concerning the application. RESULTS: The average score obtained on the questionnaire in the group having benefited from a consultation with e-consult® (7.12/10) was significantly higher than that obtained in the group having benefited from a consultation without e-consult® (6.4/10) (P=0.0276). CONCLUSION: Our study showed that patients understood better the information transmitted in consultation with the use of e-consult®. In our opinion, this is the only study evaluating an application in consultation. However, our study has several weaknesses, including the lack of randomization, a small number of patient, and unvalidated questionaries. Despite these promising results, more studies with better internal validity are needed. Future research may also study the impact of the application on the doctor-patient relationship.

[Robotic surgery in endometrial cancer: Feasibility in obese patients]. / Chirurgie robotique du cancer de l'endomètre chez la patiente obèse.

OBJECTIVE: Minimally invasive surgery is a technique frequently used in gynecologic surgery. The robot-assisted surgery is a recent approach, and the benefits are not yet proven. The objective of this study was to evaluate the feasibility to use robot-assisted surgery for obese patient with endometrial cancer. METHODS: All patients undergoing a robotic surgery for uterus malignant indication between March 2013 and May 2016 in our center were retrospectively included. Patients were divided in two groups, according to their body mass index (BMI). The group with BMI<30kg/m2 was the reference for this comparative study. The main criteria was the robot operative time. The other criteria were total operating time, hospital stay and intraoperative and postoperative complications. RESULTS: Seventy-seven patients met inclusion criteria for analysis. The median robot operative time was 110minutes for all patients [21-341], without difference between the five groups (P=0.60). There was no difference for the total operative time (P=0.50). The median hospital stay was 3 days (P=0.92). There were ten intraoperative complications. One patient had a conversion (1.3%). There was no statistical difference for postoperative complications (P=1). CONCLUSION: Our study found few differences in the surgical management by laparoscopic robot-assisted between obese and non obese women. Robot-assisted surgery seems to be feasible for uterine cancer treatment of obese patients. Prospective and randomized studies are needed to assess the benefit of the robotic surgery.

[Diagnostic laparoscopy in gynecological cancer, prophylactic oophorectomy: feasibility study on 22 cases]. / Cœlioscopie diagnostique en cancérologie gynécologique, annexectomie bilatérale prophylactique : étude de faisabilité sur 22 cas.

OBJECTIVES: The purpose of our study was to assess the feasibility of outpatient laparoscopy in a cohort of 22 patients admitted for bilateral oophorectomy (n=11) and preoperative diagnostic laparoscopy (n=11). PATIENTS AND METHODS: Between December 2012 and May 2013, we included 22 patients in our study. All selected patients received a questionnaire the day before surgery. The questionnaire consisted of chapters on intraoperatively, and the postoperative assessments of patients regarding a possible return home on the evening of surgery. The ability to output was measured with the score of Chung at the evening of surgery and in the morning before leaving. RESULTS: The mean age of patients was 60 years. The average length of stay was 1.2 days. Postoperative pain tends to be higher in the morning in the bilateral oophorectomy group (P=0.06), nausea and vomiting are the same in both groups. In the bilateral oophorectomy group, six patients were able to go out and five wished it; in the diagnostic laparoscopy group nine patients were able to go out and two wished it, this difference was significant (P=0.041). DISCUSSION: The outpatient hospital is the norm for many surgeries. In our study, 47% of patients able to go out wishing that output. This difference is important when comparing the two groups. There are more patients wishing an output in the oophorectomy group. This reduction in length of stay must be compensated by a medical and paramedical supervision at home. CONCLUSION: A large number of surgical procedure are performed on an outpatient basis. Patients who underwent diagnostic laparoscopy are more fragile, they should receive active postoperative support to enable an outpatient hospital.

[Quality of life after lipomodelling: retrospective study of 42 patients]. / Qualité de vie après lipomodelage: étude rétrospective à propos de 42 patientes.

OBJECTIVES: Study of the quality of life of 42 patients who underwent a lipofilling in our institution between 2009 and 2010. PATIENTS AND METHOD: Analysis of cosmetic outcomes, side effects, emotional life and preoperative information received by a cohort of 42 patients contacted by anonymous questionnaires. Comparisons between patients with a single prothesis, latissimus dorsi flap with prothesis, autologous latissimus dorsi flap and rectus abdominal flap. RESULTS: The response rate was 56% (42 patients). The average volume of fat injected was 80mL. The aspect of the reconstructed breast and the harmony between two breasts were better after lipofilling (P=0.0001, P=0.0005). The evolution of the aesthetic result is satisfying for 64.1% of the patients. In 29% of cases, patients noticed adhesions at the injection site. Apprehension to touch the reconstructed breast and to wear a swimsuit decreases after lipofilling (P=0.0345;P=0.0284). All patients declared to be satisfied with the presurgery information. Half of the patients declare that the final result corresponds to their wishes. DISCUSSION: The side effects of lipofilling were studied from an oncological point of view. Less publications describe the patients quality of life after lipofilling. This surgery improves the breast reconstruction results and helps patients in a social, affective and aesthetic way. Overall, lipofilling improves more consistency in patients reconstructed by single prothesis and improves more appearance in patients reconstructed by single flap. CONCLUSION: Lipofilling improves significantly patients' quality of life. A clinical research protocol (GRATSEC) is currently underway to extend its indications. The lipofilling should not replace a bad indication of breast reconstruction.