[Contribution of the pre-operative Mri-coloscan couple in the surgical planning of deep digestive pelvic endometriosis]. / Apport du couple IRM-coloscanner pré-opératoire dans la planification chirurgicale de l'endométriose digestive.

INTRODUCTION: The digestive involvement of endometriosis accounts for up to 20-25% of deep localisations. Precise mapping of digestive lesions is essential in order to plan surgery and specialized teams. The aim of this study is to assess the contribution of the MRI-coloscan couple in the preoperative assessment of digestive endometriosis. METHODS: We analyzed 45 files of patients referred for suspected digestive endometriosis. They had all undergone a preoperative MRI and coloscan associated with surgery throughout the year. We first compared the data collected in imaging, and then compared the synthesis of this data with the surgical procedure performed. RESULTS: 35 patients required digestive surgery. 24 of 45 files were concordant in MRI and coloscanner. Data from MRI alone matched with surgery in 69% of cases, against 84% for the coloscan. The synthesis allowed a concordance of 89%. 25 segmental resections, 2 discoid and 16 shaving were performed. The use of coloscan made up for nine extra cases: the detection of four additional cases of multifocality, a single undiagnosed case of a deep lesion, and allowed to specify the depth of the involvement in four cases. On the contrary, the MRI was correct compared to the CT in four cases. The presence of a digestive surgeon was necessary in 53% of cases. CONCLUSION: In the era of imaging staging, it would seem interesting to turn towards a subclassification of the digestive involvement of endometriosis in order to decide which surgery to perform. In our experience, the coloscan is a useful complement of MR, especially to assess the depth of involvement and the multifocality.

Factors associated with pregnancy after in vitro fertilization in infertile patients with posterior deep pelvic endometriosis: A retrospective study.

INTRODUCTION: The management of posterior deep endometriosis is not consensual. This is due to a great heterogeneity of data from the literature. Many series were small and overall, predictors of pregnancy were not all included and analyzed by multivariate analysis. We conducted this study to evaluate the factors associated with pregnancy during the first two in vitro fertilization (IVF) attempts in infertile women with posterior deep endometriosis. MATERIAL AND METHODS: 230 women were included in this retrospective observational study, between January 1st, 2007 and September 30th, 2013, at the University Hospital of Lille. A large set of variables were recorded and their association with the chance of pregnancy was analyzed by multivariate analysis (MVA), including patients' features, endometriosis items, surgery procedures and IVF data. RESULTS: After 2 IVF attempts, 48.7% of the 230 women achieved a pregnancy, including 39.1% of ongoing pregnancies. Logistic regression analysis retained five variables significantly associated to the chance of pregnancy: oocyte retrieval number (OR=0.468 (0.296-0.739) p=0.001), age (OR=0.888 (0.811-0.974) p=0.011), single embryo transfer number (OR=1.494 (1.036-2.153) p=0.031), presence of a recto-uterine nodule (OR=0.454 (0.235-0.877) p=0.019) and IVF technique (OR=0.509 (0.272-0.951) p=0.034). CONCLUSION: The presence of a recto uterine nodule is associated with a lower chance of pregnancy after IVF. It has to be checked by prospective studies whether the finding of a recto-uterine nodule whose pejorative effect has not been reported so far should encourage to perform surgery before IVF in patients with deep endometriosis.

Randomized trial comparing conventional intravenous bolus FEC and FEC with high-dose infusional 5-fluorouracil as first-line treatment of advanced breast cancer.

FEC (5-FU 500 mg/m2, epirubicin 50 mg/m2, and cyclophosphamide 500 mg/m2) administered as a conventional bolus schedule is widely used in treatment of advanced breast cancer. 5-FU is thought to be more efficient when administered at high doses as a continuous infusion. The aim of this study was to compare the response rate, time to treatment failure, and overall survival obtained with standard FEC regimen (group A) and FEC with high-dose infusional 5-FU (750 mg/m2 per day/days 1 to 5) (group B). One hundred and seventy-eight patients entered this study, 89 in each arm; 10 were noneligible. Both groups were comparable for age, performance status, menopausal status, hormonal receptor status and prior treatment of the initial tumor, duration of relapse free interval, and type and number of disease sites. One hundred and forth patients were evaluable for efficacy. The response rate was 33.3% in group A (1.4% complete response-CR), and 39.4% in group B (9.8% CR) (ns). In an intent to treat basis (n = 168) the response rates were 26.8% and 34.1%, respectively, in groups A and B (ns). The response rate in liver metastasis was significantly higher in group B (57.1%) than in group A (20.0%) (P = 0.03). The time to treatment failure and overall survival were not different between the two groups. One hundred and fifty-three patients were evaluable for toxicity. 10.7% of the patients in group A and 16.0% in group B stopped treatment due to toxicity. Stomatitis was more frequently observed in group B than in group A (46.7% versus 2.6%, respectively, p < 10(-9)). The rates of other side effects were similar in the two groups. In conclusion, the two regimens gave similar overall response rates, time to treatment failure and survival, but infusional 5-FU yielded a better response rate in the liver metastasis.

Aminoglutethimide (AG) and hydrocortisone (HC) in bone metastases: a retrospective study.

The response rate in bone metastases in 57 patients treated with aminoglutethimide and hydrocortisone was retrospectively assessed. All the X-rays were reviewed by two senior radiologists. A response was observed in 23% of the patients, a stabilization in 32%. The survival was not different whether a response or stabilization was observed. Conversely, survival was significantly worse in patients who experienced a progressive disease.